Cardiovascular Complications Of Hypertension Research Articles

Диспансеризация как важный вектор определения и профилактики сердечно-сосудистого риска в амбулаторных условиях

Aim: To assess the importance of dispensary follow-up in the prevention and determination of risk factors for cardiovascular complications in hypertension. Design: A retrospective study. Materials and methods. Dispensary observation cards of 98 patients were analyzed. The average age of patients was 45 ± 5.8 years. Risk factors for the development of cardiovascular diseases were determined (body mass index (BMI), levels of glucose and total cholesterol in the blood, blood pressure (BP) were studied), and the risk was calculated according to the SCORE scale in two formed groups of people: 1st — regularly undergoing medical examinations (n = 47), 2nd — have not passed it for more than 2 years (n = 51). Results. In the 1st group, the maximum increase in average blood pressure was recorded in patients 60–80 years (151/95 ± 5/2.3 mm Hg. Art.), in the 2nd — 60–80 (179/100 ± 3/5.4 mm Hg) and 40–60 years (171/98 ± 5/3.8 mm Hg). Overweight in the 1-st group was more often detected in patients 40–60 years old — in 37.5% cases (n = 18), obesity of 1–2 degrees — in persons 40–60 and 60–80 years old (n = 27, 57.4%). In the group of patients who have not undergone clinical examination for more than 2 years, overweight was determined in persons 40–60 and 60–80 years old (n = 21, 41.2%), grade 1 obesity was detected among patients 40–60 years old (n = 21, 41.2%), obesity of the 2nd degree — in persons 60–80 years old (n = 9, 17.6%). Hyperglycemia in the 1st group was recorded in 2 (4.3%) cases, in the 2nd group it was noted in 24 (47.1%) patients 60–80 years old. Hypercholesterolemia was diagnosed among persons 60–80 years old: in the 1st group — up to 6.4 ± 0.64 mmol/l, in the 2nd — up to 7.8 ± 0.64 mmol/l. In patients 40–60 years old in the 1st group, the average value of total cholesterol was 4.8 ± 0.64 mmol/L, in the 2nd group — 6.2 ± 0.64 mmol/L. In patients who have not undergone clinical examination for more than 2 years, compared with persons regularly participating in it, a statistically significant increase in hyperglycemia by 2 times (p < 0.001), total cholesterol increase by 1.5 times (p < 0.001), the average value of systolic BP increase by 1.5 times (p < 0.001), cases of very high (4 in the 1st group vs 17 in the 2nd (p < 0.001) and extreme (0 vs 14 (p < 0.001) cardiovascular risk in the second group. Positive correlations of mean strength between systolic blood presure, glycemia and total cholesterol were established (r = 0.41, p < 0.001 and r = 0.49, p < 0.001, respectively). Conclusion. Regular medical examination will make it possible to timely identify the risk of developing cardiovascular complications in hypertension and carry out prevention. Keywords: medical examination, arterial hypertension, prevention

Transforming growth factor, arterial stiffness and vascular aging in patients with uncontrolled arterial hypertension

Abstract Introduction Arterial stiffness and vascular aging is associated with a risk factors for cardiovascular complications in hypertension. It is known that, transforming growth factor β1 (TGF-β1), a pleiotropic cytokine, enhances proliferation and growth of smooth muscle cells, as well as the accumulation of extracellular matrix, that is, the processes underlying vascular remodeling in hypertension. But still there is no data about influence off TGF-β1 on arterial stiffness and vascular aging. Purpose The aim of our study was to identify the relationship between TGF-β1, arterial stiffness and vascular age in patients with uncontrolled arterial hypertension Materials and methods The study included 140 patients: 30 people with uncontrolled hypertension (UAH), 80 people with controlled hypertension (CAH) and 30 people in the control group. All patients underwent determination of arterial stiffness, vascular age using cardio-ankle vascular index (CAVI) by means of volumetric sphygmography and TGF-β1 concentration level. Results The TGF-β1 level was 19,2 [17,2; 24,7] ng/ml in the CAH group. In the UAH group – 22,6 [20,6; 25,6] ng/ml. In the control group - 17.4 [11,8; 19,3] ng/ml. Value of the CAVI was 9,2 [8,5; 9,9] in UAH group, 7.8 [7,0; 8,5] in CAH group and 7 [6,5; 7,5] in control group. The maximum and minimum values vascular age were observed in the group UAH 71,5 [64; 74] and control group 54 [44; 59], respectively (p<0,05), in the CAH group there was an intermediate value of the vascular age 59 [49; 69] (p<0,05). There was significant difference between vascular and passport age in CAH and UAH groups (p<0,05) and no significant difference between passport and vascular age in control group (p>0,05). The correlation analysis revealed a significant relationship between the TGF-β1 level and CAVI for patients with hypertension (CAH r=0,777; UAH r=0,753; p<0.05). Positive correlation was also revealed between TGF-β1 and vascular age in UAH group (r=0,657) and CAH (r=0,649) p<0,05. Conclusion An increase in the concentration of TGF-β1, vascular age and an increase of arterial stiffness were revealed in patients of the UAH group in comparison with the other groups. The relationship between TGF-β1, vascular age and arterial stiffness was also found in patients with arterial hypertension. Funding Acknowledgement Type of funding sources: None.

Homoarginine as a laboratory cardiovascular risk biomarker

Background. Low plasma concentration of L-homoarginine (hArg) is associated with the progression of cardiovascular disease. However, the association between plasma hArg and cardiovascular complications in hypertension is not established. Objective. To assess and compare hArg levels as a biomarker of cardiovascular risk in hypertension. Design and methods. We included 60 hypertensives with moderate (n = 12), high (n = 16) and very high (n = 32) cardiovascular risk. Blood plasma tests including hArg were assessed. The control group included 30 age-matched regular donors. Results. The level of hArg was significantly lower in hypertensives compared to ocontrols (р < 0,001). There were negative correlations between hArg and echocardiography parameters of left ventricular hypertrophy. In the higher cardiovascular risk groups hArg was lower (р = 0,042). ROC-analysis showed AUC 0,860 (95 % confidence interval 0,787–0,933) with the threshold for hArg ≤ 1,69 µM, sensitivity 72,0 % and specificity 93,3 %. Conclusion. The hArg plasma level is associated with the expression and enzyme activity of the protein arginine: glycinamidinetransferase in various tissues. The hArg level ≤ 1,69 µM can be considered a cumulative laboratory biomarker of high cardiovascular risk. Further studies of prognostic and diagnostic role of hArg are needed.

BLOOD PRESSURE VARIATION IS DEPENDENT ON THE BALANCE OF SYMPATHETIC AND PARASYMPATHETIC ACTIVITY

Objective: Blood pressure variability is an independent risk factor for cardiovascular complications in hypertension. There were reports that sympathetic nervous system was involved in the regulation of blood pressure, whereas beta-blocker was not involved in blood pressure variability. Therefore, the relationship between autonomic nervous system and blood pressure variability is unclear. We reported the usefulness of the pupillary function test as an index of sympathetic and parasympathetic nerves. In the present study, we clarify how the autonomic nervous system is related to blood pressure variability using the pupillary function test. Design and method: For 23 patients undergoing outpatient visits, blood pressure and heart rate variability factors were measured at 14 consecutive outpatient visits. The coefficient of variation of systolic blood pressure, diastolic blood pressure, and heart rate was calculated. In the pupillary function test, mydriatic velocity was used as an index of sympathetic nerve function, and miotic speed was used as an index of para-sympathetic function. Results: The average age is 66 ± 6 years old. The coefficient of variation for systolic blood pressure, diastolic blood pressure, and heart rate was 5.57 ± 2.13, 6.78 ± 2.96 and 6.73 ± 2.79, respectively. Mydriatic velocity and contraction velocity were 3.29 ± 0.79 ms and 1.69 ± 0.58 ms. Variation coefficient of systolic blood pressure, diastolic blood pressure and heart rate were not significantly correlated with mydriatic and miotic velocity. On the other hand, there was a significant negative correlation between coefficient of variation of systolic blood pressure, diastolic blood pressure and heart rate and ratio of mydriatic and miotic velocity. Conclusions: Visit-to-visit variability of systolic pressure, diastolic pressure and the heart rate was not related to sympathetic or parasympathetic activity alone but balance between both are involved in these variabilities.

Effective strategies for prevention of cardiovascular complications in elderly patients with arterial hypertension and obesity (clinical example)

The frequency of arterial hypertension has a clear tendency to increase with age. The presence of obesity imposes additional difficulties on the choice of antihypertensive therapy regimen due to the variety of pathophysiological mechanisms of raising blood pressure in patients with a combination of hypertension and obesity. This article presents the clinical case of a 68-year-old patient with hypertension and obesity, discusses a comprehensive approach that includes diet, regular physical activity, cognitive training and pharmacotherapy with the fixed combination of amlodipine with telmisartan and the imidazoline receptor agonist moxonidine. The choice of this combination is due to the following reasons: the ultra-prolonged action of both drugs, which allows you to control blood pressure during the day, including in the morning, when there is the greatest number of cardiovascular events; organoprotective properties; improving carbohydrate metabolism; reducing the risk of diabetes; antiatherosclerotic properties. The choice of moxonidine is due to the need of effective control of blood pressure, reduction of the activity of the sympathetic nervous system, because hypersympathicotonia is one of the central pathogenetic mechanisms for raising blood pressure in patients with hypertension and obesity, and the decrease in resting heart rate less than 80 bpm (an independent risk factor for cardiovascular complications in hypertension). Dietary recommendations will help to reduce body weight and blood pressure, slow the progression of atherosclerosis, prevent the development of cardiovascular catastrophes, and improve the quality of life. The aim of physical activity is reducing body weight, improve cognitive functions and reduce cardiovascular risks. Cognitive training will help improve cognitive function and, consequently, increase patient adherence to treatment. After six weeks of complex treatment, the patient noted the achievement of the target blood pressure, weight loss, improved mood, increased exercise tolerance, improved quality of life, as well as a decrease in proteinuria, which completely disappeared after another three months of therapy.

Risk factors of the progression to hypertension and characteristics of natural history during progression: A national cohort study.

BackgroundAlthough the high disease burden that results from cardiovascular complications of hypertension, factors related to the progression to hypertension in the normotensive population are not actively reported. The purpose of this study was to estimate the rate of the progression to hypertension and to reveal the associated risk factors.MethodsThe study included normotensive participants from the National Health Insurance Service-National Health Screening Cohort, and contained a 10% sample of all adults who received a national health screening test in either 2002 or 2003. At the end of the study in 2015, the patients were divided into two groups based on whether or not they progressed to hypertension. Cox proportional hazard modeling was performed to identify risk factors for progression. Subgroup analysis using logistic regression was employed to reveal factors influencing the different natural history of the progression.ResultsAmong the 75,335 included participants, the progression rate to hypertension was 66.39% (50,013), with an adjusted incidence rate of 8.62 per 100 person-year in the aged 40–64 group and 12.68 in the aged 65 or above group. Age, BMI, hemoglobin, and family history of hypertension and other diseases were related to the progression. Among the progression group, 78.21% (39,116) participants skipped a pre-hypertensive status; this group consisted of older females with lower pulse pressure and more alcohol consumption compared to people who had pre-hypertensive status before the progression.ConclusionSubstantial risk factors for the progression to hypertension should be carefully managed even in normotensive participants who receive health screening tests.

The Effects of Heme Oxygenase Upregulation on Obesity and the Metabolic Syndrome.

Significance: Obesity is a chronic condition that is characterized by inflammation and oxidative stress with consequent cardiovascular complications of hypertension, dyslipidemia, and vascular dysfunction. Obesity-induced metabolic syndrome remains an epidemic of global proportions. Recent Advances: Gene targeting of the endothelium with a retrovirus using an endothelium-specific promoter vascular endothelium cadherin (VECAD)-HO-1 offers a potential long-term solution to adiposity by targeting the endothelium. This has resulted in improvements of both vascular function and adiposity attenuation. Critical Issues: Heme oxygenase plays an ever-increasing role in the understanding of human biology in the complex conditions of obesity and the metabolic syndrome. The heme oxygenase 1 (HO-1) system creates biliverdin/bilirubin, which functions as an antioxidant, and carbon monoxide, which has antiapoptotic properties. Future Directions: Upregulation of HO-1 has been shown to improve adiposity as well as vascular function in both animal and human studies.

Effects of Remote Monitoring of Blood Pressure in Management of Urban Hypertensive Patients: A Systematic Review and Meta-Analysis.

Background:Remote home blood pressure monitoring (RBPM) has been shown as effective in managing hypertension in underserved areas. Effects on urban patients, who are more easily provided with high-quality medical services, are still unclear. We systematically review previously published randomized controlled trials on the effect of RBPM for urban hypertensive patients.Methods:We searched electronic databases for studies published in English up to October 2018. Studies comparing the use of RBPM to face-to-face care were included. Outcome measures were changes in office blood pressure (BP) and the rate of BP control.Results:We identified 1,433 potential references for screening, of which 27 were eligible for review. Substantial heterogeneity was evident for the investigated variables. A significant standardized mean difference (SMD) was observed for RBPM for systolic BP, but the effect size was small compared to face-to-face care and was clinically irrelevant in avoiding cardiovascular events (0.212, 95% confidence interval 0.148-0.275; p < 0.001). For diastolic BP, the SMD between the two groups was small (0.170, p < 0.001) and the effect of RBPM was irrelevant in preventing cardiovascular events. The effect on the rate of BP control was significantly high for the intervention group (relative risk: 1.136; p = 0.018).Conclusions:This review demonstrates that RBPM performed on urban hypertensive patients has limited value and seems not to be superior to ordinary care in avoidance of cardiovascular events. Further studies are needed to provide more reliable information about the effectiveness of RBPM in preventing hypertensive cardiovascular complications.

Effects of Remote Monitoring of Blood Pressure in Management of Urban Hypertensive Patients: A Systematic Review and Meta-Analysis

Background Remote home blood pressure monitoring (HBPM) has been shown as effective in managing hypertension in underserved areas. Effects on urban patients, who are more easily provided with high-quality medical services, are still unclear. We systematically review previously published randomized controlled trials on the effect of HBPM for urban hypertensive patients. Methods We searched electronic databases for studies published in English up to October 2018. Studies comparing the use of HBPM to face-to-face care were included. Outcome measures were changes in office blood pressure (BP) and the rate of BP control. Results We identified 1,433 potential references for screening, of which 27 were eligible for review. Substantial heterogeneity was evident for the investigated variables. A significant standardized mean difference (SMD) was observed for HBPM for SBP, but the effect size was small compared to face-to-face care and was clinically irrelevant in avoiding cardiovascular events (0.212: 95% confidence interval, 0.148 to 0.275; P < 0.001). For diastolic BP, the SMD between the two groups was small (0.170, P < 0.001) and the effect of HBPM was irrelevant in preventing cardiovascular events. The effect on the rate of BP control was significantly high for the intervention group (relative risk: 1.136; P = 0.018). Conclusion This review demonstrates that HBPM performed on urban hypertensive patients has limited value and seems not to be superior to ordinary care in avoidance of cardiovascular events. Further studies are needed to provide more reliable information about the effectiveness of HBPM in preventing hypertensive cardiovascular complications.

Effects of initial treatment on the dynamics of renal functional reserve in stage-I hypertensive patients

Objective: To determine the functional state of the kidneys in patients with the I stage essential hypertension with different total risk of cardiovascular complications and to assess the effect of early medication (angiotensin II receptor blocker) on the dynamics of changes in the functional renal reserve. Material and Methods: This study included 80 patients with the established diagnosis - the I stage essential hypertension of the I-III grade in age from 18 to 60 years (28 women (35 %), the average age is 40,1 (35,0-56,0) years; men - 57 (71%), average age – 40,2 (37,0-53,0) years. A risk factor count was used to assess the overall risk of cardiovascular complications in hypertension. Functional renal reserve and endothelium-independent vasodilation of the brachial artery were defined. Statistical analysis was performed using SPSS Statistics. Results: In patients with high risk, the depleted and decreased functional renal reserve was most often detected, which was 55% of patients. It is also important to note that patients with even a low risk of cardiovascular complications have already had renal damage as a reduced or depleted functional renal reserve. Patients with a low risk of cardiovascular complications who had not started drug treatment on their first visit had a 2.3-fold (95% CI 1,048-4,896) higher relative risk of developing kidney damage in comparison with patients who had started medication therapy without delay. Conclusion: Diagnosis of functional renal reserve in patients with a low risk of developing cardiovascular complications in stage I arterial hypertension is an important component for predicting the further development of kidney damage and timely prevention of its progression. The early onset of drug treatment reduces the relative risk of developing kidney damage by 2.3 times in patients with arterial hypertension.

Blood pressure control status and associated factors among adult hypertensive patients on outpatient follow-up at University of Gondar Referral Hospital, northwest Ethiopia: a retrospective follow-up study.

BackgroundLarge segments of the hypertensive population in the world are either untreated or inadequately treated. The incidence of heart failure and mortality from cardiovascular complications of hypertension is high among patients with uncontrolled blood pressure (BP). But BP control status of hypertensive patients has not been investigated in the study area. The study aimed to assess BP control status and determinant factors among adult hypertensive patients on antihypertensive medication attending outpatient follow-up at University of Gondar Referral Hospital, northwest Ethiopia.MethodsAn institution-based retrospective follow-up study was conducted from September 2015 to April 2016. Data were collected using a structured and pretested questionnaire adopted from the World Health Organization STEPwise approach. BP records of 6 months were used, and patients were classified as having controlled BP if their BP readings were <140/90 mmHg for all adults ≥18 years of age and <150/90 mmHg for adults aged ≥60 years. A generalized estimating equation was fitted, and the odds ratio with a 95% confidence level was used to determine the effect of covariates on BP control status.ResultsAmong 395 participants, 50.4% (95% CI: 45–55) of them controlled their BP in the last 6 months of the survey. Physical activity (adjusted odds ratio [AOR]=1.95, 95% CI: 1.41–2.68), duration on antihypertensive drugs of 2–4 years (AOR=1.70, 95% CI: 1.13–2.56) and 5 years or more (AOR=1.96, 95% CI: 1.32–2.92), and high adherence (AOR=2.18, 95% CI: 1.14–4.15) to antihypertensive drugs were positively associated with BP control, while salt intake (AOR=0.67, 95% CI: 0.49–0.93), overweight (AOR=0.50, 95% CI: 0.36–0.68), and obesity (AOR=0.56, 95% CI: 0.36–0.87) were inversely associated with BP control.ConclusionIn this study, only half of the hypertensive patients controlled their BP. Thus, health care providers need to be made aware about the importance of counseling hypertensive patients on drug adherence, moderate physical activity, and salt restriction to improve BP control.

Cardiovascular risk stratification and renal functional reserve in patients with essentials hypertension

The article is devoted to the role of renal functional reserve (RFR) in essentials hypertension (EH) in the diagnosis of early kidney damage. Particular attention is paid to the effect of cardiovascular (CV) complications on RFR.The objective: to assess the functional state of the kidneys in patients with EH I stage and different total risk of CV complications.Materials and methods. The study involved 80 people with the established diagnosis EH of I stage of the I–II grade according to the WHO/ISH, 2003 (World Health Organization/International Society of Hypertension) and Order of the Minister of Health from May, 24, 2012 No.384 [2, 4, 8], in age from 18 to 60 years (women – 28 (35%), the average age is 40,1 (35,0–56,0) years, men – 57 (71%), average age – 40,2 (37,0–53,0) years. The average duration of EH stage I was 3,5 (1,2–5,0) years. Non-inclusion criteria were acute infectious diseases, symptomatic arterial hypertension, valvular heart disease, cardiac rhythm disturbances, chronic heart failure, chronic kidney disease, diabetes mellitus, coronary heart disease. Patients at the time of inclusion in the study did not take antihypertensive therapy. All patients underwent a comprehensive examination: a history, clinical examination and body anthropometric measurements (height, weight, waist and hip circumference and waist-to-thigh ratio (WTR)), complete blood count and urine tests, biochemical blood test (total protein, urea, creatinine, glucose, lipid profile, cystatin C), albumincreatinine ratio (ACR) in urine, ABPM, ECG, Echo-CG, ultrasound of carotid arteries, ophthalmoscopy. A risk factor count was used to assess the overall risk of CV complications in hypertension. In addition, RFR was determined the method water and salt load (under patentUkraine42,860) [1]. Statistical analysis of the results was carried out on a computer using the Microsoft Excel 2016 software package and IBM SPSS Statistics (version 21,USA).Results. When stratifying the risk, it was found that 56% of patients had a high risk, 20% of patients had an average risk and 24% had low risk of developing CV complications. In this case, high risk patients had 3–5 risk factors, the average – less than 3 risk factors, and patients with low risk had 1–2 or had no risk factors at all. Of all the risk factors most often met dyslipidemia, male sex, abdominal obesity and family history of premature CVD. In the course of the study, it was clear that even in patients with a low risk of CV complications, kidney damage was noted in the form of a reduced and depleted RFR.Conclusions. An important study of renal damage in EH I stage is the definition of a functional renal reserve. In patients with even a low risk of CV complications in EH I stage, a reduced and depleted RFR is defined. The most commonly depleted RFR was detected in patients with a high risk of developing CV complications.

Cardiovascular Risk Associated With White-Coat Hypertension: Con Side of the Argument.

Cardiovascular Risk Associated With White-Coat Hypertension: Con Side of the Argument.

Relationships between 24-h blood pressure variability and 24-h central arterial pressure, pulse wave velocity and augmentation index in hypertensive patients.

Twenty-four-h blood pressure variability (BPV) predicts cardiovascular complications in hypertension, but its association with pulse wave indices (central arterial pressure, pulse wave velocity (PWV) and augmentation index (AIx)) is poorly understood. In the present study, we assessed the degree of the effect of 24-h BPV on 24-h pulse wave indices. Brachial blood pressure was measured non-invasively over the 24 h with an electronic, oscillometric, automated device (BPLab) in 661 uncomplicated treated or untreated hypertensive patients. Digitalized oscillometric waveforms were analyzed with a validated algorithm to obtain pulse wave indices. Twenty-four-h BPV was calculated as the unweighted (SDu) or weighted s.d. (SDw) of the mean blood pressure or as the average real variability (ARV). Twenty-four-h systolic BPV showed a direct and significant relationship with the central arterial systolic pressure (r=0.28 SDu, r=0.40 SDw, r=0.34 ARV), PWV (r=0.10 SDu, r=0.21 SDw, r=0.19 ARV) and AIx (r=0.17 SDu, r=0.27 SDw, r=0.23 ARV). After adjustment for age, sex, body mass index, antihypertensive treatment and 24-h systolic blood pressure, the relationship lost some power but was still significant for all measures, except for the AIx. Pulse wave indices were higher in patients with high BPV than in those with low BPV: after adjustment, these differences were abolished for the AIx. The diastolic BPV showed a weak association with the pulse wave indices. In conclusion, in hypertensive patients, 24-h systolic BPV is moderately and independently associated with 24-h central arterial pressure and stiffness.

Outcome Trials in the Therapeutic Management of Hypertension in East Asians

According to the most recent epidemiological data, the prevalence of hypertension ranged from about 25% in Chinese living either in the mainland or in Taiwan and Koreans, to approximately 40% in Mongolians. The control rate of hypertension was about 35% in Koreans and Japanese, 24% in Mongolians, and less than 10% in Chinese. Four placebo-controlled trials in China unequivocally proved that antihypertensive therapy may prevent stroke and other cardiovascular complications in hypertension or patients with a history of stroke or transient ischemic attack. Four actively-controlled trials in Japan did not show significant difference between various classes or combinations of antihypertensive drugs. Two trials that compared intensive with less intensive blood pressure control in elderly Japanese hypertensive patients did not show further benefit of controlling systolic blood pressure to a level below 140 mmHg in comparison with blood pressure control to a level of 140 mmHg or above. These trials that compared various classes of antihypertensive drugs or intensive with less intensive blood pressure control often had small sample size and hence inadequate power to detect modest or moderate benefit. There is still a need for high quality outcome trial data in East Asians.

3D.05

Objective:24-hour blood pressure variability (BPV) is a predictor of cardiovascular complications in hypertension, but its association with arterial stiffness is poorly understood. We recently showed that central aortic pressure and stiffness evaluated non-invasively over the 24-hours are increased

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Objective: This study aimed to assess the 24-hour blood pressure pattern of hypertensive (HTN) individuals living with HIV and quantify the major contributive risk factors of non-dipping. Although hypertensive cardiovascular complications are closely related to 24-hour blood pressure pattern, major gaps in current knowledge exist regarding this subject in HIV+ populations. Design and method: Data analysed was from the Register of cardiovascular Complications among people living with HIV (RECOVIH) which included 174 known hypertensive HIV+ individuals with 1 or more CV risk factors who underwent 24-hour Ambulatory Blood Pressure Monitoring (ABPM) in our cardiac centre. Multiple logistic regression with non-dipping as outcome quantified risk factors and their impact. Diagnostic criteria: Hypertension on ABPM: at or above 130/80 mmHg, systolic and/or diastolic Dipping: day to night systolic blood pressure decline at or above 10% Non-dipping: day to night systolic blood pressure decline less than 10% Results: The cohort had a mean age of 52 ± 7.5 years, was predominantly male (90%), and had a long duration of HIV and antiretroviral (ARV) exposure (14 ± 6 and 10 ± 4.5 years respectively). The cohort had a mean BMI of 24.5 ± 4, 27% were current smokers, 24% had clinical lipodystrophy (60% atrophic), 13% had diabetes, and 71% were under antihypertensive therapy (72% under renin angiotensin antagonists, 35% under beta-blockers, 24% under diuretics and 16% under calcium channel blockers). Non-dipping hypertension prevalence was 48% in RECOVIH. No statistically significant differences between dippers and non-dippers were observed for demographic, clinical and biologic parameters. No statistically significant differences between the two groups were detected for nocturnal heart rate decrease or duration of known HIV status, ART exposure, and HIV-related biologic parameters. Non-dipping was associated with age (p = 0.049; OR 1.04; 95%CI 1.0002–1.08), use of diuretics (p = 0.03; OR 0.36; 95%CI 0.14–0.88), known hepatitis B virus (p = 0.049; OR 4.09; 95%CI 1.005–16.64), and HTN on the ABPM (p = 0.04; OR 2.02; 95%CI 1.05–3.88). Conclusions: Non-dipping hypertension prevalence is high among RECOVIH's middle age subjects at moderate to high risk of cardiovascular disease. If and how this high frequency of non-dipping pattern is associated with worse cardiovascular prognosis needs further study.

Duelling receptors: estrogen receptor versus mineralocorticoid receptor in the cardiovascular system.

here are times when investigators pursuing 2 distinctlines of research that address a common topic appeartobeoperatinginaparalleluniverse.Anyonewhohasservedin a grant review process will have pondered the irony of aseriesofgrantapplicationsaddressingthesamequestionbutvia different approaches or biological systems, each con-vincedtheirsisthekeypathwaywhilesteadfastlyignoringallother approaches. This has arguably been true of the workaddressing the role of steroid hormones in cardiovasculardisease,ormorespecificallycardiacfibrosis.Forsomeyears,thebeneficialeffectsofestrogenhavebeenextensivelychar-acterizedwithrespectnotonlytovascularreactivitybutalsofibrosis (1–3). The clinical correlate is of course the relativeprotection against cardiovascular disease in premenopausalwomen that is lost after the menopause. In the parallel uni-verse, a number of groups, including our own, have proveddetailedcharacterizationofthemolecularmechanismsdriv-ingtheproinflammatory,profibroticconsequencesofexcessmineralocorticoid receptor (MR) activation, be it by aldo-steroneorcortisol/corticosterone(reviewedinRef.4).Thesestudies,aswiththoseforestrogen,haveastrongclinicalcon-nection exemplified by the excess adverse consequences ofhyperaldosteronism, where the cardiovascular complica-tions of hypertension are clearly worse for the equivalentrises in blood pressure with hyperaldosteronism than forother causes of hypertension (5). This key role of MR acti-vation is further confirmed by a series of clinical trials thathave demonstrated improved outcomes for cardiac failurewhereanMRantagonistisaddedtoconventionaltherapy(6).The initial report of a pathophysiological role for ad-renalhormonesinvascularinflammationandfibrosiswasmadebyHansSeylein1946,butthisfindingwasnotfullyappreciated until Brilla and Weber in 1992 stimulated in-terestintheroleofaldosteroneincardiacfibrosis(4).Thesubsequent studies not only established a role for activa-tion of the MR, independent of hypertension and hyper-trophy, in cardiovascular inflammation and fibrosis butalso identified MR, activated by aldosterone, deoxycor-ticosterone, or cortisol/corticosterone, as the critical me-diator. More recent studies from our group and othershave dissected the tissue specificity of the response usingtissue-selective MR-null mice with key roles attributed tothe vascular MR (endothelial and smooth muscle cells)together with cardiomyocytes and cells of the monocyte/macrophagelineage(4).Ararelyacknowledgedsubtextinthese various rodent studies is that they are almost inev-itably performed in male animals, with the explanationbeing: “the response is more robust,” blinkered thinkingthat perhaps hides a critical biological significance. Morerecently, recognition has emerged that both experimen-tally and clinically sex-selective differences in the re-sponsestomineralocorticoidexcessandindeedmineralo-corticoid antagonist therapy need to be considered (7).Studiesusingarangeofanimalmodelsofvascularinjuryand/or cardiac fibrosis report exacerbation by aldosteroneand attenuation by estrogen (8), albeit almost never in thesamestudy.Arias-Lozaetal(9)directlyexaminedthisques-tion,findingthatestradiol(E2)actingthroughbothestrogenreceptors (ERs), ER and ER , was able to attenuate aldo-sterone-induced cardiovascular remodeling in salt-treatedrats. Pedram et al (1) have reported a critical role for ER -specific agonists in the prevention of cardiac hypertrophyand progression to cardiac fibrosis in female mice. This

Association of sodium and potassium intake with ventricular arrhythmic burden in patients with essential hypertension

Abstract Background Hypertensive populations suffer from an increased susceptibility to ventricular arrhythmias and sudden cardiac death. A high-salt diet appears to be a major factor involved in cardiovascular complications in hypertension. We examined the relationship between dietary salt and potassium, as indicated by urinary sodium (UNa), urinary potassium (UK), and urinary sodium/potassium ratio (UNa/K), and the arrhythmic burden in patients with essential hypertension. Methods We included 255 consecutive adult patients with well-controlled hypertension who were being followed in the hypertension outpatient clinic of a university tertiary hospital and complained of episodes of atypical chest pain and/or palpitations. All underwent 24-hour ambulatory electrocardiograph monitoring and their UNa, UK, and UNa/K ratio from 24-hour urinary excretion specimens were evaluated. Results No significant correlation was found between premature supraventricular contractions and the parameters that were examined. However, the percentage of premature ventricular contractions (PVC%) showed a weak positive association with UNa (r = 0.2; P = .001) and a moderate negative association with UK (r = −0.396; P P Conclusions A higher UNa/UK excretion ratio is significantly associated with PVCs, indicating an increased susceptibility to ventricular arrhythmias even among hypertensives with well-controlled blood pressure. Our findings reinforce recommendations for dietary interventions in those populations.

Association of sodium and potassium intake with ventricular arrhythmic burden in patients with essential hypertension

BackgroundHypertensive populations suffer from an increased susceptibility to ventricular arrhythmias and sudden cardiac death. A high-salt diet appears to be a major factor involved in cardiovascular complications in hypertension. We examined the relationship between dietary salt and potassium, as indicated by urinary sodium (UNa), urinary potassium (UK), and urinary sodium/potassium ratio (UNa/K), and the arrhythmic burden in patients with essential hypertension. MethodsWe included 255 consecutive adult patients with well-controlled hypertension who were being followed in the hypertension outpatient clinic of a university tertiary hospital and complained of episodes of atypical chest pain and/or palpitations. All underwent 24-hour ambulatory electrocardiograph monitoring and their UNa, UK, and UNa/K ratio from 24-hour urinary excretion specimens were evaluated. ResultsNo significant correlation was found between premature supraventricular contractions and the parameters that were examined. However, the percentage of premature ventricular contractions (PVC%) showed a weak positive association with UNa (r = 0.2; P = .001) and a moderate negative association with UK (r = −0.396; P < .001). The partial correlation coefficient of PVC% with the UNa/UK ratio remained significant even after controlling for left ventricular mass index (r = 0.437; P < .001). ConclusionsA higher UNa/UK excretion ratio is significantly associated with PVCs, indicating an increased susceptibility to ventricular arrhythmias even among hypertensives with well-controlled blood pressure. Our findings reinforce recommendations for dietary interventions in those populations.