Prothrombotic factors, endothelial function and left ventricular hypertrophy in isolated systolic hypertension compared with systolic-diastolic hypertension

Background Individuals with systolic-diastolic hypertension (SDH, systolic blood pressure (SBP) > 160 mmHg and diastolic blood pressure (DBP) > 90 mmH g) are at increased risk of thrombotic complications, such as stroke and he art attacks, which may be related to a hypercoagulable state. Individuals w ith only isolated systolic hypertension (ISH; i.e. SEP > 160 mmHg but DBP < 90 mmHg) are also at significant cardiovascular risk. We hypothesized that patients with ISH would exhibit a prothrombotic state similar to that seen in SDH. A secondary hypothesis was that individuals with ISH had similar e chocardiographic parameters to those seen in SDH. Methods We measured indices of haemorheology, endothelial dysfunction, thro mbogenesis and platelet activation in 23 individuals with ISH (mean blood p ressure 193/82 mmHg), who were compared with 51 matched patients with SDH ( mean blood pressure 198/112 mmHg) and 34 age- and sex- matched normotensive healthy control individuals (mean blood pressure 130/78 mmHg). Echocardiog raphic parameters in patients with ISH were compared to those from patients with SDH. Results Mean plasma viscosity (an index of blood rheology, ANOVA, P = 0.001 ), von Willebrand factor (an index of endothelial damage, P = 0.013), plasm inogen activator inhibitor-1 and lipoprotein (a) (both markers of thromboge nesis; Kruskal-Wallis test, both P < 0.001) were all significantly raised i n ISH and SDH relative to controls. Individuals with SDH also had high mean plasma fibrinogen (P= 0.018) and haematocrit (P = 0.010) levels compared w ith control individuals. There were no significant differences in levels of fibrin D-dimer or the platelet activation marker soluble P-selectin in the hypertensive patients (i.e. ISH and SDH) compared with control individuals . Patients with ISH had similar M-mode and Doppler echocardiographic parame ters compared to patients with SDH. Conclusions We conclude that individuals with ISH have abnormalities in pla sma prothrombotic factors and markers of endothelial dysfunction, and echoc ardiographic parameters, broadly similar to that seen in SDH, This is consi stent with the increased risk of thrombotic events (strokes and heart attac ks) in patients with ISH. J Hypertens 1999, 17:1203-1207 (C) Lippincott Wil liams & Wilkins.