Cause Of Elevated Blood Pressure Research Articles

Abstract P359: Resident Management Of Hypertensive Urgency

Objective: Hypertensive urgency is generally defined as a severely elevated blood pressure without evidence of end-organ damage. Consensus statements do not recommend the acute lowering of blood pressure nor referral to the emergency room. Rapid lowering of blood pressure in patients who are chronically hypertensive carries the risk of hypoperfusion and therefore ischemia to vital organs. The objective of this study was to assess residents’ perception of the management of hypertensive urgency. Methods: An anonymous survey was sent via email to all active resident physicians of an academic internal medicine residency program. It comprised of 8 questions regarding the outpatient and inpatient treatment of hypertensive urgency. Results: A total of 47 residents responded to the survey. Most respondents (44 of 47) knew that evaluating for reversible causes of elevated blood pressure is the first step of management. Fewer residents (37 of 47) said the next course of action would be to up-titrate the oral blood pressure regimen. When asked about real life practice, 35 of 47 attested to conservative management with 12 of 47 respondents regularly using IV antihypertensives to treat hypertensive urgency. The most common contributing reason (25 of 47) to pushing IV antihypertensives was pressure from colleagues and staff, with only 2 residents denying ever administering IV antihypertensives. Residents were also aggressive in the management of hypertensive urgency in the outpatient setting with 15 of 47 respondents reporting most commonly referring patients to the ER for blood pressure lowering (31.91%) and 5 of 47 reporting administering clonidine in the office for quick blood pressure lowering. Conclusion: Resident physicians in our program should be less aggressive in treating hypertensive urgency, especially in the outpatient setting. We suspect that the notion that hypertensive urgency warrants immediate blood pressure lowering is prevalent as pressure from staff/colleagues was the largest cited reason to giving IV antihypertensives in urgency. Further efforts should be pursued to educate residents about the current guidelines regarding hypertensive urgency.

Determination of the association between excessive intake of Rasa and Retinal vascular changes in Pregnancy-Induced Hypertension- A Pilot Study

Background: Pregnancy-induced hypertension (PIH) is a hypertensive disorder in pregnancy that occurs in the absence of other causes of elevated blood pressure. There are many complications documented for PIH and associated retinal vascular changes in one of them. During pregnancy if proper antenatal care along with diet is not followed, patient may land into complications like PIH related retinopathy. Aim: To determine the retinal changes in pregnancy induced hypertension (PIH) and any association between the retinal changes and excess intake of specific Rasa. Methods: All the patients admitted in ward with diagnosis of PIH were included in this study. Age, race, gravida, gestation period, blood pressure, and proteinuria along with dietary habit were noted from the case records. After taking history for any eye symptoms, fundus examination was done after dilating the pupils with direct ophthalmoscope in the ward itself. All the findings were noted on a data sheet, and were analyzed. Results: A total of 24 patients of PIH were examined. Majority were urban (75%) and remaining are from rural area (25%). The majority of patients are from 24-28 years age group followed by below 20 years age group. The gestation period ranged from 20 weeks to 38 weeks; 16 (66.6%) were primi gravida. Nineteen (79.1%) patients had mild preeclampsia, 03 (12.5%) had severe preeclampsia and 2 (8.33%) had eclampsia. Retinal changes (hypertensive retinopathy) were not seen in any of these patients Haemorrhages or exudates or retinal detachment were not seen in any patient. There was no association of retinal changes and Rasa Sevan a found in present pilot study. Conclusion: Retinal changes were not seen in any of the patients with PIH in present study sample and there was not found to be associated with excess intake of specific Rasa and severity of the disease. Fundus examination is necessary in assessment of the PIH patient.

Фармакотерапевтичні особливості ведення пацієнтів із вторинними артеріальними гіпертензіями ендокринного генезу

Secondary arterial hypertension is the arterial hypertension, the etiology of which can be established. Secondary arterial hypertension becomes the cause of elevated blood pressure in 5–10% of patients with hypertension. More than 50 diseases and clinical conditions contributing to the development of secondary arterial hypertension have been identified. In most cases, such arterial hypertension is characterized by high blood pressure, an unfavorable prognosis of the disease, and a high frequency of cardiovascular complications. However, in some forms of it, timely diagnosis and adequate treatment allow to achieve normalization of blood pressure and prevent the development of complications. In cases of the secondary arterial hypertension, in addition to antihypertensive therapy, drug treatment or surgical treatment of the underlying disease that caused hypertension is required. Knowledge of modern diagnostics and principles of treatment of these conditions has to improve the quality of care for patients suffering from hypertension. The purpose of the study was to consider the main clinical, pathogenic, diagnostic and pharmacotherapeutic aspects of the secondary arterial hypertension of endocrine genesis. Secondary endocrine arterial hypertensions develop in diabetes mellitus, hyperaldosteronism primary (Kon's syndrome) and pseudoprimary (idiopathic hyperplasia of the adrenal cortex), Itsenko-Cushing syndrome, pheochromocytoma, pheochromoblastoma, paraganglioma, acromegaly, hypothyroidism, hyperthyroidism, hyperparathyroidism, etc. Each of these diseases has a special etiopathogenesis of arterial hypertension, which makes it necessary to carry out special screening and diagnostic tests in order to prescribe reasonable therapy. In the management of patients with secondary endocrine arterial hypertension, there cannot be universal approaches to the appointment of antihypertensive drugs, instead, an individualized approach contributes to effective control of the disease and prevention of possible complications. Conclusion. So, taking into account the high and progressive incidence of arterial hypertension worldwide, the high frequency of life-threatening complications, a large number of risk factors, constant updating of knowledge on the clinical, pathogenic, diagnostic and pharmacotherapeutic aspects of the management of such patients becomes extremely relevant. A significantly large part of secondary arterial hypertension in the structure of this pathology requires special attention of practicing doctors regarding differential diagnosis, especially in the cohort of young patients. Information about features of the pathogenic therapy of the secondary arterial hypertension of endocrine origin is necessary for a wide range of doctors of various specialties for the maximum effective management of such patients

Cross-sectional analysis of the association between personal exposure to household air pollution and blood pressure in adult women: Evidence from the multi-country Household Air Pollution Intervention Network (HAPIN) trial

Elevated blood pressure (BP) is a leading risk factor for the global burden of disease. Household air pollution (HAP), resulting from the burning of biomass fuels, may be an important cause of elevated BP in resource-poor communities. We examined the exposure-response relationship of personal exposures to HAP —fine particulate matter (PM2.5), carbon monoxide (CO), and black carbon (BC) — with BP measures in women aged 40–79 years across four resource-poor settings in Guatemala, Peru, India and Rwanda. BP was obtained within a day of 24-h personal exposure measurements at baseline, when participants were using biomass for cooking. We used generalized additive models to characterize the shape of the association between BP and HAP, accounting for the interaction of personal exposures and age and adjusting for a priori identified confounders. A total of 418 women (mean age 52.2 ± 7.9 years) were included in this analysis. The interquartile range of exposures to PM2.5 was 42.9–139.5 μg/m3, BC was 6.4–16.1 μg/m3, and CO was 0.5–2.9 ppm. Both SBP and PP were positively associated with PM2.5 exposure in older aged women, achieving statistical significance around 60 years of age. The exact threshold varied by BP measure and PM2.5 exposures being compared. For example, SBP of women aged 65 years was on average 10.8 mm Hg (95% CI 1.0–20.6) higher at 232 μg/m3 of PM2.5 exposure (90th percentile) when compared to that of women of the same age with personal exposures of 10 μg/m3. PP in women aged 65 years was higher for exposures ≥90 μg/m3, with mean differences of 6.1 mm Hg (95% CI 1.8–10.5) and 9.2 mm Hg (95% CI 3.3–15.1) at 139 (75th percentile) and 232 μg/m3 (90th percentile) respectively, when compared to that of women of the same age with PM2.5 exposures of 10 μg/m3. Our findings suggest that reducing HAP exposures may help to reduce BP, particularly among older women.

BLOOD PRESSURE MEASUREMENT AMONG PATIENTS WITH PERIPARTUM CARDIOMYOPATHY; CONTROL AND BARRIERS DURING FOLLOW UP

Objective: To identify the frequency of blood pressure (BP) control among patients with peripartum cardiomyopathy (PPCM), barriers for follow up, and causes for elevation of BP. Design and method: Data about BP values, control, follow up, and treatment were prospectively documented for patients with PPCM who were presented to the cardio-maternal unit between 2015 - 2020. Baseline BP values were compared with the second readings between six months to one year postpartum. Adherence to medication and identifying the causes of elevated BP were reported. Results: Among 64 patients with PPCM presented to the unit, loss of follow up reported in 59.4% of patients; 60.5% for unknown cause, 21.1% due to COVID-19 pandemic, and 18.4 due to death. For 26 (40.6%) patients who adhered to follow up, the mean age was (32.5 ± 7), 61.5% patients had normal BP at baseline and during follow up, while 38.5% of them had elevated BP at baseline or during follow up (cutoff 140/90); 30% showed reduced BP to normal values comparing to their baseline measurements, and 70% developed increased in BP values during follow up (Table 1). All patients with increased BP measurements during follow up had hypertension associated with pregnancy, however, only 28.6% of them had known history of hypertension before pregnancy. Most common anti-hypertensive drug used post delivery was angiotensin-converting enzyme inhibitors 77%. Causes for increased BP measurements during follow up were obesity 57.1%, stress 28.6%, and use of oral contraceptive pills 14.3%. Conclusions: Among patients with PPCM with elevated BP at baseline, control of BP was reported in less than one-third of the patients. However, data for more than half of the patients was missing due to loss of follow up which is related to COVID-19 pandemic or mortality, but for the majority of patients the cause was unknown. Factors associated with elevated BP were obesity, stress, and use of oral contraceptive pills. Therefore, future enhancement in patient education regarding the importance of follow up and life style modifications is essential for better BP control among patients with PPCM.

A Comparative Study to Assess Effect of Hypertonic Saline (3%Nacl) versus Salbutamol Nebulization Therapy on Breathing Pattern among the Children Suffering with Lower Respiratory Tract Infection Admitted to the Selected Hospitals of Central Gujarat

Background of the study: In the contemporary epoch, In India there is a rapid health transition with major and increasing burden of chronic non communicable diseases, supremely hypertension, cancer, diabetes mellitus, chronic lung disease and stroke and increased age was one the cardinal cause of elevated blood pressure. Objectives: 1) to assess breathing pattern of children suffering with lower respiratory tract infection after nebulization therapy with hypertonic saline (3%Nacl). 2) To assess breathing pattern of children suffering with lower respiratory tract infection after nebulization therapy with salbutamol. 3) To compare the effect of hypertonic saline (3%Nacl) and Salbutamol nebulization therapy on breathing pattern of children suffering with lower respiratory tract infection.4) To find out the association between selected demographic variables and breathing pattern of children suffering with lower respiratory tract infection after nebulization therapy with hypertonic saline (3%Nacl) and salbutamol. Methodology: A comparative study was carried out by selecting 86 children which were suffering with LRTI through non probability purposive sampling technique. Demographic data was collected by questionnaire as well as breathing pattern was assessed by modified clinical severity score. Result: The study finding shows that the mean clinical severity score 1.4283 with hypertonic saline nebulization therapy was lesser than the mean clinical severity score 1.8469 with salbutamol nebulization therapy with the mean difference of was 0.4186. ANOVA calculated; P value is 0.000which less than 2.91 (df 2, level of significant 0.05).so, that H0 is rejected. This indicates that the hypertonic saline (3% Nacl) is effective to improve breathing pattern compare to salbutamol nebulization therapy. Conclusion: The research study concluded that hypertonic saline(3% Nacl) nebulization therapy is more effective compare to salbutamol nebulization therapy.

SAT-189 Pheochromocytoma as a Rare Cause of Elevated Blood Pressure During Pregnancy

Endocrine causes of elevated blood pressure during pregnancy are considered a rare, mainly when compared to the more frequent pregnancy-related hypertensive disorders. Thus, the diagnosis of endocrine-related secondary hypertension cases and the outcome of pregnancy will largely depend upon a high clinical suspicion.A 28 year-old female, presented in pregnancy with elevated, difficult to control blood pressure, leading to induced delivery of a preterm 32 week baby. The baby was admitted to the NICU, where she stayed for 3 weeks.After delivery, Patient was evaluated in the Endocrine Clinic. She reported episodes of pulsatile headaches, palpitations and excessive sweating for the past 1 year. Each episode would last around 10 minutes and resolved spontaneously. Systolic blood pressure during these episodes was in the 200s and would return back to normal afterwards.Past medical, surgical and social history was unremarkable. She reported that her mother died suddenly in her 30s from an unknown cause. Physical exam, including blood pressure, was unremarkable in the clinic.The patient underwent a work up for secondary causes of hypertension after delivery. Tests included plasma metanephrines: 327pg/ml (<57pg/ml), plasma normetanephrines: 7,135pg/ml (<148pg/ml), Chromogranin A 768 ng/ml (<93ng/ml) and a 24 Hour fractionated total metanephrines: 10,170 mcg/24hrs (40-412mcg/24h). She had normal TSH, aldosterone, renin and AM cortisol level.CT scan of chest, abdomen and pelvis showed a large right retroperitoneal, heterogeneously enhancing mass, measuring 5.8 x 3.7 x 8.3 cm, which encircles the aorta approximately 180 degrees, without evidence of vascular invasion.Diltiazem three times a day was initiated for preoperative blood pressure control. After 2 weeks, she underwent laparoscopic resection. Pathology showed lesional cells that are positive for synaptophysin and chromogranin while negative for AE1/3 and sustentacular cells that are highlighted by S100, thus supporting a diagnosis of paragangliomas.Postoperatively, the patient was weaned off all blood pressure medications. Repeat testing showed plasma metanephrines: 26 pg/ml and plasma normetanephrines: 164 pg/ml. The patient is scheduled to establish care with Endocrine Genetics Clinic.A timely diagnosis of pheochromocytoma during pregnancy can dramatically affect maternal and fetal mortality rates (1). This case illustrates the importance of a high clinical suspicion for pheochromocytoma as a cause of elevated blood pressure during pregnancy, particularly in patients who lack other characteristics typical of pregnancy related hypertension disorders (proteinuria, edema, etc.) or present with an elevated blood pressure early in pregnancy.

Animal Models of Hypertension: A Scientific Statement From the American Heart Association.

Hypertension is the most common chronic disease in the world, yet the precise cause of elevated blood pressure often cannot be determined. Animal models have been useful for unraveling the pathogenesis of hypertension and for testing novel therapeutic strategies. The utility of animal models for improving the understanding of the pathogenesis, prevention, and treatment of hypertension and its comorbidities depends on their validity for representing human forms of hypertension, including responses to therapy, and on the quality of studies in those models (such as reproducibility and experimental design). Important unmet needs in this field include the development of models that mimic the discrete hypertensive syndromes that now populate the clinic, resolution of ongoing controversies in the pathogenesis of hypertension, and the development of new avenues for preventing and treating hypertension and its complications. Animal models may indeed be useful for addressing these unmet needs.

Ocular Fundus changes in pregnancy induced hypertension – A case series study

<strong>Back ground:</strong> Pregnancy Induced Hypertension is a challenging stigma in the field of obstetrics and one of major contributors to maternal and perinatal mortality. PIH is a hypertensive disorder in pregnancy that occurs after 20 weeks of pregnancy in the absence of other causes of elevated blood pressure.

Sodium intake and blood pressure in children and adolescents: a systematic review and meta-analysis of experimental and observational studies

High sodium intake is a cause of elevated blood pressure in adults. In children and adolescents, less evidence is available and findings are equivocal. We systematically reviewed the evidence from experimental and observational studies on the association between sodium intake and blood pressure in children and adolescents. A systematic search of the Medline, Embase, CINAHL and CENTRAL databases up to March 2017 was conducted and supplemented by a manual search of bibliographies and unpublished studies. Experimental and observational studies involving children or adolescents between 0 and 18 years of age were included. Random-effects meta-analyses were performed by pooling data across all studies, separately for experimental and observational studies, and restricting to studies with sodium intake and blood pressure measurement methods of high quality. Subgroup meta-analyses, sensitivity analyses and meta-regressions were conducted to investigate sources of heterogeneity and confounding. The dose-response relationship was also investigated. Of the 6572 publications identified, 85 studies (14 experimental; 71 observational, including 60 cross-sectional, 6 cohort and 5 case-control studies) with 58531 participants were included. In experimental studies, sodium reduction interventions decreased systolic blood pressure by 0.6 mm Hg [95% confidence interval (CI): 0.5, 0.8] and diastolic blood pressure by 1.2 mm Hg (95% CI: 0.4, 1.9). The meta-analysis of 18 experimental and observational studies (including 3406 participants) with sodium intake and blood pressure measurement methods of high quality showed that, for every additional gram of sodium intake per day, systolic blood pressure increased by 0.8 mm Hg (95% CI: 0.4, 1.3) and diastolic blood pressure by 0.7 mm Hg (95% CI: 0.0, 1.4). The association was stronger among children with overweight and with low potassium intake. A quasi-linear relationship was found between sodium intake and blood pressure. Sodium intake is positively associated with blood pressure in children and adolescents, with consistent findings in experimental and observational studies. Since blood pressure tracks across the life course, our findings support the reduction of sodium intake during childhood and adolescence to lower blood pressure and prevent the development of hypertension.

Arterial hypertension: Modern problems

Arterial hypertension (AH) is one of the most common diseases. Despite numerous studies, many problems related to this pathology remain to be elucidated. The modern classifications of AHare contradictory and true causes of elevated blood pressure (BP) are unknown. There are no methods for diagnostics of early stages of AH nor is there adequateunderstanding of what hypertensive crises are, how they are to be classified and why they develop. Pathomorphosis of AH is practically unexplored. There are no efficient medications and therapies for the radical treatment of AH. The authors propose classification of hypertensive crisis, hypertensive disease, and symptomatic AH. It is recommended to use 24-hour blood pressure monitoring in all AH patients. New approaches to diagnostics of early stages of AH are proposed.

Associations of air pollution exposure with blood pressure and heart rate variability are modified by oxidative stress genes: A repeated-measures panel among elderly urban residents.

BackgroundOxidative stress has been suggested as a major cause of elevated blood pressure (BP) and reduced heart rate variability (HRV) due to air pollution. We hypothesized that the associations of air pollution exposure with BP and HRV are modified by oxidative stress gene polymorphisms.MethodsBetween 2008 and 2010, we conducted up to 5 surveys of 547 elderly participants, measured their BP and HRV, and genotyped 47 single nucleotide polymorphisms (SNPs) in 18 oxidative stress genes. Linear mixed models were constructed to evaluate the associations of particulate matter ≤10 μm, nitrogen dioxide, and sulfur dioxide with BP and HRV, as well as the modifications of these associations by the genotyped SNPs.ResultsSingle-SNP analyses revealed interactions between air pollution and 15 SNPs (for BP) and 33 SNPs (for HRV) (all, P for interaction < 0.05). When we generated genetic risk scores for BP and HRV, using the SNPs with interactions in the single-SNP models, we found that associations of air pollution exposure with BP and HRV were modified by the genetic risk scores (P for interaction < 0.05).ConclusionsThese results strongly suggest that the associations of air pollution with BP and HRV are mediated by oxidative stress pathways.Electronic supplementary materialThe online version of this article (doi:10.1186/s12940-016-0130-3) contains supplementary material, which is available to authorized users.

Physiology in perspective: adaptive responses: changing to survive.

“Change in all things is sweet” (Aristotle in Nicomachean Ethics , c. 350 BCE). Aristotle recognized that change in our world occurs naturally and can be both good and bad. Today, we recognize that adaptation is an essential physiological process by which our physiology changes in response to

From Policy to Action: Next Steps in Achieving Population‐Wide Reduction in Sodium Intake

The burden of blood pressure (BP)–related disease is substantial and unacceptable. Elevated BP is the leading preventable cause of death worldwide, in low- and middle-income countries as well as high-income countries.1 Medication treatment of elevated BP is currently the mainstay of efforts to prevent BP-related cardiovascular disease (CVD), but sole reliance on medication treatment for patients with elevated BP is an incomplete solution. Treatment has no impact on individuals with prehypertension who remain at elevated risk for CVD2 but who are not yet candidates for medication therapy. More importantly, treatment for middle- and older-aged individuals has no impact on the age-related rise in BP, a phenomenon that begins early in life and that underlies the problem of elevated BP. Indeed, the clinical problem of elevated BP reflects a lifelong health process with clinical manifestations at older ages. Addressing the underlying causes of elevated BP remains the best hope for interrupting this lifelong process. To this end, excess sodium intake has an important, if not predominant, role in the pathogenesis of elevated BP.3 As reported in this issue of the Journal, the World Hypertension League and International Society of Hypertension have developed a joint policy statement that calls on governments, nongovernment organizations, and the food industry to reduce sodium intake.4 This statement and other calls to action from leading professional organizations5-8 are important intermediate steps between the accumulated evidence on the harmful effects of excess sodium intake and the eventual attainment of population-wide reductions in sodium intake. The statement from the World Hypertension League and International Society of Hypertension has identified several action items. A more comprehensive roadmap, at least for the United States, is the Institute of Medicine's Strategies to Reduce Sodium in the United States.9 Accomplishing sodium reduction is largely a matter of changing the environment such that sodium reduction is a passive process for most individuals.10 The alternative, an active process in which billions of persons receive education and behavioral counseling to reduce their sodium intake, is an unrealistic approach to the public health pandemic of elevated BP. While the medical and public health communities advocate for regulatory and other environmental strategies to reduce sodium intake, the concurrent support of clinicians is vital. To assist their patients in reducing BP and thus their risk for CVD, clinicians need to support both public health approaches and the individual efforts of their patients. Now is a time for action, not hesitation. Dr Appel has received grant support from the McCormick Science Foundation, and has received royalties from the sales of a book on the Dietary Approaches to Stop Hypertension diet.

Relation of ocular fundus changes with blood pressure and proteinuria in pregnancy induced hypertension

Context: Pregnancy induced hypertension (PIH) is defined as hypertensive disorder of pregnancy, which occurs in the absence of other causes of elevated blood pressure (BP) and is associated with pedal edema, proteinuria or both. Aims: To evaluate the ocular fundus changes and its relation with the severity of proteinuria and BP in PIH patients. Settings and Design: Hospital based prospective observational study. Subjects and Methods: Study conducted over a period of 2 years. A total 100 patients of pregnancy having preeclampsia and eclampsia were included. Statistical Analysis Used: Chi-square test. Results: Of 100 cases 32 (32%) had mild preeclampsia while 50 (50%) had severe preeclampsia. Eighteen (18%) patients had eclampsia. All cases had proteinuria of varying degree ranging from 1+ to 4+. Forty-four cases (44%) had retinal changes. Cases with severe proteinuria and higher BP had more severe grades of retinopathy. Conclusions: Examination of fundus by ophthalmoscope is simple, noninvasive, safe, and reliable procedure, which can be done in out-patient department or at bedside. It should be done routinely in all patients of PIH. It is the BP, systolic and diastolic to which the severity of the retinal changes was found to be directly proportional. Higher grades of proteinuria were associated with higher grades of retinal changes.

Control of metabolic and cardiovascular function by the leptin–brain melanocortin pathway

Obesity is recognized as a major worldwide health problem. Excess weight gain is the most common cause of elevated blood pressure (BP) and markedly increases the risk of metabolic, cardiovascular and renal diseases. Although the mechanisms linking obesity with hypertension have not been fully elucidated, increased sympathetic nervous system (SNS) activity contributes to elevated BP in obese subjects. Recent evidence indicates that leptin and the central nervous system (CNS) melanocortin system, including melanocortin 4 receptors (MC4R), play a key role in linking obesity with increased SNS activity and hypertension. Leptin, a peptide-hormone produced by adipose tissue, crosses the blood-brain barrier and activates brain centers that control multiple metabolic functions as well as SNS activity and BP via the CNS melanocortin system. The crosstalk between peripheral signals (e.g., leptin) and activation of CNS pathways (e.g., MC4R) that regulate energy balance, SNS activity and BP represents an important target for treating obesity and its metabolic and cardiovascular consequences.

Control of electrolyte balance through ubiquitination

The specific causes of elevated blood pressure cannot be determined in the vast majority of patients with hypertension. However, identification of genes causing rare Mendelian forms of hypertension has provided penetrating insights into the basic mechanisms of human hypertension, highlighting the key role of altered sodium handling by the kidney as a final common pathway in hypertension pathogenesis (1). Pseudohypoaldosteronism type II (PHAII) is one of these Mendelian syndromes, characterized by the unusual combination of hypertension and high levels of potassium in the blood (hyperkalemia). The Lifton laboratory had previously found mutations in four distinct genes that can cause PHAII (2, 3). In PNAS, Shibata et al. show that impaired ubiquitination of With no lysine kinases (WNKs), key molecular switches for regulating electrolyte flux in the distal nephron, explain clinical features of PHAII (4).

AT1A Angiotensin Receptors in the Renal Proximal Tubule Regulate Blood Pressure

Hypertension affects more than 1.5 billion people worldwide but the precise cause of elevated blood pressure (BP) cannot be determined in most affected individuals. Nonetheless, blockade of the renin-angiotensin system (RAS) lowers BP in the majority of patients with hypertension. Despite its apparent role in hypertension pathogenesis, the key cellular targets of the RAS that control BP have not been clearly identified. Here we demonstrate that RAS actions in the epithelium of the proximal tubule have a critical and nonredundant role in determining the level of BP. Abrogation of AT(1) angiotensin receptor signaling in the proximal tubule alone is sufficient to lower BP, despite intact vascular responses. Elimination of this pathway reduces proximal fluid reabsorption and alters expression of key sodium transporters, modifying pressure-natriuresis and providing substantial protection against hypertension. Thus, effectively targeting epithelial functions of the proximal tubule of the kidney should be a useful therapeutic strategy in hypertension.

Barriers to Screening and Intervention for ED Patients at Risk For Undiagnosed or Uncontrolled Hypertension

We describe clinician-reported knowledge of the Joint National Committee (JNC7) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure definitions of Stage I hypertension; perceived causes of elevated blood pressure; barriers to blood pressure re-assessment; risk of adverse events associated with the elevated blood pressure. Health care providers from five emergency departments completed a questionnaire assessing knowledge of blood pressure criteria for hypertension, perceived causes of elevated blood pressures, barriers to re-assessment, and perceived risk of an adverse event at one year in a patient within three defined systolic and diastolic blood pressure ranges. Descriptive statistics were used to analyze the data. Seventy-two percent (379/524) of providers (68 attending physicians, 87 residents, 209 nurses, and 15 nurse practitioners) completed questionnaires. One hundred and four providers (27%) correctly listed the systolic and diastolic criteria for Stage 1 hypertension. Nurses and physicians rated uncontrolled, known hypertension [mean (standard deviation)] [8.7 (2.1), 8.9 (1.9)] the highest and pain [8.3 (2.3), 8.3 (2.1)] as the second highest cause of elevated BP. Nurses and physicians rated the lack of time to perform a reassessment [5.2 (3.4), 4.7 (2.8)] and a lack of adequate staffing [4.7 (3.4), 4.6 (2.9)] the highest as barriers to re-assessment. Nurses' mean adverse risk assessment twice that of physicians. Twenty seven percent of providers were aware of the JNC7 criteria and often attributed elevated blood pressures to chronic, uncontrolled hypertension, pain or anxiety. No single barrier to repeating elevated blood pressures was identified.

Is Obstructive Sleep Apnea a Risk Factor for Hypertension?—Differences between the Wisconsin Sleep Cohort and the Sleep Heart Health Study

Is Obstructive Sleep Apnea a Risk Factor for Hypertension?—Differences between the Wisconsin Sleep Cohort and the Sleep Heart Health Study