Treatment Of Systemic Hypertension Research Articles

Study of changes in serum lipid profile and blood sugar level by perindopril and telmisartan during treatment of systemic hypertension

Background: This study was designed to compare adverse effects on serum lipid profile and blood sugar level in the treatment with two commonly used drugs perindopril and telmisartan in cases of hypertension. This was an “observational” and “cross-sectional” study. Methods: A total of 100 patients were included in each, Groups A and B. In both groups, half the patients were given perindopril 4 mg OD and half were given telmisartan 40 mg OD for 24 weeks. Total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), triglycerides (TG), fasting blood sugar (FBS), and postprandial blood sugar (PPBS) level was estimated initially and then at 4 th , 12 th , and 24 th week. Statistical analysis was done using ANOVA. Results: With perindopril initial means of TC, HDL, LDL, TGs, FBS, and PPBS in Groups A and B were 190.32, 49.76, 117.96, 165.04, 84.56, 122.60, and 188.80, 51.64, 118.52, 159.12, 93.92, 133.60, respectively. After 24 weeks, these values were 190.84, 50.68, 118.60, 163.84, 83.48, 120.20, and 190.96, 52.04, 118.28, 157.56, 93.96, 133.68, respectively (p > 0.05). With telmisartan, initial means of TC, HDL, LDL, TG, FBS, and PPBS in both groups were 188.08, 49.76, 118.84, 167.20, 83.72, 120.68, and 188.08, 46.88, 121.96, 167.84, 91.44, 131.72, respectively. After 24 weeks, these values in both groups were 189.36, 49.80, 120.04, 165.96, 82.60, 118.36 and 186.12, 45.28, 121.08, 167.72, 92.76, 129.56 respectively (p > 0.05). Conclusions: It concluded that both perindopril and telmisartan had not any significant adverse effects on plasma lipid profile and blood sugar level in both groups.

Consensus Recommendations for Standard Therapy of Glomerular Disease in Dogs

Standard therapy forms the basic foundation for care of dogs with glomerular disease, as it is herein recommended for use in all affected animals regardless of causation of the disease. Consensus recommendations target the evaluation and management of proteinuria, inhibition of the renin-angiotensin-aldosterone system, modification in dietary intake with special consideration for those nutrients with renal effects, diagnosis and treatment of systemic hypertension, and evaluation and management of body fluid volume status in dogs with glomerular disease.

Renal Sympathetic Denervation for the Treatment of Systemic Hypertension

Systemic hypertension is a common cardiovascular problem that often cannot be fully treated with existing nonpharmacologic and pharmacologic measures. A catheter-based strategy which denervates the renal afferent and efferent autonomic nervous system has been developed for the treatment of drug-resistant hypertension. In early clinical trials, this procedure was shown to be both feasible and safe in reducing blood pressure in patients with uncontrolled hypertension receiving treatment with a minimum of 3 antihypertensive drugs. In addition, this procedure has been associated with decreased renin secretion, preservation of renal function, improved glucose tolerance, and a reduction in left ventricular hypertrophy. The long-term effects of this procedure (beyond 3 years) still need to be determined. A large 530-patient sham-controlled trial is now in progress.

Adherence to the treatment of diabetes mellitus and systemic arterial hypertension: a focus on gender relations

ABSTRACTObjectives: to analyze through testimonies of participants the knowledge on diabetes mellitus (DM) and systemic arterial hypertension (SAH), measures to prevent complications, and treatment; to identify the adherence to treatment among men and women; and to compare the adherence to treatment among the genders. Method: this is an exploratory study with qualitative analysis, using for data collection the method of focal group, after the approval by the Ethics Committee of Hospital Universitario of Universidade Federal de Juiz de Fora, Minas Gerais, Brazil, under the Protocol 134/09. Results: it became evident that women have a better knowledge on DM and SAH, besides their risk factors, complications, and adherence to the therapeutic schemes proposed. By their turn, most men proved to be adherent to the practice of physical activities, unlike women, who are not adherent to it due to complications of DM and SAH or other diseases. Conclusion: although men practice physical activities, they have a great difficulty to adhere to the therapeutic schemes proposed in the treatment. To improve the adherence to treatment the interdisciplinary team work is essential, in order to meet, in an integral way, the basic needs of the users of health services. Descriptors: hypertension; diabetes mellitus; gender identity; nursing; combined therapy.RESUMOObjetivos: analisar pelos depoimentos dos participantes os conhecimentos do diabetes mellitus (DM) e da hipertensão arterial sistêmica (HAS), as medidas de prevenção das complicações e tratamento; identificar a adesão ao tratamento entre homens e mulheres; e comparar a adesão ao tratamento a partir dos gêneros. Método: trata-se de um estudo exploratório com análise qualitativa, utilizando-se para a coleta dos dados o método de grupo focal, após aprovação pelo Comitê de Ética do Hospital Universitário da Universidade Federal de Juiz de Fora/MG, sob o Protocolo n. 134/09. Resultados: ficou evidenciado que as mulheres possuem mais conhecimento sobre o DM e a HAS, além de seus fatores de risco, complicações e aderência aos esquemas terapêuticos propostos. Por outro lado, a maioria dos homens mostrou-se aderente à prática de atividades, ao contrário das mulheres, que não são aderentes por conta de complicações do DM e HAS ou outras doenças. Conclusão: apesar de os homens praticarem atividades físicas, eles têm muita dificuldade em aderir aos esquemas terapêuticos propostos no tratamento de saúde. Para melhorar a adesão ao tratamento é essencial o trabalho em equipe interdisciplinar, de modo a atender, de forma integral, as necessidades básicas dos usuários dos serviços de saúde. Descritores: hipertensão; diabetes mellitus; identidade de gênero; enfermagem; terapia combinada.RESUMENObjetivos: analizar por medio de los testimonios de los participantes el conocimiento acerca del diabetes mellitus (DM) y de la hipertensión arterial sistémica (HAS), las medidas de prevención de las complicaciones y tratamiento; identificar la adhesión al tratamiento entre hombres y mujeres; y comparar la adhesión al tratamiento por medio de los géneros. Método: esto es un estudio exploratorio con análisis cualitativo, utilizando para recogida de datos el método del grupo focal, después de la aprobación por el Comité de Ética del Hospital Universitário de la Universidade Federal de Juiz de Fora, Minas Gerais, Brasil, bajo el Protocolo 134/09. Resultados: quedó evidente que las mujeres tenen un mejor conocimiento acerca de DM y HAS, además de sus factores de riesgo, complicaciones y adhesión a los esquemas terapéuticos propuestos. Por otro lado, la mayoría de los hombres se mostró adherente a la práctica de actividades, al contrario de las mujeres, que no son adherentes por las complicaciones de DM y HAS o otras enfermedades. Conclusión: a pesar de los hombres practicaren actividades físicas, ellos tienen mucha dificultad para adherir a los esquemas terapéuticos propuestos en el tratamiento. Para mejorar la adhesión al tratamiento es esencial el trabajo en equipo interdisciplinario, para atender, de manera integral, las necesidades básicas de los usuarios de los servicios de salud. Descriptores: hipertensión; diabetes mellitus; identidad de género; enfermería; terapia combinada.

Amlodipine-Induced Gingival Hyperplasia in a Great Dane

A 3 yr old, 70 kg (154 lbs) female spayed Great Dane developed gingival hyperplasia after treatment of systemic hypertension with amlodipine 7.5 mg q 12 hr for 16 mo. Physical examination was unremarkable except for systemic hypertension and severe gingival hyperplasia. Amlodipine was replaced with hydralazine (0.72 mg/kg [0.32 mg/lb]). Nine months later, gingival hyperplasia was nearly resolved and hypertension was well controlled. Calcium channel blockers such as amlodipine are a rare cause of gingival hyperplasia in the canine patient. Recognition of this side effect is important because a full recovery can be achieved when the offending agent is removed.

Feline systemic hypertension: Classification and pathogenesis

the increased availability of indirect blood pressure monitoring devices in clinical practice over the past decade has highlighted the significance of systemic hypertension in the feline population. Without routine monitoring and appropriate intervention, cats with undiagnosed systemic hypertension may first be presented with sudden-onset blindness as a consequence of either hyphaema or retinal detachment. the primary aim in the early diagnosis and treatment of systemic hypertension is prevention of hypertensive target organ damage (with respect to the eye, kidney, cardiovascular and central nervous systems, in particular). A prerequisite is a knowledge of the pathophysiological mechanisms and disease conditions that may contribute to the development of hypertension. This allows the clinician to determine those cases in which blood pressure assessment and longitudinal monitoring is essential and can assist in determining appropriate therapeutic strategies for control of blood pressure. Recent studies have also begun to explore the relationship that systemic hypertension may have with proteinuria and the progression of kidney disease. the geriatric cat appears most susceptible to the development of systemic hypertension, and monitoring of systolic blood pressure is often advocated as part of a routine health screen in cats over 9-12 years old. Consideration must also be given to cats suspected of having an underlying disease such as chronic kidney disease or hyperthyroidism, or which are receiving therapeutic agents, irrespective of their age. much of our understanding of the pathogenesis of feline hypertension is extrapolated from studies performed in experimental animal models or in human patients, and interspecies differences are often poorly understood.

Continuous positive airway pressure as treatment for systemic hypertension in people with obstructive sleep apnoea: randomised controlled trial

Objective To assess the effect of continuous positive airway pressure (CPAP) on 24 hour ambulatory blood pressure monitoring values in a large number of patients with untreated systemic hypertension of...

Hypertensive optic neuropathy and choroidopathy in an 18-year-old woman with renal failure.

To describe hypertensive optic neuropathy and choroidopathy caused by renal failure in an 18-year-old woman. The clinical and angiographic findings of a young patient with hypertensive optic neuropathy and choroidopathy caused by hypertensive emergency secondary to renal failure are described. The patient's visual acuity, bilateral optic nerve swelling, and macular edema improved with blood pressure control. Several small areas of exudative retinal detachment remain. Accelerated or malignant hypertension is a common cause of bilateral optic nerve swelling and exudative retinal detachments. Treatment of systemic hypertension is essential in reversing the ocular manifestations of the condition.

Treatment of systemic hypertension in children and adolescents

This review aims to update the practitioner in recent developments in the treatment of hypertension in children and adolescents. In the last years, the treatment of hypertension in children and adolescents has been characterized by an improvement in the definition of hypertension and the more widespread use of the 24-h blood pressure monitor to define the hypertension pattern and assess efficacy of the therapy. A few studies on the use of converting enzyme inhibitors and angiotensin II receptor blocker emphasizing doses, efficacy, and side effects have been published. Of special interest is the tantalizing hypothesis on the role of uric acid in essential hypertension and the practical application of the use of allopurinol as monotherapy for this condition. The authors aim to convey the need to define the blood pressure pattern in these patients before any type of therapy is started and the titration of medications according to the pathophysiologic mechanisms involved.

Endothelin as a Clinical Target in the Treatment of Systemic Hypertension

Endothelin is a potent vasoconstrictor substance that also can exert proliferative, inflammatory, and fibrotic changes in blood vessels and other organs. It acts on tissues in a paracrine and autocrine fashion, with local production and regulation occurring in both endothelial and nonendothelial cells. Endothelin stimulation of ETA and ETB receptors results in different and often opposing effects, which under physiologic conditions, establishes a balance that contributes to the regulation of vascular tone and blood pressure. Dysregulation of the endothelin system can induce or mediate endothelial dysfunction and organ damage in systemic hypertension (HTN), effects which may be ameliorated by endothelin antagonists. Endothelin receptor antagonists are currently being used in the treatment of pulmonary HTN. Both selective and dual-acting endothelin receptor blockers can also reduce systemic blood pressure in animal models and in hypertensive patients. Clinical trials evaluating the efficacy and safety of these agents are underway, and show potential as a new class of antihypertensives. Studies are also in progress with a single moiety dual angiotensin-endothelin A receptor antagonist, which is being evaluated in HTN. Issues that need to be addressed include the net contribution of endothelin in the pathophysiology of HTN, its interaction with other neurohormonal systems such as the renin-angiotensin-aldosterone system, and the clinical demonstration of the effect of endothelin receptor antagonism on end-organ damage in hypertensive patients.

Adrenergic Polymorphism and the Human Stress Response

Tyrosine hydroxylase (TH) is the rate-limiting enzyme in catecholamine biosynthesis. Does common genetic variation at human TH alter autonomic activity and predispose to cardiovascular disease? We undertook systematic polymorphism discovery at the TH locus, and then tested variants for contributions to sympathetic function and blood pressure. We resequenced 80 ethnically diverse individuals across the TH locus. One hundred seventy-two twin pairs were evaluated for sympathetic traits, including catecholamine production and environmental (cold) stress responses. To evaluate hypertension, we genotyped subjects selected from the most extreme diastolic blood pressure percentiles in the population. Human TH promoter haplotype/reporter plasmids were transfected into chromaffin cells. Forty-nine single nucleotide polymorphisms (SNPs) and one tetranucleotide repeat were discovered, but coding region polymorphism did not account for common phenotypic variation. A block of linkage disequilibrium spanned four common variants in the proximal promoter. Catecholamine secretory traits were significantly heritable, as were stress-induced blood pressure changes. In the TH promoter, significant associations were found for urinary catecholamine excretion, as well as blood pressure response to stress. TH promoter haplotype #2 (TGGG) showed pleiotropy, increasing both norepinephrine excretion and blood pressure during stress. In hypertension, a case-control study (1266 subjects, 53% women) established the effect of C-824T in determination of blood pressure. We conclude that human catecholamine secretory traits are heritable, displaying joint genetic determination (pleiotropy) with autonomic activity and finally with blood pressure in the population. Catecholamine secretion is influenced by genetic variation in the adrenergic pathway encoding catecholamine synthesis, especially at the classically rate-limiting step, TH. The results suggest novel pathophysiological links between a key adrenergic locus, catecholamine metabolism, and blood pressure, and suggest new strategies to approach the mechanism, diagnosis, and treatment of systemic hypertension.

Plasma Asymmetric Dimethylarginine, Symmetric Dimethylarginine, l‐Arginine, and Nitrite/Nitrate Concentrations in Cats with Chronic Kidney Disease and Hypertension

Chronic kidney disease (CKD) and hypertension have been associated with decreased bioavailability of nitric oxide (NO) and endothelial dysfunction. Increased concentrations of the endothelial nitric oxide synthase (eNOS) inhibitor asymmetric dimethylarginine (ADMA) are implicated. Plasma ADMA concentration is increased in cats with CKD and systemic hypertension corresponding to a decrease in total plasma nitrate/nitrite (NOx) availability. Decrease in systolic blood pressure (SBP) and proteinuria during treatment of hypertension with amlodipine besylate may be associated with increased NOx availability. Sixty-nine client-owned normotensive and hypertensive cats with variable azotemia. Plasma ADMA, symmetric dimethylarginine (SDMA), and l-arginine were measured simultaneously by hydrophilic-interaction liquid chromatography-electrospray tandem mass spectrometry in cats from 6 groups: normotensive nonazotemic (n = 10), normotensive mildly azotemic (n = 10), hypertensive mildly azotemic with hypertensive retinopathy (n = 20), hypertensive mildly azotemic without hypertensive retinopathy (n = 10), normotensive moderately azotemic cats (n = 10), and hypertensive nonazotemic cats (n = 9). Plasma NOx concentrations were measured. A moderate correlation between plasma creatinine and ADMA (n = 69, r= .608, P < .001), SDMA (n = 69, r= .741, P < .001), and NOx concentrations (n = 69, r= .589, P < .001) was observed. There was no association among plasma ADMA, SDMA, and NOx concentrations and SBP. Plasma ADMA and SDMA concentrations are increased in cats with CKD and correlate with plasma creatinine concentration. This may imply the presence of endothelial dysfunction in cats with CKD. Plasma ADMA concentrations were not associated with systemic hypertension. Treatment of systemic hypertension with amlodipine besylate did not affect plasma ADMA or NOx concentrations.

Direct Inhibition of Renin as a Cardiovascular Pharmacotherapy

The important role of renin-angiotensin-aldosterone system blockade in the treatment of systemic hypertension, heart failure, diabetic kidney disease, and atherogenesis has been clearly established. The theoretical therapeutic advantages for inhibiting the detrimental effects of the renin-angiotensin system at its most upstream point have served as the impetus for the development of renin inhibitors. The advent of aliskiren, the first in a novel class of orally active, nonpeptide, highly specific, human renin inhibitors, provides a new modality in the armamentarium of renin-angiotensin system antagonists. Studies in marmosets and rats demonstrated that aliskiren reduced blood pressure in a dose-dependent manner and is highly efficacious in blocking plasma renin activity with parallel reductions in the levels of the other downstream constituents of the renin-angiotensin system. Clinical trials in hypertensive patients have confirmed these benefits with aliskiren whose blood pressure-lowering efficacy is similar to or better than those of standard therapeutic doses of enalapril, losartan, irbesartan, and hydrochlorothiazide. Aliskiren is well tolerated, with few reported adverse effects even at the highest doses tested. Given the established beneficial effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in the treatment of cardiovascular and renovascular diseases, future studies may further elucidate a similar protective role for aliskiren both as a monotherapy and as part of a combination therapy.

Tyrosine Hydroxylase, the Rate-Limiting Enzyme in Catecholamine Biosynthesis

Tyrosine hydroxylase (TH) is the rate-limiting enzyme in catecholamine biosynthesis. Does common genetic variation at human TH alter autonomic activity and predispose to cardiovascular disease? We undertook systematic polymorphism discovery at the TH locus and then tested variants for contributions to sympathetic function and blood pressure. We resequenced 80 ethnically diverse individuals across the TH locus. One hundred seventy-two twin pairs were evaluated for sympathetic traits, including catecholamine production, reflex control of the circulation, and environmental (cold) stress responses. To evaluate hypertension, we genotyped subjects selected from the most extreme diastolic blood pressure percentiles in the population. Human TH promoter haplotype/reporter plasmids were transfected into chromaffin cells. Forty-nine single-nucleotide polymorphisms were discovered, but coding region polymorphism did not account for common phenotypic variation. A block of linkage disequilibrium spanned 4 common variants in the proximal promoter. Catecholamine secretory traits were significantly heritable (h2), as were stress-induced blood pressure changes. In the TH promoter, significant associations were found for urinary catecholamine excretion and for blood pressure response to stress. TH promoter haplotype 2 (TGGG) showed pleiotropy, increasing both norepinephrine excretion and blood pressure during stress. Coalescent simulations suggest that TH haplotype 2 likely arose approximately 380,000 years ago. In hypertension, 2 independent case-control studies (1266 subjects with 53% women and 927 subjects with 24% women) replicated the effect of C-824T in the determination of blood pressure. We conclude that human catecholamine secretory traits are heritable, displaying joint genetic determination (pleiotropy) with autonomic activity and finally with blood pressure in the population. Catecholamine secretion is influenced by genetic variation in the adrenergic pathway encoding catecholamine synthesis, especially at the classically rate-limiting step, TH. The results suggest novel pathophysiological links between a key adrenergic locus, catecholamine metabolism, and blood pressure and suggest new strategies to approach the mechanism, diagnosis, and treatment of systemic hypertension.

Treating Hypercholesterolemia and Hypertension Based on Lifetime Global Risk

In the December 1, 2006, issue of the American Journal of Cardiology, the Editor-in-Chief, William C. Roberts, MD, made a strong case for early initiation of therapy with statin drugs. He stated that because life insurance policies were often purchased by individuals in their 20s, statin drugs with or without ezetimibe could be started at the same time.1 I fully agree with him and emphasize that prevention should not be limited to decreasing low-density lipoprotein (LDL) cholesterol, but also to lifestyle change and the treatment of systemic hypertension and other risk factors.

Does Treated Systemic Hypertension Affect Progression of Optic Nerve Damage in Glaucoma Suspects?

Purpose: To evaluate whether treatment of systemic hypertension has an effect on progression of optic nerve parameters in glaucoma suspects using confocal scanning laser ophthalmoscopy. Methods: Two hundred eyes of 103 glaucoma suspect patients were included in this retrospective cohort study. Thirty one patients (of whom 59 eyes were included in the study) had systemic hypertension under treatment (based on medical history). The remaining 72 age-matched normotensive controls (of whom 141 eyes were included in the study) were not on blood-pressure-lowering medications. Each patient had a follow-up period of at least 4 years with a minimum of four Heidelberg retinal tomograph tests (one baseline and three follow-up scans). The slopes of progression of optic nerve head parameters with time were studied and compared between these two groups using mixed effects regression models. Results: Patients with systemic hypertension showed a statistically significant increase in cup area (slope 0.2, p = 0.03), cup-to-disk area ratio (slope 0.01, p = 0.007), and decrease in rim area (slope −0.4, p = 0.03), rim-to-disk area ratio (slope −0.01, p = 0.005), and global Retinal Nerve Fiber Layer (RNFL) thickness (p = 0.008) with time. The differences in slopes of progression of many parameters between hypertensives and normotensives were statistically significant. Conclusions: Systemic hypertension treated with hypotensive medications may be a risk factor for increased progression of optic nerve parameters in glaucoma suspects compared with age-matched normotensive subjects.

Riesgo cardiovascular en diabetes mellitus e hipertensión arterial en España. Estudio CORONARIA

Diabetes mellitus is a prevalent disease with high cardiovascular mortality. Treatment of risk factors can reduce the associated cardiovascular risk. The CORONARIA study included 7253 patients with high risk systemic hypertension from different regions of Spain. The aim of this study was to analyze the cardiovascular risk (CR) of diabetic patients at baseline and after one-year follow-up. A total of 2105 (29%) patients with type 2 diabetes and systemic hypertension are included in the CORONARIA study. The CR profile is evaluated at baseline and after treatment of systemic hypertension with amlodipine (5-10 mg), while other cardiovascular risk factors were also treated. Data were compared with non diabetics. Patients with systemic hypertension in Spain show a very high prevalence of diabetes (29%); it is higher in women than men (p<0.05) and higher in secondary prevention than primary prevention (p<0.05). Prevalence diabetes was higher in Murcia, Andalucía, Extremadura and Comunidad Valenciana, and lower in Madrid and País Vasco than the Spanish mean. The CR in primary prevention was significantly higher in diabetics than in non-diabetics (female: 22.9% vs 12.3% in Framingham, and 10.1% vs 5.2% in REGICOR; male: 39.9% vs 27.8% in Framingham and 15.7% vs 10.3% in REGICOR). After one year treatment, cardiovascular risk decreased significantly in both groups of patients, but it did more in diabetics (Framingham: -11.6% vs -6.7%; REGICOR: -5.3% vs -2.8%). Most patients with diabetes and systemic hypertension did not have an adequate control of CR factors and presented a high cardiovascular risk. Treatment reduced the CR significantly in a greater proportion of diabetic than non diabetic-patients.

Section 3: Prevention of Ventricular Remodeling, Cardiac Dysfunction, and Heart Failure

Section 3: Prevention of Ventricular Remodeling, Cardiac Dysfunction, and Heart Failure

The future of endothelin-receptor antagonism as treatment for systemic hypertension

Endothelin (ET) is an endogenous peptide secreted predominantly by endothelial cells that mediates its effects via vasoconstriction and hypertrophy of vascular smooth muscle. Because the role of ET has been described in multiple pathologic processes in cardiovascular disease, including hypertension, there has been a strong interest in the development of therapeutic agents that inhibit ET receptors. ET receptor antagonists have shown much promise in disease states such as pulmonary arterial hypertension, essential hypertension, and various forms of secondary hypertension. This review serves to summarize the current role of ET and ET receptor antagonists in both the pathophysiology and the treatment of hypertension.

Hypertension and head injury

Systemic hypertension and tachycardia are often observed in the acute phase of traumatic brain injury. What causes systemic hypertension after head injury? Is systemic hypertension somehow beneficial to the injured brain? Are vasodilating drugs the first choice for treatment of systemic hypertension after traumatic brain injury? The occurrence of a hyperadrenergic state, the effects of systemic hypertension on the injured brain, the ideal blood pressure, and the management of systemic hypertension after traumatic brain injury are reviewed herein.