Lower Incidence Of Hypertension Research Articles

Predisposing Factors of Ischemic Colitis: Data from 14 Years of Experience in a Single Center.

Background and Aims While several case reports on ischemic colitis (IC) suggest the presence of predisposing causative factors, a few studies have investigated the predisposing factors in IC. This study aimed to identify the characteristics of patients with IC, particularly focusing on the predisposing factors. Methods We conducted a single-center, retrospective analysis of 159 patients with IC. Clinical characteristics, laboratory data, endoscopic findings, and medical records were reviewed. Data were compared between groups of patients defined according to the predisposing factors. The predisposing factors are defined as temporary states or episodic events occurring within a week before the development of IC such as colonoscopy, enema, use of laxatives, heavy drinking, pancreatitis, shock, and burn. Results Compared to the group of patients without predisposing factors of IC, the group of patients with predisposing factors was characterized by a relatively higher prevalence of male sex (56.9% versus 33.3%, p = 0.005), younger age (60.9 ± 15.4 versus 67.2 ± 13.4 years, p = 0.010), lower incidence of hypertension (43.1% versus 60.2%, p = 0.044), and fewer risk factors (1.24 ± 1.18 versus 1.82 ± 1.22, p = 0.005). Conclusions Among men with predisposing factors, IC may develop even at a relatively younger age and in the absence of multiple risk factors, suggesting that predisposing factors may be involved in the pathogenesis of IC.

High-Fiber Diet and Acetate Supplementation Change the Gut Microbiota and Prevent the Development of Hypertension and Heart Failure in Hypertensive Mice.

Dietary intake of fruit and vegetables is associated with lower incidence of hypertension, but the mechanisms involved have not been elucidated. Here, we evaluated the effect of a high-fiber diet and supplementation with the short-chain fatty acid acetate on the gut microbiota and the prevention of cardiovascular disease. Gut microbiome, cardiorenal structure/function, and blood pressure were examined in sham and mineralocorticoid excess-treated mice with a control diet, high-fiber diet, or acetate supplementation. We also determined the renal and cardiac transcriptome of mice treated with the different diets. We found that high consumption of fiber modified the gut microbiota populations and increased the abundance of acetate-producing bacteria independently of mineralocorticoid excess. Both fiber and acetate decreased gut dysbiosis, measured by the ratio of Firmicutes to Bacteroidetes, and increased the prevalence of Bacteroides acidifaciens. Compared with mineralocorticoid-excess mice fed a control diet, both high-fiber diet and acetate supplementation significantly reduced systolic and diastolic blood pressures, cardiac fibrosis, and left ventricular hypertrophy. Acetate had similar effects and markedly reduced renal fibrosis. Transcriptome analyses showed that the protective effects of high fiber and acetate were accompanied by the downregulation of cardiac and renal Egr1, a master cardiovascular regulator involved in cardiac hypertrophy, cardiorenal fibrosis, and inflammation. We also observed the upregulation of a network of genes involved in circadian rhythm in both tissues and downregulation of the renin-angiotensin system in the kidney and mitogen-activated protein kinase signaling in the heart. A diet high in fiber led to changes in the gut microbiota that played a protective role in the development of cardiovascular disease. The favorable effects of fiber may be explained by the generation and distribution of one of the main metabolites of the gut microbiota, the short-chain fatty acid acetate. Acetate effected several molecular changes associated with improved cardiovascular health and function.

Vegetarian diet reduces the risk of hypertension independent of abdominal obesity and inflammation: a prospective study.

A vegetarian diet may prevent elevation of blood pressures and lower the risk for hypertension through lower degrees of obesity, inflammation, and insulin resistance. This study investigated the association between a vegetarian diet and hypertension incidence in a cohort of Taiwanese adult nonsmokers and examined whether this association was mediated through inflammation, abdominal obesity, or insulin resistance (using fasting glucose as a proxy). This matched cohort study was from the 1994-2008 MJ Health Screening Database. Each vegetarian was matched with five nonvegetarians by age, sex, and study site. The analysis included 4109 nonsmokers (3423 nonvegetarians and 686 vegetarians), followed for a median of 1.61 years. The outcome includes hypertension incidence, as well as SBP and DBP levels. Regression analysis was performed to assess the association between vegetarian diet and hypertension incidence or future blood pressure levels in the presence/absence of potential mediators. Vegetarians had a 34% lower risk for hypertension, adjusting for age and sex (odds ratio: 0.66, 95% confidence interval: 0.50-0.87; SBP: -3.3 mmHg, P < 0.001; DBP: -1.5 mmHg, P < 0.001). The results stay statistically significant after further adjustment for C-reactive protein, waist circumference, and fasting glucose (odds ratio: 0.72, 95% confidence interval: 0.55-0.86; SBP: -2.4 mmHg, P < 0.05; DBP: -1.1 mmHg, P < 0.05). The protective association between vegetarian diet and hypertension appeared to be consistent across age groups. Taiwanese vegetarians had lower incidence of hypertension than nonvegetarians. Vegetarian diets may protect against hypertension beyond lower abdominal obesity, inflammation, and insulin resistance.

Total coronary occlusion of infarct-related arteries in patients with non-ST-elevation myocardial infarction undergoing percutaneous coronary revascularisation.

The prevalence and impact of total coronary occlusion of an infarct-related artery (IRA) on outcomes in patients with non-ST-elevation myocardial infarction (NSTEMI) remain unclear. We evaluated the clinical significance of total coronary occlusion in NSTEMI patients. A total of 2767 patients with NSTEMI enrolled in the Polish Registry of Acute Coronary Syndromes, who underwent percutaneous coronary interventions, were analysed. The patients were divided into two groups according to preprocedural culprit vessel thrombolysis in myocardial infarction (TIMI) flows (TIMI flow 0 - total coronary occlusion [TO]: 728, 26.3% of the patients, and TIMI flow 1-3 - non-total occlusion [non-TO]: 2039, 73.7% of the patients). Patients with total occlusion were younger, were more often current smokers, and had lower incidence of hypertension and diabetes mellitus. The left circumflex artery (LCx) was the major IRA in the TO group (48.1%), whereas the left anterior descending artery (LAD) was more commonly the IRA in the non-TO group (38.8%). Multivariate analysis revealed that LCx as the culprit lesion (OR ± 95 CI 1.54 [1.26-1.89], p < 0.0001) was an independent predictor of TIMI flow 0 in IRA. In-hospital and one-month mortality occurred more frequently in the TO group (4.0% vs. 1.7%, p = 0.0005 and 5.5% vs. 3.5%, p = 0.0175, respectively), no differences in the 12-, 24-, or 36-month mortalities were observed between these groups. Only LCx as a culprit lesion was an independent predictor of total occlusion in IRAs. The NSTEMI patients with TO had higher in-hospital and one-month mortalities, but their long-term outcomes were similar to those of non-TO patients.

Belatacept for the prophylaxis of organ rejection in kidney transplant patients: an evidence-based review of its place in therapy.

BackgroundBelatacept is a novel immunosuppressive therapy designed to improve clinical outcomes associated with kidney transplant recipients while minimizing use of calcineurin inhibitors (CNIs).MethodsWe searched for clinical trials related to administration of belatacept to kidney transplant patients compared to various immunosuppression regimens, as well as for studies that utilized data from belatacept trials to validate new surrogate measures. The purpose of this review is to consolidate the published evidence of belatacept’s effectiveness and safety in renal transplant recipients to better elucidate its place in clinical practice.ResultsAnalysis of the results from the Belatacept Evaluation of Nephroprotection and Effi-cacy as First-Line Immunosuppressive Trial (BENEFIT) study, a de novo trial that compared cyclosporine (CsA)-based therapy to belatacept-based therapy in standard criteria donors, found a significant difference in mean estimated glomerular filtration rate (eGFR) of 13–15 mL/min/1.73 m2 and 23–27 mL/min/1.73 m2 at 1 year and 7 years, respectively. The BENEFIT-EXT study was similarly designed with the exception that it included extended criteria donors. Renal function improved significantly for the more intensive belatacept group in all years of the BENEFIT-EXT study; however, it was not significant in the less intensive group until 5 years after transplant. Belatacept regimens resulted in lower blood pressure, cholesterol levels, and incidence of new-onset diabetes after transplant compared to CsA-based regimens. Results from conversion of CNIs to belatacept therapy, dual therapy of belatacept with sirolimus, and belatacept with corticosteroid avoidance therapy are also included in this article.ConclusionThe evidence reviewed in this article suggests that belatacept is an effective alternative in kidney transplant recipients. Compared to CNI-based therapy, belatacept-based therapy results in superior renal function and similar rates of allograft survival. In terms of safety, belatacept was shown to have lower incidence of hypertension, hyperlipidemia, and diabetes; however, incidence of posttransplantation lymphoproliferative disorder and the cost of belatacept may hinder use of this medication.

Association between Physical Activity and Hypertension in Chronic Obstructive Pulmonary Disease

연구배경: 만성 폐쇄성 폐질환(COPD) 환자에서 고혈압의 높은 동반 이환을 보여주는 앞선 연구 및 조사결과들이보고되고 있으며 그로 인한 심혈관질환의 이환이 높아져사망률 또한 높아짐이 보고되고 있다. 이에 본 연구에서는COPD 환자군에 있어 신체활동 정도에 따른 고혈압 이환정도를 알아보고자 한다. 방법: 2010-2012년에 수행된 제5기 국민건강영양조사 자료를 이용하여 만 40세 이상의 성인 중 1,243명의 COPD 환자를 대상으로 교차분석 및 로지스틱 회귀분석을 실시하였으며, 신체활동의 정도에 따라 대상자를 분류하여 고혈압 동반 이환과의 관련성을 알아보았다. 결과: COPD 환자 중 고혈압이 없는 자에서 중등도 신체활동을 하는 자의 분율이 고혈압이 있는 자에서의 분율보다 4.3% 유의하게 높았다(P=0.012). COPD 환자에서 신체활동 정도와 고혈압 동반 이환의 위험도를 살펴보기 위해나이, 성별, 소득수준, 비만도, 흡연과 음주 여부, 당뇨, 고지혈증의 동반 이환, 에너지 섭취량 등을 고려하여 보았을때 중등도 운동을 시행하는 군에서 고혈압의 동반된 위험도가 0.536배(95% 신뢰구간, 0.288-0.997) 낮았다. 결론: COPD 환자군에서 신체활동 중 중등도의 신체활동을 하는 경우 고혈압의 이환 정도가 유의하게 낮음을 알수 있었다.

Abstract 10450: Prognostic Effect of Estimated Glomerular Filtration Rate in Patients With Cardiac Arrest Undergoing Extracorporeal Cardiopulmonary Resuscitation

Introduction: Extracorporeal membrane oxygenation (ECMO) can provide immediate and adequate systemic circulation and oxygenation in patients with refractory cardiac arrest. Even mild renal dysfunction has been identified as an independent cardiovascular risk factor. We hypothesized that renal dysfunction influences resuscitation outcomes. The aim of this study was to elucidate the association between initial renal function just before implantation and clinical outcome in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR). Methods: A cohort of 298 patients who underwent ECMO at our hospital was registered from January 2005 to April 2015. After excluding 70 patients with non-cardiac arrest, we analyzed the clinical outcome which was defined as all-cause death at 30 days of the remaining 228 patients (58.4±14.8 years old, 81% male, 196 with cardiogenic events, 32 with non-cardiogenic events). The patients were divided into 2 groups according to initial estimated-glomerular filtration rate (eGFR). Non-CKD Group: eGFR ≥60ml/min/1.73m2 (n=70); CKD Group: eGFR &lt;60 (n=158). Results: The rate of out-of-hospital cardiac arrest was 40%. In baseline characteristics, Non-CKD group was significantly younger (52.7 vs. 61.3 years old), lower incidence of hypertension (28 vs.52 %) and known coronary artery disease (6 vs 21%) in past history and lower BUN (14.5 vs. 26.2 mg/dl, all p&lt;0.05) than CKD group. Incidence of all-cause death at 30 days was significantly lower in the non-CKD than CKD group (53 vs. 78%, p&lt;0.0001). CKD was an independent predictor of mortality after adjustment for multiple cofounders (OR: 4.49, 95% CI: 2.07-9.77, p&lt;0.001). Kaplan-Meier curve showed better outcome in the non-CKD versus CKD group (p&lt;0.01). Conclusions: Initial low e-GFR just before implantation provides worse clinical outcome in patients undergoing ECPR.

Long-term outcome of IgA nephropathy with minimal change disease: a comparison between patients with and without minimal change disease

The clinicopathological characteristics, treatment response and long-term outcome of immunoglobulin (Ig)A nephropathy with minimal change disease (MCD-IgAN) are not well defined. Patients with biopsy-proven MCD-IgAN from the Jinling Hospital IgA nephropathy Registry were systematically reviewed and compared with those with IgA nephropathy without minimal change disease (Non-MCD-IgAN). We compared data of 247 MCD-IgAN patients and 1,121 Non-MCD-IgAN patients. Compared to Non-MCD-IgAN, MCD-IgAN patients were younger,with male predominance, had higher levels of proteinuria, total cholesterol and estimated glomerular filtration rate (eGFR), lower incidence of hypertension and microhematuria, lower level of serum creatinine, and had less severe glomerular, tubulointerstitial and vascular lesions in renal pathology. In the Non-MCD-IgAN group, 157 patients (14.0%) reached the renal endpoint and 103 patients (9.2%) entered end-stage renal disease (ESRD). The 5-,10-, 15- and 20-year cumulative renal survival rates from ESRD, calculated by Kaplan-Meier method, were 95.0, 83.0, 72.9 and 65.4%, respectively. In the MCD-IgAN group, no patients entered ESRD and only 4 (1.6%) reached the renal endpoint. Patients with MCD-IgAN had a significantly better renal outcome than Non-MCD-IgAN (p<0.01). At multivariate Cox analysis, proteinuria>1.0g/day, hypertension, eGFR<60ml/min/1.73m(2), hypoproteinemia and hyperuricemia were independent risk factors of renal survival for Non-MCD-IgAN patients [hazard ratio (HR) 3.43, p<0.001; HR 1.65, p<0.05; HR 2.61, p<0.001; HR 2.40, p<0.001; HR 2.27, p<0.001, respectively), but not for patients with MCD-IgAN. The long-term outcome of patients with MCD-IgAN is significantly better than that of patients with Non-MCD-IgAN.

Abstract W P146: Clinical Characteristics of PFO Stroke in Pregnancy

Background: Stroke can be a devastating complication of pregnancy. Patent foramen ovale (PFO), an incomplete closure of antenatal interatrial communication, may cause maternal stroke by allowing venous clots to travel directly to the brain. PFO is common in the general population (approximately 25%) and poses unique challenges during pregnancy. Clinically PFO is thought to increase the risk of stroke during pregnancy due to increased venous hypercoagulability in the peripartum period. However, data on PFO related stroke during pregnancy is lacking. We prospectively study the clinical characteristics of stroke in pregnant patients with and without PFO. Method: Following IRB-approved protocol, we prospectively collected and compared clinical characteristics of pregnant stroke patients with and without PFO over a 25 year period at our medical center. Results: Of 8134 PFO related stroke patients at our center, 24 patients had PFO related stroke during pregnancy. Compared to 46 age-matched pregnant stroke patients without PFO, PFO stroke patients had higher NIHSS scores at presentation (6.1 vs 3.8; P&lt;0.05). While the two groups were similar in conventional risks such as hyperlipidemia, gestational diabetes, smoking, EtOH/drug use (Table), PFO patients had a trend toward lower incidence of hypertension (p=0.054), but statistically significantly higher incidence of hypercoagulable state (p=0.0004), migraine with aura (p=0.006), and May-Thurners Syndrome (p=0.001). (Table). Conclusion: PFO may pose unique risks compared to non-PFO related stroke in pregnancy. Novel risk factors such as May-Thurner’s anatomy, which promote venous clotting with the increase in abdominal girth are important during pregnancy. For high risk individuals (such as those with known hypercoagulable state), screening for PFO may be of clinical utility in preventing strokes. Further studies are ongoing to validate these preliminary findings.

Comparison between Glidescope and Lightwand for tracheal intubation in patients with a simulated difficult airway.

BackgroundAlthough Lightwand and Glidescope have both shown high success rates for intubation, there has been no confirmation as to which device is most effective for difficult endotracheal intubation. We compared the Glidescope and Lightwand devices in terms of duration of intubation and success rate at the first attempt in a simulated difficult airway situation.MethodsFifty-eight patients were randomized to undergo tracheal intubation with either the Glidescope (Glidescope group, n = 29) or the Lightwand (Lightwand group, n = 29). All patients were fitted with a semi-hard cervical collar in order to simulate a difficult airway, and intubation was attempted with the assigned airway device. The data collected included the rate of successful endotracheal intubation, the number of attempts required, the duration of the intubation, as well as the interincisor distance, hemodynamic variables, and adverse effects.ResultsThere was no difference between Glidescope group (92.6%) and Lightwand group (96.4%) in terms of success rate for the first attempt at intubation. The duration of successful intubation for the first tracheal intubation attempt was significantly longer in Glidescope group than in Lightwand group (46.9 sec vs 29.5 sec, P = 0.001). All intubations were completed successfully within two intubation attempts. The incidence of hypertension was significantly higher in Glidescope group than in Lightwand group (51.9% vs 17.9%, P = 0.008).ConclusionsIn a simulated difficult airway situation, endotracheal intubation using Lightwand yielded a shorter duration of intubation and lower incidence of hypertension than when using Glidescope.

Abstract 221: Prognostic Impact of Estimated Glomerular Filtration Rate in Patients with Percutaneous Veno-arterial Extracorporeal Membrane Oxygenation

Purpose: Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) has been reported to improve survival in patients with cardiogenic shock or cardiac arrest. We investigated the association between initial renal function just before implantation and clinical outcome in patients undergoing VA-ECMO due to cardiogenic shock and cardiac arrest. Methods: A cohort of 212 patients (58.8±16.2 years old, 86% male) who underwent ECMO at our hospital was registered from January 2007 to December 2013. We excluded 68 patients caused by non-cardiogenic event. The remaining 144 patients (91 with acute myocardial infarction, 37 with refractory ventricular fibrillation, 6 with refractory congestive heart failure, and 6 with fulminant myocarditis) were divided into 2 groups according to initial estimated-glomerular filtration rate (eGFR). Non-CKD Group: eGFR ≥60ml/min/1.73m 2 (n=98); CKD Group: eGFR &lt;60 (n=46). Clinical outcome was defined as all-cause death at discharge. Results: The 82% of patients received VA-ECMO due to cardiac arrest. In baseline characteristics, Non-CKD group was significantly younger (50.4 vs. 62.8 years old), lower incidence of hypertension in past history (26.1 vs.52.0 %), lower BUN (13.7 vs. 24.3 mg/dl), and lower K (3.9 vs. 4.5 mEq/l, all p&lt;0.05) than CKD group. Incidence of all-cause death was significantly lower in Non-CKD group than in CKD group (Non-CKD vs. CKD: 60.9% vs. 78.6%: p=0.026) (Figure). The low eGFR was an independent predictor of mortality after adjustment of multiple cofounders (eGFR &lt;60, OR: 2.87, 95% confidence interval: 1.04-7.94, p=0.042). Negative independent predictors of mortality were fulminant myocarditis (OR: 0.08, 95% CI: 0.007-0.99, p=0.049) and count of platelet (per increase, OR: 0.94, 95% confidence interval: 0.88-0.99, p=0.037) Conclusion: Initial low e-GFR just before implantation provides worse clinical outcome in patients with VA-ECMO due to cardiogenic shock and cardiac arrest.

Clinical features of acute aortic dissection from the Registry of Aortic Dissection in China

To establish a systematic registry of aortic dissection in China, assess the clinical features of Chinese patients with acute aortic dissection (AAD), and compare our results with the data published by the International Registry of Acute Aortic Dissection (IRAD). We established the first Registry of Aortic Dissection in China (Sino-RAD) in 2011. Then we evaluated 1003 patients with AAD in Sino-RAD and compared our results with those reported by IRAD. Compared with IRAD, the patients with AAD in Sino-RAD were significantly younger. Also, the ratio of male patients in Sino-RAD was significantly greater for the total cohort and the type A and B cohorts. The overall in-hospital mortality was 10.3% in Sino-RAD. For type A dissection, more patients in Sino-RAD received medical treatment and fewer received surgical treatment. The overall mortality, mortality of medical treatment, and mortality of surgical treatment was lower in Sino-RAD. In type B dissection, fewer patients in Sino-RAD received medical and surgical treatment and more received endovascular treatment. The first Sino-RAD, including 15 large cardiovascular centers throughout China, was established. Our data were compared with those reported by IRAD. We found that, compared with Western populations, Chinese patients with AAD showed 6 differences, including earlier onset, more male patients, a low incidence of hypertension, a low incidence of chest pain, a high incidence of back pain, great differences in the choice of therapeutic strategies, and relatively low in-hospital mortality.

Long-Term Outcome of IgA Nephropathy Patients with Recurrent Macroscopic Hematuria

Background/Aims: The long-term renal outcomes of patients with IgA nephropathy (IgAN) who present with recurrent macroscopic hematuria (RMH) have not been described in previous studies. Methods: Patients with biopsy-proven primary IgAN in Jinling Hospital were divided into three groups according to different patterns of macroscopic hematuria (MH): RMH, isolated MH (IMH), and those without a history of MH (NMH). Results: A total of 1,155 patients were enrolled in the study (158 in the RMH group, 256 in the IMH group, and 741 in the NMH group). At biopsy, patients with RMH were younger, had lower median proteinuria, a lower incidence of hypertension, and a higher estimated glomerular filtration rate than those in the NMH group. Pathologically, patients with RMH had a lower level of mesangial hypercellularity and segmental glomerulosclerosis as well as less tubular atrophy than those with NMH. The demographic and clinical features of patients with IMH fell between patients with RMH and those with NMH. During a median follow-up of 7.9 years, the 5-, 10- and 20-year cumulative renal survival after biopsy, as calculated by K-M methods, were 98, 91, and 91% in the RMH group, 95, 89, and 64% in the IMH group, and 95, 79, and 57% in the NMH group. The renal survival in patients with RMH was significantly better than patients with NMH or IMH. Conclusions: The long-term prognosis of patients who present with RMH is significantly better than patients with NMH or IMH.

Should Proximal LAD be treated differently? Insights from a large DES stent registry

The current revascularization treatment recommendation is different according to lesion location and a higher recommendation is given to surgery for proximal LAD (pLAD) lesions over PCI. This is based on previous studies and expert opinion. We aimed to investigate whether indeed there is a difference in outcome with respect to LAD lesion location while using a drug eluting stent (DES). The NOBORI-2 trial, enrolled 3067 consecutive patients in 125 centers who were treated with DES for single and multivessel disease. We compared 834 [27.2%] patients who underwent PCI of the pLAD as part of their revascularization, to 2203 [71.8%] patients in which stenting to other lesion(s) but not the pLAD was performed. The pLAD group had lower incidence of hypertension, peripheral vascular disease, prior PCI and CABG, but had more lesions treated [1.55 ± 0.8 vs. 1.35 ± 0.6], more stents implanted [1.98 ± 1.2 vs. 1.66 ± 1.0] and longer overall stent length [31.8 ± 20.2 vs. 28.2 ± 17.8 mm]. There was no difference in the occurrence of the primary endpoint [cardiac death, myocardial infarction and target lesion revascularization] at 1 or 2 years of follow up between the pLAD and non pLAD [6.0% vs. 4.6%, p=0.14 and 7.7% vs. 6.6%; p=0.22, respectively]. The relief from anginal symptoms was similar. Multivariate analysis showed that pLAD location was not a variable that predicted MACE or TLF. Stent thrombosis rate was similar. When considering PCI with DES, there is no difference in outcome between patients with and without proximal LAD lesions.

Assessment of adiponectin and its isoforms in Polish centenarians

BackgroundThe physiological mechanisms that promote longevity remain unclear. It has been suggested that insulin sensitivity is preserved in centenarians, whereas typical aging is accompanied by increasing insulin resistance. The oldest-old individuals display raised total adiponectin levels, despite the potential correlation between enhanced adiponectin and all-cause and cardiovascular mortality. AimTo evaluate the level of adiponectin and its isoforms in sera of centenarians and to assess associations between adiponectin and metabolic parameters. ParticipantsA group of 58 Polish centenarians (50 women and 8 men, mean age 101±1.34years) and 68 elderly persons (55 women and 13 men, mean age 70±5.69years) as controls. MeasurementsSerum samples were analyzed to evaluate the following parameters: adiponectin array (total adiponectin, HWM-, MMW- and LMW-adiponectin; all by ELISA methods), insulin (by IRMA methods), glucose and lipid profiles. HOMA-IR was calculated. Clinical data were collected. Statistical analyses were performed. ResultsThe concentrations of all adiponectin isoforms were significantly higher in the oldest-old participants. In the centenarian group, total adiponectin positively correlated with age and HDL-cholesterol, and HMW-adiponectin was negatively associated with insulin and triglycerides. The long-lived participants had a lower incidence of hypertension, type 2 diabetes, overweight and obesity, with lower concentrations of serum glucose and insulin, and reduced HOMA-IR. ConclusionOur findings support the thesis that centenarians possess a different adiponectin isoform pattern and have a favorable metabolic phenotype in comparison with elderly individuals. However, additional work is necessary to understand the relevance of these findings to longevity.

Temporal changes in cardiorespiratory fitness and the incidence of hypertension in initially normotensive subjects

Low-cardiorespiratory fitness (CRF) has been associated with incident hypertension, but whether temporal changes in CRF are associated with incident hypertension in initially normotensive subjects are not known. We investigated the relationship of baseline CRF and longitudinal changes in CRF with incident hypertension in initially normotensive subjects. Subjects were 3,831 men who participated in two health examinations during 1998-2009. All subjects were free of cardiovascular diseases and hypertension at baseline. CRF was directly measured by peak oxygen uptake using expired gas analysis during a standard treadmill test. During an average of 5 years of follow-up, 373 (9.7%) subjects developed hypertension. The incidence of hypertension was inversely associated with baseline CRF quartiles [Q1 (lowest) 11.8%, Q2 10.4%, Q3 9.1%, and Q4 (highest) 7.5%; P < 0.05 for trend]. The relative risk (RR) of incident hypertension in the lowest CRF quartile versus the highest CRF quartile was 1.69 (95% CI: 1.22-2.34) after adjustment for risk factors. Each metabolic equivalent increment higher peak oxygen uptake at baseline examination was associated with 10% (RR 0.90, 95% CI: 0.83-0.98) lower incidence of hypertension in multivariate adjusted model. Subjects whose CRF decreased (<-1.18 ml/kg/min per year) over time had a 72% increased risk in developing hypertension (RR 1.72, 95% CI: 1.20-2.49) compared to subjects with increased CRF (>0.13 ml/kg/min per year) after adjustment for risk factors. These results demonstrate that both baseline CRF levels and changes in CRF over time were associated with the incidence of hypertension independent of risk factors.

Cardiorenal Effects of Newer NSAIDs (Celecoxib) versus Classic NSAIDs (Ibuprofen) in Patients with Arthritis

Background. Arthritis is a common condition that co-exists in the elderly population. This condition leads to frequent administration of comorbid analgesics especially non steroidal anti-inflammatory drugs (NSAIDs). Aim. To study cardiorenal toxicity of celecoxib versus ibuprofen in arthritic patients. Subjects and Methods. Seven hundred ninety-wo arthritic patients were enrolled in the study for 6 months. Three hundred ninety-six patients administered celecoxib 400 mg twice a day; 396 patients administered ibuprofen 300 mg three times a day. Effects measured included investigator-reported hypertension, edema, or congestive heart failure, increases in serum creatinine or reduction in serum creatinine clearance, and changes in serum electrolytes. Results. Celecoxib was associated with significant (P < .05) lower incidence of hypertension and edema in comparison with ibuprofen. Systolic hypertension occurred significantly less (P < .05) with celecoxib compared with ibuprofen. Serum creatinine was significantly increased (P < .05) in patients treated with ibuprofen in comparison with celecoxib. Creatinine clearance was significantly lower (P < .05) in cases treated with ibuprofen in comparison to celecoxib. Nonsignificant changes in serum body electrolytes occurred. Conclusion. The most important finding of this study was the lowering incidence of cardiorenal toxicity of celecoxib in comparison with ibuprofen.

Newly Reported Hypertension After Military Combat Deployment in a Large Population-Based Study

High-stress situations, such as combat deployments, are a potential risk factor for hypertension. Although stress is postulated to increase blood pressure, the underlying role of stress on hypertension is not well established. We sought to determine the relations between combat deployment-induced stress and hypertension. The Millennium Cohort baseline questionnaire (2001-2003) was completed by 77,047 US active-duty and Reserve/National Guard members. Follow-up was completed by 55,021 responders approximately 3 years later (2004-2006). Multivariable logistic regression was used to estimate the 3-year risk of newly reported hypertension, adjusting for general and mental health, demographics, and occupational and behavioral characteristics. After applying exclusion criteria, our analyses included 36 061 service members. Subanalyses of deployers included 8829 participants. Newly reported hypertension was identified in 6.9% of the cohort between baseline and follow-up, many of whom had deployed on military operations in support of the conflicts in Iraq and Afghanistan. After adjusting, deployers who experienced no combat exposures were less likely to report hypertension than nondeployers (odds ratio: 0.77; 95% CI: 0.67 to 0.89). Among deployers, those reporting multiple combat exposures were 1.33 times more likely to report hypertension compared with noncombat deployers (95% CI: 1.07 to 1.65). Although military deployers, in general, had a lower incidence of hypertension than nondeployers, deployment with multiple stressful combat exposures appeared to be a unique risk factor for newly reported hypertension.

Prevalence of arterial hypertension in cirrhosis of liver

Sir, Systemic hypertension is a common disorder. Cirrhotic patients have hyperdynamic circulation with a decrease in effective circulatory blood volume, which has been attributed to the underlying vasodilatory state in these patients. On this background, we conducted a study to evaluate the prevalence of essential hypertension among patients with cirrhosis and the related cardiovascular changes among them. We prospectively evaluated 260 cirrhotic patients at the Stanley Medical College, Chennai, India, regularly attending the Liver Clinic, of whom alcohol was the cause in 140 cases. All patients underwent blood pressure (BP) recording in supine and sitting posture, ECG, and echocardiogram. Among the 260 cases, 23 (8.8%) patients with arterial hypertension were identified, of whom four patients were excluded because of secondary hypertension. Among the remaining 19 (7%) patients with hypertension, the mean age was 51 ± 14.46 years, M:F ratio was 3.1:1, and the mean BMI was 25.8 kg/m2. The mean arterial pressure (MAP) was 120 mmHg. Ten patients (52.6%) were categorized as Child's A, six (31.5%) as Child's B, and three (15.7%) as Child's C. Abnormalities in ECG were noted in seven patients (36.8%), and abnormalities in echocardiogram were observed in six (31.6%) patients. In the normotensive group, comprising 237 patients, the mean age was 53 ± 13.56 years, M:F ratio was 1.8:1, mean BMI was 24.2 kg/m2, and the MAP was 83 mmHg; abnormalities in ECG were present in four (1.6%) patients, and none had abnormalities in echocardiogram. There has been a relatively low prevalence of hypertension among patients with hepatic cirrhosis.[1] Cirrhosis is a state of hyperdynamic circulation with increased cardiac output and low systemic vascular resistance.[2] This is mainly due to the abnormal distribution of increased blood volume with decreased effective circulatory blood volume, neurohumoral activation, and abnormal sodium and water handling.[3] There is also evidence that the static and dynamic properties of the large arteries are changed.[4] These factors probably account for the relatively low incidence of hypertension in patients with cirrhosis. In the current study, the prevalence of hypertension among cirrhotic patients was 7%, which is less than that among the general population (10–15%). Incidence of hypertension was found to be higher in patients with Child's A cirrhosis and showed a decreasing trend on worsening of liver disease. The study has shown the relatively low incidence of hypertension and cardiac events among the patients with cirrhosis, thereby postulating the possible protective effects of cirrhosis on the cardiovascular system.

Why Can’t a Woman Be More Like a Man?

In Pygmalion , Henry Higgins asked, “Why can’t a woman be more like a man?” But when it comes to hypertension, Henry actually should have asked, “Why can’t a man be more like a woman?” Women have lower blood pressure (BP) and a lower incidence of hypertension than aged-matched men through much of their lives.1 We need to understand why, because a better understanding of what protects the female from this potentially devastating disease ultimately could lead to new therapeutic treatments for both men and women. According to the American Heart Association, hypertension is a disease that afflicts >73 million people and kills >50 000 people per year in the United States alone. Uncontrolled hypertension leads to heart failure, myocardial infarction, stroke, and renal failure. Surprisingly, we still do not know the cause of essential hypertension, although it accounts for >90% of all cases of hypertension. In this issue of Hypertension , using a model of angiotensin II (Ang II)–induced hypertension, Sampson et al1 suggest that the angiotensin type 2 receptor (AT2R) provides a major clue for solving the mystery of sex differences in hypertension. Ang II infusion is a widely used experimental model of hypertension, because inhibitors of Ang II synthesis and action have been very effective clinically to treat hypertension. In fact, most hypertensive patients respond to Ang II synthesis inhibitors and angiotensin type 1 receptor (AT1R) blockers, indicating that essential hypertension is primarily Ang II dependent. Thus, the mechanisms uncovered in this experimental model are likely to be clinically relevant. At high doses, Ang II (400 to 800 ng/kg per minute) can elicit a “rapid direct pressor” response in a matter of hours. At low doses, Ang II (100 to 200 ng/kg per minute) increases mean arterial pressure (MAP) gradually over …