Relationship between increased systemic inflammation and impaired aortic elasticity in young patients with prehypertension Turgay Celik a , Uygar Cagdas Yuksel d , Sait Demirkol a , Baris Bugan a , Atila Iyisoy a , Hasan Kutsi Kabul a , Selim Kilic b , Francesco Fici e and Halil Yaman c Aim This study was designed to evaluate the possible relationship between vascular inflammatory status [namely, high-sensitivity C-reactive protein (hs-CRP) and white blood cell (WBC)] and aortic elasticity parameters in patients with prehypertension. Materials and methods The study population consisted of 25 newly diagnosed prehypertensive individuals (18 men, mean age = 34±6 years) and 25 healthy controls (16 men, mean age = 33 ± 6 years) eligible for this study. Aortic elasticity parameters were calculated from aortic diameters measured by echocardiography and blood pressures, simultaneously measured by sphygmomanometry. hs-CRP measurements were taken with latex-enhanced reagent using a Behring BN ProSpec analyzer. Results Baseline characteristics of patients with prehypertension and controls were homogeneous. Inflammatory markers were significantly higher in patients with prehypertension compared with those of controls [for WBC ( ¾ 10 9 /l): 11.46 ± 0.77 (11.50) vs. 8.94 ± 0.91 (9.20), P < 0.001; for hs-CRP (lg/dl): 137.84 ± 50.71 (130.00) vs. 78.30 ± 35.20 (65.27), P < 0.001]. There was a strong positive correlation between the mean aortic stiffness index and markers of inflammation (for WBC, r = 0.857, P < 0.001; for hs-CRP, r = 0.858, P < 0.001), whereas strong negative correlations were observed between aortic elasticity parameters and markers of inflammation (for aortic distensibility of WBC and hs-CRP, r = – 0.862, P < 0.001; r = – 0.869, P < 0.001, respectively, and for aortic strain of WBC and hs-CRP, r = – 0.890, P < 0.001; r = – 0.906, P < 0.001, respectively). Conclusion Young prehypertensives have increased markers of inflammation, namely, hs-CRP and WBC, compared with controls. More importantly, impaired arterial stiffness is significantly associated with the markers of inflammation in patients with prehypertension. Blood Press Monit 16:55–61  c 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Blood Pressure Monitoring 2011, 16:55–61 Keywords: arterial stiffness, inflammation, prehypertension, young age Departments of a Cardiology, b Epidemiology, c Clinical Biochemistry, Gulhane Military Medical Academy, School of Medicine, Etlik-Ankara, d Department of Cardiology, Sarikamis Army District Hospital, Sarikamis, Turkey and e Excellence Research Center for Cardiovascular Disease, 2nd University of Naples, Italy Correspondence to Turgay Celik, MD, Department of Cardiology, Gulhane Military Medical Academy, School of Medicine, General Tevfik Saglam Street, GATA Kardiyoloji A.D, Etlik, Ankara 06018, Turkey Tel: + 90 312 3044268; fax: + 90 312 3044250; e-mail: benturgay@yahoo.com Received 4 August 2010 Revised 6 October 2010 Accepted 3 December 2010 Introduction In the Joint National Committee’s seventh report, prehypertension category has been used for the patients whose systolic (SBP) and diastolic blood pressure (DBP) values are 120–139 and 80–89 mmHg, respectively [1]. Patients with prehypertension have been shown to be at an increased risk for progression to hypertension; those patients with prehypertension are at twice the risk to develop hypertension as those with lower values [2]. It has been shown that hypertension is one of the most important predictors of reduced arterial elasticity, in- dependent of age [3]. More importantly, our group has recently shown that aortic elasticity is impaired in young patients with prehypertension compared with healthy controls [4]. Vascular inflammation such as high-sensitivity C-reactive protein (hs-CRP), have been shown to be predictive of cardiovascular events. In a cross-sectional study, hs-CRP levels were found to be elevated in patients with hypertension, and increased hs-CRP levels in normoten- sive patients also predicted the future development of hypertension [5]. In the hypertensive population, hs-CRP is an independent predictor of progression of atherosclerosis that is superior to either pulse pressure (PP) or SBP [6]. hs-CRP, a marker of systemic inflam- mation, is found to be independently related to pulse wave velocity (PWV), a marker of aortic stiffness, and augmentation index (AIx), a manifestation of wave reflection, in essential hypertension [7]. Although there are some inconsistencies, a number of recent studies have suggested that in a healthy popula- tion, there may be a significant relationship between hs-CRP and measures of arterial stiffness. Yasmin et al. [8] found that hs-CRP is related to PWV but not to AIx. Clinical methods and pathophysiology 55 1359-5237  c 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins DOI: 10.1097/MBP.0b013e3283450268