1,126 results on '"End organ damage"'
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2. Carotid Artery Stiffness Mechanisms Are Associated With End Organ Damage and All‐Cause Mortality: MESA (Multi‐Ethnic Study of Atherosclerosis)
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Ryan Pewowaruk, Claudia Korcarz, Ian De Boer, Bryan Kestenbaum, Susan R. Heckbert, Yacob G. Tedla, and Adam D. Gepner
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chronic kidney disease ,dementia ,end organ damage ,vascular stiffness ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Arterial stiffness can be separated into 2 main mechanisms: (1) load‐dependent stiffening from higher blood pressure and (2) structural stiffening due to remodeling of the vessel wall. The relationship between stiffness mechanisms and end organ damage is unknown. Methods and Results MESA (Multi‐Ethnic Study of Atherosclerosis) participants with carotid ultrasound were included in this study (n=6147). Carotid pulse wave velocity (cPWV) was calculated to represent total stiffness. Structural stiffness was calculated by adjusting cPWV to a 120/80 mm Hg blood pressure with participant‐specific models. Load‐dependent stiffness was the difference of total and structural stiffness. Associations with incident chronic kidney disease (CKD), dementia, and mortality were assessed with adjusted Cox models. During 14.3±4.8 years of follow‐up, 773 CKD events, 535 dementia events, and 1529 deaths occurred. Total cPWV was associated with mortality (hazard ratio [HR], per 1 m/s, 1.04 [95% CI, 1.01–1.08], P=0.02) and dementia (HR, 1.06 [95% CI, 1.01–1.12], P=0.03) but not CKD (HR, 1.03 [95% CI, 0.98–1.08], P=0.33). Structural cPWV was significantly associated with mortality (HR, 1.04 [95% CI, 1.00–1.08], P=0.04) but not CKD (HR, 1.00 [95% CI, 0.94–1.05], P=0.86) or dementia (HR, 1.06 [95% CI, 0.99–1.13], P=0.06). Load‐dependent cPWV was significantly associated with CKD (HR, 1.38 [95% CI, 1.17–1.63], P
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- 2023
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3. The role of triglyceride-glucose index in determining subclinical atherosclerosis in patients with primary hypertension.
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INAN, O., SAHINER, E. S., and ATES, I.
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OBJECTIVE: With the current study, we aimed at examining the relationship between the triglyceride-glucose (TyG) index and subclinical atherosclerosis in patients with primary hypertension. PATIENTS AND METHODS: 185 patients with primary hypertension were included in this study. The following findings were considered to be associated with target organ damage (TOD): urinary protein excretion > 150 mg/dL and microalbumin excretion > 30 mg/dL, carotid intima-media thickness (CIMT) ≥ 0.9 mm or carotid plaque and/or left ventricular mass index (LVMI) > 95 g/m2 in women, > 115 g/m2 in men. RESULTS: TyG index values were positively correlated with levels of CIMT (r=0.434; p<0.001), LVMI (r=0.351; p<0.001), microalbuminuria (r=0.347; p<0.001), and proteinuria (r=0.355; p<0.001). In the multivariable regression model, in which the variables associated with the presence of TOD were included, increased age (OR: 1.04, p=0.025), increased body mass index (OR: 1.10, p=0.042), and increased TyG index value (OR: 1.05, p<0.001) had independent associations with TOD. The threshold value of the TyG index for the presence of TOD was determined as > 8.85 with 79.0% sensitivity and 77.1% specificity (AUC±SE: 0.859±0.03, +PV: 70.6%, -PV: 84.0%, p<0.001). The TyG index had a superior diagnostic discrimination compared to its components in predicting the presence of TOD. CONCLUSIONS: Increased TyG index values in patients with primary hypertension are associated with damage to target organs, not merely subclinical atherosclerosis. [ABSTRACT FROM AUTHOR]
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- 2022
4. Leukocyte and lipid-based inflammation indices as predictors of asymptomatic organ damage in treatment-naive and newly diagnosed hypertension patients
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Mehmet Sait Altıntaş and İbrahim Taşkın Rakıcı
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Atherosclerosis ,end organ damage ,hypertension ,inflammation index ,Medicine - Abstract
Aim: Low-grade inflammation is known to facilitate the development of hypertensive organ damage. This study aimed to investigate the relationship between the leukocyte and lipid-based inflammation indices and asymptomatic organ damage (AOD) in treatment-naive and newly diagnosed hypertension patients (TNNDH). Methods: The study included 200 patients with TNNDH who are treating by the Cardiology Clinic and 100 healthy controls. Left venriculer mass index (LVMI) of >95 g/m2 in women and >115 g/m2 in men, and carotis intima media thickness (CIMT) of >0.9 mm or presence of plaque in the carotid artery and microalbuminuria of >30 mg/day were evaluated as AOD indicators. Platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), systemic immune-inflammation index (SII), monocyte to HDL ratio (MHR), and atherogenic index of plasma (AIP) levels were calculated based on the complete blood count. Results: Positive correlations were found between all inflammation indices and AOD indicators. AOD was detected in 66.7% of the TNNDH patients. The mean PLR (143.0±37.9 vs. 138.0±36.2; p
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- 2022
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5. Adding screening for "end organ damage" to the noncommunicable disease package in primary care.
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Sadanandan, Rajeev and Sivaprasad, Sobha
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MEDICAL screening , *NON-communicable diseases , *PRIMARY care , *SECONDARY care (Medicine) , *DIABETES complications , *DIABETIC retinopathy - Abstract
There are several global and local initiatives aimed at screening for noncommunicable diseases (NCD). The fundamental health system strengthening to achieve this goal is by developing the primary care infrastructure. Most newly developed or improved primary care centers focus on maintaining an NCD register for onward reporting. However, the register is also the cornerstone for implementing systematic screening of all complications of NCDs. With epidemiologic transition, end organ damage due to NCDs is one of the most common causes of morbidity and mortality. Screening for end organ damage and early identification of treatable complications are far more impactful than waiting for self-reported symptomatic complications. Here, we show an example of how the Government of Kerala utilized the NCD register to implement a systematic diabetic retinopathy screening that allows for annual or biennial re-call in the primary care and refer treatable eye conditions to secondary care. The success of this program enabled the Government to initiate a holistic approach to screen for other complications of diabetes. [ABSTRACT FROM AUTHOR]
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- 2021
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6. Status of end organ damage in newly detected hypertension, hypertension in thyroid disorders and knowledge and awareness of hypertension among physicians and public
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Ramachandran, Meenakshi Sundaram
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616.1 ,hypertension ,end organ damage ,EOD ,thyroid disorders ,Awareness ,LVH ,retinopathy ,microalbuminuria ,hypothyroid ,hyperthyroid - Abstract
Hypertension is associated with end organ damage (EOD). Since EOD is a risk factor for cardio- and cerebrovascular complications, it is a major requirement for these to be detected, prevented and treated. A total of 147 consecutive patients with newly-diagnosed essential hypertension and attending the outpatient clinic were included in this study based on a set of inclusion and exclusion criteria (patients with co-morbid illnesses were excluded from the investigation). Among them, 86% (70 male (M) and 56 female (F)) had one or more EODs, an observation which was very close to statistically significance (P=0.054). The presence of one or more EODs in newly-detected hypertension indicates widespread vascular damage which carries the high risk for cardio- and cerebrovascular morbidity and mortality. Although thyroid dysfunctions exert significant effects on blood pressure (BP), published literature available has revealed contradictory data. Objective of our study was to explore the inter-relationships between selected thyroid dysfunctional status (hyper and hypothyroid) and established biomarkers [thyroid stimulating hormone (TSH) and thyroxine (T4)]; and BP components [specifically Systolic BP (SBP), Diastolic BP (DBP), and Mean Arterial Pressure (MAP), and uniquely SBP:DBP ratio]. We followed rigid criteria in order to select adults with hyperthyroidism (n=71) and hypothyroidism (n=300), together with healthy age-matched controls (n =300), and applied a series of statistical analyses on the datasets acquired. We have observed thyroid dysfunctional status is associated with elevated BP, and increasing BP is positively-correlated with elevated serum thyroid biomarkers, hyper and hypothyroid disorders should be recognized and treated early in order to avoid critical hazards presented by high BP. Also, we have studied awareness among public and physicians in managing hypertension. Overall, the levels of knowledge and awareness among both groups are sub-optimal. Hence there is an urgent need for empowerment among both groups to enhance awareness and to bring effective standard of care.
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- 2014
7. Multiple Organ Failure
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Gordy, Stephanie, Moore, Laura J., editor, and Todd, S. Rob, editor
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- 2017
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8. Relationship between nocturnal blood pressure patterns and end organ damage and diastolic dysfunction in heart transplant recipients.
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Oreschak, Kris, Wolfel, Eugene E., Saba, Laura M., Ambardekar, Amrut V., Lindenfeld, JoAnn, and Aquilante, Christina L.
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HEART transplant recipients , *BLOOD pressure , *LEFT ventricular hypertrophy , *MITRAL valve , *CHRONIC kidney failure - Abstract
Background: We assessed the relationship between circadian blood pressure (BP) patterns and clinical outcomes in a contemporary cohort of adult heart transplant recipients. Methods: This retrospective, cross‐sectional study included adult heart transplant recipients at least 6 months post‐transplant. Ambulatory BP measurements were recorded over 24 hours. Nondippers were defined as a decline in average nighttime BP ≤ 10% compared with daytime. Primary outcomes were the presence of end organ damage, that is, microalbuminuria, chronic kidney disease, and/or left ventricular hypertrophy. Secondary outcomes were measures of diastolic dysfunction (ie, mitral valve deceleration time, e/e′, E/A, and isovolumetric relaxation time), microalbumin/creatinine ratio, eGFR, interventricular septal thickness, and left ventricular posterior wall thickness. Results: Of 30 patients, 53.3% (n = 16) were systolic nondippers and 40% (n = 12) were diastolic nondippers. Diastolic nondippers had three times higher urine microalbumin/creatinine ratios than diastolic dippers (P =.03). Systolic nondippers had 16.3% lower mitral valve deceleration time (P =.05) than systolic dippers, while diastolic nondippers had 20.4% higher e/e′ (P =.05) than diastolic dippers. There were no significant relationships between BP dipping status and any of the primary outcomes. Conclusions: These data suggest that systolic and diastolic nondipping BP patterns are associated with subclinical kidney damage and diastolic dysfunction in heart transplant recipients. [ABSTRACT FROM AUTHOR]
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- 2020
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9. Racial Differences in the Influence of Risk Factors in Childhood on Left Ventricular Mass in Young Adulthood.
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Mendizábal, Brenda, Khoury, Philip, Woo, Jessica G., and Urbina, Elaine M.
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Objective(s): To examine racial differences in the relationship between cardiovascular (CV) risk factors measured since age 10 years and left ventricular mass index (LVMI) in adulthood in the National Heart, Lung, and Blood Institute Growth and Health Study.Study Design: Longitudinal investigation with CV risk factors measured throughout childhood and LVMI measured in adulthood. In total, 556 black and white girls were recruited from schools in the greater Cincinnati area. Analyses examined traditional CV risk factors at baseline, follow-up, and over time (ie, area under the curve [AUC]). LVMI was collected with 2-dimensional guided echocardiographic imaging at a mean age of 25.7 ± 1.7 years.Results: Black girls had higher adiposity and insulin and lower heart rate across time (all P < .05). Blacks had higher LVMI compared with whites in adulthood. Major determinants of young adult LVMI, were race, body mass index z score AUC, systolic blood pressure z score AUC, percent body fat by skin fold AUC, heart rate AUC, and an interaction between race and heart rate (model R2 = 0.40, P < .0001).Conclusions: The major determinants of LVMI in young female adults are race, adiposity, and systolic blood pressure. [ABSTRACT FROM AUTHOR]- Published
- 2020
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10. Carotid artery intima-media thickness and hypertensive heart disease: a short review
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Costan G. Magnussen
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Hypertension ,Carotid artery intima-media thickness ,End organ damage ,Blood pressure ,Review ,Medicine ,Internal medicine ,RC31-1245 - Abstract
Abstract Sustained by its relative ease of assessment, carotid artery intima-media thickness (cIMT) has emerged as an important surrogate marker of target organ damage in hypertensive heart disease over the last three decades. However, the prognostic utility of cIMT in hypertensive heart disease differs depending on its application. This review outlines cIMT and its prognostic utility among patients with hypertensive heart disease. It provides an overview of limitations of cIMT and areas for future research.
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- 2017
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11. Multiple Myeloma in a Patient with Sarcoidosis and Heavy Proteinuria: A Case Report
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Behzad Asanjrani, Esmat Abdollahpour, Samira Alesaeidi, and Hamed Zainaldain
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end organ damage ,granuloma ,inflammatory disease ,Medicine - Abstract
The present case is of 44-year-old woman who was a known case of sarcoidosis revealed granulomatous inflammation without caseafication. She also reported to suffer from proteinuria about 2 g/day, which was reported as Focal Segmental Glomerulosclerosis (FSGS) secondary to sarcoidosis after renal biopsy and thorough evaluation. Skeletal survey showed multiple lytic lesions in her skull, ribs, vertebra and iliac bone. The patient fully met diagnostic criteria for symptomatic Multiple Myeloma (MM) and chemotherapy was started with Velcade, Cyclophosphamide and Dexamethasone. Having completed chemotherapy, bone marrow plasma cells reached 8% and there were no peak of the serum or urine protein. Our patient is the first report of correlation of three diseases of Sarcoidosis and MM together and FSGS. Immune system impairment may be the main predisposing factor. The relationship between sarcoidosis and MM is unclear. Since in sarcoidosis, impaired immune system is involved, it predisposes developing malignancies in sarcoidosis. It is suggested that two important factors i.e. aneuploidy in the granuloma and peripheral blood lymphocytes can cause haematologic malignancy via developing genetic instability.
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- 2019
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12. Gradual hypertension induction in middle‐aged Cyp1a1‐Ren2 transgenic rats produces significant impairments in spatial learning
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Mari N. Willeman, Monica K. Chawla, Marc A. Zempare, Lauren A Biwer, Lan T. Hoang, Ajay R. Uprety, Megan C. Fitzhugh, Matthew De Both, Paul D. Coleman, Theodore P. Trouard, Gene E. Alexander, Kenneth D. Mitchell, Carol A. Barnes, Taben M. Hale, and Matthew Huentelman
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Cognition ,end organ damage ,hypertension ,renin angiotensin system ,Physiology ,QP1-981 - Abstract
Abstract Hypertension is a major health concern in the developed world, and its prevalence increases with advancing age. The impact of hypertension on the function of the renal and cardiovascular systems is well studied; however, its influence on the brain regions important for cognition has garnered less attention. We utilized the Cyp1a1‐Ren2 xenobiotic‐inducible transgenic rat model to mimic both the age of onset and rate of induction of hypertension observed in humans. Male, 15‐month‐old transgenic rats were fed 0.15% indole‐3‐carbinol (I3C) chow to slowly induce renin‐dependent hypertension over a 6‐week period. Systolic blood pressure significantly increased, eventually reaching 200 mmHg by the end of the study period. In contrast, transgenic rats fed a control diet without I3C did not show significant changes in blood pressure (145 mmHg at the end of study). Hypertension was associated with cardiac, aortic, and renal hypertrophy as well as increased collagen deposition in the left ventricle and kidney of the I3C‐treated rats. Additionally, rats with hypertension showed reduced savings from prior spatial memory training when tested on the hippocampus‐dependent Morris swim task. Motor and sensory functions were found to be unaffected by induction of hypertension. Taken together, these data indicate a profound effect of hypertension not only on the cardiovascular‐renal axis but also on brain systems critically important for learning and memory. Future use of this model and approach may empower a more accurate investigation of the influence of aging on the systems responsible for cardiovascular, renal, and neurological health.
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- 2019
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13. OSA patients not treated with PAP - Evolution over 5 years according to the Baveno classification and cardiovascular outcomes
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Daniela de Oliveira Werneck Rodrigues, R.J. Carneiro, M. van Zeller, Mariana Serino, Marta Drummond, Joana Ferra, Catarina Cardoso, Filipa Aguiar, and Maria J. Redondo
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Adult ,Male ,Sleep Apnea, Obstructive ,medicine.medical_specialty ,business.industry ,End organ damage ,Polysomnography ,Mean age ,General Medicine ,Middle Aged ,Esophageal and Gastric Varices ,Logistic regression ,medicine.disease ,Severity of Illness Index ,Body Mass Index ,respiratory tract diseases ,Obstructive sleep apnea ,Internal medicine ,medicine ,Humans ,Female ,business ,Body mass index ,Cardiovascular outcomes - Abstract
Introduction The evolution of patients with obstructive sleep apnea (OSA) non-eligible for PAP-therapy at diagnosis is unknown. Currently, the severity of OSA is based on the apnea-hypopnea index (AHI), but its prognostic relevance has raised concerns. The Baveno classification may allow a better stratification of severity and therapeutic guidance in OSA. Methods Patients with AHI≥5/h in 2015, classified into Baveno groups A and B and non-eligible for PAP therapy at diagnosis and over 5 years, were analyzed. Patients were reclassified into Baveno groups (A-D) and changes in groups over 5 years were explored. Patients in Baveno groups C and D, who developed major cardiovascular comorbidities (CVC) or end-organ damage (EOD group), were compared with patients in Baveno groups A and B (non-EOD group). To identify predictors of the development of major CVC or EOD, a logistic regression analysis was performed. Results There were 76 patients, 58% male, mean age 51.9 ± 10.1 years, mean body mass index (BMI) of 30.3 ± 5.0 kg/m2 and median AHI of 8.9 (5.9–12.0) events/h. At diagnosis, 46% and 54% of patients were classified into Baveno group A and group B, respectively. In total, 21% of patients developed major CVC or EOD (Baveno group C or D); higher age (p = 0.011) and BMI (p = 0.004) and a higher percentage of central apneas (p = 0.012) at diagnosis significantly predicted it, while sex, sleepiness, insomnia, AHI, ODI and T90 were not. Conclusions A significant percentage of patients non-eligible for PAP-therapy at diagnosis of OSA developed CVC or EOD; higher age and BMI and a higher percentage of central apneas were significant predictors.
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- 2021
14. Overexpression of dimethylarginine dimethylaminohydrolase 1 protects from angiotensin II-induced cardiac hypertrophy and vascular remodeling
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Natalia Jarzebska, Anne Kolouschek, Stefanie M. Bode-Böger, Stefan R. Bornstein, Silke Billoff, Jens Martens-Lobenhoffer, Andreas Deussen, Arduino A. Mangoni, Roman N. Rodionov, Vinitha Nair Ragavan, Norbert Weiss, and Irakli Kopaliani
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Male ,medicine.medical_specialty ,Time Factors ,Physiology ,End organ damage ,Heart Ventricles ,Blood Pressure ,Mice, Transgenic ,Inflammation ,Vascular Remodeling ,Ventricular Function, Left ,Amidohydrolases ,chemistry.chemical_compound ,Fibrosis ,Physiology (medical) ,Internal medicine ,Renin–angiotensin system ,medicine ,Animals ,Aorta ,Ventricular Remodeling ,biology ,business.industry ,Angiotensin II ,medicine.disease ,Mice, Inbred C57BL ,Vasodilation ,Nitric oxide synthase ,Disease Models, Animal ,Blood pressure ,Endocrinology ,chemistry ,Enzyme Induction ,Hypertension ,biology.protein ,Hypertrophy, Left Ventricular ,Inflammation Mediators ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Asymmetric dimethylarginine ,business - Abstract
Cardiovascular complications are the leading cause of death, and elevated levels of asymmetric dimethyarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, are implicated in their pathophysiology. We investigated the role of dimethylarginine dimethylaminohydrolase 1 (DDAH1), an enzyme hydrolyzing ADMA, in prevention of cardiovascular remodeling during hypertension. We hypothesized that the animals overexpressing DDAH1 will be protected from angiotensin II (ANG II)-induced end organ damage. Angiotensin II (ANG II) was infused in two doses: 0.75 and 1.5 mg/kg/day in DDAH1 transgenic mice (DDAH1 TG) and wild-type (WT) littermates for 2 or 4 wk. Echocardiography was performed in the first and fourth weeks of the infusion, systolic blood pressure (SBP) was measured weekly, and cardiac hypertrophy and vascular remodeling was assessed by histology. Increase in SBP after 1 wk of ANG II infusion was not different between the groups, whereas TG mice had lower SBP at later time points. TG mice were protected from cardiovascular remodeling after 2 wk of ANG II infusion in the high dose and after 4 wk in the moderate dose. TG mice had higher left ventricular lumen-to-wall ratio, lower cardiomyocyte cross-sectional area, and less interstitial fibrosis compared with WT controls. In aorta, TG mice had less adventitial fibrosis, lower medial thickness with preserved elastin content, lower counts of inflammatory cells, lower levels of active matrix metalloproteinase-2, and showed better endothelium-dependent relaxation. We demonstrated that overexpression of DDAH1 protects from ANG II-induced cardiovascular remodeling and progression of hypertension by preserving endothelial function and limiting inflammation.NEW & NOTEWORTHY We showed that overexpression of dimethylarginine dimethylaminohydrolase 1 (DDAH1) protects from angiotensin II-induced cardiovascular damage, progression of hypertension, and adverse vascular remodeling in vivo. This protective effect is associated with decreased levels of asymmetric dimethylarginine, preservation of endothelial function, inhibition of cardiovascular inflammation, and lower activity of matrix metalloproteinase-2. Our findings are highly clinically relevant, because they suggest that upregulation of DDAH1 might be a promising therapeutic approach against angiotensin II-induced end organ damage.
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- 2021
15. Impact of sickle cell trait on morbidity and mortality from SARS-CoV-2 infection
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Maureen O Achebe, Hae Soo Park, David M. Dorfman, Gerda Menard, Revital Freedman, Katherine Jolley, Kavita Mistry, Lauren E. Merz, and Donna Neuberg
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medicine.medical_specialty ,End organ damage ,Population ,Sickle Cell Trait ,chemistry.chemical_compound ,Internal medicine ,Pandemic ,Humans ,Medicine ,Social determinants of health ,education ,Pandemics ,Creatinine ,education.field_of_study ,Sickle cell trait ,SARS-CoV-2 ,business.industry ,COVID-19 ,Hematology ,medicine.disease ,Stimulus Report ,United States ,Health equity ,surgical procedures, operative ,chemistry ,Cohort ,Morbidity ,business ,human activities - Abstract
The COVID-19 pandemic has highlighted racial health disparities within the United States. Although social determinants of health are the most likely drivers of this disparity, it is possible that genetic traits enriched in the black population like sickle cell trait (SCT) could worsen the morbidity and mortality of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients admitted for SARS-CoV-2 infection who identified as black or African American were included in the study (n = 166). Blood remnants were tested for SCT, and clinical data were abstracted from the chart. There was no difference in mortality between those with SCT and those without. There was no difference in respiratory complications between groups, but those without SCT had a much higher burden of chronic lung disease (P = .004). Those with SCT had higher creatinine on admission (P = .004), but no difference in in-hospital renal complications (P = .532). Notably, 12% of the cohort had SCT, which is higher than the expected 7.31% (P = .025). Our study did not show any evidence of increased end organ damage, morbidity, or mortality from SARS-CoV-2 infection among patients with SCT but did show differences in admission creatinine and preexisting lung disease., Key Points • There is no impact of SCT on respiratory, renal, or circulatory complications or mortality in patients with SARS-CoV-2 infection. • The prevalence of SCT in the hospitalized cohort was significantly higher than the prevalence in the community (12% vs 7.31%).
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- 2021
16. Modulation by antenatal therapies of cardiovascular and renal programming in male and female offspring of preeclamptic rats
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Sherien A. Abdelhady, Mahmoud M. El-Mas, Inas El Sayed Darwish, Mennatallah A. Gowayed, Yasser H. Habib, and Nevine M. El-Deeb
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Pharmacology ,medicine.medical_specialty ,Proteinuria ,business.industry ,Offspring ,End organ damage ,Atrasentan ,Renal function ,General Medicine ,medicine.disease ,Preeclampsia ,Endocrinology ,Terutroban ,Internal medicine ,Medicine ,medicine.symptom ,business ,Endothelin receptor ,medicine.drug - Abstract
Morbidity and mortality risks are enhanced in preeclamptic (PE) mothers and their offspring. Here, we asked if sexual dimorphism exists in (i) cardiovascular and renal damage evolved in offspring of PE mothers, and (ii) offspring responsiveness to antenatal therapies. PE was induced by administering NG-nitro-L-arginine methyl ester (L-NAME, 50 mg/kg/day, oral gavage) to pregnant rats for 7 days starting from gestational day 14. Three therapies were co-administered orally with L-NAME, atrasentan (endothelin ETA receptor antagonist), terutroban (thromboxane A2 receptor antagonist, TXA2), or α-methyldopa (α-MD, central sympatholytic drug). Cardiovascular and renal profiles were assessed in 3-month-old offspring. Compared with offspring of non-PE rats, PE offspring exhibited elevated systolic blood pressure and proteinuria and reduced heart rate and creatinine clearance (CrCl). Apart from a greater bradycardia in male offspring, similar PE effects were noted in male and female offspring. While terutroban, atrasentan, or α-MD partially and similarly blunted the PE-evoked changes in CrCl and proteinuria, terutroban was the only drug that virtually abolished PE hypertension. Rises in cardiorenal inflammatory (tumor necrosis factor alpha, TNFα) and oxidative (isoprostane) markers were mostly and equally eliminated by all therapies in the two sexes, except for a greater dampening action of atrasentan, compared with α-MD, on tissue TNFα in female offspring only. Histopathologically, antenatal terutroban or atrasentan was more effective than α-MD in rectifying cardiac structural damage, myofiber separation, and cytoplasmic alterations, in PE offspring. The repair by antenatal terutroban or atrasentan of cardiovascular and renal anomalies in PE offspring is mostly sex-independent and surpasses the protection offered by α-MD, the conventional PE therapy.
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- 2021
17. Low serum corin levels predict end-organ damage in patients with hypertensive crisis
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Okan Bari, Macit Koldas, Esma Yucetas, Ozgur Sogut, Burcu Genc Yavuz, and Şahin Çolak
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Adult ,medicine.medical_specialty ,Mean arterial pressure ,Systole ,End organ damage ,business.industry ,Serine Endopeptidases ,Hypertensive urgency ,Diastole ,Blood Pressure ,medicine.disease ,Stroke ,Editorial ,Blood pressure ,RC666-701 ,Internal medicine ,Hypertension ,medicine ,Cardiology ,Humans ,Diseases of the circulatory (Cardiovascular) system ,Hypertensive emergency ,Myocardial infarction ,business - Abstract
OBJECTIVE The study aimed to investigate the predictive power of serum corin levels for distinguishing between hypertensive urgency (HU) and hypertensive emergency (HE) in patients with hypertensive crisis (HC) admitted to the emergency department. METHODS A total of 120 consecutive consenting adult patients diagnosed with HC and 55 age- and sex-matched healthy controls were enrolled. Blood pressure measurements [(systolic, diastolic, and mean arterial pressure (MAP)] and the evidence of end-organ damage at the first admission were recorded. Patients with HC were classified as patients with HE or HU according to the presence or absence of acute end-organ damage. Serum corin levels were compared between the 2 groups. RESULTS The mean serum corin level was significantly lower in the HC group than in the control group; it was also lower in the HE group than in the HU group (p
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- 2021
18. Hypertensive Retinopathy and the Risk of Hemorrhagic Stroke
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Regunath Kandasamy, Pulivendhan Sellamuthu, and Ramani Thiagarajah
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Intracerebral hemorrhage ,medicine.medical_specialty ,Clinical Article ,business.industry ,End organ damage ,General Neuroscience ,Glasgow Outcome Scale ,Glasgow Coma Scale ,macromolecular substances ,medicine.disease ,Hypertensive retinopathy ,Vascular ,Internal medicine ,Relative risk ,medicine ,Surgery ,Neurology (clinical) ,Hemorrhagic stroke ,business ,Stroke ,Retinopathy - Abstract
Objective Hemorrhagic stroke (HS) and hypertensive retinopathy are known end organ damage of the brain and eye respectively, with HS having deleterious consequence to the patients. This study is to correlate between hypertensive retinopathy and HS in hypertensive disease. Methods A control group of hypertensive patients only, and an investigated group of hypertensive HS patients. Fundoscopic examination to determine the grade of retinopathy was performed and then divided into low or high severity hypertensive retinopathy. Clinical and radiological parameter included are demography, vital signs, Glasgow coma scale (GCS) on admission, clot volume, site of clot, Intracerebral hemorrhage (ICH) score and Glasgow outcome scale (GOS). Data were correlated with the severity of hypertensive retinopathy. Results Fifty patient in the control group and 51 patients in the investigated group were recruited. In the hypertensive HS group, 21 had low severity retinopathy (no or mild retinopathy) accounting for 41.2% and 30 patients had high severity (moderate or severe retinopathy). In the hypertensive patients 49 had low severity and one had high severity (p-value of 0.001). In HS group low severity showed better GCS score of 9-15 on admission (p-value of 0.003), clot volume less than 30 mL (p-value 0.001), and also a better 30 days mortality rate by using the ICH score (p-value 0.006), GOS score of 4 and 5 the low severity retinopathy fair better than the high severity retinopathy (p-value of 0.001), and the relative risk to develop HS in low severity and high severity retinopathy was 0.42 and 29.4, respectively. Conclusion Hypertensive retinopathy screening could be used as an indicator in hypertensive patient, to evaluate the risk of developing hypertensive HS in the future.
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- 2021
19. Hypertension in a resource-limited setting: Is it associated with end organ damage in older adults in rural Tanzania?
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Putnam, Harry W. I., Jones, Rebecca, Rogathi, Jane, Gray, William K., Swai, Bernadetha, Dewhurst, Matthew, Dewhurst, Felicity, and Walker, Richard W.
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Few data from sub-Saharan Africa exist on the effects of hypertension on the organs of the human body. We aimed to establish the prevalence of hypertensive end organ damage (EOD) in an elderly cohort of Tanzanians. The population aged 70 years and over of 2 villages in northern Tanzania (n = 246), had blood pressure (BP) data available from 2010 and 2013, and underwent in-depth follow-up for markers of hypertensive EOD in 2016. Assessment included ankle-brachial pressure index, lying-standing BP, electrocardiogram, and mid-stream urine dip. Sustained hypertension (those with hypertension at all 3 assessments) was found in 129 (52.4% subjects). Of the entire cohort, 13.9% had left ventricular hypertrophy and 26.4% had peripheral arterial disease, both of which were associated with sustained hypertension, although orthostatic hypotension, stroke, proteinuria, and arterial stiffening were not. Further investigation, particularly in younger age groups, is merited if hypertension-associated morbidity is to be controlled. [ABSTRACT FROM AUTHOR]
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- 2018
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20. Organ damage changes in patients with resistant hypertension randomized to renal denervation or spironolactone: The DENERVHTA (Denervación en Hipertensión Arterial) study.
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Oliveras, Anna, Armario, Pedro, Sans, Laia, Clarà, Albert, Vázquez, Susana, Molina, Luis, Pareja, Júlia, de la Sierra, Alejandro, and Pascual, Julio
- Abstract
Renal denervation and spironolactone have both been proposed for the treatment of resistant hypertension, but their effects on preclinical target organ damage have not been compared. Twenty-four patients with 24-hour systolic blood pressure ≥140 mm Hg despite receiving three or more full-dose antihypertensive drugs, one a diuretic, were randomized to receive spironolactone or renal denervation. Changes in 24-hour blood pressure, urine albumin excretion, arterial stiffness, carotid intima-media thickness, and left ventricular mass index were evaluated at 6 months. Mean baseline-adjusted difference between the two groups (spironolactone vs renal denervation) at 6 months in 24-hour systolic blood pressure was -17.9 mm Hg (95% confidence interval [CI], -30.9 to -4.9; P = .01). Mean baseline-adjusted change in urine albumin excretion was -87.2 (95% CI, -164.5 to -9.9) and -23.8 (95% CI, -104.5 to 56.9), respectively (P = .028). Mean baseline-adjusted variation of 24-hour pulse pressure was -13.5 (95% CI, -18.8 to -8.2) and -2.1 (95% CI, -7.9 to 3.7), respectively (P = .006). The correlation of change in 24-hour systolic blood pressure with change in log-transformed urine albumin excretion was r = .713 (P < .001). At 6 months there was a reduction in albuminuria in patients with resistant hypertension treated with spironolactone as compared with renal denervation. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
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21. Puerarin Improves Vascular Insulin Resistance and Cardiovascular Remodeling in Salt-Sensitive Hypertension.
- Author
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Tan, Chunxiang, Wang, Aimei, Liu, Chan, Li, Yao, Shi, Yuepin, and Zhou, Ming-Sheng
- Subjects
- *
ANALYSIS of variance , *ANIMAL experimentation , *DIABETES , *ENZYME-linked immunosorbent assay , *HERBAL medicine , *HISTOLOGY , *HYPERTENSION , *INSULIN resistance , *CHINESE medicine , *RATS , *RESEARCH funding , *SALT , *STATISTICS , *TUMOR necrosis factors , *WESTERN immunoblotting , *ISOFLAVONES , *DATA analysis , *DATA analysis software - Abstract
Puerarin is an isoflavonoid isolated from the Chinese herb, Kudzu roots (also known as Gegen), which has been widely used for the treatment of hypertensive diseases and diabetic mellitus in traditional Chinese medicine. Dahl salt-sensitive (DS) rat is a genetic model of salt-sensitive hypertension with cardiovascular injury and vascular insulin resistance. Here, we investigated whether puerarin improved vascular insulin resistance and attenuated cardiac and aortic remodeling in salt-sensitive hypertension. DS rats were given a normal (NS) or high salt diet (HS) for five weeks. An additional group of DS rats was pretreated with puerarin and NS for 10 days, then switched to HS plus puerarin for five weeks. HS for five weeks increased systolic blood pressure (SBP), cardiac hypertrophy and fibrosis, and aortic hypertrophy with increased the expression of phosphor-ERK1/2 in the aorta and heart; puerarin attenuated cardiac and aortic hypertrophy, cardiac fibrosis and phosphor-ERK1/2 with a mild reduction in SBP. Hypertensive rats also manifested impairment of acetylcholine- and insulin-mediated vasorelaxation and insulin-mediated Akt and eNOS phosphorylation associated with the activation of NFB/TNF/JNK pathway. Puerarin improved acetylcholine- and insulin-mediated vasorelaxation and insulin-stimulated Akt/NO signaling with the inhibition of the NFB inflammatory pathway. Our results demonstrated that in salt-sensitive hypertension, puerarin improved vascular insulin action with cardiovascular beneficial effects. Our results found that the underlying mechanisms may involve its inhibition of NFB/JNK and ERK1/2 pathway. These results suggest that puerarin could be used as a new antihypertensive agent to expand our armamentarium for the prevention and treatment of end-organ damage in individuals with hypertension and metabolic diseases. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
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22. Hemophagocytic lymphohistocytosis in a COVID-19 patient in the acute phase: case report
- Author
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Mazen Kenj and Maher Salamoon
- Subjects
Covid‑19 ,medicine.medical_specialty ,ARDS ,Coronavirus disease 2019 (COVID-19) ,business.industry ,End organ damage ,Outbreak ,Case Report ,Hematology ,medicine.disease ,Phase (combat) ,03 medical and health sciences ,0302 clinical medicine ,Lymphohistocytosis ,Oncology ,Respiratory failure ,030220 oncology & carcinogenesis ,Intervention (counseling) ,Hemopagocytic ,medicine ,Cytokine storm ,Intensive care medicine ,business ,Acute phase ,030215 immunology - Abstract
Summary The outbreak of coronavirus disease 2019 (COVID-19) has put health systems worldwide under great pressure on numerous levels. COVID-19 is a heterogeneous situation where some people experience mild symptoms for which no serious intervention is needed, while others may experience serious situations ranging from acute respiratory distress syndrome (ARDS) or even respiratory failure and end organ damage. Serious COVID-19 cases may be complicated with a cytokine storm caused by hemophagocytic lymphohistocytosis, which is a life-threatening situation. Efforts should be directed to reveal accompanying diseases that may trigger the cytokine storm. Early diagnosis leads to a better understanding of how to deal with this emergency status; however, even with early intervention, outcomes are still very poor.
- Published
- 2021
23. Impact and associations of lymphopenia in a cohort of Egyptian systemic lupus erythematosus patients: Potential link to complement (C3) and corticosteroids
- Author
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Amira M. Ibrahim and Abdelkawy Moghazy
- Subjects
medicine.medical_specialty ,Multivariate analysis ,Cyclophosphamide ,End organ damage ,business.industry ,Medical record ,Complement ,Lupus ,Disease ,RC581-607 ,Infections ,medicine.disease ,University hospital ,Rheumatology ,immune system diseases ,Lymphopenia ,Internal medicine ,Cohort ,medicine ,Immunologic diseases. Allergy ,skin and connective tissue diseases ,business ,Pulse steroid therapy ,medicine.drug - Abstract
Aim of the work: To investigate the relation between lymphopenia and clinical disease activity, disease associated end organ damage, laboratory markers and medications received in systemic lupus erythematosus (SLE) patients. Another objective was to investigate the prognostic value of lymphopenia. Patients and methods: The medical records of 698 SLE patients under follow-up at the Rheumatology clinics of Cairo and KafrElsheikh University hospitals were revised. Demograghic and laboratory data, SLE disease activity index (SLEDAI), damage index and drug history were assessed. Results: Mean age of 28.4 ± 8.8 years (12–60 years), they were 640 females and 58 males (F:M 11:1) and a disease duration of 6.2 ± 4.7 (0.1–31 years). The study included 674 adults and 24 juvenile cases. 280 (40%) had lymphopenia. Patients with lymphopenia had significantly consumed complement 3 (C3) (p 40 mg/day, infections, antiphospholipids for associated lymphopenia. On multivariate analysis only consumed C3 (p = 0.008) and pulse steroid therapy (p = 0.036) remained as independent risk factors for lymphopenia. Conclusion: Lymphopenia may be more than a hematological finding in SLE patients that was found to be associated with complement consumption, high steroid doses and cyclophosphamide administration, infections and antiphospholipids. The key independent risk factors for lymphopenia are pulse steroid and C3.
- Published
- 2021
24. Targeted therapy with BRAF inhibitor Vemurafenib in relapse/refractory multisystem langerhans cell-retrospective analysis from a tertiary care center in India
- Author
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Minnie Bodhanwala, Mukesh Desai, Parth J. Ganatra, Bharat Agarwal, Archana Swami, Vibhu Krishnan, Sangeeta Mudaliar, Purva Kanvinde, and Nitin Shah
- Subjects
Oncology ,medicine.medical_specialty ,Langerhans cell ,Subsequent Relapse ,End organ damage ,medicine.medical_treatment ,Pediatrics ,Tertiary care ,RJ1-570 ,Targeted therapy ,BRAFV600E mutation ,Refractory ,Internal medicine ,medicine ,Vemurafenib ,Chemotherapy ,business.industry ,Langerhans cell histiocytosis ,Hematology ,medicine.disease ,medicine.anatomical_structure ,Pediatrics, Perinatology and Child Health ,business ,medicine.drug - Abstract
Introduction BRAF V600 E mutation is present in 50% cases of LCH and is associated with aggressive forms of disease-particularly liver dysfunction in infants and younger children. It is associated with increased mortality due to poorer response to chemotherapy and higher rate of relapse. Though targeted therapy with Vemurafenib shows rapid clinical response and prevents end organ related mortality, optimal duration of therapy and combination of chemotherapy needs further studies. Material & methods We discuss here follow up of 3 patients with Relapse/Refractory LCH and BRAF mutation who were salvaged with Vemurafinib. Results Three patients with Relapse/Refractory MS LCH were treated in our centre with Vemurafenib. All 3 patients showed dramatic response to Vemurafenib at initiation as well as subsequent relapse on stopping. On PET scan, 2 patients had CR at 6 weeks and 3rd patient had PR on 6 and 12th week. We then used slow taper of vemurafenib with/without addition of oral chemotherapeutic agents and continued a minimal dose successfully in all the 3 patients to prevent recurrences. Conclusion Vemurafenib is a safe and effective salvage option to be used early in refractory/relapsed disease to prevent end organ damage. Gradual taper and maintaining a minimal dose with/without addition of oral chemotherapeutic agents may help in preventing recurrences.
- Published
- 2021
25. Blood pressure monitoring in kidney transplantation: a systematic review on hypertension and target organ damage
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Davide Bolignano, Graziella D'Arrigo, Alberto Ortiz, Grégoire Wuerzner, Jean-Michel Halimi, Alexandre Persu, Liffert Vogt, Gérard M. London, Ioannis N Boletis, Michel Burnier, Francesca Mallamaci, Patrick Rossignol, Nada Kanaan, Pantelis Sarafidis, Charalampos Loutradis, Bénédicte Sautenet, Carmine Zoccali, Anna Pisano, and Charles J. Ferro
- Subjects
Transplantation ,Creatinine ,medicine.medical_specialty ,Kidney ,education.field_of_study ,Ambulatory blood pressure ,business.industry ,End organ damage ,Population ,Renal function ,medicine.disease ,chemistry.chemical_compound ,medicine.anatomical_structure ,chemistry ,Nephrology ,Internal medicine ,Cardiology ,Medicine ,Circadian rhythm ,business ,education ,Kidney transplantation - Abstract
Background Few studies show that ambulatory blood pressure (BP) monitoring (ABPM) is superior to office BP (oBP) measurements to predict target organ damage and cardiovascular (CV) events in kidney transplant recipients (KTRs). We performed a systematic review aimed at determining the potential associations between BP recordings by different methods and renal and CV outcomes in this population. Methods Major medical databases were searched for studies enrolling adult KTRs undergoing 24-h ABPM compared with office or home BP measurements. The main outcomes were associations between different BP recordings and renal and CV outcomes. Additionally, any association between the circadian BP pattern (dipping/non-dipping status) and outcomes was assessed. Results Twenty-two studies (2078 participants) were reviewed. Among 12 studies collecting data on renal endpoints, 10 studies found that BP assessed by ABPM was a stronger predictor of renal function decline, assessed by serum creatinine and/or creatinine clearance or estimated glomerular filtration rate, than traditional office measurements. Twelve studies analysed the relation between different BP recordings and CV target organ damage and reported robust correlations between echocardiographic abnormalities (i.e. left ventricular mass index) and 24-h ABPM, but not with office BPs. Furthermore, 24-h ABPM correlated better than oBP with markers of vascular damage, such as carotid intima-media thickness, diffuse thickening and endothelial dysfunction. Additionally, an abnormal circadian BP pattern (non-dippers and reverse dippers) identified a group of kidney recipients at risk for kidney function loss and CV abnormalities. Conclusions In our systematic review, ABPM reflected target organ damage more closely than oBP in KTRs. Furthermore, an altered circadian BP profile associated with renal and CV target organ damage.
- Published
- 2021
26. Blood Pressure in Childhood and Adolescence
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Shakia T Hardy and Elaine M. Urbina
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medicine.medical_specialty ,Adolescent ,End organ damage ,Blood Pressure ,Disease ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Epidemiology ,Internal Medicine ,Humans ,Medicine ,030212 general & internal medicine ,Family history ,Child ,business.industry ,Pediatric hypertension ,Compendium on Hypertension Across the Life Span ,Guideline ,medicine.disease ,Obesity ,United States ,Blood pressure ,Hypertension ,business - Abstract
Elevated blood pressure (BP) and hypertension commonly occur in children and adolescents and increase the risk of cardiovascular disease in adulthood. The purpose of this review is to summarize recent research in pediatric hypertension including changes in defining hypertension, BP measurement techniques, hypertension epidemiology, risk factors, treatment, and BP-related target organ damage. Defining pediatric hypertension using the 2017 American Academy of Pediatrics’ updated Clinical Practice Guideline resulted in a larger proportion of children being classified as having elevated BP or hypertension compared with prior guidelines. Trends in the distribution of BP among US children and adolescents suggest that BP levels and the prevalence of hypertension may have increased from 2011–2014 to 2015–2018. Factors including a family history of hypertension, obesity, minority race/ethnicity, physical inactivity, high dietary intake of sodium, and poor sleep quality are associated with an increased prevalence of elevated BP and hypertension. Evidence of a linear relationship between systolic BP and target organ damage indicates that BP levels currently considered normal could increase the risk of target organ damage in childhood. Lifestyle changes, such as adhering to the Dietary Approaches to Stop Hypertension diet, are a central component of effectively reducing BP and have been shown to reduce target organ damage. Pharmacologic treatment using angiotensin-converting enzyme inhibitors and angiotensin receptor blockers is an effective and safe method for reducing BP among children with uncontrolled BP after implementing lifestyle changes. Research gaps in the prevention, detection, classification, and treatment of hypertension in children demonstrate opportunities for future study.
- Published
- 2021
27. Immune mechanisms in arterial hypertension. Recent advances
- Author
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Marlies Bode, Ulrich Wenzel, and Heimo Ehmke
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Arterial hypertension ,0301 basic medicine ,Histology ,End organ damage ,T cell ,Complement ,Inflammation ,Review ,030204 cardiovascular system & hematology ,Pathology and Forensic Medicine ,End-organ damage ,03 medical and health sciences ,0302 clinical medicine ,Immune system ,medicine ,Animals ,Humans ,Innate immune system ,business.industry ,Monocyte ,Immunity ,Cell Biology ,medicine.disease ,Natural killer T cell ,Acquired immune system ,030104 developmental biology ,medicine.anatomical_structure ,Hypertension ,Immunology ,medicine.symptom ,business - Abstract
Increasing evidence indicates that hypertension and hypertensive end-organ damage are not only mediated by hemodynamic injury. Inflammation also plays an important role in the pathophysiology and contributes to the deleterious consequences of this disease. Cells of the innate immune system including monocyte/macrophages and dendritic cells can promote blood pressure elevation via effects mostly on kidney and vascular function. Moreover, convincing evidence shows that T and B cells from the adaptive immune system are involved in hypertension and hypertensive end-organ damage. Skin monocyte/macrophages, regulatory T cells, natural killer T cells, and myeloid-derived suppressor cells have been shown to exert blood pressure controlling effects. Sodium intake is undoubtedly indispensable for normal body function but can be detrimental when taken in excess of dietary requirements. Sodium levels also modulate the function of monocyte/macrophages, dendritic cells, and different T cell subsets. Some of these effects are mediated by changes in the microbiome and metabolome that can be found after high salt intake. Modulation of the immune response can reduce severity of blood pressure elevation and hypertensive end-organ damage in several animal models. The purpose of this review is to briefly summarize recent advances in immunity and hypertension as well as hypertensive end-organ damage.
- Published
- 2021
28. A novel approach to percutaneous aortic thrombectomy
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Navneet Narula, Quinn Silverglate, Karan Garg, and Thomas S. Maldonado
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medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Percutaneous ,End organ damage ,medicine.medical_treatment ,Ischemia ,lcsh:Surgery ,030204 cardiovascular system & hematology ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Case report ,Aortic mural thrombus ,medicine ,cardiovascular diseases ,Aortic thrombus ,Thrombectomy ,business.industry ,Open surgery ,Arterial Embolization ,Thrombolysis ,lcsh:RD1-811 ,medicine.disease ,Surgery ,lcsh:RC666-701 ,cardiovascular system ,Cardiology and Cardiovascular Medicine ,business ,Limb loss - Abstract
Aortic mural thrombus in the absence of underlying aortic disease is rare and results in a risk of distant arterial embolization that can result in limb loss or other end organ damage. Current management involves open surgery, anticoagulation, and systemic thrombolysis; however, each carries inherent risks. We report the case of aortic thrombus with distal emboli in two patients, a 56-year-old man and a 68-year-old man, neither with underlying aortic pathology and both presenting with limb threatening ischemia. We performed percutaneous mechanical thrombectomy using the FlowTriever System (Inari Medical, Irvine, Calif) with successful removal of the aortic thrombus in both patients.
- Published
- 2020
29. Fuster-BEWAT score versus cardiovascular health score to predict subclinical target organ damage: Insights from a large-scale Asian population
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Hao-Yu Wang, Yingxian Sun, and Ke-Fei Dou
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Adult ,Male ,China ,medicine.medical_specialty ,Scale (ratio) ,Epidemiology ,End organ damage ,Cardiovascular health ,Diagnostic Techniques, Cardiovascular ,MEDLINE ,Predictive Value of Tests ,Risk Factors ,medicine ,Health Status Indicators ,Humans ,Aged ,Subclinical infection ,business.industry ,Middle Aged ,medicine.disease ,Target organ damage ,Cardiovascular Diseases ,Asymptomatic Diseases ,Emergency medicine ,Asian population ,Female ,Cardiology and Cardiovascular Medicine ,business - Published
- 2020
30. Severe Acute Respiratory Syndrome Coronavirus 2, COVID-19, and the Renin-Angiotensin System
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Louis J. Dell'Italia, Joseph A. Murray, Matthew A. Sparks, Janani Rangaswami, Scott E. Kasner, Carissa M. Baker-Smith, Biykem Bozkurt, Kathy Griendling, W. Robert Taylor, Andrew D. Badley, Daniel Batlle, Susan B. Gurley, Roberto Cattaneo, Marc A. Pfeffer, Andrew M South, Andria L. Ford, Karl A. Nath, Steven D. Crowley, and Vesna D. Garovic
- Subjects
Male ,0301 basic medicine ,China ,End organ damage ,Pneumonia, Viral ,Disease ,Peptidyl-Dipeptidase A ,030204 cardiovascular system & hematology ,Severe Acute Respiratory Syndrome ,medicine.disease_cause ,Bioinformatics ,Risk Assessment ,Article ,Renin-Angiotensin System ,03 medical and health sciences ,0302 clinical medicine ,Renin–angiotensin system ,Internal Medicine ,medicine ,Humans ,Pandemics ,Coronavirus ,business.industry ,Incidence ,COVID-19 ,Blood Pressure Determination ,Prognosis ,medicine.disease ,Entry into host ,Angiotensin II ,030104 developmental biology ,Research Design ,Hypertension ,Practice Guidelines as Topic ,Angiotensin-converting enzyme 2 ,Female ,Cardiovascular Injury ,Angiotensin-Converting Enzyme 2 ,Coronavirus Infections ,business ,hormones, hormone substitutes, and hormone antagonists - Abstract
The coronavirus disease 2019 (COVID-19) pandemic is associated with significant morbidity and mortality throughout the world, predominantly due to lung and cardiovascular injury. The virus responsible for COVID-19—severe acute respiratory syndrome coronavirus 2—gains entry into host cells via ACE2 (angiotensin-converting enzyme 2). ACE2 is a primary enzyme within the key counter-regulatory pathway of the renin-angiotensin system (RAS), which acts to oppose the actions of Ang (angiotensin) II by generating Ang-(1–7) to reduce inflammation and fibrosis and mitigate end organ damage. As COVID-19 spans multiple organ systems linked to the cardiovascular system, it is imperative to understand clearly how severe acute respiratory syndrome coronavirus 2 may affect the multifaceted RAS. In addition, recognition of the role of ACE2 and the RAS in COVID-19 has renewed interest in its role in the pathophysiology of cardiovascular disease in general. We provide researchers with a framework of best practices in basic and clinical research to interrogate the RAS using appropriate methodology, especially those who are relatively new to the field. This is crucial, as there are many limitations inherent in investigating the RAS in experimental models and in humans. We discuss sound methodological approaches to quantifying enzyme content and activity (ACE, ACE2), peptides (Ang II, Ang-[1–7]), and receptors (types 1 and 2 Ang II receptors, Mas receptor). Our goal is to ensure appropriate research methodology for investigations of the RAS in patients with severe acute respiratory syndrome coronavirus 2 and COVID-19 to ensure optimal rigor and reproducibility and appropriate interpretation of results from these investigations.
- Published
- 2020
31. Prognostic value of ambulatory blood pressure and clinical use of echocardiography to detect left ventricular hypertrophy in children evaluated for primary hypertension
- Author
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Grace Truong, Sarah Kamal, Cynthia S. Bell, and Joshua Samuels
- Subjects
Nephrology ,medicine.medical_specialty ,education.field_of_study ,Ambulatory blood pressure ,End organ damage ,business.industry ,Population ,030232 urology & nephrology ,030204 cardiovascular system & hematology ,Logistic regression ,medicine.disease ,Left ventricular hypertrophy ,03 medical and health sciences ,0302 clinical medicine ,Blood pressure ,Internal medicine ,Pediatrics, Perinatology and Child Health ,medicine ,Cardiology ,cardiovascular diseases ,Risk factor ,education ,business - Abstract
Hypertension (HTN) is common in children and often associated with pathologic progression to end organ damage, specifically left ventricular hypertrophy (LVH). The primary goal of this retrospective chart review is to determine if patients with higher blood pressure were more likely to complete echocardiogram (ECHO) and more likely to have LVH, among a pediatric population referred for hypertension evaluation before the 2017 American Academy of Pediatrics (AAP) guidelines. To meet this goal, the number of patients evaluated by ECHO and prevalence of LVH was examined for independent associations with blood pressure and BMI categories by logistic regression. It was found that higher blood pressure was associated with having an ECHO evaluation (p = 0.012). Among patients evaluated by ECHO, one-third had LVH but the presence of LVH was not associated with blood pressure severity or use of anti-hypertensive medication. Instead, BMI was the only factor associated with LVH cardiac remodeling in our population (p = 0.025). Newly updated AAP practice guidelines recommend evaluation of HTN via ABPM, with ECHO performed only at the initiation of pharmaceutical therapy. It is notable that BMI, the only risk factor of LVH found in this study, is not addressed in the current AAP guidelines for ECHO evaluation among hypertensive children. This study suggests that ECHO evaluation may be warranted in a larger subset of children as is recommended by current European Society of Hypertension pediatric guidelines.
- Published
- 2020
32. Does Blood Pressure Variability Affect Hypertension Development in Prehypertensive Patients?
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Serpil Muge Deger, Turgay Arinsoy, T Akpolat, Mustafa Arici, Rahmi Yilmaz, Ulver Derici, Sule Sengul, Gulsum Ozkan, Yunus Erdem, Sehsuvar Erturk, Sukru Ulusoy, İstinye Üniversitesi, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü, and Akpolat, Tekin
- Subjects
medicine.medical_specialty ,Ambulatory blood pressure ,End organ damage ,Population ,Blood Pressure ,Logistic regression ,Prehypertension ,Pregnancy ,Internal medicine ,Internal Medicine ,ABPM ,Blood Pressure Variability ,Medicine ,Humans ,Prospective Studies ,education ,education.field_of_study ,business.industry ,Blood Pressure Monitoring, Ambulatory ,Hypertension Diagnosis ,medicine.disease ,Blood pressure ,Cohort ,Hypertension ,Cardiology ,Female ,BPV ,business ,Cohort study - Abstract
BACKGROUND Blood pressure variability (BPV) is associated with end organ damage and cardiovascular outcomes in hypertensive patients. Prehypertensive patients frequently develop hypertension (HT). The purpose of the present study was to evaluate the effect of BPV on the development of HT. METHODS Two hundred and seven prehypertensive patients from the Cappadocia cohort were monitored over 2 years, and 24-hour ambulatory blood pressure monitoring (ABPM), office BP, and home BP measurements were subsequently performed at 4- to 6-month intervals. BPV was calculated as average real variability (ARV) from 24-h ABPM data, home BP, and office BP measurements at first visit. The relationship was evaluated between baseline ARV and the development of HT. RESULTS HT was diagnosed in 25.60% of subjects. Baseline 24-hour ABPM systolic blood pressure (SBP)ARV and diastolic blood pressure (DBP)ARV and home SBPARV were significantly higher in patients who developed HT than the other patients (P 0.006, 0.001 and 0.006, respectively). Baseline 24-hour ABPM SBPARV and home SBPARV exceeding the 90th percentile were identified as parameters affecting development of HT at logistic regression analysis. CONCLUSION In conclusion, our prospective observational cohort study showed that short-term BPV in particular can predict the development of HT in the prehypertensive population.
- Published
- 2022
33. Glucocorticoids Induced End Organs Damage in Patients with Systemic Lupus Erythematosus.
- Author
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Abd-El-Atty, Mohammed Afify, Hafez, Eman Ahmed, Shedid, Noha Hussien, and El Sherbiny, Dalia Abdel Hamid
- Subjects
- *
GLUCOCORTICOIDS , *SYSTEMIC lupus erythematosus , *MULTIPLE organ failure , *DISEASE prevalence , *DISEASE complications - Abstract
Background: Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that affects multiple organs and requires long term treatment with GCs. GC-related end organ damage in SLE appears in the form of: osteoporosis, Avascular Necrosis (AVN), cataracts, diabetes (DM) and cardiovascular disease. Aim of the work: the present work was to assess the prevalence of the complications in SLE patients who were treated with GCs for long periods and with moderate to severe cumulative steroid doses. Patients and Methods: This study was done on 50 SLE patients who fulfilled the SLICC criteria for diagnosis of SLE. All patients subjected to full history taking, clinical examination, slit-lamp examination to assess cataract, laboratory investigations (ESR, CRP, FBS, 2-H PP, CBC, C3, C4 and anti-dsDNA), DEXA scan, MRI scan (when needed), SLEDAI score and SLICC score assessments. All data were collected, tabulated and statistically analyzed. Results: Regarding the frequency of steroid induced complications, 38% were osteopenic, while 18% were osteoporotic patients. 10% had AVN. 18% had cataract. 14% had DM. There was very strong relationship between steroid duration and the frequency of DM and cataract. But in osteopenia, osteoporosis and AVN, there were weak relationship regarding steroid duration. There was very strong relationship between cumulative steroid dose and the frequency of DM, cataract, osteoporosis and AVN. There was no relationship between age and osteoporosis and AVN but in cataract and DM, there was strong relationship. There was no relationship between sex and complications (DM, cataract, osteopenia, osteoporosis and AVN). There was no relationship between disease activity (measured by SLEDAI score) and frequency of steroid complications (DM, cataract, osteopenia, osteoporosis and AVN). There was strong relationship between end organ damage (measured by SLICC damage index) and frequency of steroid complications (DM, cataract, osteoporosis and AVN). Conclusion: Steroid intake (duration and dose) were major risk factors for developing end organ damage in SLE patients. [ABSTRACT FROM AUTHOR]
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- 2017
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34. Carotid Artery Stiffness Mechanisms Are Associated With End Organ Damage and All-Cause Mortality: MESA (Multi-Ethnic Study of Atherosclerosis).
- Author
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Pewowaruk R, Korcarz C, De Boer I, Kestenbaum B, Heckbert SR, Tedla YG, and Gepner AD
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- Humans, Pulse Wave Analysis methods, Prognosis, Carotid Arteries diagnostic imaging, Renal Insufficiency, Chronic, Atherosclerosis, Vascular Stiffness physiology, Dementia
- Abstract
Background Arterial stiffness can be separated into 2 main mechanisms: (1) load-dependent stiffening from higher blood pressure and (2) structural stiffening due to remodeling of the vessel wall. The relationship between stiffness mechanisms and end organ damage is unknown. Methods and Results MESA (Multi-Ethnic Study of Atherosclerosis) participants with carotid ultrasound were included in this study (n=6147). Carotid pulse wave velocity (cPWV) was calculated to represent total stiffness. Structural stiffness was calculated by adjusting cPWV to a 120/80 mm Hg blood pressure with participant-specific models. Load-dependent stiffness was the difference of total and structural stiffness. Associations with incident chronic kidney disease (CKD), dementia, and mortality were assessed with adjusted Cox models. During 14.3±4.8 years of follow-up, 773 CKD events, 535 dementia events, and 1529 deaths occurred. Total cPWV was associated with mortality (hazard ratio [HR], per 1 m/s, 1.04 [95% CI, 1.01-1.08], P =0.02) and dementia (HR, 1.06 [95% CI, 1.01-1.12], P =0.03) but not CKD (HR, 1.03 [95% CI, 0.98-1.08], P =0.33). Structural cPWV was significantly associated with mortality (HR, 1.04 [95% CI, 1.00-1.08], P =0.04) but not CKD (HR, 1.00 [95% CI, 0.94-1.05], P =0.86) or dementia (HR, 1.06 [95% CI, 0.99-1.13], P =0.06). Load-dependent cPWV was significantly associated with CKD (HR, 1.38 [95% CI, 1.17-1.63], P <0.001) but not mortality (HR, 1.11 [95% CI, 0.99-1.25], P =0.07) or dementia (HR, 1.14 [95% CI, 0.94-1.38], P =0.19). Conclusions The mechanisms of arterial stiffness were associated with all-cause mortality and CKD. Structural stiffness was associated with all-cause mortality, and load-dependent stiffness was associated with CKD. Total stiffness was associated with dementia but load-dependent and structural stiffness were not.
- Published
- 2023
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35. Multiple Myeloma in a Patient with Sarcoidosis and Heavy Proteinuria: A Case Report.
- Author
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ASANJRANI, BEHZAD, ABDOLLAHPOUR, ESMAT, ALESAEIDI, SAMIRA, and ZAINALDAIN, HAMED
- Subjects
- *
SARCOIDOSIS , *MULTIPLE myeloma , *FOCAL segmental glomerulosclerosis , *BONE marrow cells , *PROTEINURIA , *BLOOD proteins - Abstract
The present case is of 44-year-old woman who was a known case of sarcoidosis revealed granulomatous inflammation without caseafication. She also reported to suffer from proteinuria about 2 g/day, which was reported as Focal Segmental Glomerulosclerosis (FSGS) secondary to sarcoidosis after renal biopsy and thorough evaluation. Skeletal survey showed multiple lytic lesions in her skull, ribs, vertebra and iliac bone. The patient fully met diagnostic criteria for symptomatic Multiple Myeloma (MM) and chemotherapy was started with Velcade, Cyclophosphamide and Dexamethasone. Having completed chemotherapy, bone marrow plasma cells reached 8% and there were no peak of the serum or urine protein. Our patient is the first report of correlation of three diseases of Sarcoidosis and MM together and FSGS. Immune system impairment may be the main predisposing factor. The relationship between sarcoidosis and MM is unclear. Since in sarcoidosis, impaired immune system is involved, it predisposes developing malignancies in sarcoidosis. It is suggested that two important factors i.e. aneuploidy in the granuloma and peripheral blood lymphocytes can cause haematologic malignancy via developing genetic instability. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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36. Aortic Ambulatory Blood Pressure Monitoring and Target Organ Damage: Are the Data Really Conflicting?
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Argyris, Antonios A, Weber, Thomas, and Protogerou, Athanase D
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BLOOD pressure measurement ,BRACHIAL artery ,BIOMEDICAL engineering ,MULTIPLE organ failure ,HYPERTENSION - Abstract
The article focuses on the measurement of blood pressure (BP) and brachial due to development is seen in biomedical engineering in ambulatory conditions. Topics include BP closure to hypertension which is associated with target organ damage (TOD), availability of technologies such as radial tonometric and brachial oscillometric, and study on left ventricular mass (LVM).
- Published
- 2018
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37. Der hypertensive Notfall
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J-S Padberg, U. Jehn, P. Kümpers, R. Pistulli, Markus Strauss, Roman Leischik, and Holger Reinecke
- Subjects
Aortic dissection ,medicine.medical_specialty ,business.industry ,End organ damage ,medicine.drug_class ,Hypertensive urgency ,Emergency Nursing ,Urapidil ,Critical Care and Intensive Care Medicine ,medicine.disease ,Compliance (physiology) ,03 medical and health sciences ,0302 clinical medicine ,Blood pressure ,Internal medicine ,Emergency Medicine ,Internal Medicine ,medicine ,Cardiology ,Hypertensive emergency ,030212 general & internal medicine ,business ,Antihypertensive drug - Abstract
The hypertensive emergency situation is characterized by an acute-mostly life-threatening-blood pressure derailment with the risk of acute end organ damage. It is an acute manifestation of arterial hypertension, which manifests in a variety of symptoms. The etiology is in most cases long-term (chronic) hypertension as a result of low compliance or inadequate antihypertensive therapy. It can also occur as a first manifestation of arterial hypertension. It requires timely antihypertensive drug therapy, which should be initiated in an intensive or intermediate care unit. The choice of antihypertensive therapy regimen should be based on the underlying end organ damage. Fast-acting, easily controllable and intravenously administered substances should be preferred. The most commonly used substances (groups) are urapidil, nitroglycerin, beta blockers and short-acting calcium channel blockers. With a few exceptions, a deliberate, rapid reduction in blood pressure of no more than 20-25% of the initial value is sufficient for extracerebral causes. A subsequent systolic blood pressure target of 160/100 mm Hg should be aimed for within the next 2-6 h. An overly rapid drop in blood pressure can lead to reduced blood flow to the central nervous system due to changes in autoregulation. Exceptions to this rule are acute aortic dissection and flash pulmonary edema-in these cases, prompt blood pressure normalization should be achieved. The initial acute therapy should be followed by a more detailed investigation of the cause and a long-term therapy setting based on this.
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- 2020
38. Drug development in oncology and devices—lessons for heart failure drug development and approval? a review
- Author
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Marco Metra, Faiez Zannad, Alexandre Mebazaa, Gad Cotter, Stefanie Senger, John R. Teerlink, Beth A. Davison, Barry H. Greenberg, Adriaan A. Voors, and Gerasimos Filippatos
- Subjects
Oncology ,medicine.medical_specialty ,End organ damage ,Clinical studies ,Heart failure ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,03 medical and health sciences ,0302 clinical medicine ,Drug Development ,Quality of life ,Internal medicine ,Humans ,Medicine ,030212 general & internal medicine ,Ejection fraction ,business.industry ,Disease progression ,Cancer ,Stroke Volume ,medicine.disease ,Drug development ,Quality of Life ,Accelerated approval ,Cardiology and Cardiovascular Medicine ,business - Abstract
Heart failure (HF) and cancer are of the most common diseases globally, both associated with significant adverse outcomes and greatly impaired quality of life. Despite those similarities, over the last 15 years, the United States (USA) and European authorities have approved only 5 and 3 new drugs for HF respectively, none using an accelerated process and none for patients with either acute HF (AHF) or with HF and preserved ejection fraction (HFpEF). During the same period, more than 100 new drugs were approved for treatment of various cancers, several receiving accelerated approval. HF drugs in the last 15 years were mostly approved for reduction in mortality, whereas most approved cancer drugs addressed disease progression and surrogate markers. Consequently, the size of the trials in HF were far greater than those in oncology which was associated with lower probability of success. Given the larger study size and smaller probability of approval, pharma progressively reduces the necessary investments in new HF drugs. We suggest for HF drugs be developed, especially those used to treat patients with HFpEF and AHF, consideration of approval based beyond morbidity and mortality on improvements in symptoms and functional capacity and, like oncology, based on measures of disease progression and end organ damage. At the same time, HF drug development should adopt some approaches used in other diseases (such as oncology) focusing on better defining specific phenotypes and defining specific disease-related targets for new drugs.
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- 2020
39. Altered Hemodynamics and End-Organ Damage in Heart Failure
- Author
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Marco Guazzi, Barry A. Borlaug, Frederik H. Verbrugge, Jeffrey M. Testani, Clinical sciences, Medicine and Pharmacy academic/administration, Cardiology, Intensive Care, Verbrugge, Frederik Hendrik/0000-0003-0599-9290, Borlaug, Barry/0000-0001-9375-0596, VERBRUGGE, Frederik, Guazzi, Marco, Testani, Jeffrey M., and Borlaug, Barry A.
- Subjects
Lung Diseases ,kidney ,lung disease ,medicine.medical_specialty ,Cardiac output ,End organ damage ,heart failure ,Hemodynamics ,Article ,lung ,Physiology (medical) ,Internal medicine ,Humans ,Medicine ,Myocytes, Cardiac ,Cardiac Output ,Lung ,Ejection fraction ,business.industry ,Cardiogenic shock ,medicine.disease ,medicine.anatomical_structure ,Nephrology ,Heart failure ,Cardiology ,Kidney Diseases ,Cardiology and Cardiovascular Medicine ,business ,Perfusion - Abstract
Heart failure is characterized by pathologic hemodynamic derangements, including elevated cardiac filling pressures ("backward" failure), which may or may not coexist with reduced cardiac output ("forward" failure). Even when normal during unstressed conditions such as rest, hemodynamics classically become abnormal during stressors such as exercise in patients with heart failure. This has important upstream and downstream effects on multiple organ systems, particularly with respect to the lungs and kidneys. Hemodynamic abnormalities in heart failure are affected by processes that extend well beyond the cardiac myocyte, including important roles for pericardial constraint, ventricular interaction, and altered venous capacity. Hemodynamic perturbations have widespread effects across multiple heart failure phenotypes, ranging from reduced to preserved ejection fraction, acute to chronic disease, and cardiogenic shock to preserved perfusion states. In the lung, hemodynamic derangements lead to the development of abnormalities in ventilatory control and efficiency, pulmonary congestion, capillary stress failure, and eventually pulmonary vascular disease. In the kidney, hemodynamic perturbations lead to sodium and water retention and worsening renal function. Improved understanding of the mechanisms by which altered hemodynamics in heart failure affect the lungs and kidneys is needed in order to design novel strategies to improve clinical outcomes. Dr Verbrugge is supported by a Fellowship of the Belgian American Educational Foundation and by the Special Research Fund of Hasselt University (grant no. BOF19PD04). Dr Borlaug is supported by grants R01 HL128526 and U01 HL125205, both from the US National Heart, Lung, and Blood Institute. Borlaug, BA (corresponding author), Mayo Clin & Mayo Fdn, 200 First St SW, Rochester, MN 55905 USA. borlaug.barry@mayo.edu
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- 2020
40. Cytokine release syndrome: inhibition of pro-inflammatory cytokines as a solution for reducing COVID-19 mortality
- Author
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Nima Rezaei, Melika Shafeghat, Negar Moradian, Mahdi Gouravani, Mohammad Amin Salehi, Arash Heidari, and Michael R. Hamblin
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Corona virus ,End organ damage ,medicine.medical_treatment ,Clinical Biochemistry ,Immunology ,Review ,macromolecular substances ,Disease ,medicine.disease_cause ,Antibodies ,Proinflammatory cytokine ,Pharmacotherapy ,medicine ,Humans ,Immunology and Allergy ,Pandemics ,Coronavirus ,treatment ,Interleukin-6 ,SARS-CoV-2 ,Tumor Necrosis Factor-alpha ,business.industry ,Mortality rate ,COVID-19 ,cytokine release syndrome ,medicine.disease ,COVID-19 Drug Treatment ,Cytokine release syndrome ,Cytokine ,business - Abstract
Coronavirus disease (COVID-19) reached pandemic proportions at the beginning of 2020 and continues to be a worldwide concern. End organ damage and acute respiratory distress syndrome are the leading causes of death in severely or critically ill patients. The elevated cytokine levels in severe patients in comparison with mildly affected patients suggest that cytokine release syndrome (CRS) occurs in the severe form of the disease. In this paper, the significant role of pro-inflammatory cytokines, including IL-1, IL-6, and TNF-alpha, and their mechanism of action in the CRS cascade is explained. Potential therapeutic approaches involving anti-IL-6 and anti-TNF-alpha antibodies to fight COVID-19 and reduce mortality rate in severe cases are also discussed.
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- 2020
41. Central Nervous System and Cardiac Involvement in the Hypereosinophilic Syndrome: A Case Report
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Reza Kiani, Saeed Ebrahimi Meymand, Anita Sadeghpour, Batoul Naghavi, Ahmad Amin, Ali Zahedmehr, Ata Firouzi, Hamidreza Pouraliakbar, Armin Marashizadeh, and Simin Almasi
- Subjects
0301 basic medicine ,Pathology ,medicine.medical_specialty ,End organ damage ,Heart Ventricles ,Immunology ,Central nervous system ,Hypereosinophilia ,Context (language use) ,Pericardial effusion ,03 medical and health sciences ,0302 clinical medicine ,hemic and lymphatic diseases ,Cardiac tamponade ,Hypereosinophilic Syndrome ,medicine ,Humans ,Hypereosinophilic syndrome ,business.industry ,Brain ,General Medicine ,Middle Aged ,medicine.disease ,Cardiac Tamponade ,030104 developmental biology ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Organ involvement ,Female ,medicine.symptom ,business - Abstract
Hypereosinophilic syndrome is a rare entity and heterogeneous group of disorders characterized by hypereosinophilia and organ involvement. In this study, we presented a 49-year-old woman with cardiac tamponade in the context of Hypereosinophilic syndrome. Identifying hypereosinophilia as the underlying cause can have tremendous clinical implications for rapid initiation of appropriate treatment to minimize further end organ damage.
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- 2020
42. Can ocular OCT findings be as a predictor for end-organ damage in systemic hypertension?
- Author
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Hatice Selen Kanar, Huseyin Cetin, Batur Gonenc Kanar, Engin Ersin Simsek, Mustafa Kürşat Tigen, and Aysu Arsan
- Subjects
Male ,medicine.medical_specialty ,Physiology ,End organ damage ,Pharmacology toxicology ,Hypertensive Retinopathy ,030204 cardiovascular system & hematology ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Hypertensive retinopathy ,Ophthalmology ,Internal Medicine ,Humans ,Medicine ,030212 general & internal medicine ,Aged ,business.industry ,Retinal ,General Medicine ,Middle Aged ,medicine.disease ,chemistry ,Hypertension ,Female ,business ,Tomography, Optical Coherence - Abstract
Detection of end-organ damage (EOD) in systemic hypertension is essential for the management of systemic hypertension. We aimed to evaluate subfoveal choroidal thickness (SFCT) and retinal layers' thicknesses by using spectral domain optical coherence tomography (SD‑OCT) in patients with systemic hypertension and to assess the relationship between EOD and SD-OCT parameters.A total of 189 consecutive patients with systemic hypertension and 100 controls were included. Patients were examined to detect EOD including hypertensive retinopathy (HTRP), left ventricular hypertrophy assessed by transthoracic echocardiography and microalbuminuria assessed by 24-h urine analysis. SFCT, inner plexiform-ganglion cell complex (IP-GCC), peripapillary retinal nerve fiber layer (pRNFL) and central macular thickness (CMT) were measured with SD-OCT.Patients with systemic hypertension had significantly lower SFCT and retinal layer thicknesses than controls (P˂0.001). In the dilated fundus photographic evaluation, 94 patients with systemic hypertension had HTRP and these patients had lower SFCT, CMT, IP-GCC and pRNFL thicknesses compared to hypertensive patients without HTRP and healthy controls. Patients with EOD had significantly lower SFCT, CMT, IP-GCC and pRNFL thicknesses and as the number of EOD increased, the SFCT decreased significantly. In the multivariate analysis, SFCT was found as an independent predictor of EOD (P˂0.001, odds ratio: 0.0605).Hypertensive patients, especially with EOD had significantly lower SD-OCT parameters compared to controls. It would be rational to add SD-OCT assessment to conventional hypertensive retinopathy evaluation in patients with systemic hypertension for early diagnosis of end-organ damage, burden of target organ involvement and monitoring anti-hypertensive treatment.
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- 2020
43. Necrotising Soft Tissue Infection in the Twenty-First Century—a Clinical and Microbiological Spectrum Analysis
- Author
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Balachandra Menon, Murali Krishna, Sandeep Mehrotra, and A Galagali
- Subjects
medicine.medical_specialty ,Microbiological culture ,business.industry ,End organ damage ,Emergency department ,medicine.disease ,Cardiac surgery ,03 medical and health sciences ,0302 clinical medicine ,Cardiothoracic surgery ,030220 oncology & carcinogenesis ,Internal medicine ,Pediatric surgery ,medicine ,030211 gastroenterology & hepatology ,Surgery ,Observational study ,Neurosurgery ,business - Abstract
Necrotising soft tissue infection (NSTI) is a lethal infectious disease with rapid progression towards early hemodynamic failure, end organ damage, and death. A prospective observational study was conducted to analyse the clinical and microbiological spectrum of NSTI cases. All patients of NSTI presenting to the emergency department and consenting to participate in the study were included. Demographic details, clinical findings, laboratory parameters, operative findings, length of stay, and final outcome were noted in a study proforma. A total of 100 patients were included in the study, among whom 84 were males and 16 were females. The average age was 65.8 years with SD of 13.4. The most common presenting symptom was pain followed by redness of skin. Positive microbial culture was noted in 43 cases, and Streptococcus was the most common organism that had grown. The average length of stay was around 21 days, and patients underwent on an average 7 procedures. There were 16 fatal outcomes, and age, renal function, haemoglobin levels, bilirubin levels, and blood sugar levels were found to be significant predictors of mortality. NSTI, even in today’s era, continue to cause substantial mortality and morbidity. Aggressive debridement and broad spectrum antibiotics form the mainstay of therapy.
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- 2020
44. Cardioprotective Effects of the Novel Compound Vastiras in a Preclinical Model of End-Organ Damage
- Author
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Francesco Spelta, Gustavo Jose Justo da Silva, William E. Louch, Michael Frisk, George W. Booz, Fouad A. Zouein, Alessandro Cataliotti, and Raffaele Altara
- Subjects
Male ,0301 basic medicine ,Cardiac function curve ,medicine.medical_specialty ,Cardiotonic Agents ,End organ damage ,medicine.drug_class ,Drug Evaluation, Preclinical ,Natriuresis ,Blood Pressure ,Cardiomegaly ,Smad2 Protein ,030204 cardiovascular system & hematology ,Kidney ,Dinoprostone ,03 medical and health sciences ,0302 clinical medicine ,Atrial natriuretic peptide ,Internal medicine ,Internal Medicine ,medicine ,Natriuretic peptide ,Albuminuria ,Animals ,Myocytes, Cardiac ,Sodium Chloride, Dietary ,Rats, Inbred Dahl ,Ventricular Remodeling ,business.industry ,Heart ,Atrial Remodeling ,medicine.disease ,Fibrosis ,Peptide Fragments ,Hypertensive heart disease ,Rats ,030104 developmental biology ,Endocrinology ,Blood pressure ,Heart failure ,Hypertension ,Potassium ,cardiovascular system ,Kidney Diseases ,business ,Atrial Natriuretic Factor ,Glomerular Filtration Rate - Abstract
Cardiac hypertrophy and renal damage associated with hypertension are independent predictors of morbidity and mortality. In a model of hypertensive heart disease and renal damage, we tested the actions of continuous administration of Vastiras, a novel compound derived from the linear fragment of ANP (atrial natriuretic peptide), namely pro-ANP 31–67 , on blood pressure and associated renal and cardiac function and remodeling. Of note, this peptide, unlike the ring structured forms, does not bind to the classic natriuretic peptide receptors. Dahl/Salt–Sensitive rats fed a 4% NaCl diet for 6 weeks developed hypertension, cardiac hypertrophy, and renal damage. Four weeks of treatment with 50 to 100 ng/kg per day of Vastiras exhibited positive effects on renal function, independent of blood pressure regulation. Treated rats had increased urine excretion, natriuresis, and enhanced glomerular filtration rate. Importantly, these favorable renal effects were accompanied by improved cardiac structure and function, including attenuated cardiac hypertrophy, as indicated by decreased heart weight to body weight ratio, relative wall thickness, and left atrial diameter, as well as reduced fibrosis and normalized ratio of the diastolic mitral inflow E wave to A wave. A renal subtherapeutic dose of Vastiras (25 ng/kg per day) induced similar protective effects on the heart. At the cellular level, cardiomyocyte size and t-tubule density were preserved in Vastiras-treated compared with untreated animals. In conclusion, these data demonstrate the cardiorenal protective actions of chronic supplementation of a first-in-class compound, Vastiras, in a preclinical model of maladaptive cardiac hypertrophy and renal damage induced by hypertension.
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- 2020
45. Impact of Uric Acid on Hypertension Occurrence and Target Organ Damage: Insights From the STANISLAS Cohort With a 20-Year Follow-up
- Author
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Jean-Loup Machu, Nicolas Girerd, Jean-Marc Boivin, Sandra Wagner, Patrick Rossignol, Faiez Zannad, Erwan Bozec, Mehmet Kanbay, Kevin Duarte, João Pedro Ferreira, Koç University, Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy] (INI-CRCT), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], French-Clinical Research Infrastructure Network - F-CRIN [Paris] (Cardiovascular & Renal Clinical Trialists - CRCT ), The STANISLAS study is sponsored by the Nancy CHRU.This work is supported by the French Ministry of Health 'Programme Hospitalier de Recherche Clinique Inter regional 2013,' by the Contrat de Plan Etat-Lorraine and FEDER Lorraine, and a public grant overseen by the French National Research Agency (ANR) as part of the second 'Investissements d’Avenir' program FIGHT-HF (reference: ANR-15-RHU-0004) and by the French PIA project 'Lorraine Université d’Excellence,' Reference ANR-15-IDEX-04-LUE. It is also supported by the European Fibro-Targets Project (grant agreement no. SP7#602904), European HOMAGE project (grant agreement no. Heart 'Omics' in Ageing, 7th Framework Program grant # 305507), the MEDIA project (Européen 'Cooperation'—Theme 'Health'/FP7-HEALTH- 2010-single-stage (reference: 261409), FOCUS-MR (reference:ANR-15-CE14-0032-01), ERA-CVD EXPERT (reference:ANR-16-ECVD-0002-02), and the Fondation de Recherche en Hypertension Artérielle., IMPACT GEENAGE, ANR-16-ECVD-0002,EXPERT,Exploring new pathways in age-related heart diseases(2016), ANR-15-CE14-0032,MR-focus,Régulation, Diagnostique et Thérapeutique ciblée du récepteur minéralocorticoïde dans le remodelage cardiaque(2015), ANR-15-RHUS-0004,FIGHT-HF,Combattre l'insuffisance cardiaque(2015), ANR-15-IDEX-0004,LUE (ISITE),Lorraine Université d'Excellence(2016), European Project: 261409,EC:FP7:HEALTH,FP7-HEALTH-2010-single-stage,MEDIA(2011), European Project: 305507,EC:FP7:HEALTH,FP7-HEALTH-2012-INNOVATION-1,HOMAGE(2013), European Project: 602904,EC:FP7:HEALTH,FP7-HEALTH-2013-INNOVATION-1,FIBRO-TARGETS(2013), DE CARVALHO, Philippe, Exploring new pathways in age-related heart diseases - - EXPERT2016 - ANR-16-ECVD-0002 - ERA-CVD - VALID, Régulation, Diagnostique et Thérapeutique ciblée du récepteur minéralocorticoïde dans le remodelage cardiaque - - MR-focus2015 - ANR-15-CE14-0032 - AAPG2015 - VALID, Combattre l'insuffisance cardiaque - - FIGHT-HF2015 - ANR-15-RHUS-0004 - RHUS - VALID, ISITE - Isite LUE - - LUE2015 - ANR-15-IDEX-0004 - IDEX - VALID, The MEtabolic Road to DIAstolic Heart Failure - MEDIA - - EC:FP7:HEALTH2011-01-01 - 2016-06-30 - 261409 - VALID, Heart OMics in AGEing - HOMAGE - - EC:FP7:HEALTH2013-02-01 - 2019-01-31 - 305507 - VALID, and Targeting cardiac fibrosis for heart failure treatment - FIBRO-TARGETS - - EC:FP7:HEALTH2013-09-01 - 2017-08-31 - 602904 - VALID
- Subjects
Male ,[SDV]Life Sciences [q-bio] ,030204 cardiovascular system & hematology ,Left ventricular hypertrophy ,Cohort Studies ,Ventricular Dysfunction, Left ,0302 clinical medicine ,Risk Factors ,Longitudinal Studies ,030212 general & internal medicine ,Hyperuricemia ,Pulse wave velocity ,2. Zero hunger ,education.field_of_study ,[SDV.MHEP] Life Sciences [q-bio]/Human health and pathology ,blood pressure ,Middle Aged ,[SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,left ventricular hypertrophy ,3. Good health ,[SDV] Life Sciences [q-bio] ,Creatinine ,Cohort ,Cardiology ,Female ,Hypertrophy, Left Ventricular ,France ,Glomerular Filtration Rate ,Adult ,medicine.medical_specialty ,hypertension ,End organ damage ,pulse wave velocity ,Population ,Pulse Wave Analysis ,albuminuria ,03 medical and health sciences ,Vascular Stiffness ,uric acid ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Internal medicine ,Internal Medicine ,medicine ,Humans ,cardiovascular diseases ,Renal Insufficiency, Chronic ,education ,Aged ,business.industry ,medicine.disease ,Blood pressure ,business ,Body mass index ,chronic kidney disease ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
BACKGROUND Recent studies have shown that hyperuricemia may be associated with incident hypertension (HTN). We examined whether serum uric acid (SUA) is a predictor of HTN and target organ damage (TOD) 20 years later in initially healthy middle-aged individuals. METHODS Participants from the Suivi Temporaire Annuel Non-Invasif de la Santé des Lorrains Assurés Sociaux (STANISLAS) a single-center familial longitudinal cohort study (961 initially healthy adults and 570 children) underwent clinical and laboratory measurements at baseline and after approximately 20 years. Blood pressure (BP: using ambulatory BP measurements), urine albumin-to-creatinine ratio, estimated glomerular filtration rate (eGFR), left ventricular hypertrophy (LVH), diastolic dysfunction, and carotid–femoral pulse wave velocity (PWV) were measured at the end of follow-up. RESULTS In the parent population, higher baseline or last SUA levels and higher change in SUA (ΔUA) were significantly associated with an increased risk of HTN development, even after adjusting for known HTN risk factors (all P < 0.01). Higher baseline SUA was marginally associated with an increased risk of having high carotid–femoral PWV (P = 0.05). The association of SUA with BP increase was body mass index dependent (the increase in BP being greater in leaner subjects; interactionp < 0.05), and the association of SUA with eGFR decline was age dependent (the decline in eGFR being greater in older subjects; interactionp < 0.05). There was no significant association between SUA and diastolic dysfunction or LVH. In the whole population (i.e. including children), a significant association between SUA at baseline and the risk of HTN and higher carotid–femoral PWV was also found (both P < 0.02). CONCLUSIONS Increased SUA is associated with the development of HTN and vascular/renal TOD in initially healthy midlife subjects.
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- 2020
46. State‐of‐the‐art considerations in post‐arrest care
- Author
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Michael Sonnier and Jon C Rittenberger
- Subjects
Coma ,medicine.medical_specialty ,Resuscitation ,End organ damage ,business.industry ,resuscitation ,Cardiology ,Psychological intervention ,coma ,Review Article ,Emergency treatment ,outcomes ,medicine.disease ,critical care ,Initial phase ,emergency treatment ,medicine ,Emergency physician ,medicine.symptom ,hypothermia ,Intensive care medicine ,business ,Intensive management ,heart arrest - Abstract
Cardiac arrest has a high rate of morbidity and mortality. Several advances in post‐cardiac arrest management can improve outcome, but are time‐dependent, placing the emergency physician in a critical role to both recognize the need for and initiate therapy. We present a novel perspective of both the workup and therapeutic interventions geared toward the emergency physician during the first few hours of care. We describe how the immediate care of a post‐cardiac arrest patient is resource intensive and requires simultaneous evaluation for the underlying cause and intensive management to prevent further end organ damage, particularly of the central nervous system. The goal of the initial focused assessment is to rapidly determine if any reversible causes of cardiac arrest are present and to intervene when possible. Interventions performed in this acute period are aimed at preventing additional brain injury through optimizing hemodynamics, providing ventilatory support, and by using therapeutic hypothermia when indicated. After the initial phase of care, disposition is guided by available resources and the clinician's judgment. Transfer to a specialized cardiac arrest center is prudent in centers that do not have significant support or experience in the care of these patients.
- Published
- 2020
47. Seasonal Variation of Home Blood Pressure and Its Association With Target Organ Damage: The J-HOP Study (Japan Morning Surge-Home Blood Pressure)
- Author
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Kazuomi Kario, Keisuke Narita, Hiroshi Kanegae, Takeshi Fujiwara, and Satoshi Hoshide
- Subjects
Male ,medicine.medical_specialty ,Evening ,hypertension ,End organ damage ,Original Contributions ,Diastole ,Blood Pressure ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,home blood pressure ,Japan ,Internal medicine ,target organ damage ,Masked Hypertension ,Natriuretic Peptide, Brain ,Internal Medicine ,medicine ,Prevalence ,Albuminuria ,Humans ,AcademicSubjects/MED00200 ,030212 general & internal medicine ,Prospective Studies ,Prospective cohort study ,Morning ,Aged ,seasonal variation ,business.industry ,Blood Pressure Measurement ,Blood Pressure Monitoring, Ambulatory ,Middle Aged ,Brain natriuretic peptide ,medicine.disease ,Circadian Rhythm ,Blood pressure ,Cross-Sectional Studies ,Cardiology ,AcademicSubjects/SCI00960 ,Female ,Seasons ,business ,Biomarkers - Abstract
Background Although seasonal variation of home blood pressure (BP) has been reported to be higher in winter, seasonal difference in home BP (HBP) and its association with target organ damage (TOD) remains unclear. Methods This is a cross-sectional study using the dataset from the Japan Morning Surge-Home Blood Pressure (J-HOP) study to assess seasonal differences in HBP, prevalence of masked hypertension, and association of HBP with TOD. The J-HOP study is a nationwide, multicenter prospective study whose participants with cardiovascular risks underwent morning and evening HBP measurements for a 14-day period in 71 institutions throughout Japan. Urine albumin–creatinine ratio (UACR) and serum-B-type natriuretic peptide (BNP) were obtained at enrollment. Results Among 4,267 participants (mean age, 64.9 ± 10.9 years; 46.9% male; 91.4% hypertensives), 1,060, 979, 1,224, and 1,004 participants were enrolled in spring, summer, autumn, and winter, respectively. Morning and evening home systolic/diastolic BP levels, and prevalence of masked hypertension (office BP Conclusions In this study, we revealed that the prevalence of masked hypertension was higher in other seasons than in summer and found a notable association between morning home diastolic BP and TOD in winter.
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- 2020
48. Racial Differences in the Influence of Risk Factors in Childhood on Left Ventricular Mass in Young Adulthood
- Author
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Jessica G. Woo, Elaine M. Urbina, Brenda Mendizábal, and Philip R. Khoury
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,End organ damage ,Heart Ventricles ,Blood Pressure ,Risk Assessment ,Article ,Ventricular Function, Left ,Left ventricular mass ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,030225 pediatrics ,Internal medicine ,Heart rate ,medicine ,Humans ,Heart rate variability ,Obesity ,030212 general & internal medicine ,Young adult ,Child ,business.industry ,Racial Groups ,Area under the curve ,medicine.disease ,United States ,Blood pressure ,Echocardiography ,Pediatrics, Perinatology and Child Health ,Cardiology ,Female ,Hypertrophy, Left Ventricular ,business ,Follow-Up Studies - Abstract
OBJECTIVE(S): Few data exist relating the burden of cardiovascular (CV) risk factors over the childhood and young adult years on left ventricular mass (LVM), a known risk factor for hard CV events later in life. Racial differences exist in the development of cardiovascular Disease (CVD), with blacks adversely affected. We examined racial differences in the relationship between CV risk factors measured since age 10 and left ventricular mass index (LVMI) in adulthood in the NHLBI Growth and Health Study. STUDY DESIGN: Longitudinal investigation with CV risk factors measured throughout childhood and LVMI measured in adulthood. 556 black and white girls recruited from schools in the greater Cincinnati area. Analyses examined traditional CV risk factors at baseline, follow-up, and over time (i.e. area under the curve, AUC). LVMI was collected with 2-D guided echocardiographic imaging at a mean age of 25.7 ± 1.7 years. RESULTS: Black girls had higher adiposity and insulin and lower heart rate across time (all p < 0.05). Blacks had higher LVMI compared to whites in adulthood. Major determinants of young adult LVMI, were race, body mass index z-score AUC, systolic blood pressure z-score AUC, percent body fat by skin fold AUC, heart rate AUC, and an interaction between race and heart rate (model R(2) = 0.40, p < .0001). CONCLUSIONS: The major determinants of LVMI in young adult females are race, adiposity and systolic blood pressure. The contribution of heart rate to LVMI in whites may relate to previously noted higher sympathetic tone in obese whites.
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- 2020
49. Characteristics and Outcomes of Patients Presenting With Hypertensive Urgency in the Office Setting: The Campania Salute Network
- Author
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Carmine Morisco, Raffaele Izzo, Bruno Trimarco, Giovanni de Simone, Giuliano De Stefano, Giovanni Albano, Costantino Mancusi, Maria Angela Losi, Emanuele Barbato, Nicola De Luca, Mancusi, Costantino, Losi, Maria Angela, Albano, Giovanni, De Stefano, Giuliano, Morisco, Carmine, Barbato, Emanuele, Trimarco, Bruno, De Luca, Nicola, de Simone, Giovanni, and Izzo, Raffaele
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,carotid plaque ,Office Visits ,End organ damage ,Blood Pressure ,030204 cardiovascular system & hematology ,Left ventricular hypertrophy ,Risk Assessment ,Asymptomatic ,03 medical and health sciences ,0302 clinical medicine ,hypertensive crisi ,Risk Factors ,target organ damage ,Internal medicine ,Prevalence ,Internal Medicine ,medicine ,Humans ,Registries ,030212 general & internal medicine ,Aged ,business.industry ,Proportional hazards model ,Hazard ratio ,Hypertensive urgency ,blood pressure control ,Middle Aged ,Prognosis ,medicine.disease ,left ventricular hypertrophy ,Blood pressure ,Italy ,Cardiovascular Diseases ,Hypertension ,Cardiology ,Female ,medicine.symptom ,business ,Kidney disease - Abstract
BACKGROUND Hypertensive urgencies (HypUrg) are defined as severe elevation in blood pressure (BP) without acute target organ damage. In the office setting, treated asymptomatic patients, with severe BP elevation meeting criteria for urgency are often seen. We evaluate incident Cardiovascular (CV) events (n = 311) during follow-up (FU) in patients with HypUrg at first outpatient visit. METHODS HypUrg was defined by systolic BP ≥180 mm Hg and/or diastolic BP ≥110 mm Hg. Patients were >18 years old, with available ultrasound data, without prevalent CV disease, and no more than stage III Chronic Kidney Disease. BP control was defined as the average BP during FU RESULTS Four hundred and sixty-nine of 6,929 patients presented with HypUrg at first visit. Patients with HypUrg were more likely to be women, obese and diabetic and with higher prevalence of left ventricle (LV) hypertrophy and carotid plaque (all P < 0.05). During FU patients with HypUrg had 5-fold higher risk of uncontrolled BP (95% confidence interval (CI) 4.1–6.8, P < 0.0001). In Cox regression presenting with HypUrg was not associated with increased CV risk after adjusting for significant covariates, including age, sex, BP control, LV hypertrophy, and carotid plaque (hazard ratio (HR) 1.42, 95% CI (0.96–2.11), P = 0.08). CONCLUSIONS Patients with HypUrg have worst CV risk profile, reduced probability of BP control during FU and greater prevalence of target organ damage, but the excess CV event risk appears to be mediated through BP control, non-BP cardio-vascular disease risk factors, and demographic attributes. CLINICALTRIALS.GOV IDENTIFIER NCT02211365.
- Published
- 2020
50. Soluble guanylate cyclase stimulator praliciguat attenuates inflammation, fibrosis, and end-organ damage in the Dahl model of cardiorenal failure
- Author
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Guang Liu, Jaime L. Masferrer, Gavrielle M Price, Renee Sarno, Mark G. Currie, Courtney Shea, and Emmanuel S. Buys
- Subjects
Male ,0301 basic medicine ,Physiology ,End organ damage ,Blood Pressure ,Inflammation ,Stimulation ,030204 cardiovascular system & hematology ,Pharmacology ,Kidney ,Nitric Oxide ,Nitric oxide ,03 medical and health sciences ,chemistry.chemical_compound ,Soluble Guanylyl Cyclase ,0302 clinical medicine ,Fibrosis ,Natriuretic Peptide, Brain ,medicine ,Animals ,Renal Insufficiency ,Cyclic GMP ,Chemokine CCL2 ,Rats, Inbred Dahl ,Tissue Inhibitor of Metalloproteinase-1 ,Chemistry ,Guanylyl Cyclase C Agonists ,Soluble Guanylate Cyclase Stimulator ,Cgmp signaling ,medicine.disease ,Peptide Fragments ,Rats ,Pyrimidines ,030104 developmental biology ,cardiovascular system ,Pyrazoles ,Osteopontin ,medicine.symptom ,Biomarkers ,Signal Transduction ,Guanylate cyclase - Abstract
Reduced nitric oxide (NO) and a decrease in cGMP signaling mediated by soluble guanylate cyclase (sGC) has been linked to the development of several cardiorenal diseases. Stimulation of sGC is a potential means for enhancing cGMP production in conditions of reduced NO bioavailability. The purpose of our studies was to determine the effects of praliciguat, a clinical-stage sGC stimulator, in a model of cardiorenal failure. Dahl salt-sensitive rats fed a high-salt diet to induce hypertension and organ damage were treated with the sGC stimulator praliciguat to determine its effects on hemodynamics, biomarkers of inflammation, fibrosis, tissue function, and organ damage. Praliciguat treatment reduced blood pressure, improved cardiorenal damage, and attenuated the increase in circulating markers of inflammation and fibrosis. Notably, praliciguat affected markers of renal damage at a dose that had minimal effect on blood pressure. In addition, liver fibrosis and circulating markers of tissue damage were attenuated in praliciguat-treated rats. Stimulation of the NO-sGC-cGMP pathway by praliciguat attenuated or normalized indicators of chronic inflammation, fibrosis, and tissue dysfunction in the Dahl salt-sensitive rat model. Stimulation of sGC by praliciguat may present an effective mechanism for treating diseases linked to NO deficiency, particularly those associated with cardiac and renal failure. Praliciguat is currently being evaluated in patients with diabetic nephropathy and heart failure with preserved ejection fraction.
- Published
- 2020
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