Wall U, Jern C, Bergbrant A, Jern S
Enhanced levels of tissue-type plasminogen activator in borderline hypertension

Hypertension (Nov) 26:796-800 1995

Recent data suggest that thrombogenic mechanisms may play an important role in myocardial infarction, sudden death, and stroke. Among the means whereby thrombotic tendencies may be quantified are measurement of plasma levels of t-PA (tissue type plasminogen activator) antigen and activity, and PAI-1 (plaminogen activator inhibitor) levels. Abnormal levels of PAI-1 predict recurrent MI, and abnormal levels of t-PA antigen predict future MI, cardiac death, and thrombotic stroke.

Wall et al asked the question: Is endogenous fibrinolysis abnormal in borderline hypertensive patients? They measured t-PA antigen and activity levels, as well as PAI-1 levels in 39 young (age 22-34) male subjects with borderline hypertension as well as in 17 normotensive controls. Young subjects were purposefully chosen to look for an early primary, as opposed to a secondary defect in fibrinolysis. None of the patients were on any medication

Blood was sampled before and after a 15 min period of venous occlusion by armcuff between systolic and diastolic BP (Robertson method). t-PA antigen and activity levels were very markedly increased in the borderline hypertensive patients, especially after venous occlusion. PAI-1 antigen levels were similar in the two groups. Cholesterol, insulin, and obesity indices were similar in the two groups. PAI-1 antigen levels correlated with obesity, and t-PA activity levels correlated inversely with BMI.

Comment: Because of increased evidence linking specifically t-PA antigen levels to cardiovascular events, this is an important study. The mechanism for these abnormalities in fibrinolysis at this early stage of hypertension remains to be explained. (Daugirdas)

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H: Pathophysiology : Coagulation abnormalities