Elevated Arterial Blood Pressure Research Articles

Effect Of Intermittent Isometric Handgrip Exercise On Cognitive Function

Previous study reported that an isometric handgrip (IHG) exercise improves cognitive function. However, an isometric exercise may increase the risk for cardiovascular disease because of a larger increase in arterial blood pressure (ABP) compare with dynamic exercise, especially in elderly patients. PURPOSE: The purpose of the present study was to examine the effect of acute intermittent IHG exercise without a large increase ABP on cognitive function. METHODS: Five healthy subjects performed a cognitive task (Go/No-go task) before and immediately after IHG exercise protocols; 16 sets of 30-s IHG at 30% of maximum voluntary contraction and 45-s recovery. ABP was measured continuously throughout the experiment. Cognitive function was evaluated by the Go/No-go task. RESULTS: Mean arterial pressure at the end of IHG exercise protocol (92 ± 12 mmHg) was not significantly different from the baseline (86 ± 4 mmHg, P > 0.05). Also, the number of error trials in the Go/No-go task was unchanged; however, the reaction time was decreased in four out of five subjects after IHG exercise. CONCLUSION: These results provided the possibility that intermittent isometric exercise may improve cognitive function without an elevation in ABP. However, further investigation with large sample size is needed to identify our questions.

P0279DIABETIC KIDNEY DISEASE VERSUS CHRONIC KIDNEY DISEASE IN ADULTS WITHOUT DIABETES MELLITUS: A RENAL SURVIVAL ANALYSIS

Abstract Background and Aims Diabetic kidney disease (DKD) is the most common cause of end-stage renal disease, but the decline in kidney function varies considerably between chronic kidney diseases (CKD), and determinants of renal function loss, early in the course of the disease, are still a matter of debate. Method We retrospectively examined the renal outcome at 31 July 2017 of 309 CKD patients (age 59.1 (50.1-68.6) years; 60% male; eGFR 32.7 (21.7-44.8) mL/min) admitted in our hospital during January 2007-December 2012 with a median follow up time of 7.2 (95%CI, 6.8-7.6) years. Only patients who had at least 3 admissions and who were alive during the study period were included. CKD was defined as the presence of an eGFR <60ml/min/1.73m2 or the presence of albuminuria >30mg/g creatinine for more than 3 months. The primary endpoint was renal survival defined as renal replacement therapy (RRT) initiation. Factors affecting renal survival were evaluated in a Cox proportional hazard model. Results DKD (24%), glomerular (GN, 24%), tubulo-interstitial (TIN, 27%) and vascular nephropathies (VN, 25%) were the causes of CKD. Patients with DKD (66.8 (56.5-72.2) years) and VN (68.5 (59.7-76.2) years) were older than those with GN (50.3 (37.4-59.0) years) and TIN (55.6 (45.8-61.8) years). Moreover, the highest cardiovascular comorbidity score was found in patients with VN and DKD (p<0.001). Median eGFR decline was -1.23 ( -3.39 – 0.35) mL/min/year; 29% of the patients had CKD progression of >3mL/min/year and 14% had rapid progression (>5mL/min/year). Patients with GN had the lowest eGFR (26.8 (19.1-38.9) versus DKD 36.2 (23.4-47.7), VN 34.9 (22.4-51.0), TIN 32.4 (21.8-44.8) mL/min, p<0.001), the fastest eGFR decline (-3.1 versus DKD -1.9, VN -1, TIN -1,2 mL/min/year, p 0.5) and the highest proteinuria (2.7 versus DKD 1.4, VN 0.4, TIN 0.6 g/24h, p<0.001). During follow up, 29% of the studied patients started RRT; mean renal survival time for the entire cohort was 7.4 (95%CI, 7.0-7.8) years. CKD cause (versus DKD p=0.04, Figure 1), lower eGFR (HR 0.89 (95%CI, 0.85-0.93)), elevated albuminuria (HR 1.4 (95%CI, 1.2-1.7)), higher total serum cholesterol (HR 1.00 (95%CI, 1.00-1.01)) and elevated mean arterial blood pressure (HR 1.03 (95%CI, 1.00-1.06)) were associated with RRT initiation in the Cox regression model. Conclusion Patients with DKD and VN had similar poorer renal survival as compared with GN and TIN. Earlier referral to the diabetic renal clinic and intensive management of the modifiable risk factors (albuminuria, hypercholesterolemia, hypertention) are necessary to retard progression of CKD and, subsequently, prolong renal survival.

Maternal Metabolic Alterations in Monosodium Glutamate Fed Rats during Gestation and Lactation Period

Background: Monosodium glutamate (MSG), an extensively used food additive, is claimed to cause many health problems, its use is still under debate. Aim: to explore the metabolic and hypertensive effect of MSG dietary administration in pregnant and lactating female rats, and its possible underlying mechanism. Methods: 16 adult female albino Wister rats were divided into 2 groups, control group; were fed standard rat chow, and MSG group; were fed 2% MSG supplemented rat chow throughout gestation and lactation period. Oral glucose tolerance test (OGTT) and arterial blood pressure (ABP) were measured at mid and late gestation, mid and late lactation periods. At mid lactation period, a retroorbital samples were analyzed for fasting glucose, lipid profile; triglycerides (TGs), total cholesterol (TC) and low density lipoprotein-cholesterol (LDL-C), hormonal assays; insulin, glucagon, prolactin, corticosterone and ACTH, as well as pancreatic lipase, amylase and malondialdehyde (MDA). By the end of lactation, adipose tissue was assessed for glucose transporter-4 (GLUT-4) and hormone sensitive lipase (HSL) relative expression. Results: MSG rats showed elevated ABP during pregnancy and lactation, with impaired OGTT at mid and late lactation period. Fasting serum glucose, TGs, TC, LDL-C, glucagon, corticosterone, pancreatic lipase and amylase, MDA as well as adipose tissue HSL expression were significantly elevated, while, fasting serum insulin, ACTH and adipose tissue GLUT-4 expression were significantly declined in MSG fed rats as compared to control group. Conclusion: MSG feeding during pregnancy and lactation induced hypertension and metabolic alterations that could be due to pancreatic and adrenal affection secondary oxidative stress.

Chronic exercise mediates epigenetic suppression of L-type Ca2+ channel and BKCa channel in mesenteric arteries of hypertensive rats.

Regular exercise is a lifestyle intervention for controlling hypertension and has an improving effect on vascular function. Voltage-gated L-type Ca (LTCC) and large-conductance Ca-activated K (BKCa) channels are two principal mediators of vascular smooth muscle cell contractility and arterial tone. The present study tested the hypothesis that DNA methylation dynamics plays a key role in exercise-induced reprogramming and downregulation of LTCC and BKCa channel in mesenteric arteries from spontaneously hypertensive rats (SHRs). SHRs and Wistar-Kyoto (WKY) rats were subjected to exercise training or kept sedentary, and vascular molecular and functional properties were evaluated. Exercise inhibited hypertension-induced upregulation of LTCC and BKCa channel function in mesenteric arteries by repressing LTCC α1c and BKCa β1 subunit expression. In accordance, exercise triggered hypermethylation of α1c and β1 gene in SHR, with concomitant decreasing TET1, increasing DNMT1 and DNMT3b expression in mesenteric arteries, as well as altering peripheral α-KG and S-adenosylmethionine/ S-adenosylhomocysteine ratio. Acting synergistically, these exercise-induced functional and molecular amelioration could allow for attenuating hypertension-induced elevation in arterial blood pressure. Our results indicate that exercise suppresses LTCC and BKCa channel function via hypermethylation of α1c and β1 subunits, which contributes to the restoration of mesenteric arterial function and vasodilation during hypertension.

Antihypertensive activity of a new c-Jun N-terminal kinase inhibitor in spontaneously hypertensive rats.

c-Jun N-terminal kinases (JNKs) are involved in the myocardial and aortic remodeling, increased arterial tone, and arterial blood pressure elevation associated with hypertension. The aim of the present study was to investigate the antihypertensive effect of a new JNK inhibitor, 1H-indeno[1,2-b]quinoxalin-11-one oxime sodium salt (IQ-1S), on spontaneously hypertensive rats (SHRs). Experiments were performed using normotensive Wistar-Kyoto (WKY) rats and SHRs. Experimental groups of SHRs received IQ-1S intragastrically for 6 weeks in daily doses of 5 and 50 mg/kg; experimental groups of WKY rats received 50 mg/kg IQ-1S according to the same regimen. The IQ-1S administration regimen induced decreases in systolic blood pressure, mean arterial blood pressure, total peripheral resistance, blood viscosity, hematocrit, myocardial cell cross-sectional area, and aortic wall thickness in SHRs vs untreated SHRs. There were no significant differences in systolic blood pressure values between the control and experimental groups of WKY rats during the treatment period. A concentration-dependent decrease in the tone of carotid arterial rings isolated from SHRs was observed after JNK inhibitor application in vitro. Application of the JNK inhibitor diminished endothelin-1 secretion by human umbilical vein endothelial cells in vitro. The main mechanisms of the antihypertensive effect of IQ-1S included the attenuation of blood viscosity due to decreased hematocrit, a vasodilatory effect on arterial smooth muscle cells, and a decrease in endothelin-1 production by endothelial cells.

Progesterone decreases apnoea and reduces oxidative stress induced by chronic intermittent hypoxia in ovariectomized female rats.

What is the central question of this study? Does progesterone reduce the effect of chronic intermittent hypoxia (CIH) on arterial blood pressure, respiratory control and oxidative stress in the central nervous system in ovariectomized rats? What is the main finding and its importance? Progesterone does not prevent the elevation of arterial blood pressure in rats exposed to CIH, but normalizes respiratory control, and reduces cerebral oxidative stress. This study draws focus to a potential role of progesterone and the consequences of sleep apnoea in menopausal women. We tested the hypothesis that progesterone (Prog) reduces the effect of chronic intermittent hypoxia (CIH) on arterial blood pressure, respiratory chemoreflexes and oxidative stress in the central nervous system. Ovariectomized female rats were implanted with osmotic pumps delivering vehicle (Veh) or Prog (4mgkg-1 day-1 ). Two weeks following the surgery, rats were exposed to room air (Air) or CIH (7days, 10% O2 , 10 cyclesh-1 , 8hday-1 ). We studied three groups: Veh-Air, Veh-CIH and Prog-CIH. After the CIH exposures, we measured the mean arterial pressure (MAP; tail cuff) and assessed the frequency of apnoeas at rest and ventilatory responses to hypoxia and hypercapnia (whole body plethysmography). The activities of the pro-oxidant enzyme NADPH oxidase (NOX) and antioxidant enzymes superoxide dismutase (SOD; in mitochondrial and cytosolic fractions) and glutathione peroxidase (GPx), as well as the concentration of malondialdehyde (MDA), a marker of lipid peroxidation, were measured in brain cortex and brainstem samples. CIH exposure increased the MAP, the frequency of apnoeas, and the respiratory frequency response to hypoxia and hypercapnia. Prog did not prevent the CIH-induced elevation in MAP, but it reduced the CIH-induced frequency of apnoeas and increased hypoxic and hypercapnic ventilatory responses. In the brain cortex, CIH increased NOX activity, and decreased the cytosolic and mitochondrial SOD activities. These effects were prevented by Prog. NOX activity was increased by CIH in the brainstem, and this was also blocked by Prog. The study draws focus to the links between ovarian hormones and the consequences of sleep apnoea in women.

Diabetic nephropathy in the nurse practice

Diabetic nephropathy (DN) is a clinical syndrome characterized by kidney lesions and formation narrow or diffusion glomerulosclerosis, which later becomes kidney failure. It is manifested by persistent albuminuria (>300 mg/day or >200 μg/min), that is confirmed on at least 2 occasions 3–6 months apart, with a progressive decrease in glomerular filtration rate (GFR) and elevated arterial blood pressure (BP).

Adherence to antihypertensive medications in patients attending public hospitals in Kano State, Nigeria

Hypertension is a chronic medical condition characterized by an elevated arterial blood pressure with increasing prevalence in developing countries including Nigeria. One of the integral elements in management of hypertension is adherence to medication and life-style modification. This study aimed to assess adherence level for anti-hypertensive medications among adult hypertensive patients attending public hospitals in Kano State, Nigeria. The study was a cross sectional prospective survey involving 600 patients from six public healthcare facilities selected by multistage sampling technique. Adherence status was assessed using Morisky medication adherence scale. Sociodemographic data and other factors that may influence adherence to hypertension medications were evaluated. Out of the 598 patients that participated in the study, only 178 (29.8%) have their BP controlled based on JNC8. Three hundred and thirty two (55.5%) out of 598 patients have good adherence, while 266 (45.5%) have poor adherence. Of the 178 patients who had good BP control, 120 (67.5%) have good adherence while 58 (32.5%) have poor adherence. BP control was significantly higher in those that adhered to antihypertensive medication compared with non-adhering patients (χ2 = 14.526; df = 1; p-value = < 0.001). Additionally, Chi-square test showed significant association between number of antihypertensives and blood pressure control. (χ2=37.556, df=3, p<0.001). The study established that 55.5% of the respondents have good adherence to their antihypertensive medication while 29.8% had their BP controlled. Adherence and number of antihypertensive medication a patient is taking were found to have significant relationship with BP control.
 Keywords: Medication, adherence, hypertension, antihypertensive

Pre‐hypertensive molecular alterations in the paraventricular nucleus of the hypothalamus during angiotensin‐II hypertension

The paraventricular nucleus of the hypothalamus (PVN) plays a critical role in the development of hypertension in response to elevated levels of angiotensin‐II (Ang‐II). Upstream circumventricular organs, regions lacking a blood‐brain‐barrier, sense circulating Ang‐II and in turn influence endocrine and autonomic control via efferent projections to the PVN. Despite progress in unraveling the function of the PVN in hypertension development, the underlying signaling mechanisms remain unclear. Notably, the majority of investigations have examined alterations in the PVN during established hypertension, which limits our understanding of temporal changes that may occur prior to elevations in arterial blood pressure. Based on this, we investigated key molecular targets in the PVN during the pre‐hypertensive phase of Ang‐II hypertension. C57Bl/6J male mice were implanted with subcutaneous osmotic minipumps for chronic delivery of low dose Ang‐II (600 ng/kg/min). Brains were harvested for immunohistochemistry analysis of target molecules (n=3–4/group) at baseline (day 0) and pre‐hypertensive (days 3, 5, 7) timepoints. Histological analysis of synaptophysin, a marker for synaptic terminal innervation, indicated a progressive increase in immunoreactivity that peaked by ~10% within the first week of Ang‐II infusion (day 7 fold change: 1.1± 0.03 density/area, p<0.05); indicative of increased synaptic input to the PVN prior to elevations in arterial blood pressure. Previous findings have demonstrated that circulating arginine vasopressin protein (AVP) is elevated during chronic Ang‐II hypertension. Consistent with this, AVP immunoreactivity in the PVN was elevated as early as day 3 of Ang‐II infusion (day 3 fold change: 1.7 ± 0.09 density/area, p<0.05), and this response was sustained for up to 7 days (day 5 fold change: 1.4 ± 0.02; day 7 fold change: 1.3 ± 0.03 density/area, both p<0.05). Interestingly, we also observed synaptic end AVP immunoreactivity in the circumventricular subfornical organ very early during Ang‐II infusion (e.g. day 3 fold change: 1.2 ± 0.02 density/area, p<0.05), suggesting a possible feedback loop between the PVN and subfornical organ in AVP regulation. Unlike AVP, PVN oxytocin immunoreactivity was not changed during Ang‐II hypertension (e.g. day 7 fold change: 1.01 ± 0.08 density/area, p>0.05). Collectively, these findings indicate early molecular changes within the PVN prior to the development of Ang‐II hypertension including: 1) Gradual synaptic innervation of the PVN during the first week of Ang‐II infusion; 2) Very early Ang‐II associated elevations in PVN AVP expression, but not oxytocin; and 3) Potential alterations in the innervation of hypothalamic AVP fibers to the circumventricular subfornical organ in response to Ang‐II.Support or Funding Information19CDA34630010 (to Jin Kwon Jeong) and 1R01HL141393 (to Colin N. Young)

Chronic Stress Induces Persistent Hypertension and Increases NMDA Receptor Activity in the Paraventricular Nucleus in Borderline Hypertensive Rats

Stress activates sympathetic outflow and promotes hypertension development in humans with genetic predisposition. The enhanced N‐methyl‐D‐aspartate receptor (NMDAR) activity in the hypothalamus paraventricular nucleus (PVN) plays a critical role in controlling sympathetic output in hypertension. However, it is unclear how chronic stress affects NMDAR activity in the PVN in borderline hypertensive rats (BHR). BHR are the F1 male offspring from crossing female spontaneously hypertensive rats with male Wistars Kyoto rats (WKY). Arterial blood pressure (ABP) was monitored in free moving rats by using radiotelemetry. Using a 6‐week chronic unpredictable stress protocol, we found that stressed WKY rats had increased ABP during chronic stress but ABP returned to the normal level within a few days after stress. However, the stressed BHR showed a greater increase in ABP during stress and the elevated ABP was sustained for at least 2 weeks after discontinuing stress. Furthermore, whole‐cell voltage clamp recording in brain slices showed that the amplitude of evoked‐NMDAR currents in spinally projecting PVN neurons was significantly higher in stressed BHR than in non‐stressed BHR controls. Inhibiting α2δ‐1 with gabapentin normalized the increased synaptic NMDAR activity of spinally projecting PVN neurons in stressed BHR. In addition, the expression level of GluN1 and α2δ‐1 in the PVN was significantly greater in stressed BHR than in stressed WKY or non‐stressed BHR. These results suggest that chronic stress induces persistent hypertension in BHR, which is associated with α2δ‐1‐mediated NMDAR hyperactivity in PVN presympathetic neurons.Support or Funding InformationAcknowledgmentsSupported by NIH grants HL131161 and HL142133.

Dynamic cerebral autoregulation in anterior and posterior cerebral circulation during cold pressor test

We hypothesized that cerebral blood flow (CBF) regulation in the posterior circulation differs from that of the anterior circulation during a cold pressor test (CPT) and is accompanied by elevations in arterial blood pressure (ABP) and sympathetic nervous activity (SNA). To test this, dynamic cerebral autoregulation (dCA) in the middle and posterior cerebral arteries (MCA and PCA) were measured at three different conditions: control, early phase of the CPT, and the late phase of the CPT. The dCA was examined using a thigh cuff occlusion and release technique. The MCA and PCA blood velocities were unchanged at CPT compared with the control conditions despite an elevation in the ABP. The dCA in both the MCA and PCA remained unaltered at CPT. These findings suggest that CPT-induced elevations in the ABP and SNA did not cause changes in the CBF regulation in the posterior circulation compared with the anterior circulation.

Sonographic assessment of carotid arteries in adults with radiographic features of hypertensive cardiomegaly at Kano, North Western Nigeria

Context: Hypertension is a chronic medical condition in which there is elevation of arterial blood pressure (s). Hypertensive cardiomegaly is a complication and effect of long standing systemic hypertension on the heart. Aims: This study is to relate a component of hypertensive heart disease with sonographic changes found in the carotid arteries of these patients, as they are directly linked to atherosclerotic effect of hypertension. Materials and Methods: In this prospective crosssectional study, four hundred (400) subjects with primary hypertension were recruited. The study group (200) is having cardiomegaly on PA chest radiograph. The carotid arteries of all participants were insonated on both gray scale and Doppler modes. Demographic characteristics, CIMT, and Doppler velocimetric indices (PSV, EDV, and RI) were generated and subjected to statistical analysis. Results: The mean age for the study group was 48.91 ± 10.0, consisting of 110 (53.9%) males and 90 (45.9%) females. Cardiothoracic ratio was seen to increase with age (P

The Correlation Between Body Weight and Arterial Blood Pressure in 11 and 15 Years Old Children: Retrospective Cross-Sectional Study

Background. Children’s body weight is the predictor of pathologic elevation of arterial blood pressure (ABP) in adult life. The aim of the study is to divide the data on body weight and ABP in adolescents and to find correlations between them. Methods. The randomised study of 11 and 15 years old pupils from general education institutions was carried out. The 16 months research was executed in 9 different regions of the country (one region from every federal district and 5 schools (with juniors and seniors) in each were randomly selected). In addition to measurement of ABP (three times by Korotkov’s method) and body weight (using general bathroom scales) all children were examined by the group of pediatric specialists (pediatrician, gastroenterologist, allergologist, otolaryngologist, ophthalmologist, neurologist, psychologist, cognitive specialist, orthopedic traumatologists, nephrologist, ultrasound and laboratory diagnostic specialist).Results. The study included 1911 teenagers. The correlation (p<0,010 for all groups) between systolic/diastolic blood pressure and body weight was revealed in group of boys at the age of 11 (r=0,394/0,206) and 15 (r=0,231/0,185) years old and in group of girls of the same age age (r=0,330/0,227 and r=0.228/0.148 respectively). Conclusion. The significant correlation between body weight and levels of systolic and diastolic blood pressure in 11 and 15 years old children has been revealed.

Лечебно-диагностические подходы к ведению больных с острым повышением артериального давления

Лечебно-диагностические подходы к ведению больных с острым повышением артериального давления

THE INFLUENCE OF SEASONS ON THE DEVELOPMENT OF EXACERBATIONS OF THE MOST COMMON DISEASES OF THE CIRCULATORY SYSTEM. GENDER AND AGE PECULIARITIES

Introduction. The aim of the study was to assess seasonal differences in the exacerbations rate of diseases of the circulatory system (DCS), taking into account the nosological form (ICD code), gender and age of patients. Material and methods. 428 727 emergency medical service (EMS) calls to patients with exacerbations of DCS in Yaroslavl for the period 2012-2017 were analyzed. The EMS calls to men and women were analyzed separately. Four groups were identified: AH (arterial hypertension), CHD (coronary heart disease), RD (rhythm disturbance), CVD (cerebrovascular disease), which were divided into age subgroups. To assess the impact of the seasons of the year, the subgroups “winter” (all emergency calls in the winter period (from December to February) and “summer” (all emergency calls in the summer period (from June to August) were additionally identified. Results. The calls due to an elevated arterial blood pressure were most frequent among all the EMS calls from DCS patients. Among them, in all age subgroups older than 40, there were significantly more calls from women, while the calls for exacerbation of other DCS were significantly higher from men. In winter, the number of EMS calls for arterial hypertension was significantly higher than in summer in all age subgroups of men and women older than 40 years. For other analyzed DCS, such regularities were not detected. Conclusion. The patterns revealed in this study should be taken into account both in clinical and preventive practice, and in the organization of work of emergency medical service.

Correlation between Knowledge and the Adherence to Take Antihypertensive Medication for Elderly Hypertensive Patients in Krian Public Health Center Sidoarjo Regency

Abstract: Hypertension is a condition of elevated abnormal arterial blood pressure that lasts persistently. Some knowledge that should be known by hypertensive patients are such as the meaning of hypertension, the cause of hypertension, the symptoms that come along, and the importance of regular and long term treatment, also knowing the dangers posed if not taking the medication. This study aims to determine the correlation between knowledge and adherence to taking antihypertensive medication in elderly hypertensive patients at the Krian Public Health Center, Sidoarjo Regency. In this study, the population was elderly hypertensive patients who examined themselves or only took control to take medication at the Elderly Polyclinic of Krian Public Health Center in Sidoarjo Regency with 332 populations with 75 samples taken. The result of this research was obtained sig. value = 0,000 (<0,05). This study used the Spearman Correlation statistical test in analyzing the data. From the results of this study it was concluded that there was a relationship between knowledge and adherence to taking antihypertensive medication in elderly hypertensive patients at the Krian Public Health Center, Krian District, this was proved by the acquisition of sig values. = 0,000 (<0.05). Keywords: knowledge, the adherence of taking medication, hypertension

Early hematoma expansion in primary intracerebral hemorrhage: incidence and predictors

BackgroundHematoma expansion (HE) is the leading cause of early neurological deterioration, poor functional outcome, and increased mortality in patients with spontaneous intracerebral hemorrhage (S-ICH). The study aimed to estimate the risks and predictors of early HE in patients with S-ICH and the effect of this HE on patient’s survival and functional outcome.MethodsThis study was carried out on 72 patients with S-ICH submitted to baseline non-contrast brain CT (NCCT) and CT angiography for determination of hematoma site, size, border irregularity, blend sign, and spot sign score (SSS). Rescan was done 48 h after stroke onset or on clinical deterioration to resize the HV and diagnose HE. Modified Rankin Scale (MRS) was done 3 months after stroke onset to assess the effect of HE on patients’ physical dependence.ResultsHE occurred in 28/72 (38.9%) of included patients. Risks of HE included old age, smoking, elevated baseline mean arterial blood pressure, and high admission modified National Institute of Health stroke scale. NCCT predictors of HE included large volume, irregular border, and presence of blend sign. The presence of spot sign in early CTA is more accurate than NCCT predictors with 54%, 91%, 79%, and 75% for sensitivity, specificity, positive predictive value, and negative predictive value, respectively.ConclusionsHE is a major cause of early clinical deterioration, increased mortality, and poor functional outcome. Early CTA for detection of spot sign is indicated in patients with large volume, irregular border, and/or blend sign in NCCT.

Evaluation of left ventricular function in overweight children and teenagers with arterial hypertension and white coat hypertension.

Obesity in childhood is strongly associated with elevated arterial blood pressure and risk of hypertension. The aim of the study was the evaluation of left ventricular (LV) function in hypertensive and white coat hypertensive overweight children and teenagers. The study group consisted of 74 overweight patients aged 10.3 ± 3.1 years (range: 6-16 years) diagnosed as hypertensive in standard blood pressure measurement. The control group consisted of 31 normotensive and normoweight children. Ambulatory blood pressure monitoring (ABPM) and echocardiographic assessment of the LV mass and function were performed in all participants. Using ABPM hypertension was confirmed in 20 (27%) children. In the 54 (73%) remaining children white coat hypertension was diagnosed. The analysis of echocardiographic parameters revealed higher LV mass index (LVMI) in hypertensive overweight than in normotensive normoweight children (47.5 ± 9.2 g/m2.7 vs. 39.8 ± 12.1 g/m2.7; p < 0.05) and no difference between overweight hypertensive and white coat hypertension-hypertensive groups. The deceleration time of mitral early filling (DCT) was longer in hypertensive normoweight children than in normotensive overweight patients (219.5 ± 110.3 ms vs. 197.8 ± 65.8 ms; p < 0.05). A significant correlation between systolic blood pressure load (SBPL) and DCT (r = 0.57) and moderate correlation between SBPL and LVMI (r: 0.48) as well as between LVMI and isovolumetric relaxation time (r = 0.37) were found. In overweight children the diagnosis of hypertension should be confirmed in ABPM because of the high prevalence of white coat hypertension. Periodic echocardiographic examinations should be recommended in overweight children with increased SBPL and decreased systolic nocturnal deep because of the possibility of LV function impairment.

Effects of high-protein diet on glycemic control, insulin resistance and blood pressure in type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials.

Obesity is a well-known risk factor of type 2 diabetes mellitus (T2DM), and it is commonly accompanied by T2DM. It is estimated that almost two thirds of the population with T2DM is also affected by hypertension. Elevated arterial blood pressure would increase the risk for diabetes development. Recently some studies indicated that a high-protein diet was effective for weight loss, and therefore we hypothesized that a high-protein diet could help control blood glucose, mitigate insulin resistance (IR) and improve blood pressure by weight management in T2DM patients. The study aimed to systematically review the effects of a high-protein diet on glycemic control, IR and blood pressure in T2DM patients. We searched four electronic databases until May 1st 2018 and included all randomized clinical trials comparing a high-protein diet with other diets. Two reviewers independently identified the trials for inclusion and independently extracted data. Either a fixed- or a random-effects model was used to combine the changes in each outcome from baseline to the end of the intervention. The meta-analysis was performed with RevMan 5.3 software. Twelve articles (thirteen studies) including 1138 T2DM patients met our inclusion criteria. Glycemic control was not significantly different between the high-protein diet and control group, with the changes in fasting plasma glucose (FPG) (-0.13 (95% CI (-0.46, 0.19), p=0.43) mmol/L) and HbA1c% (-0.05 (95% CI (-0.18, 0.08, p=0.92))) from baseline to the end of intervention. However, the difference in IR between the two groups was statistically significant. Most changes in lipids profiles were favorable. The changes in HDL, LDL, TC, and TG were+0.03 (95% CI (-0.04,0.11), p=0.35) mmol/L,-0.10 (95% CI (-0.18,-0.02), p=0.02) mmol/L,-0.21 (95% CI (-0.31,-0.12), p<0.01) mmol/L and-0.19 (95% CI (-0.33,-0.05), p<0.01) mmol/L, respectively. The result of HOMA-IR was-0.27 (95% CI (-0.47,-0.06), p<0.01). Additionally, the difference in blood pressure in terms of systolic blood pressure (-0.57 (95% CI (-2.45, 1.32), p=0.55)) and diastolic blood pressure (-0.73 (95% CI (-2.48, 1.02), p=0.41)) was not significant. This review showed that a high-protein diet does not significantly improve glycemic control and blood pressure, but can lower LDL, TC, TG and HOMA-IR levels in T2DM patients. Further studies are needed to clarify the effects of a high-protein diet on glycemic control, IR and blood pressure control in T2DM patients.

Renal sensory nerves increase sympathetic nerve activity and blood pressure in 2-kidney 1-clip hypertensive mice.

Renal denervation lowers arterial blood pressure (ABP) in multiple clinical trials and some experimental models of hypertension. These antihypertensive effects have been attributed to the removal of renal afferent nerves. The purpose of the present study was to define the function, anatomy, and contribution of mouse renal sensory neurons to a renal nerve-dependent model of hypertension. First, electrical stimulation of mouse renal afferent nerves produced frequency-dependent increases in ABP that were eliminated by ganglionic blockade. Stimulus-triggered averaging revealed renal afferent stimulation significantly increased splanchnic, renal, and lumbar sympathetic nerve activity (SNA). Second, kidney injection of wheat germ agglutinin into male C57Bl6 mice (12-14 wk; Jackson Laboratories) produced ipsilateral labeling in the T11-L2 dorsal root ganglia. Next, 2-kidney 1-clip (2K1C) hypertension was produced in male C57Bl6 mice (12-14 wk; Jackson Laboratories) by placement of a 0.5-mm length of polytetrafluoroethylene tubing around the left renal artery. 2K1C mice displayed an elevated ABP measured via telemetry and a greater fall in mean ABP to ganglionic blockade at day 14 or 21 vs. day 0. Renal afferent discharge was significantly higher in 2K1C-clipped vs. 2K1C-unclipped or sham kidneys. In addition, 2K1C-clipped vs. 2K1C-unclipped or sham kidneys had lower renal mass and higher mRNA levels of several proinflammatory cytokines. Finally, both ipsilateral renal denervation (10% phenol) or selective denervation of renal afferent nerves (periaxonal application of 33 mM capsaicin) at time of clipping resulted in lower ABP of 2K1C mice at day 14 or 21. These findings suggest mouse renal sensory neurons are activated to increase SNA and ABP in 2K1C hypertension. NEW & NOTEWORTHY This study documents the function, anatomy, and contribution of mouse renal sensory nerves to neurogenic hypertension produced by renal stenosis. Activation of renal afferents increased sympathetic nerve activity and blood pressure. Renal afferent activity was elevated in hypertensive mice, and renal afferent denervation lowered blood pressure. Clinically, patients with renal stenosis have been excluded from clinical trials for renal denervation, but this study highlights the potential therapeutic efficacy to target renal nerves in these patients.