Degree Of Blood Pressure Increase Research Articles

Cerebrovascular disorders in patients with type 2 diabetes mellitus and resistant hypertension

BACKGROUND : Diabetes mellitus (DM) and hypertension are risk factors for cerebral stroke, which are exacerbated by the combination of these diseases. Identifying the factors involved in the development of subclinical brain damage could change the therapeutic strategy for protecting the brain. AIM : to study severity of MRI- sings of brain damage and to identify factors associated with their development in patients with type 2 diabetes and RHTN. MATERIALS AND METHODS : 46 patients with type 2 DM and RHTN were included in a single-center observational uncontrolled study. Patients underwent brain MRI (1.5 Tesla) with calculation of Evans’s index (EI), clinical and lab examinations (HbA 1c , glucose, insulin, C-peptide, leptin, resistin, TNF- α, hsCRP, blood aldosterone, insulin-like growth factor-1 (IGF-1)), measurement of the office and ambulatory blood pressure (BP), assessment of peripheral and cerebral vasoreactivity (test with hyperventilation and breath holding). RESULTS : The most frequent MR brain changes were white matter lesions (WML) in periventricular region (PVR) (89%), focal WML (52%) and expansion both of the ventricles (45%) and subarachnoid spaces (65%). Multiple direct correlations were revealed between parameters of carbohydrate metabolism with the degree of WML in PVR and the density of the MR-signal in the basal nucleus (BN), as well as with EI. Adipokines had a direct relationship with the size of the chiasmatic cistern and IE (for resistin), as well as with the density of the MR signal from the BN and IE (for leptin), that was also directly related to the IGF-1 level. The aldosterone level positively correlated with the size of III ventricle. An increase in TNF-α and hsCRP was accompanied by an increase in the density of the MR-signal in the PVR. Impairment of cerebrovascular reactivity is associated with an increase in the density of the MR- signal in PVR and with indirect signs of cerebral atrophy (increase in EI, the size of cisterns and lateral ventricles). Impairment of peripheral vasoreactivity had direct relationship with EI and the expansion of the III ventricle. There were no direct correlations between the severity of MR-sings of brain damage and BP levels. CONCLUSION : The combination of type 2 DM with RHTN is characterized by a high frequency of WML and liquorodynamics disturbances, which related with metabolic, neurohormonal and hemodynamic factors in the absence of a direct relationship with the degree of BP increase

Gender differences in the effects of weight reduction on future blood pressure elevation in the overweight middle-aged population

Abstract Background The effectiveness of weight loss (WL) to prevent blood pressure (BP) elevation is common knowledge; however, the effect of gender differences on this efficacy is not known. We aimed to investigate whether there were gender differences in the degree of BP increase and the prevalence of hypertension in the future when middle-aged obese participants achieved slight WL. Methods We analyzed the annual health checkup data for the general Japanese population collected from January 2001 through December 2015. Middle-aged participants (40–49 years old) with overweight (body mass index [BMI], 25.0–29.9 kg/m2) who had examination data for two follow-up time-points (after 3 and 10 years) were included. The participants with a BMI decrease ≥1.0 kg/m2 in 3 years (WL group) were propensity score (PS)-matched to those with a BMI decrease <1.0 kg/m2 or weight gain (non-WL group) based on the data of the first examination, including age, BMI, smoking and drinking status, eGFR, systolic BP and diastolic BP, and hypertension (defined as SBP ≥140 mmHg and/or DBP ≥90 mmHg). We compared the BMI, systolic BP, and hypertension prevalence after 10 years in both groups. Results There were 17,554 individuals, aged 40–49 years, with overweight. After excluding subjects who did not satisfy the inclusion criteria and PS matching, we identified 232 men and 160 women in both WL and non-WL groups. The BMI in the WL group after 3 years was significantly lower than that in the non-WL group (men, 25.2±1.4 kg/m2 vs. 27.1±1.6 kg/m2, P<0.001; women, 24.9±1.4 kg/m2 vs. 27.1±1.5 kg/m2, P<0.001), and the significance persisted even after 10 years among both men and women (men, 25.5±1.8 kg/m2 vs. 26.8±2.1 kg/m2, P<0.001; women, 25.3±2.0 kg/m2 vs. 26.8±2.2 kg/m2, P<0.001). Among women, the systolic BP and hypertension prevalence after 10 years were significantly lower in the WL group than in the non-WL group (systolic BP, 124.8±16.3 mmHg vs. 130.3±19.0 mmHg, P<0.01; hypertension prevalence, 35.0% vs. 48.1%, P<0.05). In contrast, there were no significant differences in the SBP and hypertension prevalence after 10 years among men between the groups (systolic BP, 129.0±17.7 mmHg vs. 129.0±17.5 mmHg, P=0.96; hypertension prevalence, 46.1% vs. 48.7%, P=0.57). Conclusions There were gender differences in the effectiveness of WL to prevent future BP elevation in overweight middle-aged participants. WL could prevent future BP elevation and the hypertension onset in women but not in men. Funding Acknowledgement Type of funding source: None

Abstract P018: The Angiotensin Type 2 Receptor (AT 2 R) Is Involved In The Etiology Of Inverse Salt Sensitivity Of Blood Pressure

Renal proximal tubule (RPT) dopamine D 1 -like receptors (D 1 R) and angiotensin II type-2 receptor (AT 2 R) inhibit sodium reabsorption and counter regulate the renin angiotensin systems AT 1 R which stimulates sodium reabsorption. Salt sensitivity of blood pressure (SS) is defined as a ≥7-mmHg rise in blood pressure following a week of daily consumption of 350 mM sodium chloride (NaCl). Inverse salt sensitivity (ISS) is defined as a ≥7-mm Hg increase in blood pressure (BP) after a week of 10 mM NaCl/day. Salt resistant controls were defined as < 7mM Hg change in BP whether on 10 or 350mmHg NaCl/day for one week. Previously, we demonstrated that D 1 R RPT membrane recruitment was inversely proportional to an individual’s degree of BP increase on a 350 mM diet. We hypothesize that the degree of salt sensitivity of blood pressure would be inversely correlated with the recruitment of the AT 2 R to the plasma membrane induced by NaCl. Immunostaining shows that D 1 R was distributed in a fine granular manner throughout the whole plasma membrane, while AT 2 R shows a punctate pattern in both urine-derived SR and ISS RPTCs. There was no difference of basal D 1 R or AT 2 R expression. Increasing cell NaCl (monensin ionophore 10 μM, 1 hour) resulted in a significantly more AT 2 R and D 1 R(control) recruitment to cell surface in ISS cells than in SR cells (D 1 R: MON/VEH: SR, 1.032 ± 0.056, n=4; ISS, 1.537 ± 0.097, n=4; t-test, p<0.01; AT 2 R :MON/VEH: SR, 0.923 ± 0.063, n=3; ISS, 1.28 ± 0.106, n=3; t-test, p<0.05). Because ISS individuals present to the medical system with elevated blood pressure while on a low salt diet, they are often misdiagnosed as hypertensive. As our studies were conducted on RPT cells isolated from individual's urine, the D 1 R and AT 2 R response may contribute to the diagnosis of ISS individuals with elevated blood pressure while on a 10 mM salt diet, and provide better understanding on the etiology of ISS.

Amlodipine and celecoxib for treatment of hypertension and osteoarthritis pain

ABSTRACTIntroduction: Osteoarthritis constitutes one of the leading causes of pain and disability worldwide with a significant impact on health-care costs. Patients with osteoarthritis are often affected by a number of cardiovascular comorbidities, including hypertension, which is present in about 40% of cases. Just recently, a single tablet combination of amlodipine besylate, a calcium channel blocker, and celecoxib, a nonsteroidal anti-inflammatory drug, indicated for patients for whom treatment with amlodipine for hypertension and celecoxib for osteoarthritis are appropriate, has been recently approved.Areas covered: We reviewed data from clinical studies that investigated safety and efficacy of the combination of amlodipine and celecoxib in hypertensive patients with osteoarthritis published before 31 August 2018. The literature search was conducted using research Methodology Filters.Expert commentary: The advantages of this single formulation over sequential administration include increased compliance, possibly reduced cost, and less likelihood of dosage-related issues. Moreover, this single tablet formulation combines the anti-inflammatory activity of the celecoxib with the systemic vasodilatation induced by the amlodipine. It is a promising treatment for patients with osteoarthritis and hypertension. Nevertheless, celecoxib may cause a variable degree of blood pressure increase and only a small clinical trial has been conducted before approval to assess interactions related to blood pressure effect between these two molecules.

THE STRUCTURE OF PHARMACOTHERAPY OF ARTERIAL HYPERTENSION AND ADHERENCE IN YOUNG PATIENTS

Aim: To determine the indicators of adherence to drug therapy in young patients with arterial hypertension (АН) and the correlation between the indicators and therapy management.Materials and methods: The study enrolled 514 patients aged 25 to 45 years diagnosed with essential hypertension. We studied the structure of antihypertensive pharmacotherapy and adherence to treatment using the Moriski−Green test and the original questionnaire. The patients were distributed depending on the degree of blood pressure increase, administered treatment, age, economic factor, and drug source.Results: The adherence level by Moriski−Green test was 36.8%; according to the original questionnaire: high adherence level was 38.3%, incomplete adherence ― 33.7%, and poor adherence ― 28.0%. The monotherapy with ACE inhibitors predominated in the majority of cases; the fixed combinations were more typical for the treatment of the stage II AH, drug combinations ― for stage III AH. The highest therapy adherence was registered in patients with stage III AH receiving treatment with combinations of drugs in a single dosage form. The life quality of respondents and the drug source did not influence the adherence significantly.Conclusion: In young patients with arterial hypertension, some features of treatment structure determine the therapy adherence.

PP.15.10] CLINICAL CHARACTERISTICS OF PATIENTS WITH PAROXYSMAL HYPERTENSION

Objective: Paroxysmal hypertension or pseudopheochromocytoma is a quite common problem in clinical practice. However, only little is known about general clinical characteristics, degree of blood pressure increase and symptoms of these patients. Design and method: We searched hospital records of patients referred to our department for symptomatic paroxysmal hypertension between April 2008 and October 2014. We reviewed demographic data, significant patient comorbidities, clinical symptoms accompanying paroxysmal hypertension, blood pressure (BP), heart rate and laboratory values. Results: We enrolled 64 patients, predominantly older women (81.3 %, mean age 67 years), of whom majority (89.1 %) also had a permanent (chronic) arterial hypertension and were treated by a mean of 3.1 antihypertensive drugs. Only a small proportion (23.4 %) had a history of a manifest cardiovascular disease prior enrollment. Mean baseline office BP was 147.6/83.8 mmHg. Most patients had hypertensive paroxysms on a weekly basis, mean BP during the paroxysm was 188.1/102.5 mmHg and this represented a mean 40 mmHg (30.1%) increase compared to their resting office systolic BP. With the exception of 4 (6.3 %) patients, who had only sole elevation of BP, most of patients experienced various accompanying symptoms during hypertensive paroxysms, of which most common were anxiety, palpitations, headache and chest pain (please see Table 1).Conclusions: In paroxysmal hypertension the BP increase is usually substantial and accompanied by a wide range of other clinical symptoms. Further research and particularly establishment of effective therapy for this condition is warranted.

Как увеличить эффективность антигипертензивной терапии в реальной клинической практике: результаты российской наблюдательной программы ФОРСАЖ

im of the study - to evaluate the possibility of increasing the effectiveness of antihypertensive therapy by simplifying regimens, improving knowledge and practical skills of the doctors on the use of modern tactical approaches to treatment as well as patients education methods of measuring blood pressure (BP), the principles of a healthy lifestyle and explain the need to follow the prescribing physician.Post-marketing observational discovery program FORSAZH held in 29 cities of the Russian Federation. Participation in the program received 442 physician (internists and general practitioners), which included 1969 patients with prior failure of combination antihypertensive therapy. Patients in 86% of cases took the free combination, 14% - fixed combinations of drugs. The change of the treatment on reception of a preparation containing a fixed combination of perindopril/indapamide (10 mg/2.5 mg) after 3 months led to decrease in systolic blood pressure by an average of 39.5 mm Hg, diastolic - 18.7 per mm Hg. The frequency of achieving the target BP <140 mm Hg and 90 it was 76%. Marked reduction in BP and frequency to achieve the target BP is not dependent on additional training of physicians and patients, the use of prior therapy in free or fixed combination, but depended on the initial degree of increase in BP and duration of therapy. Predictors of failure to achieve target BP were age, male gender, low initial adherence, good health, a higher baseline BP, elevated cholesterol levels, body weight, heart rate and decreased glomerular filtration rate. Adherence to therapy patients (on a scale of Morisky-Green) and health assessment on a visual analog scale significantly increased. This tactic has been a change of therapy is not only effective but also safe. Adverse events were reported in 28 patients (1.4% of the total number of observed cases) and only 1 case required dose reduction due to development of clinically manifested hypotension.In enhancing the effectiveness of the treatment of patients with hypertension was decisive simplification of drug therapy through the use of a fixed combination of perindopril A/indapamide.

Role of the morphogenetic proteins FGF-23 and Klotho and the glycoprotein sclerostin in the assessment of the risk of cardiovascular diseases and the prognosis of chronic kidney disease

AIM. To analyze changes in the serum concentrations of the morphogenetic proteins fibroblast growth factor 23 (FGF-23) and Klotho, as well as sclerostin, an osteocyte-secreted glycoprotein, in relation to the degree of hypertension, left ventricular (LV) hypertrophy, and arterial stiffness in patients with chronic kidney disease (CKD) at its different stages. Sixty-five patients (33 men and 32 women) aged 20-65 years, including 25 with chronic glomerulonephritis, 15 with tubulointerstitial nephritis, and 25 with hypertensive nephrosclerosis, were examined. A control group consisted of 15 healthy volunteers matched to the study group patients for age and gender. Serum FGF-23 concentrations and blood pressure (BP) were measured in the all subjects. Patients with BPs > 140/80 mm Hg underwent echocardiography, followed by determination of LV mass (LVM) and calculation of LVM index. Vascular circulation, pulse wave velocity, cardiac and vascular calcifications, and vascular functional properties were estimated. There was a strong direct Correlation between the serum concentration of FGF-23 and the stage of CKD and an inverse correlation between the levels of Klotho and sclerostin and the stage of CKD. As the glomerular filtration rate became lower, the concentration of FGF-23 increased and that of Klotho and sclerostin decreased just in Stage III CKD while hyperphosphatemia and elevated parathyroid hormone levels were noted in Stages IV-V CKD. As CKD progressed, the serum concentrations of Klotho and sclerostin were inversely correlated with the levels of phosphorus and parathyroid hormone. The degree of blood pressure elevation correlated positively with serum FGF-23 concentrations and inversely with Klotho levels. There was no significant correlation of the level of sclerostin with the degree of BP increase. The direct correlation between higher FGF-23 level and higher VLM is most pronounced in hypertensive patients. There was a strong direct relationship between FGF-23 and Klotho levels and a strong inverse relationship between sclerostin levels and pulse wave velocity. Lower Klotho concentrations were associated with the detection rate of calcifications in the heart valves and large arteries (the abdominal aorta). The reduced serum levels of Klotho and sclerostin were also correlated with concentric LV remodeling. It was demonstrated that there was a clear link between increased serum FGF-23 and decreased Klotho concentration as CKD progressed, and that between arterial stiffness and calcification and myocardial remodelling regardless of traditional risk factors. More experimental and clinical studies are required to clarify the role of sclerostin in CKD.

Эффективность и безопасность комбинированной терапии на основе хлорталидона и атенолола в одной таблетке (тенорик) у пациентов с гипертонической болезнью: первые результаты Всеукраинского научно-исследовательского проекта TRUST

Целью настоящей работы является оценка эффективности и безопасности комбинированной терапии на основе хлорталидона и атенолола в одной таблетке (тенорик) у пациентов с гипертонической болезнью.В исследовании принимали участие 330 врачей первичного контакта из различных регионов Украины. Всего в исследование было включено 3000 больных с уровнем артериального давления (АД) 140/90 мм рт.ст. и выше. В основе настоящей статьи лежит анализ первых 1798 пациентов, включенных в исследование. Первичной конечной точкой исследования было снижение АД у включенных в исследование пациентов.Шестинедельная терапия тенориком обеспечивала эффективное снижение уровня артериального давления у 97,7 % больных гипертонической болезнью I–II стадии с 1–3-й степенью повышения артериального давления. При этом целевой уровень артериального давления (менее 140/90 мм рт.ст.) был достигнут у 53,9 % пациентов. На фоне лечения наблюдалось прогрессирующее (возрастающее по мере длительности приема препарата) достоверное снижение уровня как САД, так и ДАД с достижением уровня 135/80 мм рт.ст. на 4-м визите через 6 недель. Таким образом, снижение АД составило 31/19 мм рт.ст. Кроме этого, отмечалось снижение частоты сердечных сокращений на 17 уд/мин, которая на последнем визите достигла в среднем 71 уд/мин. Наиболее частым побочным эффектом была головная боль (17,7 %), а также покраснение кожных покровов (8 %). Оба побочных эффекта не требовали отмены препарата. Число пациентов, у которых исходно наблюдалась гипокалиемия (уровень калия в сыворотке ниже 3,5 ммоль/л), составило 8,3 % (21 пациент). На фоне лечения снижение уровня сывороточного калия ниже указанного предела наблюдалось еще у 6 больных, что составило 11,7 % (27 пациентов). Особого внимания требует оценка частоты брадикардии (5,2 %) и блокад сердца (0,5 %). Это наиболее серьезные побочные эффекты, которые требовали пересмотра дозировок или даже отмены препарата. Препарат был отменен всего у 51 больного (3,1 %).Таким образом, терапия тенориком по указанной схеме в течение 6 недель обеспечивала эффективное снижение уровня АД у 97,7 % больных гипертонической болезнью I–II стадии с 1–3-й степенью повышения АД.

Emerging therapies in the management of hypertensive patients with osteoarthritis

Osteoarthritis (OA) constitutes one of the leading causes of pain and disability worldwide. The incidence of OA will likely rise over the next few decades, with a significant impact on healthcare costs. Patients with OA are often affected by a number of cardiovascular comorbidities, including hypertension, which is present in approximately 40% of cases. Cyclooxygenase (COX) inhibitors, both nonselective and selective COX-2 inhibitors, are often used to control pain in these patients. Unfortunately, such drugs may cause a variable degree of blood pressure increase. Because even small increases in blood pressure values may lead to a significant increase in the risk of major cardiovascular events and death, the consequent healthcare concerns have led to the development of the COX-inhibiting nitric oxide donator class of drugs. These new drugs are aimed to improve cardiovascular and gastrointestinal safety profiles, as compared with nonsteroidal anti-inflammatory drugs, through the release of nitric oxide.

Increased Pain Sensitivity in Low Blood Pressure

There is broad evidence for a functional interaction between the cardiovascular and pain regulatory systems. One result of this interaction is the reduced sensitivity to acute pain in individuals with elevated blood pressure, which has been established in numerous studies. In contrast to this, possible alterations in pain perception related to the lower range of blood pressure have not yet been investigated. In the present study pain sensitivity was assessed in 30 hypotensive women (mean blood pressure 95/56 mmHg) and 30 normotensive control persons (mean blood pressure 119/77 mmHg) based on a cold pressor test. Possible effects on pain perception of hypotension-related impairment of subjective state were controlled for by including a mood-scale. The hypotensive as compared to the normotensive group displayed lower pain threshold and pain tolerance levels, as well as increased sensory and affective experiences of pain. Moreover, a slight negative correlation was found, both in hypotensive and control persons, between pain sensitivity and the degree of blood pressure increase during the execution of the cold pressor test. In accordance with the previous findings on hypertension-related hypoalgesia, the present results suggest an inverse relationship between blood pressure and pain sensitivity across the total blood pressure spectrum. Different degrees of pain attenuation through afferent input from the arterial baroreceptor system are discussed as a physiological mechanism mediating this relationship.

Pathophysiological interactions of ventilation, arousals, and blood pressure oscillations during cheyne-stokes respiration in patients with heart failure.

Arousals from sleep can be associated with increases in blood pressure (BP). However, it is uncertain whether this is due to a direct effect of arousals on BP, or is secondary to respiratory stimuli present at the time of the arousal. Cheyne-Stokes respiration (CSR) in patients with congestive heart failure (CHF) provides unique conditions that may allow these two possibilities to be distinguished. In CSR, the apnea-hyperpnea cycle can be dissociated from arousals because when CSR occurs during wakefulness, it does so in the absence of arousals, and when it occurs during sleep, arousals occur either at the termination of apnea (early arousals) or several breaths after the onset of hyperpnea (late arousals). We therefore measured BP during wakefulness and non-rapid eye movement (NREM) sleep in eight patients with CHF and CSR. During wakefulness, CSR was associated with wide fluctuations in systolic BP (mean +/- SD, 11.3 +/- 6.0 mm Hg) synchronous with the apnea-hyperpnea cycle, in the absence of arousals. Similar fluctuations in BP were observed during CSR with early arousals (13. 7 +/- 7.0 mm Hg) in NREM sleep. However, late arousals during CSR were associated with a small, but significant additional effect on systolic BP (14.2 +/- 7.1 mm Hg, p < 0.05). Furthermore, the degree of BP increase following arousals was directly related to the associated increase in ventilation (r = 0.70, p < 0.05). We conclude that BP fluctuations during CSR in patients with CHF are primarily related to oscillations in ventilation during the CSR cycle and can occur in the absence of arousals. Arousals augment these BP oscillations, but only when they occur late in hyperpnea.

Successful vitrification of stroke-prone spontaneously hypertensive and normal Wistar rat 2-cell embryos.

Stroke-prone spontaneously hypertensive rats (SHRSPs) have been widely used as models of hypertension and cerebral apoplexy. They were obtained by selective sib-breeding of Wistar Kyoto rats with higher blood pressure than rats of the original Wistar Kyoto strain. For vitrification of SHRSP 2-cell embryos, DPS solution containing 2.75 M dimethylsulfoxide, 2.75 M propylene glycol and 1.0 M sucrose was prepared and diluted in a modified phosphate-buffered saline, PB1, containing 0.3% bovine serum albumin. Embryos were exposed to the resulting solution in one step at room temperature, kept in the solution for 15 s, vitrified in liquid nitrogen, and warmed rapidly. The post-warming survival rate as morphologically assessed was 70% (148/210), which was comparable (P > 0.05) to the rate of 88% (78/89) for the solution control. After vitrification, the embryos were transferred into recipient animals, and 62% (48/78) were normally delivered, comparable (P > 0.05) to the percentage for the solution control (68%, 57/84). These was no significant difference between pups from vitrified embryos and those from unvitrified control embryos in either the growth curve or degree of blood pressure increase. These findings demonstrate the effectiveness of the simple vitrification method we used for cryopreservation of SHRSP and Wistar rat 2-cell embryos, and also demonstrate that vitrification-mediated cryopreservation does not affect the phenotypic characteristics of SHRSPs.

Blood platelets in human essential hypertension.

Blood platelets of patients with essential hypertension display signs of both increased sensitivity in vitro to aggregating stimuli believed to contribute to thrombosis and of activation in vivo possibly expressing the release of vasoactive products. The mean features of the modified platelet profile in hypertension include an increased alpha 2-adrenergic receptor density, an enhanced rate of adhesion/aggregation in particular in response to ADP and arachidonic acid, a greater sensitivity for thrombin and adrenaline to stimulate increases in cytoplasmic-free Ca2+, increased resting levels of cytoplasmatic-free Ca2+, a reduced content of serotonin often combined with a defective uptake mechanism, a facilitated efflux rate of noradrenaline, an exaggerated release reaction in vivo as indicated by the increased plasma levels of Beta-thromboglobulin and a shortened platelet life span. These changes occur to various extents in some, but not all, hypertensive patients and are not always strictly related to the degree of blood pressure increase. On the contrary, platelet cyclooxygenase and thromboxane synthetase activity are in the normal range.