Hypertension BP Research Articles

Analysis of blood pressure measurement by pediatricians, in patients from 3 to 20 years of age in the electronic health record

Blood pressure measurement (BPM) is a recommended practice at least once a year for all of healthy children starting from 3 years old and before that age in population at risk. Pediatricians fulfilling of this recommendation is irregular. Objective. Identify the prevalence of records of BPM in a pediatric electronic health record (EHR) in patients from 3 to 20 years of age and the prevalence of records of hypertension (HBP) and prehypertension (preHBP) according to sex, age and percentile of height. A cross-sectional and analytical study was conducted. 8140 patients from 3 to 20 years of age seen by their primary care physician at least in one opportunity between January and June 2005 were evaluated. Hypertension, prehypertension and normal BP was defined based on the recommendation published in Pediatrics 2004 Aug; 114: 555-76. 2.723 of the 8.140 patients had BP registered in the EHR (33.4%), 76% of the records were of normal BP, 17% of preHBP and 7% of HBP. The percentage of preHBP was significantly higher in males (21.7% vs. 13.4%) OR: 1.6 (IC 95% 1.3-1.9), but not in HBP (7.4% vs. 6.8%). 50% of the pediatricians registered 9% or less of their patients BP. The prevalence of BPM was a third; there is a need of generating actions that stimulate this practice.

Effect of "no added salt diet" on blood pressure control and 24 hour urinary sodium excretion in mild to moderate hypertension

BackgroundThe incidence of Hypertension as a major cardiovascular threat is increasing. The best known diet for hypertensives is 'no added salt diet'.In this study we evaluated the effect of 'no added salt diet' on a hypertensive population with high dietary sodium intake by measuring 24 hour urinary sodium excretion.MethodsIn this single center randomized study 80 patients (60 cases and 20 controls) not on any drug therapy for hypertension with mild to moderate hypertension were enrolled. 24 hour holter monitoring of BP and 24 hour urinary sodium excretion were measured before and after 6 weeks of 'no added salt diet'.ResultsThere was no statistically significant difference between age, weight, sex, Hyperlipidemia, family history of hypertension, mean systolic and diastolic BP during the day and at night and mean urinary sodium excretion in 24 hour urine of case and control groups. Seventy eight percent of all patients had moderate to high salt intake.After 6 week of 'no added salt diet' systolic and diastolic BP significantly decreased during the day (mean decrease: 12.1/6.8 mmhg) and at night (mean decrease: 11.1/5.9 mmhg) which is statistically significant in comparison to control group (P 0.001 and 0.01).Urinary sodium excretion of 24 hour urine decreased by 37.1 meq/d ± 39,67 mg/dl in case group which is statistically significant in comparison to control group (p: 0.001).Only 36% of the patients, after no added salt diet, reached the pretreatment goal of 24 hour urinary sodium excretion of below 100 meq/dl (P:0.001).ConclusionDespite modest effect on dietary sodium restriction, no added salt diet significantly decreased systolic and diastolic BP and so it should be advised to every hypertensive patient.Trial RegistrationClinicaltrial.govnumber NCT00491881

Hypertension, Prehypertension and Blood Pressure Related Diseases

Hypertension is defined as either an elevation of systolic blood pressure (SBP) to ≥ 140 mmHg and/or elevation of diastolic blood pressure (DBP) to ≥ 90 mmHg for adults. Hypertension is a frequent, age-related disorder and a major risk factor for stroke, coronary heart disease, heart failure and renal failure. The relation between BP and cardiovascular disease (CVD) mortality and morbidity is strong, direct and continuous over a wide range such that BP values must be viewed as a continuum in which a high BP means an increased cardiovascular risk and worse prognosis. Thus, the paradigm has shifted from hypertension to BP-related diseases. The magnitude of the burden of hypertension and high BP in both developed and developing countries contributes to prediction of worldwide epidemic of CVD. Effective strategy emphasizes focusing on SBP, identifying high-risk patients and targeting reductions in multiple risk factors, including end-organ damages. Recent studies have focused on six modifiable risk factors, namely cigarette smoking, lipids abnormalities, diabetes, BP levels, obesity, and stress. Three protective factors have also been individualized, namely the Mediterranean regimen, regular physical activity and regular, moderate alcohol consumption. Besides health promoting lifestyle modifications, the major classes of antihypertensive agents, namely diuretics, β-blockers, calcium antagonists, angiotensin converting enzyme inhibitors, angiotensin receptor antagonists, are suitable for the initiation and maintenance of therapy, and there is a frequent need to use at least two drugs in combination in order to achieve optimal BP. It is important to point out the fact that most clinical trials are of short duration and their significance must be confirmed on longterm outcomes.

Treatment of Combined Aortic Regurgitation and Systemic Hypertension: Insights From an Animal Model Study

Hypertension (HT) and aortic valve regurgitation (AR) often coexist but the specific impacts of AR + HT on the left ventricle (LV) are still unknown. The best treatment strategy for this combination of diseases is also unclear. The objectives of this study were 1) to evaluate LV function, remodeling and 2) to assess the effects of the angiotensin-converting enzyme (ACE) inhibitor captopril (C) in rats with AR +/- HT in spontaneously hypertensive rats (SHR). Animals were grouped as follows: normotensive (NT) Wistar-Kyoto, NT + AR, hypertensive SHR (HT), and HT + AR receiving or not captopril (150 mg/kg/d). Hearts were evaluated in vivo by echocardiography and harvested for tissue analysis after 6 months of evolution. The HT + AR rats had the worst LV hypertrophy (LVH), subendocardial fibrosis, and lowest ejection fraction. Captopril normalized BP in HT and HT + AR, but could not prevent LVH in HT + AR as well as it did in isolated HT. The LV ejection fraction remained below normal in HT + AR + captopril compared to HT alone + captopril. Cardiomyocyte hypertrophy remained in HT + AR + captopril but was normalized in HT + captopril. Subendocardial fibrosis was reduced by captopril in HT + AR. The AR + HT rats had the most severe myocardial abnormalities. High dose captopril was effective to slow LVH and preserve normal LV ejection fraction in isolated HT or AR, but was less effective when both pathologies were combined. Prohypertrophic stimuli clearly remain active in HT + AR despite ACE inhibition. These results suggest that a very aggressive medical treatment strategy may be required to optimize LV protection when AR and HT co-exist.

Aliskiren may lower BP in hypertension

Aliskiren may lower BP in hypertension

Increased serum heat shock protein 70 level in hypertensive patients with target organ damage

P-582 Key Words: Heat Shock Protein 70, Target Organ Damage, Inflammatory Markers

Mild renal dysfunction and cardiovascular risk in hypertensive patients.

Mild renal dysfunction, defined as GFR <60 to 70 ml/min and/or the presence of increased urinary albumin excretion, is associated with higher cardiovascular morbidity and mortality in primary hypertension. The aim of the present study was to investigate the relationship between renal dysfunction and target organ damage (TOD), namely left ventricular hypertrophy (LVH), retinal vascular changes, and carotid atherosclerosis, in a large cohort of unselected middle-aged hypertensive patients with normal serum creatinine. A group of 934 untreated patients with primary hypertension (543 men, 391 women; mean age 50 +/- 11 yr) was studied. Renal function was estimated by the creatinine clearance using the Cockcroft-Gault formula and by the presence of albuminuria, measured as the albumin to creatinine ratio (A/C) in first morning urine samples. LVH was determined according to electrocardiographic criteria, and retinal vascular changes were evaluated by direct ophthalmoscopy in all patients. In a subgroup of patients (n = 340; 208 men, 132 women; mean age 47 +/- 9), the presence and extent of cardiac and vascular organ damage was also assessed by ultrasound techniques. Creatinine clearance was on the average 82 +/- 20 ml/min. The overall prevalence of ECG-detected LVH and retinopathy was 12 and 49%, respectively. Creatinine clearance was inversely related to duration of disease, systolic BP, serum glucose, total cholesterol, LDL cholesterol, and early signs of TOD, namely retinal vascular changes and LVH. Patients in the bottom quintile of creatinine clearance showed higher prevalence of both ECG-determined LVH (P = 0.04) and retinal vascular changes (P = 0.02). In the subgroup of patients who underwent ultrasound evaluation of cardiovascular structures, the prevalence of mild renal dysfunction was 18%, whereas the prevalence of LVH and carotid plaque was 49 and 26%, respectively. Patients with mild renal dysfunction showed higher left ventricular mass and increased intima-media thickness (P < 0.0001), as well as higher prevalence of LVH and carotid plaque as compared with those with normal renal function. Controlling for duration of hypertension and mean BP, the risk of TOD in our cohort increased by 20% for each 10 ml/min decrease in creatinine clearance and by 30% for each 0.2 mg/mmol increase in Log A/C. In conclusion, mild renal dysfunction is associated with preclinical end-organ damage in patients with primary hypertension. These data may help to explain the observed increase in cardiovascular mortality reported in these patients. The evaluation of creatinine clearance and urinary albumin excretion could be useful for identifying patients who are at higher cardiovascular risk.

Are centrally acting imidazoline agents appropriate therapy for renovascular hypertension?

An increased role of the sympathetic nervous system has been suggested to be a major contributor to the chronic elevation of BP in renovascular hypertension. We assessed the effects of rilmenidine, a centrally acting antihypertensive imidazoline agent, on BP and renal sympathetic nerve activity (RSNA) in 2K1C renovascular hypertensive conscious rabbits. Rabbits were made hypertensive with a renal clip or were sham-operated and were studied 3 and 6 weeks later. Acute treatment with rilmenidine reduced BP to a greater extent in the hypertensive rabbits. Although rilmenidine reduced the heart rate by the same extent in all groups, rilmenidine produced much less inhibition of RSNA in the hypertensive animals. These studies suggest that the contribution of the sympathetic nervous system is greater in 2K1C hypertension and that imidazoline agents may be beneficial in treating renovascular hypertension.

The Effect of Correction of Sleep-Disordered Breathing on BP in Untreated Hypertension

To compare BP response to 3 weeks of nasal continuous positive airway pressure (CPAP) in hypertensive patients with and without sleep-disordered breathing (SDB). A controlled, interventional trial of nasal CPAP in patients with and without SDB. Twenty-four men, aged 30 to 60 years, with mild to moderate untreated hypertension recruited from employee health and primary care clinics. Based on in-laboratory polysomnography, 14 hypertensive patients had SDB, defined by five or more episodes of apnea and hypopnea per hour of sleep (apnea-hypopnea index [AHI], > or = 5), and 10 had no SDB (AHI, < 5). We performed 24-h ambulatory BP monitoring on all patients at baseline, during CPAP, and after CPAP treatment. In patients with an AHI > or = 5, nasal CPAP was titrated to reduce the AHI to < 5. Patients with an AHI < 5 received CPAP of 5 cm H(2)O to control for any potential effect of CPAP per se on BP. Both groups received CPAP for 3 weeks. After adjusting for age and body mass index, the mean nocturnal systolic and diastolic BP changes after CPAP treatment in the SDB group were significantly different from those in the no-SDB group: -7.8 vs +0.3 mm Hg (p = 0.02), and -5.3 vs -0.7 mm Hg (p = 0.03), respectively. There was a similar, although statistically insignificant, difference in the adjusted mean daytime systolic and diastolic BP changes after CPAP treatment between the two groups (-2.7 vs +0.4 mm Hg and -2.3 vs -1.7 mm Hg, respectively). Three weeks of nasal CPAP treatment of SDB in hypertensive men caused the lowering of nocturnal systolic and diastolic BP values, suggesting that increased nocturnal BP in persons with hypertension was causally related to the apnea and hypopnea events of SDB.

Impaired cognitive status in elderly hypertensive patients

The aim of the study was to determinate the impaired cognitive function in elderly patients with uncontrolled hypertension. We analyse the cognitive status in hypertensive patients who were aged more than 65 year old. To evaluate cognitive function we used Mini-Mental Status Examination (MMSE). Eighty-six hypertensive patients were included, 44 women and 42 men, mean age 67.4±4.4 years. Mean systolic BP was 164.42±12.43 mmHg, mean diastolic BP 96.22±6.16 mmHg and pulse pressure 68.19±13.01mmHg. According to the grade of hypertension 20.9% were patients with mild hypertension (grade 1) according to the OMS criteria; 60.5% moderate hypertension (grade 2) and 18.6% severe hypertension (grade 3). Other cardiovascular risk factors were, 19.8% smokers, 45.3% hyperlipidemics, 17.4% diabetics and 7% presents a history of cardiovascular disease. The values observed in MMSE was 22-35 with a mean 31.27±3.6 and median 32. Only 8% patients showed MMSE < 25. The patients with mild hypertension presents a higher values of MMSE than patients with moderate and severe hypertension. We found a negative correlation between values of MMSE and values of systolic BP, r= - 0.316, p= 0.003, values of diastolic BP, r= - 0.269, p= 0.012, and the age of the patients, r = - 0.316, p=0.001. No significant correlation was observed with pulse pressure and heart rate. We conclude that only 8% of patients shows a deterioration of cognitive status, showed by MMSE, in that old population, with no control of BP. However, a relationship between MMSE and blood pressure could be shown. The severity of the hypertension and higher BP, shows a decreased cognitive function.

Determination of optimal blood pressure for patients with IgA nephropathy based on renal histology.

To evaluate the optimal BP control for patients with IgA nephropathy (IgAN) based on the histologic severity of the nephropathy and the degree of renal dysfunction. We analyzed 332 consecutive renal biopsy specimens and clinical data from patients with IgAN. Patients were divided into three groups based on their BP at the time of biopsy: an optimal BP (SBP<120 mmHg and DBP<80 mmHg), a hypertensive BP (SBP > or = 140 mmHg and/or DBP > or = 90 mmHg), and an intermediate BP group. Each biopsy specimen was evaluated for mesangial proliferation, degree of sclerosis and/or hyalinosis of the arterioles and the interlobular artery using a semiquantitative method. Creatinine clearance and the percentage of sclerosed glomeruli were also determined. Both the degree of renal dysfunction and the histologic changes correlated significantly with BP, even in patients with a BP <140/90 mmHg. The patients with an optimal BP at the time of biopsy had significantly less histologic damage with respect to mesangial proliferation and vessel changes than those with an intermediate or hypertensive BP. In the patients with a hypertensive BP, the percentage of sclerotic glomeruli was significantly higher and the creatinine clearance was significantly lower. The optimal BP proposed by the WHO in 1999 prevents histologic evidence of renal damage for patients with IgAN.

Left ventricular hypertrophy, treadmill tests, and 24-hour blood pressure in pediatric transplant patients

Hypertension and left ventricular hypertrophy (LVH) are possible complications in pediatric patients after renal transplantation. We performed left ventricular echocardiography, 24-hour ambulatory blood pressure monitoring (24-hr ABPM), and treadmill tests in 28 pediatric renal transplant patients (mean age 16.1 +/- 3.7; time since transplantation 36 +/- 23 months). Left ventricular mass (LVM) was indexed for height 2.7. LVH was found in 82% of the patients. Seven of these patients were normotensive by 24-hour ABPM, but five patients showed a hypertensive systolic BP response during the treadmill test. LVM/height 2.7 correlated significantly with the mean 24-hour systolic BP (P = 0.002) and with the maximal exercise systolic BP (P = 0.002). LVH is frequent in pediatric renal transplant patients. More information is needed with respect to the risk for LVH, including data from 24-hour ABPM and treadmill testing.

Chronic effects of lovastatin and bezafibrate on cortical and medullary hemodynamics in deoxycorticosterone acetate-salt hypertensive mice.

Cholesterol synthesis inhibitors and fibrates both exercise effects that could influence BP and renal function in hypertension. To test this issue, transit-time ultrasound flow probes, implanted optical fibers, and laser-Doppler flowmetry were used for measurements of total and regional renal blood flows in lovastatin (40 mg/kg body wt) and bezafibrate (50 mg/kg body wt) chronically treated deoxycorticosterone acetate (DOCA)-salt hypertensive mice. Total renal blood flow was well autoregulated between 70 and 150 mmHg (approximately 3.5 ml/min per g kidney weight in DOCA-salt mice). Both lovastatin and bezafibrate increased renal blood flow to a range between 4.7 and 5.5 ml/min per g kidney weight. In the renal perfusion pressure ranges investigated, renal vascular resistance increased in lovastin- and bezafibrate-treated DOCA-salt mice, but not as steeply as in vehicle-treated DOCA-salt mice. During a stepwise increase in renal perfusion pressure in lovastatin-treated DOCA-salt mice, medullary blood flow increased up to 130% of baseline values, which was not seen in vehicle- or bezafibrate-treated mice. After extracellular volume expansion with 1% saline, 1 ml over 1 min, total renal blood flow was also higher in lovastatin- or bezafibrate-treated DOCA-salt mice, whereas medullary blood flow increased more steeply in lovastatin-, compared with bezafibrate- or vehicle-treated mice. Systemic BP was significantly decreased in lovastatin-treated DOCA-salt mice compared with vehicle-treated mice. Lovastatin prevented histologic evidence for hemostasis in the medullary circulation of DOCA-salt mice. The results suggest that both lovastatin and bezafibrate diminished DOCA-salt-induced reductions in total renal blood flow. Lovastatin also abolished the perturbed medullary blood flow reactions to increased perfusion pressure or to volume expansion. Finally, lovastatin decreased systemic BP in DOCA-salt mice. These data suggest that cholesterol synthesis inhibition or fibrate treatment improve disturbed renal function in a mouse model of salt-dependent hypertension.

Polymorphisms of the renin-angiotensin genes and the outcome of BP and microalbuminuria in essential hypertension: a prospective three years follow-up study

Polymorphisms of the renin-angiotensin genes and the outcome of BP and microalbuminuria in essential hypertension: a prospective three years follow-up study

Tasosartan reduces BP in essential hypertension

Tasosartan reduces BP in essential hypertension

A Sibling-Pair Analysis of Fasting Lipids and Anthropometric Measurements and Their Relationship to Hypertension

Fifty non-diabetic, young Chinese hypertensives were compared to their normotensive siblings with respect to body fat distribution and fasting lipid and glucose (FPG) profiles. Sitting BP in hypertensives met conventional hypertension criteria after a 4-week washout period on placebo. Hypertensives had greater body mass index (BMI), subscapular skinfold thickness (SFT), waist circumference (W), waist-to-height (WHtR) and waist-to-hip ratio (WHR), p<0.0001 for all. Higher triglycerides (p=0.004) and lower HDL-cholesterol (p=0.015) concentrations were also observed. Weight, W, WHtR and BMI were higher in hypertensives in both male (n=9) and female gender-concordant sibling pairs (n=21). Higher WHR, hip circumference and subscapular SFT were only seen in the male hypertensives. Hypertension is associated with central adiposity and adverse lipid profiles in this group of young hypertensives, supporting the hypothesis that obesity, particularly central, is closely associated with hypertension in Chinese as in other ethnic groups.

Left Ventricular mass Regression with Amlodipine in Elderly Hypertensives

We evaluated effect of amlodipine therapy on left ventricular (LV) mass and function indices in 34 elderly hypertensives having echocardiographic evidence of left ventricular hypertrophy (LVH). LV mass and LV function indices were evaluated before and after 4 months of effective amlodipine therapy. Fourteen patients completed the study. Blood pressure was effectively controlled in all the patients; dose requirement of amlodipine being 5 mg/day in 8 and 10 mg/day in 6 patients. We found significant regression of LV mass indices such as thickness of interventricular septum (IVS) and left ventricular posterior wall (LVPW), and LV mass index after 4 months of amlodipine therapy. However, LV function indices did not alter following treatment. In conclusion, amlodipine therapy besides effectively contrlolling BP in elderly hypertensives, produced significant regression of LV mass indices without affecting the LV function.

Postexercise decrease in arterial blood pressure, total peripheral resistance and in circulatory responses to brief hyperoxia in subjects with mild essential hypertension.

The objective of our study was: (1) to compare the influence of moderate exercise on circulatory after-response in mildly hypertensive (n = 8) and normotensive male subjects (n = 9); (2) to examine the circulatory response to 3-min hyperoxic inactivation of arterial chemoreceptors at rest and during postexercise period in both groups. Hypertensive men (HTS) with a systolic blood pressure (SBP) 148 +/- 5 mm Hg, diastolic blood pressure (DBP) 92.4 +/- 4 mm Hg; and normotensive men (NTS), with a SBP 126 +/- 3 mm Hg, DBP 75.6 +/- 1.3 mm Hg, were submitted to 20-min of moderate exercise on a cycloergometer (up to the level of 55% of each subject's resting heart rate reserve). Finger arterial BP was recorded continuously with Finapres, impedance reography was used for recording stroke volume, cardiac output and arm blood flow. In HTS a significant decrease in SBP by 14.5 +/- 3.4 mm Hg, DBP by 8.9 +/- 1.9 mm Hg, total peripheral resistance (TPR) by 0.45 +/- 0.05 TPR u. (33.7 +/- 2.7%), and in arm vascular resistance (AVR) by 11.0 +/- 2.7 PRU u. (35.6 +/- 7%), was observed over a 60-min postexercise period. NTS exhibited insignificant changes in SBP, DBP, AVR except a significant decrease in TPR limited only to 20-min postexercise period. Hyperoxia decreased SBP, DBP and TPR in HTS. This effect was significantly attenuated during the postexercise period. Long-lasting antihypertensive effect of a single dynamic exercise in HTS suggests that moderate exercise may be applied as an effective physiological procedure to reduce elevated arterial BP in mild hypertension. We suggest also that the attenuation of the sympathoexcitatory arterial chemoreceptor reflex may contribute to a postexercise decrease in arterial BP and in TPR in mildly hypertensive subjects.

G2 - Hypertension and 24-H ambulatory BP montoring: Differences related to age and gender

G2 - Hypertension and 24-H ambulatory BP montoring: Differences related to age and gender

Bisoprolol markedly reduces BP in sustained essential hypertension

Bisoprolol markedly reduces BP in sustained essential hypertension