Mild Essential Hypertension Research Articles

Inflammatory cytokines induce neutrophil extracellular traps interaction with activated platelets and endothelial cells exacerbate coagulation in moderate and severe essential hypertension.

Essential hypertension (EH) patients suffer from paradoxically thrombotic rather than haemorrhagic, although the exact mechanism remains elusive. Our aim is to explore whether and how neutrophil extracellular traps (NETs) play the procoagulant role in EH patients, as well as evaluated whether the NET releasing were triggered by inflammatory cytokines. The concentration of plasma NETs components were detected by ELISA. The morphology of cells and NETs formation were analysed using immunofluorescence. Procoagulant activity was analysed by clotting time, purified coagulation complex and fibrin generation assays. Phosphatidylserine (PS) exposure on endothelial cells (ECs) was analysed with flow cytometry. Moderate to severe EH patients plasma NETs levels were significantly higher compared to mild EH patients or controls. Furthermore, inflammatory cytokines can induce NETs generation, depleting these patients plasma inflammatory cytokines led to a reduction in NET releasing. NETs from moderate to severe EH patients neutrophils led to significantly decreased clotting time (CT), increased potency to generate thrombin and fibrin (all P < 0.05). These procoagulant effects were markedly attenuated by approximately 70% using DNase I. Additionally, high concentrations NETs exerted a strong cytotoxic effect on ECs, conferring them a procoagulant phenotype. Our study reveals that EH drives a systemic inflammatory environment, which, in turn, drives neutrophils to prime and NET releasing, and found a link between hypercoagulability and NETs levels in moderate to severe EH patients. Therefore, anti-inflammatory combined with block the generation of NETs may represent a new therapeutic target for preventing thrombosis in EH patients.

Effect of High-intensity Aerobic Exercise Versus Moderate-intensity Aerobic Exercise on Serum Uric Acid in Hypertension

Background &amp; purpose: Methods: Thirty hypertensive men (Mild Essential Hypertension) with ages ranging from 45 to 55 years old and BMIs ranging from 25 to 35 kg/m2 took part in the study (overweight and class1 obesity). The participants were classified randomly into two main domains; A and B. As for the first Group, (A) did high-intensity (interval) aerobic activity, while group (B) did moderate-intensity (continuous) aerobic exercise. Both categories exercised for 30-40 minutes on an electrical treadmill three times a week for eight weeks. Blood uric acid, serum creatinine, and serum urea were tested for each patient before and after the trial. The arterial blood pressure measurements were also taken before and after the study to draw comparisons and to set evaluations. Results: Both high-intensity interval and continuous moderate exercise had a significant lowering effect on serum uric acid and creatinine (p.05), with continuous moderate exercise having a better effect with a 16 percent improvement in serum uric acid and a 27.5 percent improvement in creatinine, while high-intensity interval exercise had an 8 percent improvement in serum uric acid and a 17 percent improvement in creatinine. On the other hand, arterial blood pressure and blood urea levels improved at the same rate. Conclusion: Moderate continuous exercise reduces serum uric acid and creatinine better than high-intensity interval exercise. Both have the same effect on blood pressure and urea, but moderate continuous exercise has a crystal-clear effect that cannot be denied.

Correction to: Efficacy and Safety of Chinese Herbal Medicine Compared With Losartan for Mild Essential Hypertension: A Randomized, Multicenter, Double-Blind, Noninferiority Trial.

Correction to: Efficacy and Safety of Chinese Herbal Medicine Compared With Losartan for Mild Essential Hypertension: A Randomized, Multicenter, Double-Blind, Noninferiority Trial.

Efficacy and Safety of Chinese Herbal Medicine Compared With Losartan for Mild Essential Hypertension: A Randomized, Multicenter, Double-Blind, Noninferiority Trial.

Hypertension is one of the most challenging public health problems worldwide. Previous studies suggested that the Songling Xuemaikang capsule (SXC)-a Chinese herbal formula-was effective for essential hypertension. However, the efficacy of SXC monotherapy for hypertension remains unclear. We aimed to compare the blood pressure (BP)-lowering efficacy and safety of SXC versus losartan in patients with essential hypertension. In this multicenter, randomized, double-blind, noninferiority trial in China, patients 18 to 65 years of age with mild essential hypertension were randomly allocated to receive either SXC or losartan for 8 weeks. The primary outcome was the change in sitting diastolic BP from baseline to 8 weeks, with a predefined noninferiority margin of -2.5 mm Hg. Of the 755 patients who entered a 2-week run-in period, 628 patients (327 women and 301 men; mean [SD] age, 52.6 [9.2] years) were randomly assigned to the SXC (n=314) or losartan (n=314) group. The primary analysis based on the intention-to-treat principle showed that the change in diastolic BP from baseline to 8 weeks was similar between the SXC and losartan groups (-7.9 [8.0] versus -8.1 [7.9]). The lower boundary of 95% CI (mean difference, -0.24 [95% CI, -1.51 to 1.03]) was above the margin of -2.5 mm Hg, showing noninferiority. Results were consistent with per-protocol analysis. SXC produced greater improvements in total hypertension symptom score (-5.7 [4.2] versus -5.0 [4.0]; P=0.020) and total cholesterol (-0.1 [1.0] versus 0.1 [1.2]; P=0.025). There were no differences between groups in the other BP and patient-reported outcomes. Incidence and severity of adverse events were similar between groups. SXC was well tolerated and demonstrated noninferior to losartan in BP lowering in patients with mild hypertension. SXC might be an alternative for mild hypertension, particularly for patients with a preference for natural medicine. URL: www.chictr.org.cn; Unique identifier: ChiCTR-IPR-16008108.

Effect of Songlingxuemaikang on mild essential hypertension in patients: a randomized parallel-controlled study.

To evaluate the effect of songlingxuemaikang (SLXMK) on mild essential hypertension in patients in terms of endothelial function. We enrolled 90 patients with mild essential hypertension in Xuanwu Hospital from January 2016 to December 2016. To evaluate the effects of SLXMK, the 90 patients were randomly assigned at a 2∶1 ratio into 2 groups: the SLXMK group (500 mg per capsule, 4500 mg/d, n = 60) and the losartan potassium group (50 mg per table, 50 mg/d, n = 30). The total study period was 12 weeks, and the changes of blood pressure, laboratory test and endothelium function were compared between two groups. After 12 weeks of treatment with SLXMK, blood pressure (BP) and plasma lipid levels significantly improved (P < 0.05). Meanwhile, the reactive hyperemia index (RHI) increased in the SLXMK group (P < 0.05). The results of multivariate logistic regression analyses examining the association of selected variables with showed that high level of oxidized low density lipoprotein (ox-LDL) was positively associated with endothelial dysfunction. SLXMK not only effectively decreased BP and plasma lipid levels, but also reduced ox-LDL and RHI in patients with mild essential hypertension. And SLXMK might improve endothelial function through decreasing the circulating ox-LDL.

Effect of direct renin inhibition on vascular function after long-term treatment with aliskiren in hypertensive and diabetic patients.

We tested the hypothesis that chronic treatment with the direct renin inhibitor aliskiren improves vascular function in resistance and conduit arteries of type two diabetic and hypertensive patients. Sixteen patients with mild essential hypertension and with a previous diagnosis of noninsulin-dependent diabetes mellitus were included in the study. Patients were then randomized to aliskiren (150 mg once daily, n = 9), or ramipril (5 mg once daily, n = 7). Each patient underwent a biopsy of the subcutaneous tissue and small arteries were dissected and mounted on a pressurized micromyograph to evaluate endothelium dependent vasorelaxation in response to acetylcholine ± N omega-nitro-L-arginine methyl ester hydrochloride in vessels precontracted with norepinephrine. Endothelial function has been quantified also in large conduit arteries by flow-mediated dilation. A similar office blood pressure-lowering effect was observed with the two drugs, although changes in DBP were not statistically significant in the ramipril group. Aliskiren significantly improved endothelium-dependent relaxation in subcutaneous resistance arteries, as well as increased flow-mediated dilation in conduit arteries, whereas the effects induced by ramipril did not reach statistical significance. Only aliskiren significantly increased the expression of p1177-endothelial nitric oxide synthase in the endothelium. Both aliskiren and ramipril had a negligible effect on markers of oxidative stress. Aliskiren restored endothelial function and induced a more prompt peripheral vasodilation in hypertensive and diabetic patients possibly through the increased production of nitric oxide via the enhanced expression and function of the active phosphorylated form of endothelial nitric oxide synthase.

Allisartan Isoproxil Improves Endothelial Function and Vascular Damage in Patients with Essential Hypertension: A Single-Center, Open-Label, Randomized Controlled Trial.

Allisartan isoproxil is a novel angiotensin II type 1 receptor antagonist that has been confirmed to lower blood pressure and protect target organs effectively. However, its role in improving endothelial function and vascular damage has not been investigated yet. Patients with initially diagnosed mild essential hypertension (BP ranging from 140/90 to 159/99mmHg) with age from 25-75years were randomly assigned 1:1 to either the allisartan group (allisartan 240mg/day and lifestyle modification) or the lifestyle modification group and were followed up for 30days. Flow-mediated dilation (FMD), brachial-ankle pulse wave velocity (baPWV) and endothelialmicroparticles (EMPs) were measured for evaluation of endothelial function and vascular damage. In addition, we enrolled 36 normotensive individuals as healthy control. Seventy-two mildly hypertensive patients were enrolled in this study. After 30days of treatment, a significant increase in FMD was observed in the allisartan group (0.9 ± 0.7%, p < 0.001) and remained unchanged in the lifestyle modification group, but the difference between the two groups did not reach statistical significance (p = ns). EMPs, baPWV, SBP and DBP decreased by 251.0 ± 255.9 counts/μl (p < 0.001), 102.8 ± 84.2cm/s (p < 0.001), 13.20 ± 3.9mmHg (p < 0.001) and 9.35 ± 2.5mmHg (p < 0.001), respectively, in the allisartan group, while by 21.3 ± 84.3 counts/μl (p = ns), 0.4 ± 22.0cm/s (p = ns), 3.2 ± 6.0mmHg (p < 0.01) and 1.0 ± 2.5mmHg (p = ns), respectively, in the lifestyle modification group. All of the indexes above achieved statistical significance between the allisartan and lifestyle modification groups (p < 0.05). Besides, after 30days of allisartan administration baPWV and EMPs were comparable to those measured in the healthy control group, while the difference in SBP, DBP and FMD remained significant between the allisartan and healthy control groups (p < 0.05). The present study demonstrates for the first time that allisartan isoproxil exerts a favorable effect on improving endothelial function and vascular damage in patients with mild EH, making it a promising drug for management of EH. ChiCTR2000032332.

Behaviour of carbonyl groups in several clinical conditions: Analysis of our survey.

Protein carbonylation is a marker of oxidative protein damage, that is likely involved in the pathogenesis of several diseases. The aim of this study was to evaluate the protein carbonyl (PC) groups in different clinical conditions. It included different groups of subjects: 81 trained subjects; 23 subjects with mild essential hypertension; 31 middle-aged subjects with metabolic syndrome (MS); 106 subjects with MS not selected for age (subdivided into two subgroups, with and without diabetes mellitus); 91 obese adults subdivided in two subgroups (BMI 30-35 Kg/m2 and BMI > 35 kg/m2); 48 subjects with obstructive sleep apnea syndrome (OSAS) subdivided in accordance with the apnea/hypopnea index (AHI); 27 subjects with chronic kidney disease (CKD) on conservative therapy; 31 subjects with CKD on haemodialysis treatment; and 50 subjects with juvenile myocardial infarction. PC groups were reduced in trained subjects in comparison with sedentary controls, while no variation was observed in mild essential hypertension. PC groups were increased in MS subjects and in adult obese subjects. In MS subjects the PC groups were not influenced by the presence of diabetes mellitus and in adult obese subjects were not influenced by the obesity degree. In OSAS subjects only those with AHI > 30 showed an increase of PC groups. PC groups increased in CKD subjects undergoing conservative treatment and haemodialysis therapy. In dialyzed subjects, after a standard dialysis session, there was a marked increase in PC groups. In juvenile myocardial infarction PC groups were higher than in controls; there was no difference between STEMI and NSTEMI and their concentration was unaffected by the number of cardiovascular risk factors or stenosed coronary vessels.

The exaggerated natriuresis of essential hypertension occurs independently of changes in renal medullary blood flow.

In patients with essential hypertension, abnormal renal sodium handling includes exaggerated natriuresis in response to extracellular volume expansion. We tested the hypothesis that exaggerated natriuresis is associated with increases in medullary and/or cortical renal blood flow. Patients with mild essential hypertension, but no signs of end organ damage, and control subjects were studied after 4days of dietary standardization (<60mmol Na+ day-1 ) preceded in patients by a 14-day drug washout period. On the study day, subjects received a 4-hour intravenous volume expansion with saline (2.1% of body mass). Renal medullary and cortical blood flows were measured by PET scanning using H215 O as tracer; anatomical regions of interest were defined by contrast-enhanced CT scanning. In patients, arterial blood pressure increased during volume expansion (107±2-114±3mmHg, P<0.05) in contrast to the control group (92±2-92±2mmHg). Renal sodium excretion increased more in patients than in controls (+133±31µmolmin-1 vs +61±14µmolmin-1 , respectively, P<0.05) confirming exaggerated natriuresis. During volume expansion, renal medullary blood flow did not change significantly in patients (2.8±0.4-2.5±0.5mL (g tissue)-1 min-1 ) or in controls (3.2±0.3-3.1±0.2mL (g tissue)-1 min-1 ). In control subjects, renal cortical blood flow fell during volume expansion (4.1±0.3-3.7±0.2mL (g tissue)-1 min-1 , P<0.05) in contrast to patients in which deviations remained insignificant. Exaggerated natriuresis, a hallmark of essential hypertension, is not mediated by increases in regional, renal blood flow.

The Effect of Dongeui Qigong for Prehypertension and Mild Essential Hypertension.

Although several previous studies have reported the effect of qigong on lowering blood pressure, rigorous trials are lacking. Studies evaluating the effect of qigong on prehypertension are also scarce. This study aimed to assess the effect of qigong on prehypertension and mild hypertension. Participants with prehypertension or mild hypertension were randomized to the Dongeui qigong group or a nontreated control group. In the qigong group, Dongeui qigong was administered 5 times/week for 12 weeks. The control group did not receive any intervention for blood pressure control. Fifty-two participants were included in this study. Even though diastolic blood pressure was significantly reduced in the qigong group after 8 weeks (p = 0.04) compared to baseline, the difference in change in blood pressure between the qigong and control groups was not significant. There were no significant differences in quality of life between the qigong and control groups. Dongeui qigong is not significantly effective in pre/mild hypertension compared with controls. This result could be due to a lack of effect of qigong or caused by other factors, such as the type of qigong, target symptoms, inappropriate sample size, and compliance of participants. Trial Registration. This trial is registered with KCT0001397 (Clinical Research Information Service).

Higher cost sharing for visiting general hospitals and the changing trend in the first-visited healthcare organization among newly diagnosed hypertension patients.

Unnecessary use of high-quality resources in general hospitals hinders treatment of patients with urgent and complicated conditions. Thus, the Korean Government has sought to reduce general hospital visiting of patients with 52 mild diseases, including hypertension. The higher cost sharing for medical expenses and medications from general hospitals were enacted in 2009 and 2011, respectively.We determined whether these regulations were effective through evaluating changing trends in first-visited healthcare organizations and defined the first visiting healthcare organization level (primary clinics, hospital, and general hospital) as an outcome measure.Data of 32,830 mild hypertension patients from 2004 to 2013 were retrieved from the Korean National Health Insurance Service National Sample Cohort. This was a retrospective study involving a large national cohort with patient samples (representing 2% of the total Korean population) stratified on the basis of sociodemographic information.Mutinomial logistic regression were performed for the first visiting to different health organizations, compared to the first visiting to primary clinics.Patients in 2012 and 2013 had significantly lower odds ("2012": 0.68, 95% confidence interval [CI]: 0.56-0.81/"2013": 0.66, 95% CI 0.54-0.81) of first visiting general hospitals compared with those in 2008, although decreased tendencies (albeit nonsignificant) were already evident in 2010 and 2011.Thus, government health policies for cost-containment seem effective in decreasing first visiting of general hospitals among patients with mild essential hypertension. These policies have since extended to Medical Aid beneficiaries; thus, it is needed to continue monitor their results carefully.

Lanosterol Synthase Gene Polymorphisms and Changes in Endogenous Ouabain in the Response to Low Sodium Intake.

Circulating levels of endogenous ouabain (EO), a vasopressor hormone of adrenocortical origin, are increased by sodium depletion. Furthermore, lanosterol synthase, an enzyme involved in cholesterol biosynthesis, has a missense polymorphism (rs2254524 V642L) that affects EO biosynthesis in adrenocortical cells. Here, we investigated the hypothesis that lanosterol synthase rs2254524 alleles in vivo impact the blood pressure (BP) and EO responses evoked by a low dietary Na intake (<100 mEq/d, 2 weeks) among patients with mild essential hypertension. During the low salt diet, the declines in both systolic BP (SBP: -8.7±1.7 versus -3.0±1.5; P=0.013) and diastolic BP (DBP: -5.1±0.98 versus -1.4±0.94 mm Hg; P<0.05), and the slope of the long-term pressure-natriuresis relationship affected significantly the presence of the lanosterol synthase rs2254524 A variant (AA: 0.71±0.22, AC 0.09±0.13, and CC 0.04±0.11 mEq/mm Hg/24 h; P=0.028). In addition, BP rose in ≈25% of the patients in response to the low salt diet and this was associated with increased circulating EO. Lanosterol synthase gene polymorphisms influence both the salt sensitivity of BP and changes in circulating EO in response to a low salt diet. The response of BP and EO to the low salt diet is markedly heterogeneous. Approximately 25% of patients experienced adverse effects, that is, increased BP and EO when salt intake was reduced and may be at increased long-term risk. The augmented response of EO to the low salt diet further supports the view that adrenocortical function is abnormal in some essential hypertensives.

Abstract 024: The Direct Renin Inhibitor Aliskiren Improves Vasodilation and Endothelial Function in Resistance Arteries from Diabetic and Hypertensive Patients

We previously demonstrated that the direct renin inhibitor aliskiren (ALK) significantly reduced the remodeling of subcutaneous resistance arteries of hypertensive patients as compared to the angiotensin-converting enzyme inhibitor ramipril (RAM). Here we questioned whether endothelial function of resistance arteries would improve after 1 year of blood pressure (BP) control with ALK or RAM. Sixteen diabetic patients with mild essential hypertension were randomized to ALK (150-300 mg once daily, n=9) or RAM (5-10 mg once daily, n=7). Subcutaneous resistance arteries were dissected from gluteal biopsy and mounted on a pressurized micromyograph. Endothelium-dependent and -independent relaxations were assessed by concentration-response curves to acetylcholine (1 nM to 100 μM) and sodium nitroprusside (10 nM to 1 mM) respectively, in arteries pre-contracted with norepinephrine (10 μM). Carotid-femoral pulse wave velocity (PWV) was assessed by applantion tonometry. Forearm flow mediated dilation (FMD) was assessed by ultrasounds. The expression of P-eNOS/e-NOS and the markers of oxidative stress nitrotyrosine and LOX-1 were assessed by immunohistochemistry in resistance arteries. Patients were similar for age, sex, BMI and glycemic and metabolic control. Systolic BP was significantly and equally reduced by both ALK and RAM (153±8.9 mmHg reduced to 128±7.3 mmHg and 151±10.6 mmHg reduced to 121±12.1, respectively, P&lt;0.01) whereas diastolic BP was significantly reduced only in ALK-treated but not in RAM-treated patients (94.2±7.17 mmHg reduced to 81.4±6.31 mmHg, P&lt;0.01; and 84.7±12.22 reduced to 78.6±7.48, NS, respectively). PWV and FMD were similar in both groups before and after treatment. Endothelium-dependent vasodilation was improved only by ALK (max dilation 92.5±3.8% vs 50.5±14%, P&lt;0.05) but not by RAM (max dilation 72.9±5.6% vs 61.8±14.5%, NS). Endothelium-independent vasodilation was similar in all the groups. Only ALK increased P-eNOS/eNOS expression (+44% vs before treatment, p&lt;0.05). The markers of oxidative stress were similar in both groups before and after treatment. In conclusion ALK improved endothelial function and induced vasodilation in resistance arteries from diabetic and hypertensive patients.

Anaesthesia Management of a Patient with Large Atrial Septal Defect with Moderate Pulmonary Hypertension for Total Abdominal Hysterectomy

Atrial septal defect (ASD) is a common cardiac anomaly that may be first encountered in the adults and occurs more frequently in females. ASD accounts for 10% of congenital cardiac defects in adults. A 50 year old female patient posted for Total Abdominal Hysterectomy was diagnosed to have ostium secundum large ASD with mild tricuspid regurgitation with moderate pulmonary hypertension and mild essential hypertension. We report the successful management of the case using combined general anaesthesia with Bilateral Transversus Abdominis plane (TAP) block for postoperative analgesia. During the general anesthesia for the procedure our objectives were to avoid hypotension, hypoxemia, hypercarbia, hypothermia, reversal of shunt and fluid overload and postoperative analgesia by TAP block, The patient had an eventful perioperative course and discharged from the hospital on the 5 th -postoperative day in good physical condition.

Overactivation of muscle mechanoreflex in human hypertension

Our previous study in patients with mild essential hypertension demonstrated that moderate level rhythmic handgrip (RHG) at 30% maximal voluntary contraction (MVC), which typically had no effect on sympathetic nerve activity (SNA) in healthy normotensive subjects, evoked asympathoexcitatory response in hypertensive subjects. This finding indirectly suggested that mechanoreflex function was enhanced in hypertension. However, mechanoreflex function has not been directly assessed in hypertensive patients.Accordingly, we measured SNA with intraneural microelectrodes in 5 subjects with untreated hypertension (HTN) and 6 age‐matched normotensive controls (NT) during passive arm cycling (PAC). PAC was used to preferentially stimulate the mechanoreflex. Surface electromyography was monitored during arm cycling to avoid inadvertent muscle contraction.We found that SNA increased significantly in HTN compared to NT within the first minute of PAC, which was sustained at 3 minutes (27±10 vs. 2±6% total activity, p &lt; 0.05). The increase in SNA was accompanied by a significant increase in mean arterial pressure (MAP) from 102±4 to 106±3 mmHg in the HTN group (p &lt;0.05), while MAP remained unchanged in NT group (96±3 vs. 96±3 mmHg, p = NS). Rhythmic handgrip at 30% MVC also induced greater increases in SNA in the HTN than NT group (46±14 vs. ‐1±6% total activity, p &lt;0.05).Thus, our data represent the first direct evidence for enhanced mechanoreflex function in human hypertension.

Efficacy and safety evaluation of perindopril–lercanidipine combined therapy in patients with mild essential hypertension

Objective:To investigate the efficacy and safety of perindopril–lercanidipine combination versus perindopril or lercanidipine monotherapies in patients with mild essential hypertension.Methods:A total of 180 patients with mild essential hypertension were randomly assigned to three groups: group A (perindopril 2 mg plus lercanidipine 5 mg; n = 60), group B (lercanidipine 10 mg; n = 60) and group C (perindopril 4 mg; n = 60). The treatment efficacy and the incidence of adverse events were evaluated at the end of 4, 8 and 12 weeks after treatment initiation.Results:The blood pressure in group A was already lower than in group B and group C at week 4 after treatment initiation. Systolic blood pressure was 148 ± 13 mmHg in group A, 151 ± 14 mmHg in group B, and 153 ± 13 in group C (p < 0.001); diastolic blood pressure was 89 ± 8, 92 ± 7 and 92 ± 6 mmHg, respectively (p < 0.001). At the end of treatment the normalization rate was significantly higher in group A, compared with group B and group C (71.7%, 68.3%, and 48.3%, respectively; p < 0.05). Four adverse events were observed in group A, while seven and nineteen adverse events occurred in group B and in group C, respectively. Statistically significant differences in adverse reaction incidence were reported among three groups.Conclusion:Although its results were collected in an overall limited number of patients in a single center, this study shows that the combination of perindopril and lercanidipine, compared with lercanidipine alone or perindopril alone, was effective in improving blood pressure in mild essential hypertensive patients, and also decreased the incidence of adverse events.

Is there any association between mild hypertension and hot flash experience among women?

Objective: To determine the association between ambulatory blood pressure (ABP), heart rate, and hot flash (HF) experience among women. Materials and Methods: The authors recruited 110 women aged 22 to 65 years with mild essential hypertension or normotension confirmed by 24-hour ABP monitoring. None of the women had organ damage, inflammatory diseases, on estrogen replacement therapy or any other risk factors. Participants wore an ABP monitor that both records heart rate during 24 hours and noted their awake and sleep times. HF were assessed using an everyday complaint questionnaire that included symptoms associated with menopause. Each participant was asked whether or not she had experienced each symptom during the two weeks before the interview. Results: Fifty-five of the participants (45%) reported having had HF during the two weeks before they completed the questionnaire. The results show that the prevalence of essential hypertension (EH) in the group of women who had HF was significantly higher than the group of women that did not have HF (p = 0.035). The authors also found that hypertensive women had HF more often than normotensive women (p = 0.035), but other parameters including mean awake and sleep systolic BP values, mean awake and sleep diastolic BP values, heart rates, and nocturnal dipping of BP did not differ statistically among the group of women who had HF and the group of women who did not have HF (p > 0.05). Conclusions: These data suggest that the prevalence of EH in the group of women who have HF is significantly higher than the group of women that does not have HF.

Selective renal vasoconstriction, exaggerated natriuresis and excretion rates of exosomic proteins in essential hypertension.

In essential hypertension (EH), the regulation of renal sodium excretion is aberrant. We hypothesized that in mild EH, (i) abnormal dynamics of plasma renin concentration (PRC) and atrial natriuretic peptide (ANP) are responsible for the exaggerated natriuresis, and (ii) exosomic protein patterns reflect the renal tubular abnormality involved in the dysregulation of sodium excretion. After 2-week drug washout and 4-day diet, systemic and renal hemodynamics, cardio-renal hormones, glomerular filtration and renal excretion were studied in male patients during saline loading (SL). Excretion rates of exosome-related urinary proteins including apical membrane transporters were determined by proteomics-based methods. In patients, baseline renal vascular conductance was reduced (-44%, P < 0.001), but non-renal vascular conductances were normal while PRC was reduced and ANP elevated (both P < 0.01). SL induced exaggerated natriuresis and reduced PRC (P < 0.01), at normal suppression rate. SL increased arterial pressure in patients (+11 mmHg, P < 0.001), but not in controls; however, during time control, patients showed identical increases (+10 mmHg, P < 0.005) apparently dissociating arterial pressure from natriuresis. At baseline, excretion rates of 438 proteins ranged from 0.07 to 49.8 pmol (mmol creatinine)(-1); 12 proteins were found in all subjects, and 21 proteins were found in two or more patients, but not in controls. In patients, the excretion rate of retinoic acid-induced gene 2 protein was reduced, and excretion rates of other proteins showed increased variances compatible with pathophysiological and clinical applicability. Essential hypertension patients exhibit selective renal vasoconstriction and individually varying excretion rates of several exosome-related proteins. Hormonal changes, rather than arterial pressure, seem to cause exaggeration of natriuresis.

Effect of aliskiren on circulating endothelial progenitor cells and vascular function in patients with type 2 diabetes and essential hypertension.

The aim of this study was to investigate the effects of aliskiren on vascular function and endothelial progenitor cells (EPCs) in patients with type 2 diabetes and essential hypertension. The study enrolled type 2 diabetic patients aged >50 years under stable glycemic control and first diagnosed mild essential hypertension. In phase A (n = 20), patients received aliskiren 150-300 mg daily for 3 months. In phase B (n = 12), hydrochlorothiazide (HCTZ) 12.5-25mg daily substituted for aliskiren for 3 more months. At baseline and at the end of each phase, we assessed (i) brachial blood pressure (BBP); (ii) central aortic systolic pressure (CSP), aortic augmentation index (Aix), and pulse wave velocity (PWV) as markers of arterial stiffness; (iii) brachial artery flow-mediated dilatation (FMD) as a marker of endothelial function; (iv) left ventricular (LV) twisting and untwisting as markers of LV function and (v) EPC numbers in culture of peripheral blood mononuclear cells. Aliskiren similarly reduced BBP and CSP, increased FMD (P < 0.001) and EPC numbers (P < 0.001), decreased PWV and Aix (P < 0.05), and improved LV twisting and untwisting (P < 0.05). Although substitution of HCTZ sustained BBP at similar levels, CSP and echocardiographic indices nearly returned at baseline levels, and the improvement of FMD, PWV, Aix, and EPC numbers was abolished. Aliskiren had a favorable effect on endothelial function and EPCs, reduced arterial stiffness, and improved LV twisting and untwisting. These effects were independent of BBP lowering, as they were not observed after the achievement of similar values of BBP with HCTZ.

Effects of a long-term treatment with aliskiren or ramipril on structural alterations of subcutaneous small-resistance arteries of diabetic hypertensive patients.

Structural alterations of subcutaneous small-resistance arteries are associated with a worse clinical prognosis in hypertension and non-insulin-dependent diabetes mellitus. The effects of the direct renin inhibitor aliskiren on microvascular structure were never previously evaluated. Therefore, we investigated the effects of aliskiren in comparison with those of an extensively used angiotensin-converting enzyme inhibitor, ramipril, on peripheral subcutaneous small-resistance artery morphology, retinal arteriolar structure, and capillary density in a population of patients with non-insulin-dependent diabetes mellitus. Sixteen patients with mild essential hypertension and with a previous diagnosis of non-insulin-dependent diabetes mellitus were included in the study. Patients were then randomized to 1 of the 2 active treatments (aliskiren 150 mg once daily, n=9; or ramipril 5 mg once daily, n=7). Each patient underwent a biopsy of the subcutaneous fat from the gluteal region, an evaluation of retinal artery morphology (scanning laser Doppler flowmetry), and capillary density (capillaroscopy), at baseline and after 1 year of treatment. Subcutaneous small arteries were dissected and mounted on a pressurized micromyograph, and the media-to-lumen ratio was evaluated. A similar office blood pressure-lowering effect and a similar reduction of the wall-to-lumen ratio of retinal arterioles were observed with the 2 drugs. Aliskiren significantly reduced media-to-lumen ratio of subcutaneous small-resistance arteries, whereas ramipril-induced reduction of media to lumen ratio was not statistically significant. No relevant effect on capillary density was observed. In conclusion, treatment with aliskiren or ramipril was associated with a correction of microvascular structural alterations in patients with non-insulin-dependent diabetes mellitus.