Platelet and haemorheological markers in 'high risk' hypertensives are improved by tighter blood pressure control and cardiovascular risk management: a substudy of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT).
OBJECTIVE
To investigate the impact of intensified cardiovascular risk management on soluble markers of platelet, endothelial and rheological function in a population of middle-aged hypertensive patients at high risk of cardiovascular complications.


METHODS
Prospective follow-up study.


METHODS
A total of 159 hypertensive patients [138 male, mean age 64 (+/-8) years] and 80 healthy controls were studied. Plasma levels of soluble P-selectin (sP-sel, a marker of platelet function), von Willebrand factor (vWF, an index of endothelial damage/dysfunction) and rheological indices [fibrinogen (Fib), plasma viscosity (PV), haematocrit (HCT), white blood count (WBC) and platelet count] were measured at baseline and again (in the patients) after 6 months' treatment.


RESULTS
As expected, 6 months of intensified cardiovascular risk management resulted in a significant fall in mean blood pressure (BP) and total cholesterol. It also resulted in reduced haematocrit, vWF, sP-sel, WBC and PV levels (all P < 0.001), but not plasma fibrinogen. There were no correlations between the fall in BP and the improvement in any of the research indices.


CONCLUSIONS
Intensified cardiovascular risk management results in significant improvements in indices of endothelial, platelet and rheological function in a population of hypertensives at high risk of cardiovascular events. These improvements appear to be independent of the degree of change in BP. Given the fundamental role of interactions between the endothelium and circulating blood components in the pathogenesis of hypertensive complications this may be of importance in preventing adverse cardiovascular outcomes.
Spencer
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CG
Haemostasis, Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK.
Gurney
D
D
Felmeden
D C
DC
Blann
A D
AD
Beevers
D G
DG
Lip
G Y H
GY
D000924:Anticholesteremic Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001772:Blood Cell Count; D001775:Blood Circulation / Q000502:physiology*; D001792:Blood Platelets / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology; D001809:Blood Viscosity / Q000502:physiology; D002784:Cholesterol / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D005500:Follow-Up Studies; D006400:Hematocrit; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D019007:P-Selectin / Q000097:blood; D011446:Prospective Studies; D012307:Risk Factors; D014841:von Willebrand Factor / Q000032:analysis
D000924:Anticholesteremic Agents; D015415:Biomarkers; D019007:P-Selectin; D014841:von Willebrand Factor; D005340:Fibrinogen; D002784:Cholesterol