Search

Purpose Hydralazine, doxazosin, and verapamil are currently recommended by the Endocrine Society as acceptable bridging treatment in those in whom full cessation of antihypertensive medication is infeasible during screening for primary aldosteronism (PA). This is under the assumption that they cause minimal to no effect on the aldosterone-to-renin ratio, the most widely used screening test for PA. However, limited evidence is available regarding the effects of these particular drugs on said ratio. Methods In the present study, we retrospectively assessed the changes in aldosterone, renin, and aldosterone-to-renin values in essential hypertensive participants before and after treatment with either hydralazine (n = 26) or doxazosin (n = 20) or verapamil (n = 15). All samples were taken under highly standardized conditions. Results Hydralazine resulted in a borderline significant rise in active plasma renin concentration (19 vs 25 mIU/L, p = 0.067) and a significant fall in the aldosterone-to-renin ratio (38 vs 24, p = 0.017). Doxazosin caused declines in both plasma aldosterone concentration (470 vs 330 pmol/L, p = 0.028) and the aldosterone-to-renin ratio (30 vs 20, p = 0.020). With respect to verapamil, we found no statistically significant effect on any of these outcome variables. Conclusion We conclude that the assumption that these drugs can be used with little consequence to the aldosterone-to-renin cannot be substantiated. While it is possible that they are indeed the best option when full antihypertensive drug cessation is infeasible, the potential effects of these drugs must still be taken into account when interpreting the aldosterone-to-renin ratio.

Blood pressure (BP) in children and adolescents is associated with their growth. BP is most strongly associated with height during height gain and with degree of obesity after reaching final height. BP in childhood and adolescence is correlated with BP in adulthood. The pathophysiology of pediatric essential hypertension is associated with obesity, excess salt intake, and a low birth weight. The common causes of pediatric secondary hypertension are renal parenchymal and renovascular diseases. The significance of diagnosing pediatric hypertension involves detecting secondary hypertension and preventing organ damage due to hypertension as well as tracking essential hypertension in adulthood. Appropriate BP measurement procedures are required for diagnosing pediatric hypertension. The inflatable bladder of an appropriately sized cuff should exceed 40% of the arm circumference. BP measurements should be performed consecutively at least 3 times using an appropriately sized cuff. The diagnosis of hypertension requires that all BP values measured on 3 or more occasions be above the reference value. The criteria for pediatric hypertension are determined based on the distribution of BP in healthy children and adolescents, with values above the 95th percentile of normal representing hypertension. Japanese criteria define pediatric hypertension as ≥120/70 mmHg for preschool children, ≥130/80 mmHg for 1st–3rd graders, ≥135/80 mmHg for 4th–6th graders, ≥140/85 mmHg for 7th–9th grade boys, ≥135/80 mmHg for 7th–9th grade girls, and ≥140/85 mmHg for senior high school boys and girls. The prevalence of Japanese pediatric hypertension was 0.9% based on proper measurement protocols. The basis of managing pediatric essential hypertension is healthy lifestyle modifications. Pharmacotherapy is indicated for persistent hypertension, symptomatic hypertension, secondary hypertension, the development of target organ damage, the presence of chronic kidney disease, and diabetes mellitus. Screening for pediatric hypertension is important; therefore, BP should be routinely measured in children and adolescents.

Previous studies have demonstrated that the levels of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide (NO) synthesis, are strongly associated with hypertension, diabetes, and cardiovascular diseases. Profilin‐1, an actin‐binding protein, has been documented to be involved in endothelial injury and in the proliferation of vascular smooth muscle cells resulting from hypertension. However, the role of profilin‐1 in ADMA‐induced vascular injury in hypertension remains largely unknown. Forty healthy subjects and forty‐two matched patients with essential hypertension were enrolled, and the related indexes of vascular injury in plasma were detected. Rat aortic smooth muscle cells (RASMCs) were treated with different concentrations of ADMA for different periods of time and transfected with profilin‐1 small hairpin RNA to interrupt the expression of profilin‐1. To determine the role of the Janus kinase 2/signal transducer and activator of transcription 3 (JAK2/STAT3) pathway, RASMCs were pretreated with AG490 or rapamycin. The expression of profilin‐1 was tested using real‐time polymerase chain reaction (PCR) and western blot analysis. Cell proliferation was measured by flow cytometry and 3‐(4,5‐dimethylthiazol‐2yl)‐2,5‐diphenyltetrazoliumbromide assays. Compared with healthy subjects, the levels of ADMA and profilin‐1 were markedly elevated in hypertensive individuals, while the levels of NO were significantly decreased (p

Objectives To assess the effectiveness of telemedicine video visits in the management of hypertensive patients at home during the first year of the COVID-19 pandemic. We also evaluated associated measures of patient satisfaction with these holistic visits. Patients and Methods A quantitative analysis was performed of all home video visits coded with a diagnosis of Essential Hypertension during the first 12 months of the COVID-19 pandemic (March, 2020 through February, 2021). A total of 10,634 patients with 16,194 hypertension visits were present in our national telemedicine practice database during this time period. Among this population, a total of 569 patients who had 1,785 hypertension visits met the criteria of having two or more blood pressure readings, with the last blood pressure reading occurring in the report period. We analyzed baseline characteristics and blood pressure trends of these 569 patients over the study period. Voluntarily submitted patient satisfaction ratings, which were systematically requested at the end of each visit, were also analyzed. Results The mean age of the patients in this study cohort of 569 patients was 43.9 years, and 48.3% were women. Over 62% of the patients had an initial systolic BP over140 mm Hg, and 25% had an initial SBP of greater than 160 mm Hg. The average number of visits over the study period was 3.1 visits per patient. An average of 6.4 BP measurements per patient were available over the study period. Over the study period, 77% of the patients experienced an improvement in either systolic or diastolic blood pressure, with mean reductions of -9.7 mm Hg and -6.8 mm Hg in systolic and diastolic blood pressures, respectively. A total of 416 patients in the cohort started with a blood pressure above 140/90 mm Hg. For this subset of patients, 55.7% achieved a BP of

Мета дослідження : вивчити антигіпертензивну ефективність і можливість органопротекції комбінованою терапією індапамідом з амлодипіном і блокатором РААС (периндоприлом або валсартаном) в процесі 24-тижневої терапії у хворих з есенціальною гіпертонією (ЕГ) з високим і дуже високим ризиком серцево-судинних ускладнень (ССУ). Матеріали та методи. У дослідження були включені 115 хворих з ЕГ II–III ступеня (ESH/ESC, 2013) чоловічої та жіночої статі. Середній вік хворих склав 56,47 ± 9,18 року, середня тривалість захворювання — 10,20 ± 7,22 року. Проводилось офісне вимірювання артеріального тиску за методом Короткова, ЕхоКГ. Біохімічні аналізи проводили на автоаналізаторі DAYTONA. Швидкість клубочкової фільтрації (ШКФ) визначали за формулою MDRD. Контурний аналіз пульсової хвилі проводився за допомогою приладу SphygmoCor (AtCor Medical, Австралія). Результати. Застосування комбінованої терапії індапамідом з амлодипіном і блокатором РААС у хворих з ЕГ із високим і дуже високим ризиком ССУ дозволяє швидко досягти цільових показників САТ і ДАТ. Цільові значення САТ, ДАТ, АДсер. були досягнуті у 95 (82,6 %) хворих. Ступінь зниження САТ і ДАТ становила –21,61 ± 5,81 і –21,63 ± 9,58 % відповідно (р = 0,000). Антиремоделюючі ефекти індапаміда з амлодипіном і блокатором РААС асоціювалися зі зменшенням числа хворих із гіпертрофією лівого шлуночка (ГЛШ), склавши 53 (46,1 %) проти 72 (62,6 %) на початковому етапі, тобто в цілому по групі відсоток хворих з ГЛШ зменшився на 16,5 %. Спостерігалося достовірне зменшення товщини комплексу інтима-медіа (КІМ) від 1,07 ± 0,24 мм на початку до 1,01 ± 0,20 мм у динаміці (р = 0,019). Мікроальбумінурія зменшилася з 30,18 ± 59,26 мг/л на початку до 19,86 ± 37,53 мкмоль/л у динаміці (р = 0,041). Рівень креатиніну зменшився з 100,56 ± 22,29 мкмоль/л на початку до 96,01 ± 20,40 мкмоль/л у динаміці (р = 0,044). ШКФ збільшилася з 64,23 ± 13,19 мл/хв/1,73 м 2 на початку до 68,88 ± 14,94 мл/хв/1,73 м 2 у динаміці (р = 0,032). З огляду на проведену трикомпонентну комбіновану терапію відзначалися достовірне зниження центрального систолічного і пульсового тиску, тенденція до зниження центрального діастолічного тиску. Зниження аортальної аугментації та індексу аугментації відбилося на достовірному зниженні швидкості пульсової хвилі (ШПВ) з нормалізацією її показників (< 10 м/с). При цьому терапія характеризувалася доброю переносимістю. Висновки. Трикомпонентна терапія амлодипіном, індапамідом і блокатором РААС відрізняється високою антигіпертензивною ефективністю, вираженістю органопротективних ефектів, впливаючи на процеси судинного ремоделювання з нормалізацією центральної гемодинаміки, ШПХ, і зменшенням товщини КІМ загальної сонної артерії, добре переноситься, що в цілому характеризує цю комбінацію як найбільш оптимальну і ефективну у зниженні ризику ССУ у більшості хворих з АГ.

В огляді висвітлюються питання та перспективи превентивного харчування при гіпертонічній хворобі на тлі аліментарного ожиріння, роль і місце окремих нутрієнтів у дієтах, що рекомендуються пацієнтам із гіпертонічною хворобою й ожирінням високого кардіоваскулярного ризику з ішемічною хворобою серця, дисліпідеміями, порушеннями вуглеводного та пуринового обмінів. Коментуються американські та українські рекомендації з харчування і модифікації стилю життя, результати багатоцентрових досліджень при гіпертонічній хворобі й ожирінні, європейські дієтичні раціони з доведеною ефективністю (DASH-дієта, Mediterranean Diet, MIND, TLC, дієти Орніша, Polymeal, Omni Heart, клініки Майо, Paleolithic diet, Weight Watchers, дієти LCHF, South Beach, методика MEDFICTS зі скринінгу харчових жирів), особливості їх призначення при гіпертонічній хворобі, ожирінні, цукровому діабеті 2-го типу, атеросклерозі, короткі рекомендації з розширення фізичної активності в даної категорії пацієнтів.

Introduction. The role of hypertension in the development of cognitive impairment is emphasized in numerous works. Nearly all data were obtained from a group of old patients. Therefore it is of great importance to diagnose the cognitive impairment in hypertensive patients of working age beforehand. Objective. To determine the role of age and hypertensive anamnesis in the development of cognitive impairments in patients with essential hypertension of the 2nd degree. Materials and methods. We examined 102 patients with the second degree of essential hypertension, whose average age was 49.84 ± 0.83 years old. The patients were divided into 3 groups depending on their age and disease duration. A number of neuropsychological tests were used to study cognitive impairment. Results. Significant lowering of MoCA test results by 6.1 % were observed in the group of the patients older than 56 years old compared with those of the group with patients of 45 years old and younger. In the group with disease duration not more than 5 years cognitive impairments were absent. The results of MoCA test in patients with hypertensive disease duration more than 10 years were significantly less in comparison with the group of patients experienced disease up to 5 years and from 5 to 10 years in 9.9 % and in 4.9 %, respectively. Сonclusions. We have found that longer duration of the disease and older age in the patients of working age with essential hypertension of the second degree are associated with significant increase in cognitive impairment. An integral part of a comprehensive survey of hypertensive patients should be the identification of cognitive impairment., Актуальность. В многочисленных работах подчеркивается роль артериальной гипертензии в развитии когнитивных нарушений. Почти все данные получены на популяции лиц старшей возрастной группы, поэтому представляет интерес раннее выявление когнитивных нарушений у больных гипертонической болезнью трудоспособного возраста. Цель работы: определение роли возраста и длительности артериальной гипертензии в развитии когнитивных нарушений у больных гипертонической болезнью II стадии. Материалы и методы. Обследовано 102 больных гипертонической болезнью II стадии, средний возраст которых 49,84 ± 0,83 года. Пациенты были разделены по возрасту и длительности заболевания на 3 группы. Для изучения когнитивных нарушений применяли ряд нейропсихологических тестов. ­Результаты. Достоверное снижение показателей теста Монреальской шкалы оценки когнитивных функций (MoCA) на 6,1 % отмечается в третьей группе пациентов старше 56 лет по сравнению с пациентами до 45 лет первой группы. В группе с длительностью заболевания до 5 лет когнитивные нарушения отсутствовали. Показатели MoCA-теста в группе больных с длительностью гипертонической болезни более 10 лет достоверно меньше в сравнении с группой до 5 лет продолжительности заболевания и от 5 до 10 лет — на 9,9 и 4,9 % соответственно. Выводы. Нами установлено, что с увеличением длительности заболевания и возраста больных с гипертонической болезнью II стадии трудоспособного возраста отмечается достоверное нарастание когнитивных нарушений. Неотъемлемой частью комплексного обследования больных гипертонической болезнью должно быть выявление когнитивных нарушений., Актуальність. У численних роботах підкреслюється роль артеріальної гіпертензії в розвитку когнітивних порушень. Майже всі дані отримані на популяції осіб старшої вікової групи, тому становить інтерес раннє виявлення когнітивних порушень у хворих на гіпертонічну хворобу працездатного віку. Мета роботи: визначення ролі віку і тривалості артеріальної гіпертензії в розвитку когнітивних порушень у хворих на гіпертонічну хворобу II стадії. ­Матеріали та методи. Обстежені 102 хворі на гіпертонічну хворобу II стадії, середній вік яких 49,84 ± 0,83 року. Пацієнти були розділені за віком і тривалістю захворювання на 3 групи. Для вивчення когнітивних порушень застосовували ряд нейропсихологічних тестів. Результати. Достовірне зниження показників тесту Монреальської шкали оцінки когнітивних функцій (MoCA) на 6,1 % відзначається в третій групі пацієнтів старше 56 років порівняно з пацієнтами до 45 років першої групи. У групі з тривалістю захворювання до 5 років когнітивні порушення були відсутні. Показники MoCA-тесту в групі хворих з тривалістю гіпертонічної хвороби більше 10 років достовірно менші порівняно з групою до 5 років тривалості захворювання і від 5 до 10 років — на 9,9 і 4,9% відповідно. Висновки. Нами встановлено, що зі збільшенням тривалості захворювання і віку хворих на гіпертонічну хворобу II стадії працездатного віку відзначається достовірне наростання когнітивних порушень. Невід’ємною частиною комплексного обстеження хворих на гіпертонічну хворобу має бути виявлення когнітивних порушень.

Вивчені рівні в крові потужних активаторів ангіогенезу з прозапальною дією — васкулоендотеліального фактора росту та ангіопоетину-2 у хворих на гіпертонічну хворобу. Виявлено достовірне підвищення рівнів у крові вказаних факторів у хворих на гіпертонічну хворобу порівняно з практично здоровими особами. Встановлено, що рівні у крові ангіопоетину-2 достовірно зростають у хворих на гіпертонічну хворобу при підвищенні тяжкості гіпертензії та при наявності таких метаболічних порушень, як абдомінальне ожиріння, гіперглікемія натще, порушення толерантності до глюкози, гіперурикемія та комбінована дисліпопротеїнемія. Рівні в крові васкулоендотеліального фактора росту були достовірно більш високими у хворих на гіпертонічну хворобу зі стабільною стенокардією напруження порівняно з хворими без стенокардії. Отримані дані вказують на важливу роль активації ангіогенезу в розвитку гіпертонічної хвороби та її серцево-судинних ускладнень.

Метою дослідження є оцінка впливу моно- та комбінованої антигіпертензивної терапії на показники системного запалення (С-реактивний протеїн (СРП), інтерлейкін (ІЛ)-6 і фактор некрозу пухлини (ФНП) α у взаємозв’язку з динамікою характеристик добового профілю артеріального тиску.Обстежено 99 хворих на гіпертонічну хворобу І–ІІ стадії 1–2-го ступеня, які були рандомізовані в 3 групи терапії: 29 пацієнтів отримували монотерапію телмісартаном у дозі 40–80 мг/добу, 27 — S-амлодипіном у дозі 5 мг/добу та 43 — фіксовану комбінацію валсартану з амлодипіном у дозі 160/5 мг/добу). Визначення вмісту СРП, ІЛ-6 і ФНП-α проводили до початку (після 7-денного безмедикаментозного періоду) та після 6 міс. терапії.Було встановлено, що лікування телмісартаном сприяє зниженню сироваткового рівня СРП на 13,9 % та ІЛ-6 — на 36,4 %, проте не впливає на вміст ФНП-α у крові хворих на гіпертонічну хворобу. Монотерапія антагоністом кальцію S-амлодипіном призводить до зменшення вмісту в крові прозапальних цитокінів: ІЛ-6 — на 39 % та ФНП-α — на 11,9 %. Застосування фіксованої комбінації валсартану з амлодипіном чинить більш суттєвий антигіпертензивний ефект, проте це не супроводжувалося більш вираженим, ніж у групах монотерапії, зниженням СРП і ІЛ-6, що становило відповідно 12,5 і 31,5 %.Було виявлено, що зниження АТ прямо пов’язане зі зменшенням активності системного запалення. Так, зменшення сироваткового вмісту ФНП-α корелює зі зниженням систолічного та діастолічного АТ у всі періоди доби під впливом лікування, а зниження рівня СРП асоціюється зі змінами середньодобового та середньоденного систолічного артеріального тиску, його добового індексу та нічної варіабельності.Отримані нами дані засвідчують зменшення активності запалення низької градації під впливом блокаторів рецепторів ангіотензину ІІ (телмісартан) та антагоністів кальцію (S-амлодипін) як при монотерапії, так і при використанні їх комбінації (валсартан із амлодипіном), яке прямо корелює зі зниженням артеріального тиску за даними амбулаторних вимірювань.

Метою дослідження є оцінка антигіпертензивної ефективності телмісартану та його впливу на активність системного запалення і показники вуглеводного та ліпідного метаболізму у хворих на гіпертонічну хворобу (ГХ). Матеріали та методи. Обстежено 29 пацієнтів із ГХ І–ІІ стадії, 1–2-го ступеня, яким після 7-денного безмедикаментозного періоду та через 6 місяців терапії телмісартаном проводили комплексне клінічне дослідження, амбулаторне моніторування артеріального тиску (АТ), визначення вмісту С-реактивного протеїну (СРП), интерлейкіну-6 (ІЛ-6) і фактора некрозу пухлини α (ФНП-α), показників вуглеводного (глюкоза, інсулін, НОМА, глікований гемоглобін (HbA1с)) та ліпідного метаболізму. Результати. Монотерапія телмісартаном дозволила досягти цільового АТ у 75,6 % пацієнтів; через 6 місяців лікування зниження систолічного АТ становило 20 мм рт.ст., діастолічного АТ — 13 мм рт.ст. Препарат сприяв відновленню нормального двофазного ритму АТ у пацієнтів з вихідними його порушеннями та зменшував варіабельність систолічного АТ в нічні години. Обговорення. Під впливом телмісартану відбулось поліпшення показників вуглеводного обміну, що проявлялось достовірним зменшенням базальної інсулінемії на 21,5 %, зниженням рівня глюкози з 5,5 ± 0,2 ммоль/л до 5,3 ± 0,1 ммоль/л (р = 0,04) і HbA1c з 5,6 ± 0,1 % до 5,4 ± 0,1 % (р = 0,04). На фоні прийому телмісартану зменшився вміст у крові тригліцеридів на 17 % (р = 0,03), спостерігалась тенденція до зниження рівня загального холестерину та холестерину ліпопротеїдів низької щільності. Встановлено, що лікування телмісартаном сприяє зниженню сироваткового рівня СРП на 13,9 % (р = 0,04) та ІЛ-6 на 36,4 % (р = 0,02), проте не впливає на вміст ФНП-α в крові хворих на ГХ. Висновки. Отримані дані свідчать про високу антигіпертензивну ефективність і сприятливі метаболічні ефекти телмісартану, а також його здатність пригнічувати активність запалення низької градації. В статті також обґрунтовано поєднане використання телмісартану та фіксованої комбінації «S-амлодипін/аторвастатин» з точки зору поліпшення прогнозу хворих на ГХ за рахунок синергізму антигіпертензивного та ліпідознижуючого потенціалу і плейотропних ефектів цих препаратів, дія яких направлена на сповільнення прогресування ГХ і атеросклерозу.

The article describes a group of drugs used for comorbidity, the comparative characterization of angiotensin II receptor blockers (ARB) and angiotensin-converting enzyme (ACE) inhibitors, listed on the efficacy and safety data from a representative group of ARBs – azilsartan, presented the results clinical studies on these issues., В статье рассмотрены группы препаратов, применяемые при сочетанной патологии, проведена сравнительная характеристика блокаторов рецепторов ангиотензина II (БРА) и ингибиторов ангиотензин-превращающего фермента (АПФ), приведены данные по эффективности и безопасности представителя из группы БРА – азилсартана, представлены результаты клинических исследований по данным вопросам., У статті розглянуті групи препаратів, що застосовуються при поєднаній патології, проведена порівняльна характеристика блокаторів рецепторів ангіотензину II (БРА) та інгібіторів ангіотензин-перетворюючого ферменту (АПФ), наведені дані щодо ефективності та безпеки представника з групи БРА – азілсартану, представлені результати клінічних досліджень з цих питань.

Обстежені 63 пацієнти з гіпертонічною хворобою та цукровим діабетом 2-го типу. Контрольну групу становили 16 практично здорових осіб. Комплекс обстеження включав загальноприйняті клініко-лабораторні та інструментальні методи, ультразвукове дослідження серця з допплерографією, визначення концентрації апеліну в крові імуноферментним методом. У пацієнтів із гіпертонічною хворобою та цукровим діабетом 2-го типу порівняно з групою контролю відзначається вірогідне зниження рівня апеліну, що асоціюється з розвитком патологічного ремоделювання серця, збільшенням розмірів лівого передсердя та діастолічною дисфункцією серця.

The objective — to study the peculiarities of the heart and blood vessels condition in patients with essential hypertension (EH) with or without type 2 diabetes mellitus. Materials and methods. The study involved 134 patients: the first group — 44 patients with II stage EH, grade 2 and 3, the second group — 45 patients with II stage EH, grade 2 and 3, associated with type 2 diabetes mellitus, control group — 45 healthy volunteers. The groups were comparable in age, sex, risk factors for cardiovascular complications. The methods of ultrasonography and multivariate statistical methods were used. Results. Using the factor analysis as a method of multivariate statistics, among 140 ultrasonographic indicators, which are recommended by the European Society of Echocardiography, 14 indicators were selected, and four integrated indicators were created on their base. Their clinical interpretation shows that these indicators characterize the functional state of the heart, macrocirculation, microcirculation and structural condition of the heart. At the same time, the indicators of structure and microcirculation may be considered as type 2 diabetes mellitus markers. Conclusions. With the help of factor analysis as a method of multivariate statistics, new combinations of ultrasonographic indicators were obtained in terms of factors, which are the systemic description of the target organs response on comorbid pathology: remodeling of the main blood vessels and microvessels, structural and functional cardiac remodeling. Holistic, multidimensional concept of the remodeling processes is possible only taking into account values of all indicators that create the factor.

Despite hypertension ranks among the leading causes of chronic kidney disease (CKD), the impact of chronic hypertensive nephropathy, the so-called ‘nephrosclerosis’ (NS), on CKD progression is often unpredictable, particularly in elderly population. We have conducted a prospective, observational study to define renal function patterns and outcomes in elderly CKD individuals with or without NS. Three hundred four individuals with an already established CKD were categorized according to the etiology of CKD. NS was defined as the presence of CKD associated with long-term essential hypertension, hypertensive retinopathy, left ventricular hypertrophy and minimal proteinuria. Time trajectories in estimated glomerular filtration rate (eGFR) (CKD-Epi) were computed over a 4-year follow-up. In addition, we analyzed the occurrence of a composite outcome of doubling of serum creatinine levels, eGFR reduction ≥25% and/or the need of chronic renal replacement therapy. CKD was secondary to nephrosclerosis (CKD-NS) in 220 (72.3%). In the whole cohort, the average estimated annual GFR slope was 1.8 mL/min/1.73 m2. eGFR decline was slower in CKD-NS as compared with others (1.4 vs 3.4 mL/min/1.73 m2; p

Background The relationship between obesity indices and arterial stiffness (AS) has not been fully discovered nor has it been studied in depth in large hypertensive patient populations. The aim of this study was to explore the association between body mass index (BMI) and waist-hip ratio (WHR) levels and AS based on brachial-ankle pulse wave velocity (baPWV) in Chinese rural adults with hypertension. Methods This cross-sectional study analyzed 5049 Chinese rural adults with essential hypertension. BMI was calculated as the body weight in kilograms divided by the square of the height in meters (kg/m2). Central obesity was defined as WHR ≥ 0.9 for males and ≥ 0.85 for females. Measurement of arterial stiffness was carried out via brachial-ankle pulse wave velocity (baPWV). Results The prevalence of overweight, general obesity, central obesity and increased AS were 26.88%, 3.39%, 63.85% and 44.01%, respectively. Multivariate logistic regression analysis indicated that BMI levels were negatively associated with the prevalence of increased AS (adjusted-OR per SD increase: 0.74, 95% CI 0.67–0.81, P SD increase: 1.25, 95% CI 1.14–1.36, P CI 1.28–1.81, P β per SD increase: − 0.57, 95% CI − 0.68 to − 0.46, P β per SD increase: 4.46, 95% CI 3.04–5.88, P Conclusion There was an inverse relationship between BMI levels and increased AS or baPWV levels, whereas WHR levels and central obesity were positively associated with increased AS or baPWV levels in Chinese rural adults with hypertension.

BACKGROUND The relationship between office vs. ambulatory blood pressure (BP) indices are well-studied in patients with essential hypertension and based on these data, it is known that the average 24-h ambulatory BP is typically lower than office BP. However, emerging data show that office SBP underestimates arterial afterload in patients with coarctation of aorta (COA), and a minimal increase in stroke volume during low-intensity exercise results in an exaggerated rise in SBP as compared to those with essential hypertension. We hypothesized that COA patients will have higher ambulatory SBP and a higher prevalence of masked hypertension compared to patients with essential hypertension. METHODS Case-control study of 118 COA patients and 118 patients with essential hypertension matched by age, sex, BMI and office SBP. RESULTS Although both groups had similar office SBP (132 ± 17 mmHg) by design, the COA group had paradoxical increases in 24-h ambulatory SBP (135 ± 14 vs. 126 ± 13; P

Background: In the 21st century, the prevalence pattern of hypertension in different developing countries differs from developed countries. Persistent hypertension is one of the risk factors and is the leading cause of heart disease, chronic kidney disease (CKD) & cerebrovascular disease. Even mild to moderate essential hypertension usually causes significant renal function impairment only after several years. Objectives: To assess the serum uric acid level in hypertensive patients and compare the findings with those found in normotensive people. Materials & Methods: This case-control study was done at the Department of Biochemistry, Mymensingh Medical College, Mymensingh during the period of January 2010 to December 2010. A total of 143 subjects of both sexes were selected for the purpose. Out of them, 73 were the case and 70 were the control. The subjects were classified into the following groups; Group I includes 73 were essential hypertensive subjects. Group II includes 70 were healthy adults. All statistical parameters analysis were done by SPSS 12.0 version; P-value

Rationale: Hypertension is the most important risk factor for cardiovascular and cerebrovascular diseases. Getting deep insight into the pathogenesis of hypertension is necessary. Objective: To investigate the role of ANK (ankyrin) repeat domain 36 ( ANKRD36 ) in hypertension. Methods and Results: We first recruited an essential hypertension cohort and then performed genome-wide transcriptome analysis with peripheral blood mRNA. ANKRD36 was found to be significantly lower expressed in hypertension. The anchorin repeat domain mediates a variety of protein-protein interactions. The ENaC (epithelial sodium channel) genes expression was found upregulated in human umbilical vein endothelial cells with ANKRD36 knockdown by using Affymetrix expression profile chip. In human embryonic kidney epithelial cells and HEK293T (human embryonic kidney cells), ANKRD36 overexpression significantly downregulated expression of ENaC genes, and ANKRD36 knockdown upregulated their expression. The chromosome immunoprecipitation assay and yin yang 1 ( YY1 ) knockdown showed the expression of ENaC was regulated by ANKRD36 via YY1, a dual-function transcription factor ubiquitously expressed in human tissues. Immunocoprecipitation and fluorescence resonance energy transfer assay confirmed the interaction between ANKRD36 and YY1. The nucleo-cytoplasmic ratio of YY1 decreased when ANKRD36 was overexpressed and also increased when ANKRD36 was knocked down. ANK2 domain of ANKRD36 was critical to its interaction with YY1. Ankrd36 knockout mice showed higher blood pressure levels and Na + reabsorption, especially when fed with high-salt diet. Higher expression of ENaC genes was observed in renal tubular epithelial cells from the knockout mice, and Yy1 knockdown mitigated the alteration. Ankrd36 knockout mice also showed more sensitive response to ENaC inhibitor amiloride treatment. Conclusions: We identified that ANKRD36 was involved in blood pressure regulation by interacting with YY1 and then altering expression of ENaC genes. Lower expressed ANKRD36 in hypertension might be a potential therapeutic target, and the application of ENaC inhibitors on hypertension treatment might be extended when serum K + levels are closely monitored.

Nowadays, there are robust clinical and pathophysiological evidence supporting the beneficial effects of physical activity on cardiovascular (CV) system. Thus, the physical activity is considered a key strategy for CV prevention. In fact, exercise training exerts favourable effects on all risk factors for CV diseases (i.e. essential hypertension, type 2 diabetes mellitus, hypercholesterolemia, obesity, metabolic syndrome, etc…). In addition, all training modalities such as the aerobic (continuous walking, jogging, cycling, etc.) or resistance exercise (weights), as well as the leisure-time physical activity (recreational walking, gardening, etc) prevent the development of the major CV risk factors, or delay the progression of target organ damage improving cardio-metabolic risk. Exercise training is also the core component of all cardiac rehabilitation programs that have demonstrated to improve the quality of life and to reduce morbidity in patients with CV diseases, mostly in patients with coronary artery diseases. Finally, it is still debated whether or not exercise training can influence the occurrence of atrial and ventricular arrhythmias. In this regard, there is some evidence that exercise training is protective predominantly for atrial arrhythmias, reducing the incidence of atrial fibrillation. In conclusion, the salutary effects evoked by physical acitvity are useful in primary and secondary CV prevention.

Impairment of extracellular and intracellular calcium homeostasis can have a damaging effect on the functioning of both individual organs and systems and the whole organism. In the cardiovascular system, disorders ofcalcium metabolism trigger a cascade of auto-inflammatory responses, leading to persistent morphological and functional disturbances. In this review, impaired calcium homeostasis is defined as a predictor of the development of hypersensitivity in cardiovascular diseases. We analyzed the development of a cardiovascular pathology (atherosclerosis, aortic valve calcification, and essential hypertension) with impaired calcium metabolism and pathological mechanisms that cause the disturbances. Calcium sensors, polymorphic variants of genes, and hormones involved in calcium metabolism can reveal the features of calcium metabolism and contribute to a personalized approach to treatment of cardiovascular diseases.

BACKGROUND AND PURPOSE: Arterial sclerosis resulting from hypertension slows CSF transportation in the perivascular spaces, showing the intrinsic relationship between the CSF and the blood vasculature. However, the exact effect of hypertension on human CSF flow dynamics remains unclear. The present study aimed to evaluate CSF flow dynamics in treatment-naive patients with essential hypertension using phase-contrast cine MR imaging. MATERIALS AND METHODS: The study included 60 never-treated patients with essential hypertension and 60 subjects without symptomatic atherosclerosis. CSF flow parameters, such as forward flow volume, forward peak velocity, reverse flow volume, reverse peak velocity, average flow, and net flow volume, were measured with phase-contrast cine MR imaging. Differences between the 2 groups were assessed to determine the independent determinants of these CSF flow parameters. RESULTS: Forward flow volume, forward peak velocity, reverse flow volume, reverse peak velocity, and average flow in the patients with hypertension significantly decreased (all, P

Introduction. Chronic kidney disease (CKD) is commonly diagnosed in patients with cardiovascular diseases (CVDs) and also manifests itself in most patients with urolithiasis. Numerous studies have shown that renal dysfunction is not only directly related to the high risk of developing various CVDs and chronic heart failure (CHF) as one of the most common complications but also the mortality rate in comorbid patients. CKD and CHF have similar pathogenetic mechanisms and common target organs; co-existing, both pathological conditions accelerate the progression of major diseases and significantly aggravate their course. In patients with recurrent nephrolithiasis combined with CVDs, all the causes leading to the formation of CKD (recurrent obstructive pyelonephritis, nephroangiosclerosis, etc.) are present to some extent.Purpose of the study. To evaluate the incidence and characteristics of CKD in patients suffering from recurrent urolithiasis associated with CVDs.Materials and methods. The prospective study included 406 patients who were treated for recurrent nephrolithiasis and concomitant CVDs from 2007 to 2020 (Urology Division, Burdenko Principal Military Clinical Hospital). From long-term follow-up respondents who lived at least 10 years after inclusion in the study (n = 52), three groups were formed: group I (n = 18) included patients with a combination of essential hypertension (EH) and ischemic heart disease (IHD), complicated by CHF; group II (n = 15) consisted of patients with uncomplicated CVDs (EH – 7 patients, IHD – 8 patients). The control group III (n = 19) included respondents suffering from nephrolithiasis without CVDs. The glomerular filtration rate (GFR) was determined by the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) following the Russian National Guidelines for «Chronic Kidney Disease». The analysis of the obtained data was carried out using Statistica 8.0; the Fisher and Wilcoxon criteria were calculated; the differences were considered significant at p < 0.05.Results. All patients included in the study were repeatedly hospitalized urgently and as planned and underwent at least one non-invasive manipulation or surgery. The average age of the patients was 58.9 ± 2.95 years; men predominated (~ 75 – 78%). A GFR decrease was recorded in 41.1% of patients included in the study, in 40.5% of patients with a combination of nephrolithiasis and uncomplicated CVDs, Also, its decrease was found in 60 (58.8%) of patients with chronic heart failure (CHF) in 41.1% of cases from the general sample and 40.5% of patients without CHF. CKD stage II occurred in 44 (43.1%) cases of CHF; CKD stages III Ca and Cb were detected in 10 (9.8%) and 4 (1%) cases, respectively; CKD stage IV developed in 1 (0.25%) patient with one of the re-hospitalizations. Of the 52 patients included in the second study part, the ratio of men and women was 41/11 (78.8 and 21.2%, respectively). All three groups were also dominated by men. The initial values of GFR in group I patients significantly differed from those in the control group; in group II, statistically significant differences appeared 4 years after the s the study initiation, and in group I – after 2 years. A sharp (1.5-fold) significant decrease in renal filtration function was registered in group I by the 6th research year, in group II (1.3-fold) – by the 8th research year, and in group III (1.28-fold) – only by the 10th research year. The GFR level in group I and group II decreased during the 1st follow-up year by 2.36 and 1.65 times, respectively.Conclusion. CKD in patients suffering from recurrent nephrolithiasis in combination with IHD and EH is generally benign. The progression rate of filtration deficiency is relatively low and is (at least in the early stages) about 4.5 ml/min per year. The addition of CHF increases the rate of decline in renal filtration function by up to 25% (from 4 ml/min per year to 5 ml/min per year). The main negative effect of concomitant CVDs (especially complicated CHF) is not an ultrahigh decrease in GFR but a reduction in kidney functioning stable period up to complete cessation.

Hypertension is a most common cardiovascular disorder posing a major public health challenge to the population. Many factors e.g. heredity, obesity, sedentary habits, stressful life and many more makes a person prone to develop hypertension. Homoeopathy is a holistic system of treatment; it works on individuality of every patient. So, there is no medicine for hypertension, but for the patient. There is a wider scope for the hypertensive patient and homoeopathy works effectively on many accompanying complaints with hypertension and hypertension itself.

The aim of the study was to compare blood pressure and electrocardiogram indices, assessed by their daily monitoring, and anamnestic data on mild traumatic brain injury between a group of patients with essential hypertension ≥6 months after a hemorrhagic stroke and a group of patients with essential hypertension without complications. Materials and methods. The total number of examined patients was 198 people, who were divided into 2 groups: the main (n = 94; age – 54,4±8,8 years, M±σ years) and the control (n = 104; age – 53,7±8,9 years) one. Patients in the main group suffered a hemorrhagic stroke as a complication of essential hypertension ≥6 months ago. The control group included patients with essential hypertension, stage II. In both groups of patients, the parameters of 24-hour ambulatory blood pressure monitoring and electrocardiogram were determined. Results. The indices of 24-hour ambulatory blood pressure monitoring in the main group and the control group were the following ones, respectively: the mean daytime systolic blood pressure was 109,6±1,6 and 121,1±1,1 mm Hg, the minimal one was 74,4±2,0 mm Hg and 82,3±12,5 mm Hg, and the maximal one was 168,2±1,9 and 161,9±1,7 mm Hg, p

Эссенциальная гипертензия по-прежнему представляет собой наиболее распространенный фактор риска сердечно-сосудистой системы, отвечающий за большую часть глобального бремени заболеваний во всем мире. Антигипертензивная терапия, направленная на снижение уровня артериального давления (АД) в рекомендованных терапевтических целях, доказала снижение риска развития сердечно-сосудистых, цереброваскулярных и почечных осложнений. Несмотря на эти доказательства, общий уровень контроля АД остается достаточно низким в большинстве европейских и западных стран, а также в развивающихся странах, что способствует увеличению расходов на лечение и инвалидность, связанных с гипертензией. По этим причинам превентивные стратегии, направленные на улучшение уровня контроля АД у больных артериальной гипертензией (АГ), которые принимают медикаментозную терапию, и снижение АД при его высоком нормальном уровне у бессимптомных здоровых лиц могут способствовать уменьшению бремени заболеваний, связанных с гипертензией. С этой точки зрения было показано, что использование определенных питательных веществ и пищевых добавок может обеспечить благоприятные эффекты в лечении и контроле АГ, вне приема фармакологических препаратов и нефармакологических вмешательств. Их применение может эффективно и безопасно снижать уровень АД до целевых показателей и предотвращать прогрессирование заболевания с высокого нормального уровня АД к гипертензии 1-й степени. В этом консенсусном документе представлены систематический обзор и критический анализ имеющихся в настоящее время доказательств в пользу использования питательных веществ и пищевых добавок у лиц с высоким нормальным уровнем АД при различных степенях сердечно-сосудистого риска.

Актуальность. На сегодняшний день существуют данные о влиянии повышенного индекса массы тела (ИМТ) на развитие когнитивных нарушений (КН). Цель: оценить роль повышенного артериального давления (АД) и ИМТ в возникновении КН у пациентов с гипертонической болезнью (ГБ). Материалы и методы. В исследование включены 62 пациента (1-я группа) с ГБ II–III стадии 2–3-й степени и 30 практически здоровых лиц (2-я группа) с нормальным уровнем АД. Пациенты 1-й группы были разделены на две подгруппы: 1А подгруппу составили 38 больных с ГБ и повышенным ИМТ, 1Б подгруппу — 24 больных с ГБ и нормальным ИМТ. Для изучения когнитивных функций применялась краткая шкала исследования психического статуса (MMSE). Результаты. Средний балл по шкале MMSE составил 26,9 ± 1,5 и 28,8 ± 1,1 у пациентов 1-й и 2-й группы соответственно, что свидетельствует о достоверном ухудшении когнитивных функций у пациентов с ГБ (p

Annotation. In recent decades, the number of studies on the role of known and new biomarkers in the diagnosis of cardiovascular problems, among which your place is in the family of natriuretic peptides, has been growing for a long time. However, one of its representatives, vascular natriuretic peptide (CNP), has been restored, and the question of determining its final role still remains open. The aim of the study was to supplement the data on the possibility of using CNP as a biomarker of structural and functional changes in the myocardium in uncomplicated and complicated essential hypertension (EH) in postmenopausal women with polymorphic variants of the BNP gene. We examined 180 women aged 40-65 living in the Podillia region of Ukraine: 62 women with uncomplicated EH with left ventricular hypertrophy (LVH), 51 women with EH complicated by chronic heart failure (CHF), and 67 women without symptoms cardiovascular pathology, which formed the control group. All patients underwent a standardized general clinical, instrumental and laboratory examination. Genotyping of the BNP gene was performed by polymerase chain reaction. Plasma concentrations of natriuretic peptide were determined by plate solid-phase enzyme-linked immunosorbent assay. Mathematical processing was performed using the standard statistical package Statistica 10.0, using parametric and nonparametric statistical methods. The frequency of distribution of polymorphic gene variants in the population was checked according to the Hardy-Weinberg equilibrium. It was found that among the polymorphic variants of the BNP gene in women aged 40-65 years, the frequency of carriers of the T381C genotype and C allele significantly prevails, while inheriting a certain type of polymorphic variant of the BNP gene does not affect the concentration of CNP in blood plasma in all examined groups. Significantly the highest level of plasma concentration of CNP, which was 6.63±0.13 pmol/ml, was determined in members of the group with EH complicated by CHF. In groups of women with both uncomplicated EH and EH complicated by CHF, BMI is inversely correlated with plasma CNP levels.

The review article includes information on data on the treatment of patients with essential hypertension and manifestations of metabolic syndrome and their effectiveness in preventing the development of long-term complications of COVID-19. The pandemic of acute respiratory syndrome caused by SARS-CoV-2 requires changes in the approach to the treatment and prevention of metabolic syndrome and essential hypertension, as the presence of these comorbidities worsens the course and prognosis of infectious disease. Some pathogenetic links have been identified that affect these pathological conditions. Emphasis is placed on the key role of a balanced and healthy diet, as a component of a healthy lifestyle, in maintaining the optimal functional state of the cardiovascular system. It is also noted that the course of infectious disease caused by SARS-CoV-2 in patients with metabolic syndrome is more severe and more often leads to complications. Since COVID-19 is recognized as a multi-organ disease with a wide range of manifestations and long-term symptoms, data on the course of this disease in patients with hypertension and metabolic syndrome were analyzed. Endothelial dysfunction is highlighted as one of the pathogenetic links that combines essential hypertension, insulin resistance and atherosclerosis, and options for its correction are considered. Standards for the treatment of essential hypertension and metabolic syndrome in view of the COVID-19 pandemic are presented. Information on the ability of statins to increase glycemia with long-term use, especially in patients with metabolic syndrome, is given. Conclusion. A number of drugs that have antioxidant, vasodilator and anti-inflammatory properties that do not cause an increase in glycemia, including quercetin, have been proposed. Its positive effect on the level of blood pressure has been revealed, which implies its use as an adjunct to antihypertensive therapy. The combination of quercetin and vitamin C is considered as an adjunct to basic therapy for COVID-19 disease and its long-term complications. Further studies are planned to determine the clinical value of quercetin supplements in therapy of essential hypertension, rehabilitation of patients after COVID-19, stabilization of dyslipidemia and insulin resistance, as well as dose adjustment and study of possible drug interactions between quercetin and antihypertensive drugs

Background: To evaluate the prevalence of microalbuminuria in patients with essential hypertension and its relationship to severity of hypertension, to renal function and its association with coronary artery disease and target organ damage, present study was conducted. Materials and Methods: Total 100 primary hypertensive, non diabetic patients and 25 healthy normotensive, non diabetic patients (controls) admitted in S.S.G.H (Sir Sayajirao General Hospital) from June 2009 to November 2011. Patient's complete history, routine investigation along with microalbuminuria was measured by ACR by immunoturbidimetric method. Results: In present study patient’s mean age was 52.7 years. Total 70% of patients selected for study were males and 30% were females. Total 50% to 75% of patients in the 61 -80 year age group were positive for microalbuminuria. Total 42.85% of males were positive for microalbuminuria as compared to 33.33% of females. Total 75% of patients having hypertension for more than 8 years had microalbuminuria. Total 67.5% of patients positive for microalbuminuria had associated target organ damage. Total 45% of patients positive for microalbuminuria had left ventricular hypertrophy and 40% of patients had hypertensive retinopathy. Conclusion: Microalbuminuria helps to identify incipient nephropathy and vascular changes. Its detection can thus help to prevent the development of complications by aggressive treatment to get down targeting blood pressure. Keywords: Microalbuminuria, Hypertension, Hypertensive Retinopathy, Left Ventricular Hypertrophy.

Hypertension is responsible for many morbidities and increasing mortality in India. A lot needs to be done to find safe and yet effective treatment of hypertension. Ayurveda has no direct reference of blood pressure or hypertension in its classics, but various conditions mentioned in classical texts resembles hypertension. A poly herbal combination of ten Ayurvedic herbs called “Shamak Yoga” was in use in Pakwasa hospital, Nagpur for more than twenty five years for management of hypertension along with anxiety, palpitation and insomnia. Objective- To evaluate the effect of Shamak Yoga (SY) on essential hypertension in comparison of Atenolol. Material and Methods – thirty four clinically freshly diagnosed patients of hypertension were randomly divided in two groups. Control group was treated with Tablet Atenolol 50 mg once a day orally and experimental group was treated with SY 2 gm orally twice a day with plain water for 4 weeks. Subjective criteria and objective criteria were observed and recorded; data was analyzed statistically. Results - SY was found comparable and statistically significant effective with Atenolol for systolic and diastolic blood pressure in mild hypertensive patients. SY is most effective on symptoms like headache, giddiness, fatigue, dizziness, sleeplessness, body ache and palpitation.

У статті патогенетично обґрунтовано доцільність застосування методики визначення функціонального ниркового резерву шляхом проведення водно-сольового навантаження 0,5% розчином хлориду натрію в кількості 0,5 % від маси тіла в пацієнтів, які страждають від хронічної хвороби нирок. Показано інформативність визначення величини функціонального ниркового резерву в клінічній нефрології на прикладі хворих на артеріальну гіпертензію, цукровий діабет, СНІД для визначення характеру та ступеня пошкодження нефронів.

In recent decades, numerous scientific works are devoted to the study of the clinical and prognostic significance of albuminuria, methods of its detection, as well as treatment measures aimed at controlling this pathological condition. The objective of this work was to determine the features of changes of plasma hemostasis in patients with essential hypertension (EH), depending on the presence of albuminuria. Materials and methods. We have exa-mined 113 people: 14 apparently healthy ones (group 1, controls), 41 patients with EH stage II with concomitant albuminuria (group 2), 58 patients with EH stage II without concomitant albuminuria (group 3). We have conducted laboratory studies: measured activated partial thromboplastin time, prothrombin index, thrombin time, fibrinogen, soluble fibrin monomer complex (SFMC), time of XIIa-dependent fibrinolysis, antithrombin III, protein C. Results. There was found an increased content of SFMC, which in patients from group 3 was 135 % higher, and in patients of group 2 — 247 % higher than reference values. At that, in patients with albuminuria, this index was much higher even than in individuals with EH without albuminuria — exceeded by 48 %. Time of XIIa-dependent fibrinolysis in both group 2 and 3 was much longer than normal one. Expressed changes occurred in the system of natural anticoagulants, which were statistically significant in relation to the control group only in patients with albuminuria, and in the group of patients without albuminuria they were not significantly different from the control group. Conclusions. Patients with essential hypertension, regardless of the severity of albuminuria, showed a significant inhibition of fibrinolytic activity of the blood and activation of the last units of blood clotting — fibrin formation. Albuminuria was associated with a more significant activation of fibrin formation and was combined with inhibition of own anticoagulant activity of the blood, as evidenced by the decrease in the content of antithrombin III and protein C.

Elevated blood pressure (BP), or hypertension, is the main risk factor for cardiovascular disease. As a multifactorial and systemic disease that involves multiple organs and systems, hypertension remains a challenging disease to study. Models of hypertension are invaluable to support the discovery of the specific genetic, cellular and molecular mechanisms underlying essential hypertension, as well as to test new possible treatments to lower BP. Rodent models have proven to be an invaluable tool for advancing the field. In this review, we discuss the strengths and weaknesses of rodent models of hypertension through a systems approach. We highlight the ways how target organs and systems including the kidneys, vasculature, the sympathetic nervous system (SNS), immune system and the gut microbiota influence BP in each rodent model. We also discuss often overlooked hypertensive conditions such as pulmonary hypertension and hypertensive-pregnancy disorders, providing an important resource for researchers. LINKED ARTICLES: This article is part of a themed issue on Preclinical Models for Cardiovascular disease research (BJP 75th Anniversary). To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v179.5/issuetoc.

The use of glycated hemoglobin for diabetes mellitus (DM) diagnosis is recommended by World Health Organization as of 2011. The level of glycated hemoglobin (HbA1c) ≥ 6.5 % is a diagnostic criterion for DM but HbA1c level of 6.0–6.4 % does not exclude diabetes mellitus diagnosis with hyperglycemia. Moreover, when diagnosing, evaluation of this criterion is a must, since decision about the nature and the scope of sugar-reducing therapy is based on the level of HbA1c. Counterregulatory hormones are glucagon, adre­nalin, somatotropin, glucocorticoids and thyroid hormones. Pathogenic mechanism of carbohydrate metabolism disorders with hypersecretion of counterregulatory hormones is caused by peripheral insulin resistance, decrease in insulin secretion, increase in gluconeogenesis and glycogenolysis in liver and increase in the absorption of intestinal glucose with insulin being the only hormone decreasing the blood glucose. So, the endocrine diseases (hypercorticism, acromegalia, pheochromocytoma, hyperparathyroidism and hyperthyroidism) with excessive secretion of counterregulatory hormones suggest the necessity of secondary diabetes diagnosis. Screening tests with quite high sensitivity and specificity have been developed for early diagnosis of endocrynopathies. Screening tests for hypercorticism diagnosis are dexamethasone (1 mg) suppression test, daily urinary cortisol excretion and nighttime salivary cortisol. Optimal test for screening acromegalia is considered to be insulin-like growth factor 1 which shows the secretion of somatotropic hormone during previous day and is not subject to significant fluctuations. One-time detection of increased insulin-like growth factor 1 level compared to referential values for specific sex and age is enough for confirmation of hypersomatotropinemia. Thyroid-stimulating hormone is recommended as a screening test for thyrotoxicosis diagnosis. When choosing this test, doctor should consider the parameter of analytical sensitivity of test system for thyroid-stimulating hormone. Screening for hyperparathyroidism is the detection of blood ionized calcium level. This examination is particularly relevant for patients from risk group for initial hyperparathyroidism — patients with gallstone disease, urolithiasis, stomach ulcer and/or duodenal ulcer, essential hypertension, etc. Free metanephrines of blood plasma and conjugated urine metanephrines are the screening tests for pheochromocytoma diagnosis. The level of methylated secondary catecholamines (metanephrines, normetanephrines) shows the daily tumor activity of pheochromocytoma. Thus, glycemic screening and endocrynopathies screening with hypersecretion of counterregulatory hormones should be conducted together. This will allow detecting secondary forms of diabetes mellitus and compensating glycemic state of the patient.

Recent evidence supports a role for the gut microbiota in hypertension, but whether ambulatory blood pressure is associated with gut microbiota and their metabolites remains unclear. We characterized the function of the gut microbiota, their metabolites and receptors in untreated human hypertensive participants in Australian metropolitan and regional areas. Ambulatory blood pressure, fecal microbiome predicted from 16S rRNA gene sequencing, plasma and fecal metabolites called short-chain fatty acid, and expression of their receptors were analyzed in 70 untreated and otherwise healthy participants from metropolitan and regional communities. Most normotensives were female (66%) compared with hypertensives (35%, P Acidaminococcus spp ., Eubacterium fissicatena, and Muribaculaceae were higher, while Ruminococcus and Eubacterium eligens were lower in hypertensives. Importantly, normotensive and essential hypertensive cohorts could be differentiated based on gut microbiome gene pathways and metabolites. Specifically, hypertensive participants exhibited higher plasma acetate and butyrate, but their immune cells expressed reduced levels of short-chain fatty acid-activated GPR43 (G-protein coupled receptor 43). In conclusion, gut microbial diversity did not change in essential hypertension, but we observed a significant shift in microbial gene pathways. Hypertensive subjects had lower levels of GPR43, putatively blunting their response to blood pressure-lowering metabolites.

Loss of cardiomyocytes due to apoptotic or necrotic death is an important component of the pathogenesis of heart failure. Initiation of apoptosis by the mitochondrial pathway depends on the balance between proapoptotic and antiapoptotic factors, in particular, Bax and Bcl-2. Cardiomyocyte apoptosis in essential hypertension is studied in sufficient details. At the same time, apoptotic processes in the myocardium in diabetes mellitus alone and in combination with essential hypertension remain poorly understood. Here we studied the expression of Bax and Bcl-2 in the left ventricular cardiomyocytes of 38-week-old male Wistar-Kyoto rats and 38- and 57-week-old SHR rats with essential hypertension, diabetes mellitus, and a combination of these pathologies. Insulin-dependent diabetes mellitus was modelled by a single parenteral administration of streptozotocin in a dose 65 mg/kg. Expression of Bax and Bcl-2 was assessed by the immunohistochemical method. In essential hypertension and diabetes mellitus, the apoptotic processes in the ventricular myocardium were enhanced, as is seen from the increase in the content of the proapoptotic factor Bax and a decrease in the expression of the antiapoptotic factor Bcl-2. However, in case of combined pathology, Bax content increased less markedly, while the expression of antiapoptotic Bcl-2 was significantly increased.

Serum transforming growth factor-beta [TGF-beta1] production was estimated for 10 patients with essential hypertension, 12 patients with glomerulonephritis [5 hypertensive and 7 normotensive] and 10 healthy controls. The glomerulonephritis group received angiotensin-converting enzyme inhibitor captopril 25-75 mg/day for 4 weeks. Blood urea, serum creatinine, 24-hour urinary protein and serum TGF-beta1 were then re-estimated. Urea and creatinine were significantly higher in the hypertension and glomerulonephritis groups than in the controls and also higher in the glomerulonephritis group than the hypertension group. TGF-beta1 was significantly higher in the glomerulonephritis groups than in the control and hypertension groups. TGF-beta1 and 24-hour urinary protein were significantly reduced in the glomerulonephritis group

Hypertension is a complex disease which is mainly influenced by genetic factors. Recently, genome-wide association study (GWAS) found three novel endothelial dysfunction-related sites: Vascular endothelial growth factor A (VEGFA) rs9472135, Faciogenital dysplasia 5 (FGD5) rs11128722, Zinc Finger C3HC-type Containing 1 (ZC3HC1) rs11556924. Endothelial dysfunction is one of the early events in pathophysiology of essential hypertension. To investigate the association of endothelial dysfunction-related genes with essential hypertension, we conducted a case-control study of 431 patients with hypertension and 345 controls. The polymorphisms were detected using Taqman Probe. The alleles and genotypes of ZC3HC1 rs11556924 and VEGFA rs9472135 were not statistically different between the two groups, while the allele of FGD5 rs11128722 was different [P = 0.045, OR = 1.265, 95% CI = (1.009–1.586)], especially in the male [P = 0.035, OR = 1.496, 95% CI = (1.037–2.158)]. Analyzing the different of genotype distribution of 3 SNPs in the two groups under different genetic models, the genotypes of FGD5 rs11128722 showed difference in male under dominant model [P = 0.049, OR = 1.610, 95% CI = (1.018–2.544)]. The polymorphism of FGD5 rs11128722 had a significant difference in Body Mass Index (BMI) among different genotypes; In the additive genetic model, BMI of GA genotype was higher than that of GG (P = 0.038); GA + AA was higher than GG in the dominant genetic model (P = 0.011). In our study, we found that the polymorphisms of VEGFA rs9472135 and ZC3HC1 rs11556924 may not significantly associated with the risk of essential hypertension, and FGD5 rs11128722 may increase the risk of it, especially in elderly men.

BACKGROUND: Middle meningeal artery embolization (MMAE) has been used as an effective minimally invasive treatment for chronic subdural hematomas (cSDH). The demographics and clinical outcomes after MMAE treatment for cSDH have not yet been studied using the large scale of a national database. METHODS: We queried all MMAE cases up to October 7(th), 2020, from the TriNetX Analytics Network. We identified patients >18 years old who underwent MMAE for the treatment of cSDH. Patient demographics, baseline characteristics, comorbidities, and clinical outcomes were evaluated within 180 days post-MMAE. 180-day mortality and recurrence analyses were performed after propensity score matching to control for baseline characteristics and comorbidities. RESULTS: A total 191 patients were included (mean age: 71.2 ± 13.5, 73.3% male, 69.6% White, 13.6% Black/African American, and 16.8% other). Essential hypertension (71.3%), heart disease (62.8%), type 2 diabetes mellitus (27.2%), nicotine dependence (23.6%), chronic kidney disease (19.4%), and overweight/obesity (19.4%) were among the most prevalent comorbidities. At presentation, 20.4% and 40.3% were on antiplatelet and anticoagulation therapy, respectively. Outcomes within a 180-day follow-up were 6.3% (or 1.0–5.8% when propensity-matched) for mortality (12 patients), 7.3% for craniotomy/craniectomy after MMAE (14 patients), 0.52–5.2% for burr hole procedures (1–10 patients), and no patients with low vision/blindness. CONCLUSION: MMAE is a safe and effective minimally invasive procedure for the treatment of cSDH. This represents the first analysis of patients undergoing MMAE for cSDH using a national database.

Aims Digital therapeutics is a new approach to facilitate the non-pharmacological treatment of hypertension using software programmes such as smartphone applications and/or device algorithms. Based on promising findings from a small pilot trial, the HERB Digital Hypertension 1 (HERB-DH1) pivotal trial investigated the efficacy of digital therapeutics in patients with hypertension not receiving antihypertensive medication. Methods and results This prospective, open-label, randomized controlled study was performed at 12 sites in Japan. Patients with hypertension [office systolic blood pressure (SBP) 140 to, Graphical Abstract

Literature data concerning the role of endothelium and nitric oxide in the pathogenesis of cardiovascular diseases, administration of L-arginine as a part of a comprehensive therapy of patients suffering from essential hypertension (EH) and ischemic heart disease (IHD) are cited.Objective: to systematize current literature data concerning the role of endothelium and nitric oxide in the pathogenesis of cardiovascular diseases, clinical experience of L-arginine administration in patients with EH and IHD. Conclusion. Nowadays endothelial dysfunction conception is defined with insufficient production of nitric oxide as a central part of EH and IHD pathogenesis. Nitric oxide deficiency occurring with cardiovascular diseases can be compensated by means of NO donors.

Isolated systolic hypertension is the most common hemodynamic form of hypertension in the elderly. With a rapidly aging population, the prevalence of hypertension, particularly isolated systolic hypertension, is increasing steadily. Isolated systolic hypertension is associated with substantial mortality and morbidity, particularly of cerebrovascular disease. It is a rapidly growing public health concern and its management continues to remain a challenge to practicing physicians. Recent studies like the Systolic Blood Pressure Intervention Trial (SPRINT) and Heart Outcomes Prevention Evaluation (HOPE)-3 have implications for antihypertensive therapy in general and for the management of isolated systolic hypertension in particular. Keywords: Hypertension, Cardiovascular disease, Isolated Systolic Hypertension, Essential hypertension

BACKGROUND Mitochondrial DNA (mtDNA) pathogenic variants have been identified to be associated with maternally inherited essential hypertension (MIEH). However, the distinctive clinical features and molecular pathogenesis of MIEH are not fully understood. METHODS In this study, we collected a Chinese MIEH family with extraordinary higher penetrance of essential hypertension (88.89%) and early ages of onset (31–40 years old), and performed clinical and genetic characterization for this family. The complete mitochondrial genome of the proband was sequenced and analyzed. RESULTS The maternally related members in this family were presented with severe increased blood pressure, left ventricular remodeling, and metabolic abnormalities. Through sequencing the entire mtDNA of the proband and performing systematic analysis of the mtDNA variants with a phylogenic approach, we identified a potentially pathogenic tRNA variant (m.15992A>G in the MT-TP gene) that may account for the MIEH in this family. One nonsynonymous variant (m.15077G>A in the MT-CYB gene) was identified to play a synergistic role with m.15992A>G to cause a high penetrance of MIEH. CONCLUSIONS Our results, together with previous findings, have indicated that tRNA pathogenic variants in the mtDNA could act important roles in the pathogenesis of MIEH through reducing mitochondrial translation and disturbing mitochondrial function.

Objective: In Indian hypertensive patients, to investigate the prevalence and characteristics of the MS was the main objective of the present study. Material and Method: Current study was conducted in a tertiary care OPD among 130 patients who were diagnosed with essential hypertension. Any patients who were more that 18 years of age and diagnosed with essential hypertension and willing to participate in the study were included. By routine laboratory techniques which is generally used at NABL accredited private or government testing laboratories for analysis of lipid profile total cholesterol, total triglycerides, low-density lipoprotein cholesterol and high density lipoprotein cholesterol were assayed. Result: Average MS score were high in both the male and female group. Both male and female groups patients receives adequate blood pressure lowering treatment. In both the groups maximum patients were in ARB therapy. All parameters which are related to occurrence of metabolic syndrome like, abdominal obesity, Total Cholesterol (TC), Triglycerides (TG), Low Density Lipoprotein (LDL), fasting blood glucose (FBG) and uric acids were significantly higher in both male and female patients than the control one. Conclusion: Current study conclude that, in Indian hypertensive patients, especially in females, metabolic syndrome was highly prevalent. Keywords: Metabolic syndrome, metabolic risk factors, hhypertension

Background: There has been controversy regarding the association between primary aldosteronism (PA) and dyslipidemia and few studies considered the effects of diabetes and renal function on lipid metabolism. We analyzed lipid profiles of PA patients and compared them to propensity-score (PS)-matched essential hypertension (EH) patients adjusting for glycemic status and renal function.Methods: Patients who were diagnosed with PA using a saline-infusion test at Seoul National University Hospital from 2000 to 2018 were retrospectively analyzed. EH patients who had aldosterone-renin ratio (ARR) results were selected as controls. Covariates, including diabetes, were PS-matched for patients with PA, lateralized PA, non-lateralized PA, and high ARR to EH patients, respectively.Results: Among a total of 80 PA and 80 EH patients, total cholesterol (TC) and triglyceride (TG) levels were significantly lower in the PA patients than in the EH patients (least-squares mean±standard error: 185.5±4.4 mg/dL vs. 196.2±4.4 mg/dL, P=0.047, for TC; and 132.3±11.5 mg/dL vs. 157.4±11.4 mg/dL, P=0.035, for TG) in fully adjusted model (adjusting for multiple covariates, including diabetes status, glycosylated hemoglobin level, and estimated glomerular filtration rate). There were no significant differences in high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol levels between the two groups. According to increments in aldosterone levels, an increasing tendency of HDL-C and decreasing tendencies of TG and non-HDL-C were observed.Conclusion: PA patients had lower TC and TG levels than EH patients, independent of glycemic status and renal function.

Although numerous clinical and experimental studies have clearly identified a sexual dimorphism in blood pressure control, the mechanism(s) underlying gender differences in blood pressure remain unclear. Over the past two decades, numerous laboratories have utilized the spontaneously hypertensive rats (SHR) as an experimental model of essential hypertension to increase our understanding of the mechanisms regulating blood pressure in males and females. Previous work by our group and others have implicated that differential regulation of adrenergic receptors, the renin–angiotensin system, oxidative stress, nitric oxide bioavailability and immune cells contribute to sex differences in blood pressure control in SHR. The purpose of this review is to summarize previous findings to date regarding the mechanisms of blood pressure control in male versus female SHR.

The rapid progression of chronic kidney disease and higher incidence of cardiovascular complications are well known in patients with hyperaldosteronism. However, detailed renal histopathologic characteristics of this disease have remained unknown. Therefore, renal biopsy specimens of 19 cases with unilateral hyperaldosteronism were compared with 22 autopsy renal cases of estimated glomerular filtration rate-matched essential hypertension without nephropathy or endocrine disorders to explore the hyperaldosteronism-specific histopathologic renal changes in this study. Global and segmental glomerulosclerosis, interstitial fibrosis, infiltration of inflammatory cells, arteriosclerosis, hyalinization of arterioles and immunoreactivity of mineralocorticoid receptor, 11β-hydroxysteroid dehydrogenase type 1 and 2, and renin were all quantitatively evaluated. The ultrastructural analysis was added in 3 hyperaldosteronism cases. Both mineralocorticoid receptor ( P P P P P =0.08). Glomerular size was significantly larger in hyperaldosteronism ( P P =0.08), and intima-to-media ratio was significantly lower ( P =0.02) in hyperaldosteronism. Arteriolar hyalinization was significantly more pronounced ( P P

Fibroids are benign tumors caused by the proliferation of myometrial smooth muscle cells in the uterus that can lead to symptoms such as abdominal pain, constipation, urinary retention, and infertility. While traditionally thought of as a disease process intrinsic to the uterus, accumulating evidence suggests that fibroid growth may be linked with the systemic vasculature system, although cell-intrinsic factors are certainly of principal importance in their inception. Fibroids are associated with essential hypertension and preeclampsia, as well as atherosclerosis, for reasons that are becoming increasingly elucidated. Factors such as the renin–angiotensin–aldosterone system, estrogen, and endothelial dysfunction all likely play a role in fibroid pathogenesis. In this review, we lay out a framework for reconceptualizing fibroids as a systemic vascular disorder, and discuss how pharmaceutical agents and other interventions targeting the vasculature may aid in the novel treatment of fibroids.

Background: A study titled ‘Integration of AYUSH (Ayurveda) with National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS)’ implemented in India in three districts of three states, namely Bhilwara (Rajasthan), Gaya (Bihar), and Surendranagar (Gujarat) since 2015 for the management of various non-communicable diseases (NCDs) through integrated approach. Objective(s): To evaluate the effect of Ayurveda medication, lifestyle modification, and Yoga in integration with standard care for the management of essential hypertension. Material and methods: A retrospective analysis of the demographic and clinical records available from NPCDCS-AYUSH Integration Project was done. The data of participants with Essential Hypertension (EHTN), aged between 30 and 60 years, who had completed six months integrated management as per the treatment protocol of the NPCDCS-AYUSH Integration project between July 2018 and March 2019 were taken and distributed in two groups based on their intervention. Those advised for lifestyle modification and Yoga in addition to standard care with any of the five medicines/combinations i.e. Amlodipine or Atenolol or Amlodipine + Atenolol or Losartan or Telmisartan were assigned Group I and those who were given Ayurveda medication, lifestyle modification and Yoga in addition to standard care were assigned to Group II. The change in blood pressure was analysed and dose reduction/discontinuation of conventional medications was also observed. Results: Data of 1938 participants who had completed treatment under the NPCDCS program was analysed. At the 6th month, systolic and diastolic blood pressure was significantly reduced (P

Background-Essential hypertension is a multifactorial disease of unknown etiology characterized by a chronic elevation of blood pressure without any secondary causes. Nitric oxide and hydrogen sulfide are vasodilatory gasotransmitters whose deficiency results in endothelial dysfunction and vasoconstriction and hence is one of the etiological factors in the development of hypertension. Aims and Objectives – The study aimed to estimate the serum levels of NO and H₂S and to find out their correlation in essential hypertension cases and normotensive controls. Materials and Methods- Serum levels of NO and H₂S were measured using chemical methods, in fifty patients with essential hypertension and compared with fifty age-matched controls. Results- The mean serum NOx level in essential hypertension cases is 45.45 ± 11.09 µmol/L which is significantly lower (p-value