Cause Of High Blood Pressure Research Articles

Clinical Implications

HomeHypertensionVol. 62, No. 1Clinical Implications Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBClinical Implications Originally published1 Jul 2013https://doi.org/10.1161/HYP.0b013e31829d4408Hypertension. 2013;62:2Angiotensinogen Expression in Human Adipose Tissue (page 41)Blood pressure is a heritable trait; the genetic causes of essential hypertension remain unclear. Despite being the first gene linked to hypertension, the importance of polymorphisms in angiotensinogen, the precursor to angiotensin-II, remains controversial. The renin–angiotensin system has both endocrine and intracrine functions controlling arterial pressure. The mechanisms regulating angiotensinogen expression is complicated. Because sequence variants in the promoter may differentially affect transcription factor binding, the mechanisms regulating angiotensinogen may differ depending on the polymorphism(s) carried. The current issue of Hypertension reports an effective strategy to examine whether variation in the angiotensinogen promoter effects its expression through differential binding of transcription factors in adipose tissue. The investigators report increased expression of angiotensinogen mRNA and binding of the transcription factor USF2 in chromatin specifically from the −20C allele in subcutaneous adipose tissue from subjects heterozygous for the −20A/C alleles of angiotensinogen. Thus, subjects carrying high-expressing alleles may have increased levels of angiotensinogen and angiotensin-II in some fat depots. This may be clinically important because circulating angiotensinogen derived from adipose tissue is increased in obesity and evidence implicates a role for angiotensin-II derived from adipose angiotensinogen in the regulation of metabolism and blood pressure. Consequently, further studies will need to assess whether this and other polymorphisms control the level of angiotensin-II in hypertensive and obese subjects.Download figureDownload PowerPointCD8+ T Cells and Chemokines in Human Hypertension (page 126)The pathogenic role of T cells in the development of hypertension has been well documented in animal studies. However, the existence of T-cell–driven inflammation in human hypertension has not been demonstrated. In this issue of Hypertension, Youn et al reported an increased fraction of immunosenescent, proinflammatory, cytotoxic CD8+ T cell, and increased circulating levels of T cell chemokines (MIG, IP-10, and I-TAC) in patients with hypertension. In patients with hypertensive nephrosclerosis, I-TAC was expressed more abundantly in the proximal and distal tubules. This evidence, along with an increased level of serum granzyme B, supports the increased activity of cytotoxic T cells in human hypertension. The authors provide evidence for the first time in favor of the existence of T-cell–driven inflammation in human hypertension.Download figureDownload PowerPointCardiac Effects of Hyperaldosteronism (page 62)Affecting >11% of the patients referred to specialized hypertension centers, primary aldosteronism (PA) is the most common endocrine cause of high blood pressure. Furthermore, it induces cardiovascular damage in excess of that expected based on the degree of blood pressure elevation. PA is potentially curable with a targeted treatment, but whether normalization of the blood pressure and regression of associated cardiovascular damage could be achieved in the long term remained uncertain. Rossi et al prospectively assigned 180 PA patients to either adrenalectomy (n=110) or medical therapy (n=70), based on whether there was lateralization of aldosterone excess at adrenal vein sampling. Long-term follow-up study with serial echocardiography evaluations showed for the first time in a prospective study that atrial fibrillation was ≈6-fold higher in PA than in essential hypertensive patients. After treatment blood pressure fell comparably in adrenalectomized and medically treated PA, as it did in optimally treated essential hypertensives. Left ventricular (LV) mass index and the rate of LV hypertrophy also fell mainly through LV inward remodeling in PA patients. Notwithstanding this, the rate of LV mass that was disproportionally elevated for cardiac workload and sex in PA subjects unexpectedly increased. While highlighting the cardiovascular consequences of PA patients, these findings underscore the importance of a timely identification of PA to enable reversal of the LV abnormalities and lowering cardiovascular risk.Download figureDownload PowerPoint Previous Back to top Next FiguresReferencesRelatedDetails July 2013Vol 62, Issue 1 Advertisement Article InformationMetrics © 2013 American Heart Association, Inc.https://doi.org/10.1161/HYP.0b013e31829d4408 Originally publishedJuly 1, 2013 PDF download Advertisement

Long-Term Control of Arterial Hypertension and Regression of Left Ventricular Hypertrophy With Treatment of Primary Aldosteronism

Primary aldosteronism (PA), a common cause of high blood pressure (BP), induces left ventricular (LV) hypertrophy and an excess rate of cardiovascular events. Whether its treatment provides long-term cure of hypertension and regression of cardiovascular damage remains uncertain. To the aim of assessing the effect of treatment of PA on BP and LV changes, we prospectively recruited 323 patients in a long-term follow-up study entailing serial echocardiography evaluations. Of them, 180 had PA and were assigned to either adrenalectomy (n=110) or medical therapy (n=70) on the basis of the adrenal vein sampling. The remaining 143 were consecutive optimally treated primary hypertensive patients. At baseline, the PA patients had more inappropriate LV mass than PH patients (27.1% versus 16.2%; P=0.020), despite similar BP values. At a median follow-up of 36 months (range, 6-225), BP was lowered (P<0.0001 versus baseline) to similar values in adrenalectomized (135±15/83±9 mm Hg), medically treated PA (133±11/83±7 mm Hg), and PH (139±15/86±9 mm Hg) patients. To this end, the adrenalectomized patients required significantly less drugs than the other groups. In PA patients, the LV mass index and the rate of LV hypertrophy fell through LV inward remodeling to the level of optimally treated PH patients, indicating that the LV work markedly decreased. Findings were similar when long-term (≥5 and ≥10 years) data were examined. Thus, an early diagnosis and a specific treatment of PA warrant normalization of BP and reversal of detrimental LV changes at long term.

An uncommon cause of high blood pressure in young people: retroperitoneal paraganglioma with vascular invasion.

An uncommon cause of high blood pressure in young people: retroperitoneal paraganglioma with vascular invasion.

A survey on the causes of headache among pregnant women attending the emergency department (Imam Khomeini Hospital, Sari).

Background and Objective: Delivering and growing up a healthy child is one the most common wishes of all women worldwide. Therefore, all women regularly evaluate the progress and conditions of their health during pregnancy to avoid any potential risk factors. Pregnancy itself imposes different physiological and behavioral changes in the pregnant woman and different factors influence the pregnancy conditions and outcomes. The present study aims to evaluate the reasons and causes of headache among pregnant women attending the emergency department (Imam Khomeini Hospital, Sari). Materials and Methods: This was a descriptive cross-sectional study conducted 30 pregnant women attending the emergency department because of headache during October to December 2011. Sampling method was counting all patients.The patients were assessed at the end of their treatment process using a customized questionnaire. All patients attended the department for treatment during the study period voluntarily answered the items of the questionnaire. Results: A total of 30 pregnant women complaining about persistent headaches attended the emergency department. They were assessed for the pregnancy poisoning. 19 patients experienced headache during the third trimester of pregnancy. Assay poison of pregnancy women &19 women stricken headaches in three month last of pregnancy. Conclusion: If the headaches of pregnant women in their third trimester of pregnancy are accompanied by hypertension and proteinuria, they should visit a specialist to assess the presence of pre-eclampsia. When the pre-eclampsia test is positive, the patient should be seriously treated. Proteinuria test was performed on all patients and all of them have hypertension. In a rare condition the hypertension and proteinuria occur in first days of post-delivery. The cause of high blood pressure may be the pregnancy itself which is transient, or the patients had hypertension prior to the pregnancy and not aware of their problem. In the latter case, the problem can persist after pregnancy. Long-time hypertension increases the risk of pre-eclampsia so that 25% women, who have hypertension, experienced pre-eclampsia, while only 5% pregnant women usually experience pre-eclampsia. Therefore, if the blood pressure is high in a pregnant woman without any previous history, it cannot be predicted that the hypertension either remains unchanged, increases or leads to pre-eclampsia. If the patient catches pre-eclampsia, the proteinuria test shows excess level of urine protein that leads to swelling in the arms and legs. This symptom indicates the failure of kidney function as a result of hypertension. In some cases both the mother and fetus are under serious risks. Pre-eclampsia and hypertension are among serious health threats for pregnant women and also the most common cause of mortality in pregnant women. Therefore, presence of headache in the third trimester of pregnancy should be treated seriously.

Surgical Management of Primary Aldosteronism. Not Everything that Shines is Gold

Background: Primary aldosteronism (PA) is a syndrome which includes a group of clinical entities in which aldosterone production is inappropriately high and nonsupressible by sodium loading. The most frequent causes of PA are adrenal adenoma and unilateral or bilateral primary hyperplasia. Methods: We report a case of a 55-year-old man with a 10-year history of hypertension in whom functional hormonal studies were indicative of PA. Because adrenal venus sampling was not available at our hospital, the investigation was conducted with a computed tomography (CT) scan and a scan with 131-iodocholesterol (NP-59) which both revealed a left adrenal adenoma. Results: The tumor was excised laparoscopically without any complications and the histological findings confirmed the diagnosis of an aldosterone-producing adenoma. Blood pressure remained normal despite the discontinuation of antihypertensive drugs, further supporting that the adrenal tumor was indeed the cause of high blood pressure. Unfortunately, blood pressure began to rise again 2 months later, and laboratory findings indicated the presence of PA once again. Spironolactone was instituted and blood pressure significantly improved and was finally controlled by the addition of amlodipine. Conclusion: We report this case to underline the difficulties in the discrimination between adenoma and hyperplasia in everyday clinical practice. Although the CT and scintigraphic findings strongly pointed toward an adenoma, the fact that PA re-appeared shortly after the operation, indicated that the underlying cause of the PA was hyperplasia and not adenoma after all.

From humans to giraffes: The evolution of hypertension and hormones

From humans to giraffes: The evolution of hypertension and hormones

The development of a national salt reduction strategy for Australia.

Excess dietary salt is a well established cause of high blood pressure and vascular disease. National and international bodies recommend a significant reduction in population salt intakes on the basis of strong evidence for health gains that population salt reduction strategies could achieve. The Australian Division of World Action on Salt and Health (AWASH) coordinates the Drop the Salt! campaign in Australia. This aims to reduce the average amount of salt consumed by Australians to six grams per day over five years through three main implementation strategies targeting the food industry, the media and government. This strategy has the potential to achieve a rapid and significant reduction in dietary salt consumption in Australia. With industry and government engagement, this promises to be a highly effective, low cost option for preventing chronic disease.

Activation of the Bradykinin System by Angiotensin-Converting Enzyme Inhibitors

The Bradykinin (BK) system has a very significant role in the regulation of blood pressure (BP). Hence, reduced activity of BK receptors mediated via decreased circulating endogenous kinin might explain the cause of high BP. This system also governs the activation of the angiotensin system at various axes in control of the physiological BP. The BK receptor antagonists can block the hypotensive action of angiotensin-converting enzyme inhibitors (ACEIs) in hypertensive and normotensive animals. The hypotensive action of BK is highly increased with ACEIs or kininase II inhibitor treatment. The development of specific BK agonists may provide a new direction to explore the experimental approach for examining the role of BK in hypertension.

TAKOTSUBO CARDIOMYOPATHY WITH HYPERVASOPRESSINEMIA

To the Editor: An 88-year-old woman presented with shortness of breath and appetite loss. Chest X-ray revealed significant right pleural effusion, and blood examination showed hyponatremia (119 mmol/L). She had no contributory medical history, and electrocardiography (ECG) was normal at admission. Findings on routine laboratory tests were not remarkable except for hyponatremia. The cytological examination of pleural effusion and chest computed tomography demonstrated that pleural metastasis of lung adenocarcinoma caused the effusion. Further blood examinations showed a high serum arginine vasopressin (AVP) concentration (25.0 pg/mL; normal range 0.3–3.5 pg/mL), low serum osmolality (246 mOsm/L), and high urine osmolality (625 mOsm/L). Her thyroid function and adrenal function were normal. Because of these results, she was diagnosed with syndrome of inappropriate secretion of antidiuretic hormone1 caused by high intrathoracic pressure due to marked pleural effusion. On her 14th hospital day, she suddenly complained of chest pain and chest oppression. ECG showed ST-segment elevation in the V3, V4, and V5 leads. She was diagnosed with acute ST-elevation myocardial infarction (STEMI) and transferred to the cardiovascular center. However, before coronary angiography (CAG) could be performed, chest pain and oppression disappeared, and we no longer found ST-segment elevation on ECG. There was no coronary artery atherosclerosis or spasm identified by CAG, and left ventriculography did not detect any abnormality. Blood examination after CAG showed no enzymatic evidence of myocardial necrosis. A diagnosis of Takotsubo cardiomyopathy2 was considered at this point. Follow-up ECG showed T-wave inversion in the V3, V4, and V5 leads on the 19th hospital day. On the 21st hospital day, the pleural effusion was drained and the intrathoracic pressure lowered. Blood examinations on the 30th hospital day showed a decrease in serum AVP concentration (1.5 pg/mL), increased serum osmolality (268 mOsm/L), decreased urine osmolality (339 mOsm/L), and normalization of serum sodium concentration (137 mmol/L). Many previous articles have reported that recurrence of Takotsubo cardiomyopathy is rare,2, 3 and this patient has not complained of chest pain and chest oppression since the initial episode. Takotsubo cardiomyopathy has cardiac symptoms that are difficult to distinguish from acute STEMI and is observed especially in women aged 60 and older.2 The patients diagnosed with Takotsubo cardiomyopathy complain of chest pain and chest oppression. ECG shows ST-segment elevation, and left ventriculography shows wall motion abnormalities, but CAG shows no evidence of obstructive atherosclerosis of the coronary arteries. Takotsubo cardiomyopathy is associated with several clinical events, such as subarachnoid hemorrhage,4 pheochromocytoma,5 Guillain-Barré syndrome,6 and mental stress.7 Although the pathophysiology and the reason for the strong elderly female predominance remain unknown, and accepted criteria for diagnosis have not been established, some hypotheses are suggested: catecholamine-mediated myocardial stunning, catecholamine-induced microcardiac artery spasm, and epicardial coronary artery spasm.2 AVP is a hormone produced in the cells located predominantly in the supraoptic and paraventricular hypothalamic nuclei, the axons of which terminate in the posterior lobe of the pituitary gland, and is well known as a antidiuretic hormone.8 There are three subtypes of receptors for AVP: V1a, V1b, and V2. AVP also functions as a vasoconstrictor and myocardial contractor through V1a receptors, which are located on vascular smooth muscle cells and cardiomyocytes.9 Because AVP causes peripheral vasoconstriction in the skin, skeletal muscles, gastrointestinal organs, fat tissue, renal arterioles, and coronary arteries, it is used as a vasoconstrictor to support blood pressure in refractory septic shock.10 This case showed hypervasopressinemia (20 times as high as normal level) before she was diagnosed with Takotsubo cardiomyopathy. Her blood pressure was always normal (108/66 mmHg), but it went up to 142/82 mmHg when she complained of chest pain. AVP may have been one of the causes of high blood pressure, working as a strong vasoconstrictor. Because of these results, this case can suggest a new hypothesis in the pathophysiology of Takotsubo cardiomyopathy; AVP may have induced microcardiovascular spasm, causing left ventricular wall motion abnormalities “Takotsubo cardiomyopathy.” Although Takotsubo cardiomyopathy is becoming recognized as a common heart disease, especially in elderly women, acceptable criteria for diagnosis are not established, and the pathophysiology remains unknown. More cases and studies are needed to ascertain the pathophysiology and management of this syndrome. We first demonstrated a relation between Takotsubo cardiomyopathy and hypervasopressinemia. Hypervasopressinemia may be an important trigger of reversible left ventricular dysfunction “Takotsubo cardiomyopathy.” Financial Disclosure: Norinaga Urahama's research has no financial and material support. None of the authors have any potential conflicts of interest associated with this study, and no authors have anything to disclose. Author Contribution: Norinaga Urahama participated in the study concept and design and contributed significantly to the treatment of the patient, acquisition of data, and preparation of manuscript. Hideki Nakashima, Hirokazu Kurose, and Tadatsugu Ohno treated the patient and prepared the manuscript. Sponsor's Role: No sponsor.

The Knowledge, Attitude and Practice of Blood Pressure Management from the Patient's Viewpoint: A Qualitative Study

This study adopted a qualitative method to explore the layman's beliefs and experience concerning high blood pressure and its management in order to develop a strategy to increase adherence to proper medical treatment. Semi-structured interviews that focused on personal experiences with hypertension and its management were conducted with 26 hypertensive patients. The participants were selected according to a BP above 140/90 mmHg (hypertension stage 1), based on the seventh report of the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure (JNC-VII). The interviews lasted for approximately 30 minutes (range: 20-60 minutes). The resulting questions were formulated into open-ended questions. The interview questionnaire was composed 17 items to examine non-adherence to treatment and 19 items to examine adherence to treatment. Most participants recognized that the direct cause of high blood pressure was unhealthy behavior rather than inheritance. Thus, the hypertensive patient believed they could recover their blood pressure to a normal level through removing the direct cause of hypertension (weight reduction, diet, exercise) instead of taking drugs. The reasons for these statements were that the drugs for controlling hypertension are not natural or they are artificial, and they may have side effects, and drugs are not treatment for the root cause of hypertension. Most of the hypertensive patients chose to manage their behaviors as soon as they knew their blood pressure was high. Therefore, we should not divide the subjects into two groups according to their taking drugs or not, but they should be divided into two groups according to their willingness or not to manage their condition. For developing a strategy for an individual approach to hypertension management, we need to develop a client-centered attitude and strategy. That is, we need to tailor our approach to individual cases to avoid generalizations and stereotyping when developing an adherence increasing strategy.

TALKING ABOUT…

TALKING ABOUT…

Le sens de l'observance. Ethnographie des pratiques médicamenteuses de personnes hypertendues

L’etude de l’experience des traitements hypotenseurs met au jour les logiques plurielles, sociales et symboliques, permettant de comprendre ce qui construit culturellement les pratiques medicamenteuses des individus. Le suivi de l’ordonnance repond a des logiques d’imputation (mecanisme causal de l’hypertension arterielle, effets indesirables des medicaments), des logiques d’appropriation (fidelisation au traitement, experimentation, integration du traitement dans la vie quotidienne) et des logiques d’autoregulation (continuite du traitement, maitrise du corps et du traitement). L’observance est analysee dans la relation medecin-patient comme un comportement de soumission a l’autorite medicale, mais aussi comme une maniere d’objectiver la relation de confiance et de renforcer l’identite professionnelle des generalistes.

The Heartfile Lodhran CVD Prevention Project- end of Project Evaluation

Mainstream preventive interventions often fail to reach poor populations with a high risk of cardiovascular diseases (CVDs) in Pakistan. A community-based CVD primary prevention project aimed at developing approaches to reduce risk factors in such populations was established by Heartfile in collaboration with the National Rural Support Program in the district of Lodhran. The project implemented a range of activities integrated with existing social and health service mechanisms during a three year intervention period 2000/01-03/04. These were targeted in 4 key settings: community health education, mass media interventions, training of health professionals and health education through Lady Health Workers. The project received support from the Department for International Development, U.K. At the community level, a pre-test-post-test quasi-experimental design was used for examining project outcomes related to the community component of the intervention. Pre and post-intervention (training) evaluations were conducted involving all health care providers in randomly selected workshops in order to determine baseline levels of knowledge and the impact of training on knowledge level. In order to assess practices of physician and non-physician health care providers patient interviews, with control comparisons were conducted at each health care facility. Significant positive changes were observed in knowledge levels at a community level in the district of intervention compared with baseline knowledge levels particularly in relation to a heart healthy diet, beneficial level of physical activity, the causes of high blood pressure and heart attack and the effects of high blood pressure and active and passive smoking on health. Significant changes in behaviors at a practice level were not shown in the district of intervention. However the project played a critical role in spurring national action for the prevention and control of non-communicable diseases and introducing sustainable public health interventions for poor communities in Pakistan.

Can't pay? Won't pay? Managing debt in practice

BAD debts are one of the principal causes of high blood pressure in the offices of many veterinary practices, while slow payers are a hindrance to good cash flow and...

Creation and characterization of mice with selective mutation of the cyclic GMP-dependent protein kinase I interaction domain

Vascular tone is dynamically regulated by vascular smooth muscle cell contractile state. Vascular contraction by many agonists is mediated by Gq-coupled receptor activation, calcium mobilization and myosin light chain (MLC) phosphorylation. Nitric oxide (NO) inhibits vascular contraction by activating cGMP-dependent protein kinase I α (PKGI-α), which causes MLC dephosphorylation and vascular smooth muscle relaxation. Cyclic GMPdependent protein kinase I (PKGI) is the principle effector of nitric oxide (NO) signaling in vascular smooth muscle cells (VSMC). Activation of PKGI? by NO signaling has several effects in VSMC, including activation of myosin phosphatase (PP1M), which dephosphorylates the myosin light chain, causing relaxation. We have shown that PKGIα binds directly to the MBS subunit of the PP1M phosphatase via leucine zipper (LZ) motifs in each protein, providing a molecular basis for the effects of NO and cGMP on vascular relaxation. In recent studies, we found that PKGI-α also attenuates signaling by the Gq-coupled thrombin receptor PAR-1 by directly activating the regulator of G-protein signaling, RGS2. The same PKGI-α LZ domain that interacts with PP1M also mediates binding of PKGIα to RGS2. PKGI phosphorylates RGS2 and thereby activates the GTPase activity of Gq, inhibiting PAR-1 signaling. In addition, Rgs2-/mouse blood vessels have enhanced contraction and decreased cGMP-mediated relaxation, and these mice have marked hypertension. The presence of vasomotor dysfunction and hypertension in the RGS-2 knockout mice raises the possibility that intrinsic abnormalities of VSMC relaxation alone are sufficient to cause hypertension. To explore this hypothesis and the role pf PKGIα in regulation of vascular tone and blood pressure, we have used gene targeting to generate mice that express a LZ mutant (LZM) form of PKGIα in which critical amino acids in the leucine zipper motif have been substituted to disrupt LZ binding. The generation and characterization of the LZM mice will be described and data from LZM mouse studies will be presented. The studies support an essential role for PKGIα in maintenance of normal vascular tone and blood pressure and are consistent with the hypothesis that intrinsic abnormalities of VSMC regulation can be a primary, non-renal cause of high blood pressure.

Hypertension curriculum review: epidemiology and the prevention of hypertension.

Hypertension curriculum review: epidemiology and the prevention of hypertension.

Interview With Jerry Stamler, MD

Interview With Jerry Stamler, MD

Risk factor criteria.

The concept of the risk factor for chronic diseases, such as cardiovascular disorders, is derived from the application of epidemiological methods initially developed for infectious and nutritional deficiency diseases to chronic conditions to identify the factor(s) linked to the development of the chronic disease. Typically in infectious or nutritional deficiency conditions, a single causative agent or primary cause is identified. Thus, the cause of tuberculosis is the tubercle bacillus, and the cause of pellagra is niacin deficiency. However, for cardiovascular diseases, in which causes are usually complex and multifactorial, new concepts were required. For example, individuals with hypertension have a far greater risk for cardiovascular disease than those without hypertension, but many individuals with hypertension never have clinical sequelae, and many individuals with diagnosed cardiovascular diseases have no hypertension. One can also argue that many individuals who are exposed to the tubercle bacillus do not develop clinical tuberculosis, but the converse is not true; no one has tuberculosis without the tubercle bacillus. This provides a clear distinction between multifactorial diseases, such as coronary disease where the risk factor concept is paramount, and other health conditions. The initial application of the risk factor concept was well developed long before the term was coined. Early in the previous century, insurance companies noted that individuals with high blood pressure were at higher risk for premature mortality1 and therefore would be accepted for life insurance only on payment of an additional premium. Insurance companies also recognized the related risk factor of obesity, and imposed higher premiums on overweight clients. In this context, risk factors are used as predictors of disease and mortality. Surprisingly, insurance companies failed to recognize the enormous contribution of smoking to cardiovascular risk until later. Although the underlying concept had been widely discussed and applied, the term “risk factor” was …

The factors affecting blood pressure in pediatric renal transplant recipients

To investigate the parameters affecting systemic blood pressure in pediatric renal transplant recipients, we retrospectively examined the data from 19 adolescent renal transplant recipients including 6 girls overall, mean age of 15,47 ± 3.56 years. Serum creatinine (Scr), fractional extraction of sodium (FENa), whole blood trough cyclosporine(C0), plasma total cholesterol (TC) and triglyceride levels, and systolic and diastolic blood pressure (SBP and DBP) were monitored during a total of 677 visits. SBP and DBP, classified as <95p (groups 1s and 1d) and >95p (groups 2s and 2d), were correlated with differences between groups 1 and 2.Group 2s Scr and FENa levels were higher than group 1s (P = .002 and P = .048, respectively), whereas C0 and FENa levels were higher in Group 2d than Group 1d (P = 0.028 and P = 0.036, respectively). Among the entire group, SBP and DBP positively correlated with C0; Scr and SBP, with FENa. While there was a positive correlation between SBP and C0 in groups 1s and 2s (r = 0.188, P < .000; and r = 0.145, P = .040), DBP was only associated with C0 in group 1d (P = .03, r = 0.156). In contrast, DBP showed a positive correlation with Scr in group 2d (P = .023, r = 0.132), and SBP with Scr in Group 1s. C0 and Scr levels were correlated in Groups 1s, 1d and 2d. At high BP levels (>95p), SBP is mostly affected by C0; DBP, with Scr. However, in both groups these two parameters positively correlate with each other. Thus, in adolescent renal transplant recipients the cause of high blood pressure does not appear to be solely related to cyclosporine related to induced allograft dysfunction.

Concentrações de sódio em bebidas carbonatadas nacionais

O consumo de bebidas carbonatadas no Brasil é elevado e não existem dados sobre os teores de sódio neste tipo de bebida comercializada no país. O presente trabalho examinou 97 amostras de refrigerantes compreendendo 14 marcas e 7 tipos de bebidas (cola, guaraná, limão, laranja, uva, soda e água tônica). Os teores de sódio encontrados variaram de 19 a 202mg Na/L. As bebidas adoçadas com açúcar apresentaram uma média de 74 ± 13mg Na/L e as bebidas com adoçantes artificiais, uma média de 151 ± 39mg Na/L. Portanto, os refrigerantes adoçados artificialmente fornecem cerca de duas vezes o teor de sódio das bebidas adoçadas com açúcar. Como conseqüência, um consumidor médio de refrigerantes (259mL/dia) poderá ingerir por dia cerca de 19mg de sódio provenientes do refrigerante, caso consuma bebidas adoçadas com açúcar enquanto que, o consumidor médio que preferir bebidas do tipo "light" estará ingerindo aproximadamente 39mg Na/dia. Já o grande consumidor de refrigerantes (2L/dia) ao preferir os adoçados artificialmente estará ingerindo cerca de 300mg Na/dia provenientes deste tipo de bebida. Tal fato deve ser levado em consideração por pessoas com recomendação de dieta hipossódica.