Factor In Development Of Hypertension Research Articles

Role of Insertion/Deletion Polymorphism for Angiotensin Converting Enzyme Gene in Hypertension

Insertion/deletion polymorphism of the angiotensin converting enzyme (ACE) gene is a key component of the Renin-Angiotensin-Aldosterone System (RAAS). It has been proposed as an independent factor for hypertension and other cardiovascular diseases. Consequently, it has been extensively studied in various populations. The aim of this study is to investigate I/D polymorphism of ACE gene and its connection to hypertension in population of Tuzla Canton (Bosnia & Herzegovina). The study included 60 hypertensive subjects and 60 healthy control subjects with no risk factors for hypertension. I/D polymorphism was genotyped by polymerase chain reaction followed by gel electrophoresis and data obtained were statistically analysed using Chi square test. Odd’s ratios were calculated with a 95% confidence interval. P-value < 0.05 was considered significant. Odd’s ratios were calculated with a 95% confidence interval. P-value <0.05 was considered significant. Higher frequency of genotype D/D and allele D was determined in subjects with hypertension compared to control subjects but there is no statistical significance (p>0.05). However, statistically significant association was found in compared groups of subjects with genotypes DD + ID, in regards to genotype I/I (p<0.05). The results indicate the conclusion that ACE I/D polymorphism cannot be considered the main risk factor for development of hypertension, but its influence should be investigated together with other genetic and acquired risk factors that are associated with hypertension. This research contributes to the on-going exploration of molecular-genetic associations with hypertension.

A study on assessment of correlation between obesity and blood groups among school children of Gujarat, India

Background: Obesity is a positive risk factor in development of hypertension, diabetes, gallbladder diseases, coronary heart diseases, and few types of cancers. Body mass index (BMI) is an inexpensive and easy screening method for weight category: Underweight, healthy weight, overweight, and obesity. Only a few studies have been conducted until now which focuses on finding any relationship between BMI and blood group of school going children. Aims and Objectives: The aims of this were as follows: (a) To find out BMI in school children of study center and (b) to find out correlation of BMI with blood groups and other variables of participants. Materials and Methods: It was a cross-sectional study conducted among 101 children of school going age group 10–15 years at one of the private schools of Ahmedabad, Gujarat. A questionnaire was prepared which included sections of demographic details, blood group, diet history, and family history. Results: About 50% of participants were from of either age 13 or 14. There was almost same proportion of participants of both sexes. About 70% of participants were found to be underweight, while about 15% were overweight. Overweight category of BMI is most commonly seen in children having blood group “A” while no child of “O” blood group was found to be overweight. This association was statistically significant. Conclusion: Almost 70% of participants were underweight, while about 15% were overweight. Overweight was most commonly seen in children having blood group “A.” No child of “O” blood group was found to have overweight.

High-normal blood pressure in midlife is a stronger predictor for development of hypertension in women than in men

Abstract Background Identification of modifiable risk factors in midlife may optimize prevention of hypertension. Sex differences in the multifactorial development of hypertension is not well understood. Purpose To explore the associations of health factors in midlife, with incident hypertension 26 years later, in women and men. Methods In the community-based Hordaland Health Study (HUSK) 1025 women and 703 men were examined at age 42 years (baseline) and re-examined after 6 and 26 years. Patients with hypertension at baseline were excluded. Attended blood pressure (BP) was measured in triplets. High-normal BP was identified as BP 130–139/85–89 mmHg. Incident hypertension was identified as BP ≥140/90 mmHg or patient reported use of antihypertensive drugs on the last study visit. The association of health factors at baseline and changes during midlife, with incident hypertension at follow-up were explored in sex specific multivariable logistic regression analyses. Models were adjusted for baseline body mass index (BMI), high-normal BP, heart rate, physical activity, daily smoking, education, serum cholesterol, and serum triglycerides. Results are presented as odds ratios (OR), 95% confidence intervals (CI) and p-values. Results At baseline, average BP was 119/73 mmHg in women and 126/76 mmHg in men (p<0.001). A high-normal BP was found in 26% of women and 47% of men (p<0.001). After 26 years of follow-up, 39% of women and 45% of men had developed hypertension (p<0.05). In multivariable logistic regression analyses, high-normal BP at baseline, was the strongest predictor of incident hypertension in both sexes, but significantly stronger in women (OR 4.8, 95% CI 3.4–6.9) than in men (OR 2.1, 95% CI 1.5–2.8), p<0.01 for sex interaction (Table 1). Increase in BMI from first to second study visit was significantly associated with incident hypertension in both sexes (both p<0.01). And an increase in serum triglycerides from first to second visit was significant only in women (p<0.05). Conclusions High-normal BP in midlife was a particularly strong risk factor for development of hypertension later in life and significantly stronger in women. An increase in BMI in midlife was associated with incident hypertension but did not differ between sexes. Awareness of sex differences in modifiable health factors in midlife enable improved prevention of hypertension. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): University of Bergen

Association of body mass index with systolic and diastolic blood pressure in rural Indians

Abstract Funding Acknowledgements Type of funding sources: None. Background Body mass index (BMI) is positively and independently associated with morbidity and mortality from hypertension, cardiovascular disease, type II diabetes mellitus, and other chronic diseases. In Caucasian and Asian populations, a strong association has been depicted between BMI and mortality. Globally, high blood pressure is estimated to cause 7.1 million deaths, about 13% of the total. About 62% of cerebrovascular disease and 49% of ischemic heart disease are attributable to suboptimal BP (systolic > 115 mm Hg). Overweight and obesity increase the risks of high BP, coronary heart disease, ischemic stroke, type II diabetes mellitus, and certain cancers. Worldwide, about 58% of diabetes mellitus and 21% of ischemic heart disease are attributable to BMI above 21 kg/m2. The combination of blood pressure and Body Mass Index (BMI) contribute more than 60% cases of cardiovascular disease. Purpose The main objective was to determine the correlation between BMI and systolic and diastolic blood pressure of rural Indian patients. Materials and Methods 310 patients who visited our hospital in rural India from January 15,2021 to February 15,2021 were included in this study and their systolic and diastolic blood pressure, weight and height were measured. BMI was calculated by weight in kilograms divided by square of height in meters. Using this, the patients were categorized as underweight (<18.5 kg/m2), normal or lean BMI (18.5–22.9 kg/m2), overweight (23.0 –24.9 kg/m2) and obese (≥25 kg/m2) based on the revised consensus guidelines for India. Descriptive analysis and Spearman correlation test were used to analyze the data. Results The results of the bivariate analysis using Spearman correlation test showed that there is significant relationship between BMI and systolic blood pressure (p < 0.001, r = 0.375) as well as BMI and diastolic blood pressure (p <0.001, r = 0.432). This study shows that as BMI increases both systolic and diastolic blood pressure increases. Conclusion This study shows statistically significant relationship between Body Mass Index (BMI) and systolic and diastolic blood pressure in rural Indian patients. Weight gain seems to be an important risk factor for development of hypertension. Weight loss has been recommended for obese hypertensive patients and has been shown to be most effective non pharmacological treatment approach. Physical activity and caloric restriction should be promoted to control the obesity epidemic which will significantly reduce global cardiovascular disease burden.

Telomere length and uric acid in patients with new cases of hypertension according to the 10-year prospective study in urban randomized population

Abstract Objective To reveal the association between lymphocyte telomere length and serum uric acid level in 10-year prospective randomized study of Belarusian urban population. Design and method In 2007/2008 a 10-year prospective study of 3500 persons living in a district of a belarussian city and selected by the random number method started (coverage of the survey was 97.9%). In 2012/2013 according to the results of the second screening 2888 people were examined (coverage of the survey was 84.3%). A 10-year prospective analysis was provided in 2017/2018 and included 145 randomized subjects with hypertension diagnosed in the second screening. Examination of these patients consisted of standard cardiovascular risk factors questionnaires, measurements of blood pressure, blood chemistry, electrocardiography, echocardiography, ultrasound examination of brachiocephalic vessels, real time PCR for the detection of telomere length of peripheral blood lymphocytes. Results 2171 persons with normal blood pressure and 1257 persons with hypertension were examined in 2007/2008. In the second screening we established 286 new cases of hypertension (14,4% of men and 12,2% of women). According to multifactorial regression analysis, adjusted for age and sex, a significant positive relationship between new cases of hypertension and IV quartile of uric acid level (339–527 μmol/l) was revealed in 5 years (df=1; χ2 Wald=5,1; p<0,05). Regression analysis of 145 randomized subjects of 286 new cases of hypertension showed that, adjusted for age and sex, the IV quartile of uric acid level (339–527 μmol/l), determined in the first screening, was also associated with the I quartile of telomere length in 10 years (df=1; χ2 Wald=4,5; p<0,05). It was investigated that the level of telomere length had a significant negative association with BMI (p<0.05), R wave in aVL (p<0.05), IL-6 level (p<0,05) in these subjects in cross-sectional study in 2017/2018. Conclusions Regardless of age and sex, level of serum uric acid ≥339 μmol/l was a risk factor for development of hypertension in randomized population in 5-year prospective analysis and predicted lower telomere length in patients with new cases of hypertension in 10-year prospective analysis. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): State scientific and technical program “Medical and diagnostic technologies”, subprograms “Heart and blood vessels”

Serum uric acid levels in essential hypertension and its correlation with the severity of hypertension

Background: Serum uric acid has been closely linked and considered as an independent risk factor for development of hypertension. This study was carried out to assess the serum uric acid levels in essential hypertension and its correlation with the severity and known duration of hypertension.Methods: The present observational case control study was conducted between November 2019 to February 2020 on total 100 out patients (30-65 years) of which 50 known cases of essential hypertension irrespective of treatment status and were graded into different stages of hypertension as per Joint National Committee VII (JNC VII) guidelines. Rest 50 patients who were age- sex matched and without any co-morbidity were included as control. Relevant clinical and laboratory data were recorded using proforma. Statistical analysis was done using Statistical package for social software (SPSS) software.Results: Mean systolic/diastolic blood pressure (BP) was found significantly higher in cases 168/102 mmHg compare to control 114/74 mmHg. Among cases maximum patients were found in stage 2 hypertension which has significant difference in mean systolic/diastolic BP (186/112 mmHg, p<0.001) compare with stage 1 (146/94 mmHg) and isolated hypertensive patients (148/85 mmHg). Serum uric acid levels were significantly higher in stage 2 than other two hypertensive stages among cases and also compare to controls. Patients with >5 years of hypertension also has significant high serum uric acid level than <5 years of hypertension.Conclusions: Serum uric acid can be used probably as an early biochemical marker to determine the severity of hypertension as stage 2 hypertensive had more elevation in serum uric acid levels as compared to other hypertensive patients.

Effect of night duties on blood pressure of healthy female nursing staff

Background: Hypertension is one of the most common non-communicable diseases worldwide. 1.13 billion people world-wide are suffering from hypertension. Hypertension increases risk of Cardiac, central nervous system, and renal diseases. Staff engaged in shift duties, which disturbs their circadian rhythm, is more prone for non-communicable diseases. Hospitals employ more nightshift workers than any other industry which may be a cause of health hazard in hospital workers. Aim and Objectives: The aim of the study was to determine the effect of night shift and day shift duties on blood pressure (BP). Materials and Methods: An evaluation study with 35 healthy female nurses is undertaken to study the changes and correlation of BP in day and night shift. Healthy female nurses of age group 20–30 years, working on shift basis in Victoria Hospital, Bengaluru, were chosen considering inclusion and exclusion criteria. Selected subject’s anthropometric measurements were taken to calculate body mass index. BP was recorded every day morning for 5 days as soon as their night shift is done and BP was recorded again on same subject during evening times at the end of their day shift. Both the readings were statistically analyzed. Results: The mean systolic BP and diastolic BP were statistically high after a night shift duty when compared to their BP after day shift duty with P < 0.001. Conclusion: Our study has shown a correlation of elevated BP with night shift duties in female nurses. This could be a predisposing factor for development of hypertension in the later stage. To reduce this impact on night shift workers, duties of the nurses can be spaced well with organized intervals between day and night duties.

Idiopathic hypercalciuria presents: a precocious marker of osteoporosis

Epidemiological studies in the last ten years have provided that nephrolithiasis is a risk factor for development of hypertension and have higher prevalence of diabetes mellitus and some hypertensive and diabetic patients are at greater risk for stone formation in connecting with altered calcium homeostasis; likewise in these last ten years, the deficit of zinc in the serum has been associated with the diabetes mellitus and another illnesses as: hipogonodism, Cushing Syndrome, celiac illness, and renal inadequacy, that propitiate to any age the osteoporosis appearance. It was used the creative idea as analysis method of data, applying the comparison by analogy between the well-known alterations of the homeostasis of the calcium and of the zinc, and those that can take place for the interaction among them. Review the data from the selected literature by this way, shows that, as conclusions: The event idiopathic calcium oxalate nephrolithiasis it is concomitant with the idiopathic hypercalciuria; the oxidative stress may be identifying by the presence of a direct correlation in the urine between the increments of calcium (hypercalciuria) and of zinc (hyperzincuria); the presence of idiopathic hypercalciuria it may be constitutes a precocious marker of the osteoporosis.

P5463Hyperfiltration could be a risk factor for development of hypertension: A five-year cohort study

Abstract Background Some recent studies showed that hyperfiltration is a risk for cardiovascular disease. However, the mechanism is still unknown. This longitudinal study tested the hypothesis that hyperfiltration could be a risk for hypertension. Methods This study retrospectively included Japanese healthy adults between 30 and 85 years of age who had medical check-up at our Center for Preventive Medicine, both at enrollment (2004) and at 5-year follow-up (2009). We excluded the subjects with hypertension, diabetes mellitus, dyslipidemia, hyperuricemia, or chronic kidney disease (estimated glomerular filtration &lt;60 mL/min/1.73 m2) at the baseline. We divided this study subjects into three categories of eGFR (60–80 (reference), 80–100, and 100≤mL/min/1.73 m2), and defined hyperfiltration as more than 100 mL/min/1.73 m2 of eGFR. We used logistic regression analyses to examine risk factors for development of hypertension with multiple adjustments for age, sex, smoking, drinking habits, body mass index, and eGFR categories. Results In this study, 6045 subjects without comorbidities (mean age of 47±10 years, 1,842 men) were followed for 5 years. Of those, 450 subjects had developed hypertension. After multiple adjustments, hyperfiltration is a risk for development of hypertension (OR: 1.374; 95% confidence incidence (CI), 1.013–1.864), as well as aging (OR: 1.063; 95% CI, 1.052–1.073), higher BMI (OR: 1.244; 95% CI, 1.200–1.289), and drinking habits (OR: 1.387, 95% CI, 1.117–1.721). Conclusion Hyperfiltration carries a significant risk for developing hypertension in Japanese individual without comorbidities. We should take account for hyperfiltration as a risk for hypertension, as well as chronic kidney diseases.

Abstract P324: Role of GABAergic Signaling in AgRP Neurons in the Dipsogenic and Metabolic Responses to Brain Angiotensin

Obesity is a major risk factor for development of hypertension, and evidence supports a role for the suppression of resting metabolic rate (RMR) in the development and maintenance of obesity. Angiotensin II (ANG) AT1A receptors, localized to cells expressing the leptin receptor and Agouti-related peptide (AgRP) within the arcuate nucleus of the hypothalamus (ARC), are involved in transcriptional control of AgRP and γ-aminobutyric acid (GABA) synthetic genes ( Gad65 , Gad67 , Slc32a1 ) within the ARC, as well as the integrative control of thermogenic sympathetic nerve activity (SNA) and RMR responses in vivo to various stimuli including leptin and high fat diet. These data led us to hypothesize that AT1A functions to suppress GABA signaling in AgRP neurons, ultimately to disinhibit SNA and RMR. Treatment of cultured mouse hypothalamic N43/5 cells (which express endogenous Agtr1a , AgRP and Gad67 ) with 100 nM ANG for 1 hour (n=6) resulted in reduced AgRP (0.57-fold of control, p=0.03) and Gad67 (0.72-fold of control, p=0.09) mRNA. Mice with targeted disruption of Slc32a1 (vesicular GABA transporter; VGAT) in AgRP neurons (VGAT AgRP-KO mice) were generated on a mixed background. Compared to littermates (male n=9-17, female n=7-8), VGAT AgRP-KO mice (male n=8-13, female n=2-3) at 8 weeks of age exhibited normal body mass (genotype p=ns, sex p&lt;0.05, interaction p=ns), no changes in food intake (genotype p=ns, sex p=ns, interaction p=ns), but a sex-dependent genotype effect on fluid intake was observed (male con 4.5±0.3 vs KO 5.1±0.4; fem con 5.1±0.4 vs KO 3.7±0.6 mL/d; interaction p&lt;0.05). A preliminary study of male mice instrumented for chronic infusion of ANG (5 ng/hr, 21 days icv) was also performed. This caused modest increases in drinking (con+aCSF n=7, 3.3±0.8, con+ANG n=4, 5.2±1.0, KO+ANG n=3, 7.9±1.1 mL/d, p&lt;0.05) but no change in energy efficiency (11.2±2.9, 11.3±3.5, 10.1±4.1 mg/kcal), indicating no change in energy expenditure, possibly due to the mixed background of this strain. We conclude that ANG acts at AgRP cells of the ARC to suppress GABA and AgRP signaling, and this contributes to energy and fluid homeostasis in a complex, strain- and sex-dependent manner.

PP.11.04] THE ROLE OF SERUM URIC ACID IN DEVELOPMENT OF HYPERTENSION IN THE BELARUSIAN URBAN POPULATION

Objective: To analyze the role of serum uric acid levels in development of hypertension in a large adult population using the data from Belarusian national representative survey. Design and method: A 5-year prospective analysis included 3500 individuals in a district of Vitebsk in 2007/2008 (coverage of the survey was 97.9%), 2010/2011 (coverage of the survey was 77.8%) and 2012/2013 (coverage of the survey was 84.3%). Hypertension was evaluated according to the WHO/ISH (1999). The survey included standard questionnaires for detection of cardiovascular risk factors, measurements of blood pressure, electrocardiography, serum uric acid and C-reactively protein, cholesterol data. Results: We examined 2170 persons with normal blood pressure and 1257 persons with hypertension. Men and women were similar of mean age. In 5 years 285 new cases of hypertension developed (16.4% of men and 13.6% of women). There was revealed significant positive association between IV quartiles of serum uric acid level (339–527 mmol/l) and the frequency of new cases of hypertension adjusted for age and sex (df = 1; X2Wald = 5,1; p < 0,05). According to multifactorial regression analysis high uric acid level (>338 mmol/l) (p < 0.001) the same as systolic blood level (> 120 mmHg) (p < 0.001), high body mass index level (>25.7 kg/m2) (p < 0.001), high level of the amount of ECG peaks (SV1 + RV5 − V6 > 25 mm) (p < 0.001), moderate increase in body mass index (23,7 kg/m2 < BMI < = 25,7 kg/m2) (p < 0.001), high level of heart rate (>70 beat/min) (p < 0.01), alcohol abuse (p < 0.01), family history of stroke (p < 0.05) are the most significant factors affecting the frequency of new cases of hypertension in the studied population. At the same time the level of serum uric acid was associated with male sex (p < 0,001). And there was no relation between serum uric acid and other risk factors. Conclusions: The serum uric acid level is an independent risk factor for development of hypertension in the Belarusian urban population associated with male sex.

Genetic and environmental factors in development of hypertension.

Genetic and environmental factors in development of hypertension.

Dietary L-arginine intake and the incidence of coronary heart disease: Tehran lipid and glucose study.

BackgroundWe investigated the association of regular dietary intake of L-arginine and both the incidence of coronary heart disease (CHD) and changes of blood pressure.MethodsEligible adults (n = 2284) who participated in the Tehran Lipid and Glucose Study were followed for a mean of 4.7 years. Dietary intake of L-arginine was assessed at baseline (2006–2008); biochemical variables were evaluated at baseline and the follow-up examination. Multivariate Cox proportional hazard regression models adjusted for potential confounders were used to estimate the risk of CHD across tertiles of L-arginine intake. Linear regression models were also used to indicate the association of L-arginine intake with changes of serum lipids and blood pressure during the follow-up.ResultsMean age of participants (42.8 % men) was 38.2 ± 13.4, at baseline. During a mean 4.7 ± 1.4 y of follow-up, 57 participants experienced CHD events. A significant negative association was observed between plant-derived L-arginine intake and changes of both systolic and diastolic blood pressure, whereas animal-derived L-arginine intake was related to increased levels of diastolic blood pressure (P < 0.01). Participants in the 2nd tertile (1.45–1.78 g/d) had a significantly increased risk of CHD events compared to the participants in the 1st tertile (<1.45 g/d) (HR = 1.90, 95 % CI = 1.03–3.58). The risk of CHD had a decreasing trend across increasing plant-derived L-arginine intake (HR = 1.0, HR = 0.91, 95 % CI = 0.51–1.62, HR = 0.72, 95 % CI = 0.39–1.32, P for trend = 0.03).ConclusionHigher intake of plant derived L-arginine may have a protective effect whereas animal-derived L-arginine may be a risk factor for development of hypertension and CHD events.

Utility of Placental Laterality and Uterine Artery Doppler Abnormalities for Prediction of Preeclampsia

To find out whether placental laterality and abnormal uterine artery waveform and resistance index, as determined by antenatal ultrasonography and Doppler, can be used as a predictor for the development of preeclampsia. This prospective observational cohort study was conducted from August 2013 to October 2014. Two hundred and one (201) normotensive, primigravida women with singleton pregnancies attending the antenatal clinics without any high-risk factor for development of hypertension were subjected to ultrasonography at 18-22weeks of gestation to determine the placenta location. All the subjects with lateral placentas were subjected to Doppler ultrasonography to look for abnormal Doppler waveform and resistance index. They were followed for the development of preeclampsia till 40weeks of gestation or delivery. Out of the total 201 women, 71 (24.5%) had laterally located placentas and of them 37 (52%) developed preeclampsia, while the remaining 130 (75.5%) had centrally located placentas and of them 14 (10.8%) developed preeclampsia (p<0.001). In subjects with lateral placentas alone (n=33), 2 (6%) developed preeclampsia while as those with lateral placentas with Doppler abnormality (n=38), 35 (92%) developed preeclampsia (p<0.001). The overall risk of developing preeclampsia with laterally located placenta was 9.27 (odds ratio), and 95% confidence interval was (4.30-19.98). Pregnant women with lateral placentas are at significant risk for development of preeclampsia. Lateral placentas when associated with uterine artery Doppler abnormality, risk for development of preeclampsia increases significantly as compared to lateral placentas alone.

Ubiquitous Salt: Mineral to Now Watch Out For

Background: As per the WHO global status report on Non Communicable Diseases, the South East Asian region has been found to have 36% adults who are hypertensive. Epidemic of hypertension is touching epic proportions today, with even children and adolescents being affected Studies highlight that excess salt consumption is a significant risk factor for development of hypertension. It has been found that consumer knowledge to a large extent influences salt consumption thus; there is a need to clarify the role of salt and beliefs in relation to its usage within the population. With this background it was decided to carry out an assessment of knowledge, attitude and practice of salt consumption in a representative sample of individuals in an urban community. Methods: The survey was a descriptive study based on a validated salt knowledge assessment questionnaire administered to 405 individuals. Results: 88.9% individuals felt that high quantities of salt can damage health. 53.3% individuals were aware of the quantity of salt that is considered optimum 57.8% had a habit of sprinkling salt over food and 86.7% got their blood pressure checked regularly. Conclusion: Despite being educated large gaps in knowledge and practice still exist in the society. Until the time when there is widespread availability of food products with lower amounts of salt, active participation from consumers will be required to reduce the salt in their diet Awareness generation is the need of the hour with a holistic approach targeting the children also.

Altered cardiovascular autonomic function in young normotensive offspring of hypertensive parents - Is obesity an additional risk factor?

A study was undertaken to analyze the nature and magnitude of autonomic dysregulation that starts early in the offspring of a hypertensive parent and also whether obesity in them add an additional risk for future hypertension. Forty normotensive subjects aged 18-25 years with at least one hypertensive parent constitute the study group. The study group was divided into obese and non-obese depending on their body mass index (non-obese with BMI 18.50-24.99 kg/m2; obese with BMI≥30 kg/m2). Twenty age-matched normotensive, without parental history subjects constitute the control group. Anthropometric parameters, heart rate, systolic and diastolic pressures were recorded. Heart rate variability indices like total power, LF, HF, LF/HF, SDNN, RMSSD, and PNN50% were studied. One-way ANOVA was used for simultaneous multiple group comparison followed by post hoc Tukey's test for groupwise comparison. The Pearson correlation coefficient was used to assess the relationship between BMI and other variables. Subjects who were obese with parental history of hypertension showed significantly higher heart rate, diastolic blood pressure, LF, LF/HF ratio and reduced total power, HF, SDNN, RMSSD, and PNN50% compared to the other groups with normal BMI. HF and all the time domain indices showed negative correlation and LF a positive correlation with BMI. In the obese offspring of hypertensive parents, HRV markers, which represent a vagal dominance were reduced substantially, and indices of sympathetic activity were increased. So obesity in a normotensive offspring of a hypertensive parent is an additional risk factor for the future development of hypertension as it further dysregulates the autonomic control of the heart.

Factors affecting blood pressure profile in pre and postmenopausal women with obstructive sleep apnea hypopnea syndrome.

Obstructive sleep apnea hypopnea syndrome (OSAHS) is an independent risk factor for development of hypertension. Epidemiological surveys have found that risk of cardiovascular diseases increased in postmenopausal women. However, it is not well known about the profiles of hypertension of women with OSAHS in their different reproductive stages. This study aimed to investigate the difference of blood pressure profile between pre and postmenopausal women with OSAHS. Women who were tested by polysomnography (PSG) (n = 207) in Ruijin Hospital were recruited in the study. The subjects were divided into two groups of premenopausal women (24 with and 30 without OSAHS), and two groups of postmenopausal women (116 with and 37 without OSAHS). Among the groups, the differences of demographic and PSG variables were compared. The factors influencing blood pressure were further studied. The prevalence of hypertension (56.9%) in postmenopausal OSAHS patients was higher than the other three groups. Among OSAHS patients, both average systolic blood pressure (SBP) and diastolic blood pressure (DBP) of postmenopausal women were higher than those of premenopausal ones [(129.9 ± 16.16mmHg vs. 123.7 ± 18.89), (84.96 ± 9.88mmHg vs. 78.81 ± 10.34), P = 0.05, P < 0.01, respectively], with the elevation of DBP being more pronounced. For premenopausal women, body mass index (BMI) was the only factor affecting blood pressure (p < 0.05); in postmenopausal women, BMI was a factor affecting SBP, while BMI and apnea hypopnea index (AHI) affecting DBP (P < 0.05). Blood pressure profile of postmenopausal women with OSAHS was affected by both BMI and AHI. But those of premenopausal ones were predominantly related to BMI.

CARDIOVASCULAR RESPONSES TO AUTONOMIC STRESSORS IN YOUNG ADULTS BELONGING TO HYPERTENSIVE FAMILY

Hypertension is major risk factor for cardiovascular disease as well as stroke. In present era , stress leads to autonomic dysfunction; which act as aggrev ating factor for development of hypertension. The present study was carried out in 1 st year medical students. To assess the effect of stressors, we have studied change in Mean Blood Pressure (MBP) and Heart Rate (HR) by i nducing autonomic stressors by cold pressure test and Valsalva maneuver in young healthy adults as indicat or of autonomic dysfunction in hypertensive family as well as non hypertensive family. On the basis of present study the offs pring of hypertensive parent may be advocated to change or bring modification in their lifestyles, to prevent or delay hypertension at a later stage in their life.

Sex-specific effects of low protein diet on in utero programming of renal G-protein coupled receptors.

Intrauterine growth restriction (IUGR) is an important risk factor for development of hypertension, diabetes and the metabolic syndrome. Maternal low protein (LP) intake during rat pregnancy leads to IUGR in male and female offspring, although females may be resistant to the development of effect. Current evidence suggests that changes in the renin-angiotensin system (RAS) in utero contribute to this programmed hypertension, via sex-specific mechanisms. The previously orphaned G-protein coupled receptor (GPR91) was identified as a central player in the development of hypertension in adult mice, through a RAS-dependent pathway. However, whether the GPR91 pathway contributes to fetal programming is unknown. Furthermore, the nature of involvement of downstream modulators of the RAS including Gqα/11α and GαS has not been investigated in IUGR-LP rats. Therefore, we postulated that renal GPR91, in conjunction with RAS, is differentially impacted in a sex-specific manner from LP-induced IUGR rats. Pregnant Wistar rats were fed control (C, 20% protein) or LP (8% protein) diet until embryonic day 19 (E19) or postnatal d21. At E19, GPR91 protein and mRNA were increased in both male and female LP kidneys (P<0.05), whereas renin and angiotensin converting enzyme (ACE) were only increased in males (P=0.06 and P<0.05, respectively). On d21, AT1R and Gqα/11α were increased in LP males, while in LP females, AT2R protein was elevated and renin expression was decreased (P<0.05). This study demonstrates that in IUGR-LP rats, up regulation of GPR91 in fetal kidney is mirrored by increased ACE and renin in males. These in utero alterations, when combined with postnatal increases in AT1R-Gqα/11α specifically in male offspring, may predispose to the development of hypertension.

Biobanks: understanding chronic diseases in their complexity

The concept of biobanks can well be explained through the example of SAPALDIA cohort study which involves multicentric collection and central storage of blood, plasma, serum, buffy coat and DNA extracts. Personalized medicine through genomic sequencing and genetic risk profiling is very much a possibility with the publication of genome-wide associations. Even though access to complete genome sequencing is technically feasible the clinical utility and relevance of DNA sequencing is still very poorly understood and it should not be assumed that research will provide answers quickly. Genomics helps in the study of gene-environment interactions thus contribution to insights in genetic epidemiology. But genetic testing can also be a motivating factor for behavioural change. Limitations in environmental epidemiology of chronic diseases has left several gaps in understanding the causality of risk factors, etiological pathways and shared pathways. The environment and lifestyle varies over time, exposures are difficult to measure and susceptibilities have been ignored in the past. Biobanking and genomic studies are important in understanding the pathways by which risk factors and behaviours result in chronic diseases in a particular environmental context. The exposome concept refers to the exposures of an individual over a lifetime and the relation of these exposures to health. The exposome changes throughout life as our bodies, diets and lifestyles change. Measurement of exposures and their effects are important in describing the exposome and understanding the interaction between environmental exposures and genetic and epigenetic mechanisms. The use of biomarkers to determine exposures, effect of exposures, disease progression and susceptibility factors are common to the “omics” technologies of genomics, transcriptomics, proteomics and metabonomics. A blood or urine sample taken from an individual could provide a snapshot of what that person has been exposed to. The metabolic profile thus potentially reflects the interactions between the exposome and genome with the ability to provide insights into causal pathways of complex, chronic diseases. Metabonomics refers to the study of metabolic responses to environmental changes, drugs, genetic modifications and it involves measurement of small molecular weight compounds which may act as regulatory signals in the biological system. Examples of metabonomic studies include the INTERMAP study which is a multi-centric investigation into the role of dietary factors in development of hypertension in adults. Study populations differ by ethnicity, diet, diet-related major cardiovascular risk factors and prevalence of hypertension/coronary heart disease/stroke. Another study involving identification of urinary metabolites suggests well differentiated metabolic phenotypes. Most discriminatory metabolites are of dietary origin or gut microbial co-metabolites. Candidate biomarkers emerging from other studies include formate for blood pressure, proline-betaine as a marker for citrus consumption and C-Reactive protein as a marker in the pathway of coronary heart disease. In addition several genetically determined metabolic phenotypes are also being identified. The expected benefits from studying exposomes and biomarkers include decreased exposure misclassification , identification of early disease markers , assigning causality, identification of determinants of susceptibility and the understanding of biological mechanisms . Complex chronic diseases can be studied through biomarkers of susceptibility, exposure and disease. Understanding the differential burden of chronic diseases and risk factors across different ethnic, cultural and geographic settings through biomarkers can improve the causal understanding. Establishing mega cohorts and international cohorts can help better understanding of lifestyle, environment, biomarkers and diseases through proper networking. They provide important policy inputs, maintain and strengthen competitive research, help scientific and technological advancement in addition to funding and job opportunities.