Overweight Hypertensive Patients Research Articles

Mediating effect of the NLR on the relationship between HbA1c and left atrial stiffness in overweight patients with hypertension.

We aimed to investigate the association between hemoglobin A1c (HbA1c) and left atrial (LA) stiffness in patients with hypertension and to explore the mediating effect of the neutrophil/lymphocyte ratio (NLR) on this association. Essential hypertensive patients (n=292) aged 18 to 83 years were enrolled and divided into two groups based on the LA stiffness index (LASI): Group I (LASI≤0.32, n=146) and Group II (LASI>0.32, n=146). The LASI was defined as the ratio of early diastolic transmitral flow velocity/lateral mitral annulus myocardial velocity (E/e') to LA reservoir strain. Multivariate linear regression analysis was performed to determine the independent predictors of the LASI. Age, BMI, SBP, HbA1c, CRP and the NLR were significantly greater in Group II than in Group I (P<0.05). Additionally, Group II had a greater LA volume index (LAVI), left ventricular mass index (LVMI), and E/e' and lower LA reservoir, conduit and booster pump strains than Group I (P<0.001). Univariate and multivariate linear regression models revealed that age, SBP, HbA1c, and the NLR were independently associated with the LASI. Further mediation analysis was performed to determine the mediating effect of the NLR on the association between HbA1c and the LASI and revealed that the NLR had a mediating role only in overweight hypertensive patients, and the proportion of the mediating effect was 21.9%. The NLR was independently correlated with the LASI and played a mediating role in the relationship between HbA1c and the LASI in overweight hypertensive patients.

Circulating ERBB3 levels are inversely associated with the risk of overweight-related hypertension: a cross-sectional study

BackgroundHypertension and overweight are independent risk factors for cardiovascular disease, and overweight increase the risk of developing high blood pressure. ERBB3( also known as HER3) plays a considerable role in the development of cardiovascular diseases. However, the effect of ERBB3 levels in hypertensive overweight patients is unknown. The aim of this study was to assess the association between ERBB3 levels and hypertension in overweight Chinese patients.MethodsWe evaluated the height,weight, blood pressure, biochemical indicators, and ERBB3 levels in 128 Chinese adults aged 33–79 years. Plasma ERBB3 levels were assessed by the enzyme-linked immunosorbent assay, and body mass index(BMI) was calculated as body weight divided by height squared. Participants were allocated into three groups according to blood pressure and BMI: healthy control (CNT, n = 31; normotensive and non-overweight), hypertension (HT, n = 33; hypertension and non-overweight), and hypertension with overweight (HTO, n = 64; hypertension and overweight). Statistical significance was defined as a two-tailed P < 0.05.ResultsThere was no significant difference in mean ERBB3 levels among the three groups, although a linear decrease from CNT (1.13 ± 0.36), HT (1.03 ± 0.36), to HTO (0.84 ± 0.26 ng/mL) was observed in men (P = 0.007). Among the drinking population, the ERBB3 level was significantly reduced in the HTO group as compared with those of the CNT and HT groups (0.76 ± 0.23 versus 1.18 ± 0.37 and 1.20 ± 0.30, respectively). ERBB3 levels were negatively correlated with diastolic blood pressure in men (r= − 0.293, P = 0.012), smoking (r= − 0.47, P = 0.004), and drinking (r = − 0.387, P = 0.008). BMI in men and among drinkers, and uric acid among drinkers were negatively correlated with ERBB3 levels. Multivariate conditional logistic regression showed that plasma ERBB3 levels were associated with a reduced risk of HTO in men [odds ratio (OR) 0.054; 95 % confidence interval (CI): 0.007–0.412) and drinkers (OR 0.002; 95 % CI: 0.000–0.101).ConclusionsERBB3 may contribute to the pathogenesis of hypertension in overweight patients, with BMI, gender, and drinking all potentially modulating the process.

Myeloperoxidase (MPO) and high sensitivity C-reactive protein (hsCRP) as inflammatory biomarkers of endothelial and leukocyte activation in overweight hypertensive patients

Background: Low-grade inflammation mediates the relation between overweight and the development of cardiovascular diseases. The study aimed to examine if myeloperoxidase (MPO) and hsCRP (high-sensitivity C-reactive protein) in overweight hypertensive patients can be used as biomarkers of endothelial and leukocyte activation. Material and methods: Seventy-five subjects were included in the study; 38 had essential arterial hypertension (AH) and 37 were normotensive controls (NC), subsequently divided into overweight (OW; BMI ≥ 25 kg/m 2 ) and normal weight subgroups (NW; BMI < 25 kg/m 2 ). Body mass index (BMI), inflammatory markers concentrations, association of MPO and hsCRP with AH and/or overweight were assessed. Results: AH patients had higher MPO (median 132.5 pmol/L, IQR: 53.8–691.9) (p < 0.001), while hsCRP did not significantly differ compared to normotensive controls (NC). NW-AH patients had higher MPO (p = 0.02) than normotensive NW patients. MPO was similar between normotensive patients OW and NW, while hsCRP concentration was significantly higher in the OW (median 1.85 mg/L, IQR: 0.47–7.19) (p = 0.01) compared to NW. OW-AH patients had significantly higher MPO (median 137.4 pmol/L, IQR: 53.80–703.4) (p = 0.002) compared to normotensive NW and OW (p < 0.001) patients, likely reflecting neutrophilic activation in hypertension. Additionaly, OW-AH patients had significantly higher hsCRP (median 1.71 mg/L, IQR: 0.22–14) (p = 0.005) than normotensive NW patients. hsCRP significantly positively correlated with BMI in both AH (r = 0.41, p = 0.009) and NC groups (r = 0.38, p = 0.01), while MPO did not correlate, supporting inflammation in OW, particularly in OW with AH. Conclusions: All together, the results suggest that inflammation may mediate mutual association of AH and OW, suggesting MPO as inflammatory biomarker for AH and hsCRP for overweight.

Treatment and adherence to antihypertensive therapy in France: the roles of socioeconomic factors and primary care medicine in the ESTEBAN survey.

Antihypertensive drugs remain one of the main beneficial strategies for cardiovascular disease prevention. The objective of our study was to investigate the associations of different clinical and socioeconomic (SES) factors, and the use of primary care medicine with treatment and adherence (proportion of days covered (PDC) by treatment) to hypertension management in French participants aware of their hypertension. Cross-sectional analyses of treatment for hypertension and adherence to treatment were performed using data from 396 participants from the ESTEBAN survey, a representative sample of the French population. Logistic regression analyses were performed to investigate associations between SES factors (age, sex, education, income, civil status), clinical factors, health care (general practitioner (GP)visits, cardiologistvisits, number of consultations, home blood pressure measurement (HBPM)), treatment and adherence. A total of 265 of the 396 hypertensive patients were treated. Antihypertensive drug use was more common among elderly individuals (OR: 2.73 [1.14; 4.32), diabetic patients (OR: 4.18 [1.92; 6.44] and overweight hypertensive patients (OR = 3.04 [1.09; 4.99]). GP consultations and HBPM were associated with increased treatment (OR: 1.03 [1.01; 1.05]; OR: 1.97 [1.06; 2.61], respectively). The PDC was higher among men (p = 0.045) and couples living together (p = 0.018) but lower among diabetic patients (p = 0.012) and patients visiting a cardiologist (p = 0.008). Education and income levels were not associated with either treatment or the PDC. In France, SES factors seemed to have little impact on treatment and adherence to antihypertensive drug regimens. However, treatment administered by GPs and HBPM may play key roles in hypertension management. Although the PDC was quite low, both the number of GP consultations and HBPM were positively associated with pharmacological treatment.

Serum progranulin/tumor necrosis factor-\u03b1 ratio as independent predictor of systolic blood pressure in overweight hypertensive patients: a cross-sectional study

BackgroundVascular inflammation plays a key role in the progression of hypertension. Progranulin (PGRN), an anti-inflammatory growth factor, mediated inhibition of tumor necrosis factor-α (TNF-α), a pleiotropic cytokine, activity has been well-established. Despite the role of chronic low-grade inflammation in hypertension, serum levels of PGRN and PGRN/TNF-α ratio and, their association with systolic and diastolic blood pressure has not been determined in hypertensive patients till now. This study aims to find and correlate the serum levels of pro-inflammatory cytokine (TNF-α), anti-inflammatory growth factor (PGRN), and PGRN/TNF-α ratio with the blood pressure in systolic-diastolic hypertension (SDH) and isolated systolic hypertension (ISH) patients.ResultsA cross-sectional study was conducted on SDH patients (mean age, 52.95 ± 12.6 years; male/female (M/F) number = 15/10) and ISH patients (mean age, 55.80 ± 9.40 years; M/F number = 12/13) (n = 25 each). Twenty-five age and body mass index (BMI)-matched healthy subjects (mean age, 56.00 ± 8.55 years; male/female number = 11/14) were considered as control. All patients and healthy subjects were overweight (BMI, 25–30 kg/m2). Overnight fasting blood samples of subjects were taken and levels of PGRN and TNF-α were measured using ELISA diagnostic kits. PGRN and TNF-α levels were found significantly high, whereas PGRN/TNF ratio was found very low, in SDH and ISH patients as compared to healthy subjects. Reduced PGRN/TNF-α ratio and pulse pressure were found as independent predictors of SBP both in SDH and ISH patients.ConclusionsFindings of elevated PGRN levels in response to raised TNF-α levels depict the counter regulation by PGRN to neutralize TNF-α. Findings of reduced PGRN/TNF ratio, and it being an independent predictor of SBP, ascertain the key role of imbalance in pro- and anti-inflammatory environment in hypertension. Thus, it strengthens the cross-link between the concept of immunity–adiposity–inflammation–blood pressure¸ a vicious network. Further, this cross-link of SBP and progranulin must be explored in longitudinal studies. New researches should be focused not only on impact of pro-inflammatory environment rather to find on a balance between pro- and anti-inflammatory status, so that new target sites could be explored for therapeutic management of hypertension.

2427-PUB: Role of Cardiac Autonomic Alterations and of Free Fatty Acids (FFA) on Hypertension in Overweight Patients

Objective: In diabetic patients, autonomic alterations are associated with hypertension. In healthy individuals, FFAs were shown to enhance sympathetic activity. We aimed to examine the influence of autonomic function alterations and FFA on hypertension and artery stiffness (pulse wave velocity, PWV) in overweight patients with normal or impaired glucose intolerance (NGT orIGT) or orally-treated type 2 diabetes. Patients and Methods: We included 122 normotensive or well-controlled hypertensive patients;38 NGTs, 28 IGTs, 15 well-controlled T2Ds, 41 poorly-controlled T2Ds; meanage 41.1/41.7/53.8/54.2 years BMI 38.4/36.6/28.7/29.3 kg/m²; HbA1c 5.2/5.5/6.7/9.1% respectively. At fasting, cardiac vagal (HFnu-HR) and sympathetic (LFnu-HR) activity and sympatho-vagal balance (LF/HF-HR) were measured by spectral analysis of heart rate variations, PWV by applanation tonometry;FFA measured in IGTs and poorly-controlled T2Ds. Results: Spectral indexes were similar in NGT, IGT and well-controlled T2D patients (meanHF-HRnu 68% andLF-HRnu 32%), but different vs. poorly-controlled T2Ds (37% and63%, respectively). Comparedto patients with HF-HR&amp;gt;median value, those with HF-HR&amp;lt;median were older (p&amp;lt;0.01), had lower BMI (p&amp;lt;0.05); similar glycemic status, HbA1c, PWV; higher LF/HF-HR(p&amp;lt;0.001) and more of them were hypertensive (40% vs. 20%, p&amp;lt;0.04), these differences remaining significant after adjustment for age, BMI, glycemic status. FFA correlated positively with LF-HR and negatively with HF-HR (p&amp;lt;0.04), also after multiple adjustment, in IGTs but not in poorly-controlled T2Ds (of whom49% were hypertensive). Conclusion: In NGT, IGT orwell-controlled T2D overweight patients, lower vagal activity may contribute to hypertension independently from glycemic status, and FFA may reduce vagal activity and enhance sympathetic activity and thus promote hypertension while in poorly-controlled T2Ds this profile is more likely related to long-term hyperglycemia. Disclosure A. Rezki: None. M. Fysekidis: None. E. Cosson: Board Member; Self; Abbott, Boehringer Ingelheim Pharmaceuticals, Inc., LifeScan, Inc., Lilly Diabetes, Medtronic, Merck Sharp &amp; Dohme Corp., Novartis France, Novo Nordisk A/S, Roche Diagnostics France, Sanofi. Research Support; Self; Air Liquide, Lilly Diabetes, Novo Nordisk A/S, Roche Diagnostics France, Roche Foundation, Sanofi. P. Valensi: None.

Clinical Implications

Clinical Implications

Reduction of leukocyte-derived H2S linked to abnormal glycolipid metabolism in hypertensive subjects

ABSTRACTWe deduced that leukocyte-derived H2S would also play a pivotal role regarding nutrition homeostasis in hypertensive subjects. Plasma was obtained from patients with hypertension (n = 151) as well as control (n = 41). Leukocyte-derived H2S speed was determined, and biochemical indices of glucose and lipid metabolism were measured. Western blot analyses of CSE were also performed. Inflammation factors were measured. Leukocyte-derived H2S is produced at a significantly lower rate in overweight or obese patients (p < 0.05). There is a significant negative correlation between H2S and the levels of HOMA-RI and insulin in overweight patients and has a positive relationship with HDL-C only in overweight hypertensive patients (p < 0.05). Patients with high insulin levels showed down-regulation of CSE (p < 0.05). The levels of IL-10 decreased in both the obese and the overweight which showed significant relationship with all metabolism parameters such as HDL-C(r = 0.176, p = 0.031), insulin (r = −0.181, p = 0.027), HOMA-IR (r = −0.166, p = 0.045), and H2S speed (r = 0.995, p = 0.001). Linear regression analysis showed that insulin levels will increase (β = −1.685, p = 0.041) with the slower speed of H2S. Leukocyte-derived H2S production varied according to the nutritional status of hypertensive subjects, and the H2S/IL-10 signaling pathway may be the junction point among hypertension, disturbance of nutritional status, and inflammation.

Abstract P274: Fruit Extract (blueberry, Cranberry, And Promegranate) Improved Insulin Resistance In Overweight Hypertensive And Normotensive Subjects

Arterial hypertension is frequently associated to glucose and lipid metabolism abnormalities. The purpose of this study was to determine if antioxidants (fruit extract) supplementation interfere with glucose and lipid metabolism in overweight hypertensive patients. A randomized clinical trial was conducted with 30 individuals, 23 hypertensive patients (group A) and 7 normotensive controls (group B). They were randomized to take 3 capsules of different fruits extract a day (blueberry, cranberry and pomegranate) or placebo for 4 weeks. This is a crossover study, which started with placebo changed to capsules and vice versa. Blood samples were collected after 12 hours fasting for biochemical tests (glucose, insulin, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides), anthropometric assessment (weight, height, and body mass index), systolic BP, diastolic BP and heart rate were evaluated at baseline, after 4, and 8 weeks. The comparisons between groups were held with the GLM repeated measures. Twenty three hypertensive patients (age 47 years, 14 females) and 7 normotensive controls (age 40 years, 7 females) were evaluated. BMI, blood pressure, heart and lipid profile did not differ between groups. HOMAir decreased significantly in both groups. See results in table 1. Values are expressed as medians (±SD) In these preliminary results a 4-weeks supplementation of antioxidants (fruit extract) improved insulin resistance in overweight hypertensive and normotensive subjects. Financial support: FAPESP 2014/25808-3

Treatment of hypertension in overweight patients

The aim of the treatment of hypertension in patients with overweight is not only normalization of blood pressure, but also improvement of endothelial function, reduction of insulin resistance and lipid metabolism. Some of the drugs with a broad therapeutic spectrum and huge evidential base, - I1-imidazoline-receptor agonists can be applied in both monotherapy and as a part of the combined therapy in overweight patients.

Effects of exercise intensity on postexercise hypotension after resistance training session in overweight hypertensive patients.

Among all nonpharmacological treatments, aerobic or resistance training (RT) has been indicated as a significantly important strategy to control hypertension. However, postexercise hypotension responses after intensity alterations in RT are not yet fully understood. The purpose of this study was to compare the outcomes of differing intensities of RT on hypertensive older women. Twenty hypertensive older women participated voluntarily in this study. After a maximum voluntary contraction test (one repetition maximum) and determination of 40% and 80% experimental loads, the protocol (3 sets/90″ interset rest) was performed in a single session with the following exercises: leg press, leg extension, leg curl, chest press, elbow flexion, elbow extension, upper back row, and abdominal flexion. Systolic and diastolic blood pressures were evaluated at rest, during exercise peak, and after 5, 10, 15, 30, 45, and 60 minutes of exercise and compared to the control. Both experimental loads were effective (P<0.01) in promoting postexercise systolic hypotension (mmHg) compared to controls, after 30, 45, and 60 minutes, respectively, at 40% (113±2, 112±4, and 110±3 mmHg) and 80% (111±3, 111±4, and 110±4 mmHg). Both procedures promoted hypotension with similar systolic blood pressures (40%: −11%±1.0% and 80%: −13%±0.5%), mean arterial blood pressures (40%: −12%±5.5% and 80%: −12%±3.4%), and rate-pressure products (40%: −15%±2.1% and 80%: −17%±2.4%) compared to control measures (systolic blood pressure: 1%±1%, mean arterial blood pressure:\\ 0.6%±1.5%, rate-pressure product: 0.33%±1.1%). No differences were found in diastolic blood pressure and heart rate measures. In conclusion, hypertensive older women exhibit postexercise hypotension independently of exercise intensity without expressed cardiovascular overload during the session.

Abstract 105: Obesity Paradox in Patients with Non-Hemorrhagic Stroke: Increased Short-Term Survival with Decreased Longevity

Background: Obesity is associated with improved outcomes in patients with congestive heart failure and/or coronary artery disease; the obesity paradox. Effects of obesity on mortality in non-hemorrhagic stroke patients have not been well investigated. Material and Methods: Retrospective chart review was performed in 146 consecutive patients treated for non-hemorrhagic stroke at a single academic medical center. Patients were divided in to 4 groups according to their BMI: Group I with BMI (0-18.5 kg/m 2 )-4 patients (3%) Group II BMI (18.6-25 kg/m 2 )-51 patients (35%), Group III BMI (26-30 kg/m 2 )-46 patients (32%), and Group IV BMI (31+)-45 patients (31%). Long-term outcomes were ascertained through the National Death Index. This study was approved by the institutional IRB. Results: Prevalence of CAD, female gender, hypertension, atrial fibrillation, hyperlipidemia, PVD and chronic kidney disease were similar between BMI groups. Overweight patients with non-hemorrhagic stroke were younger, with an increased incidence of diabetes (4% in Group II, 25% in Group III, and 37% in Group IV, p&lt;0.0016). There was a trend of increased prevalence of hypertension in overweight patients with non-hemorrhagic stroke (51% in Group II, 55% in Group III, and 70% in Group IV, p=0.3146). Lower BMI was associated with increased short-term mortality (52% in Group II, 33% in Group III and 12% in Group IV, p &lt;0.004). Despite improved short term mortality, the overall longevity in obese stroke patients were significantly reduced, as compared to patients with normal weight. Average age at time of death was 86+/- 9.6 years old in Group II patients, 76 +/- 15 years old in Group III, and 76 +/- 9.8 years old in Group IV patients, p&lt;0.003 for Group III vs. II and p&lt;0.001 in Group IV vs. II) Conclusions: Obese patients present with non-hemorrhagic stroke at a younger age. Despite short term improved outcomes, obesity is not associated with improved overall longevity.

The role of aldosterone receptor blocker therapy in hypertension and heart failure

The aldosterone receptor blocker therapy as an “add-on” to hypotensive therapy is an excellent therapeutic strategy that has proved to be particularly effective in treating refractory hypertension, hypertension with organ damage and overweight hypertensive patients. Aldosterone receptor blockers are extremely useful in inhibiting hormonal activation linked with heart failure: they have cardioprotective effects not only during full-blown heart failure, but also in its early stages, and this effect can be observed even more frequently in heart failures with metabolic syndrome. The use of molecules such as canrenone with a favorable tolerability profile ensures a better tolerability ratio by providing benefits linked to fewer drug interactions, lower incidence of side effects and improved therapy adherence.

Positive effect of the use of accelerometry on lifestyle awareness of overweight hypertensive patients.

Sedentary habits are strongly associated with increase of cardiovascular risk factors. The present study aimed to verify the role of accelerometry in identifying sedentary behavior, and the possible short term positive effect of this intervention on some anthropometric variables in a group of patients with cardiovascular risks factors. To quantify daily Spontaneous Motor Activity (SMA) levels and identify sedentary behavior, an accelerometer was employed, in addition to a simple questionnaire, in a group of overweight, hypertensive subjects. A personalized unsupervised 3 month long physical exercise program was planned. After this time, acceleroometry was again undertaken to analyze the impact of the intervention on some life style parameters, including the number of the steps taken daily, and Physical Activity Level (PAL). In addition, body water balance, weight, and Body Mass Index (BMI) were also evaluated. Assessment of physical activity by accelerometry identifies sedentary behaviors in a larger number of individuals. After three months of regular unsupervised aerobic exercise, PAL improved from 1.56 ±0.1 to 1.68±0.2 with P<0.005, weight (kg) reduced from 85.13 ± 20 to 83.10 ± 19 (P<0.05), BMI from 29.58 to 28.7 (P<0.05). Accelerometry allows to objectify PAL, and can be used to monitor improvement of variables strongly related to cardiovascular risk.

P 8: Peripheral insulin resistance influence the presence of hypertension in overweight type 2 diabetic patients

Increased obesity is closely related to insulin resistance (IR) promoting the development of type 2 diabetes (T2D) and cardiovascular disease. IR represents a well established risk factor for development of hypertension, but the significance of the associations between the IR and obesity in the development of hypertension in overweight patients with type 2 diabetes (T2D) still remains unclarified. We analyzed the levels of insulin resistance in: overweight T2D patients with hypertension (group A, n=48, 30≤ BMI ≥25kg/m2), overweight T2D patients without hypertension (group B, n=43, 30≤ BMI ≥25kg/m2) and overweight nondiabetics without hypertension (group C, n=40, 30≤ BMI ≥25kg/m2). Patients were aged 40–70 years, matched by gender, duration of diabetes, with optimal metabolic control (HbA1c=6.5+/−0.6%). Hypertension was defined as systolic BP ≥140 and diastolic BP ≥ 90mmHg measured by sphygmomanometer, or by established use of antihypertensive drugs. Assessment of IR were done with two complementary indexes of insulin sensitivity: (1) oral glucose insulin sensitivity (OGIS) index derived from 75 g oral glucose tolerance test and (2) homeostasis model assessment of insulin resistance (HOMA-IR) determined from fasting glucose and plasma insulin (PI) levels. PI and levels were measured by RIA method. We have found significantly higher PI levels in group A (A: 38.05+/−4.24; B: 29.33+/−3.13; C:21.34+/−2.23 mIU/ml, A vs B; A vs C and B vs C p<0.05). Simultaneously, there was no significant difference in the level of HOMA-IR among diabetics (A: 9.43+/−2.69; B: 7.52+/−2.08; C: 5.73+/−1.83; A vs B p=NS; A vs C and B vs C p<0.05), reflecting hepatic insulin sensitivity. However, lowest OGIS were found in group A, being significantly lower in group A in comparison to group B (A: 287.67±35.42; B: 359.22±32.0; C: 494.29±23.81; A vs B p<0.05; A vs C p<0.01 and B vs C p<0.05) as measurement of peripheral IR. We have not found significant correlation between PI and presence of hypertension (r=0.177, p=NS). Also, there was no significant correlation between HOMA-IR and presence of hypertension among diabetics (r=0.218, p=NS). However, presence of hypertension among diabetics negatively correlate with OGIS index (r=−0.384, p<0.01), and in the model of linear regression analysis level of OGIS predicting the presence of hypertension irrespectively of the obesity (β= −0.334, p=0.07). Our results imply that increased peripheral insulin resistance compared to hepatic insulin resistance stronger influence the presence of hypertension in overweight type 2 diabetic patients. Moreover, this association was not depending of obesity.

Dietary counseling on long-term weight loss in overweight hypertensive patients

OBJECTIVE:This study aimed to evaluate long-term weight loss in overweight hypertensive patients receiving dietary counseling.METHODS: Longitudinal study included overweight hypertensive patients who had an initial individual consultation with a nutritionist between January 2002 and December 2005 and were followed for four years in a hypertension clinic. Patients who had at least four consultations during the follow-up period were included in the dietary counseling group. Those who scheduled their first consultation but missed that appointment or had fewer than four consultations during the follow-up period were allocated to the control group. Target Energy intake was calculated at 20–25 kcal/kg actual body weight/day.RESULTS:The study included 102 patients aged 55±1 years old (58 in the dietary counseling group). As compared with the control group, patients in the dietary counseling group showed a significantly greater reduction in body weight (-3.6±0.8 vs. 0.8±0.7 kg), which remained significant after controlling for age, gender, baseline body mass index, and the use of different antihypertensive and antidiabetic drugs. Weight loss between 5.0% and 9.9% was observed in a significantly higher percentage of patients in the dietary counseling group (28% vs. 11%). A weight loss of at least 10% was only observed in dietary counseling group patients, who had a significantly lower odds ratio for increasing the number and/or dosage of antihypertensive agents, even after controlling for age, gender, and baseline body mass index.CONCLUSIONS:Dietary counseling may be associated with long-term weight loss in overweight hypertensive patients.

Influência do exercício aeróbio na renina de portadores de hipertensão arterial com sobrepeso

BACKGROUND: The activity of the renin-angiotensin-aldosterone system (RAAS) is directly related to overweight and sedentary lifestyles, both of which are associated with hypertension. Aerobic exercise helps control blood pressure (BP) by acting on mechanisms of blood pressure regulation, such as plasma renin activity (PRA). OBJECTIVE: To assess the effect of aerobic exercise on plasma renin activity in overweight hypertensive patients. METHODS: Blood pressure, serum biochemistry and anthropometric parameters of twenty subjects were measured before and after a 16-week exercise training program, three days a week, at 60-80% of maximal heart rate. Data were expressed as mean ± standard deviation or median and interquartile range and analyzed using the student's t-test, Mann-Whitney test, and ANOVA (p < 0.05). RESULTS: Mean age of the study population was 57 ± 7.0, and mean body mass index was 30 ± 3.5 kg/m2. The aerobic training decreased body fat (35 ± 7.8 to 30 ± 5.6 %), heart rate (HR) (80 ± 10.4 to 77 ± 8.5 bpm), and pulse pressure (PP) (50 ± 11.8 to 46 ± 10.0 mmHg) (p < 0.05), but not plasma renin activity, which ranged from 0.8 (0.45-2.0) to 1.45 (0.8-2.15) ηg/ml/h (p = 0.055). The group that achieved a reduction in waist circumference (WC) (n = 8) experienced also a reduction in systolic BP and PP (p < 0.05). In the group without reduction in WC, none of the BP variables changed. Plasma renin activity (PRA) was not associated with any variable studied. Aerobic training was associated with a decrease in PP in the study group as a whole and with a decrease in systolic BP in the subgroup who experienced a decrease in waist circumference. CONCLUSION: The aerobic exercise training failed to reduce plasma renin activity in overweight hypertensive patients.

Reversible severe pulmonary hypertension in obesity hypoventilation and Mohr syndrome

A young overweight patient with Mohr–Claussen Syndrome was admitted to our department with the clinical diagnosis of pulmonary hypertension complaining about dyspnea at rest and excessive daytime sleepiness. Pulmonary function testing indicated severe airflow limitation and respiratory insufficiency. Pulmonary artery (PA) pressure was markedly increased. Pulmonary embolism, Alpha-1-antitrypsin-deficiency, emphysema and anatomical obstructions were excluded. Polysomnography showed recurrent oxygen desaturations compatible with alveolar hypoventilations. Hypercapnic ventilatory response testing (HCVR) indicated a missing increase in minute ventilation when exposed to hypercapnia. After 6 weeks of nocturnal non-invasive ventilation therapy, her clinical condition markedly improved. Furthermore, PA pressure returned to normal values. HCVR testing showed an adequate response to hypercapnia. Mohr–Claussen syndrome is a rare genetic disease affecting the mouth, face and digits. Adult patients are usually very obese; exposing them at risk for obesity hypoventilation syndrome (OHS). OHS is described as a combination of obesity and awake arterial hypercapnia (PaCO 2 > 45 mmHg) in the absence of other known causes of chronic alveolar hypoventilation. Unclear pulmonary hypertension in overweight patients should raise the suspicion for OHS.

Effect of a sequential training programme on inflammatory, prothrombotic and vascular remodelling biomarkers in hypertensive overweight patients with or without metabolic syndrome

It is not known whether serum level of vascular remodelling parameters, such as matrix metalloproteinases could be modulated by physical activity and whether the eventual change could be influenced by metabolic syndrome (MS) diagnosis. Open, intervention study to evaluate the effects of a sequential physical activity training on inflammatory, prothrombotic and vascular remodelling biomarkers in overweight patients with and without MS. We enrolled 80 overweight patients (mean age: 62.9+/-8.3 years; male : female = 36 : 44) with newly diagnosed hypertension, with or without MS. After 3 months of American Heart Association step 2 diet, they followed a sequential training programme including 56 days of added three metabolic equivalent tasks/week and 56 days of six metabolic equivalent tasks/week. All patients experienced a significant decrease in body mass index, waist circumference and blood pressure after both the training phases. High-density lipoprotein-cholesterolemia, triglycerides, and glycaemia significantly improved only after the intensive training phase compared with the baseline in MS patients. Prothrombotic parameters improved irrespectively from the MS diagnosis. High-sensitivity C-reactive protein P level significantly decreased towards baseline and towards the previous phase, after exercise intensification, but only in MS patients. The plasma level of matrix metalloproteinase 2 and 9, and their activated forms improved significantly when compared with the baseline both after the first and the second training period, independently from the MS diagnosis. Diagnosis of MS is a determinant of changes in metabolic and inflammatory biomarkers, but not of the prothrombotic and vascular remodelling ones in a sample of overweight hypertensive patients.

Comparative Effects of Telmisartan and Eprosartan on Insulin Sensitivity in the Treatment of Overweight Hypertensive Patients

The aim of this study was to compare the effect of telmisartan and eprosartan on insulin sensitivity in overweight hypertensive patients. Fifty overweight (BMI > or = 25 and <30 kg/m (2)) outpatients, aged 41-65 years, with mild to moderate hypertension [systolic blood pressure (SBP) >140 and diastolic blood pressure (DBP) > or = 90 and < or = 110 mmHg], after a 4-week placebo period, were randomized to receive telmisartan 80 mg or eprosartan 600 mg for 8 weeks. Following another 4-week placebo period, patients were crossed to the alternative regimen for further 8 weeks. At the end of each placebo and active treatment period, blood pressure (BP), insulin sensitivity (by euglycemic hyperinsulinemic clamp), fasting plasma glucose (FPG), insulin (FPI), total cholesterol (TC), LDL-C, HDL-C, and triglycerides (Tg) were evaluated. Insulin sensitivity was expressed as the amount of glucose infused during the last 30 min (glucose infusion rate, GIR) in micromol/min/kg. Both telmisartan and eprosartan significantly reduced SBP/DBP values (by a mean of 19.4/13.3 mmHg and 17.9/12.1 mmHg respectively, all p<0.001 vs. placebo), with no significant difference between the two treatments. GIR was significantly increased by telmisartan (2.25+/-0.61 micromol/min/kg, p<0.05 vs. placebo) but not by eprosartan (0.25+/-0.14 micromol/min/kg, p=ns), the difference between the two drugs being statistically significant (p<0.02). No change in FPG, FPI, HDL-C, and Tg was observed with either treatment. Telmisartan significantly reduced TC (-9.9 mg/dl, -5%, p<0.04 vs. placebo) and LDL-C (-8.8 mg/dl, -7%, p<0.03 vs. placebo), whereas eprosartan did not influence them. These findings indicate a superiority regarding an improvement of insulin sensitivity and plasma lipid profile in overweight hypertensives by telmisartan as compared to eprosartan, possibly related to the selective stimulating PPAR-gamma property of telmisartan.