Journal of Hypertension: Open Access

Background: Hypertension is poorly controlled in hemodialysis (HD). Extracellular fluid volume control, restriction of salt intake and antihypertensive therapy are needed to control blood pressure (BP) control in this population. Research on patterns of antihypertensive use on BP has not been extensively studied in the chronic HD population.

Methods: A descriptive secondary correlational analysis of n = 118 chronic HD patients was conducted to determine the patterns of antihypertensive medication use and their relationship to BP.

Results: Participants were taking an average of three antihypertensive medications. Total number of antihypertensive medications was not correlated with BP. There were no differences in BPs in patients who took or did not take a specific antihypertensive drug class except for ace-inhibitors. Those participants who did take ace-inhibitors had significantly higher BPs.

Conclusions: Future studies examining antihypertensive class, optimal dosing and time of administration need to be conducted to determine the best hypertensive management intervention for chronic HD patients.

Background: Studies in patients with an impaired efferent baroreflex led to the discovery that ingestion of water induces a robust increase in blood pressure and vascular resistance. This response was also present in healthy subjects with intact baroreflexes. We aimed to clarify the physiological role of the osmopressor response by determining the change of plasma somatostatin after water ingestion in young healthy subjects.

Methods and results: In a randomized, controlled, crossover fashion, 17 young healthy subjects (aged 22-35 years) ingested either 500 or 50 mL of water. Heart rate, blood pressure, cardiac index, and total peripheral vascular resistance were measured using a Finometer hemodynamic monitor. Blood sampling was performed at 5 min before and at 25 and 50 min after water ingestion. Plasma somatostatin was measured by ELISA. At 25 min after the ingestion of 500 mL of water, total peripheral resistance increased and plasma osmolality decreased, significantly. Plasma somatostatin increased significantly after ingestion of 500 mL of water, and the magnitude of change in plasma somatostatin strongly correlated with the change in total peripheral vascular resistance.

Conclusions: An increase in plasma somatostatin associated with the drop in osmolality after water ingestion might contribute to the physiology of the osmopressor response.

The objective is to analyze the association between the degree of compliance with Mediterranean Diet and blood pressure in 1078 Spanish schoolchildren (514 boys, 564 girls) aged 9 to 16 years. We measured weight (kg), height (cm), waist circumference (cm), skinfold thicknesses (bicipital, tricipital, subscapular and suprailiac) and blood pressure. The Waist-to-Height Ratio (WtHR), Body Mass Index (BMI), and the percent body fat (%BF) were calculated. Subjects were classified as “underweight”, “normal weight”, “overweight” or “obese” according to the International Obesity Task Force (IOTF). Diet quality was assessed by the KIDMED Index and the hypertensive status according to National High BP Education Program Working Group.

Results show that media values of systolic and diastolic blood pressure significantly increase at the same time that diminished the quality of the diet. Schoolchildren with high blood pressure (4.66% boys; 4.78% girls) are not distributed uniformly in the different KIDMED categories. In the “poor” diet category (KIDMED-score <3) there were 8.33% of hypertensive children, in the “average” category (KIDMED-score 3-7) there were a 3.38% and, by contrast, there were not hypertensive children in “good” category (KIDMED-score > 7). A multiple linear regression analysis found that KIDMED index had a negative correlation with systolic and diastolic pressure. Also BMI and WtHR were positively correlated with both blood pressure levels, and % BF was associated only with diastolic BP. In conclusion, although the KIDMED index is a fast and simple tool to assess diet quality, it clearly reveals an inverse association between adherence to Mediterranean diet and blood pressure in healthy Spanish schoolchildren.

Similar to preeclamptic women, hypertension in the chronic Reduced Uterine Perfusion Pressure Rat Model Of Preeclampsia (RUPP) is associated with increased CD4+ T cells, cytokines, sFlt-1 and agonistic autoantibodies to the AngII receptor (AT1-AA). We examined the effect inhibition of T cell co-stimulation in RUPP rats treated with (A) (abatacept, 250 mg/kg, infused i.v. at gestation day 13), on hypertension and sFlt-1, TNF-α and AT1-AA. RUPP surgical procedure was performed on day 14. On day 19 MAP increased from 94+2 mmHg in Normal Pregnant (NP) to 123 ± 3 mmHg in RUPP control rats. This response was attenuated by Abatacept, MAP was 104 ± 2 mmHg in RUPP ± A, and 96 ± 2 mmHg NP ± A. Percent circulating CD4+ T cells were 66 ± 3% in RUPPs compared to 55 ± 3% NP rats (p<0.04) but were normalized in RUPP ± A rats (54 ± 3%). The twofold increase in TNF alpha seen in RUPPs (277 ± 47 pg/ml) was decreased to 80 ± 18 pg/ml in RUPP+A. Placental sFlt-1 was reduced 70 % to 151 ± 28 in RUPP ± A compared 488 ± 61 pg/ml in RUPP (p<0.001). AT1-AA decreased from 20 ± 0.8 bpm in control RUPP to 6 ± 0.7 bpm in RUPP ± A. We next determined the effect of RUPP in causing hypertension in pregnant T cell deficient rats by examining MAP in NP (123 ± 5 mmHg) and RUPP athymic nude rats (123 ± 7 mmHg). In the absence of T cells, hypertension in response to placental ischemia was completely abolished. Collectively these data indicate that CD4+ Tcells in response to placental ischemia play an important role in the pathophysiology of hypertension associated with preeclampsia.

Hypertension is a common problem encountered in everyday clinical practice. Patients with poorly controlled hypertension may present to the emergency room with “hypertensive emergency” - severely elevated blood pressure (>180/120 mmHg) associated with end organ damage, involving neurological, cardiovascular or renal systems. There is a paucity of literature regarding the preferred rate of decline of blood pressure, while treating these patients, as well as the appropriate medications to be used. Based on expert opinion and anecdotal data, it is recommended that the initial management should focus on promptly identifying impending or established end organ damage and decreasing the blood pressure by about 25% in the first 2 hours, except in aortic dissection where rapid lowering of blood pressure is recommended. This review provides a focused approach to the management of hypertensive emergencies.

In the present study we analyzed the impact of a genetic variant in CYP2C8 on coronary artery disease (CAD) in Bulgarian population. We conducted a case-control study to determine whether the common genetic variation rs890293 (CYP2J2*7) in CYP2J2 gene was associated with the risk of CAD.

The purpose of this study is to investigate the relations between Apo B/Apo, LDL/HDL and the metabolic syndrome. Apolipoprotein B, APO B/APO A1 ratio and the ratio LDL/HDL cholesterol can be used as indicators of metabolic syndrome. The ratios APO B/APO A1 and LDL/HDL cholesterol allow for more accurate risk assessment of metabolic syndrome.