Chronic Essential Hypertension Research Articles

Optical coherence tomography angiography findings in patients with essential hypertension

AbstractPurpose: To study the variation of retinal and choroidal density in patients with essential hypertension using Swept Source Optical Coherence Tomography Angiography (SS‐OCT A).Methods: Prospective cross‐sectional study carried out at the Ophthalmology department of Habib Thameur University Hospital of Tunis between June, 1st 2021 and March, 30th 2022. Fifteen volunteer healthy patients (30 eyes) were included. All patients underwent complete ophthalmic examination, measurements of resting systolic and diastolic blood pressure and 3 × 3 and 4.5 × 4.5 SS‐OCT A angiograms in both eyes. Perimeter of avascular central zone (ACZ), superficial retinal plexus density (SRPD), deep retinal plexus density (DRPC) and choriocapillaris capillary vessel density (CVD) were calculated on exported jpg format images using the Fiji Software. Comparative Mann Whitney and Spearman tests were performed using 21.0 SPSS.Results: Eleven males and four females were eligible for the study. Mean age was 53.33 ± 9.73 years. Eight patients (53.3%) with chronic essential hypertension were compared to seven healthy volunteers (46.7%). Mean ACZ, SRPD, DRPD and CVD were respectively 2.62 ± 0.52 mm, 13.20 ± 2.10%, 17.14 ± 1.17% and 51.05 ± 0.85%. Mean systolic blood pressure was 13 ± 5 mmHg and mean diastolic blood pressure was 7.67 ± 5.16 mmHg. CVD was lower in patients with chronic hypertension than in the control group (50.59 vs 51.41, p = 0.047). There were no significant differences between hypertension group and normal group in ACZ, SRPD and DRPC measurements (p = 0.089, p = 0.90 and p = 0.70, respectively). No correlations were found between resting blood pressure values and ACZ measurements.Conclusions: Chronic hypertension does not affect retinal vessels and capillaries quantitative parameters. However, it may alter choroidal vascular structures by decreasing choriocapillaris vessel density. Larger studies are needed to strengthen these results.

Telemedicine Clinical Skills Needs Assessment in Early Medical Students.

As clinicians increasingly rely on telemedicine, medical students will need to learn how to appropriately use telemedicine in patient care. A formal approach to curriculum development is needed to identify gaps and needs in early medical student performance. In October 2020, 120 second-year medical students completed a telemedicine visit with a standardized patient with chronic essential hypertension. Students were assessed across five domains (history-gathering, communication, vitals, physical exam, and assessment/management). An anonymous, voluntary survey was distributed to assess self-efficacy in telemedicine skills. Students perform well in history-gathering and communication (98% of student scored 4 or 5 out of 5 on history, 100% of students received a 7 or 8 out of 8 on communication). Students perform poorly in obtaining vital signs (23% scored 3 or 4 out of 4) and assessment/management (14% scored 3 or 4 out of 4). Students received their lowest scores in physical examination (2% score 4 or 5 out of 5). The number of telemedicine visits completed with patients prior to the standardized patient exercise had no impact on student performance during the exercise. Student response rate on the postexercise survey was 88%. Self-efficacy was lowest in physical examination telemedicine skills compared to other domains. Findings suggest that early medical students are able to gather history and communicate over telemedicine, but perform poorly on telemedicine physical examination skills. More robust curriculum development addressing telemedicine physical examinations skills is needed early in medical training.

Якість життя та респіраторні порушення у пацієнтів із хронічним обструктивним захворюванням легень та гіпертонічною хворобою: погляд крізь призму апоптозу та тіол-дисульфідного балансу

The purpose of the study was an assessment of the quality of life and respiratory disappearances in patients with chronic obstructive pulmonary disease and essential hypertension in the context of the study of apoptosis markers and a thiol-disulfide balance. Materials and methods. The results of the study are based on the data of a comprehensive examination and dynamic observation of 121 patients of both sexes aged 30 to 67 years, who were examined in the period 2016-2018 and received inpatient treatment at the municipal non-profit enterprise "Zaporizhzhya Regional Clinical Hospital" of Zaporizhzhya regional council. The patients were divided into 3 groups, comparable in age and sex: the main group included 40 patients with chronic obstructive pulmonary disease stage II-III (moderate) in combination with essential hypertension stage II of different cardiovascular risk (mean age 50.81±0.99 years); the 1st comparison group included 48 patients with chronic obstructive pulmonary disease stage II-III (mean age 50.7±1.53 years); the second comparison group consisted of 33 patients with essential hypertension stage II with different cardiovascular risk (mean age 51.68±1.22 years). To determine the reference values of the studied indicators, 20 healthy individuals were examined as a control group. Results and discussion. In patients with chronic obstructive pulmonary disease, in combination with essential hypertension, a reliable element of the pro-apoptotic marker of Caspase-7 was established compared with the group of patients with an isolated essential hypertension and a group of patients with chronic obstructive pulmonary disease (by 3.73 and 2.16 times, respectively; p <0.05). The highest level of Caspase-9 was noted in the group of patients with the comorbidity of the chronic obstructive pulmonary disease and essential hypertension, and exceeded the same indicator in patients with essential hypertension by 60% and chronic obstructive pulmonary disease by 85.83% (p <0.05). The comorbidity of the flow of chronic obstructive pulmonary disease and essential hypertension is accompanied by a violation of thiol-disulfide balance and the antioxidant properties of the body. This is confirmed by the lower activity of antioxidant glutathion-dependent enzymes (glutathione transferase, glutathione reductase and glutathione peroxidase) compared with patients with monopathology (2.57±0.32, 0.87±0.13 and 4.25±0.63 μmol/(min*g protein), respectively; p <0.05), with a decrease in the ratio of reduced/oxidized glutathione forms (3.81±0.34 conventional units; p <0.05). At the same time, in patients with chronic obstructive pulmonary disease and essential hypertension, a decrease in the potential of a thiol-disulfide system was noted by 2 times when compared with essential hypertension patients and 1.7 times – when compared with the chronic obstructive pulmonary disease group (p <0.05). Conclusion. According to the results of single-factor dispersion analysis, the key characteristic of the quality of life (on the St. George’s Respiratory Questionnaire scale) the following factors are most significantly influenced: the index of patch-years (F = 21.80; p <0.01), the duration of the chronic obstructive pulmonary disease (f = 19.35; p <0.01), forced expiratory volume 1 (F = 21.80; p <0.01), elderly age (F = 9.49; p <0.01), as well as activation of apoptotic mechanisms (F = 11.90; p <0.01), the intensification of free-radical reactions (F = 8.60; p <0.01), a violation of a thiol-disulfide balance (F = 10.69; p <0.01), the expression level of the ST2 protein (F = 14.42; p <0.01)

Management of Hypertension and Blood Pressure Dysregulation in Patients with Parkinson's Disease-a Systematic Review.

The aim of this review article was to summarize the cardiovascular and blood pressure profile regarding Parkinson disease patients and to provide an update on the recent advancements in the field of the diagnosis and management of blood pressure abnormalities in these patients. Our goal was to guide physicians to avoid pitfalls in current practice while treating patients with Parkinson disease and blood pressure abnormalities. For this purpose, we searched bibliographic databases (PubMed, Google Scholar) for all publications published on blood pressure effects in Parkinson disease until May 2020. Furthermore, we highlight some thoughts and potential perspectives for the next possible steps in the field. Blood pressure dysregulation in patients with Parkinson's disease has several implications in clinical practice and presents an ongoing concern. Compared with chronic essential hypertension, the syndrome of combined neurogenic orthostatic hypotension and supine hypertension in Parkinson's disease has received little attention. If left untreated, hypertension may lead to cardiovascular disease whereas hypotension may lead to fall-related complications, with tremendous impact on the quality of life of affected individuals. The effect of blood Epressure control and the risk of death from cardiovascular disease in Parkinson disease are largely unexplored. Blood pressure abnormalities in Parkinson disease present bidirectional relationship and the rationale for treating and controlling hypertension in persons with Parkinson disease and concurrent neurogenic orthostatic hypotension and/or supine hypertension is compelling. Further research is warranted in order to clarify the mechanisms, clinical implications, and potential reversibility of compromised cardiovascular function, in persons with Parkinson disease.

Clinical efficiency of exogenous L-arginine in patients with essential hypertension against the background of chronic obstructive pulmonary disease

Хроническое обструктивное заболевание легких (ХОЗЛ) и гипертоническая болезнь (ГБ) – одна из распространенных, ведущих и актуальных проблем практического здравоохранения. Цель работ ы – оценка клинической эффективности средства метаболической коррекции (Тивортин) в комплексном лечении больных хроническим обструктивным заболеванием легких при наличии гипертонической болезни. Материалы и методы. Обследовали 23 больных (основная группа) с диагнозом ГБ II стадии с уровнем артериальной гипертензии I–III степени и ХОЗЛ II стадии без клинически значимой сопутствующей патологии, средний возраст – 51,72 ± 1,22, с различным кардиоваскулярным риском, без адекватной систематической антигипертензивной терапии; 82,6 % – активные курильщики, индекс пачко-лет – 17,23 ± 2,69, на профессиональный фактор (производственный) указали 23,53 % обследованных. Все больные основной группы принимали L-аргинин аспартат в виде 4,2 % раствора внутривенно по 100 мл 1 раз в сутки (курс 10–12 дней) с последующим переходом на раствор для перорального применения по 10 мл 5 раз в сутки (курс 3 мес. ± 3 суток). Также обследовали (изначально и через 3 мес.) группу сравнения (n = 15, возраст – 49,15 ± 1,40 года), сопоставимую по клинико-демографическим показателям с основной группой. Обследованные из группы сравнения получали аналогичную традиционную терапию ГБ и ХОЗЛ без применения метаболитотропного препарата – экзогенного L-аргинина Тивортин. Диагностику ХОЗЛ и ГБ проводили на основании общепринятых критериев. Параметры качества жизни оценивали согласно «Краткого опросника оценки статуса здоровья» SF-36. Метаболизм глутатиона и состояние тиол-дисульфидного баланса изучали по содержанию окисленного и восстановленного глутатиона и активности ферментов – глутатион-S-трансферазы, глутатионредуктазы и глутатион пероксидазы в сыворотке крови. Содержание ST2, CASPASE-7 и CASPASE-9 в крови определяли с использованием соответствующих тест-систем ИФА. Результаты. Назначение L-аргинина способствовало подавлению оксидативного стресса и восстановлению тиол-дисульфидного баланса и, как результат вышеуказанных процессов, тормозило апоптоз в организме пациентов с коморбидностью. Уровень экспрессии белка ST2 после лечения пациентов с ГБ и ХОЗЛ Тивортином уменьшился в два раза, а компенсаторная возможность организма больного, которая заключается во включении кардиозащитного сигнального каскада предотвращения фиброза и ремоделирования сердца наиболее оптимальным путем будет реализована именно после проведения экспериментального лечения. Кроме регресса клинических симптомов, нормализации артериального давления и улучшения бронхиальной проходимости на фоне снижения уровня активности апоптотических маркеров, наблюдается восстановление качества жизни, как физического, так и психосоциального статуса. Выводы. Дополнительное назначение L-аргинина на фоне традиционной терапии ХОЗЛ и ГБ способствует более значимому и достоверному угнетению оксидативного стресса и восстановлению тиол-дисульфидного баланса и, как результат вышеуказанных процессов, тормозит интенсификацию процессов апоптоза у пациентов с указанной коморбидностью. Кроме регресса клинических симптомов, нормализации артериального давления и улучшения бронхиальной проходимости на фоне снижения уровня активности апоптотических маркеров, наблюдается достоверное восстановление качества жизни, как физического, так и психосоциального статуса.

P243 Successful renal transplantation in elderly patient with multiple disorders across positive cross match

A 74 old Male patient admitted to the hospital for living related (son) renal transplant with a history of Diabetes mellitus due to underlying condition with diabetic chronic kidney disease, Essential hypertension, and End-stage kidney disease for 1.5 year with high blood pressure for more than 20 years. His laboratory workup results showed multiple viral infections, IgG antibodies in serum for HSV1/2, EBV (VCA) and VZ. Creatinine level was at 1075 μmol/L. Pre-transplant laboratory workup showed the following: HLA typing, performed by one lambda SSO for low/intermediate resolution, for the patient HLA-A∗03, 31, HLA-B∗18, 51, HLA-C12, 15, HLA-DRB1∗11:04, 13:01, HLA-DRB3∗01, 02, DQB1∗03:01, 06:03. Donor typing HLA-A∗02, 03, HLA-B∗14, 18, HLA-C∗08, 12, HLA-DRB1∗11:04, 15:03, HLA-DRB3∗02, DRB5∗01, DQB1∗03:01, 06:03. 6/14 antigens mismatch with his son, DR53 as circulating antibody reported by one lambda single antigen beads with cut off of 1000 MFI, no DSA and Negative virtual crossmatch (XM). His initial Flow XM showed positivity in T and B cell IgG +80 and +79 Median Chanel Shift respectively. XM repeated after three months prior to OR result showed positivity in XM of T and B cell IgG as well as positive auto XM for T and B cells IgG, 50+ and 81 + Median Chanel Shift respectively. The patient was induced with basiliximab prior to transplant and without any desensitization procedure. Post-transplant the kidney works immediately, his Creatinine level dropped fast to 92 μmol/L and no de novo antibodies were detected. Conclusion: Positive T and B cell IgG flow XM should not automatically consider as a conclusive immunological risk for renal transplant, especially in light of virtually negative XM and positive auto XM. That might be caused by non-HLA antibodies binding or previous viral infection, as we assumed in this case.

Evaluation of Myocardial Function in Cases of Gestational Hypertension Using Myocardial Performance Index

Background: Gestational hypertension represents a transient period of elevated blood pressure with special effects on the maternal left ventricle that is different from the effects observed in chronic essential hypertension; it affects a previously normal heart and lasts for a maximum of nine months associated with volume and pressure overload on the maternal heart. Tei index (also called myocardial performance index) was found to be a dependent combined index evaluating the systolic and diastolic function of the left ventricle and represents a sensitive indicator for many types of heart diseases.Objective: to evaluate the effects of gestational hypertension on the maternal myocardial function during the third trimester by measuring the Tie index using transthoracic echocardiography.Method: This study was performed in Baghdad teaching hospital in the time period from November 2015 to August 2016. The study included a total of 150 women; 100 women had gestational hypertension, in the third trimester of a singleton pregnancy and with a mean age (29.83 ± 5.33 year), gestational hypertension was identified as elevated systolic or diastolic blood pressure over 140/90 mmHg that emerges after the20th week of gestation with proteinuria level lower than 300 mg/dl. Another 50 normotensive pregnant women with singleton pregnancy and mean age (28 ± 3.18 year) were used as controls. Left ventricular mass index (LVMI) and relative wall thickness (RWT) were measured to find the type of hypertrophy in gestational hypertension. Ejection fraction (EF) was measured with 2D directed M mode echocardiography,and isovolumic relaxation time (IVRT), isovolumic contraction rime (ICT) and ejection time (ET) were measured for both groups using pulse wave Doppler echocardiography in order to calculate the myocardial performance index which is also called “Tei index” and equals the sum of IVRT and IVCT divided by theET (Tei index = IVRT+IVCT/ET).Results: Left ventricular mass index and relative wall thickness were significantly higher in gestational hypertensive women, 41% of gestational hypertensive women had normal geometry and 59% had abnormal geometry (34% eccentric hypertrophy, 19% concentric hypertrophy and 6% concentric remodeling). IVRT and IVCT were significantly higher in gestational hypertensive women with p value of 0.0001 and P =0.003. ET showed a non-significant lower values (p= 0.34) in gestational hypertensive women. Tei index was significantly higher in Gestational hypertension (P=0.011).Conclusion: Women with gestational hypertension had altered myocardial function characterized by the higher Tei index values associated with eccentric hypertrophy which can be explained by the fact that gestational hypertension poses higher afterload on the left ventricle instead the state of low peripheral resistance that is ysually expected during normotensive pregnancy.

Fisonomía clínica de la preeclampsia de repetición y su pronóstico

La preeclampsia de repetición, modalidad de toxemia gravídica que ofrece contornos propios, es una realidad clínica no discutible. Puede adoptar diferentes expresiones -dentro de la vasta gama de tonalidades de este cuadro tan particular del estado grávido- y su sintomatología retrograda, para desaparecer de manera definitiva, una vez producido el parto. Cuando el síndrome hipertensivo domina la escena, los fenómenos vasculares agudos pueden desencadenar crisis convulsivas y generar hemorragias en el territorio útero-placentario, accidentes éstos propios de los estados preeclámpticos. EI diagnóstico diferencial con enfermedades hipertensivas preexistentes suele ser difícil y será necesaria una exploración acuciosa que ratifique la indemnidad anatómica de la silueta cardíaca, la normalidad de las pruebas de funcionalismo renal, la ausencia de esclerosis en las arterias retinales, etc. De manera general puede aceptarse que mientras que los procesos antiguos hacen eclosión en la primera mitad del embarazo, agravándolo desde sus primeras etapas, la toxemia recurrente como aquella que aparece de primera intención, es tardía y se anuncia en el último trimestre, aun cuando por excepción puede estallar precozmente, interfiriendo en una época que no es de su específico dominio. Pese a la acción de impactos repetidos, suele evolucionar de manera reiterada como enfermedad genuinamente gravídica, sin dejar les iones anatómicas definitivas. Como toda toxemia, no obstante, puede ser el punto de origen de enfermedades vasculares definitivas, sea la glomérulonefritis crónica o la hipertensión esencial; para este grupo significó un 13.3 %. EI pronóstico, conforme a la experiencia ajena y a la del autor, es benigno, sin sujeción a la sintomatología a veces ruidosa y a los eventuales accidentes. En efecto, pese a los efectos propios de una enfermedad recurrente (2 y 3 veces) -37 gestaciones pertenecientes a 15 pacientes- la mortalidad del grupo fue de 0%, siendo que en la misma época la mortalidad genera: por preeclampsia alcanzó a 1.1 %. La mortalidad fetal perinatal, en cambio, fué apreciable (35.1 %), principalmente en las mujeres de mayor edad, en donde llegó a 78 .5%.

PP.20.18

Objective: In chronic essential hypertension, ascending aorta dilation is a frequent finding. However, the determinants of this relationship are incompletely understood. Design and method: We studied 780 consecutive newly diagnosed hypertensives (51 ± 13 years, 45% females). Based on the echocardiographic presence of ascending aorta dilation (>3.5 cm) patients were split in two groups: (Dilated AA, n = 230) and (Normal AA, n = 550). Results: Compared to NAA, DAA were older, with higher prevalence of male gender, obesity, metabolic syndrome, alcohol intake and TODs. Despite that there wasn’t any difference regarding BP levels, DAA consistently had significantly lower heart rate values in all ages. Multivariate logistic regression revealed that age (OR:1.05 95% CI: 1.04-1.07, p < 0.001), male gender (OR:2.3, 95% CI: 1.6-3.5, p < 0.001), BMI (OR: 1.07 95% CI: 1.03-1.11, p = 0.001), alcohol consumption (OR: 2.01, 95% CI: 1.04-3.9, p = 0.038) and heart rate (OR: 0.98 95% CI: 0.97-0.99, p = 0.03) are independent predictors of AAD. Moreover, we found a significant interaction between male gender and alcohol consumption (males with moderate alcohol consumption OR: 1,9, 95%CI: 1,2-3,3, p = 0.008, males with heavy alcohol consumption: OR:3,3 95%CI: 1,7-6,4, p < 0.001).Conclusions: Ascending aorta dilation is already present in one third of newly diagnosed essential hypertensive patients. Older age, male gender, high alcohol intake and BMI are independent predictors of this condition, with increased heart rate to possess beneficial effects, probable due to diminished stroke volume and cyclic aortic expansion.

Vasopressin in preeclampsia: a novel very early human pregnancy biomarker and clinically relevant mouse model.

Preeclampsia, a cardiovascular disorder of late pregnancy, is characterized as a low-renin hypertensive state relative to normotensive pregnancy. Because other nonpregnant low-renin hypertensive disorders often exhibit and are occasionally dependent on elevated arginine vasopressin (AVP) secretion, we hypothesized a possible use for plasma AVP measurements in the prediction of preeclampsia. Copeptin is an inert prosegment of AVP that is secreted in a 1:1 molar ratio and exhibits a substantially longer biological half-life compared with AVP, rendering it a clinically useful biomarker of AVP secretion. Copeptin was measured throughout pregnancy in maternal plasma from preeclamptic and control women. Maternal plasma copeptin was significantly higher throughout preeclamptic pregnancies versus control pregnancies. While controlling for clinically significant confounders (age, body mass index, chronic essential hypertension, twin gestation, diabetes mellitus, and history of preeclampsia) using multivariate regression, the association of higher copeptin concentration and the development of preeclampsia remained significant. Receiver operating characteristic analyses reveal that as early as the sixth week of gestation, elevated maternal plasma copeptin concentration is a highly significant predictor of preeclampsia throughout pregnancy. Finally, chronic infusion of AVP during pregnancy (24 ng per hour) is sufficient to phenocopy preeclampsia in C57BL/6J mice, causing pregnancy-specific hypertension, renal glomerular endotheliosis, proteinuria, and intrauterine growth restriction. These data implicate AVP release as a novel predictive biomarker for preeclampsia very early in pregnancy, identify chronic AVP infusion as a novel and clinically relevant model of preeclampsia in mice, and are consistent with a potential causative role for AVP in preeclampsia in humans.

The optimal choice of antihypertensive therapy in patients with comorbid diseases: chronic obstructive pulmonary disease and essential hypertension. Justification is based on personal experience

The aim of our study was to evaluate the effectiveness of various schemes of antihypertensive therapy in patients with chronic obstructive pulmonary disease and concomitant hypertension. Three different schemes of combined therapy with antihypertensive drugs have been assessed. It has been established that prolonged use of a combination of ACE inhibitors and beta –blockers caused a significant decrease in heart rate, in the number of episodes of painful and silent myocardial ischemia, ventricular extrasystoles of high grade. When combined, ACE inhibitor and diuretic decrease the value of the functional class of heart failure, the positive inotropic effect and the quality of life parameters improve significantly.A combination of ramipril and amlodipine had much better antyremodulating effect, and the pressure in the pulmonary arteries dropped. At the same time, all three therapies equally effectively reduced the level of office pressure.

Fundus autofluorescence in chronic essential hypertension.

Purpose:To evaluate fundus autofluorescence (FAF) changes in patients with chronic essential hypertension (HTN).Methods:In this case-control study, 35 eyes of 35 patients with chronic essential HTN (lasting >5 years) and 31 eyes of 31 volunteers without history of HTN were included. FAF pictures were taken from right eyes of all cases with the Heidelberg retina angiography and then were assessed by two masked retinal specialists.Results:In total, FAF images including 35 images of hypertensive patients and 31 pictures of volunteers, three apparently abnormal patterns were detected. A ring of hyper-autofluorescence in the central macula (doughnut-shaped) was observed in 9 (25.7%) eyes of the hypertensive group but only in 2 (6.5%) eyes of the control group. This difference was statistically significant (P = 0.036) between two groups. Hypo- and/or hyper-autofluorescence patches outside the fovea were the other sign found more in the hypertensive group (22.9%) than in the control group (6.5%); however, the difference was not statistically significant (P = 0.089). The third feature was hypo-autofluorescence around the disk noticed in 11 (31.4%) eyes of hypertensive patients compared to 8 (25.8%) eyes of the controls (P = 0.615).Conclusion:A ring of hyper-autofluorescence in the central macula forming a doughnut-shaped feature may be a FAF sign in patients with chronic essential HTN.

Microneurographic research in women

This article reviews microneurographic research on sympathetic neural control in women under both physiological and pathophysiological conditions across the lifespan. Specifically, the effects of sex, age, race, the menstrual cycle, oral contraceptives, estrogen replacement therapy, and normal pregnancy on neural control of blood pressure in healthy women are reviewed. In addition, sympathetic neural activity during neurally mediated (pre)syncope, the Postural Orthostatic Tachycardia Syndrome (POTS), obesity, the Polycystic Ovary Syndrome (PCOS), gestational hypertension, and preeclampsia, chronic essential hypertension, heart failure, and myocardial infarction in women are also reviewed briefly. It is suggested that microneurographic studies provide valuable information regarding autonomic circulatory control in women of different ages and in most cases, excessive sympathetic activation is associated with specific medical conditions regardless of age and sex. In some situations, sympathetic inhibition or withdrawal may be the underlying mechanism. Information gained from previous and recent microneurographic studies has significant clinical implications in women's health, and in some cases could be used to guide therapy if more widely available.

Recorded Pregnancy Histories of the Mothers of Singletons and the Mothers of Twins: A Longitudinal Comparison

A population-based record linkage case cohort of 239,995 births, to 119,214 women, born in Western Australia from 1980 to 2001 inclusive, was used to measure the recording of selected indicators of maternal health (current and prior) during pregnancy. We compared records of women with singleton pregnancies with that in twin pregnancies Mothers of first- and second-born singletons (n = 117,647) were compared with women with a first-born singleton followed by twins (n = 1,567). Binary indicators were used to calculate population prevalence of medical conditions, pregnancy complications and birth outcomes. Infant outcomes included stillbirth, low birthweight, preterm birth and birth defects. Women with twins were significantly older and taller, with similar rates of medical conditions and pregnancy complications during first singleton pregnancies compared with women with two consecutive singletons. However, during their second pregnancy, women with twins had significantly higher rates of essential hypertension, pre-eclampsia, threatened abortion, premature rupture of the membranes and ante partum hemorrhage with abruption than women with singletons. For both groups, maternal conditions in the first pregnancy were underreported in the second pregnancy, including diabetes, epilepsy, asthma, chronic renal dysfunction and essential hypertension. At the second birth, twins were 3 times more likely to be stillborn, 17 times more likely to be low birthweight and 4 times more likely to be delivered preterm compared with singletons. This research demonstrates the importance for epidemiologists and others, of having access to a complete maternal medical history for analyses of risks associated with maternal, infant and childhood morbidity.

Expression of eNOS in kidneys from hypertensive patients

Endothelium-derived nitric oxide (NO) is essential for maintenance and regulation of blood pressure. In animal models, altered endothelium-derived nitric oxide synthase (eNOS) expression and impaired NO generation are important factors for renal injury. However, the pattern of eNOS expression in the kidneys from hypertensive patients has not been well established. We have studied the eNOS immuno-expression in kidney biopsies from hypertensive patients. Compared to kidneys from normotensive individuals, there were no significant alterations of eNOS immuno-expression in the vasculature of patients with chronic essential hypertension. In contrast, the expression of eNOS was significantly decreased in the glomeruli and arterioles/small arteries of patients with malignant hypertension, particularly in those with significant intimal edema and myxoid degeneration or thrombi. Endothelial dysfunction is an important pathogenetic factor for chronic primary hypertension and eNOS plays a major role in the regulation of vascular tone and function. Unchanged eNOS in the kidney vasculature in chronic primary hypertension indicates that these patients have an ability to compensate. In patients with malignant hypertension, the expression of eNOS protein was diminished in the injured vasculature. Loss of the compensatory mechanism via continued release of NO to prevent vascular injury may be responsible for morphological changes typically seen in the renal vasculature in patients with accelerated hypertension.

A randomized trial of tight vs. less tight control of mild essential and gestational hypertension in pregnancy

To assess the effects of applying a tight vs. a less tight control of mild chronic essential or gestational non-proteinuric hypertension in pregnancy. A randomized trial was conducted in 2006-2007 in the University of Ain Shams, Egypt. Eligible participants (n=125) were randomly assigned to either tight or less tight control of mild chronic (essential) or gestational (non-proteinuric) hypertension. The primary outcome measure was the development of severe hypertension during follow-up. Analysis was by intention-to-treat. In the tight target group, adjustment of the dose with an increment of 191 mg yielded a mean dose of methyldopa of 1267+/-406 mg. Both systolic and diastolic BP levels were significantly less than in the tight target group. More women in the less tight group had severe hypertension during follow up (RR 3.167 and 95% CI 1.36-7.37). The rate of antenatal hospitalization was significantly higher in the less tight target group with a relative risk of 2.57 and 95% CI 1.16-5.70. The gestational age at delivery was significantly better in the tight target group. Preterm delivery and birth weight were not significantly different between the study groups. Tight control of blood pressure reduces the rate of antenatal hospitalization and does not adversely affect perinatal outcomes in women with mild essential or gestational hypertension.

Dietary Influences on Blood Pressure: The Effect of the Mediterranean Diet on the Prevalence of Hypertension

Hypertension has long been recognized as a major risk factor for several common cardiovascular diseases. The World Health Organization reports that the number of people with hypertension worldwide is estimated at 600 million, while 3 million will die annually as a result of hypertension. There is evidence to support that several factors related to lifestyle habits may influence blood pressure levels. Among these, the beneficial effect of diet on human health, as well as on the control of hypertension, has been underlined in several studies. Moreover, adherence to a Mediterranean diet has been associated with reduced all-cause mortality and, especially, coronary heart disease. The effect of this traditional diet on blood pressure levels has not been well understood and appreciated. This review summarizes the current understanding of the dietary influences on blood pressure control and the findings of observational and clinical studies that have evaluated the effect of the Mediterranean dietary pattern on the prevalence of chronic essential hypertension.

Effect of angiotensin II receptor antagonism on cerebral vasomotor reserve in humans.

Angiotensin II receptor antagonists have been reported to modulate cerebrovascular flow in animals. We applied frequency-domain techniques to explore whether angiotensin II receptor activity plays a role in cerebrovascular dynamics in humans. Essential hypertensive patients with (AIIA, n = 10) and without (HT, n = 10) an angiotensin II receptor antagonist (Volsartane) and healthy with matched (CON, n = 10) and younger (YOUNG, n = 10) ages were enrolled. They underwent measurement of middle cerebral artery flow velocity (MCAFV) by transcranial Doppler ultrasound and noninvasive beat-to-beat arterial blood pressure (ABP). Fluctuations in ABP and MCAFV were diffracted into high-frequency (HF, 0.15-0.4 Hz), low-frequency (LF, 0.04-0.15 Hz), and very low-frequency (VLF, 0.016-0.04 Hz) components. The mean age did not statistically significantly differ among the CON, HT, and AIIA groups. HT had significantly higher mean ABP, lower LF fluctuations of ABP and MCAFV, but similar ABP-MCAFV transfer magnitude compared with CON. HF transfer magnitude of AIIA was significantly higher than those of HT and CON, but similar to that of YOUNG. We conclude that the elderly with chronic essential hypertension has a suppressive effect on cerebral vasomotor reserve, in which angiotensin II receptor activity may play an active role.

Heart rate variability and its determinants in patients with severe or mild essential hypertension

How cardiac autonomic nervous control is related to the severity of essential hypertension in patients receiving long-term antihypertensive therapy is not well known. The aim of this study was to examine heart rate variability (HRV), a non-invasive measure of cardiac autonomic function, in patients with long-term and medically treated mild and severe essential hypertension and healthy control subjects, and to assess the clinical determinants of HRV in these patients. Thirty-four patients with severe essential hypertension (SEHT) and 29 with mild essential hypertension (MEHT) as well as healthy age- and sex-matched control subjects were studied. HRV was assessed from 10 min ECG-recordings during paced (0.2 Hz) breathing at rest and expressed as time and frequency domain measures. In the SEHT group time (SDNN, RMSSD) and frequency domain measures (total power, low-frequency (LF) power and high-frequency (HF) power of HRV in absolute units, and LF and HF power of HRV in normalized units) of HRV were significantly lower when compared with those of the control group. The MEHT and control groups did not differ from each other with respect to time or frequency domain measures of HRV. Comparison between the hypertensive groups showed that SDNN, total power, LF power and HF power were lower in the SEHT group compared with the MEHT group (P<0.05 for all). Among hypertensive patients RR-interval, age, gender, systolic finger blood pressure and diastolic office blood pressure as well as 24-h blood pressure were significant determinants of HRV. In conclusion, we found that the severity of chronic essential hypertension seems to be related to the severity of impairment of cardiac autonomic control.

Hypertension in pregnancy: new recommendations for management.

Hypertension in pregnancy is a frequent complication that has substantial adverse perinatal outcomes. Hypertension may be preexisting (chronic) essential or secondary hypertension; a second entity is pregnancy induced (gestational hypertension, preeclampsia). Recent advances have identified newer markers for pregnancy hypertension: several potential candidate genes may explain the apparent family inheritance of preeclampsia, and some thrombophilic markers have been associated with the condition. Management options for mild to moderate hypertension include a short hospital stay to exclude ongoing severe hypertension and to ascertain fetal well-being. Outpatient care with appropriate maternal and fetal surveillance, including umbilical artery doppler velocimetry, is recommended for better perinatal outcomes. Acute care for severe hypertension includes the use of magnesium sulfate to prevent eclampsia and antihypertensive medication. Expeditious delivery is recommended when the maternal or fetal states cannot be stabilized. Follow-up after delivery allows the uncovering of any other coexisting hypertensive or cardiovascular disorder.