Persistent High Blood Pressure Research Articles

Herbs Used for the Management of Hypertension: A Systematic Review

Background: Hypertension is characterized by persistent high blood pressure and has emerged as a critical risk factor for severe cardiovascular diseases. Although several drugs have been designated to reduce blood pressure, these drugs can potentially cause side effects for patients. Therefore, medicinal plants are used to complement conventional drugs to treat various ailments. Methods: This study reviews the anti-hypertensive potential of herbs and plants and their mechanism of action in reducing blood pressure at their evaluated effective doses. Databases such as PubMed, Scopus, Science Direct, and Google Scholar were used to search articles from January 2016 to Sept 2022. The key search terms included “hypertension”, “lowers blood pressure”, “anti-hypertensive”, and “plants”. These generated 807 documents and using the PRISMA guidelines, thirty plants were identified for this review. Research studies with similar plant parts extracted from similar solvents, more than one dose, and animal models with a positive control were considered in this review. Studies that did not show significant blood pressure reduction were excluded. Results: Based on this criterion, the mechanism of actions of these plants was thematically grouped into three categories, namely 1) antioxidant, 2) angiotensin-converting enzyme (ACE) inhibition, and 3) calcium influx in vascular smooth muscle. The effective doses, plant parts used, and traditional medicine usage are presented in this review. Conclusion: Further research is highly recommended to identify the active compounds and to potentially develop them into anti-hypertensive drugs as well as to establish the safe doses and standardization of these plant extracts. This review is partially funded by grants from the Ministry of Higher Education.

Microbial influence on blood pressure: unraveling the complex relationship for health insights

Hypertension, a critical global health concern, is characterized by persistent high blood pressure and is a major cause of cardiovascular events. This perspective explores the multifaceted implications of hypertension, its association with cardiovascular diseases, and the emerging role of the gut microbiota. The gut microbiota, a dynamic community in the gastrointestinal tract, plays a pivotal role in hypertension by influencing blood pressure through the generation of antioxidant, anti-inflammatory, and short-chain fatty acids metabolites, and the conversion of nitrates into nitric oxide. Antihypertensive medications interact with the gut microbiota, impacting drug pharmacokinetics and efficacy. Prebiotics and probiotics present promising avenues for hypertension management, with prebiotics modulating blood pressure through lipid and cholesterol modulation, and probiotics exhibiting a general beneficial effect. Personalized choices based on individual factors are crucial for optimizing prebiotic and probiotic interventions. In conclusion, the gut microbiota’s intricate influence on blood pressure regulation offers innovative perspectives in hypertension therapeutics, with targeted strategies proving valuable for holistic blood pressure management and health promotion.

Auto-Immune Cardiac Degeneration as a Complication of Essential Hypertension

Essential hypertension is persistent high blood pressure in the systemic arteries with no identifiable secondary cause. The study was designed to assess auto-immune cardiac degeneration in essential hypertensive patients in Ekiti State. The study included 40 subjects with no history of hypertension (control), 40 hypertensive subjects undergoing treatment and 40 hypertensive subjects without treatment. Body Mass Index (BMI) was calculated, systolic and diastolic blood pressure (SBP and DBP) readings were taken using digital sphygmomanometer, Aspartate Aminotransferase (AST) was measured using spectrophotometer, Cardiac Troponin (CTnI) and Anti-mitochondrial antibody M7 (AMA-M7) were estimated using ELISA. Results obtained were expressed as mean ± SD and statistical analysis was done using SPSS. Values were statistically significant at p<0.05. The results obtained showed that BMI and DBP of treated hypertensive patient was insignificant when compared with control subjects (p>0.05), whereas SBP, AST, AMA-M7 and CTnI were significantly higher (p<0.05) in treated hypertensive patients compared with the control subjects. Similarly, BMI, SBP, DBP, AMA-M7, AST and CTnI of untreated hypertensive patient were significantly higher (p<0.05) compared with non-hypertensive subjects (control). Furthermore, BMI, SBP, DBP, AMA-M7, AST and CTnI were significantly lower (p<0.05) in treated hypertensive patient compared with untreated hypertensive subjects. In conclusion, AMA-M7 is more sensitive marker in detecting auto-immune cardiac degeneration faster than the routine serum AST and Cardiac Troponin I in indicating the functional state of the heart. Therefore, early detection of auto-immune cardiac degeneration in hypertension subjects is important as there is a link between autoimmunity and hypertension.

The evaluation of the effect of long-term antihypertensive drug usage on bone density with dental volumetric tomography.

HT is a systemic disease that presents with persistent high blood pressure, which has become an important health problem due to its cause of serious complications and high prevalence in the community. Aim: This study aims to examine the bone mineral density (BMD) of male patients using different groups of antihypertensive drugs for long terms with dental volumetric tomography. The study was carried out using the data of patients who applied to the Dicle University Faculty of Dentistry and underwent the Dental Volumetric Tomography (DVT) scan for any reason. The patients included in the study were divided into 4 groups according to their antihypertensive use; Group 1: 60 patients who never used hypertensive medication before, Group 2: 60 patients who received Calcium Channel Blocker treatment for over 5 years, Group 3: 60 patients who received Beta Blocker treatment for over 5 years, Group 4: 60 patients who received ACE inhibitor treatment for over 5 years. Radiomorphometric measurements were made on the DVT data and the DVT-Mandibular Index Inferior, DVT-Cortical Index, Hounsfield Unit-Cortical and Hounsfield Unit-Spongios values were calculated. The Kruskal-Wallis test, the Mann Whitney test with Bonferroni correction, the One-Way ANOVA and Post-Hoc Tukey test were used in the study. A significant increase in DVT-CI and a significant decrease in HU-CORTIKAL, HU-SPONGIOS and DVT-MII values were observed in the patients using Calcium Channel Blocker medication. These findings pointed to osteoporosis. In addition, no statistically significant difference in the use of antihypertensive drugs in the Beta Blocker and ACE Inhibitor groups compared to the Control Group were found. The long term use of Calcium Channel Blocker group antihypertensive drugs should be considered as a risk factor for osteoporosis in men. Key words:Antihypertensive drug, Osteoporosis, Radiomorphometric index, Mandible, Dental volumetric tomography, Bone mineral density.

O-03 Adrenalectomy for Cushing's syndrome during pregnancy

Abstract Introduction Cushing's syndrome (CS) is rare in pregnancy because CS itself is a cause of anovulatory infertility due to excess cortisol secretion. Moreover it is also difficult to diagnose CS in pregnancy because placental production of corticotropin releasing and adrenocorticotropic hormone (ACTH), increased maternal production of estrogen induced corticosteroid binding globulin leads to physiological hypercortisolism during pregnancy. So physicians face a clinical overlap in many features of CS such as weight gain, fatigue, edema, hypertension, hyperglycemia, stretch marks, mood changes that can also be attributed to pregnancy. Thus their coexistence represents a diagnostic challenge. Herein we report a case of CS that was diagnosed and successfully treated during pregnancy. Clinical Case A 43-year-old gravida 3 female was consulted at the 21st week of gestation with persistent high blood pressure and hyperglycemia for a month. She had an obstetric history of 2 spontaneous first term abortion, 2 healthy labor 18 years ago and she was healthy after. She was in such a depressive mood that she was consulted with psychiatry many times. On physical examination edema, proximal weakness of lower extremities and hirsutism (modified Ferriman–Gallwey score of 9) was detected. Initial laboratory tests were all within normal range except potassium level (2.7 mmol/L), the results were not consistent with preeclampsia and there was a suspicious adrenal mass detected on ultrasound. She was currently receiving high dose antihypertensive treatment with methyldopa, calcium channel blockers, rapid acting and detemir insulin for diabetes and i.v. potassium replacement. We ruled out conns syndrome with normal plasma aldosterone renin ratio and found catecholamine levels normal. Hormonal analyses revealed with high plasma cortisol levels, increased nocturnal cortisolemia, a suppressed plasma ACTH and dehydroepiandrosterone sulfate level and distinctly elevated 24-hour urinary cortisol greater than 3-fold the upper normal reference range. Non contrast magnetic resonance imaging demonstrated a 47×32 mm left adrenal mass. Laparoscopic adrenalectomy was performed in the 26th week of gestation and the following histopathology revealed an adrenocortical adenoma. Antihypertensive medication was progressively reduced, glycemic control and hypokalemia reversal were achieved. She was followed up with appropriate glucocorticoid replacement. At 34 weeks of gestation, after sudden labor pain and regular uterine contractions a 2586 g male infant with Apgar scores of 8 was born by cesarean section. They were discharged in good health. Conclusion CS should be kept in mind especially in the case of hypertension and diabetes that started before the 20th gestational age. Analysis of the urinary free cortisol level and circadian rhythm of cortisol is necessary to diagnose. Despite the diagnostic challenge we can achieve better maternal and fetal outcomes with proper management.Figure 1.Non-contrast magnetic resonance imaging of the patient Table 1.Patient's laboratuary test results Table 2.Patient's laboratory test results

Arteriovenous Length Ratio: A Novel Method for Evaluating Retinal Vasculature Morphology and Its Diagnostic Potential in Eye-Related Diseases.

Retinal imaging is a non-invasive technique used to scan the back of the eye, enabling the extraction of potential biomarkers like the artery and vein ratio (AVR). This ratio is known for its association with various diseases, such as hypertensive retinopathy (HR) or diabetic retinopathy, and is crucial in assessing retinal health. HR refers to the morphological changes in retinal vessels caused by persistent high blood pressure. Timely identification of these alterations is crucial for preventing blindness and reducing the risk of stroke-related fatalities. The main objective of this paper is to propose a new method for assessing one of the morphological changes in the fundus through morphometric analysis of retinal images. The proposed method in this paper introduces a novel approach called the arteriovenous length ratio (AVLR), which has not been utilized in previous studies. Unlike commonly used measures such as the arteriovenous width ratio or tortuosity, AVLR focuses on assessing the relative length of arteries and veins in the retinal vasculature. The initial step involves segmenting the retinal blood vessels and distinguishing between arteries and veins; AVLR is calculated based on artery and vein caliber measurements for both eyes. Nine equations are used, and the length of both arteries and veins is measured in the region of interest (ROI) covering the optic disc for each eye. Using the AV-Classification dataset, the efficiency of the iterative AVLR assessment is evalutaed. The results show that the proposed approach performs better than the existing methods. By introducing AVLR as a diagnostic feature, this paper contributes to advancing retinal imaging analysis. It provides a valuable tool for the timely diagnosis of HR and other eye-related conditions and represents a novel diagnostic-feature-based method that can be integrated to serve as a clinical decision support system.

SKRINING DAN EDUKASI PENCEGAHAN HIPERTENSI PADA MASYARAKAT PESISIR KAMPUNG SALO, KOTA KENDARI

Hypertension is a condition characterized by elevated systolic blood pressure above 140 mmHg and diastolic blood pressure above 90 mmHg. Persistent high blood pressure can lead to symptoms such as nausea, vomiting, headaches, nosebleeds, shortness of breath, and others. It can also increase the risk of stroke, heart failure, and kidney failure. Nearly 95% of hypertension cases are influenced by environmental risk factors and genetic predisposition. The prevalence of hypertension in Indonesia is quite high, warranting special attention and management. The Asian Medical Student's Association (AMSA) Unit of Halu Oleo University conducted the "Berjuang untuk Solidaritas, Peduli Hipertensi" event as part of the AMSA-UHO 2023 program. The objective was to raise awareness about nutrition management and dietary therapy for hypertension patients through lectures, discussions, demonstrations, and health screenings. The event showed an improvement in knowledge among the participants. A pre-test was conducted with a questionnaire consisting of 10 questions, involving 35 individuals. The results indicated that prior to the event, 17% had good knowledge, 25% had moderate knowledge, and 58% had poor knowledge about hypertension. After the educational activities and knowledge demonstrations, 83% had good knowledge and 16% had moderate knowledge. Furthermore, out of the 35 participants, 20 were found to have hypertension, 5 had prediabetes, and 7 had hyperuricemia. The coastal community of Kampung Salo in Kendari City demonstrated a relatively good level of knowledge regarding nutrition management to prevent the occurrence of non-communicable diseases, particularly hypertension. Additionally, they actively participated in health screenings for early detection of hypertension and other related conditions. It is hoped that the community of Kampung Salo will continue to actively engage in early prevention efforts, both at an individual and community level.

An unusual route of non-intentional intoxication by ecstasy in a toddler

We report a pediatric case of ecstasy intoxication via an unusual route. A mother called the emergency services after her daughter had inserted an ecstasy pill into her nose. During transportation, the child developed hypertension, tachycardia, and tachypnea. She was admitted to the nearest regional hospital, where a physical examination revealed psychomotor agitation, mydriasis, hypertension, tachycardia, and no hyperthermia. Blood tests showed no abnormalities. She was subsequently transferred to a tertiary-level pediatric hospital. During transportation, she was described as being intensely agitated with persistent mydriasis, tachycardia, and high blood pressure. Urinary toxicological screening confirmed the presence of MDMA. She was discharged after 24 h.

Novel biomarkers and emerging tools to identify causal molecular pathways in hypertension and associated cardiovascular diseases.

Hypertension (HT) is a modifiable risk factor for life-threatening cardiovascular diseases (CVDs) including coronary artery disease, heart failure, or stroke. Despite significant progress in understanding the pathophysiological mechanisms of the disease, the molecular pathways targeted by HT treatment remain largely unchanged. This warrants the need for finding novel biomarkers, which are causally related to persistent high blood pressure (BP) and may be pharmacologically targeted. Analytical output derived from large-scale biobanks, containing high-throughput genetic and biochemical data, such as OLINK and SomaScan-based proteomics or Nuclear Magnetic Resonance-based metabolomics, as well as novel analytical tools including the Mendelian randomization (MR) approach, enabling genetic causal inference, may create new treatment opportunities for HT and related CVDs. MR analysis may constitute additional evidence for observational studies and facilitate selection of drug targets for clinical testing and has been already used to nominate potentially causal biomarkers for HT and CVDs such as circulating glycine, branched-chain amino acids, lipoprotein(a), insulin-like growth factor 1, or fibronectin 1. Using the MR framework, genetic proxies for targets of already known drugs, such as statins, PCSK9, and ACE inhibitors, may additionally be informative about potential side effects and eventually contribute to more personalized medicine. Finally, genetic causal inference may disentangle independent direct effects of correlated traits such as lipid classes or markers of inflammation on cardiovascular clinical outcomes such as atherosclerosis and HT. While several novel HT-targeting drugs are currently under clinical investigation (e.g. brain renin-angiotensin-aldosterone system inhibitors or endothelin-1 receptor antagonists), analysis of high-throughput proteomic and metabolomic data from well-powered studies may deliver novel druggable molecular targets for HT and associated CVDs.

Comparison of lipid profiles and hypertension in type 02 diabetes mellitus patients with and without hypertension a multi center study

Introduction: Persistent hyperglycemia and anomalies in the metabolism of proteins, lipids, and carbohydrates are hallmarks of diabetes mellitus, which is brought on by insufficient insulin synthesis or action. Other associated systemic problems, such dyslipidemia and hypertension, may result from this. Dyslipidemia increases cardiovascular events such persistent high blood pressure by raising serum triglycerides, free fatty acids, and HDL cholesterol and lowering it. This research examined hyperlipidemia. Type 2 diabetics, regardless of hypertension. Objective: to compare T2DM with and without hypertension, the present study evaluated the blood lipid profiles of both groups. Layout of the study An experimental research approach is used, along with a comparative study methodology. Methodology: the multi-center study conducted in department of medicine HMC hospital Peshawar OPDs and Out Door Patients hosted the research. From January 2021 to January 2022, performed lab tests. The Multi center study achieved our aim. The study comprised 100 type 2 diabetics divided into cases and controls. Cases had type 02 diabetes and hypertension, but controls did not. Both groups estimated cholesterol, triglycerides, LDL, and HDL levels. The statistical analysis uses SPSS version 28. Mean values and an independent student T-test were used to compare groups.

A false positive 68Ga-DOTA-TATE involvement in an adrenal mass: Kaposi Sarcoma

Abstract Introduction Pheochromocytomas (PCC) are rare tumors (0.8/100000) arising from adrenal medulla cells. The most common symptom of PCC is persistent high blood pressure. Apart from symptomatic cases, PCCs can also be asymptomatic and can be detected incidentally. Surgical treatment is urgent if catecholamine hypersecretion is detected. After the detection of hormonal hyperfunction in patients with PCC, the diagnosis is confirmed by anatomical and functional imaging. As we all know, there is no possibility of histopathological diagnosis before surgery in PCC. Therefore, rare coexistence of false positive Ga68-DOTA-TATE uptake and falsely high urinary catecholamine metabolite levels may lead to adrenalectomy of the patients without PCC. Here we describe a patient who underwent adrenalectomy with a prediagnosis of PCC but received a different pathological diagnosis. Clinical Case A 50-year-old male patient who was diagnosed with AIDS after being investigated for fever of unknown origin was referred to the endocrinology department because of a mass in the left adrenal gland. The patient had complaints of headache, palpitation and sweating. On physical examination, there was a red nodular lesion on his face and a palpable lymph node in the inguinal region. His blood pressure was 160/100 mm-Hg, pulse was 100/min and body temperature were 37.1°C. Ambulatory blood pressure measurements showed that the patient's blood pressure was constantly high. Non-contrast CT showed a tumor of 20×15 mm in size (Hounsfield Unit:38) in the left adrenal gland (Fig-1). In terms of hormonal hyperfunction, no cortisol or aldosterone hypersecretion was detected, but urine normetanephrine was found to be 4 times higher than the upper normal limit (Table 1). Functional imaging revealed pathologically increased Ga68-DOTA-TATE uptake in the left adrenal mass and multiple lymph nodes (SUVmax 5.9 and 3.2) (Fig-1). The pathology of the patient who underwent simultaneous inguinal lymph node excision and adrenalectomy was reported as Kaposi sarcoma (KS). The patient is currently receiving treatment for AIDS and KS. Conclusion KS is a type of cancer that occurs especially in immunocompromised patients. Although there have been publications in the last decade suggesting that 18F-FDG-PET/CT imaging may be beneficial in KS, there are no articles recommending the use of Ga68-DOTA-TATE. Upregulation of neuroendocrine genes has also been shown in publications investigating KS, which is thought to originate from endothelial cells. This may explain why there is Ga68-DOTA-TATE involvement in these lesions. Pheochromocytoma is referred to as “the great mimicker” in the articles of radiology and its similarity with all types of adrenal lesions causes PCC to not be excluded by anatomical imaging. We wanted to share these two diseases, which are very unlikely to come together and cause confusion, and explain the factors that can lead to this confusion.

Gender differences in changes in metabolic syndrome status and its components and risk of cardiovascular disease: a longitudinal cohort study

BackgroundWe aimed to investigate the gender difference in the association between changes in metabolic syndrome (MetS) and its components with the risk of cardiovascular disease (CVD) and coronary heart disease (CHD) among adult participants in the Tehran lipid and glucose study cohort.MethodsA total of 4624 adults (aged ≥ 30 years) who participated in two Phases 2 (2002–2005) and 3 (2005–2008) were included and followed up until 2018. Based on the status of MetS and its components in two phases, we divided participants into four groups: MetS-free, MetS-developed, MetS-recovery and MetS-stable groups, and similar categories were defined for MetS components. Multiple Cox regression models were used to estimate the adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs), and women-to-men ratios of HRs (RHRs).ResultsDuring a median follow-up of 11.6 years, 619 CVD events (292 women) and 512 CHD events (230 women) occurred. In both genders, the MetS-stable group had the highest risk of CVD and CHD, compared with the MetS-free group, but the associations were stronger in women than men: the HR (95% CI) were (2.76, 2.00-3.82) and (3.08, 2.15–4.40) for CVD and CHD, respectively, in women, and (1.60, 1.23–2.09) and (1.74, 1.30–2.31) for men. The multivariate adjusted women-to-men RHRs were (1.72, 1.16–2.56) for CVD and (1.77, 1.14–2.73) for CHD. Only among women, the risks for CVD in MetS-recovery group (1.67, 1.06–2.63) and MetS-developed group (1.89, 1.16–3.06|) were higher than MetS-free group. For CHD, women in MetS-developed group (1.86, 1.07–3.22) had higher risk than MetS-free group. However, no evidence of gender difference was observed in these associations. Among MetS components, persistent high blood pressure (BP) conferred greater risk for CVD and CHD in women than men; the women-to-men RHRs of CVD and CHD for high BP-stable groups were 1.54 (1.05–2.26) and 1.62 (1.07–2.47), respectively. For CHD events, persistent high fasting plasma glucose was associated with greater risk in women than men with women-to-men RHRs of 1.62 (1.09–2.40).ConclusionChange in MetS and its key components were associated with different risks for CVD events in both genders, with generally stronger associations in women than men.

Back to Life Treatment of Resistant Hypertension- An Update

Resistant hypertension is characterized by severe and persistent high blood pressure that is not normalized even after administering two or more antihypertensive medications, of which one is a diuretic. Although resistant hypertension is commonly encountered in clinics, the prognosis is largely unclear. Mounting evidence indicate that resistant hypertension is a multifactorial pathology of diverse etiology. A wide variety of predisposed factors including age, ethnicity, obesity, obstructive sleep apnea, primary aldosteronism, chronic kidney disease, excessive sympathetic activation and baroreflex dysfunction may be implicated. Although a cocktail of three or four major classes of antihypertensive drugs are recommended for treatment, the benefits of pharmacological interventions is limited in many patients, so surgical denervation of the renal artery is widely practiced to improving patient outcome. Thus, surgical interventions include (i) renal sympathetic denervation, (ii) renal sympathetic innervation, and (iii) device-based carotid baroreceptor electric stimulation may be considered back-to-life options to treat resistant hypertension. Moreover, over the years, these surgical procedures have been refined and fine-tuned to optimize benefits, while minimizing adverse effects. Thus, the current surgical practice has been greatly improved from the time of inception. Therefore, this review will focus on the role of surgical interventions in the treatment and management of resistant hypertension. With the global escalation of hypertension in epidemic proportions and the huge socio-economic burden posed to patients, their families and healthcare systems, it is of utmost importance to improve treatment strategies for all forms of hypertension including resistant hypertension.

Reversing the Polycystic Kidney Disease Using Dietary Modification: A Case Study

Polycystic Kidney Disease (PKD) is an inherited disorder in which the anomalous composition of the renal tubules results in the buildout of multiple cysts within the kidney. The genetic PKD mainly occurs between 30 to 40 years of age but acquired PKD can occur because of obesity, persistent high blood pressure, irregular eating patterns, and a sedentary lifestyle at any stage of life. The severe side or back pain, abdomen fullness, edema, hematuria, and weight gain are most common in both females and males. Several therapies are presented for PKD, including weight management, blood pressure control, medicaments like Tenormin, Dietary Approaches to Stop Hypertension (DASH) diet, and the use of cumin along with ajwain in place of salt. Case Summary: This case reported a 30-years-old female approached for evaluation of hypertension, severe side or back pain, and high blood pressure as well as overweight with a sedentary lifestyle. Conclusion: Cortisol hormone levels were elevated with an increased level of creatinine and urea in the blood. Tenormin and DASH diet, and cumin and ajwain were the best treatment choices for PKD patients that need additional investigation before being recommended on a long-term basis and fruitful treatment result.

Perirenal adipose afferent nerves sustain pathological high blood pressure in rats

Hypertension is a pathological condition of persistent high blood pressure (BP) of which the underlying neural mechanisms remain obscure. Here, we show that the afferent nerves in perirenal adipose tissue (PRAT) contribute to maintain pathological high BP, without affecting physiological BP. Bilateral PRAT ablation or denervation leads to a long-term reduction of high BP in spontaneous hypertensive rats (SHR), but has no effect on normal BP in control rats. Further, gain- and loss-of-function and neuron transcriptomics studies show that augmented activities and remodeling of L1-L2 dorsal root ganglia neurons are responsible for hypertension in SHR. Moreover, we went on to show that calcitonin gene-related peptide (CGRP) is a key endogenous suppressor of hypertension that is sequestered by pro-hypertensive PRAT in SHRs. Taken together, we identify PRAT afferent nerves as a pro-hypertensive node that sustains high BP via suppressing CGRP, thereby providing a therapeutic target to tackle primary hypertension.

TREATMENT OF PERSISTENT RENAL DYSFUNCTION AFTER PREECLAMPSIA WITH BENAZEPRIL: A RANDOMIZED, DOUBLE-BLIND TRIAL

Objective: Preeclampsia increases the long-term cardiovascular and renal risk of women. Guidelines recommend to closely follow pre-eclamptic women in the post-partum (PP), but there is no consensus about treatment in women with early persistent kidney damage and high blood pressure after delivery. Objectives: to assess the efficacy of benazepril in improving surrogate markers of renal function of the PP period. Design and method: This was a double blind randomized controlled trial (benazepril 10 mg or placebo) in women with persisting microalbuminuria and/or blood pressure > 140/90 mmHg, and/or ongoing antihypertensive treatment 6–8 weeks PP. The primary outcome was to assess the efficacy of benazepril on GFR, albuminuria, CRP and blood pressure at 3 and 6 months. Results: We included 120 preeclamptic women, mean age was 34.1 ± 5.4 y, BMI before pregnancy was 25.7 ± 5.4 kg/m2; 6 weeks after delivery mean GFR was 114.5 ± 17.6 ml/min/1.73m2, microalbuminuria/urine creatinine ratio was 9.4 ± 13.9 mg/mmol, CRP was 9.3 ± 14. mg/L, SBP was 130.6 ± 13.1, and DBP was 90.4 ± 11.4 mmHg. At 3 months (resp. 6 months) postpartum, microalbuminuria and blood pressure improved in both groups but both parameters were significantly lower with benazepril than with placebo group (Table). Conclusions: Our study shows that benazepril was effective to improve renal surrogates in women having suffered from preeclampsia. The clinical benefits of maintaining the treatment beyond 6 months remain to be demonstrated.

Persistent high blood pressure and renal dysfunction in preterm infants during childhood.

Infants born very preterm (≤32 weeks gestational age, GA) and very-low birth weight (≤1500 g; PT-VLBW) demonstrate high systolic blood pressure (SBP), renal dysfunction, and obesity at 6 months-3 years and in early adulthood. Their parallel measurement and progression during childhood is unclear. We reenrolled 62/120 patients originally seen at 1-3 years at 10-13 years and remeasured anthropometric indices, SBP, and serum creatinine (Cr) and cystatin C (cysC) to determine estimated glomerular filtration rate (eGFR). We selected Term-matched Controls at 10-13 years from the 2015-2016 NHANES database at a ratio of 2 Controls:1 Case (124:62). Reenrolled patients were predominantly Hispanic, birth weight 1073 ± 251 g, and GA at birth 28 ± 2 weeks. At 10-13 years, 45% were classified overweight/obese, 48% had SBP ≥ 90th centile (77% considered hypertensive), and 34% had low eGFR (<90 mL min-1 [1.73 m2]-1). Notably, 57% of reenrolled PT-VLBW Cases had low eGFRcysC at both 1-3 and 10-13 years, P < 0.03. Compared to Controls, Cases had four times the adjusted odds for having an elevated SBP and low eGFRCr despite similar proportions with overweight/obesity among Cases and Controls. PT-VLBW infants seen at 1-3 years exhibit obesity, elevated SBP, and low eGFR in infancy and 10-13 years. Although the small sample size may limit conclusions, pediatricians should consider serial evaluations of PT-VLBW throughout childhood. The association between preterm birth and elevated blood pressure, renal dysfunction, and obesity in young adults begins as early as 1 year and persists at 10-13 years of age. This is the first study reporting serial measurements of blood pressure, renal function, and obesity from infancy to preadolescence in children born very preterm. Fifty-seven percent of preterm 1-3 year olds have persistent low estimated glomerular filtration rate associated with hypertension at 10-13 years. Clinicians should consider serial evaluations of blood pressure, renal function, and obesity throughout infancy and childhood in all preterm births.

Detection and Grading of Hypertensive Retinopathy Using Vessels Tortuosity and Arteriovenous Ratio.

Hypertensive retinopathy (HR) refers to changes in the morphological diameter of the retinal vessels due to persistent high blood pressure. Early detection of such changes helps in preventing blindness or even death due to stroke. These changes can be quantified by computing the arteriovenous ratio and the tortuosity severity in the retinal vasculature. This paper presents a decision support system for detecting and grading HR using morphometric analysis of retinal vasculature, particularly measuring the arteriovenous ratio (AVR) and retinal vessel tortuosity. In the first step, the retinal blood vessels are segmented and classified as arteries and veins. Then, the width of arteries and veins is measured within the region of interest around the optic disk. Next, a new iterative method is proposed to compute the AVR from the caliber measurements of arteries and veins using Parr-Hubbard and Knudtson methods. Moreover, the retinal vessel tortuosity severity index is computed for each image using 14 tortuosity severity metrics. In the end, a hybrid decision support system is proposed for the detection and grading of HR using AVR and tortuosity severity index. Furthermore, we present a new publicly available retinal vessel morphometry (RVM) dataset to evaluate the proposed methodology. The RVM dataset contains 504 retinal images with pixel-level annotations for vessel segmentation, artery/vein classification, and optic disk localization. The image-level labels for vessel tortuosity index and HR grade are also available. The proposed methods of iterative AVR measurement, tortuosity index, and HR grading are evaluated using the new RVM dataset. The results indicate that the proposed method gives superior performance than existing methods. The presented methodology is a novel advancement in automated detection and grading of HR, which can potentially be used as a clinical decision support system.

Molecular Mechanisms of Hypertensive Nephropathy: Renoprotective Effect of Losartan through Hsp70.

Hypertensive nephrosclerosis is the second most common cause of end-stage renal disease after diabetes. For years, hypertensive kidney disease has been focused on the afferent arterioles and glomeruli damage and the involvement of the renin angiotensin system (RAS). Nonetheless, in recent years, novel evidence has demonstrated that persistent high blood pressure injures tubular cells, leading to epithelial–mesenchymal transition (EMT) and tubulointerstitial fibrosis. Injury primarily determined at the glomerular level by hypertension causes changes in post-glomerular peritubular capillaries that in turn induce endothelial damage and hypoxia. Microvasculature dysfunction, by inducing hypoxic environment, triggers inflammation, EMT with epithelial cells dedifferentiation and fibrosis. Hypertensive kidney disease also includes podocyte effacement and loss, leading to disruption of the filtration barrier. This review highlights the molecular mechanisms and histologic aspects involved in the pathophysiology of hypertensive kidney disease incorporating knowledge about EMT and tubulointerstitial fibrosis. The role of the Hsp70 chaperone on the angiotensin II–induced EMT after angiotensin II type 1 receptor (AT1R) blockage, as a possible molecular target for therapeutic strategy against hypertensive renal damage is discussed.

ESSENTIAL HYPERTENSION OR A MISSING CAUSE FOR SECONDAY HYPERTENSION?

Objective: The case highlights the importance of diagnosing secondary hypertension and adequate treatment in the setting of a patient with classical cardiovascular risk factors which would otherwise make primary hypertension the most likely diagnosis. Design and method: Clinical Case Results: A 57 year-old male with cardiovascular risk factors (smoking, dislypidemia), grade 2 essential hypertension (ESC/ESH) and G3a stage chronic kidney disease (CKD) presents to our clinic with fatigue and persistent high blood pressure values despite treatment with ACEi. Clinical exam was unremarkable except for a 10mmHg difference between the arm and foot systolic blood pressure. The 24-hour ambulatory blood pressure monitoring revealed a non-dipping profile, with a mean blood pressure value of 150/100mmHg. TTE was performed and the following were observed: bicuspid aortic valve with tight aortic stenosis (mean AV PG &gt; 40mmHg, AVA = 1.12cm2) and LV systolic dysfunction (LVEF = 35%). TEE was also performed and confirmed the bicuspid aortic valve. Given the context of the patient, computed tomography angiography (CTA) was the investigation of choice in order to visualize the aorta. Postductal coarctation was detected with a hypoplastic thoracic aorta and multiple collateral vessels. The coronary angiogram was normal. The ACEi was stopped and the patient received a dihydropyridine calcium channel blocker in combination with an adolsterone receptor antagonist with a favourable course. Aortic valve replacement surgery with mechanical valve implantation was recommended. Considering the multiple collateral vessels and complex vascular morphology, surgical correction of the coarctation was considered no longer feasible Conclusions: CoA was the actual cause for the persistent high blood pressure values in an adult male with cardiovascular risk factors who was believed to have essential hypertension. In the setting of aortic stenosis with impaired LV systolic function, high blood pressure values are not typical. Taking into account the BAV, the clinical suspicion of CoA was high and prompted further investigations. The CKD is the result of the the underperfusion of the kidneys secondary to the CoA and the use of ACEi.