Elevation Of Blood Pressure Levels Research Articles

Comparison of placental expression of basic fibroblast growth factor and insulin-like growth factor-1 in placentae of normal, pregnancy-induced hypertension, and preeclamptic pregnancies in Iraqi mothers

Abstract Background: Many pathological insults are associated with elevation of blood pressure levels during pregnancy resulting in a difficult pregnancy and a poor outcome on both mother and baby. Objective: In this study, we examine the histological and immunohistochemical markers of the placentae in cases of hypertension in pregnancy and preeclampsia and compared them to a placenta of normal pregnancy among a random sample of Iraqi pregnant women. Materials and Methods: Ninety women divided into three groups, 30 in each, selected with straightforward pregnancies (Group A), mothers with pregnancy-induced hypertension (Group B), and preeclamptic mothers (Group C) were chosen from the indoor patients of the gynecology and obstetrics department of Al-Khansaa teaching hospital in Mosul for placental tissues examination. Histological examination was done by using hematoxylin and eosin stain (H & E), and immunohistochemistry was achieved by using immunohistochemical markers named: insulin-like growth factor-1 (IGF-1) and basic fibroblast growth factor (b-FGF) markers, which are expressed in placental tissues. Results: Different changes were observed in the placentae affected when compared with normal one, such as syncytial knots formation, thickening of trophoblastic basement membrane, cytotrophoblastic cellular proliferation, fibrinoid necrosis, endothelial proliferation, calcified and hyalinised villous spots, villous edema, and atherosis of the uteroplacental arteries. Significant immunohistochemical changes were obtained when compared with normal placentae where elevation of both b-FGF and IGF-1 in preeclamptic placentae was observed when compared to hypertensive and control cases. Conclusion: Significant changes appeared in the placentae of hypertensive and preeclamptic mothers, both in histological and immunohistochemical examinations.

Cardiovascular Disease Prevention in Patients With Atherosclerotic Renovascular Disease-Induced Resistant Hypertension: Further Considerations for 24-Hour BloodPressure Profiles.

Cardiovascular Disease Prevention in Patients With Atherosclerotic Renovascular Disease-Induced Resistant Hypertension: Further Considerations for 24-Hour BloodPressure Profiles.

Association Between Nonoptimal Blood Pressure and Cochlear Function.

The association between hearing loss and risk factors for cardiovascular disease, including high blood pressure (BP), has been evaluated in numerous studies. However, data from population- and laboratory-based studies remain inconclusive. Furthermore, most prior work has focused on the effects of BP level on behavioral hearing sensitivity. In this study, we investigated cochlear integrity using distortion product otoacoustic emissions (DPOAEs) in persons with subtle elevation in BP levels (nonoptimal BP) hypothesizing that nonoptimal BP would be associated with poorer cochlear function. Sixty individuals [55% male, mean age = 31.82 (SD = 11.17) years] took part in the study. The authors measured pure-tone audiometric thresholds from 0.25 to 16 kHz and computed four pure-tone averages (PTAs) for the following frequency combinations (in kHz): PTA0.25, 0.5, 0.75, PTA1, 1.5, 2, 3, PTA4, 6, 8, and PTA10, 12.5, 16. DPOAEs at the frequency 2f1-f2 were recorded for L1/L2 = 65/55 dB SPL using an f2/f1 ratio of 1.22. BP was measured, and subjects were categorized as having either optimal BP (systolic/diastolic <120 and <80 mm Hg) or nonoptimal BP (systolic ≥120 or diastolic ≥80 mm Hg or use of antihypertensives). Between-group differences in behavioral thresholds and DPOAE levels were evaluated using 95% confidence intervals. Pearson product-moment correlations were run to assess the relationships between: (1) thresholds (all four PTAs) and BP level and (2) DPOAE [at low (f2 ≤ 2 kHz), mid (f2 > 2 kHz and ≤10 kHz), and high (f2 > 10 kHz) frequency bins] and BP level. Linear mixed-effects models were constructed to account for the effects of BP status, stimulus frequency, age and sex on thresholds, and DPOAE amplitudes. Significant positive correlations between diastolic BP and all four PTAs and systolic BP and PTA0.25, 0.5, 0.75 and PTA4, 6, 8 were observed. There was not a significant effect of BP status on hearing thresholds from 0.5 to 16 kHz after adjustment for age, sex, and frequency. Correlations between diastolic and systolic BP and DPOAE levels were statistically significant at the high frequencies and for the relationship between diastolic BP and DPOAE level at the mid frequencies. Averaged across frequency, the nonoptimal BP group had DPOAE levels 1.50 dB lower (poorer) than the optimal BP group and differences were statistically significant (p = 0.03). Initial findings suggest significant correlations between diastolic BP and behavioral thresholds and diastolic BP and mid-frequency DPOAE levels. However, adjusted models indicate other factors are more important drivers of impaired auditory function. Contrary to our hypothesis, we found that subtle BP elevation was not associated with poorer hearing sensitivity or cochlear dysfunction. We consider explanations for the null results. Greater elevation in BP (i.e., hypertension itself) may be associated with more pronounced effects on cochlear function, warranting further investigation. This study suggests that OAEs may be a viable tool to characterize the relationship between cardiometabolic risk factors (and in particular, stage 2 hypertension) and hearing health.

Maternal deaths due to eclampsia in teenagers: Lessons from assessment of maternal deaths in South Africa.

BackgroundEclampsia remains a major cause of maternal mortality, particularly in teenage pregnancies. Healthcare professionals providing antenatal must regard teenagers as a high risk group for the pre-eclampsia-eclampsia syndrome.SettingData extracted from the South African Saving Mothers Report: 2014–2016.AimTo establish the clinical details in teenage maternal deaths owing to eclampsia.MethodRetrospective review of the case records and maternal death assessment forms of teenagers that died due to eclampsia during 2014–2016.ResultsThere were 47 teenagers (aged 14 to 19 years) who died from eclampsia. Of these 18 out of 47 (38%) deaths occurred in the post-partum period. Forty (85.1%) of the patients had antenatal care. Three (6.4%) had post-partum eclampsia, and of the remaining 44 of the 47 (93.6%), the gestational age at first occurrence of a seizure ranged from 25 to 39 weeks. The blood pressures at the time of seizure ranged from systolic of 131 to 210 mmHg and diastolic of 89 to 130 mmHg. The commonest final causes of death were intracerebral haemorrhage associated with severe hypertension and multi-organ failure. Avoidable factors included transport delays, referral to the wrong levels of health care and poor care by health professionals.ConclusionTeenage pregnancy is a risk factor for eclampsia-related death; awareness of borderline elevations of blood pressure levels from baseline values (prehypertension levels) and taking following national guidelines on the management of hypertensive disorders of pregnancy will decrease deaths from eclampsia.

Distância percorrida em indivíduos hipertensos: estudo de corte transversal

INTRODUÇÃO: A hipertensão arterial sistêmica é uma condição clínica ocasionada por diversos fatores que acarretam na elevação dos níveis de pressão arterial de forma sustentada, sendo importante avaliar a capacidade funcional desses indivíduos, visando ter-se um diagnóstico precoce, além de ser um meio de prevenção das repercussões da hipertensão. Um dos instrumentos utilizados é o teste de caminhada de seis minutos (TC6) que é executado em nível submáximo, possibilitando a análise das respostas dos sistemas envolvidos durante as atividades. OBJETIVOS: Verificar a distância percorrida dos indivíduos hipertensos. MATERIAIS E MÉTODOS: Estudo de corte transversal, com população de hipertensos, entre 30 e 60 anos. O TC6 foi realizado de acordo com protocolo padronizado pela ATS e calculada a distância prevista através da equação preditiva de Enright e Sherrill. Foi utilizado o teste T de Student para comparação das médias de distância e calculado o percentual da diferença entre os valores percorridos e previstos. RESULTADOS: 44 sujeitos de ambos os sexosforam avaliados e observou-se média de idade de 48,80±7,08 anos, 56,8% dos indivíduos apresentaram pressão controlada, 81,8% estavam em uso regular da medicação anti-hipertensiva. A média da distância obtida nos indivíduos que alcançaram os valores previstos foi de 503±38,6 metros. Sendo que a maioria dos indivíduos percorreram em média 86,3±7,2% da distância prevista. CONCLUSÃO: Indivíduos com hipertensão arterial apresentam diminuição da distância percorrida, independente da pressão arterial estar controlada ou não.

The risk of developing cardiovascular disease in Bangladesh: does diabetes mellitus matter? Which socioeconomic status does it impact? A cross sectional study

The elevation of blood pressure levels has been recognized as a determinant of the risk for several common cardiovascular diseases. This work explores the evidence of disparities in the form of association between hypertension and diabetes mellitus in different socioeconomic statuses (SESs) at household level. A population sample of 7561 individuals aged ≥35 years from the 2011 Bangladesh Demographic Health Survey (BDHS) was used for this study. Concentration indexes are used to measure the disparities of myocardial infarction and diabetes mellitus with SES. A two-level hierarchical logit model was used to examine the effects of participants and household SES accompanied by other explanatory variables on having hypertension. Then, the analysis is stratified by SES groups to examine how the overall effect of diabetes mellitus on hypertension may vary with SES. Finally, predictive margins are determined to understand the predictive probability of diabetes and SES of having hypertension as a risk factor of developing cardiovascular disease. The descriptive summary measures of SES inequality indicate that prevalence of hypertension and diabetes was higher among high SES. The multivariate analysis covering all samples reveals that there is a strong association between diabetes and hypertension (P < .01). Likewise, after stratifying, it is evident that in high SES, there is a strong association between individuals with diabetes mellitus and hypertension development; they have around four-fold higher chance of being affected by hypertension in comparison to individuals with normal fasting plasma glucose (P < .01). Moreover, there are strong associations between individuals in low and medium SESs having diabetes and having hypertension (P < .01); the likelihood of having hypertension is almost double compared to individuals who have no diabetes. The result of this study also shed light on the chance of an increase in prevalence of hypertension in prediabetes individuals and in medium and high SES groups, although the association is statistically insignificant (P > .05). Finally, the predictive analysis reveals that the predictive margin of having hypertension is high among individuals belonging to the high SES (23%; CI, 20–23) and diabetic patients with high SES (37%; CI, 33–47). Contrary to other developed countries, hypertension in Bangladesh is prevalent among all SES, and the likelihood is high among diabetic patients in the medium and high SES. Hence, urgent preventive measures are needed to control the impending comorbidity of diabetes and developing cardiovascular disease risk.

Impact of lower range of prehypertension on cardiovascular events in a general population

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) defined blood pressure (BP) levels of 120-139/80-89 mmHg as prehypertension. The objective of the present analysis was to examine the impact of prehypertension and its population-attributable fraction for development of cardiovascular events in a general Japanese population. Two thousand, six hundred and thirty-four residents of the town of Hisayama aged at least 40 years without cardiovascular disease were followed up for 19 years. BP categories were defined using JNC7, and prehypertension was divided into the lower (120-129/80-84 mmHg) and higher ranges (130-139/85-89 mmHg). During the follow-up period, 449 participants developed cardiovascular disease (305 strokes and 187 coronary heart diseases). The frequencies of normal BP, prehypertension, and stages 1 and 2 hypertension were 24.9, 37.7, 23.8, and 13.6%, respectively. The age and sex-adjusted incidence of cardiovascular disease rose progressively with elevation of BP levels (P < 0.001 for trend). The risks of cardiovascular disease in lower and higher ranges of prehypertension were 58% [95% confidence interval (CI) 11-126%] and 70% (95% CI 18-144%) higher than normal BP even after controlling for other cardiovascular risk factors. The population-attributable fraction of prehypertension was 13.2%, which was similar to those of stages 1 and 2 hypertension. The risks of cardiovascular disease increased significantly from the lower range of prehypertension in a general Japanese population. Approximately one-third of excess cardiovascular events attributable to elevated BP levels were estimated to occur among individuals with prehypertension.

Impact of Kidney Disease and Blood Pressure on the Development of Cardiovascular Disease

Kidney disease is associated with an increased risk of cardiovascular disease (CVD); however, there have been few well-designed prospective studies of this issue in Asian populations. Recent epidemiological studies have suggested that a lower blood pressure level may be associated with an increased risk of CVD in individuals with kidney dysfunction. Using data from 10 community-based cohort studies in Japan, we conducted follow-up on a total of 30 657 individuals 40 to 89 years of age without preexisting CVD or kidney failure and examined the relationship between reduced glomerular filtration rate (GFR) and the risk of CVD. During an average 7.4-year follow-up, 727 individuals experienced CVD. The age- and sex-adjusted incidence of CVD increased significantly in subjects with GFR of 60 to 89 mL . min(-1) . 1.73 m(-2) (4.3 per 1000 person-years, P=0.002) and in those with a GFR <60 mL . min(-1) . 1.73 m(-2) (6.5, P<0.001) compared with those with a GFR >/=90 mL . min(-1) . 1.73 m(-2) (2.9). Even after adjustment for potential confounding factors, subjects with a GFR <60 mL . min(-1) . 1.73 m(-2) had a 57% (95% CI 14% to 115%) greater risk of CVD than those with a GFR >/=90 mL . min(-1) . 1.73 m(-2). The multivariate-adjusted hazard ratios of CVD increased in a log-linear manner with elevations in blood pressure levels, regardless of GFR levels (all P for trend <0.01). Our findings suggest that a reduced GFR is a significant risk factor for CVD in the general Japanese population. Additionally, a log-linear association of blood pressure level with CVD risk was observed, without evidence of a J-curve association, regardless of GFR levels.

Cadmium Exposure and Hypertension in the 1999–2004 National Health and Nutrition Examination Survey (NHANES)

IntroductionCadmium induces hypertension in animal models. Epidemiologic studies of cadmium exposure and hypertension, however, have been inconsistent.ObjectiveWe aimed to investigate the association of blood and urine cadmium with blood pressure levels and with the prevalence of hypertension in U.S. adults who participated in the 1999–2004 National Health and Nutrition Examination Survey (NHANES).MethodsWe studied participants ≥ 20 years of age with determinations of cadmium in blood (n = 10,991) and urine (n = 3,496). Blood and urine cadmium were measured by atomic absorption spectrometry and inductively coupled plasma–mass spectrometry, respectively. Systolic and diastolic blood pressure levels were measured using a standardized protocol.ResultsThe geometric means of blood and urine cadmium were 3.77 nmol/L and 2.46 nmol/L, respectively. After multivariable adjustment, the average differences in systolic and diastolic blood pressure comparing participants in the 90th vs. 10th percentile of the blood cadmium distribution were 1.36 mmHg [95% confidence interval (CI), −0.28 to 3.00] and 1.68 mmHg (95% CI, 0.57–2.78), respectively. The corresponding differences were 2.35 mmHg and 3.27 mmHg among never smokers, 1.69 mmHg and 1.55 mmHg among former smokers, and 0.02 mmHg and 0.69 mmHg among current smokers. No association was observed for urine cadmium with blood pressure levels, or for blood and urine cadmium with the prevalence of hypertension.ConclusionsCadmium levels in blood, but not in urine, were associated with a modest elevation in blood pressure levels. The association was stronger among never smokers, intermediate among former smokers, and small or null among current smokers. Our findings add to the concern of renal and cardiovascular cadmium toxicity at chronic low levels of exposure in the general population.

Hypertensive crisis profile. Prevalence and clinical presentation.

To assess the prevalence of hypertensive crisis, related clinical findings, and the organic lesions involved. This retrospective study comprised the analysis of the medical records of symptomatic patients with an elevation in diastolic blood pressure levels > or = 120 mmHg, who sought the emergency unit of a university-affiliated hospital over 12 months. Hypertensive urgency was characterized as the symptomatic elevation of blood pressure levels with no evidence of target-organ lesions, and hypertensive emergency was characterized as the symptomatic elevation of blood pressure levels with evidence of acute or ongoing target-organ lesion. This study comprised 452 patients with hypertensive crisis, accounting for 0.5% of all clinicosurgical emergencies, of which, 273 (60.4%) were hypertensive urgencies and 179 (39.6%) were hypertensive emergencies. Eighteen percent of the patients ignored their hypertensive condition. Smoking and diabetes were risk factors associated with the development of a hypertensive crisis in 1/4 and 1/5 of the patients, respectively. The patients with a hypertensive emergency were older (59.6+/-14.8 versus 49.9+/-18.6 years, p < 0.001) and had greater diastolic blood pressure (129.1+/-12 versus 126.6+/-14.4 mmHg, p < 0.05) than those with hypertensive urgencies. Ischemic stroke and acute pulmonary edema were the most common hypertensive emergencies, being in accordance with the most frequently found clinical manifestations of neurologic deficit and dyspnea. Hypertensive crises accounted for 0.5% of all emergency cases studied and for 1.7% of all clinical emergencies, hypertensive urgency being more common than hypertensive emergency. Ischemic stroke and acute pulmonary edema were the most frequent target-organ lesions in hypertensive emergencies.

Blood pressure, antihypertensive therapy and risk for renal injury in African-Americans.

African-Americans are more likely than Caucasians to develop hypertension-related end-stage renal disease. Elevations in blood pressure levels clearly potentiate pre-existing renal disease and also contribute to kidney injury independently of other primary renal diseases in this cohort. Until recently, data relevant to a full examination of the issue of blood pressure levels and end-stage renal disease in African-Americans have largely been from post-hoc analyses of clinical trials or from small, prospective, short-term studies. The most recent United States Renal Data Systems data show hypertension as the primary cause of end-stage renal disease in African-Americans until 1997, diabetes now being the most prevalent etiology. Data from post-hoc analyses of the Modification of Diet in Renal Disease study demonstrated that African-Americans with a mean arterial pressure above 98 mmHg had a higher risk of end-stage renal disease than Caucasians. The African-American Study of Kidney Disease tested the hypothesis that a blood pressure well below the usual recommended level will further reduce renal disease progression in African-Americans. The study concluded that a blood pressure lower than that needed to reduce cardiovascular events, as defined by the Sixth Joint National Committee Report on the Detection, Evaluation and Treatment of High Blood Pressure, i.e. 135-140/80-85 mmHg, will not further slow renal disease progression in African-Americans with hypertensive nephrosclerosis. Moreover, a regimen of blood pressure lowering anchored on angiotensin-converting enzyme inhibitors, antihypertensive agents that are touted as ineffective in African-Americans, was more effective than one based on either beta-blockers or dihydropyridine calcium-channel blockers in slowing the progression of renal injury. Systolic blood pressure reduction in the range 130-139 mmHg is appropriate to reduce risk of nephropathy progression and cardiovascular risk in African-Americans with hypertensive nephrosclerosis. Moreover, a regimen that is initiated with an angiotensin-converting enzyme inhibitor should be the antihypertensive treatment of choice in African-Americans with kidney disease.

The association of Mediterranean diet with lower risk of acute coronary syndromes in hypertensive subjects

Background: The elevation of blood pressure levels has been recognised as a determinant of the risk for several common cardiovascular diseases. In this work we examined the effect of Mediterranean type of diet on coronary risk in subjects with hypertension. Methods: CARDIO2000 consisted of 848 randomly selected hospitalised patients (695 males, 58±10 years old; 153 females, 65±9 years old) for first event of coronary heart disease (CHD) and 1078 paired, by sex–age, hospitalised controls without CHD. The adoption of the Mediterranean diet was assessed through a validated questionnaire developed by the National School of Public Health. Results: 418 (49%) of the patients and 303 (28%) of the controls were hypertensive. Of them 21 (5%) patients and 36 (12%) controls were unaware of their condition, 94 (22%) and 34 (11%) were untreated, 148 (35%) and 111 (36%) were uncontrolled and 155 (38%) and 122 (41%) were controlled ( P<0.01). One hundred and sixty-two (19%) of the patients and 265 (25%) of the controls ( P<0.01) adopted the Mediterranean type of diet. Our results suggest that the adoption of Mediterranean diet reduces the risk of developing acute coronary syndromes by 17% (odds ratio=0.83, 95% CI 0.73–0.88, P<0.01) in controlled hypertensive subjects, by 8% (odds ratio=0.92, 95% CI 0.87–0.95, P<0.05) in unaware, by 7% (odds ratio=0.93, 95% CI 0.88–0.95, P<0.05) in acknowledged but uncontrolled and by 20% (odds ratio=0.80, 95% CI 0.71–0.89, P<0.01) in normotensive subjects. Conclusion: According to our findings the adoption of the Mediterranean diet is associated with the reduction of coronary risk in hypertensive subjects.

Doença de Parkinson e Gravidez

A doença de Parkinson caracteriza-se por tremores, rigidez muscular, bradicinesia e instabilidade postural e da marcha. Acomete todos os grupos étnicos, sem preferência sexual, freqüentemente aos 45-50 anos. O diagnóstico é essencialmente clínico. A associação com a gravidez é rara. A experiência com o binômio é escassa, permanecendo algumas questões sem resposta. Os autores descrevem um caso de doença de Parkinson e gestação com evolução satisfatória, apesar da piora clínica na gravidez. Apresentou elevação dos níveis pressóricos, alteração das enzimas hepáticas e oligoidrâmnio. Utilizou, por conta própria, selegilina até o terceiro mês e, posteriormente, amantadina. O neonato apresentou baixo peso, desconforto respiratório e icterícia, recebendo alta, sem outras complicações, no quarto dia de vida.

Effects of hyperinsulinemia on the regulation of regional blood flow and blood pressure in anesthetized dogs: Hemodynamic role of nitric oxide

The purpose of this study was to investigate whether acute hyperinsulinemia induces selective hemodynamic effects in the mesenteric, renal, and iliac vascular beds, and to determine whether nitric oxide (NO) plays a role in the regulation of blood flow and mean arterial pressure (MAP) during acute hyperinsulinism. In eight anesthetized dogs (Group A), the response to a hyperinsulinemic test was determined before and after NO inhibition, with l-nitro-arginine methyl esther (L-NAME), during the last 45 min of the experiment. In seven dogs (Group B), NO inhibition was induced before and maintained throughout hyperinsulinemia. In Group A, the hyperinsulinemic test did not alter MAP, but induced a significant reduction in both renal and mesenteric blood flow without a significant change in iliac blood flow. In contrast, the administration of L-NAME in Group B was followed by a significant decrease in mesenteric, renal, and iliac blood flow, but mean arterial pressure remained unchanged. In this group, hyperinsulinemia instituted after the blockade of NO was followed by a significant elevation in blood pressure levels, concomitant with reductions in blood flow to the three vascular beds. In summary, acute hyperinsulinemia induced a redistribution of blood supply, which preserves skeletal muscle irrigation while reducing blood flow to the kidney. Nitric oxide participates in this redistribution because L-NAME infusion abolishes the compensatory influence on skeletal muscle blood flow.

Antisense Inhibition of the Brain Kallikrein-Kinin System

We used antisense oligodeoxynucleotide (ODN) strategy, based on interference of information flow from gene to protein, to determine the role of kininogen and bradykinin B2 receptor genes in the pathogenesis of genetic hypertension in rats. Mean blood pressure of 9-week-old spontaneously hypertensive rats (SHR) increased 4 hours after acute intracerebroventricular injection of synthetic 18-mer antisense ODNs targeting the translation initiation codon of kininogen mRNA (from 164 +/- 5 to 181 +/- 4 mm Hg, P < .01) or bradykinin B2 receptor mRNA (from 161 +/- 5 to 185 +/- 8 mm Hg, P < .01) and then returned to basal levels within 24 hours. Prolonged vasopressor effects were observed after repeated injections of antisense ODN targeting kininogen mRNA. Antisense ODNs to kininogen and B2 receptor mRNAs increased blood pressure of normotensive Wistar-Kyoto rats only slightly compared with SHR (from 116 +/- 3 to 124 +/- 1 and from 116 +/- 2 to 126 +/- 4 mm Hg, respectively; P < .05). Cardiovascular responses were confirmed by the use of antisense ODNs targeted to bind to different non-overlapping regions of kininogen or B2 receptor mRNA. Microinjection of antisense ODN to B2 receptor mRNA into the nucleus tractus solitarii increased mean blood pressure in SHR and prevented the vasodepressor effect induced by intranuclear microinjection of bradykinin. No significant change in mean blood pressure was induced in either strain by intravenous injection of antisense ODNs or by central injection of sense or scrambled ODNs. A strong fluorescent signal was detected at the level of the hippocampus, thalamus, hypothalamus periventricularis, midbrain, and cerebrum 1 hour after central injection of fluorescein isothiocyanate-conjugated antisense ODNs. Kininogen levels were significantly lower in the brain of rats given intracerebroventricular antisense kininogen ODN compared with controls. Our results indicate that the brain kallikrein-kinin system plays a role in the central regulation of blood pressure and suggest that this system may exert a protective action against further elevations of blood pressure levels in SHR.