Essential Hypertension Pressure Research Articles

Heart rate deceleration and acceleration capacities associated with circadian rhythm of blood pressure in essential hypertension

BackgroundThis study aimed to investigate the potential association between the circadian rhythm of blood pressure and deceleration capacity (DC)/acceleration capacity (AC) in patients with essential hypertension.MethodsThis study included 318 patients with essential hypertension, whether or not they were being treated with anti-hypertensive drugs, who underwent 24-hour ambulatory blood pressure monitoring (ABPM). Patients were categorized into three groups based on the percentage of nocturnal systolic blood pressure (SBP) dipping: the dipper, non-dipper and reverse dipper groups. Baseline demographic characteristics, ambulatory blood pressure monitoring parameters, Holter recordings (including DC and AC), and echocardiographic parameters were collected.ResultsIn this study, the lowest DC values were observed in the reverse dipper group, followed by the non-dipper and dipper groups (6.46 ± 2.06 vs. 6.65 ± 1.95 vs. 8.07 ± 1.79 ms, P < .001). Additionally, the AC gradually decreased (-6.32 ± 2.02 vs. -6.55 ± 1.95 vs. -7.80 ± 1.73 ms, P < .001). There was a significant association between DC (r = .307, P < .001), AC (r=-.303, P < .001) and nocturnal SBP decline. Furthermore, DC (β = 0.785, P = .001) was positively associated with nocturnal SBP decline, whereas AC was negatively associated with nocturnal SBP (β = -0.753, P = .002). By multivariate logistic regression analysis, deceleration capacity [OR (95% CI): 0.705 (0.594–0.836), p < .001], and acceleration capacity [OR (95% CI): 1.357 (1.141–1.614), p = .001] were identified as independent risk factors for blood pressure nondipper status. The analysis of ROC curves revealed that the area under the curve for DC/AC in predicting the circadian rhythm of blood pressure was 0.711/0.697, with a sensitivity of 73.4%/65.1% and specificity of 66.7%/71.2%.ConclusionsAbnormal DC and AC density were correlated with a blunted decline in nighttime SBP, suggesting a potential association between the circadian rhythm of blood pressure in essential hypertension patients and autonomic nervous dysfunction.

The relationship between circadian rhythm of blood pressure and vascular dysfunction in essential hypertension

ABSTRACT Objective This study aimed to explore whether circadian rhythm of blood pressure is associated with brachial-ankle pulse wave velocity (baPWV) and brachial artery flow-mediated dilation (FMD) in patients with essential hypertension. Method This cross-sectional study included 4,217 patients with essential hypertension who completed 24-hour ambulatory blood pressure monitoring, baPWV, and FMD. BaPWV and FMD were measured to evaluate arterial stiffness and endothelial dysfunction. Participants were divided into dipper, non-dipper, and reverse dipping groups according to the nocturnal systolic blood pressure dipping percentage. Results In this study, baPWV was highest in the reverse dipping groups, followed by non-dipper and dipper groups (1667.11 ± 327.90 vs. 1613.88 ± 325.11 vs. 1577.45 ± 306.15 cm/s, P < .001) and FMD gradually increased (4.41 ± 2.87 vs. 4.70 ± 2.84 vs. 4.92 ± 2.79%, P = .001). baPWV and FMD were significantly associated with declining nocturnal systolic blood pressure (SBP). Interestingly, FMD (β = 0.042, P = .014) was only positively associated with a drop in nocturnal SBP decline in patients <65 years of age. Whereas baPWV was consistently negatively associated with nocturnal SBP decline regardless of age (β = -0.065, P < .001, age <65 years; β = -0.149, P = .002, age ≥ 65). Receiver operating characteristics (ROC) curves analysis showed areas under the curve (AUC) of baPWV/FMD for predicting circadian rhythm of blood pressure are 0.562/0.554 with a sensitivity of 51.7%/53.9% and specificity of 56.4%/53.4. Conclusion Impairment of baPWV and FMD were correlated with abnormal circadian rhythm of blood pressure in essential hypertension, suggesting a decrease in nighttime SBP may associate with endothelial function and arterial stiffness.

Correlation of mineral status with levels of blood pressure in essential hypertension among patients attending a tertiary care hospital in South-India

Correlation of mineral status with levels of blood pressure in essential hypertension among patients attending a tertiary care hospital in South-India

Is the Pannexin-1 Channel a Mechanism Underlying Hypertension in Humans? a Translational Study of Human Hypertension

In preclinical models, the pannexin-1 channel has been shown to be involved in blood pressure regulation through an effect on peripheral vascular resistance. Pannexin-1 releases ATP, which can activate constrictive purinergic receptors on the smooth muscle cells. Pannexin-1 opening is proposed to be mediated by α-adrenergic receptors to potentiate sympathetic constriction. This positions pannexin-1 as a putative pharmacological target in blood pressure regulation in humans. The aim was to provide the first translational evidence for a role of pannexin-1 in essential hypertension in humans by use of an advanced invasive mechanistic approach. Middle-aged stage-1 hypertensive (n=13; 135.7±6.4 over 83.7±3.7 mm Hg) and normotensive men (n=12; 117.3±5.7 over 72.2±3.5 mm Hg) were included. Blood pressure and leg vascular resistance were determined during femoral arterial infusion of tyramine (α-adrenergic receptor stimulation), sodium nitroprusside, and acetylcholine. Measurements were made during control conditions and with pannexin-1 blockade (3000 mg probenecid). Expression of Pannexin-1, purinergic- and α-adrenergic receptors in skeletal muscle biopsies was determined by Western blot. The changes in leg vascular resistance in response to tyramine (+289% versus +222%), sodium nitroprusside (-82% versus -78%) and acetylcholine (-40% versus -44%) infusion were not different between the 2 groups (P>0.05) and pannexin-1 blockade did not alter these variables (P>0.05). Expression of pannexin-1 and of purinergic- and α-adrenergic receptors was not different between the 2 groups (P>0.05). Contrary to our hypothesis, the data demonstrate that pannexin-1 does not contribute to the elevated blood pressure in essential hypertension, a finding, which also opposes that reported in preclinical models.

Correlations between sympathetic nervous system activity and smoking, as well as unattended blood pressure in essential hypertension

Abstract Background/Introduction It is a well-known fact that the sympathetic nervous system is involved with the pathophysiology of hypertension. Smoking, which is one of the most significant risk factors for cardiovascular morbidity and mortality, also contributes to the development of hypertension mainly through the stimulation of the sympathetic nervous system. Moreover, measurement of unattended blood pressure (BP) may provide additional information compared to conventionally attended BP. Purpose The aim of this study was to demonstrate the impact of smoking on sympathetic nervous system stimulation, and on BP measurement variations with and without medical supervision. Methods We studied patients with essential hypertension, who were separated into two groups, depending on their smoking habits (Group I: non-smokers, Group II: smokers). In all participants, sympathetic drive was assessed by MSNA estimations based on established methodology (microneurography). Both unattended (patient alone in the room, an oscillometric device programmed to perform 3 BP measurements, at 1-minute intervals, after 5 minutes of rest) and attended BP measurements were conducted with the same device, on the same day of MSNA recording, in random order. Then, we compared the two BP measurement values of each patient to assess which of the two was higher. Results Ninety-two consecutive patients (58±11 years, 50 males) were evaluated. Smokers (n=19) did not differ as regards 24-h ambulatory BP levels, glucose levels, renal function and left ventricular mass index when compared to non-smokers (n=73). However, higher levels of MSNA were recorded to smokers (73.16±13.42 vs. 61.04±18.10 bursts per 100 heartbeats, p&amp;lt;0.01). Furthermore, higher percentage of smokers recorded to have unattended BP values higher than attended (73.7% vs. 47.9% of them respectively, p=0.045). In particular, in smokers unattended BP was higher than attended by 10.07±6.7 mmHg, while in non-smokers unattended BP was lower than attended by 6.6±7.14 mmHg. No correlation was found between the MSNA and the differences observed in the two values resulting from the two different measurements of BP, maybe due to the small size of the sample. Conclusions Cigarette smoking is accompanied with higher sympathetic nervous system activation. Moreover, smokers exhibit higher unattended blood pressure values than normal measurements. The emerging hypothesis is that the stimulation of the sympathetic system causes this difference in measurements. A larger sample of patients is needed to fully determine the clinical significance of the above observation. Funding Acknowledgement Type of funding sources: None.

THE RELATIONSHIP BETWEEN CIRCADIAN RHYTHM OF BLOOD PRESSURE AND LEFT ATRIAL PHASIC FUNCTION IN HYPERTENSION

Objective: Objective: We used two dimensional speckle tracking echocardiography (2DSTE)-based strain and strain rate imaging to evaluate left atrial (LA) mechanics and investigated its correlation with circadian rhythm of blood pressure in essential hypertension (HT). Design and method: Design and Methods: We enrolled 249 HT patients. All subjects were evaluated by ambulatory 24-hour blood pressure monitoring and 2D-STE. According to blood pressure (BP) patterns, these patients were divided into three groups. Group I (dipper, n = 91), patients with a 10%-20% reduction in BP at nighttime; Group II (non-dipper, n = 129), patients with a &lt; 10% reduction in BP at nighttime; Group III (reverse dipper, n = 29), patients with higher BP at nighttime compared with daytime. The strain and strain rate images were studied, and the following parameters were measured: LA reservoir strain and strain rate (LAS-S, LASR-S), LA conduit strain and strain rate (LAS-E and LASR-E), LA booster strain and strain rate (LAS-A and LASR-A). LA stiffness index (LASI) was defined as the ratio of E/e‘ to LAS-S. In the present study, we also explored the correlation between LASI and cardiovascular risk factors as well as ambulatory blood pressure indexes. The factors related to LASI were evaluated by multivariate regression analysis to find the independent factors. Results: Results: LASI was significantly higher in Group III than Group I (p &lt; 0.05). LAS-E and LASR-E were significantly lower in Group III than Group I and II (p &lt; 0.05 for both). However, there were no significant differences between the Group I and II (p &gt; 0.05). Otherwise, LAS-S, LASR-S, LAS-A and LASR-A were not significantly different among these three groups. We also found LASI was correlated with ages, diabetes, courses of HT, 24-hour mean systolic blood pressure (24h-mSBP), 24-hour mean diastolic blood pressure (24h-mDBP), daytime mean SBP (d-SBP), nighttime mean SBP (n-SBP) and nighttime mean DBP (n-DBP). Multivariate regression analysis revealed that age, n-SBP and n-DBP were independent factors related to LASI. Conclusions: Conclusions: Left atrial function is associated with circadian rhythm of blood pressure. Nocturnal blood pressure may have more influence on left atrial stiffness and conduit function.

Efficacy of Nardostachys jatamansi (D.Don) DC in essential hypertension: A randomized controlled study

BackgroundNardostachys jatamansi (D.Don) DC, commonly known as muskroot and Indian spikenard, is a small, perennial, flowering, rhizomatous species of the Caprifoliaceae family. Nardostachys jatamansi (D.Don) DC (Sumbul-ut-teeb) has been used in Unani Medicine since antiquity. It is one of the important drugs mentioned by Ibn-e-Sina (Avicenna) in his treatise “Kitab al-Adwiya al- Qalbiya” for cardiac diseases. The drug has been shown to exhibit anxiolytic, sedative, antispasmodic, tranquillizing, and anti hypertensive activity. AimThe aim of the present study was to examine the efficacy of Nardostachys jatamansi in reducing blood pressure in hypertensive patients. MethodsThe single blind randomized, placebo controlled study was conducted with 40 patients aged between 35–70 years. The participants were randomly allocated to receive either a total of 3 g of N. Jatamansi (1capsule 3 times a day) or placebo for 4 weeks. Patients using ≤ 2 antihypertensive drugs with stage 1 hypertension were included in the study. Systolic and diastolic Blood pressure was recorded at baseline and at every week for four weeks. MINICHAL score (for Quality of Life) was recorded at baseline and at the end of the trial. ResultsAfter the four weeks of treatment, there was a statistically significant reduction in average systolic blood pressure 144.20 ± 11.35 mmHg (CI, 138.89–149.51) to 134.30 ± 10.08 mmHg (CI, 129.58–139.02), p < 0.001) and diastolic blood pressure (94.9. ± 3.4 mmHg (CI 93.30–96.49) to 83.10 ± 5.29 mmHg (CI 80.62–85.57), p < 0.001) in the N. Jatamansi group whereas there was no significant difference in systolic blood pressure (143.40 ± 8.39 mmHg (CI, 139.47–147.33) to 142. ± 11.68 mmHg (CI, 136.53–147.47) p = 0.148) and diastolic blood pressure 95.10 ± 3.70 mmHg (CI, 93.37–96.83) to 94.80 ± 3.69 mmHg, (CI93.07–96.52) p = 0.186) in placebo group. A comparison between baseline and post treatment, MINICHAL score in N. Jatamansi group showed significant reduction 10.85 ± 1.27 (CI, 10.25–11.44) to 6.20 ± 1.77, (CI, 5.37–7.02) p < 0.001) whereas there was no significant difference in placebo group 11.05 ± 1.50 (CI, 10.34–11.75) to 10.85 ± 1.26, 95 % (CI, 10.25–11.44) p = 0.103). ConclusionThe present findings suggest that N. Jatamansi is effective in reducing both systolic and diastolic blood pressure in essential hypertension. Moreover studies on efficacy of different doses and treatment duration of test drug are required to finetune these observations.

Effects of combined statin and ACE inhibitor therapy on endothelial function and blood pressure in essential hypertension - a randomised double-blind, placebo controlled crossover study

Background:The aim of this study was to compare the influence of 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors on endothelial function and blood pressure in patients with essential hypertension on long-term angiotensin-converting enzyme inhibitor therapy.Method:The study was designed as a prospective, double-blind, randomised, placebo controlled, crossover clinical trial. Twenty patients with essential hypertension were treated with an angiotensin-converting enzyme inhibitor; the control group included 10 healthy subjects. Hypertensive patients received in random order 80 mg of fluvastatin daily or placebo for 6 weeks. The following parameters were assessed at baseline and after each treatment period: serum lipids, flow-mediated vasodilation, activity of von Willebrand factor, concentration of vascular endothelial growth factor, C-reactive protein and 24-hour blood pressure profile.Results:Hypertensive patients did not differ from healthy subjects with respect to age, body mass and biochemical parameters, with the exception of C-reactive protein, which was higher in hypertensive patients (P=0.02). After statin therapy, low-density lipoprotein cholesterol (P<0.0001), C-reactive protein (P=0.03), von Willebrand factor (P=0.03) and vascular endothelial growth factor (P<0.01) decreased and flow-mediated vasodilation improved (P<0.001). Statins had no significant effect on blood pressure.Conclusions:Statins added to angiotensin-converting enzyme inhibitors may improve endothelial function and ameliorate inflammation independently of blood pressure.

Update on Endothelin Receptor Antagonists in Hypertension.

To review the most recent data on the development of endothelin receptor antagonists (ERAs) for the treatment of hypertension and the management of diabetic nephropathy RECENT FINDINGS: Recent reviews and meta-analyses of experimental and clinical data obtained with ERAs confirmed that endothelin receptor blockade is associated with significant decreases in blood pressure in essential hypertension but also in resistant hypertension. In addition, in patients with diabetic nephropathy, ERAs induce significant 30-40% decreases in albuminuria when administered on top of blockers of the renin-angiotensin system. Yet, the benefits of ERAs have often been limited by their tolerability profile, essentially fluid retention and the development of edema and liver toxicity. Hence, several programs have been interrupted. Today, only one ERA, aprocitentan, is still under development for the treatment of resistant hypertension. Regarding the place of ERAs in the management of diabetic nephropathy, the results of the SONAR trial with atrasentan are eagerly awaited but the recent interruption of this trial because of insufficient events is worrisome, as one might not obtain all the expected information for this major trial. Blockade of endothelin receptor have a high potential in the treatment of hypertension and the prevention of the progression of renal diseases such as diabetic nephropathy. Today, the number of clinical programs investigating the potential benefits of ERAs is limited and more data must be obtained to define the real place of ERAs in these indications.

Abstract P133: Angiotensin-(1-7) Does Not Acutely Lower Blood Pressure in Patients With Essential Hypertension

Angiotensin (Ang)-(1-7) is a beneficial renin-angiotensin hormone that produces vasodilation to lower blood pressure (BP) in animal models of hypertension. There are limited clinical studies, however, and it is unclear if Ang-(1-7) contributes to BP regulation in human hypertension. We propose the difficulties in showing cardiovascular effects in previous clinical studies relates to the buffering capacity of the arterial baroreflex. In this study, we tested the hypothesis that Ang-(1-7) would produce negligible effects on BP with intact baroreceptors, and that the cardiovascular effects of this hormone would be unmasked following elimination of baroreflex buffering. To test this, we examined the effects of acute intravenous Ang-(1-7) infusion (ascending doses from 0.5 to 20 ng/kg/min) on supine BP in subjects with essential hypertension under intact conditions and following acute autonomic withdrawal with the ganglionic blocker trimethaphan in a randomized, open-label, crossover study. BP was restored to baseline levels following autonomic blockade with individually titrated phenylephrine doses. Seven subjects with essential hypertension completed this study (6 male; 48±4 years of age; 29±2 body mass index). All subjects were withdrawn from antihypertensive medications for at least two weeks, and were placed on a fixed sodium diet (150 mEq/day) for three days, prior to each study day. When comparing change from baseline to maximum dose, Ang-(1-7) did not alter systemic hemodynamics under intact conditions (systolic BP: 3±4 mmHg; diastolic BP: 3±1 mmHg; heart rate (0±1 bpm). In contrast to our hypothesis, Ang-(1-7) did not elicit a BP-lowering effect under autonomic blockade (systolic BP: 10±8 mmHg, p=0.299 vs. intact; diastolic BP: 7±3 mmHg, p=0.512; heart rate: -2±1 bpm, p=0.166). Plasma Ang-(1-7) was measured in 4 subjects and showed an approximate 3-fold increase with infusions [0.8±0.7 baseline vs. 2.1±1.2 ng/mL after Ang-(1-7)]. These findings suggest that infusion of Ang-(1-7) to levels within a physiologic range does not acutely induce vasodilation to lower blood pressure in essential hypertension. We cannot exclude that Ang-(1-7) lowers BP by sympathetic inhibition, since those pathways were excluded by our study design.

Effect of deep breathing and positive affirmation on blood pressure in essential hypertension

The effect of deep breathing method and positive affirmation on blood pressure decrease in patients with essential hypertension in Kulon ProgoPurposeThe purpose of this paper was to compare the influence of deep breathing method and positive affirmation on the decrease in blood pressure in essential hypertensive patients in Kulon Progo.MethodsA randomized controlled trial was conducted involving 96 patients with essential hypertension who were randomly assigned to two intervention groups, namely deep breathing and positive affirmations. The DB group was asked to perform stomach breathing for approximately 10 minutes, while the AP group was asked to give one of the repetitive and rhythmically determined positive affirmation sentences for about 10 minutes.ResultsDeep breathing and positive affirmations can lower systolic blood pressure (11.9 ± 10.9 and 13.6 ± 10.5) and diastolic (8.3 ± 8.4 and 6.0 ± 8.6) in patients with essential hypertension. The mean blood pressure results on post1 and post2 measurements were not significantly different. The decrease in blood pressure in both groups was also not different.ConclusionThis study contributes to the knowledge that the effectiveness of deep breathing and positive affirmations in lowering blood pressure is the same. The decrease in blood pressure of both methods was stable up to 15 minutes after the intervention.

The immunological basis of hypertension.

A large number of investigations have demonstrated the participation of the immune system in the pathogenesis of hypertension. Studies focusing on macrophages and Toll-like receptors have documented involvement of the innate immunity. The requirements of antigen presentation and co-stimulation, the critical importance of T cell-driven inflammation, and the demonstration, in specific conditions, of agonistic antibodies directed to angiotensin II type 1 receptors and adrenergic receptors support the role of acquired immunity. Experimental findings support the concept that the balance between T cell-induced inflammation and T cell suppressor responses is critical for the regulation of blood pressure levels. Expression of neoantigens in response to inflammation, as well as surfacing of intracellular immunogenic proteins, such as heat shock proteins, could be responsible for autoimmune reactivity in the kidney, arteries, and central nervous system. Persisting, low-grade inflammation in these target organs may lead to impaired pressure natriuresis, an increase in sympathetic activity, and vascular endothelial dysfunction that may be the cause of chronic elevation of blood pressure in essential hypertension.

Uncontrolled factors of blood pressure in essential hypertension: from“patient’s high blood pressure”to“hypertensive patient”

Hypertension is a significant medical and public health issue which puts an enormous burden on health care resources and the community. It is a chronic medical condition in which the systemic arterial blood pressure (BP) is elevated. Serious complications including cardiovascular and cerebrovascular diseases would be preventable if the rise in BP with age could be prevented or diminished. The majority of hypertensive patients require long-term treatment. Oral antihypertensive drugs, lifestyle modification including exercise and dietary modification are milestones for hypertension therapy. However, the control rate of hypertension hasn't reached the expected requirements currently. "Three lows" status quo, just low awareness, low treatment, and low control, are still the major problems confronting modern medicine. Recently, uncontrolled factors of blood pressure are widely concerned, which include insomnia, constipation, mood disorders, exogenous, etc. What's more, the control strategies of hypertension should not only pay close attention to "patient's high blood pressure", but also to "hypertensive patient". Therefore, the treatment of uncontrolled factors of blood pressure plays an important role in hypertensive therapy, which could be further research priorities.

臨床 Propranolol徐放製剤(lnderal LA(R)) の本態性高血圧症における血圧日内変動に及ぼす影響

臨床 Propranolol徐放製剤(lnderal LA(R)) の本態性高血圧症における血圧日内変動に及ぼす影響

493 AMBULATORY BLOOD PRESSURE MONITORING OF HYPERTENSION PATIENTS WITH CORONARY HEART DISEASE PREDICTION FUNCTION

Objective: The 148 cases of high blood pressure of coronary disease combined dynamic blood pressure index analysis, this paper discusses the dynamic of blood pressure in essential hypertension with coronary heart disease prediction function. Methods: According to the criteria, consecutive patients with chest pain accept coronary angiography in 546 cases of essential hypertension and coronary angiography results based on merger coronary heart disease and high blood pressure group is divided into pure high blood pressure group. 148 of them routine ambulatory blood pressure monitoring. All patients will do coronary angiography, coronary artery pathological changes of blood vessels with lesions degree count and Gensini integral said. Results: The group with high blood pressure coronary heart disease risk of cardiovascular events than pure hypertension patients (P < 0.05). High blood pressure patients with coronary heart disease cardiovascular events of the 24 h group dynamic systolic blood pressure (SBP), day and night dynamic dynamic SBP SBP, 24 h dynamic pulse pressure (PP), daytime dynamic PP, dynamic PP is higher than the night without cardiovascular events group. Many factors Logistic regression analysis showed the 24 h dynamic SBP, night dynamic PP and cardiovascular events happened close relationship. Conclusion: 24 h dynamic SBP, night dynamic PP is high blood pressure patients with coronary heart disease risk factors of cardiovascular events.

Untersuchungen zur antihypertensiven Langzeitwirkung von Candesartan-cilexetil in verschiedenen Dosierungen unter dem Einfluß therapiefreier Intervalle

In a randomized, phase IV clinical study with 4 parallel treatment arms, the long-lasting treatment effect of candesartan cilexetil (CAS 145040-37-5, CC, Blopress) was to be demonstrated for a repeated therapy-free interval of 48 h in the dosages 8 and 16 mg with or without hydrochlorothiazide 12.5 mg (CAS 58-93-5, HCT; 4 groups totally). The reason for this design was the known possibility of missed tablet doses in the patients' daily practice leading to a not always sufficient lowering of blood pressure in essential hypertension. Therefore, the intake of the daily tablet dose was intentionally omitted twice (after 6 and 8 weeks) during the 8-week study treatment period. Primary efficacy variable was the comparison of blood pressure lowering before and after the first 48-hour therapy-free interval following a 6-week treatment period. The confirmatory analysis was done on the basis of paired t-tests and the Bonferroni-Holm "step-down procedure" for the systolic and diastolic results in each of the four treatment groups. Secondary variables were the efficacy 24 and 48 h after the last tablet intake following a 6- and 8-week treatment period, the blood pressure normalization rate and the tolerability. 312 out-patients from 46 study centers in Germany with mild or moderate essential hypertension strictly treated according to the protocol requirements were evaluated in terms of all primary and secondary study parameters. The patient allocation to the 4 treatment arms as well as the conditions at study start concerning demographic data, physical investigation, patient history, ECG, concomitant diseases/therapy and baseline values of blood pressure were well comparable between the four groups. The antihypertensive therapy with CC showed the expected clear effect on blood pressure lowering in 312 per-protocol treated patients with in addition an increase for the higher dosages and for the combination with HCT. The mean rate of lowering (systolic/diastolic) after 24 h for all treatment groups together was 14.5/8.1 mmHg after 6 weeks and 17.3/9.5 mmHg after 8 weeks of therapy. The described antihypertensive blood lowering effect could be maintained in nearly 100% diastolic and 100% systolic values for the first 48-hour therapy-free interval after 6 weeks and in about 100% diastolic and 80% systolic values for the second interval after 8 weeks. These results could be reproduced without relevant differences for the respective single outcome in the four treatment groups. Regarding the primary study efficacy criterion the achieved lowering of blood pressure was highly statistically significant with p-values < 0.0001 in all 4 groups both for systolic and diastolic results. In addition, the long-term action over 48 h could be confirmed by the specific analysis according to Bonferroni-Holm showing that the p-values of all eight hypotheses were below the adjusted significance levels, i.e. in terms of the systolic and diastolic endpoints within the 4 treatment groups. Furthermore, statistically significant differences between the four treatment arms could not be detected regarding the long-lasting blood pressure lowering effect over As for tolerability the entire study provides no evidence on new or unknown pathologic drug reactions as well as on a frequent occurrence of specific adverse events or relevant laboratory changes. The objectives of the present study were completely met by confirming statistically and clinically the assumption of a clear, long-lasting, safe and metabolically neutral action of CC both for low and high dosages with or without HCT. The intended lowering of blood pressure is effective and well tolerable also repeatedly during the 48-h, therapy-free interval (missed dose trial) which corresponds to a frequent omission of the daily tablet dose and thus well reflects the daily practice in antihypertensive therapeutic regimens.

Regular thermal therapy may promote insulin sensitivity while boosting expression of endothelial nitric oxide synthase – Effects comparable to those of exercise training

Regular thermal therapy, using saunas or hot baths, has the potential to improve impaired insulin sensitivity and boost endothelial expression of the "constitutive" isoform of nitric oxide synthase--effects, analogous to those of aerobic training that should promote vascular health. Previous clinical reports suggest that hot tubs may be beneficial for diabetic control, and that sauna therapy can decrease blood pressure in essential hypertension and provide symptomatic benefit in congestive heart failure. For those who lack ready access to a sauna or communal hot tub, regular hot baths at home may suffice as practical thermal therapy. Thermal therapy might be viewed as an alternative to exercise training in patients too physically impaired for significant aerobic activity.

Review: The role of noninvasive hemodynamic monitoring in the evaluation and treatment of hypertension

Advances in the understanding of the mechanisms accounting for the elevation of arterial pressure in essential hypertension suggest that there is value in assessing the relative contribution of hemodynamic factors in tailoring specific therapies to control arterial pressure. The non-invasive method of impedance cardiography (ICG) to measure hemodynamic abnormalities in hypertensive patients has emerged as a valuable adjuvant in the decision-making process of selecting antihypertensive agents. The technique is both accurate and reproducible in delineating the hemodynamic mechanisms of hypertension, comparing age-and gender-related changes in hemodynamics, detecting the presence of left ventricular dysfunction, and demonstrating clinically significant improvement in blood pressure control using ICG-guided therapy.

From treatment to organ damage; A 5‐year follow‐up study of ambulatory blood pressure in essential hypertension. Diversity between development of left ventricular hypertrophy and urinary albumin excretion

This study aimed to assess blood pressure (BP) profile, BP control, left ventricular hypertrophy (LVH) and albumin/creatinine ratio (ACR) in urine after 5 years of antihypertensive treatment in subjects with newly diagnosed essential hypertension. Fifty‐four subjects were included and prescribed calcium‐channel blocker in monotherapy during an 8‐week period, and later 46 subjects (34 men, 12 women, 53.1±8.6 years) attended a 5‐year follow‐up visit at the hypertension clinic. They underwent 24‐h ambulatory BP monitoring (ABPM), ECG and ACR at baseline and after 5 years. Echocardiography performed after 5 years revealed LVH in 54% of the subjects, while there was no change in Cornell product, an ECG criterion for LVH. BP control assessed by office BP was 33%, and only 20% using 24‐h ABP. Night‐time fall in BP was significantly attenuated from 13.2±5.9% to 10.7±6.0%, p = 0.01 for systolic BP and from 13.3±6.9% to 9.8±6.8%, p = 0.004 for diastolic BP. The number of dippers decreased after 5 years, but this did not reach statistical significance. In contrast to the lack of change in Cornell product, there was a significant decrease in ACR, and 93% of the subjects had ACR<1.5 mg/mmol after 5 years compared with 57% at baseline (p<0.001). Thus, ABPM should be encouraged in the follow‐up of all hypertensive subjects as it reveals better inadequate BP control than office BP and gives information about night‐time fall, as this may explain the high prevalence of LVH. The diversity in development of LVH and ACR during antihypertensive treatment needs to be verified.

Enhanced sodium sensitivity and disturbed circadian rhythm of blood pressure in essential hypertension

To assess whether an association between sodium-sensitive hypertension and metabolic syndrome exists; and whether, in patients with metabolic syndrome, the nocturnal fall of blood pressure decreases and salt restriction affects the circadian blood pressure rhythm. Japanese patients with essential hypertension, who were treated without any antihypertensive agent, were maintained on a high-sodium diet and a low-sodium diet for 1 week each. On the last day of each diet, the 24-h blood pressures were measured. A diagnosis of metabolic syndrome was made according to the International Diabetes Foundation definition Among the 56 patients with essential hypertension, 15 patients were complicated with metabolic syndrome while 41 patients were not. The nocturnal blood pressure fall was significant in patients without metabolic syndrome, while it was not so in patients with metabolic syndrome. Only in patients with metabolic syndrome was the nocturnal blood pressure fall enhanced by sodium restriction. The prevalence of sodium-sensitive hypertension in patients with metabolic syndrome was significantly higher than in those without metabolic syndrome (70.6 versus 36.0%, respectively; P = 0.017). A multiple logistic regression analysis revealed central obesity to be an independent risk factor for sodium-sensitive hypertension (odds ratio, 1.41; 95% confidence interval, 1.04-1.91). In patients with essential hypertension, an inter-relationship exists among metabolic syndrome, enhanced sodium sensitivity of the blood pressure and non-dipping. The elevated risk of cardiovascular diseases in patients with metabolic syndrome may be related to sodium-sensitive hypertension and non-dipping.