Increase In Blood Pressure Values Research Articles

Conditional over-expression of heme-oxygenase 1 in myelomonocytic cells reduces AngII-induced hypertension and vascular inflammation in mice

Abstract Background Systemic arterial Hypertension is one of the most important risk factor responsible for morbidity and mortality world-wide. Angiotensin II (Ang II), a potent vasoconstrictor and key player in the renin-angiotensin-aldosterone system (RAAS) is responsible for vascular dysfunction, inflammation, and tissue damage. Heme oxygenase-1 (HO-1) overexpression may confer antioxidant and anti-inflammatory properties in Ang II-induced hypertension through its action on heme catabolism, generating carbon monoxide (CO), ferritin and biliverdin/bilirubin by the action of biliverdin reductase A (BLVRA). Methods and results Male 9–12-weeks-old HO-1indxLySMCre/wt and LySMCre/wt mice were infused with AngII (1mgAngII/Day/Kg) for 7 days to induce hypertension and compared to sham treatment. Blood pressure monitoring by tail-cuff method, and endothelium-dependent vasodilator studies via organ chamber system using acetylcholine (ACh) in isolated aortic segments (~4 mm), revealed that overexpression of HO-1 in myeloid cells resulted in decreased systolic blood pressure and improved endothelial function in AngII-infused HO-1indxLySMCre/wt mice compared to controls. Concurrently, increased BLVRA expression in liver tissue and elevated plasma bilirubin levels were detected by transcriptome analysis and high-performance liquid chromatography, respectively. These results were supported by a reduction in the expression of inducible cytokines and cell adhesion molecules (CAMs) in the aorta, assessed using qPCR. Bone marrow transplant experiments demonstrated that bone marrow from LysMcre mice in HO-1indxLySMCre/wt mice abrogated the protective effect of HO-1, resulting in endothelial damage and increased blood pressure, potentially due to decreased liver BLVRA expression and the accumulation of bone marrow-derived cells in the vessel wall in response to AngII. Additionally, adeno-associated viral vector (AAV) transfection targeting specifically BLVRA activity in liver lead to an increase in blood pressure values and worse endothelium relaxation, in parallel with higher oxidative stress and the blood neutrophils concentration, as assessed in whole blood by using oxidative burst method and blood count system respectively. Conclusion The overexpression of HO-1 in myeloid cells confers anti-inflammatory protection in AngII-induced arterial hypertension in mice. Myeloid cells bone marrow-derived overexpressing HO-1 regulate the differentiation and infiltration of pro-inflammatory immune cells in the vasculature. BLVRA expression and bilirubin levels downstream of HO-1 play a critical role in protecting against vascular damage by reducing leukocyte infiltration.

CARDIOGENIC SHOCK IN A PATIENT WITH SEVERE AORTIC VALVE STENOSIS AND MULTIVESSEL CORONARY DISEASE: ADVANCED THERAPEUTIC STRATEGIES

Abstract We describe a case of a 58 years old man. He was referred to emergency room for episodes of vomiting and epigastric pain for about a week. Upon admission he was confused with systolic–diastolic blood pressure values ​​70/40 mmHg, heart rate 120 bpm, sinus rhythm. pO2 was 80 mmHg and SO2 in air 97%. Lactate values 10, blood sugar > 300 mg/dl. The electrocardiogram showed sinus tachycardia with the results of antero–septal necrosis and incomplete left bundle branch block. The fast echocardiogram showed a dilated left ventricle with severe depression of the ejection fraction (EF about 10–15%), severe low flow–low gradient aortic valve stenosis (AVA bidimensional was approximately 0.9 cm²), severe mitral valve insufficiency due to a dual mechanism. The dimension of Inferior vena cava was 1.5 cm, collapsible. There was thrombotic stratification in the apex of the left ventricle and VA coupling was 2. The patient was admitted to the ICU with stage C cardiogenic shock according to SCAI classification. We found a value of PVC 3 mmHg. After fluide challenge there was an increase in blood pressure values to 100/60 mmHg. Noradrenaline vasopressor was started and subsequently a low dose of adrenaline. Blood pressure values maintained around 90/60 mmHg and undergo a sudden drop after increasing the dosage of the vasopressor. Diuresis was approximately 50 ml/h, lactates clear completely after approximately 4 hours. After 6 hours, due to a new sudden reduction in blood pressure, the patient was referred for IABP and coronary angiography control. In the context of multivessel coronary artery disease and cardiogenic shock he was therefore a candidate for urgent cardiac surgery of aortic valve replacement, by–pass and mitral anulovalvuloplasty. This case gave us the opportunity to analyze how to proceed in such a critical conditions with the below conclusions: a) the choice of vasopressors and inotropes is limited in case of severe aortic valve stenosis b) the presence of left ventricular intracavitary thrombosis limits the choice of ventricular assistance system c) in case of cardiogenic shock and severe aortic valve stenosis the patient must be a candidate for valve replacement surgery as soon as possible.

Pheochromocytoma: Intricate Cardiovascular Manifestations

Abstract We present the case of a 60-year-old female patient, dyslipidemic, obese, diabetic and hypertensive, with a history of resected right adrenal pheochromocytoma (1999 - no subsequent surgical or endocrinological re-evaluation), presenting for increased blood pressure values and the recurrence of symptoms (headaches, palpitations, sweating), with progressive accentuation in the last months. The patient associates pain in the right costovertebral angle and weight loss. The clinical examination revealed facial erythrosis, excessive sweating, tachycardic heart sounds, increased blood pressure and orthostatic hypotension. Electrocardiography reveals sinus tachycardia, signs of left ventricular hypertrophy, with repolarization abnormalities, morphological aspect confirmed by the transthoracic echocardiography. An ultrasound of the abdomen and pelvis ultrasound objectified a large tumor formation at the level of the right adrenal gland and a liver nodule. In the context of the symptoms, the suspicion of recurrent pheochromocytoma was raised, confirmed biochemically by the increase in urinary normetanephrines and through imagistic methods (CT scan of the abdomen and pelvis), the patient having an indication for curative surgical treatment. After completing the preoperative assessment (ECG Holter monitor, ABPM), during the hospitalization period, the antihypertensive regimen was adjusted by combining 4 antihypertensive drugs, episodes of orthostatic hypotension being managed by administering glucocorticoids and colloidal solutions for volume repletion. The patient was referred to the general surgery clinic for resection of the tumor, following the antihypertensive preparation protocol. Although the post-procedural evolution was favorable, the patient presents a high risk of tumor recurrence, requiring annual evaluation for a period of 10 years. Also, due to the association of cardiovascular risk factors and target organ damage, the patient requires periodic cardiological evaluation.

#5537 GENETIC VARIABILITY IN THE PROSTAGLANDIN E2 PATHWAY IS RELATED TO SALT SENTIVITY IN TREATMENT-NAïVE HYPERTENSIVE PATIENTS

Abstract Background and Aims Hypertensive nephropathy is a common aging-related disorder. One of the main factors that contributes to the development of hypertension is salt intake. Based on blood pressure (BP) variation after sodium intake in an acute salt load test, individuals can be grouped in: sodium sensitive (SS), sodium resistant (SR) or inverse sodium sensitivity (ISS). Prostaglandin E2 (PGE2) is the main renal metabolite of the cyclooxygenase pathway, a major actor mediating renal injury and it has also been related to renal blood flow and hemodynamic changes. Our aim was to determine common, functional variants in genes involved in the PGE2 pathway to identify associations with the sodium sensitivity phenotype of hypertensive patients, as well as with parameters of renal function and BP traits. Method We studied 511 treatment-naïve hypertensive patients, who were subjected to an acute salt load test and consequently stratified into 173 SR patients, 172 SS patients and 166 ISS, after they showed an increase in BP values (SS), no substantial variation (SR) or a paradoxical decrease (ISS). Renal function was established by estimated glomerular filtration rate (eGFR) using the MDRD-4 formula. All participants were screened for 216 tag-SNPs that define the variability of 12 genes of the PGE2 pathway, namely PLA2G4A, PLA2G7, SCARB1, PTGS1, PTGS2, PGTES, PTGES2, PTGES3, PTGER1, PTGER2, PTGER3 and PTGER4. Regression models were utilized to evaluate associations with clinical parameters. Results Using the SS group as a reference, eleven variants in genes coding for two phospholipases (PLA2G4A, PLA2G7), cyclooxygenase-1 (PGTS1) and PGE2 receptors (PTGER1 and PTGER4) were linked to the susceptibility of becoming SR or ISS patients. Seven of these variants produced protective odds ratios, whilst four of them were associated with increased risk (Table 1). Next, we analyzed BP traits in each cohort. In SR, PTGES3 rs12824563 was associated with variability in nighttime BP values (p<0.001, p<0.01, p<0.001 and p<0.05 for systolic BP, diastolic BP, mean BP and nighttime BP fall, respectively). For the SS group, two variants in PTGER3, rs61777123 and rs12410289, were also associated with the same parameters (p<0.01). Finally, in the ISS group, the most significant finding was that PTGES2 rs13283456 was strongly linked to daytime and nighttime measurements (p<0.001 for each parameter). Regarding renal function, we examined the 511 patients as a whole and observed that several variants affected eGFR. Most significantly, carriers of PTGER3 rs6424406 and rs1409986 were found to be associated with higher values [Mean difference vs. non carriers: 6.34 (2.42-10.26), p<0.01 and 6.20 (1.76-10.64) ml/min/1,73 m2, p<0.01]. Conclusion Variability in genes that participate in the PGE2 pathway, is associated with the response of treatment-naïve hypertensive patients to salt intake. In addition, these genetic variants may also modify BP traits and eGFR values in these patients.

THE INFLUENCE OF DEPRESSION IN HYPERTENSIVE ELDERLY PATIENTS

Objective: Depression and cardiovascular diseases are two common pathological entities in the elderly, their incidence increasing with advancing age. Clinicians have empirically observed that depression is an independent risk factor for hypertension, thus showing the need to demonstrate this hypothesis through clinical trials and also the correlation of depression with the occurrence of other cardiovascular diseases. Design and method: The study was carried out on 127 patients in the Emergency County Hospital dr. Pompei Samarian Calarasi, with cardiovascular disease, including hypertension, and/or depression. The presented study is observational, analytical, retrospective. The study group was randomized according to inclusion and exclusion criteria established prior to patient selection. Results: Hypertension is very common in the elderly. We observe a significant increase in blood pressure values with age. Patients at low, moderate, and high cardiovascular risk tend to have mild or moderate depression, and those at very high risk tend to have moderate or severe depression. Depression influences cardiovascular risk factors, favoring the increase of serum cholesterol and triglyceride values and favoring the decrease of serum HDL-cholesterol values, the influence of depression being statistically significant. The proportion of patients with hypertension who associate depression increases with increasing blood pressure values. To emphasize the importance of depression in hypertension, we excluded patients with metabolic syndrome. It has been observed that in these patients the association between depression and hypertension increases, emphasizing the fact that depression represents a cardiovascular risk factor. Studying the relationship between the severity of depression and the degree of arterial hypertension, it was observed that in patients with high blood pressure, the degree of depression is high. Conclusions: Considering all these aspects, we emphasize the importance of the correct and early diagnosis of depression in elderly patients, this being an important risk factor for cardiovascular diseases, including hypertension, often ignored in medical practice.

Association of Depression Onset and Treatment With Blood Pressure Control After Intracerebral Hemorrhage.

Blood pressure (BP) control represents a crucial intervention to improve long-term outcomes following spontaneous intracerebral hemorrhage (ICH). However, fewer than half of ICH survivors achieve target treatment goals. ICH survivors are also at very high risk for poststroke depression, which may contribute to inadequate BP control. We, therefore, sought to determine whether depressive symptoms after ICH are associated with inadequate BP control. We also investigated whether associations between depression after ICH and BP measurements were mediated by treatment with selective serotonin reuptake inhibitors or norepinephrine-serotonin reuptake inhibitors antidepressants. We leveraged data from a single-center longitudinal study of ICH conducted at Massachusetts General Hospital (Boston, MA) between 2006 and 2018. We collected data from semiautomated review of electronic health records, baseline and follow-up interviews, and computed tomography imaging. Information on BP measurements, depression diagnoses, antidepressants medication use, and medical visits were collected longitudinally and analyzed using mixed effects models. Primary outcomes included systolic and diastolic BP measurements during long-term follow-up after ICH. We included 1243 consecutive ICH patients without pre-stroke depression history. Of these, 721 (58%) were diagnosed with incident depression over a median follow-up time of 52.8 months (interquartile range, 42.1-60.5). Depression onset was associated with subsequent increase in systolic (+8.3 mm Hg, SE, 2.4 mm Hg, P=0.012) and diastolic (+4.4 mm Hg, SE, 1.2 mm Hg) BP measurements. Resolution of depressive symptoms was associated with subsequent decrease in systolic (-5.9 mm Hg, SE, 1.4 mm Hg, P=0.031) and diastolic (-3.4 mm Hg, SE, 1.1 mm Hg, P=0.041) BP measurements. We also found associations between higher systolic BP measurements and use of selective serotonin reuptake inhibitor and noradrenaline-serotonin reuptake inhibitor antidepressants, independent of whether depression symptoms were active or not (all P<0.05). ICH survivors displayed increasing BP values after receiving a diagnosis of depression, followed by decreasing values among those experiencing resolution of depressive symptoms. Use of selective serotonin reuptake inhibitor and noradrenaline-serotonin reuptake inhibitor antidepressants was independently associated with higher systolic BP measurements. Clinicians ought to closely monitor BP for ICH survivors being treated for depression, especially using selective serotonin reuptake inhibitor and noradrenaline-serotonin reuptake inhibitor. Future studies will also be required to investigate the mechanisms underlying these associations.

Uncertain Etiology of Left Ventricular Hypertrophy in a Young Subject With Hypertension Treated With Dexamphetamine

A 28-year-old black African man with narcolepsy and positive family history of hypertension was referred to our outpatient clinic after being diagnosed with grade I hypertension. Narcolepsy was diagnosed at age 25, and for more than 1 year was treated with dexamphetamine 5 mg twice a day. Apart from low vitamin D (not on treatment) the remaing past medical history was unremrkable. From the age of 25, the patient underwent regular blood pressure screening and in the last 6 months had been presenting with increased blood pressure values. A 24-h ambulatory blood pressure monitoring performed by his general practitioner 2 months before the referral confirmed the diagnosis of grade I hypertension.

Volume of white matter hyperintensities increases with blood pressure in patients with hypertension.

ObjectiveHypertension is a risk factor for development of white matter hyperintensities (WMHs). However, the relationship between hypertension and WMHs remains obscure. We sought to clarify this relationship using clinical data from different regions of China.MethodsWe analyzed the data of 333 patients with WMHs in this study. All included patients underwent conventional magnetic resonance imaging (MRI) examination. A primary diagnosis of WMHs was made according to MRI findings. The volume burden of WMHs was investigated using the Fazekas scale, which is widely used to rate the degree of WMHs. We conducted retrospective clinical analysis of the data in this study.ResultsOur findings showed that WMHs in patients with hypertension were associated with diabetes, cardiovascular diseases, history of cerebral infarct, and plasma glucose and triglyceride levels. Fazekas scale scores for WMHs increased with increased blood pressure values in patients with hypertension.ConclusionThis analysis indicates that hypertension is an independent contributor to the prevalence and severity of WMHs.

Arterial Hypertension and Interleukins: Potential Therapeutic Target or Future Diagnostic Marker?

Hypertension as a multifactorial pathology is one of the most important cardiovascular risk factors, affecting up to 30-40% of the general population. Complex immune responses are involved in the inflammatory mechanism of hypertension, with evidence pointing to increased inflammatory mediators even in prehypertensive patients. Increased vascular permeability, thrombogenesis, and fibrosis, effects that are associated with sustained hypertension, could be attributed to chronic inflammation. Chronic inflammation triggers endothelial dysfunction via increased production of ROS through proinflammatory cytokines. Increased serum level of proinflammatory cytokines such as IL-1β, IL-6, IL-8, IL-17, IL-23, TGFβ, and TNFα in hypertensive patients has been associated with either increased blood pressure values and/or end-organ damage. Moreover, some cytokines (i.e., IL-6) seem to determine a hypertensive response to angiotensin II, regardless of blood pressure values. Understanding hypertension as an inflammatory-based pathology gives way to new therapeutic targets. As such, conventional cardiovascular drugs (statins, calcium channels blockers, and ACEIs/ARBs) have shown additional anti-inflammatory effects that could be linked to their blood pressure lowering properties. Moreover, anti-inflammatory drugs (mycophenolate mofetil) have been shown to decrease blood pressure in hypertensive patients or prevent its development in normotensive individuals. Further research is needed to evaluate whether drugs targeting hypertensive-linked proinflammatory cytokines, such as monoclonal antibodies, could become a new therapeutic option in treating arterial hypertension.

Lipid profile and cardiovascular risk of participants in the lipid measurement program in the industrial park in Höchst

Cardiovascular (CV) diseases are still the most frequent cause of death in industrial nations. Employer-initiated screening of the CV risk could make an early contribution to optimization of the prevention strategies. In a cross-sectional study the CV risk profile (e.g., dyslipidemia, hypertension, smoking, diabetes mellitus and familial disposition) of 1436 employees at the industrial park in Frankfurt Höchst was analyzed. The total risk was estimated using the PROCAM score. Ahypercholesterolemia (low-density lipoprotein, LDL >130 mg/dl) was detected in 36% of the participants. Of the high-risk participants (myocardial infarct, apoplexy and/or diabetes) 23.7% (n = 9/38) were in the target range for LDL as defined by the European Society of Cardiology (ESC) of below 70 mg/dl, 18.4% (n = 7) had levels between 70 and 100 mg/dl and 57.9% (n = 22) had levels of more than 100 mg/dl. In addition, more than half of the subjects (53.2%) had increased blood pressure values (defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg). The prevalence of diabetes (blood sugar >126 mg/dl) was very low (1.3%) as was the frequency of manifest CV diseases (1.4% myocardial infarct or apoplexy, 2.9% stabile angina pectoris or peripheral arterial occlusive disease, PAOD). The data confirm that the risk factors high blood pressure and dyslipidemia are widespread and the achievement of target values is insufficient, particularly with ahigh risk of CV. Behavioral therapeutic and/or pharmaceutical measures should be instigated in order to better exploit the high preventive potential for carriers of these risk factors.

Sympathetic Nervous System, Sleep, and Hypertension.

To evaluate the relation between sleep alterations, with or without breathing disorders, and incidence of hypertension and other cardiovascular diseases RECENT FINDINGS: Several studies have clearly shown the mechanisms linking sleep disorders and cardiovascular diseases. The sympathetic hyperactivity seems to play a fundamental role in favoring and sustaining the increase in blood pressure values. Several other mechanisms also contribute to this effect and to the increase cardiovascular risk. The mechanisms responsible for the increase in blood pressure values in subjects with alteration in sleep quantity and quality, with or without breathing disorders, have been clearly established. The recent findings refer to the result of meta-analysis of cross-sectional studies or longitudinal studies showing a significant association between short sleep duration and hypertension. It has also been shown that sleep fragmentation could be considered the main determinant of the sympathetic activation independently of the frequency and severity of oxygen desaturation.

Management of VEGF-Targeted Therapy-Induced Hypertension

From a physiological point of view, VEGFs (vascular endothelial growth factors) and their receptors (VEGFR) play a critical role in vascular development angiogenesis, endothelial function, and vascular tone. On the pathological side, VEGF-VEGFR signaling may induce dysregulated angiogenesis, which contributes to the growth and to the spread of tumors, being essential for neoplastic proliferation and invasion. Pharmacological inhibition of VEGF-VEGFR is now a cornerstone in the treatment of many malignancies; however, treatment with VEGF inhibitors is commonly associated with an increase in blood pressure values. This side effect is strictly connected with the mechanism of action of these medications and might represent an index of therapy efficacy. The optimal management of this form of hypertension is, at present, not clear. Calcium channel blockers and renin-angiotensin system inhibitors probably represent the most appropriate classes of hypertensive dugs for the treatment of this condition; however, no conclusive data are presently available.

Hypertension and Diabetes Mellitus: Coprediction and Time Trajectories.

Type 2 diabetes mellitus and hypertension overlap in the population. In many subjects, development of diabetes mellitus is characterized by a relatively rapid increase in plasma glucose values. Whether a similar phenomenon occurs during the development of hypertension is not known. We analyzed the pattern of blood pressure (BP) changes during the development of hypertension in patients with or without diabetes mellitus using data from the MCDS (Mexico City Diabetes Study; a population-based study of diabetes mellitus in Hispanic whites) and in the FOS (Framingham Offspring Study, a community-based study in non-Hispanic whites) during a 7-year follow-up. Diabetes mellitus at baseline was a significant predictor of incident hypertension (in FOS, odds ratio, 3.14; 95% confidence interval, 2.17-4.54) independently of sex, age, body mass index, and familial diabetes mellitus. Conversely, hypertension at baseline was an independent predictor of incident diabetes mellitus (in FOS, odds ratio, 3.33; 95% CI, 2.50-4.44). In >60% of the converters, progression from normotension to hypertension was characterized by a steep increase in BP values, averaging 20 mm Hg for systolic BP within 3.5 years (in MCDS). In comparison with the nonconverters group, hypertension and diabetes mellitus converters shared a metabolic syndrome phenotype (hyperinsulinemia, higher body mass index, waist girth, BP, heart rate and pulse pressure, and dyslipidemia). Overall, results were similar in the 2 ethnic groups. We conclude that (1) development of hypertension and diabetes mellitus track each other over time, (2) transition from normotension to hypertension is characterized by a sharp increase in BP values, and (3) insulin resistance is one common feature of both prediabetes and prehypertension and an antecedent of progression to 2 respective disease states.

Study on relations among increase in blood pressure values, dispersions of the myocardial indicator , body mass index and thickness of the skin-fat layer in 15-17 year old schoolchildren in Baku, Azerbaijan

In this study, relationship among arterial pressure (AP), systolic and diastolic pressure (SBP, DBP), heart beat frequency (HBF), dispersions of the myocardial indicator (MI), heart rate indicator (RI) and Body Mass Index (BMI) in schoolchildren of 15-17 years from Baku (Azerbaijan) were investigated. The results revealed that high values of above-mentioned indicators were gener-ally formed in groups with overweight and great distribution of the thickness of skin-fat layer (TSFL) on torso and top parts of the body. Aforementioned changes in these relationships indicate the formation of cardiometabolic syndrome in schoolchildren.

MiR-153/Kv7.4: a novel molecular axis in the regulation of hypertension.

This editorial refers to ‘MicroRNA-153 targeting of KCNQ4 contributes to vascular dysfunction in hypertension’, by G. Carr et al. , pp. 581–589 Characterized by a steady increase in blood pressure values, hypertension is a complex, multifactorial disease resulting from a combination of environmental and genetic factors. Blood pressure is a function of peripheral resistance, which in turn depends on arterial diameter. Several molecular mechanisms have been described as regulators of arterial diameter both chronically, leading to vascular remodelling, and acutely, by contraction or relaxation of vascular smooth muscle in the vessel wall. Although decades of research proposed several advances in anti-hypertensive therapies, there are still patients with uncontrolled hypertension, thus pressing the search for novel mechanisms underlying hypertension and its related cardiovascular modifications. MicroRNAs, small non-coding RNAs that target messenger RNAs at the post-transcriptional level, are involved in virtually all biological processes, including cellular proliferation, apoptosis, and differentiation.1 Deregulation of many individual microRNAs has been linked to the development and progression of cardiovascular diseases, …

The effects of a fat loss supplement on resting metabolic rate and hemodynamic variables in resistance trained males: a randomized, double-blind, placebo-controlled, cross-over trial.

BackgroundWhile it is known that dietary supplements containing a combination of thermogenic ingredients can increase resting metabolic rate (RMR), the magnitude can vary based on the active ingredient and/or combination of active ingredients. The purpose of this study was to examine the effects of a commercially available thermogenic fat loss supplement on RMR and hemodynamic variables in healthy, resistance trained males.MethodsTen resistance-trained male participants (29 ± 9 years; 178 ± 4 cm; 85.7 ± 11 kg, and BMI = 26.8 ± 3.7) volunteered to participate in this randomized, double-blind, placebo controlled cross-over study. Participants underwent two testing sessions separated by at least 24 h. On their first visit, participants arrived to the laboratory after an overnight fast and a 24-h avoidance of exercise, and underwent a baseline RMR, HR, and BP assessment. Next, each participant ingested a thermogenic fat loss supplement (TFLS) or a placebo (PLA) and repeated the RMR, HR, and BP assessments at 60, 120, and 180 min post-ingestion. During the second visit the alternative supplement was ingested and the assessments were repeated in the exact same manner. Data were analyzed via a 2-factor [2x4] within-subjects repeated measures analysis of variance (ANOVA). Post-hoc tests were analyzed via paired samples t-tests. The criterion for significance was set at p ≤ 0.05.ResultsA significant main effect for time relative to raw RMR data (p = 0.014) was observed. Post-hoc analysis revealed that the TFLS significantly increased RMR at 60-min, 120-min, and 180-min post ingestion (p < 0.05) as compared to baseline RMR values. No significant changes in RMR were observed for the PLA treatment (p > 0.05). Specifically, RMR was increased by 7.8 % (from 1,906 to 2,057 kcal), 6.9 % (from 1,906 to 2,037 kcal), and 9.1 % (from 1,906 to 2,081 kcal) in the TFLS, while the PLA treatment increased RMR by 3.3 % (from 1,919 to 1,981 kcal), 3.1 % (from 1,919 to 1,978 kcal), and 2.1 % (from 1,919 to 1,959 kcal) above baseline at 60, 120, and 180-min post ingestion, respectively. Additionally, the TFLS significantly elevated RMR at the 3-h time point as compared to the PLA treatment (2,081 vs 1,959 kcal, p = 0.034). A main effect for groups was observed for systolic blood pressure, and a significant interaction and main effect for time were observed for diastolic blood pressure. It should be noted that although changes in diastolic blood pressure were significant, all values stayed within normal clinical ranges (<80 mmHg).ConclusionsThe TFLS led to significant elevations in RMR as compared to baseline. These elevations came with no adverse effect relative to resting heart rate, but a slight increase in blood pressure values. Taken on a daily basis, this TFLS may increase an individual’s overall energy expenditure, however; future studies should investigate if this leads to a reduction in fat mass loss over time.

Bridging hypertension in children and adolescents with hypertension in adult individuals

There is growing awareness that in children also “essential” hypertension is the most prevalent form of blood pressure (BP) elevation, and that it may be associated with target organ damage. Evidence is also available that suggests that a child with hypertension has a higher probability of being hypertensive at an adult age than a child with normal BP levels. This suggests that pathophysiological mechanisms contributing to the development of hypertension in childhood might contribute to consolidate such a condition at an adult age. As in adults, in children being overweight or obese have become an epidemic problem associated with elevated BP. This is also the case for lack of physical exercise and excessive intake of sodium with food. It has to be emphasized that in children it is not only weight excess that is associated with increased BP, but the distribution of adipose tissue also plays a role. Among young subjects with similar body weight, those with a greater waist circumference are at a greater risk of having high BP, possibly due to humoral factors released by visceral fat. Indeed, increased insulin resistance (assessed through the HOMA index), increased leptin and uric acid levels are positively and independently associated with increased BP values in children and adolescents, while an inverse correlation has been found with plasma adiponectin levels. Another factor which might contribute to hypertension in childhood is a dysfunction of autonomic neural cardiovascular modulation, characterized by an increase in cardiovascular sympathetic and a reduction in cardiac vagal modulation, documented by a reduction of cardiac arterial baroreflex sensitivity, remaining significant even after adjustment for increased body weight. These considerations underscore the importance of using techniques for 24h ambulatory BP and heart rate monitoring in the diagnostic and therapeutic management of children and adolescents with hypertension aimed at assessing their hemodynamic reactivity and the related pattern of cardiovascular autonomic nervous modulation, in daily life conditions. Given the young age of the subjects being addressed, it is possible that pathophysiological factors contributing to hypertension might still be modifiable and that no structural cardiovascular changes have yet occurred in this age range, the appearance of which might make hypertension an irreversible condition. The hypertensive child therefore represents a challenge to the medical community for implementing interventions able to achieve true early cardiovascular disease prevention, besides being a potential model for a better understanding of the pathophysiological mechanisms underlying essential hypertension in adults.

The role of blood pressure, body weight and fat distribution on left ventricular mass, diastolic function and cardiac geometry in children.

Hypertension and obesity in childhood are related to early cardiac damage, as left ventricular hypertrophy. Few studies have analyzed the independent effects of hypertension and weight excess on diastolic function and left ventricular geometry. We studied the effects of weight, waist circumference (as an index of fat distribution) and blood pressure on left ventricular mass index, the risk of left ventricular hypertrophy, diastolic function and left ventricular geometry in 526 children (237 girls, age range 6-15 years). Children were divided into normotensive, prehypertensive and hypertensive (US Nomograms) groups, and into normal-weight, overweight, and obese (International Obesity Task Force classification) groups. Left ventricular mass index, diastolic function and left ventricular geometry were assessed. SBP z-scores and blood pressure categories significantly influenced cardiac mass (P < 0.001 and P = 0.02, respectively) and the prevalence of left ventricular hypertrophy (P < 0.001 and P < 0.05, respectively). Obesity, BMI, and waist circumference z-scores were significantly associated with an increment in E/Em ratio (P < 0.001, P < 0.01, and P < 0.01, respectively). Increasing blood pressure values and the presence of prehypertension (P < 0.05) and hypertension (P < 0.003), but not weight excess, were associated with concentric cardiac remodeling. In contrast, concentric hypertrophy was associated with hypertension (P < 0.01), obesity (P < 0.001), and increasing waist circumference (P < 001). Blood pressure values and hypertension are independently associated with an increase of cardiac mass and the presence of cardiac hypertrophy. Obesity and waist circumference, but not hypertension, are associated with a worsening of diastolic function, whereas only hypertensive children show high prevalence of concentric remodeling. Blood pressure and body weight and fat distribution have an independent and different impact on left ventricular structure and function in children.

Efeito do número de séries nas respostas cardiovasculares agudas durante exercício de alongamento

Few studies have investigated the effects of manipulating variables of stretching exercise prescription on acute cardiovascular responses. The objective of this study was to compare the acute responses of heart rate, blood pressure and double product before, during and after four sets of passive static stretching during unilateral hip flexion. The sample consisted of 16 adult men aged 18 to 27 years (22±2.8 years) with no experience in flexibility training. The cardiovascular variables were measured by photoplethysmography with continuous recording for 5 minutes at rest, during exercise and 10 minutes after stretching. A difference was observed in all variables (p<0.05) when resting and post-exercise values were compared to exercise values. There was only an increase in blood pressure values between sets. Systolic blood pressure was increased in the third set compared to the first [set 1 = 136 mmHg (±9.4); set 3 = 145 mmHg (±9.7)] and diastolic blood pressure was increased in the second set compared to the first [set 1 = 79 mmHg (±6.7); set 2 = 84 mmHg (±9.1)]. Hypotension was not observed post-exercise. It was concluded that the stretching sets have a cumulative effect on systolic and diastolic blood pressure responses, but not on heart rate. However, the stretching protocol produced no hypotensive effect after exercise.

Cerebral hemodynamic changes at basilar artery in patients with obstructive sleep apnea syndrome. A case-control study

Obstructive sleep apnea syndrome (OSAS) is characterized in polysomnography by recurrent airflow obstruction during sleep. The underlying pathogenic mechanisms of neuropsychological and cerebrovascular events in patients with OSAS have not been clarified unequivocally. Case-control study to evaluate the cerebral vasomotor reactivity assessed by breath-holding maneuver at basilar artery in patients with OSAS compared to control subjects. The study included 76 patients with OSAS and 76 controls. Vascular risk factors (arterial hypertension, diabetes mellitus, hypercholesterolemia, smoking), age, gender, coronary, and peripheral arterial diseases were similar in both groups. Patients with OSAS had breath-holding test values (31.9 ± 13.35%) lower than controls (39.06 ± 13.16%), (P = 0.001). Patients with OSAS had higher systolic and diastolic blood pressure both basal and apnea and also a higher basal heart rate. Altered cerebral hemodynamics together with increased blood pressure values in patients with OSAS may play a role in the association between this disease and the development of cerebrovascular events. This implies that this disease should be identified through guide symptoms such as snoring, sleep apnea, and daytime sleepiness in all patients who consult for these symptoms to reduce the number of cerebrovascular events.