Treatment Of Arterial Hypertension Research Articles

Refined risk stratification, current treatment, and new therapeutic approaches in pulmonary arterial hypertension.

The 2022 European Society of Cardiology/European Respiratory Society (ESC/ERS) guidelines for pulmonary hypertension have introduced arefined risk stratification to guide both initial and subsequent treatment of pulmonary arterial hypertension (PAH). The risk stratification at PAH diagnosis still comprises three risk categories (low, intermediate, high) and lists some new parameters. As the estimated 1‑year mortality is more than 20% in high-risk patients after diagnosis, an initial triple-combination therapy including parenteral prostacyclin analogues is recommended for this group. All other patients should receive adual-combination therapy with an endothelin receptor antagonist and aphosphodiesterase‑5 inhibitor. However, this approach of initial combination therapy is only recommended for classic PAH, while monotherapy followed by regular follow-up and individualized therapy should be used for patients with cardiopulmonary comorbidities. For PAH patients without cardiopulmonary comorbidities, it is recommended to assess their risk at follow-up with anew 4‑strata classification, where the intermediate-risk group is split on the basis of three noninvasive parameters. Importantly, changes from intermediate-high to intermediate-low risk have been shown to be associated with abetter prognosis. In addition, the recommendations on treatment escalation became more precise with the addition of aprostacyclin receptor agonist or switching aphosphodiesterase‑5 inhibitor to asoluble guanylate cyclase stimulator for intermediate-low risk and proceeding to triple-combination therapy with parenteral prostacyclin analogues already for intermediate-high risk. With sotatercept, the first non-vasodilator PAH treatment will become available in the near future to further enrich our treatment options for this chronic and still severe disease.

Adherence, barriers, and facilitators for the treatment of systemic arterial hypertension: rapid review of evidenceAdhesión, obstáculos y elementos facilitadores en relación con el tratamiento de la hipertensión: revisión rápida de la evidencia

To identify strategies to increase adherence to systemic arterial hypertension (SAH) treatment and describe the barriers and facilitators for implementing these strategies in primary health care (PHC). A rapid evidence review was performed. We included systematic reviews with or without meta-analyses, published in English, Spanish or Portuguese, covering adults (age 18 to ≤ 60 years) with SAH followed in the PHC. Searches were performed in nine databases in December 2020 and updated in April 2022. The systematic reviews were assessed for methodological quality using the AMSTAR 2 tool. Fourteen systematic reviews on treatment adherence strategies and three on barriers and facilitators for implementation were included. Regarding methodological quality, one systematic review was classified as moderate, four as low, and the others as critically low. Four strategies were identified as options for health policies: actions performed by pharmacists; actions performed by non-pharmaceutical health professionals; self-monitoring, use of mobile apps, and text messages; and subsidies for the purchase of medicines. Low digital literacy, limited access to the internet, work process and incipient training were barriers for professionals. The users' educational and health literacy levels, accessibility to health services and good relationships with professionals were facilitators. Positive effects of strategies related to pharmaceutical care, self-monitoring, and the use of cell phone applications and text messages were identified to increase adherence to the treatment of SAH in the context of PHC. However, for implementation purposes, it is necessary to consider barriers and facilitators, in addition to the methodological limitations of the analyzed systematic reviews.

Novel Drugs for the Treatment of Pulmonary Arterial Hypertension: Where Are We Going?

Pulmonary arterial hypertension (PAH) is a progressive disease that despite advances in therapy is associated with a 7-year survival of approximately 50%. Several risk factors are associated with developing PAH, include methamphetamine use, scleroderma, human immunodeficiency virus, portal hypertension, and genetic predisposition. PAH can also be idiopathic. There are traditional pathways underlying the pathophysiology of PAH involving nitric oxide, prostacyclin, thromboxane A2, and endothelin-1, resulting in impaired vasodilation, enhanced vasoconstriction and proliferation in the pulmonary vasculature. Established PAH medications targets these pathways; however, this paper aims to discuss novel drugs for treating PAH by targeting new and alternative pathways.

Diet and Exercise Intervention in Pulmonary Hypertension

Current pharmacologic treatments for pulmonary arterial hypertension lead to vasodilation of the pulmonary arteries, increasing cardiac output and reducing pulmonary vascular resistance in patients with pulmonary arterial hypertension. Right ventricular failure is a leading cause of death in patients with pulmonary arterial hypertension, but there remain no promising leads in the treatment of right ventricular failure. Current research demonstrates that metabolic abnormalities, particularly regarding insulin resistance and glucose intolerance, may be pathologic in the development of right ventricular failure in patients with pulmonary arterial hypertension. In this review, we will address the potential role diet and exercise may play in improving right ventricular failure in patients with pulmonary arterial hypertension.

Clinical and LASCA preliminary data on selexipag efficacy for the treatment of digital vasculopathy in systemic sclerosis.

Systemic sclerosis (SSc) is burdened by Raynaud's phenomenon (RP) and digital ulcers (DUs) and sometimes standard vasoactive therapies are ineffective or contraindicated. Selexipag is an oral selective IP prostacyclin receptor agonist approved for the treatment of SSc-related pulmonary arterial hypertension. We aimed to evaluate clinical and instrumental efficacy of selexipag in SSc digital vasculopathy. SSc patients with severe digital vasculopathy refractory or with contraindication to all other vasoactive therapies were administered selexipag, evaluating at baseline and after 3 months clinical outcomes regarding RP and DUs and digital perfusion assessed by laser speckle contrast analysis (LASCA). Selexipag was administered to 9 SSc patients (66.6% female, mean age 52.3 ±16.6 years). One of them had to stop the drug for adverse effects. After three months selexipag determined a significant reduction of RP daily episodes (p=0.012) and RP mean duration (p=0.044). DUs decreased from 10 to 4 without reaching the statistical significance. A significant improvement in the mean perfusion of the fingers (p=0.016) was observed at LASCA. Selexipag showed good potential for the treatment of SSc-digital vasculopathy. Our results are certainly preliminary but yet quite encouraging. New trials for the evaluation of selexipag efficacy in SSc-digital vasculopathy are needed.

SATISFY-JP, a phase II multicenter open-label study on Satralizumab, an anti-IL-6 receptor antibody, use for the treatment of pulmonary arterial hypertension in patients with an immune-responsive-phenotype: Study protocol.

Pulmonary arterial hypertension (PAH), an intractable disease with a poor prognosis, is commonly treated using pulmonary vasodilators modulating the endothelin, cGMP, and prostacyclin pathway. Since the 2010s, drugs for treating pulmonary hypertension based on mechanisms other than pulmonary vasodilation have been actively developed. However, precision medicine is based on tailoring disease treatment to particular phenotypes by molecular-targeted drugs. Since interleukin-6 (IL-6) is involved in the development of PAH in animal models, and some patients with PAH have elevated IL-6 levels, the cytokine is expected to obtain potentials for therapeutic targeting. Accordingly, we identified a phenotype with elevated cytokine activity of the IL-6 family in the PAH population by combining case data extracted from the Japan Pulmonary Hypertension Registry with a comprehensive analysis of 48 cytokines using artificial intelligence clustering techniques. Including an IL-6 threshold ≥2.73 pg/mL as inclusion criteria for reducing the risk of insufficient efficacy, an investigator-initiated clinical study using satralizumab, a recycling anti-IL6 receptor monoclonal antibody, for patients with an immune-responsive phenotype is underway. This study is intended to test whether use of patient biomarker profile can identify a phenotype responsive to anti-IL6 therapy.

"It's that invisible illness":Patient and clinician perspectives on outcomes in pulmonary arterial hypertension treatment.

Knowledge of what outcomes are most meaningful to pulmonary arterial hypertension (PAH) stakeholders is limited. In this qualitative study, patients and clinicians endorsed personalized physical activity, symptoms, and psychosocial well-being as key outcomes to assess PAH treatment response, yet few are routinely measured in PAH clinical trials.

Impact of the new criteria for systemic arterial hypertension diagnosis and treatment suggested by the American College of Cardiology/American Heart Association

Impact of the new criteria for systemic arterial hypertension diagnosis and treatment suggested by the American College of Cardiology/American Heart Association

Redefying the therapeutic strategies against cardiorenal morbidity and mortality: Patient phenotypes.

Chronic kidney disease (CKD) patients face an unacceptably high morbidity and mortality, mainly from cardiovascular diseases. Diabetes mellitus, arterial hypertension and dyslipidemia are highly prevalent in CKD patients. Established therapeutic protocols for the treatment of diabetes mellitus, arterial hypertension, and dyslipidemia are not as effective in CKD patients as in the general population. The role of non-traditional risk factors (RF) has gained interest in the last decades. These entail the deranged clinical spectrum of secondary hyperparathyroidism involving vascular and valvular calcification, under the term "CKD-mineral and bone disorder" (CKD-MBD), uremia per se, inflammation and oxidative stress. Each one of these non-traditional RF have been addressed in various study designs, but the results do not exhibit any applied clinical benefit for CKD-patients. The "crusade" against cardiorenal morbidity and mortality in CKD-patients is in some instances, derailed. We propose a therapeutic paradigm advancing from isolated treatment targets, as practiced today, to precision medicine involving patient phenotypes with distinct underlying pathophysiology. In this regard we propose two steps, based on current stratification management of corona virus disease-19 and sepsis. First, select patients who are expected to have a high mortality, i.e., a prognostic enrichment. Second, select patients who are likely to respond to a specific therapy, i.e., a predictive enrichment.

Chemical Characterization and Multidirectional Biological Effects of Different Solvent Extracts of Arum elongatum: in Vitro and in Silico Approaches.

Arum elongatum (Araceae) is widely used traditionally for the treatment of abdominal pain, arterial hypertension, diabetes mellitus, rheumatism and hemorrhoids. This study investigated the antioxidant properties, individual phenolic compounds, total phenolic and total flavonoid contents (HPLC/MS analysis), reducing power and metal chelating effects of four extracts obtained from A. elongatum (ethyl acetate (EA), methanol (MeOH), methanol/water (MeOH/water) and infusion). The inhibitory activity of the extracts were also determined against acetylcholinesterase, butyrylcholinesterase, tyrosinase, amylase and glucosidase enzymes. The MeOH/water extracts contained the highest amount of phenolic contents (28.85 mg GAE/g) while the highest total flavonoid content was obtained with MeOH extract (36.77 mg RE/g). MeOH/water demonstrated highest antioxidant activity against DPPH⋅ radical at 38.90 mg Trolox equivalent per gram. The infusion extract was the most active against ABTS+ ⋅ (133.08 mg TE/g). MeOH/water extract showed the highest reducing abilities with the CUPRAC value of 102.22 mg TE/g and the FRAP value of 68.50 mg TE/g. A strong metal chelating effect was observed with MeOH/water extract (35.72 mg EDTAE/g). The PBD values of the extracts ranged from 1.01 to 2.17 mmol TE/g. EA extract displayed the highest inhibitory activity against AChE (2.32 mg GALAE/g), BChE (3.80 mg GALAE/g), α-amylase (0.56 mmol ACAE/g) and α-glucosidase (9.16 mmol ACAE/g) enzymes. Infusion extract was the most active against tyrosinase enzyme with a value of 83.33 mg KAE/g. A total of 28 compounds were identified from the different extracts. The compounds present in the highest concentration were chlorogenic acids, 4-hydroxybenzoic acid, caffeic acid, p-coumaric acid, ferulic acid, isoquercitrin, delphindin 3,5-diglucoside, kaempferol-3-glucoside and hyperoside. The biological activities of A. elongatum extracts could be due to the presence of compounds such as gallic acid, chlorogenic acids, ellagic acid, epicatechin, catechin, kaempferol, 4-hydroxybenzoic acid, caffeic acid, p-coumaric acid, ferulic acid, quercetin, isoquercitrin, and hyperoside. Extracts of A. elongatum showed promising biological activities which warrants further investigations in an endeavor to develop biopharmaceuticals.

Identification of Potent, Selective, and Peripherally Restricted Serotonin Receptor 2B Antagonists from a High-Throughput Screen.

Antagonists of the serotonin receptor 2B (5-HT2B) have shown great promise as therapeutics for the treatment of pulmonary arterial hypertension, valvular heart disease, and related cardiopathies. Herein, we describe a high-throughput screen campaign that led to the identification of highly potent and selective 5-HT2B antagonists. Furthermore, selected compounds were profiled for their predicted ability to cross the blood-brain barrier. Two exemplary compounds, VU0530244 and VU0631019, were predicted to have very limited potential for brain penetration in human subjects, a critical profile for the development of 5-HT2B antagonists devoid of centrally-mediated adverse effects.

PBPK-based dose finding for sildenafil in pregnant women for antenatal treatment of congenital diaphragmatic hernia.

Sildenafil is a potent vasodilator and phosphodiesterase type five inhibitor, commercially known as Revatio® and approved for the treatment of pulmonary arterial hypertension. Maternal administration of sildenafil during pregnancy is being evaluated for antenatal treatment of several conditions, including the prevention of pulmonary hypertension in fetuses with congenital diaphragmatic hernia. However, determination of a safe and effective maternal dose to achieve adequate fetal exposure to sildenafil remains challenging, as pregnancy almost always is an exclusion criterion in clinical studies. Physiologically-based pharmacokinetic (PBPK) modelling offers an attractive approach for dose finding in this specific population. The aim of this study is to exploit physiologically-based pharmacokinetic modelling to predict the required maternal dose to achieve therapeutic fetal exposure for the treatment congenital diaphragmatic hernia. A full-PBPK model was developed for sildenafil and N-desmethyl-sildenafil using the Simcyp simulator V21 platform, and verified in adult reference individuals, as well as in pregnant women, taking into account maternal and fetal physiology, along with factors known to determine hepatic disposition of sildenafil. Clinical pharmacokinetic data in mother and fetus were previously obtained in the RIDSTRESS study and were used for model verification purposes. Subsequent simulations were performed relying either on measured values for fetal fraction unbound (fu = 0.108) or on values predicted by the simulator (fu = 0.044). Adequate doses were predicted according to the efficacy target of 15ng/mL (or 38ng/mL) and safety target of 166ng/mL (or 409ng/mL), assuming measured (or predicted) fu values, respectively. Considering simulated median profiles for average steady state sildenafil concentrations, dosing regimens of 130mg/day or 150mg/day (administered as t.i.d.), were within the therapeutic window, assuming either measured or predicted fu values, respectively. For safety reasons, dosing should be initiated at 130mg/day, under therapeutic drug monitoring. Additional experimental measurements should be performed to confirm accurate fetal (and maternal) values for fu. Additional characterization of pharmacodynamics in this specific population is required and may lead to further optimization of the dosing regimen.

Phytochemical study, antioxidant and vasodilatation activities of leafy stem extracts of Flemingia faginea Guill. & Perr. (Barker), a medicinal plant used for the traditional treatment of arterial hypertension

BackgroundFlemingia faginea Guill. & Perr. is a medicinal plant used for the endogenous treatment of hypertension. This study aimed to establish the phytochemical profile, antioxidant power, and vasodilation effects of aqueous decoction (FAD), ethyl acetate (EAF) and aqueous residual fractions (ARF) of the leafy stem of Flemingia faginea (F. faginea). MethodsThe phytochemical study was performed using high-performance thin-layer chromatography technique and high-performance liquid chromatography coupled with mass spectrometry (HPLC-MS). Folin-Ciocalteu and aluminum trichloride colorimetric methods were used, respectively, to quantify total polyphenols and flavonoids. The antioxidant properties of the extracts were determined using 2,29-azinobis-3-ethylbenzothiazoline-6-sulfonic (ABTS•), 2,2-diphenyl-1-picrylhydrazyl (DPPH•) and ferric ion reduction (FRAP) methods. The vasodilatory effects of F. faginea extracts were performed using the DMT 620M myograph technique for an ex vivo study. ResultsThe phytochemical study revealed the presence of flavonoids, tannins, coumarins, sterols, and triterpenes, alkaloids, and saponins in the extracts studied. HPLC MS analysis identified as the main phenolic compounds, gallic acid-glucoside (16.56 ± 0.06 mg/g), myricetin rhamnoside (15.39 ± 0.04 mg/g), myricetin rutinoside (9.32 ± 0.00 mg/g), quercetin rutinoside (9.05 ± 0.00 mg/g), caffeoyl-glucoside (6.07 ± 0.02 mg/g) and 5-Caffeoylquinic acid (4.52 ± 0.00 mg/g). The present data also showed higher contents of phenolic compounds and flavonoids in fractions of ARF (280.49 ± 0.08 mgGAE/g) and EAF (33.31 ± 0.33 mgQE/g) fractions respectively. Furthermore, the ARF fraction had the best iron ion reduction capacity (16.96 ± 0.01µgAAE/100 mg), while, the EAF (ABTS: IC50=67.33 ± 0.04 µg/mL; DPPH: IC50=4.69 ± 0.20 µg/mL) was the best free radical scavenger. In endothelium-intact rings, study extracts showed a vasodilation effect in a concentration-dependent manner with half-maximum effective concentration (EC50) of 0.24 ± 0.03 mg/mL, 0.85 ± 0.07 mg/mL and 0.05±0.01 mg/mL respectively for FAD, ARF and EAF. In endothelium-denuded vessels, these values were 0.26 ± 0.09 mg/mL, 0.57 ± 0.05 mg/mL, and 0.85 ± 0.01 mg/mL for EAF, FAD, and ARF, respectively. The maximum effects were of 99.94 ± 0.15%, 86.89 ± 5.58%, and 62.69 ± 5.14% (endothelium-intact) and of 100 ± 0.06%, 96.55 ± 4.68%, and 74.16 ± 4.06% (endothelium-denuded), respectively, for EAF, FAD, and ARF with a significant difference between them. ConclusionThis study reports that the decoction and fractions of F. faginea are rich in various chemical compounds and possess antioxidant and vasodilatory properties. These preliminary data provide a scientific basis which contributed to justify that plant used in traditional medicine.

Effect of Renal Denervation on the Plasma Adiponectin Concentration in Patients with Resistant Hypertension

(1) Introduction: Adiponectin is synthetized by white adipose tissue and has anti-diabetic, anti-atherosclerotic, anti-thrombotic, anti-inflammatory, and cardioprotective properties. In patients with arterial hypertension, plasma concentration of adiponectin is lower than in healthy subjects. Renal denervation, i.e., percutaneous ablation of fibers from the sympathetic nervous system located in the wall of the renal arteries by radio frequency waves, is a method of resistant arterial hypertension treatment. (2) The aim of this single center, interventional, clinical study was to assess the effect of renal denervation on the plasma adiponectin concentration in patients with resistant arterial hypertension. (3) Materials and methods: 28 patients (13 women, 15 men) aged 54.4 ± 9.2 years with resistant hypertension who underwent renal denervation using Simplicity catheters (Medtronic, Inc., Northridge, CA, USA) were enrolled in the study. Plasma adiponectin concentration was determined using the Human Adiponectin ELISA Kit (Otsuka Pharmaceutical Co, Tokyo, Japan) before the renal denervation and 6 and 12 months after this procedure. (4) Results: Blood pressure (BP) values before renal denervation and 6 and 12 months after this procedure were as follows: systolic BP 190.4 ± 24.5, 160.8 ± 14.5, 155.7 ± 17.9 mmHg (p < 0.001) and diastolic BP 111.7 ± 18.9, 88.9 ± 8.3, 91.2 + 10.2 mmHg (p < 0.001), respectively. Body mass index (BMI) before renal denervation, 6 and 12 months after this procedure were 31.5 ± 4.2, 30.5 ± 4.4, 30.2 ± 4.0 kg/m2, (p = 0.057), respectively. Plasma adiponectin concentration before the renal denervation and 6 and 12 months after this procedure were 4.79 (3.95; 9.49), 7.58 (5.04; 9.51), 6.62 (4.57; 11.65) [µg/mL] (p = 0.007), respectively. (5) Conclusions: Plasma adiponectin concentration increases significantly after successful renal denervation in patients with resistant hypertension. Higher plasma adiponectin concentration may participate-beyond blood pressure reduction-in the cardiovascular benefits related to successful renal denervation; however' clinical consequences of these results need further investigations.

Diagnostics, monitoring and treatment of arterial hypertension in children

The review presents material on the current relevance of AH in children. The prevalence of AH in overweight and obese children aged 6-18 years is 27–47 %, while secondary arterial hypertension remains dominant, especially in children younger than 5 years. AH is a major risk factor for atherosclerosis and cardiovascular disease in adults. The onset of these diseases may occur in childhood or adolescence. The use of modern methods to monitor and control BP is crucial for improving the management of AH and preventing damage to target organs. Twenty-four-hour BP measurements are an important tool in determining the prognosis and treatment of children with AH. AH in children can be classified as primary or essential if there is no identifiable cause, or as secondary AH when it arises from a specific cause. The incidence of primary arterial hypertension increases with age, whereas secondary arterial hypertension predominates in early childhood. The secondary causes of AH also depend on the age of the patient. Thus 34-79 % of patients with secondary forms of arterial hypertension have renal parenchymal disease and impaired renal structure. Signs of AH include headache, visual disturbances, dizziness and nosebleeds. Dyspnoea on exercise, facial paralysis and seizures indicate target organ damage. In children with obesity, diabetes, renal insufficiency, aortic coarctation/repaired coarctation and those receiving medication causing AH, BP should be measured at every visit to the physician. Therapeutic lifestyle changes are an early therapy in the treatment of AH in children. IAPs, BCAAs, BRAs and thiazide diuretics are the most effective drugs for AH in children.

Phase 3 Trial of Sotatercept for Treatment of Pulmonary Arterial Hypertension

BackgroundPulmonary arterial hypertension is a progressive disease involving proliferative remodeling of the pulmonary vessels. Despite therapeutic advances, the disease-associated morbidity and mortality remain high. Sotatercept is a fusion protein that traps activins and growth differentiation factors involved in pulmonary arterial hypertension.MethodsWe conducted a multicenter, double-blind, phase 3 trial in which adults with pulmonary arterial hypertension (World Health Organization [WHO] functional class II or III) who were receiving stable background therapy were randomly assigned in a 1:1 ratio to receive subcutaneous sotatercept (starting dose, 0.3 mg per kilogram of body weight; target dose, 0.7 mg per kilogram) or placebo every 3 weeks. The primary end point was the change from baseline at week 24 in the 6-minute walk distance. Nine secondary end points, tested hierarchically in the following order, were multicomponent improvement, change in pulmonary vascular resistance, change in N-terminal pro–B-type natriuretic peptide level, improvement in WHO functional class, time to death or clinical worsening, French risk score, and changes in the Pulmonary Arterial Hypertension–Symptoms and Impact (PAH-SYMPACT) Physical Impacts, Cardiopulmonary Symptoms, and Cognitive/Emotional Impacts domain scores; all were assessed at week 24 except time to death or clinical worsening, which was assessed when the last patient completed the week 24 visit.ResultsA total of 163 patients were assigned to receive sotatercept and 160 to receive placebo. The median change from baseline at week 24 in the 6-minute walk distance was 34.4 m (95% confidence interval [CI], 33.0 to 35.5) in the sotatercept group and 1.0 m (95% CI, −0.3 to 3.5) in the placebo group. The Hodges–Lehmann estimate of the difference between the sotatercept and placebo groups in the change from baseline at week 24 in the 6-minute walk distance was 40.8 m (95% CI, 27.5 to 54.1; P<0.001). The first eight secondary end points were significantly improved with sotatercept as compared with placebo, whereas the PAH-SYMPACT Cognitive/Emotional Impacts domain score was not. Adverse events that occurred more frequently with sotatercept than with placebo included epistaxis, dizziness, telangiectasia, increased hemoglobin levels, thrombocytopenia, and increased blood pressure.ConclusionsIn patients with pulmonary arterial hypertension who were receiving stable background therapy, sotatercept resulted in a greater improvement in exercise capacity (as assessed by the 6-minute walk test) than placebo. (Funded by Acceleron Pharma, a subsidiary of MSD; STELLAR ClinicalTrials.gov number, NCT04576988.)

Acute Toxicity and Effect of an Aqueous Extract of Saccahrum officinarum (Poaceae) on Diuresis in Rat

Saccharum officinarum L (Poaceae) is a plant used as a diuretic and in the traditional treatment of arterial hypertension. This study aims to evaluate the acute toxicity and the diuretic potential of the aqueous extract of Saccharum officinarum (Esol) leaves on the diuresis of rats subjected to water overload. The toxicity results show that Esol is non-toxic at a dose of 2000 mg/Kg B.W. and that the LD50 is greater than this dose. The aqueous extract of Saccharum officinarum has many chemical compounds with diuretic and antihypertensive properties such as polyphenols, flavonoids, sterols and polyterpenes and saponosides. Esol acts effectively on diuresis with 24-hour urine volumes of 12.4 ± 0.74 mL; 11.3 ± 0.72 mL for the doses of 1000 and 1300 mg/kg B.W. whose volumetric urinary excretion (VUE) is greater than 150 %. The Time to First Micturition (TFM) of 41.7 ± 6.2 min and 41.2 ± 3.8 min respectively for these 2 doses. The pH of the urine of rats treated with the extract is more alkaline between 7 and 7.35. These results therefore indicate that the aqueous extract of Saccharum officinarum has a diuretic potential, thus justifying its use in traditional medicine.

Adherence to the treatment of systemic arterial hypertension in a cardiology outpatient clinic: a scope review

Objetivo: Analisar na literatura o grau de adesão de pacientes acompanhados em ambulatório de cardiologia, bem como as estratégias desenvolvidas por esses centros para promoção e manutenção de uma boa aderência terapêutica. Métodos: Trata-se de uma Scoping Review realizada nas bases de dados SCOPUS, EMBASE e WEB OF SCIENCE usando os descritores Hypertension, Blood Pressure, High, Ambulatory, Medication Adherence, Medication Compliance, Patient Compliance, Patient Adherence, Patient Cooperation, Treatment Compliance, Treatment Adherence, Patient Compliance, Adherence, Compliance. Resultados: Encontraram-se 290 artigos, dos quais 12 foram selecionados para este estudo. Os trabalhos encontrados abrangeram estudos tanto populacionais como revisões, sendo que foram incluídos dois guidelines internacionais e um estudo de análise comparativa desses guidelines. Conclusão: Para o sucesso da terapia anti-hipertensiva, faz-se necessário o envolvimento de uma equipe multiprofissional que vise, além da terapia medicamentosa, promover um ambiente amigável, acolhedor, com escuta terapêutica franca em que o paciente se sente seguro para participar do objetivo do tratamento e com a equipe disposta a desenvolver estratégias de educação voltadas à mudança de estilo de vida e ao auxílio no monitoramento dos níveis pressóricos desses pacientes.

Physical activity and arterial hypertension

Arterial hypertension is the most important modifiable cardiovascular risk factor for all-cause morbidity and mortality worldwide. It is associated with an increased risk of cardiovascular diseases (CVD) and cognitive impairment. In this regard, accumulating evidence points to beneficial effects of intensified blood pressure lowering by implementation of protective lifestyle patterns (e.g. physical activity, diet) or pharmacotherapy. The aim of this clinical review is to summarize the role of physical activity and/or exercise in prevention and treatment of arterial hypertension. Epidemiology, prospective observational studies, and randomized controlled trials have shown positive effects of physical activity on blood pressure levels in patients with hypertension and in patients with high-normal and normal blood pressure. Thus, physical activity can prevent or slow down micro- and macrovascular end-organ damage. Physical activity should be recommended for prevention and treatment of all hypertension grades, but most patients with hypertension will concomitantly require drug treatment (depending on hypertension grade and individual cardiovascular risk profile). Currently, increasing attention is directed to the role of personalized exercise prescriptions for prevention and treatment of arterial hypertension and for addressing cardiometabolic risk.

Profile of Risk Factors for Hypertension Among Overweight Patients

A third part of the world’s population has a steady increased blood pressure (BP). According to scientific data, there is a tendency to increase the incidence of arterial hypertension (AH) up to 60 %. It is important in AH treatment to perform an optimal control of BP level, for this purpose it is necessary to consider both the risk factors for the disease development and the risk factors for the development of pathology complications. The objective: to identify risk factors in patients with AH and body mass index (BMI) more than 25 kg/m2. Materials and methods. The study included 339 patients with AH. The I group involved 299 persons with BMI≥25 kg/m2, and 40 patients with AH and BMI &lt;25 kg/m2 were included in the II group. The average age of the patients was 49.4±10.7 years, the average duration of the disease – 7.5 years. Anthropometric data, daily monitoring of BP, morphological and functional state of the heart, biochemical parameters of the blood (lipidogram, transaminase and bilirubin, urea and creatinine, glucose level) were determined in all patients. The levels of interleukin-1β, interleukin-10 and homocysteine were also detected. The speed of glomerular filtration was determined accord ing to the Cockroft–Hault formula, a psycho-emotional examination was done (a questionnaire for determining of anxiety and depression levels, the presence of alexitimia). Results. The analysis of the lipidogram indicators demonstrated a higher level of atherogenicity index in patients with excess body weight (respectively 3.4±1.3 versus 3.1±1.4; p&lt;0.05). Among patients with AH and overweight or obesity compared to patients with normal body weight, significant differences have been revealed about the frequency of complications of targetorgans (AH stage II was 2 times more common among patients in the II group). Glycemia level on empty stomach was higher in patients with overweight (5.5±1.8 mmol/l versus 4.8±0.8 mmol/l; p&gt;0.05) and 3 times more common among patients in the I group (35.6 % versus 11.5 % of patients; p&lt;0.05). Hyperuricemia was found in 48 % of patients. In patients with normal BMI, the level of uric acid was within reference values (p=0.015). In 27 % of patients with overweight the increased IL-10 was determined, in 45 % – IL-1β, while in patients with normal BMI these indicators were normal (p&lt;0.05). Patients with AH had increased levels of anxiety, and patients with excess weight had a risk of depression. Conclusions. The results of the study showed that there is a clear association of increased blood pressure (BP) with weight gain. Patients with AH and high body mass index (BMI) had additional risk factors that can cause high BP and require personalized treatment. Excessive body weight causes an acceleration of the development of target organs (1.5 times more often), in particular increases the risk of progression of systolic and diastolic dysfunction of the left ventricle and sudden cardiac arrest, leads the development of atherosclerosis and immune inflammation. The association of AH and high BMI with PPARG gene (33 % of cases) was determined.