Primary Arterial Hypertension Research Articles

Novel Insights into the Pathobiology of Pulmonary Hypertension in Heart Failure with Preserved Ejection Fraction.

Heart failure (HF) with preserved ejection fraction (HFpEF) is the most common cause of pulmonary hypertension (PH) worldwide and is strongly associated with adverse clinical outcomes. The American Heart Association recently highlighted a call to action regarding the distinct lack of evidence-based treatments for PH due to poorly understood pathophysiology of PH attributable to HFpEF (PH-HFpEF). Prior studies have described cardio-physiological mechanisms to explain the development of isolated postcapillary PH (ipc-PH); however, the consequent increased pulmonary vascular (PV) resistance (PVR) may lead to the less understood and more fatal combined pre- and postcapillary PH (cpc-PH). Metabolic disease and inflammatory dysregulation have been suggested to predispose cpc-PH, yet the molecular mechanisms are unknown. Although PH-HFpEF has been studied to partly share vasoactive neurohormonal mediators with primary pulmonary arterial hypertension (PAH), clinical trials that have targeted these pathways have been unsuccessful. The increased mortality of PH-HFpEF patients necessitates further study into viable mechanistic targets involved in disease progression. We aim to summarize the current pathophysiological and clinical understanding of PH-HFpEF, highlight the role of known molecular mechanisms in the progression of PV disease, and introduce a novel concept that lipid metabolism may be attenuating and propagating PH-HFpEF.

Primary Arterial Hypertension Associated with Cognitive Dysfunction in Young Adults: Results from a Cross-Sectional Controlled Study.

Despite evidence of primary hypertension (PH)-associated cognitive dysfunction in pediatric, middle-aged, and older adult populations, respective data in young adults remains scarce. We aimed to define differences in cognitive performance between individuals with PH and healthy controls in early adulthood. A convenience sample of young adults (age 18-45 years) with PH and their healthy sex, age, education, and household income matched counterparts were cross-sectionally tested for verbal fluency, verbal memory, general intelligence, reaction speed, attention, visual memory, and executive functioning. Between-group differences were determined using Student's t and Mann-Whitney U tests. Sensitivity analysis was performed by adjusting for body mass index (BMI) in analysis of covariance (ANCOVA) and regression models. Thirty-three adults with PH (22, 66.7% male, median age 38.8, interquartile range (IQR) = 33.2-41.6 years) and twenty-two healthy controls (9, 40.9% male, median age 36.1, IQR = 27.5-39.8 years) completed the neuropsychological assessment. Participants with PH performed worse on computerized tasks of reaction time (median response time (Z = -2.019, p = 0.044), median time for release of response button (Z = -2.509, p = 0.012)) and sustained attention (signal detection measure, RVPA (t = 2.373, p = 0.021), false alarms ÷ (false alarms + correct rejections), RVPPFA (Z = -2.052, p = 0.040)). The group variable was not a statistically significant predictor of performance in these domains after adjustment for BMI (p > 0.05). In regression analyses, high office systolic blood pressure (oSBP) was independently associated with poor sustained attention (βSBP(st.) = -0.283, multiple R2 = 0.252 (RVPA), βSBP(st.) = 0.551, multiple R2 = 0.386 (RVPPFA)). Young adults with PH were found to perform worse in tasks of response speed and sustained attention. While the difference between neuropsychological evaluation results in PH and control groups was confounded by BMI, oSBP measures were independently related to sustained attention. The selectivity of PH-associated cognitive profile in young adults has to be confirmed in larger trials.

Overview and Outcomes of Patients Hospitalised with COVID-19 Pneumonia in Rīga East University Hospital

Abstract The COVID-19 pandemic is still a burden to the global health care system, affecting its capacity to maintain essential health services. Even though specific treatment and prevention options are available, the SARS-CoV-2 virus keeps accumulating mutations over time and challenging the efficiency of vaccines, causing new outbreaks and increasing hospitalisation. Early studies suggest that mortality from COVID-19 is increased by age and certain comorbidities. Thus, the goal of this study was to analyse patients hospitalised with COVID-19 pneumonia in terms of age, sex, and comorbidities. Additionally, the influence of treatment with Remdesivir and vaccination on hospitalisation duration and disease outcome was also analysed. The results showed that lethal disease outcome is mainly increased by age and gender, where older and male patients are at a higher risk. There were less deaths in patients with primary arterial hypertension. Other comorbidities did not have a statistically significant influence on disease outcome. Among those who survived, a higher number of patients had been treated with Remdesivir. Vaccination did not have an impact on disease outcome. It could be concluded that older and male patients are the risk group with a worse disease outcome. Treatment with Remdesivir shows a positive effect on disease outcome, although further detailed analysis is necessary.

Pediatric hypertension as an early manifestation of cardiovascular disease in children.

In adults, cardiovascular events associated with arterial hypertension (AH) have a major impact on morbidity and mortality. In light of recent findings, AH in children has been interpreted as early cardiovascular disease (CVD), while exposure to CV risk factors in children proves to be a predictor of subclinical CVD in adults. The American College of Cardiology/American Heart Association has recently updated the classifications for measuring blood pressure (BP) in adults and children. Primary AH in children is generally asymptomatic, and it is associated with a family history of AH, overweight/obesity, and normal morphofunctional characteristics of the urinary system. The younger the child and the higher the BP, the greater the likelihood of secondary AH. The investigation into the etiology of AH begins with a detailed anamnesis, which should include clinical information and details on the use of medication, smoking, and alcohol consumption from the perinatal period to the time of consultation. Modifying risk factors by reducing weight, decreasing alcohol consumption and increasing vegetable intake from childhood to adulthood has been associated with the resolution of AH in the childhood-adulthood transition, and with the reversal of cardiometabolic adverse effects in non-obese adult individuals. Pharmacological therapy should be initiated in cases of symptomatic AH, AH secondary to chronic kidney disease or diabetes mellitus, presence of target organ lesions, stage 2 AH with no modifiable cause and resistant AH unresponsive to lifestyle changes.

Comparative analysis of methods for evaluating myocardial hypertrophy in children with arterial hypertension

Relevance: over the past decades, the prevalence of arterial hypertension (AH) in the pediatric population has increased significantly, but there are still many open questions related to the diagnosis and course of the disease, the validity of the choice of antihypertensive therapy and the risks of target organ injury. In clinical practice, patients with hypertension are observed by a team of specialists of various profiles, and a unified approach to managing the disease is not always formed between them. Underestimation of risk factors, late detection of target organ injury and untimely start of antihypertensive therapy significantly increase the risks of an unfavorable, progressive course of the disease, aggravating the further prognosis. Strict adherence to the methods of diagnosing the disease and its potential consequences recommended by the professional community of pediatric cardiologists ensures an adequate initiation of drug therapy, which allows not only to control the course of hypertension, but also to prevent the development of long-term complications. Objective: to analyze the indicators obtained using the formula recommended by pediatric cardiologists compared to the routine method for detecting left ventricular myocardial remodeling in children with AH. Materials and methods: a cross-sectional, cohort, non-randomized study, which included 92 patients with newly diagnosed primary arterial hypertension, who were not receiving antihypertensive therapy at the time of the examination. The standard linear dimensions of the walls and cavities of the heart were assessed during echocardiography. The results were evaluated by the standard Fisher’s test, the xi2 test in the Statistica 9 software. The sample excluded children-athletes, patients with secondary hypertension, overweight, congenital heart disease and cardiomyopathy. All children were tested the same according to the current Federal Clinical Guidelines “Diagnosis and treatment of arterial hypertension in children and adolescents”. Results: the usage of the recommended formula is not only significantly more often allowed to identify the early stages of LV myocardial hypertrophy, but has great sensitivity. The routine method for calculating LV remodeling showed the norm much more often even in case of severe violation of the geometry of the heart. Conclusion: untimely detection of LV myocardial hypertrophy leads to late initiation of antihypertensive therapy, underestimation of risk factors, which increases the risk of an unfavorable course of the disease and the occurrence of long-term cardiovascular complications at a young age.

Lung transplantation in primary pulmonary arterial hypertension and pulmonary venous hypertension.

End-stage lung disease from primary pulmonary hypertension (PPHTN) and pulmonary venous-occlusive disease (PVOD) may require lung transplantation (LT). While medical therapies exist for the palliation of PPHTN, no therapies exist for PVOD. The study's objective is to compare outcomes of LT in these patients. Patients with PPHTN and PVOD who had undergone LT were identified in the UNOS database (2005-2022). Univariable analyses compared differences between groups in demographic, clinical, and post-transplant outcomes. Multivariable logistic regression examined the association between the diagnosis group and survival. Overall survival time between groups was compared using the Kaplan-Meier method. Six hundred and ninety-six PPHTN and 78 PVOD patients underwent LT during the study period. Patients with PVOD had lower pulmonary artery mean pressure (47vs. 53mmHg, p<.001), but higher cardiac output (4.51vs. 4.31 L/min, p=.04). PVOD patients were more likely to receive lungs from donation after cardiac death donors (7.7vs. 2.9%, p=.04). There were no differences in postoperative complications or length of stay. PVOD was associated with superior survival at 30-day (100vs. 93%, p=.02) and 90-day post-transplant (93vs. 83%, p=.03), but not at later time points. In multivariable analyses, PVOD and brain death donor use were associated with better survival up to 90-day mark. Patients undergoing LT for PVOD had better initial survival, which disappeared after 1 year of transplantation. Donation after circulatory death donor use had a short-term survival disadvantage.

MICROCIRCULATORY PREDICTORS OF THE FORMATION OF PRIMARY ARTERIAL HYPERTENSION IN CHILDHOOD

Introduction. The problem of early diagnosis of arterial hypertension in children is extremely urgent. According to some foreign scientists, the prevalence of this disease among school-age children in the world has been increasing over the past ten years. Children of prepubertal and pubertal age are most prone to the development of arterial hypertension, which is largely determined by vegetative dysfunctions and microcirculation disorders characteristic of these periods of childhood.It has been proven that changes in microcirculation are determined by the variant of arterial hypertension and are a fairly early marker of the degree of damage to target organs.The aim of the study is to study microcirculatory predictors of the formation of primary arterial hypertension in childhood.Material and methods.113 school-age children from the residents of Chernivtsi region and Chernivtsi were examined. The examined children were divided into two groups: the main group consisted of 30 children with arterial hypertension and the control group - 83 children with a normal level of blood pressure.Blood pressure was measured with automatic pressure gauge with removable cuffs, in the morning on both arms, three times with an interval of 2 minutes. Results were evaluated according to percentile tables for age, sex, and height.The recommendations of the American Academy of Pediatrics (AAR) were used to diagnose hypertension in children.Capillaroscopic examination of the nail bed was used to assess the state of peripheral microcirculation in the examined children. Quantitative and qualitative parameters of microcirculation were evaluated.The research was carried out in compliance with the "Rules of Ethical Principles of Conducting Scientific Medical Research with Human Participation" approved by the Declaration of Helsinki (1964-2013), ICH GCP (1996), EU Directive No. 609 (from 24.11.1986), orders of the Ministry of Health of Ukraine No. 690 from 23.09.2009, No. 944 from 14.12.2009, No. 616 from 03.08.2012.Statistical processing of the data was performed using nonparametric methods of evaluation. Mathematical processing of the data was performed using Microsoft Office Excel and Statistica 10.0.The work was performed within the framework of the planned research work of the Department of Pediatrics, Neonatology and Perinatal Medicine of Bukovinian State Medical University: Chronobiological and adaptation aspects and features of autonomic regulation in pathological conditions in children of different age groups, (№ 0122U002245, term of execution 2022 - 2026).Results. When comparing the quantitative capillaroscopic indicators of the nail bed between the groups, it was found that the children from the main group showed probable differences in individual indicators (reduced linear density, greater distance between capillaries, 2 times less number of anastomoses, change in the shape of capillaries) compared to the control group, which indicates on changes in peripheral microcirculation in children with elevated blood pressure.After conducting a correlation analysis of the obtained data, we found correlations between changes in the microcirculation of the nail bed and indicators of the functional state of the cardiovascular system in the form of changes in the linear density of capillaries and the distance between them, the presence of increased tortuosity of capillaries and "sweetening". Thus, the linear density of capillaries had high correlations with the level of systolic blood pressure (r=0.73, p&lt;0.05) and the level of diastolic blood pressure (r=0.69, p&lt;0.05).When conducting a multifactorial analysis, a clear relationship between changes in the indicators of the state of the cardiovascular system, on the one hand, and the capillaries of the nail bed, on the other, can be traced.Conclusions. 1. Microcirculatory disorders in the capillaries of the nail bed reflect the changes in central hemodynamics and may be early signs of arterial hypertension in children.2. According to the results of the epidemiological analysis, the presence of predictors of the development of primary arterial hypertension in children was established. These factors are a reduced number of capillaries per unit area (OR = 2.54; RR = 2.12; 95% CI 2.06-4.98) and their pathological tortuosity (OR = 1.75; RR = 1.44; 95% CI 1.18-2.63).

Interest of renal scintigraphy with captopril in the diagnosis of renovascular arterial hypertension

Introduction: Renal scintigraphy with captopril test of the kidney is a simple, non-invasive functional imaging technique that can be used to demonstrate the role of stenosis in the development of renovascular hypertension (RVH). It also makes it possible to distinguish renal artery stenosis responsible for RVH from stenosis associated with primary arterial hypertension. Objective: To illustrate the benefits of renal scintigraphy with captopril test in the diagnosis of RVH. Material and method: This was a prospective and descriptive study over a period of 12 months, from 1 March 2016 to 4 March 2017, carried out in the nuclear medicine department of the Institut des Radio Isotopes (IRI) in Niamey. The parameters studied were age, frequency, creatinemia, tracer used, relative perfusion, relative renal function and maximum uptake time. Results: We collected 6 cases presenting with either hypertension refractory to well-administered two- or three- therapy, or severe hypertension at the complication stage, or hypertension associated with hypokalaemia or unexplained renal failure or reversible renal failure induced by a conversion enzyme inhibitor. The mean age was 35 years. The age of diagnosis of hypertension ranged from 20 to 28 years. Four patients underwent echodoppler of the renal arteries: unilateral stenosis in patients A, C and F, and bilateral stenosis in patient D. The captopril test was positive in 3 cases, patients A, B and C. Conclusion: Dynamic renal scintigraphy with captopril testing is a non-invasive, low-radiation diagnostic method for the investigation of renovascular hypertension. It has a triple benefit, including the detection of the most severe arterial stenoses, the prediction of the curability of the stenosis by a revascularisation procedure and, finally, post-treatment follow-up.

ENPP1 homozygous stop-loss variant causing generalized arterial calcifications of infancy: About a severe neonatal clinical case

Generalized Arterial Calcifications of Infancy (GACI) is an extremely rare autosomal recessive genetic condition, mostly due to pathogenic variations in the ENPP1 gene (GACI1, MIM #208000, ENPP1, MIM #173335). To date 46 likely pathogenic or pathogenic distinct variations in ENPP1 have been described, including nonsense, frameshift, missense, splicing variations, and large deletions. Here we report a case of GACI in a male newborn with a homozygous stop-loss variant in ENPP1 treated in Nancy Regional University Maternity Hospital. Based on proband main clinical signs, clinical exome sequencing was performed and showed a deletion of one nucleotide leading to frameshift and stop-loss (NM_006208.3 (ENPP1):c.2746del,p.(Thr916Hisfs*23)). Clinical presentation is characterized by primary neonatal arterial hypertension resulting in hypertrophic cardiomyopathy decompensated by three cardiogenic shocks and a neonatal deep right sylvian stroke. The child died at 24 days of life.This is the first report of a pathogenic stop-loss variant in ENPP1. It is an opportunity to remind clinicians of GACI disease, a rare and severe etiology in neonates with severe hypertension, and possibility of bisphosphonates therapy.

Working conditions and the prevalence of chronic non-communicable diseases among workers in the production of polyacrylonitrile fibers

Introduction. Ensuring safe working conditions and preventing health problems in the workplace is a priority measure for maintaining health and extending the working life of the working population.&#x0D; Materials and methods. The working conditions and chronic non-infectious morbidity (primary, accumulated) of workers in the production of polyacrylonitrile (PAN) fibers were studied according to the data of in-depth medical examinations (2017–2021).&#x0D; Results. Workers of modern production of PAN fibers in the course of their work were shown to be exposed to the combined effects of a complex of chemicals of 1–4 hazard classes, industrial noise, severity and labour intensity, which form an occupational health risk, assessed by hygienic criteria in categories from small (class 3.1) to high (class 3.3). The first ranking places in the nosological structure of accumulated chronic non-infectious morbidity of workers were occupied by dorsalgia (24.23%), essential (primary) arterial hypertension (14.67%), obesity (9.9%) and presbyopia (8.87%). Positive associations of weak age strength with arterial hypertension, obesity, and presbyopia were revealed (Rxy=0.280, Rxy=0.121, Rxy=0.133, respectively). Work experience had a weak positive relationship with the prevalence of presbyopia (Rxy=0.239). A causal relationship was established between a moderate degree of diseases of the musculoskeletal system and connective tissue (dorsalgia, the severity of the labour process (RR=1.893; EF=47.183%; CI=1.192–3.007), a relationship between a small degree of diseases of the eye and its adnexa with exposure acrylonitrile and methyl acrylate (RR=1.46; EF=31.522%; CI=1.970–1.082), which made it possible to attribute these pathologies to work-related diseases.&#x0D; Limitations determined by the study of the subject of research in the production of polyacrylonitrile fibers of one enterprise.&#x0D; Conclusion. Despite the modernization that has taken place in the chemical industry, working conditions in the modern production of PAN fibers continue to be harmful, presenting an occupational risk for the development of chronic non-communicable diseases in workers, which determines the relevance of developing evidence-based measures for their prevention.

#3560 STATIN THERAPY IN CHRONIC KIDNEY DISEASE PATIENTS UNDERGOING HAEMODIALYSIS

Abstract Background and Aims In 2017, around 4 million people with end-stage renal disease worldwide were on renal replacement therapy. Haemodialysis is accounted as the most common therapy, accounting for 69% of all renal replacement therapies and 89% of all dialysis. Patients receiving haemodialysis present significantly higher risk for cardiovascular events which affect more than two-thirds of patients, making it the primary cause of morbidity (Bello et al., 2022). Statin therapy is used as primary prevention of cardiovascular risk amongst the general population; nonetheless, in patients with chronic kidney disease the benefits of statins are controversial (Fellström et al., 2009). The aim of this study is to analyze data of statins use in patients from different Latvian haemodialysis centers. Method A cross-sectional observational study included consecutive patients from four haemodialysis centers from June till October 2022. Patients were interviewed about disease anamnesis, comorbidities, statins and other drug use. Data was analyzed with SPSS statistics. Results Among 113 included patients, 64.6% were man, mean age was 62.8±14.9 years, mean body-mass index was 26.66± 5.3 kg/m². Current smokers were 14.2%. Most common primary cause for hemodialysis (47.2%) was glomerular diseases. Comorbidities as primary arterial hypertension and diabetes were diagnosed in 39.8% and 17.7% of patients, respectively. History of arterial vascular disease was present in 47 (41.6%) patients, 26 (23%) patients underwent revascularization. Anamnesis of kidney transplantation was present in 17.7%. Mean plasma concentration for total cholesterol, LDL cholesterol and triglycerides were 4.4±1.3 mmol/L, 2.5±1.1 mmol/L and 1.7±1.3 mmol/L, respectively. Mean haemodyalisis period was 51.88 months and mean statin use period was 73.3 months. Statins were used in 60 (53.1%) patients, majority of them (68.3%) were using atorvastatin and 19 (31.7%) patients were using rosuvastatin. The most common type and dosage was atorvastatin 20 mg in 21 (35%) patient, following by atorvastatin 40mg in 9 (15%) and rosuvastatin 20mg in 9 (15%) patients. Majority of statin users (49.2%) had unknown therapy starting date regarding haemodialysis, while 31.7% of patients were using statins before haemodialysis and only 19% of patients started statin therapy while undergoing haemodialysis. Patients who had transplantation were associated with 2.4 times increased usage of statins (P = .09). No significant lipid concentration difference was observed between patients who underwent transplantation and those who did not (p&amp;gt;0.05). LDL concentration with and without statin use was 1.97 and 2.73 (P = .03), respectively. Patients with history of cardiovascular events had 8.4 times higher probability of using statins than patients without cardiovascular events (p&amp;lt;0.001, Cl 3.47-20.53) and 10.3 times higher probability of using statins after revascularization than patients without revascularization (p&amp;lt;0.001, Cl 2.98-37.11). Conclusion Statin therapy was related to history of cardiovascular events and revascularization, as well expressing significantly lower LDL concentration, that might be beneficial in secondary prophylaxis. History of transplantation was associated with increased statin administration.

A 48-year-old female with chronic, progressive bilateral vision loss and dyspnea.

To describe a unique case of isolated, bilateral serous retinal detachments associated with primary pulmonary arterial hypertension. Case report. A 48-year-old woman with primary pulmonary arterial hypertension presented with bilateral vision loss. She was found to have bilateral serous retinal detachments in the macula with accumulation of the fibrinous material. Optical coherence tomography demonstrated intraretinal and subretinal fluid, hyperreflective material in the subretinal space, and choroidal engorgement. Fluorescein angiography demonstrated pooling in the maculas, an area of blockage corresponding with the area of subretinal exudative material, and a petalloid pattern of leakage in the maculas without evidence of retinal vascular leakage. Her ocular symptoms improved with aggressive medical management of her pulmonary arterial hypertension with the addition of eplerenone. Primary pulmonary arterial hypertension results in chronically elevated systemic venous pressure, leading to both systemic and ocular symptoms. It is important to consider this systemic condition in the differential diagnosis of serous retinal detachments to provide adequate multidisciplinary management.

Hypotensive Effect of Electric Stimulation of Caudal Ventrolateral Medulla in Freely Moving Rats.

Background and Objectives: An altered sympathetic function is established in primary arterial hypertension (PAH) development. Therefore, PAH could be targeted by applying an electric current to the medulla where reflex centers for blood pressure control reside. This study aims to evaluate the electric caudal ventrolateral medulla (CVLM) stimulation effect on blood pressure and animal survivability in a freely moving rat model. Materials and Methods: A total of 20 Wistar rats aged 12-16 weeks were randomly assigned to either: the experimental group (n = 10; electrode tip implanted in CVLM region) or the control group (n = 10; tip implanted 4 mm above the CVLM in the cerebellum). After a period of recovery (4 days), an experimental phase ensued, divided into an "OFF stimulation" period (5-7 days post-surgery) and an "ON stimulation" period (8-14 days post-surgery). Results: Three animals (15%, one in the control, two in the experimental group) dropped out due to postoperative complications. Arterial pressure in the experimental group rats during the "OFF stimulation" period decreased by 8.23 mm Hg (p = 0.001) and heart rate by 26.93 beats/min (p = 0.008). Conclusions: From a physiological perspective, CVLM could be an effective deep brain stimulation (DBS) target for drug-resistant hypertension: able to influence the baroreflex arc directly, having no known direct integrative or neuroendocrine function. Targeting the baroreflex regulatory center, but not its sensory or effector parts, could lead to a more predictable effect and stability of the control system. Although targeting neural centers in the medullary region is considered dangerous and prone to complications, it could open a new vista for deep brain stimulation therapy. A possible change in electrode design would be required to apply CVLM DBS in clinical trials in the future.

Clinical outcomes in patients with primary arterial hypertension and basal septal hypertrophy after 7 years of follow-up

Clinical outcomes in patients with primary arterial hypertension and basal septal hypertrophy after 7 years of follow-up

Diagnostics, monitoring and treatment of arterial hypertension in children

The review presents material on the current relevance of AH in children. The prevalence of AH in overweight and obese children aged 6-18 years is 27–47 %, while secondary arterial hypertension remains dominant, especially in children younger than 5 years. AH is a major risk factor for atherosclerosis and cardiovascular disease in adults. The onset of these diseases may occur in childhood or adolescence. The use of modern methods to monitor and control BP is crucial for improving the management of AH and preventing damage to target organs. Twenty-four-hour BP measurements are an important tool in determining the prognosis and treatment of children with AH. AH in children can be classified as primary or essential if there is no identifiable cause, or as secondary AH when it arises from a specific cause. The incidence of primary arterial hypertension increases with age, whereas secondary arterial hypertension predominates in early childhood. The secondary causes of AH also depend on the age of the patient. Thus 34-79 % of patients with secondary forms of arterial hypertension have renal parenchymal disease and impaired renal structure. Signs of AH include headache, visual disturbances, dizziness and nosebleeds. Dyspnoea on exercise, facial paralysis and seizures indicate target organ damage. In children with obesity, diabetes, renal insufficiency, aortic coarctation/repaired coarctation and those receiving medication causing AH, BP should be measured at every visit to the physician. Therapeutic lifestyle changes are an early therapy in the treatment of AH in children. IAPs, BCAAs, BRAs and thiazide diuretics are the most effective drugs for AH in children.

Hypertensive retinopathy: a literature review

Enrika Mačiulaitytė1, Raminta Oleškevičiūtė1, Daiva Emilija Rekienė2 1Lithuanian University of Health Sciences, Faculty of Medicine, Kaunas, Lithuania 2Lithuanian University of Health Sciences, Department of Internal Medicine, Kaunas, Lithuania Abstract Introduction: Hypertensive retinopathy is a disease that is described as a disorder of the retinal blood vessels, caused by poorly controlled primary or secondary arterial hypertension. People who are diagnosed with this condition tend to have prolonged hypertension, have relatives with the same diagnosis and are smokers. A third of the population in Lithuania has hypertension, so it is important to be aware of the complications. Aim: to review diagnostics, treatment, and prognosis of hypertensive retinopathy. Methodology: the literature used for this review was selected using “Google Scholar” and “Pubmed” databases. Following dates from 2012 to 2022, using keywords “hypertensive retinopathy”, “hypertension”, and “eye diseases”. More than 20 publications on hypertensive retinopathy were analysed. Results. Fundoscopic exam along with previously diagnosed arterial hypertension remains the most important method for diagnosing hypertensive retinopathy. Clinical findings are not significant for diagnosis, whereas optical coherence tomography has the potential to detect and diagnose the disease. The aim of treating hypertensive retinopathy is to lower blood pressure to achieve blood pressure values below 120 – 130/80. Angiotensin – converting enzyme (ACE) inhibitors are the first – line medications for treating this disease. Conclusions. Hypertensive retinopathy is usually diagnosed during fundoscopic examination when the patient has already been diagnosed with hypertension. Mitchell–Wong classification is used to evaluate the severity of the disease. The main method of management of hypertensive retinopathy is achieving targeted blood pressure with medications. In most cases the prognosis of hypertensive retinopathy is good if blood pressure is well controlled. Keywords: hypertensive retinopathy, hypertension, eye diseases. Full article https://doi.org/10.53453/ms.2023.2.11

Hypertension Induces Pro-arrhythmic Cardiac Connexome Disorders: Protective Effects of Treatment.

Prolonged population aging and unhealthy lifestyles contribute to the progressive prevalence of arterial hypertension. This is accompanied by low-grade inflammation and over time results in heart dysfunction and failure. Hypertension-induced myocardial structural and ion channel remodeling facilitates the development of both atrial and ventricular fibrillation, and these increase the risk of stroke and sudden death. Herein, we elucidate hypertension-induced impairment of "connexome" cardiomyocyte junctions. This complex ensures cell-to-cell adhesion and coupling for electrical and molecular signal propagation. Connexome dysfunction can be a key factor in promoting the occurrence of both cardiac arrhythmias and heart failure. However, the available literature indicates that arterial hypertension treatment can hamper myocardial structural remodeling, hypertrophy and/or fibrosis, and preserve connexome function. This suggests the pleiotropic effects of antihypertensive agents, including anti-inflammatory. Therefore, further research is required to identify specific molecular targets and pathways that will protect connexomes, and it is also necessary to develop new approaches to maintain heart function in patients suffering from primary or pulmonary arterial hypertension.

Association Between 25(OH)D Levels and Primary Arterial Hypertension

Abstract This study seeks to determine whether patients from a family physician’s practice have an association between 25(OH)D levels and primary arterial hypertension (AH). The study included a total of 1068 patients who were tested for vitamin D status. Data from their outpatient medical records were analysed: sex, age, body mass index, glomerular filtration rate, and the history of AH. Primary arterial hypertension was diagnosed in 63% of the patients. The mean vitamin D level in the study population was 25 ng/ml, and the largest group, or 36%, was found to have vitamin D deficiency (20–29 ng/ml). Odds ratio (OR) for hypertension was not inversely correlated with higher vitamin D levels. No statistically significant increase was observed in OR in a multi-factor analysis. The relevant hypertension ORs were 1.8 (0.4–7.5), 1.1 (0.3–4.5), 1.7 (0.4–7.2) and 0.7 (0.1–4.8) 30 ng/ml to 45 ng/ml, 20 to 29 ng/ml, 10 to 19 ng/ml, and &lt; 10 ng/ml compared to the group of ³ 45 ng/ml. No association was found between 25(OH)D levels and the primary arterial hypertension in study participants.

HSP70 and Primary Arterial Hypertension.

Heat shock protein 70 (HSP70) production is a stress-generated cellular response with high interspecies homology. HSP70 has both chaperone and cytokine functions and may induce, depending on the context, tolerogenic anti-inflammatory reactivity or immunogenic and autoimmune reactivity. Intracellular (chaperoning transit of antigens to MHC in antigen-presenting cells) and extracellular HSP70-related effects are associated with hypertension, which is an inflammatory condition recognized as the most important risk factor for cardiovascular disease mortality. Here, we review (a) the relationship between HSP70, inflammation and immune reactivity, (b) clinical evidence relating to stress, HSP70 and anti-HSP70 reactivity with primary hypertension and (c) experimental data showing that salt-sensitive hypertension is associated with delayed hypersensitivity to HSP70. This is a consequence of anti-HSP70 reactivity in the kidneys and may be prevented and corrected by the T-cell-driven inhibition of kidney inflammation triggered by specific epitopes of HSP70. Finally, we discuss our postulate that lifelong stress signals and danger-associated molecular patterns stimulate HSP-70 and individual genetic and epigenetic characteristics determine whether the HSP70 response would drive inflammatory immune reactivity causing hypertension or, alternatively, would drive immunomodulatory responses that protect against hypertension.

Primary Arterial Hypertension and Drug-Induced Hypertension in Philadelphia-Negative Classical Myeloproliferative Neoplasms: A Systematic Review

The impact of primary arterial hypertension (HTN) in myeloproliferative neoplasms (MPNs) remains unclear, with scant literature available, mostly focusing on cardiovascular risk factors as a singular entity or on organ-specific HTN. Furthermore, available studies reporting findings on drug-induced HTN in MPNs report varying and contradictory findings. In consideration of the above, this study set out to systematically review the available literature and shed light on the occurrence of HTN in MPNs, its association with thrombosis, as well as the drugs used in MPN management that could increase blood pressure. The literature search yielded 598 potentially relevant records of which 315 remained after the duplicates (n = 283) were removed. After we screened the titles and the abstracts of these publications, we removed irrelevant papers (n = 228) and evaluated the full texts of 87 papers. Furthermore, 13 records did not meet the inclusion criteria and were excluded from the systematic review. Finally, a total of 74 manuscripts were entered into the qualitative synthesis and included in the present systematic review. Our systematic review highlights that HTN is the most common comorbidity encountered in MPNs, with an impact on both the occurrence of thrombosis and survival. Moreover, drug-induced HTN remains a challenge in the management of MPNs. Further research should investigate the characteristics of patients with MPNs and HTN, as well as clarify the contribution of HTN to the development of thrombotic complications, survival and management in MPNs. In addition, the relationship between clonal hematopoiesis of indeterminate potential, HTN, cardiovascular disease and MPNs requires examination in upcoming assessments.