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Majority of patients who appear healthy may be at risk for cardiovascular disease

November 09, 2017

"Our findings strengthen the case for early intervention to prevent diabetes," said Daniel Duprez, M.D., Ph.D., professor of medicine at the Rasmussen Center for Cardiovascular Disease Prevention Center Cardiovascular Division, University of Minnesota. "We recommend non-invasive screening for patients with prediabetes to detect cases of early cardiovascular disease, when patients may be likely to respond to lifestyle changes and effective pharmacotherapy."

Early inflammatory and metabolic changes in association with AGTR1 polymorphisms in prehypertensive subjects (OR-17)

A separate study evaluated prehypertensive patients for increased markers of inflammation and glucose metabolism. Investigators determined that prehypertensive patients who were otherwise healthy (non-obese and non-diabetic) displayed altered metabolic and inflammatory functions, which are currently known to be elevated in hypertensive patients. Further, they found that an angiotensin II receptor type 1 (AGTR1) polymorphism, previously associated with hypertension, could predict prehypertension.

Researchers recruited 405 white subjects from the USCD Twin Study. Those with hypertension, diabetes, or obesity were excluded. Fasting plasma was collected for inflammatory markers, including leptin, IL-6, CRP, and insulin. Sex and age were used as covariates in all analyses. Investigators evaluated the relationships between prehypertensive blood pressure, metabolic traits, and three common variants within AGTR1 (A1166C (rs5186), Leu191Leu (rs5182), and intron-2 A/G(rs2276736)).

We found that prehypertensive subjects were older with greater BMI than those with normal blood pressure, and after adjusting for multiple confounders, continued to display greater plasma glucose, insulin, leptin and interleukin-6. The common AGTR1 A1166C (rs5186) polymorphism in the 3'-UTR region, particularly the presence of the 1166C allele which fails to downregulate gene expression, predicted higher systolic blood pressure and greater likelihood of being in the prehypertension group. A lesser-studied polymorphism in intron-2 of AGTR1 (A/G; rs2276736) was associated with plasma leptin and HDL.

"We conclude that prehypertensive subjects already exhibit early pathophysiologic changes that place them at risk of future cardiovascular disease with metabolic and inflammatory consequences, and that AGTR1 may also contribute to this increased risk," said Maple M. Fung, M.D., assistant professor of medicine, University of California, San Diego. "Further investigation is needed to confirm these findings and their precise molecular mechanisms of action."

Source: American Society of Hypertension