1: Arch Intern Med. 2006 Nov 27;166(21):2348-55.
Related Articles, Links
Socioeconomic status and trends in disparities in 4 major risk
factors for cardiovascular disease among US adults, 1971-2002.
Kanjilal S, Gregg EW, Cheng YJ, Zhang P, Nelson DE, Mensah G, Beckles
GL.
Division of Diabetes Translation, National Center for Chronic Disease Prevention
and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
30341, USA.
BACKGROUND: It is unknown whether the previously recognized disparities in
cardiovascular disease (CVD) risk factors related to annual income and
educational level have diminished, persisted, or worsened in recent decades. The
objective of this study was to examine 31-year trends in CVD risk factors by
annual income and educational levels among US adults. METHODS: Four crosssectional national surveys were used: National Health and Nutrition Examination
Survey I (1971-1974), II (1976-1980), III (1988-1994), and 1999-2002. The main
outcome measure was prevalence of high cholesterol (> or =240 mg/dL [> or =6.2
mmol/L]), high blood pressure (140/90 mm Hg), smoking, and diabetes mellitus.
RESULTS: Between 1971 and 2002, the prevalence of all CVD risk factors,
except diabetes, decreased in all income and education groups, but there has been
little reduction in income- and education-related disparities in CVD risk factors
and few improvements during the past 10 years. The prevalence of high blood
pressure declined by about half in all income and education groups, ranging from
30.3% to 40.6% in 1971-1974 and 16.4% in 1999-2002, with the greatest
reduction among those in the lowest income quartile and those with less than a
high school education (18.0 and 15.9 percentage points, respectively). High
cholesterol prevalence also declined in all groups and ranged from 28.8% to
32.4% in 1971-1974 and 15.3% to 22.0% in 1999-2002, with the largest decline
(15.9 percentage points) among people with the highest incomes. Education- and
income-related disparities in smoking widened considerably, because there were
large declines in smoking prevalence among people with high incomes and
education (from about 33% in 1971-1974 to about 14%-17% in 1999-2002) but
only marginal reductions among those with low incomes and education (about 6percentage point decline). Diabetes prevalence increased most among persons
with low incomes and education. CONCLUSIONS: Despite the general success in
reducing CVD risk factors in the US population, not all segments of society are
benefiting equally and improvements may have slowed. Education- and incomerelated disparities have worsened for smoking, and increases in diabetes
prevalence have occurred primarily among persons with a lower socioeconomic
status. Diabetes prevention and smoking prevention and cessation programs need
to specifically target persons of lower income and education.
PMID: 17130388 [PubMed - indexed for MEDLINE]
Relate
Articles
Link
2: Circulation. 2007 Jan 16;115(2):e18; author reply e19.
Related Articles, Links
Letter by Ben-Dov and Bursztyn regarding article, "Role of
diuretics in the prevention of heart failure: the Antihypertensive and
Lipid-Lowering Treatment to Prevent Heart Attack Trial".
Ben-Dov IZ, Bursztyn M.
Publication Types:


Comment
Letter
PMID: 17228008 [PubMed - in process]
3: Hypertension. 2007 Jan 15; [Epub ahead of print]
Related Articles, Links
Ala92 Type 2 Deiodinase Allele Increases Risk for the Development
of Hypertension.
Gumieniak O, Perlstein TS, Williams JS, Hopkins PN, Brown NJ, Raby BA,
Williams GH.
Endocrinology, Diabetes, and Hypertension Division, Division of Cardiology, and
the Channing Laboratory, Department of Medicine, Brigham and Women's
Hospital, Harvard Medical School, Boston, Mass; Cardiovascular Genetics,
Cardiology Division, University of Utah, Salt Lake City; and the Department of
Medicine, Vanderbilt University, Nashville, Tenn.
Accumulating evidence suggests that genes of the hypothalamic-pituitary-thyroid
pathway influence susceptibility to hypertension. Type 2 iodothyronine
deiodinase is responsible for the conversion of thyroxine to tri-iodothyronine for
use in peripheral tissues. The present study evaluated whether a type 2
iodothyronine deiodinase nonsynonymous polymorphism, threonine 92 to alanine
(Thr92Ala), is a determinant of hypertension susceptibility. A total of 372
euthyroid subjects were genotyped for Thr92Ala polymorphism using the
Sequenom MassARRAY platform. Associations with hypertension and
hypertension-related intermediate phenotypes were performed with generalized
estimating equations. Type 2 iodothyronine deiodinase Thr92Ala allele
frequencies differed significantly between hypertensive and normotensive
subjects, with an excess of Ala92 carriers in hypertensive compared with
normotensive subjects (64.8% versus 47.1%; P=0.011). Adjusted for age, gender
and race, the estimated odds ratio for hypertension in Ala92 allele carriers
compared with Thr92 homozygotes was 2.11 (95% CI: 1.15 to 3.89). Among
euthyroid adults, the common Ala92 allele of the type 2 iodothyronine deiodinase
increases risk for the development of hypertension. These data support an
important role for genetic variation in the hypothalamic-pituitary-thyroid pathway
in influencing susceptibility to hypertension.
PMID: 17224473 [PubMed - as supplied by publisher]
4: Hypertension. 2007 Jan 15; [Epub ahead of print]
Related Articles, Links
Sympathetic Hyperactivity in Hypertensive Chronic Kidney Disease
Patients Is Reduced During Standard Treatment.
Neumann J, Ligtenberg G, Klein IH, Boer P, Oey PL, Koomans HA,
Blankestijn PJ.
Departments of Nephrology and Clinical Neurophysiology, University Medical
Center, Utrecht, the Netherlands.
Standard treatment in chronic kidney disease (CKD) patients includes an
angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker. CKD
is often characterized by sympathetic hyperactivity. This study investigates the
prevalence of sympathetic hyperactivity (quantified by assessment of muscle
sympathetic nerve activity [MSNA]) in a sizable group of patients with CKD and
assessed whether chronic angiotensin-converting enzyme inhibitor or angiotensin
II receptor blocker normalizes increased MSNA. In 74 CKD patients (creatinine
clearance 54+/-31 mL/min), MSNA, blood pressure, and plasma renin activity
were measured in the absence of antihypertensive drugs except for diuretics. In a
subgroup of 31 patients, another set of measurements was obtained after >/=6
weeks of enalapril (10 mg PO), losartan (100 mg PO), or eprosartan (600 mg PO).
Patients as compared with control subjects (n=82) had higher mean arterial
pressure (113+/-13 versus 89+/-7 mm Hg), MSNA (31+/-13 versus 19+/-7 bursts
per minute), and log plasma renin activity (2.67+/-036 versus 2.40+/-0.32 fmol/L
per second; all P<0.001). During angiotensin-converting enzyme inhibitor or
angiotensin II receptor blocker therapy (n=31), mean arterial pressure (115+/-11
to 100+/-9 mm Hg) and MSNA (33+/-11 to 25+/-9 bursts per minute) decreased
(both P<0.01) but were still higher than in control subjects (both P<0.01).
Multiple regression analysis identified age and plasma renin activity as predictive
for MSNA. In conclusion, sympathetic hyperactivity occurs in a substantial
proportion of hypertensive CKD patients. Angiotensin-converting enzyme
inhibitor or angiotensin II receptor blocker treatment reduces but does not
normalize MSNA.
PMID: 17224471 [PubMed - as supplied by publisher]
5: Hypertension. 2007 Jan 15; [Epub ahead of print]
Related Articles, Links
Genome-Wide Linkage Mapping for Valve Calcification
Susceptibility Loci in Hypertensive Sibships. The Hypertension
Genetic Epidemiology Network Study.
Bella JN, Tang W, Kraja A, Rao DC, Hunt SC, Miller MB, Palmieri V,
Roman MJ, Kitzman DW, Oberman A, Devereux RB, Arnett DK.
Weill Medical College, Cornell University, New York, NY; the Bronx-Lebanon
Hospital Center, Bronx, NY; the University of Minnesota, Minneapolis;
Washington University, St Louis, Mo; the School of Medicine, University of
Utah, Salt Lake City; the School of Medicine, Wake Forrest University, WinstonSalem, NC; and the University of Alabama at Birmingham.
It remains unclear whether genetic factors contribute to the susceptibility to valve
calcification. Accordingly, echocardiograms and genotyping were performed in
1871 hypertensive siblings who participated in the Hypertension Genetic
Epidemiology Network Study. Genome-wide affected sibpair nonparametric
linkage analysis was conducted using the allele-sharing method implemented in
the Merlin computer program. A total of 1014 sibships from 858 families were
evaluated for aortic valve sclerosis or mitral annular calcification. Of these, 78
sibships from 68 families contained >/=2 affected siblings with >/=1 type of valve
calcification (142 affected siblings). All 3 of the traits showed a modest degree of
familial aggregation, with sibling recurrence risk (SD) and sibling recurrence risk
ratio (95% CI) being 0.25 (0.035) and 2.31 (1.72 to 3.11) for aortic valve
sclerosis, 0.25 (0.035) and 1.78 (1.36 to 2.33) for mitral annular calcification, and
0.31 (0.030) and 1.52 (1.24 to 1.85) for aortic valve sclerosis and mitral annular
calcification, respectively. Affected sibpair linkage analysis revealed the highest
logarithm of odds score (3.14) in chromosome 16 at 105.6 cM for aortic valve
sclerosis. Other chromosomal regions with logarithm of odds score >/=1.9 were
found in chromosomes 19 (2.88), 16 (2.63), 1 (2.12), and 2 (2.03) for aortic valve
sclerosis and chromosome 13 (2.12) for any valve calcification. There was no
logarithm of odds score >/=1.9 for mitral annular calcification. Our study shows
strong linkage of aortic valve sclerosis to chromosome 16q22.1-q22.3 and
suggestive linkage to chromosome 19p13.11-p11 and identifies several other
promising genomic regions that may contain specific susceptibility loci for valve
calcification.
PMID: 17224468 [PubMed - as supplied by publisher]
6: Hypertension. 2007 Jan;49(1):96-106. Epub 2006 Dec 11.
Related Articles, Links
Population-based sample reveals gene-gender interactions in blood
pressure in White Americans.
Rana BK, Insel PA, Payne SH, Abel K, Beutler E, Ziegler MG, Schork NJ,
O'Connor DT.
Department of Psychiatry, University of California at San Diego, La Jolla, CA
92093, USA.
The influence of genetic contributors, such as common single nucleotide
polymorphisms, on blood pressure and essential hypertension may vary with the
gender. We used the power of a large, community-based sample to probe whether
gender interacts with genes in contributing to extremes of blood pressure in 611
male and 656 female age-matched white Americans within the top and bottom 5th
percentiles of blood pressure among >53 000 people in a health maintenance
program. This approach has >90% statistical power to detect genes contributing
as little as 3% to trait (blood pressure) variation. We scored approximately 60 000
genotypes in the subjects: 48 single nucleotide polymorphisms at 33 autosomal
and 2 X-linked genes in adrenergic and renal pathways that regulate blood
pressure. Six individual variants significantly affected blood pressure and
demonstrated gene-by-gender interaction, yielding different effects of the single
nucleotide polymorphism on blood pressure in males and females. In females,
polymorphisms at beta(1)-adrenergic receptor and alpha(2A)-adrenergic receptor
contributed to blood pressure, whereas in men, polymorphisms at beta(2)adrenergic receptor and angiotensinogen were associated. An alpha(2A)adrenergic receptor haplotype influenced blood pressure in women, whereas 2
angiotensinogen haplotypes were associated in men. We also detected gene-bygene, gender-specific interactions (epistasis) in pathophysiological pathways. This
study reveals gender-specific effects of single nucleotide polymorphisms,
haplotypes, and gene-by-gene interactions that determine blood pressure in white
Americans. Such genetic variants may define genetically and etiologically distinct
subgroups of men and women with essential hypertension and may have
implications for rational treatment selection.
Publication Types:

Research Support, N.I.H., Extramural
PMID: 17159089 [PubMed - indexed for MEDLINE]
7: Hypertension. 2007 Jan;49(1):27-33. Epub 2006 Nov 20.
Related Articles, Links
Comment in:

Hypertension. 2007 Jan;49(1):5-6.
Autonomic contribution to blood pressure and metabolism in
obesity.
Shibao C, Gamboa A, Diedrich A, Ertl AC, Chen KY, Byrne DW, Farley G,
Paranjape SY, Davis SN, Biaggioni I.
Division of Clinical Pharmacology and the Autonomic Dysfunction Center,
Vanderbilt University School of Medicine, Nashville, TN 37212, USA.
Obesity is associated with alterations in the autonomic nervous system that may
contribute to the increase in blood pressure and resting energy expenditure present
in this condition. To test this hypothesis, we induced autonomic withdrawal with
the ganglionic blocker trimethaphan in 10 lean (32+/-3 years) and 10 obese (35+/3 years) subjects. Systolic blood pressure fell more in obese compared with lean
subjects (-17+/-3 versus -11+/-1 mm Hg; P=0.019) because of a greater decrease
in total peripheral resistance (-310+/-41 versus 33+/-78 dynes/sec/cm(-5);
P=0.002). In contrast, resting energy expenditure decreased less in obese than in
lean subjects, (-26+/-21 versus -86+/-15 kcal per day adjusted by fat-free mass;
P=0.035). We confirmed that the autonomic contribution to blood pressure was
greater in obesity after including additional subjects with a wider range of blood
pressures. Systolic blood pressure decreased -28+/-4 mm Hg (95% CI: -38 to 18.0; n=8) in obese hypertensive subjects compared with lean (-9+/-1 mm Hg;
95% CI: -11 to -6; n=22) or obese normotensive subjects (-14+/-2 mm Hg; 95%
CI: -18 to -10; n=20). After removal of autonomic influences, systolic blood
pressure remained higher in obese hypertensive subjects (109+/-3 versus 98+/-2
mm Hg in lean and 103+/-2 mm Hg in obese normotensive subjects; P=0.004)
suggesting a role for additional factors in obesity-associated hypertension. In
conclusion, sympathetic activation induced by obesity is an important determinant
to the blood pressure elevation associated with this condition but is not effective
in increasing resting energy expenditure. These results suggest that the
sympathetic nervous system could be targeted in the treatment of obesityassociated hypertension.
Publication Types:


Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
PMID: 17116758 [PubMed - indexed for MEDLINE]
8: Hypertension. 2007 Jan;49(1):17-8. Epub 2006 Nov 6.
Related Articles, Links
Comment on:

Hypertension. 2007 Jan;49(1):62-8.
Effective ambulatory blood pressure control in medical practice:
good news to be taken with caution.
Mancia G.
Publication Types:

Comment


Editorial
Review
PMID: 17088450 [PubMed - indexed for MEDLINE]
9: Hypertension. 2007 Jan;49(1):55-61. Epub 2006 Nov 6.
Related Articles, Links
Exercise capacity and blood pressure associations with left
ventricular mass in prehypertensive individuals.
Kokkinos P, Pittaras A, Narayan P, Faselis C, Singh S, Manolis A.
Veterans Affairs Medical Center, Cardiology Division, Washington, DC 20422,
USA. peter.kokkinos@med.va.gov
Prehypertensive individuals are at increased risk for developing hypertension and
cardiovascular disease compared with those with normal blood pressure. Early
compromises in left ventricular structure may explain part of the increased risk.
We assessed echocardiographic and exercise parameters in prehypertensive
individuals (n=790) to determine associations between exercise blood pressure
and left ventricular structure. The exercise systolic blood pressure at 5 metabolic
equivalents (METs) and the change in blood pressure from rest to 5 METs were
the strongest predictors of left ventricular hypertrophy. We identified the systolic
blood pressure of 150 mm Hg at the exercise levels of 5 METs as the threshold
for left ventricular hypertrophy. There was a 4-fold increase in the likelihood for
left ventricular hypertrophy for every 10-mm Hg increment in systolic blood
pressure beyond this threshold (OR: 1.15; 95% CI: 1.12 to 1.18). There was also a
42% reduction in the risk for left ventricular hypertrophy for every 1 MET
increase in the workload (OR: 0.58; P<0.001). When compared with low-fit,
moderate, and high-fit individuals exhibited significantly lower systolic blood
pressure at an exercise workload of 5 METs (155+/-14 versus 146+/-10 versus
144+/-10; P<0.05), lower left ventricular mass index (48+/-12 versus 41+/-10
versus 41+/-9; P<0.05), and prevalence of left ventricular hypertrophy (48.3%
versus 18.7% versus 21.6%; P<0.001). This suggests that moderate improvements
in cardiorespiratory fitness achieved by moderate intensity physical activity can
improve hemodynamics and cardiac performance in prehypertensive individuals
and reduce the work of the left ventricle, ultimately resulting in lower left
ventricular mass.
PMID: 17088448 [PubMed - indexed for MEDLINE]
10: Hypertension. 2007 Jan;49(1):62-8. Epub 2006 Oct 30.
Comment in:

Hypertension. 2007 Jan;49(1):17-8.
Related Articles, Links
Effectiveness of blood pressure control outside the medical setting.
Banegas JR, Segura J, Sobrino J, Rodriguez-Artalejo F, de la Sierra A, de la
Cruz JJ, Gorostidi M, Sarria A, Ruilope LM; Spanish Society of
Hypertension Ambulatory Blood Pressure Monitoring Registry
Investigators.
Department of Preventive Medicine and Public Health, Autonomous University
of Madrid, Madrid, Spain. joseramon.banegas@uam.es
We studied the effectiveness of blood pressure (BP) control outside the clinic by
using ambulatory BP monitoring (ABPM) among a large number of hypertensive
subjects treated in primary care centers across Spain. The sample consisted of 12
897 treated hypertensive subjects who had indications for ABPM. Office-based
BP was calculated as the average of 2 readings. Twenty-four-hour ABPM was
then performed using a SpaceLabs 90207 monitor under standardized conditions.
A total of 3047 patients (23.6%) had their office BP controlled, and 6657 (51.6%)
were controlled according to daytime ABPM. The proportion of office resistance
or underestimation of patients' BP control by physicians in the office (office BP
>or=140/90 mm Hg and average daytime ambulatory BP <135/85 mm Hg) was
33.4%, and the proportion of isolated office control or overestimation of control
(office BP <140/90 mm Hg and average daytime ambulatory BP >or=135/85 mm
Hg) was 5.4%. BP control was more frequently underestimated in patients who
were older, female, obese, or with morning BP determination than in their
counterparts. BP control was more frequently overestimated in those who were
younger, male, nonobese, smokers, or with evening BP determination.
Ambulatory-based hypertension control was far better than office-based
hypertension control. This conveys an encouraging message to clinicians, namely
that they are actually doing better than is evidenced by office-based data.
However, the burden of underestimation and overestimation of BP control at the
office is still remarkable. Physicians should be aware that the likelihood of
misestimating BP control is higher in some hypertensive subjects.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17075026 [PubMed - indexed for MEDLINE]
11: J Am Coll Cardiol. 2007 Jan 16;49(2):198-207. Epub 2006 Dec
29.
Related Articles,
Links
Cardiovascular features of heart failure with preserved ejection
fraction versus nonfailing hypertensive left ventricular hypertrophy
in the urban Baltimore community: the role of atrial
remodeling/dysfunction.
Melenovsky V, Borlaug BA, Rosen B, Hay I, Ferruci L, Morell CH, Lakatta
EG, Najjar SS, Kass DA.
Division of Cardiology, Department of Medicine, Johns Hopkins University,
Baltimore, Maryland, USA.
OBJECTIVES: The purpose of this study was to identify cardiovascular features
of patients with heart failure with preserved ejection fraction (HFpEF) that differ
from those in individuals with hypertensive left ventricular hypertrophy (HLVH)
of similar age, gender, and racial background but without failure.
BACKGROUND: Heart failure with preserved ejection fraction often develops in
HLVH patients and involves multiple abnormalities. Clarification of changes
most specific to HFpEF may help elucidate underlying pathophysiology.
METHODS: A cross-sectional study comparing HFpEF patients (n = 37), HLVH
subjects without HF (n = 40), and normotensive control subjects without LVH (n
= 56). All subjects had an EF of >50%, sinus rhythm, and insignificant valvular or
active ischemic disease, and groups were matched for age, gender, and ethnicity.
Comprehensive echo-Doppler and pressure analysis was performed. RESULTS:
The HFpEF patients were predominantly African-American women with
hypertension, LVH, and obesity. They had vascular and systolic-ventricular
stiffening and abnormal diastolic function compared with the control subjects.
However, most of these parameters either individually or combined were
similarly abnormal in the HLVH group and poorly distinguished between these
groups. The HFpEF group had quantitatively greater concentric LVH and
estimated mean pulmonary artery wedge pressure (20 mm Hg vs. 16 mm Hg) and
shorter isovolumic relaxation time than the HLVH group. They also had left atrial
dilation/dysfunction unlike in HLVH and greater total epicardial volume. The
product of LV mass index and maximal left atrial (LA) volume best identified
HFpEF patients (84% sensitivity, 82% specificity). CONCLUSIONS: In an
urban, principally African American, cohort, HFpEF patients share many
abnormalities of systolic, diastolic, and vascular function with nonfailing HLVH
subjects but display accentuated LVH and LA dilation/failure. These latter factors
may help clarify pathophysiology and define an important HFpEF population for
clinical trials.
Publication Types:


Research Support, N.I.H., Extramural
Research Support, N.I.H., Intramural
PMID: 17222731 [PubMed - in process]
12: J Hum Hypertens. 2007 Jan 18; [Epub ahead of print]
Related Articles, Links
Surrogate estimates of insulin sensitivity in subjects with
hypertension.
Hwu CM, Hsiao CF, Grove J, Hung YJ, Chuang LM, Chen YT, Curb JD,
Chen YD, Rodriguez B, Ho LT.
[1] 1Department of Medicine, Section of General Medicine, Taipei Veterans
General Hospital, Taipei, Taiwan [2] 2Faculty of Medicine, National Yang-Ming
University School of Medicine, Taipei, Taiwan.
The purpose of the study is to compare surrogate estimates of insulin sensitivity
with a directly measured insulin sensitivity index, steady-state plasma glucose
(SSPG) from insulin suppression test (IST), in subjects with hypertension. Two
hundred and twenty-eight hypertensive patients who received IST for SSPG were
included for analysis. Estimates from fasting measurements alone, homeostasis
model assessment for insulin resistance (HOMA-IR) and quantitative insulin
sensitivity check index (QUICKI)), and indices from fasting and/or 2 h samples
(ISI(0,120) and ISI(TX)) were calculated. In addition to Pearson and partial
correlations, variance-component models were used to test the relationship
between surrogate estimates of insulin sensitivity and SSPG. A large proportion
of variance owing to covariates in the variance-component models indicated the
goodness of model fit, irrespective of the independence among variables. SSPG
was positively correlated with logarithmic transformation (Log) (HOMA-IR) and
negatively correlated with QUICKI, Log (ISI(0,120)) and ISI(TX) (all P<0.0001).
Log (ISI(0,120)) seemed to have a better correlation with SSPG (r=-0.72) than
other measures in partial correlation. The proportion of variance owing to all
covariates of Log (ISI(0,120)) and ISI(TX) were larger than those of Log
(HOMA-IR) and QUICKI in the variance-component models. After adjustments
for demographic and obesity covariates, the proportion of variance explained by
Log (ISI(0,120)) were largest among the surrogate measures in the variancecomponent models. Our results showed that ISI(0,120) and ISI(TX) correlated
better with SSPG than those used fasting measures alone (HOMA-IR and
QUICKI). Log (ISI(0,120)) currently showing the strongest association with
SSPG than other estimates is adaptable for use in large studies of
hypertension.Journal of Human Hypertension advance online publication, 18
January 2007; doi:10.1038/sj.jhh.1002137.
PMID: 17230234 [PubMed - as supplied by publisher]
13: J Hum Hypertens. 2007 Jan 18; [Epub ahead of print]
Related Articles, Links
Urinary albumin excretion is associated with impaired flow- and
nitroglycerin-mediated brachial artery dilatation in hypertensive
adults.
Malik AR, Sultan S, Turner ST, Kullo IJ.
1Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester,
MN, USA.
We investigated whether the urinary albumin/creatinine ratio (UACR), a measure
of albuminuria, is associated with non-invasive measures of arterial function in
hypertensive adults without known coronary heart disease (CHD) or stroke.
UACR was measured in the first voided morning urine sample in 469 nonHispanic white hypertensive individuals (mean age 62.2+/-9.8 years, 41% men)
belonging to hypertensive sibships. High-resolution ultrasonography of the
brachial artery was used to assess flow-mediated dilatation (FMD) - an
endothelium-dependent response - and nitroglycerin-mediated dilatation (NMD) an endothelium-independent response. Because of skewed distribution, UACR
was log transformed after addition of 0.1. The association of log (UACR+0.1)
with FMD and NMD, before and after adjustment for CHD risk factors, serum
creatinine, and hypertension medication and statin use was assessed using linear
regression analyses. In univariable analyses, variables associated with lower FMD
were greater age, male sex, history of smoking, lower high-density lipoprotein
(HDL) cholesterol, higher serum creatinine and higher log (UACR+0.1); variables
associated with lower NMD were greater age, male sex, higher systolic blood
pressure, lower HDL cholesterol, higher serum creatinine and higher log
(UACR+0.1). In separate stepwise multivariable regression analyses that adjusted
for conventional CHD risk factors, serum creatinine and hypertension medication
and statin use, higher log (UACR+0.1) was associated with lower brachial artery
FMD (P=0.035) and NMD (P=0.0002). These findings highlight the association
of increased urinary albumin excretion with impaired vascular reactivity in
hypertensive individuals.Journal of Human Hypertension advance online
publication, 18 January 2007; doi:10.1038/sj.jhh.1002143.
PMID: 17230233 [PubMed - as supplied by publisher]
14: J Hum Hypertens. 2007 Jan 18; [Epub ahead of print]
Related Articles, Links
Apolipoprotein E and low-density lipoprotein receptor gene
polymorphisms in dyslipidemias-associated essential hypertension.
Niu W, Guo X, Su Y, Qiu C.
1The Institute of Basic Medical Sciences, Chinese Academy of Medical
Sciences/Peking Union Medical College, Beijing, China.
PMID: 17230232 [PubMed - as supplied by publisher]
15: J Hypertens. 2006 Sep;24(9):1900-1; author reply 1901-2.
Related Articles, Links
Comment on:

J Hypertens. 2006 May;24(5):867-73.
Endothelial dysfunction in subcutaneous small resistance arteries
and cardiovascular events.
Zoccali C.
Publication Types:


Comment
Letter
PMID: 16915043 [PubMed - indexed for MEDLINE]
16: J Hypertens. 2006 Sep;24(9):1761-70.
Related Articles, Links
Accumulation of physical activity leads to a greater blood pressure
reduction than a single continuous session, in prehypertension.
Park S, Rink LD, Wallace JP.
Clinical Exercise Physiology Laboratory, Department of Kinesiology, Indiana
University, Bloomington, IN 47405, USA.
BACKGROUND: Despite limited research, the accumulation of physical activity
has been recommended for the treatment of prehypertension. OBJECTIVES: To
compare the duration and magnitude of blood pressure reduction after
accumulated physical activity with that after a single session of continuous
physical activity, and to investigate sympathetic modulation as a possible
mechanism for the reduction in blood pressure after each acute session.
METHODS: Prehypertensive adults (n = 21) participated in a randomized
crossover design. Ambulatory blood pressure and heart rate variability (Holter
monitoring) were measured for 12 h after accumulated physical activity (4 x 10min walks (1/h for 4 h) at 50% of VO2peak), continuous physical activity (40min walk at 50% of VO2peak) and control treatments. Blood pressure and heart
rate variability after each activity treatment were compared with the respective
periods from the control treatment. Heart rate variability was correlated with
reduction in blood pressure. RESULTS: Systolic blood pressure (SBP) was
reduced for 11 h after accumulated physical activity (P < 0.01), and for 7 h after
continuous physical activity (P < 0.05). Diastolic blood pressure (DBP) was
reduced for 10 h after accumulated physical activity (P < 0.05) and for 7 h after
continuous physical activity (P < 0.05). With accumulated physical activity, the
differences in normalized low-frequency (r = 0.517, P < 0.01) and high-frequency
(r = -0.503, P < 0.05) power were correlated with reduction in SBP and the
differences in normalized low-frequency (r = 0.745, P < 0.001), high-frequency (r
= -0.738, P < 0.001) powers, and low frequency: high frequency ratio (r = 0.756,
P < 0.001) were correlated with reduction in DBP. With continuous physical
activity, the difference in low frequency: high frequency ratio (r = 0.543, P <
0.05) was correlated with reduction in DBP. CONCLUSION: The accumulation
of physical activity appears to be more effective than a single continuous session
in the management of prehypertension. Sympathetic modulation was associated
with reduced blood pressure after each session.
Publication Types:


Randomized Controlled Trial
Research Support, Non-U.S. Gov't
PMID: 16915025 [PubMed - indexed for MEDLINE]
17: J Hypertens. 2006 Sep;24(9):1745-51.
Related Articles, Links
Systolic blood pressure response to exercise in type 1 diabetes
families compared with healthy control individuals.
Matteucci E, Rosada J, Pinelli M, Giusti C, Giampietro O.
Department of Internal Medicine, University of Pisa, Italy.
ematteuc@int.med.unipi.it
OBJECTIVE: Oxidative stress is increased in type 1 diabetes families. Since
oxidative damage is a mediator of vascular injury and familial predisposition to
hypertension increases the risk of hypertension and diabetic nephropathy, we
studied blood pressure responses to exercise and cardiovascular risk factors in
type 1 diabetes families. METHODS: Thirty-five type 1 patients, 74 first-degree
relatives, and 95 healthy individuals without established coronary heart disease
underwent a cycle ergometer test. Examination included medical history, lifestyle
questionnaire, body weight, blood pressure, and laboratory tests [fasting plasma
glucose and insulin, haemoglobin A1c (HbA1c), plasma lipids, C-reactive protein,
fibrinogen, folate, plasma thiols, and albumin excretion rate]. RESULTS:
Diabetic patients had higher plasma glucose, HbA1c, folate, and albuminuria,
while lower plasma thiols than controls; relatives differed from controls in higher
plasma total cholesterol and albuminuria, lower plasma thiols. No patient
presented exercised-induced angina. Diabetic patients achieved a higher maximal
exercise systolic blood pressure (similar workload); systolic pressure remained
high during recovery. Relatives showed higher values of systolic pressure at peak
exercise (same workload). The following were associated with an abnormal blood
pressure response to exercise: diastolic blood pressure and HbA1c in the control
sample; disease duration and fibrinogen in the diabetic group; plasma low-density
lipoprotein (LDL) cholesterol, body mass index (BMI), housework, and plasma
thiols among relatives. CONCLUSION: An abnormal blood pressure response to
exercise testing has been identified for the first time in asymptomatic
normotensive non-diabetic relatives of type 1 diabetics, which was associated
with indices of metabolic syndrome and oxidative damage. Moreover, in healthy
normotensive non-diabetic control individuals (without a family history of type 1
diabetes), the systolic blood pressure response to exercise was significantly
correlated with HbA1c levels.
PMID: 16915023 [PubMed - indexed for MEDLINE]
18: J Hypertens. 2006 Sep;24(9):1729-35.
Related Articles, Links
Comment in:

J Hypertens. 2006 Sep;24(9):1699-701.
Primary-care physicians' views about the use of home/self blood
pressure monitoring: nationwide survey in Hungary.
Tisler A, Dunai A, Keszei A, Fekete B, Othmane Tel H, Torzsa P, Logan AG.
First Department of Medicine, Semmelweis University, Budapest, Hungary.
atisler@t-online.hu
OBJECTIVE: To obtain unbiased views of primary-care physicians about home
blood pressure monitoring (HBPM). METHODS: A mail survey was conducted
in a random sample (n = 700) of all Hungarian primary-care physicians (n =
5112). Items in the questionnaire related to the extent and indications for use of
HBPM, to the significance attributed to its results, to the methods of its use, and
to concerns physicians had with HBPM. RESULTS: Of the 700 questionnaires,
405 (58%) could be analysed. HBPM was popular among the respondents: 60%
of them had more then 50 patients on HBPM, 90% of them were recommending
its use either 'often' or 'almost all the time', and 75% of them considered the
results of HBPM of either 'considerable' or of 'extreme importance'. The most
frequent indications for use were white-coat hypertension (97%), assessing 24-h
drug effects (87%), improving compliance (82%), suspicion of hypotension
(63%), and resistant hypertension (61%). Physicians actively recommended
devices with an upper-arm cuff (83%), equipped with a built in memory (63%).
Most respondents (67%) had someone in their offices to teach the patient the
correct measurement technique. Surprisingly, 65% of the physicians only
reviewed the data to obtain a 'general picture' and did not analyse the data. Most
of the respondents (78%) encouraged their patients to call their offices, and 90%
of them did receive a call. Main concerns with HBPM were the use of nonvalidated devices (75%), and patient preoccupation with blood pressure (55%).
Areas for suggested improvements were the need for patient training facilities
(48%), established measurement protocols (44%) and better methods of
displaying readings (30%). CONCLUSIONS: We found an unexpected popularity
in the use of HBPM among primary-care physicians. In order to fully exploit the
benefits of HBPM, the concerns raised (validated devices, patient preoccupation)
and areas to be improved upon (patient training, better methods of displaying
results) will have to be addressed by researchers, societies and the industry.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 16915021 [PubMed - indexed for MEDLINE]
19: J Hypertens. 2006 Sep;24(9):1715-7.
Related Articles, Links
Comment on:

J Hypertens. 2006 Sep;24(9):1891-8.
Vasculoprotective effects of angiotensin receptor blockers: beyond
the renin-angiotensin-aldosterone system?
Karthikeyan VJ, Lip GY.
Publication Types:


Comment
Editorial
PMID: 16915019 [PubMed - indexed for MEDLINE]
20: J Hypertens. 2006 Sep;24(9):1703-5.
Related Articles, Links
Comment on:

J Hypertens. 2006 Sep;24(9):1841-8.
Temporal blood pressure patterns and cardiovascular events: 'good
night' or 'good morning'?
Bilo G, Parati G.
Publication Types:


Comment
Editorial
PMID: 16915016 [PubMed - indexed for MEDLINE]
21: J Hypertens. 2006 Sep;24(9):1699-701.
Comment on:

J Hypertens. 2006 Sep;24(9):1729-35.
Related Articles, Links
Home blood pressure monitoring in general practice: expectations
and concerns.
Parati G, Hernandez-Hernandez R, Velasco M.
Publication Types:


Comment
Editorial
PMID: 16915015 [PubMed - indexed for MEDLINE]
22: J Hypertens. 2006 Sep;24(9):1697-8.
Related Articles, Links
Comment on:

J Hypertens. 2006 Sep;24(9):1683-5.
A total cardiovascular risk estimate should not be used
dichotomously.
De Backer G.
Publication Types:


Comment
Editorial
PMID: 16915014 [PubMed - indexed for MEDLINE]
23: J Hypertens. 2006 Sep;24(9):1687-96.
Related Articles, Links
Renal artery stenosis and accelerated atherosclerosis: which comes
first?
Fava C, Minuz P, Patrignani P, Morganti A.
Department of Biomedical and Surgical Sciences, Section of Internal Medicine,
University of Verona, Verona, Italy.
Renal artery stenosis (RAS) is usually observed in hypertensive patients with
extensive atherosclerosis. There is some evidence that in these patients the
atherosclerotic process and the consequent target-organ damage is more severe
than in hypertensive patients without RAS. In this review we will entertain the
hypothesis that some of the humoral factors that are activated by RAS may
contribute to accelerate the progression of atherosclerosis. Several studies
identified RAS as a predictor of cardiovascular events in high-risk patients,
although in most cases the contribution of blood pressure per se to the progression
of vascular lesions could not be determined. As a result of experimental RAS,
hypertension and increased oxidative stress are stimuli for atherosclerosis as well
as cardiac and renal damage. In the presence of RAS, the renin-angiotensin
system is stimulated, and it has been shown that angiotensin II exerts
proinflammatory, pro-oxidant and procoagulant activities in experimental models
and humans. The potential contribution of reactive oxygen species to the
prohypertensive and proatherosclerotic effects of RAS is supported by evidence
that nicotinamide adenine dinucleotide phosphate, reduced form oxidase is
specifically stimulated by angiotensin II, an activity not shared by epinephrine.
Moreover, angiotensin II triggers the release of aldosterone, endothelin 1,
thromboxane A2 and other derivatives of the arachidonic acid metabolism, all of
which can further and independently aggravate cardiovascular damage.
Epidemiological and experimental evidence so far available suggests that
accelerated atherosclerosis can be both the cause and the consequence of RAS.
Publication Types:


Research Support, Non-U.S. Gov't
Review
PMID: 16915013 [PubMed - indexed for MEDLINE]
24: J Hypertens. 2006 Sep;24(9):1683-5.
Related Articles, Links
Comment in:

J Hypertens. 2006 Sep;24(9):1697-8.
Barriers and remaining questions on assessment of absolute
cardiovascular risk as a starting point for interventions to reduce
cardiovascular risk.
Campbell NR, Khan NA, Grover SA.
Publication Types:

Editorial
PMID: 16915012 [PubMed - indexed for MEDLINE]
25: Lancet. 2007 Jan 13;369(9556):87-8.
Related Articles, Links
Living kidney donation and hypertension risk.
Nguyen T, Vazquez M, Toto R.
Department of Internal Medicine, University of Texas Southwestern Medical
Center, Dallas, TX 75390, USA.
PMID: 17223455 [PubMed - in process]
26: Stroke. 2007 Jan 11; [Epub ahead of print]
Related Articles, Links
Baseline Disease Activity, Hyperlipidemia, and Hypertension Are
Predictive Factors for Ischemic Stroke and Stroke Severity in
Systemic Lupus Erythematosus.
Mikdashi J, Handwerger B, Langenberg P, Miller M, Kittner S.
From Division of Rheumatology and Clinical Immunology, Department of
Preventive Medicine and Epidemiology, Division of Cardiology, University of
Maryland School of Medicine, University of Maryland, Baltimore, Md; the
Geriatrics Research, Education, and Clinical Center, Baltimore Department of
Veterans Affairs Medical Center, Baltimore, Md; and the Department of
Neurology, University of Maryland at Baltimore, Md.
BACKGROUND AND PURPOSE: To determine factors associated with
ischemic stroke and stroke severity in patients with systemic lupus erythematosus.
METHODS: Between 1992 and January 2005, 238 consecutive systemic lupus
erythematosus patients with no history of stroke were followed-up longitudinally
at the Maryland Lupus Clinic. Patients were monitored quarterly for a mean of 8
years after their systemic lupus erythematosus diagnosis, and 44 patients (19%)
developed first-ever ischemic stroke. At the end of study, Cox proportional
regression analyses were used to determine the effect of baseline clinical variables
of systemic lupus erythematosus patients in relation to the subsequent occurrence
of ischemic stroke and stroke severity after first-ever ischemic strokes. Severe
stroke was defined as having a National Institute of Health Stroke Scale >/=6.
RESULTS: Severe ischemic strokes occurred in 34 of 44 (77%) patients. Baseline
predictors of ischemic strokes and severe ischemic strokes included disease
activity, hyperlipidemia, and hypertension. CONCLUSIONS: Severe ischemic
strokes in systemic lupus erythematosus are not uncommon. Aggressive primary
and secondary stroke prevention measures, particularly treatment of
hyperlipidemia and hypertension, as well as vigorous treatment of clinical
symptoms of active lupus, are needed to prevent serious morbidity and
neurological disability.
PMID: 17218611 [PubMed - as supplied by publisher]
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Jan 16 2007 05:58:20
1: Am J Cardiol. 2007 Jan 1;99(1):134-44. Epub 2006 Nov 3.
The Editor's Roundtable: Concurrent Hypertension and Dyslipidemia.
Friedewald VE, Jones PH, Kaplan NM, Pool JL, Roberts WC.
Clinical Professor of Internal Medicine, University of Texas Health Sciences Center at Houston,
Houston, Texas; Visiting Professor, University of Notre Dame, Notre Dame, Indiana.
PMID: 17196477 [PubMed - in process]
2: Am J Hypertens. 2007 Jan;20(1):90-7.
Related Articles, Link
Efficacy of Indapamide SR Compared With Enalapril in Elderly Hypertensive
Patients With Type 2 Diabetes.
Puig JG, Marre M, Kokot F, Fernandez M, Jermendy G, Opie L, Moyseev V, Scheen A,
Ionescu-Tirgoviste C, Saldanha MH, Halabe A, Williams B, Mion D Jr, Ruiz M, Hermansen
K, Tuomilehto J, Finizola B, Gallois Y, Amouyel P, Ollivier JP, Asmar R.
Hospital La Paz, Servicio de Medicina Interna, Madrid, Spain.
BACKGROUND: Blood pressure control is the main influential variable in reducing
microalbuminuria in patients with type 2 diabetes. In this subanalysis of the Natrilix SR versus
Enalapril Study in hypertensive Type 2 diabetics with micrOalbuminuRia (NESTOR) study, we
have compared the effectiveness of indapamide sustained release (SR) and enalapril in reducing
blood pressure and microalbuminuria in patients >/=65 years of age. METHODS: Of the 570
hypertensive patients with type 2 diabetes and persistent microalbuminuria in the NESTOR study,
187 (33%) individuals >/=65 years of age were included in this analysis. Of these, 95 patients
received indapamide SR 1.5 mg and 92 patients received enalapril 10 mg, taken once daily in both
cases. Adjunctive amlodipine and/or atenolol was added if required. RESULTS: The urinary
albumin-to-creatinine ratio decreased by 46% in the indapamide SR group and 47% in the
enalapril group. Noninferiority of indapamide SR over enalapril was demonstrated (P = .0236;
35% limit of noninferiority) with a ratio of 0.95 (95% CI: 0.68, 1.34). Mean arterial pressure
decreased by 18 mm Hg and 15 mm Hg in the indapamide SR and the enalapril groups,
respectively (P = .1136). The effects of both treatments seen in these elderly patients were similar
to those observed in the main population, although the extent of the reduction in microalbuminuria
was slightly higher. Both treatments were well tolerated, and no difference between groups was
observed regarding glucose or lipid profiles. CONCLUSION: Indapamide SR is not less effective
than enalapril in reducing microalbuminuria and blood pressure in patients aged >65 years of age
with type 2 diabetes and hypertension.
PMID: 17198918 [PubMed - in process]
3: Am J Hypertens. 2007 Jan;20(1):77.
Related Articles, Link
Reviewer Critique of "Enhanced Plasma Soluble CD40 Ligand Levels in Essential
Hypertensive Patients With Blunted Nocturnal Blood Pressure Decrease".
Mehta JL.
Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock,
Arkansas.
PMID: 17198915 [PubMed - in process]
4: Am J Hypertens. 2007 Jan;20(1):70-76.
Related Articles, Link
Enhanced Plasma Soluble CD40 Ligand Levels in Essential Hypertensive Patients
With Blunted Nocturnal Blood Pressure Decrease.
Desideri G, Cipollone F, Valeri L, Grassi D, Necozione S, Croce G, Passacquale G, Garofalo
A, Lippi C, Mezzetti A, Ferri C.
University of L'Aquila, Department of Internal Medicine and Public Health, L'Aquila, University
of Chieti "G. D'annunzio," Chieti, Italy.
BACKGROUND: Hypertensives with a blunted nocturnal blood pressure (BP) decrease have
increased risk of developing atherosclerotic disease. Soluble CD40 ligand (sCD40L) is involved in
the pathogenesis of risk factor-related vascular damage. Therefore, we evaluated the relationship
between circulating sCD40L levels, circadian BP profile, and early carotid atherosclerosis in
essential hypertensives. METHODS: Plasma sCD40L concentrations were assessed in two groups
of 25 never-treated hypertensives, without additional cardiovascular risk factors, differentiated on
the basis of a nocturnal decrease of BP either of >10% (dippers) or <10% (nondippers) of daytime
values, and in 25 matched normotensives. Carotid intima-media thickness (IMT) was also
measured in all participants. RESULTS: Plasma sCD40L concentrations were higher in
nondippers (4.9 +/- 1.2 ng/mL) than in dippers (3.7 +/- 0.7, P = .0005) and controls (1.6 +/- 0.6, P
< .0001). These latter had lower sCD40L concentrations than dippers (P < .0001). The IMT was
higher in both hypertensive groups than in normotensives (P < .0001). In the entire hypertensive
population IMT directly correlated with circulating levels of sCD40L (r = 0.365, P = .01) and
inversely correlated with nocturnal systolic BP decreases (r = -0.286, P = .043). In a multivariate
regression analysis sCD40L was the main determinant of IMT (r(2) = 0.157, P = .004).
CONCLUSIONS: Nondippers have enhanced plasma sCD40L levels, which may contribute to
their increased susceptibility to develop vascular damage.
PMID: 17198914 [PubMed - as supplied by publisher]
5: Am J Hypertens. 2007 Jan;20(1):62-9.
Related Articles, Link
Inadequate cytoplasmic antioxidant enzymes response contributes to the oxidative
stress in human hypertension.
Chaves FJ, Mansego ML, Blesa S, Gonzalez-Albert V, Jimenez J, Tormos MC, Espinosa O,
Giner V, Iradi A, Saez G, Redon J.
Research Unit, University of Valencia, Valencia, Spain.
Untreated hypertensive patients show increased oxidative stress and decreased antioxidant enzyme
activity in mononuclear cells. Therefore, the objective of this study was to determine whether or
not the low antioxidant enzyme activity observed in mononuclear cells of hypertensive subjects is
in part dependent on a defective activity of antioxidant mechanisms. Activity and mRNA level of
antioxidant enzymes, CuZn- and Mn-superoxide dismutases, catalase, glutathione peroxidase type
1, and glutathione reductase were simultaneously measured in mononuclear cells of controls (n =
38) and hypertensive subjects (n = 35), in the absence of and during antihypertensive treatment.
An increase in oxidative stress and a decrease in the activity of cytoplasmic enzymes were
observed in untreated hypertensive patients. Concurrently, CuZn-superoxide dismutase and
glutathione reductase mRNA levels were significantly reduced, and glutathione peroxidase type 1
mRNA was slightly reduced. In contrast, increased activity and mRNA levels of the mitochondria
Mn-superoxide dismutase were observed. Antihypertensive treatment, nonpharmacologic with or
without a drug regimen of beta-blocker or angiotensin AT1 receptor blocker was administered for
a 3-month period. Afterward, after the improvement in oxidative stress during treatment, a
recovery of the cytoplasmic antioxidant enzymatic activity and a more profound decrease in
mRNA levels were observed for CuZn-superoxide dismutase, glutathione peroxidase type 1, and
glutathione reductase. Meanwhile mitochondrial enzymatic activity decreased, as did the mRNA
level. The inadequate response of the main cytoplasmatic antioxidant systems, as well as of the
enzymes participating in the maintenance of glutathione levels, may contribute to the vulnerability
of hypertensives to oxidative stress.
PMID: 17198913 [PubMed - in process]
6: Am J Hypertens. 2007 Jan;20(1):53-61.
Related Articles, Link
Involvement of ras-regulated Myosin light chain phosphorylation in the captopril
effects in spontaneously hypertensive rats.
Hu WY, Han YJ, Gu LZ, Piano M, de Lanerolle P.
Department of Physiology and Biophysics, College of Medicine, University of Illinois at Chicago
Chicago, Ilinois.
BACKGROUND: Early treatment with captopril prevents the development of hypertension by
inhibiting the generation of angiotensin II and smooth muscle contraction. Although smooth
muscle contraction is regulated by myosin light chain phosphorylation (MLC-P), the role of MLC
P in captopril effects in hypertension has not been described. Therefore, we treated spontaneously
hypertensive rats (SHR) with captopril and investigated the effects of this agent on downstream
signaling. METHODS: Male SHR (n = 12) were treated with captopril (3.7 mmol/L in drinking
water) beginning in utero and continuing up to 12 weeks of age. Age- and sex-matched untreated
SHR and Wistar-Kyoto (WKY) rats were used as controls. Rats were split into three subgroups
and were sacrificed at 12, 18, or 24 weeks of age. Systolic blood pressure, left ventricular weight,
and body weight were measured. Mesenteric arteries were removed for histologic and biochemica
studies. RESULTS: At 12 weeks, captopril significantly decreased systolic blood pressure (from
198 +/- 10 to 125+/-16 mm Hg), reduced left ventricular weight-to-body weight ratios (from 2.94
+/- 0.06 to 2.17 +/- 0.08 mg/g), and prevented vascular remodeling in mesenteric arteries in SHR.
Ras expression, extracellular receptor kinase phosphorylation (ERK-P), myosin light chain kinase
(MLCK) expression, and MLC-P were all significantly increased in mesenteric arteries in
untreated SHR compared with WKY rats. Early captopril treatment in SHR significantly inhibited
Ras and MLCK expression at all ages and decreased ERK-P and MLC-P at 12 and 18 weeks in
mesenteric arteries. CONCLUSIONS: These data demonstrate that the antihypertensive effects of
captopril are correlated with inhibition of Ras-regulated ERK activation, MLCK expression, and
MLC-P.
PMID: 17198912 [PubMed - in process]
7: Am J Hypertens. 2007 Jan;20(1):38-43.
Related Articles, Link
Increased expression and activity of phospholipase C in renal arterioles of young
spontaneously hypertensive rats.
Peng Z, Dang A, Arendshorst WJ.
Department of Cell and Molecular Physiology, School of Medicine, University of North Carolina
at Chapel Hill, Chapel Hill, North Carolina.
BACKGROUND: The aims of this study were to document the presence of phospholipase C
(PLC) isozymes beta(1), gamma(1), and delta(1) in freshly isolated renal glomeruli and resistance
vessels, to compare their expression and activity to that in aorta, and to contrast values between 6week-old Wistar-Kyoto (WKY) controls and 6-week-old spontaneously hypertensive rats (SHR)
during the developmental phase of genetic hypertension. METHODS: Aorta, preglomerular
arterioles, and glomeruli were isolated from 6-week-old rats using standard techniques. PLC
isozyme protein level and activity were determined with Western blot analysis and by measuring
inositol 1, 4, 5-trisphosphate (IP(3)) production, respectively. RESULTS: Immunoblots indicate
that all three PLC isozymes examined are detectable in freshly isolated preglomerular arterioles,
glomeruli, and aorta. Increased levels of PLC-beta(1), and -delta(1) were found in all tested
vascular tissues of SHR v WKY. No strain difference was noted for PLC-gamma(1). The relative
abundance for both groups was glomeruli > preglomerular arterioles = aorta. The strain difference
in protein expression correlated with increased PLC activity in each vascular bed of SHR.
CONCLUSIONS: Protein levels of PLC-beta(1) and -delta(1) and PLC activity are upregulated in
the systemic and renal vasculature in 6-week-old SHR, suggesting a role in exaggerated vascular
reactivity during the development of genetic hypertension. A more complete understanding of the
physiologic roles of PLC isozymes and their contributions to specific aspects of cellular function
should advance our understanding of vascular tone/reactivity and hypertrophy/remodeling in
normal and hypertensive states.
PMID: 17198910 [PubMed - in process]
8: Am J Hypertens. 2007 Jan;20(1):11-20.
Related Articles, Link
Aliskiren, an orally effective Renin inhibitor, provides antihypertensive efficacy
alone and in combination with valsartan.
Pool JL, Schmieder RE, Azizi M, Aldigier JC, Januszewicz A, Zidek W, Chiang Y, Satlin A.
Center for Experimental Therapeutics, Baylor College of Medicine, Houston, Texas.
BACKGROUND: By blocking the renin-angiotensin-aldosterone system (RAAS) at its ratelimiting step, renin inhibition may provide improved RAAS suppression. We investigated the
blood pressure (BP)-lowering effects of the oral direct renin inhibitor aliskiren, alone or in
combination with the angiotensin receptor blocker valsartan. METHODS: In this multicenter,
randomized, placebo-controlled, 8-week trial, 1123 patients with mild-to-moderate hypertension
underwent a 3 to 4 week single-blind placebo run-in and were then randomized in a modified
factorial study design to receive once-daily, double-blind oral treatment with placebo, aliskiren
monotherapy (75, 150, or 300 mg), valsartan monotherapy (80, 160, or 320 mg), aliskiren and
valsartan in combination, or valsartan/hydrochlorothiazide (160/12.5 mg). The primary efficacy
variable was the change from baseline in mean sitting diastolic BP (DBP) at endpoint. RESULTS:
Once-daily oral treatment with aliskiren 300 mg significantly (P < .0001) lowered mean sitting
DBP and systolic BP (SBP) compared with placebo; aliskiren monotherapy demonstrated a safety
and tolerability profile comparable to placebo. Changes in DBP and SBP were fitted to a firstorder dose-response surface (lack-of-fit test, P = .65), which showed that aliskiren and valsartan
alone and in combination produced dose-related reductions in DBP and SBP. Coadministration of
aliskiren and valsartan produced a greater antihypertensive effect than either drug alone,
comparable in magnitude to the effect of valsartan/hydrochlorothiazide, with similar tolerability to
the component monotherapies and to placebo. CONCLUSIONS: Aliskiren monotherapy provides
antihypertensive efficacy and placebo-like tolerability in patients with hypertension. Aliskiren and
valsartan in combination may provide additive BP-lowering effects with maintained tolerability.
PMID: 17198906 [PubMed - in process]
9: Am J Hypertens. 2007 Jan;20(1):6-10.
Related Articles, Link
Population-based examination of the interaction of primary hypertension and
obesity in South Carolina.
Sakarcan A, Jerrell J.
Department of Pediatrics, and Department of Neuropsychiatry, University of South Carolina,
Columbia, South Carolina.
Recent studies have demonstrated that the prevalence of primary hypertension (HTN) among
children is higher than early estimates of 25%. The prevalence of obesity has more than doubled
between 1980 and 2000, from 5% to 11%. To examine racial differences in the prevalence and
progression of comorbid essential HTN and obesity for children 0 to 21 years of age, onset age
distribution, controlling for widely acknowledged gender differences, a statewide Medicaid claims
database was used. Results indicate that the prevalence rate of HTN in the general pediatric
population treated during the decade between 1995 and 2004 with Medicaid was 3.7% for
essential HTN, or 90% of the total diagnosed HTN cases. Just more than half were first diagnosed
with HTN with no gender or ethnic differences, mean age of onset was 14 to 15 years of age for
HTN and 12 to 15 years of age for obesity, but with the mean age of onset for both conditions
increasing with time. Development of the comorbid conditions takes less than 2 years regardless
of which condition is diagnosed first. African Americans demonstrate more rapid onset of obesity
when HTN is diagnosed first, and both males and African Americans show more rapid onset of
HTN when obesity is diagnosed first. This study is the first population-based study to include such
a large cohort of pediatric patients who are both hypertensive and obese with information during
10 years. Pediatric males and African Americans are important groups to monitor closely in the
diagnostic and treatment phases for comorbid HTN and obesity.
PMID: 17198905 [PubMed - in process]
10: Arch Intern Med. 2006 Nov 13;166(20):2222-7.
Related Articles, Link
Asymptomatic bacteriuria in women with diabetes mellitus: effect on renal
function after 6 years of follow-up.
Meiland R, Geerlings SE, Stolk RP, Netten PM, Schneeberger PM, Hoepelman AI.
Department of Internal Medicine and Infectious Diseases, Eijman-Winkler Center for
Microbiology and Infectious Diseases, Utrecht, the Netherlands.
BACKGROUND: The long-term consequences of asymptomatic bacteriuria (ASB) on renal
function in women with diabetes mellitus (DM) are unknown. METHODS: A prospective study
was performed among women with type 1 or type 2 DM. Women with ASB (diagnosis based on
findings from 1 urine culture specimen) were compared with women without ASB for differences
in renal function development and incidence of hypertension. RESULTS: A total of 644 women
were included in the study (296 with type 1 DM and 348 with type 2 DM; mean [SD] age, 51 [15]
years) and followed up for a mean (SD) duration of 6.1 (1.9) years. The prevalence of ASB was
17%. In women with DM and ASB, the creatinine clearance decreased from 87 mL/min (1.45
mL/s) at baseline to 76 mL/min (1.27 mL/s) at study end point; in women with DM without ASB
the creatinine clearance decreased from 97 to 88 mL/min (from 1.62 to 1.47 mL/s). In the
multivariate analyses, adjusted for age, length of follow-up, duration of DM, and
microalbuminuria at baseline, no association was found between ASB and the relative or the
absolute decrease in creatinine clearance; the same results were shown also when women with
DM type 1 and women with DM type 2 were analyzed separately. Women with ASB developed
hypertension more often than women without ASB (54% vs 37%; P = .045), but there was no
significant association in the multivariate analysis (odds ratio, 1.5; 95% confidence interval, 0.73.6). CONCLUSION: Women with DM (type 1 or type 2) with ASB do not have an increased risk
for a faster decline in renal function or the development of hypertension after 6 years of follow-up
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17101940 [PubMed - indexed for MEDLINE]
11: Arch Intern Med. 2006 Nov 13;166(20):2174-6.
Related Articles, Link
Comment on:

Arch Intern Med. 2006 Nov 13;166(20):2191-201.
New-onset diabetes mellitus less deadly than elevated blood pressure? Following
the evidence in the administration of thiazide diuretics.
Phillips RA.
Publication Types:


Comment
Editorial
PMID: 17101933 [PubMed - indexed for MEDLINE]
12: Circulation. 2006 Dec 12;114(24):2572-4.
Comment on:

Circulation. 2006 Dec 12;114(24):2604-10.
Aldosterone and cardiovascular disease: smoke and fire.
Calhoun DA.
Related Articles, Link
Publication Types:



Comment
Editorial
Research Support, Non-U.S. Gov't
PMID: 17159070 [PubMed - indexed for MEDLINE]
13: Circulation. 2006 Dec 12;114(24):2663-70. Epub 2006 Dec 4.
Related Articles, Link
Emergence of sex differences in prevalence of high systolic blood pressure:
analysis of a longitudinal adolescent cohort.
Dasgupta K, O'Loughlin J, Chen S, Karp I, Paradis G, Tremblay J, Hamet P, Pilote L.
Departments of Medicine, McGill University, Montreal, Quebec, Canada.
Kaberi.Dasgupta@mcgill.ca
BACKGROUND: High systolic blood pressure (SBP) occurs more frequently both among men
and boys than among women and girls. No longitudinal study has investigated whether the impact
of SBP determinants differ according to sex in youth. METHODS AND RESULTS: Between
1999 and 2005, an adolescent cohort (n=1267) completed a questionnaire survey and underwent
biannual blood pressure and anthropometric assessment (grades 7, 9, and 11). Boys accounted for
approximately 50% of those with high SBP at grade 7 and 9 assessments but 67% of those with
high SBP at the grade 11 assessment. As computed through a generalized estimating equations
logistic regression model (sex, age, sex and age interaction term, overweight, physical activity,
sedentary behavior, heart rate, household income, tobacco use, and 4 language categories), the
likelihood of high SBP values among boys compared with girls was 1.29 (95% CI, 0.77 to 2.16) in
grade 7, 1.98 (95% CI, 1.35 to 2.93) in grade 9, and 2.74 (95% CI, 1.52 to 4.94) in grade 11.
Although there was a significant interaction between sex and age, interaction terms of sex with
overweight, sedentary behavior, and physical activity were not statistically significant. Overweigh
(odds ratio [OR], 2.63; 95% CI, 1.76 to 3.92) and sedentary behavior (OR, 1.17 for increment of 5
hours weekly; 95% CI 1.04 to 1.33) demonstrated positive associations with high SBP values.
Physical activity was inversely associated with the presence of high SBP (OR, 0.92 for increment
of 5 activities in 7 days; 95% CI, 0.84 to 1.00). CONCLUSIONS: Boys are more likely than girls
to develop high SBP as they approach adulthood. Even among overweight adolescents, reducing
sedentary behavior and increasing physical activity may lower the risk of high SBP.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17145992 [PubMed - indexed for MEDLINE]
14: Hypertension. 2007 Jan 2; [Epub ahead of print]
Related Articles, Link
Mechanisms of Oxidative Stress-Induced Increase in Salt Sensitivity and
Development of Hypertension in Sprague-Dawley Rats.
Banday AA, Muhammad AB, Fazili FR, Lokhandwala M.
Heart and Kidney Institute, College of Pharmacy, University of Houston, Tex.
High salt intake produces vascular changes that contribute to the development of hypertension in
salt-sensitive individuals. Because reactive oxygen species play a role in the pathogenesis of
cardiovascular diseases, we investigated whether oxidative stress contributes to salt-sensitive
hypertension. Sprague-Dawley rats were divided in different groups and received tap water
(vehicle), 30 mmol/L of L-buthionine sulfoximine ([BSO] an oxidant), high salt ([HS] 1% NaCl),
and BSO plus HS without and with antioxidant tempol (1 mmol/L) in drinking water for 12 days.
Compared with vehicle, BSO treatment caused oxidative stress and mild increase in blood
pressure. Thoracic aortic rings from BSO-treated rats exhibited decreased response to
endothelium-independent vasorelaxants. In HS-treated rats, the response to vasoactive agents, as
well as blood pressure, was unaffected. Concomitant treatment of rats with BSO and HS produced
a marked increase in blood pressure and a decreased response to both endothelium-dependent and
endothelium-independent vasorelaxants with an increase in EC50. Incubation of aortic tissue from
BSO-treated rats with sodium nitroprusside showed decreased cGMP accumulation, whereas HS
rats had decreased basal NO synthase activity. Tempol decreased oxidative stress, normalized
blood pressure, and restored NO signaling and responses to vasoactive compounds in BSO and
BSO plus HS rats. We conclude that BSO increases oxidative stress and reduces NO signaling,
whereas HS reduces NO levels by decreasing the NO synthase activity. These phenomena
collectively result in reduced responsiveness to both endothelium -dependent and endotheliumindependent vasorelaxants and may contribute to salt-sensitive hypertension.
PMID: 17200436 [PubMed - as supplied by publisher]
15: Hypertension. 2007 Jan 2; [Epub ahead of print]
Related Articles, Link
Age-Specific Relationship of Aortic Pulse Wave Velocity With Left Ventricular
Geometry and Function in Hypertension.
Schillaci G, Mannarino MR, Pucci G, Pirro M, Helou J, Savarese G, Vaudo G, Mannarino
E.
Unit of Internal Medicine, Angiology and Arteriosclerosis, University of Perugia, Perugia, Italy.
Aortic pulse wave velocity (PWV), generally considered an intrinsic marker of arterial stiffness,
might depend in part on the velocity of myocardial fiber shortening, but the relation between PWV
and myocardial function in humans has been understudied. A total of 237 untreated hypertensive
subjects over a wide age range (18 to 88 years) underwent aortic PWV determination and
echocardiography, from which the mean velocity of circumferential fiber shortening was
calculated as a measure of the velocity of myocardial shortening, and relative wall thickness was
taken as a measure of left ventricular concentric remodeling. Patients were divided in 3 age group
(<40 years, 40 to 59 years, and >/=60 years). In the young, aortic PWV was directly associated
with heart rate-corrected velocity of circumferential fiber shortening (r=0.39; P=0.002) but not to
relative wall thickness (r=-0.01; P=0.95). The opposite was found in the older group, in which
aortic PWV was accompanied by a concentric left ventricular geometric pattern (r=0.44 with
relative wall thickness; P=0.009) and a reduced velocity of circumferential fiber shortening (r=0.54; P<0.001) and stress-corrected midwall fractional shortening (r=-0.56; P<0.001).
Intermediate values were found in the middle-aged group (r=0.23; P<0.01 with relative wall
thickness; r=-0.07, P value not significant with velocity of circumferential fiber shortening). In
conclusion, the relation between aortic PVW and the left ventricle is strongly age dependent.
These data suggest that, in young people, aortic PWV is partly determined by an increased
velocity of myocardial shortening. With increasing age, a relationship between aortic PWV (as a
measure of arterial stiffness) and left ventricular concentric geometry emerges, which ultimately
leads to a depressed ventricular systolic function.
PMID: 17200433 [PubMed - as supplied by publisher]
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Dec 18
Incidence and clinical relevance of supraventricular tachyarrhythmias in pulmona
hypertension.
Tongers J, Schwerdtfeger B, Klein G, Kempf T, Schaefer A, Knapp JM, Niehaus M, Korte T
MM.
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
BACKGROUND: In patients with severe pulmonary hypertension (PH), right ventricular function
determinant of clinical stability and outcome. Supraventricular tachyarrhythmias (SVTs) may com
cardiac function and threaten prognosis in patients with PH, but the incidence and clinical relevanc
SVTs in PH and chronic right ventricular failure have not been evaluated. METHODS: In a 6-year
retrospective single-center analysis, 231 consecutive patients followed for pulmonary arterial hype
or inoperable chronic thromboembolic PH were studied for SVTs. Analysis included incidence, cl
consequences, treatment, and outcome. RESULTS: Thirty-one episodes of SVT were observed in
patients (cumulative incidence 11.7%, annual risk 2.8% per patient), including atrial flutter (n = 15
fibrillation (n = 13), and AV nodal reentry tachycardia (n = 3). Supraventricular tachyarrhythmia o
almost invariably associated with marked clinical deterioration and right ventricular failure (84% o
episodes). Outcome was strongly associated with the type of SVT and restoration of sinus rhythm.
follow-up, cumulative mortality was low (6.3%, follow-up 26 +/- 23 months) when sinus rhythm w
restored (all cases of AV nodal reentry tachycardia and atrial flutter). In contrast, 9 of 11 patients w
sustained atrial fibrillation died from right ventricular failure (cumulative mortality 82%, follow-u
months). CONCLUSIONS: In patients with PH, SVTs constitute a relevant problem, often resultin
clinical deterioration. Sustained atrial fibrillation may be associated with a high risk of death from
ventricular failure.
PMID: 17174650 [PubMed - in process]
2: Am Heart J. 2007 Jan;153(1):54-58.
Related A
Absence of an interaction between the angiotensin-converting enzyme insertion-de
polymorphism and pravastatin on cardiovascular disease in high-risk hypertensiv
patients: The Genetics of Hypertension-Associated Treatment (GenHAT) study.
Maitland-van der Zee AH, Boerwinkle E, Arnett DK, Davis BR, Leiendecker-Foster C, Mille
Klungel OH, Ford CE, Eckfeldt JH.
School of Public Health, University of Texas Health Science Center at Houston, 1200 Hermann Pr
Houston TX; Division of Pharmacoepidemiology & Pharmacotherapy, Utrecht Institute of Pharma
Sciences, Utrecht University, Utrecht, The Netherlands.
BACKGROUND: The aim of this study was to determine whether the angiotensin-converting enz
(ACE) insertion-deletion (ID) polymorphism interacts with pravastatin to modify the risk of coron
disease (CHD) and other cardiovascular end points in a large clinical trial. METHODS: GenHAT
ancillary study of the ALLHAT. The ACE ID genotyped population in the lipid-lowering arm of A
included 9467 participants randomly assigned to pravastatin (n = 4741) or to usual care (n = 4726)
efficacy of pravastatin in reducing the risk of primary outcome (all-cause mortality) and secondary
outcomes (fatal CHD and nonfatal myocardial infarction, cardiovascular disease [CVD] mortality,
stroke, other CVD, non-CVD mortality, stroke, and heart failure) was compared between the geno
(dominant model ID + II vs DD, additive model II vs ID vs DD), by examining an interaction term
proportional hazards model. RESULTS: The relative risk of fatal CHD and nonfatal myocardial in
among subjects randomized to pravastatin compared with subjects randomized to usual care was s
subjects with the II genotype (hazard ratio [HR] 0.84, 95% CI 0.59-1.18), the ID genotype (HR 0.8
CI 0.68-1.03), and the DD genotype (HR 0.99, 95% CI 0.77-1.27). CONCLUSIONS: We found n
that the ACE ID genotype was a major modifier of the efficacy of pravastatin in reducing the risk
cardiovascular events.
PMID: 17174637 [PubMed - as supplied by publisher]
3: Am Heart J. 2007 Jan;153(1):42-53.
Related A
The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Tr
(ALLHAT) heart failure Validation Study: Diagnosis and prognosis.
Einhorn PT, Davis BR, Massie BM, Cushman WC, Piller LB, Simpson LM, Levy D, Nwachu
Black HR; for the ALLHAT Collaborative Research Group.
National Heart, Lung, and Blood Institute, Bethesda, MD.
BACKGROUND: ALLHAT, a randomized, double-blind, active-controlled hypertension treatmen
42418 patients, reported that a thiazide-type diuretic (chlorthalidone) was superior to a calcium ch
blocker (amlodipine), an angiotensin-converting enzyme inhibitor (lisinopril), and an alpha(1)-blo
(doxazosin) in preventing the new onset of heart failure (HF). However, questions have been raise
regarding the validity of the HF diagnosis. METHODS: The ALLHAT HF Validation Study was d
to validate and elucidate the significance of HF events in ALLHAT. Records for 2778 HF hospital
1935 patients were centrally reviewed using several prespecified algorithms (based on ALLHAT a
Framingham criteria) and reviewers' global clinical judgment. Percent agreement with diagnoses a
by ALLHAT site physicians, relative risks across randomized comparisons, incidence rates, and m
after HF hospitalization were evaluated for first events validated by each of the criteria sets. RESU
Percent agreements with site physician diagnoses were 71%, 80%, and 84% for ALLHAT, Framin
and reviewers' judgment, respectively. Using these 3 criteria, relative risks (95% CI) for new-onse
compared with chlorthalidone were, respectively, 1.46 (1.27-1.68), 1.42 (1.25-1.62), and 1.45 (1.2
for amlodipine; 1.18 (1.02-1.28), 1.13 (0.99-1.30), and 1.15 (1.01-1.32) for lisinopril; and 1.79 (1.
1.71 (1.46-2.00), and 1.80 (1.55-2.10) for doxazosin. CONCLUSIONS: An independent review of
documentation showed a high degree of agreement with the HF diagnoses assigned by site physici
confirmed the higher risk of HF associated with first-step therapy using amlodipine, lisinopril, or d
compared with chlorthalidone. Thiazide-type diuretics should be the preferred first-step therapy fo
prevention of HF in high-risk patients with hypertension.
PMID: 17174636 [PubMed - in process]
4: Am Heart J. 2006 Dec;152(6):1059-63.
Related A
Antihypertensive therapy and regression of coronary artery disease: insights from
Comparison of Amlodipine versus Enalapril to Limit Occurrences of Thrombosis
(CAMELOT) and Norvasc for Regression of Manifest Atherosclerotic Lesions by
Intravascular Sonographic Evaluation (NORMALISE) trials.
Brener SJ, Ivanc TB, Poliszczuk R, Chen M, Tuzcu EM, Hu T, Frid DJ, Nissen SE.
Department of Cardiovascular Medicine and Biostatistics, Cleveland Clinic Foundation, Cleveland
44195, USA. breners@ccf.org
BACKGROUND: In patients with coronary artery disease (CAD), therapies designed to prevent c
events are not always associated with significant reduction in coronary obstruction, as measured b
quantitative coronary angiography. We set out to explore the relationship between quantitative cor
angiography parameters, baseline characteristics, and clinical events in a large trial of CAD regres
antihypertensive agents. METHODS AND RESULTS: Patients randomized to amlodipine, enalap
placebo in the CAMELOT trial were followed for 24 months for major ischemic events. Among 4
patients participating in the angiographic and intravascular ultrasound substudy NORMALISE, 29
amlodipine, 96 enalapril, and 103 placebo) had complete angiographic and intravascular ultrasoun
The patients did not differ significantly with respect to baseline characteristics (except for diabetes
extent of CAD. After 24 months, the change in minimal lumen diameter (MLD) was -0.02 +/- 0.13
amlodipine, -0.03 +/- 0.12 for enalapril, and -0.03 +/- 0.17 mm for placebo (P = .40). Major ischem
occurred in 20.2%, 24%, and 25.2%, respectively (P = .68). There was no significant correlation b
change in MLD and age, sex, statin therapy, or systolic blood pressure at baseline. The change in M
not differ in patients with and without cardiovascular events, regardless of treatment assignment (P
Only the extent of CAD was independently predictive of ischemic events. CONCLUSION: As com
placebo, amlodipine treatment resulted in fewer ischemic events after 24 months of therapy, but th
benefit was not associated with a commensurate improvement in arterial lumen dimensions.
PMID: 17161053 [PubMed - in process]
5: Am Heart J. 2006 Nov;152(5):867-75.
Related A
Examination of lower targets for low-density lipoprotein cholesterol and blood pre
diabetes--the Stop Atherosclerosis in Native Diabetics Study (SANDS).
Russell M, Fleg JL, Galloway WJ, Henderson JA, Howard J, Lee ET, Poolaw B, Ratner RE,
MJ, Silverman A, Stylianou M, Weir MR, Wilson C, Yeh F, Zhu J, Howard BV.
Phoenix Indian Medical Center, Phoenix, AZ, USA.
Diabetes incidence is increasing rapidly in the United States. Diabetes increases the risk for cardio
disease, the major cause of death in diabetic individuals. The conventional cardiovascular risk fact
hyperlipidemia and hypertension worsen diabetic vascular disease. Treatment targets for low-dens
lipoprotein cholesterol (LDL-C) and blood pressure in diabetic individuals are being debated. The
is a randomized, open-label, 3-year trial to examine the effects of aggressive LDL-C (goal <70 mg
blood pressure (BP) (goal <115/75 mm Hg) reduction versus the standard goals of <100 mg/dL fo
and <130/85 mm Hg for BP. Five hundred forty-nine American-Indian men and women >40 years
type 2 diabetes were randomized to 1 of 2 groups. Lipids and BP are managed using Food and Dru
Administration-approved medications in an algorithmic approach. The presence and progression o
atherosclerosis are evaluated by carotid ultrasonography; echocardiography assesses cardiac funct
primary end point is the composite outcome of change in carotid artery intimal medial thickness a
fatal/nonfatal cardiovascular events. These outcomes are combined by using a ranked analysis for
thickness and assigning a "worst rank" for a cardiovascular event. Secondary end points include ca
plaque score, left ventricular geometry and function, serum C-reactive protein, and safety measure
aspects of the study design and analysis plan involve the use of a composite outcome and changes
trial of LDL-C treatment goals for participants with baseline or incident cardiovascular disease in
conventional group because of changes in the standard of care. Study results will further understan
the effects of aggressive risk factor reduction on atherosclerosis burden and cardiac function in dia
individuals in US populations and will help determine optimal LDL-C and BP treatment goals for
patients.
Publication Types:


Multicenter Study
Randomized Controlled Trial

Research Support, N.I.H., Extramural
PMID: 17070147 [PubMed - indexed for MEDLINE]
6: Am J Cardiol. 2006 Oct 15;98(8):1018-21. Epub 2006 Aug 28.
Related A
Comparison of 30-day outcomes in patients <75 years of age versus >or=75 years o
with acute myocardial infarction treated by primary coronary angioplasty.
Sakai K, Nakagawa Y, Soga Y, Ando K, Yokoi H, Iwabuchi M, Yasumoto H, Nosaka H, Nob
M.
Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
We reviewed 1,087 consecutive patients treated by primary coronary angioplasty for acute myocar
infarction; 309 were >or=75 and 778 were <75 years of age. Compared with the younger group, th
group had higher 30-day (8.1% vs 4.0%, p = 0.0057) and cardiac (6.5% vs 3.6%, p = 0.038) morta
Successful reperfusion was achieved in the 2 groups at a similarly high rate (91.6% and 92.9%, p =
Successful compared with unsuccessful angioplasty decreased 30-day mortality rates in the older g
(6.0% vs 30.8%, p <0.0001) and in the younger group (3.2% vs 14.5%, p <0.0001). When reperfu
successful, the cardiac mortality rate in older patients was not significantly greater than that in you
patients (4.6% vs 2.8%, p = 0.14). By multivariate analysis in all 1,087 patients, overt cardiogenic
admission (odds ratio 44.7, 95% confidence interval 22.0 to 91.1, p <0.0001) and unsuccessful rep
(odds ratio 9.40, 95% confidence interval 4.11 to 21.5, p <0.0001) were found to be independent p
of 30-day mortality, whereas age >or=75 years (odds ratio 1.79, 95% confidence interval 0.91 to 3
0.090) was not. In conclusion, aggressive angioplasty in older patients improves prognosis.
Publication Types:

Comparative Study
PMID: 17027563 [PubMed - indexed for MEDLINE]
7: Am J Cardiol. 2006 Oct 15;98(8):1012-7. Epub 2006 Aug 22.
Related A
Genotype-phenotype association of matrix metalloproteinase-3 polymorphism and
synergistic effect with smoking on the occurrence of acute coronary syndrome.
Liu PY, Li YH, Chan SH, Lin LJ, Wu HL, Shi GY, Chen JH.
Division of Cardiology, Department of Internal Medicine, College of Medicine, National Cheng K
University, Tainan, Taiwan.
Matrix metalloproteinase-3 (MMP-3) degrades the extracellular matrix and may contribute to the w
of the plaque cap. To determine whether genotype-phenotype associations differed in different cat
acute coronary syndrome, we enrolled 650 consecutive Taiwanese patients diagnosed with acute c
syndrome. Genotypic analysis was done on DNA using polymerase chain reaction and direct sequ
the 5 adenines (5A)/6 adenines (6A; -1,171 bp) polymorphism in the MMP-3 gene promoter regio
frequency of the 5A polymorphism was higher in patients with acute coronary syndrome, especial
with ST-elevation myocardial infarction (p <0.01). The number of 5A allele polymorphisms was s
associated with more complex coronary angiography (diffuse score for 5A/5A vs 5A/6A vs 6A/6A
1.2 vs 5.3 +/- 1.3 vs 4.6 +/- 1.1, all p values <0.05 in subgroup analysis) and higher plasma MMPin this acute coronary syndrome cohort (MMP-3 level for 6A/6A vs 5A/6A vs 5A/5A, 21.0 +/- 2.2
+/- 2.1 vs 27.9 +/- 2.2 ng/ml, all p values <0.05 in subgroup analysis). Multiple logistic regression
showed that this polymorphism, in addition to hypertension, diabetes, and a history of smoking, w
independent risk factor (odds ratio 2.2, 95% confidence interval 1.1 to 4.3, p = 0.02) for the occurr
acute coronary syndrome. Further, carriers of this polymorphism who smoked had a significantly i
(20-fold) risk of acute coronary syndrome compared with nonsmoking noncarriers. In conclusion,
3 5A/6A polymorphism is significantly associated with the occurrence of acute coronary syndrom
activity, and severity of coronary atherosclerosis. There is a synergistic effect between smoking an
genetic risk factor for acute coronary syndrome.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17027562 [PubMed - indexed for MEDLINE]
8: Am J Hypertens. 2006 Dec;19(12):1293-9.
Related A
Antihypertensive drugs and fibrinolytic function impact of dual calcium channel a
Renin-Angiotensin system blockade.
Fogari R, Zoppi A.
Department of Internal Medicine, University of Pavia, Clinica Medica II, IRCCS Policlinico S. M
Pavia, Italy.
Impaired fibrinolytic function, characterized by increased plasminogen activator inhibitor type 1 (
levels and decreased tissue plasminogen activator (t-PA) activity, has been found in patients with
hypertension and may account in part for the increased risk of atherosclerosis and its clinical comp
in these patients. Failure to correct this prothrombotic state may be one of the possible reasons for
disappointing effect of antihypertensive treatment on the incidence of coronary events. In this rega
from the literature indicate that different antihypertensive drugs may vary in their influence on fib
Scarce and conflicting data exist regarding the effects of diuretics and beta-blockers on the fibrino
system. Angiotensin-converting enzyme (ACE) inhibitors (ACE-I) have generally been shown to i
the fibrinolytic balance by reducing plasma PAI-1 levels, calcium channel blockers (CCB) have be
reported to increase t-PA activity, and angiotensin receptor blockers (ARB) seem to be neutral in t
effect. Interesting data have been reported about the positive impact on fibrinolysis of combining a
with a CCB, which resulted in a decrease of PAI-1 caused by ACE inhibition, and an increase in tresulting from calcium channel blockade. The positive effect of ACE-I on the fibrinolytic system h
related to: 1) inhibition of angiotensin II, which stimulates PAI-1 expression; 2) inhibition of degr
bradykinin, a potent stmulus for tPA production; and 3) improvement of insulin sensitivity. The m
underlying the CCB effect on t-PA are less clear, but a direct action of CCB on vascular endotheli
been reported to play a major role. The greater improvement in the fibrinolytic balance because of
combined action of ACE inhibition and Ca antagonism represents a further indication to the use of
combinations of ACE-I and CCB in the treatment of hypertension.
PMID: 17161777 [PubMed - in process]
9: Am J Hypertens. 2006 Dec;19(12):1286-1292.
Related A
Antihypertensive and Renal Protective Effects of Renin-Angiotensin System Block
Uremic Rats Treated With Erythropoietin.
Lebel M, Rodrigue ME, Agharazii M, Lariviere R.
Research Centre, CHUQ, L'Hotel-Dieu de Quebec Hospital and Department of Medicine, Faculty
Medicine, Laval University, Quebec, Canada.
BACKGROUND: Correcting anemia with recombinant human erythropoietin (rhEPO) in chronic
failure has been associated with an increased blood pressure (BP), which may accelerate the declin
function. This has been attributed, in part, to the activation of the renin-angiotensin system. The pr
study was designed to investigate the protective effect of the angiotensin II-receptor blocker losart
compared with the angiotensin-converting enzyme inhibitor captopril and conventional triple thera
in uremic rats receiving rhEPO therapy. METHODS: Renal failure was induced by renal mass abl
followed by a 3-week stabilization period. Uremic rats were then divided into five groups with sim
systolic BP: vehicle; rhEPO (100 U/kg, subcutaneously, three times per week); rhEPO + losartan (
mg/kg/d); rhEPO + captopril (20 mg/kg/d); and rhEPO + TRx (reserpine 5 mg/L, hydralazine 80 m
hydrochlorothiazide 20 mg/L). Systolic BP as well as blood and renal parameters were assessed be
after a 3-week treatment period. Renal histology was evaluated at the end of the study. RESULTS
uremic rats developed hypertension, anemia, proteinuria, and increased urinary endothelin-1 (ET-1
excretion. The rhEPO corrected the anemia but aggravated the hypertension (P < .01), glomerular
tubular atrophy, and interstitial fibrosis. Treatment with losartan, captopril, and the TRx prevented
rhEPO-induced increased in systolic BP. The TRx was less effective in preventing histologic injur
similar systolic BP reduction. CONCLUSIONS: Blockade of the renin-angiotensin system is high
effective in preventing both hypertension and renal histologic damage in rhEPO-treated uremic rat
benefit seems to extend beyond the antihypertensive effect.
PMID: 17161776 [PubMed - as supplied by publisher]
10: Am J Hypertens. 2006 Dec;19(12):1278-85.
Related A
Angiotensinogen promoter sequence variants in essential hypertension.
Velez DR, Guruju M, Vinukonda G, Prater A, Kumar A, Williams SM.
Center for Human Genetics Research, Vanderbilt University, Nashville, Tennessee.
BACKGROUND: Essential hypertension is a complex multifactorial disease caused by ill-defined
factors. The angiotensinogen (AGT) gene has been implicated as a risk factor in essential hyperten
METHODS: To assess the role of AGT in hypertension, we evaluated two polymorphisms (A-6G
20A) in the 5' region of the gene that have been shown to have a role in transcriptional regulation.
463 subjects were studied: 243 African Americans (26 male and 34 female normotensives, 66 mal
female hypertensives) and 220 whites (35 male and 60 female normotensives, 55 male and 70 fem
hypertensives). African American and white subjects were examined individually, as significant d
in allele and genotype frequencies were observed between these two cohorts. RESULTS: White fe
hypertensives and normotensives differed significantly in genotype frequency at C-20A (P = .02).
single site comparisons were significantly different between hypertensives and normotensives in e
white or African American samples. Haplotype frequencies in white males also differed significan
between phenotypic classes (P = .05). To evaluate the data further, we assessed all polymorphic si
simultaneously by the examination of multisite interaction and determined the single best genetic m
each population. A model that included both sites and gender correctly predicted hypertension stat
white population 59.1% of the time (P = .039). The model generated for the African American pop
was not significant. CONCLUSIONS: Our results suggest that a complex set of genetic factors int
gender to predispose whites to hypertension.
PMID: 17161775 [PubMed - in process]
11: Am J Hypertens. 2006 Dec;19(12):1233-40.
Related A
Cardiorenal protective effects of year-long antihypertensive therapy with a Angiot
converting enzyme inhibitor or a calcium channel blocker in spontaneously hyper
rats.
Ishimitsu T, Honda T, Ohta S, Akashiba A, Takahashi T, Kameda T, Yoshii M, Minami J, T
M, Ono H, Matsuoka H.
Department of Hypetension and Cardiorenal Medicine, Dokkyo Medical University, Mibu, Tochig
BACKGROUND: The objective of this study was to evaluate the effect of year-long antihypertens
therapy with a calcium channel blocker and an angiotensin-converting enzyme (ACE) inhibitor on
and renal injury. METHODS: Male 15-week-old spontaneously hypertensive rats (SHR) were giv
normal diet and normal drinking water (n = 10), a diet containing 0.05% nitrendipine (n = 10), or d
water containing 50 mg/L of quinapril (n = 10). After 12 months of antihypertensive treatment,
cardiovascular organ injuries were evaluated. RESULTS: Tail-cuff blood pressure (BP) at 12 mon
significantly lower in animals receiving nitrendipine or quinapril than in control animals (control,
mm Hg; nitrendipine, 194 +/- 3 mm Hg; quinapril, 191 +/- 3 mm Hg; P < .001). Furthermore, aort
thickness was reduced by nitrendipine (-19%, P < .001) or quinapril (-21%, P < .001), and cardiac
ventricular weight was significantly reduced by quinapril (-18%, P < .001) but not by nitrendipine
not significant [NS]). Echocardiography at 12 months revealed that midwall fractional shortening
higher in the quinapril group than in the control or the nitrendipine groups (control, 9.3% +/- 0.5%
nitrendipine, 9.8% +/- 0.5%; quinapril, 10.6% +/- 0.6%; P < .05). Left ventricular hydroxyproline
were lower in the nitrendipine group (-21%, P < .01) and the quinapril group (-36%, P < .001) than
control animals. In control SHR, creatinine clearance began to decrease and proteinuria began to i
6 to 9 months. Quinapril but not nitrendipine attenuated these markers of renal impairment (creatin
clearance at 12 months: control, 4.7 +/- 0.4 mL/min/kg; nitrendipine, 5.0 +/- 0.4 mL/min/kg; quina
+/- 0.4 mL/min/kg; P < .05). Histologically, the glomerular injury score was lower in the quinapril
than in the control or nitrendipine groups (control, 19 [range, 8 to 30]; nitrendipine, 18 [range, 9 to
quinapril, 7 [range, 3 to 12]; P < .01). CONCLUSIONS: It is suggested that year-long antihyperten
therapy with an angiotensin-converting enzyme (ACE) inhibitor is superior to a calcium channel b
terms of cardiorenal protection in SHR.
PMID: 17161768 [PubMed - in process]
12: Am J Hypertens. 2006 Dec;19(12):1226-32.
Related A
In vivo and in vitro effects of nebivolol on penile structures in hypertensive rats.
Toblli JE, Cao G, Casas G, Mazza ON.
Laboratory of Experimental Medicine, Hospital Aleman, Buenos Aires, Argentina.
BACKGROUND: Erectile dysfunction is associated with high blood pressure and antihypertensiv
treatment, especially diuretics and traditional beta-blockers. Nevertheless, new beta-blockers such
nebivolol present some differences with respect to the classic beta-blockers. The aim of this study
determine the functional and morphologic effects of nebivolol on penile structures in hypertensive
METHODS: During a 6-month period, male spontaneously hypertensive rat (SHR) and Wistar-Ky
(WKY) rats were studied. The groups were as follows: 1) untreated SHR (Untreated-SHR); 2) SH
nebivolol 10 mg/kg/day (SHR+N); 3) SHR given amlodipine 3 mg/kg/day (SHR+AML); and 4) u
WKY (untreated-WKY). Cavernous smooth muscle (CSM) and vascular smooth muscle (VSM) fr
cavernous arteries, as well as collagen type III (COL III) in cavernous tissue, were evaluated. RES
After 6 months, SHR groups given nebivolol and amlodipine showed similar reductions in blood p
compared with untreated SHR. However, only SHR+N and control WKY showed significantly low
of CSM (P < 01), VSM (P < 01), and COL III (P < 01) when compared with untreated SHR and
SHR+AML. In addition SHR+N showed a higher endothelial nitric oxide synthase expression in s
endothelium compared with SHR, and SHR+AML (P < 01). In vitro studies revealed that SHR+N
a better relaxation response to acetylcholine than untreated-SHR and SHR+AML (P < 01). CONC
Nebivolol presented equivalent BP control compared with amlodipine. However, only nebivolol s
significant better functional outcome with a protective role against structural changes in erectile ti
are caused by arterial hypertension.
PMID: 17161767 [PubMed - in process]
13: Am J Hypertens. 2006 Dec;19(12):1217-25.
Related A
Factorial antihypertensive study of an extended-release metoprolol and
hydrochlorothiazide combination.
Papademetriou V, Hainer JW, Sugg J, Munzer D; ATTACH Study Group.
Hypertension Research, VA Medical Center and Georgetown University Medical Center, Washing
BACKGROUND: To attain goal blood pressure (BP), many hypertensive patients require combin
antihypertensive therapy. Thiazide diuretic/beta-blocker regimens lower BP, and clinical studies in
that they reduce the risk for cardiovascular consequences of hypertension. Fixed-dose combination
can simplify multidrug treatment regimens. METHODS: This multicenter, randomized, double-bli
placebo-controlled, unbalanced factorial study (N = 1571) was designed to determine whether
hydrochlorothiazide (HCT) and extended release (ER) metoprolol both contribute to an antihypert
effect. Hypertensive adults with sitting diastolic BP (SiDBP) 95 to 114 mm Hg and systolic BP (S
<180 mm Hg received one of three hydrochlorothiazide doses (6.25 mg, 12.5 mg, or 25 mg), one o
ER-metoprolol doses (25 mg, 50 mg, 100 mg, 200 mg), or one of nine of the combinations or plac
weeks. RESULTS: Blood pressure decreased with all combinations (P < .001 v placebo); reductio
dose related, ranging from 8.7 to 15.7 mm Hg (SiDBP) and 9.7 to 18.9 mm Hg (SiSBP) (model-de
values). Reductions with placebo were 5.3 (SiDBP) and 4.2 mm Hg (SiSBP). Both active agents c
to the combination effect (P = .0015 for SiDBP; P = .0006 for SiSBP). Several low-dose combinat
approximately as effective as high doses of the individual agents (differences within 1 to 2.5 mm H
adverse event discontinuation rate was 2.9%. Serum potassium decreased and uric acid increased w
increasing doses of HCT. CONCLUSIONS: Extended-release metoprolol/hydrochlorothiazide is a
effective antihypertensive combination that offers additive antihypertensive contributions from bo
components.
PMID: 17161766 [PubMed - in process]
14: Am J Hypertens. 2006 Dec;19(12):1213-6.
Related A
Nitric oxide release is impaired in hypertensive individuals with familial history of
Cosentino F, Francia P, Musumeci B, De Siati L, Rao MA, De Luca N, Balla C, De Sensi F, V
Division of Cardiology, 2(nd) Faculty of Medicine, University "La Sapienza," Rome, Italy.
BACKGROUND: A genetic origin of cerebrovascular accidents has long been suspected on the ba
epidemiologic evidence and familial aggregation. Nevertheless, the final phenotype is largely influ
concomitant risk factors. We aimed to investigate whether impairment of endothelium-dependent
vasodilation can be used as an informative intermediate vascular phenotype in hypertensive patien
familial history of stroke. METHODS: Fourteen hypertensive individuals, seven with familial hist
stroke (FH+), seven without familial history of stroke (FH-), and six normotensive volunteers (C)
included in the study. High-resolution ultrasound and Doppler were used to measure radial artery
and blood flow at rest, during reactive hyperemia, and after intra-arterial infusion of N(G)-monom
arginine (L-NMMA) to inhibit NO synthase. RESULTS: Basal blood flow and diameter were com
all groups. Flow-mediated dilation was impaired in FH+ (3.2% +/- 2%), compared with FH- (9.6%
P = . 01) and C (15.9% +/- 3%; P = . 001). The L-NMMA decreased basal flow in FH- (16.0 +/- 2
1 mL/min; P = . 04), and C (23.3 +/- 2 v 16.5 +/- 2 mL/min, P = .003) but did not exert any signifi
in FH+ subjects (16.4 +/- 3 v 15.8 +/- 2 mL/min, P = .77). CONCLUSIONS: These findings demo
that NO bioavailability is reduced in hypertensive subjects with familial history of stroke. Such a p
may represent an early marker of susceptibility to cerebrovascular events in this population.
PMID: 17161765 [PubMed - in process]
15: Am J Hypertens. 2006 Dec;19(12):1197-8.
Related A
Dr. Michael H. Alderman Takes the Helm as Editor-in-Chief of the American Jou
Hypertension.
Laragh JH.
Cardiovascular Center, New York Presbyterian - Weill Cornell Medical Center, New York, New Y
Publication Types:

Editorial
PMID: 17161762 [PubMed - in process]
16: Am J Hypertens. 2006 Oct;19(10):1049-54.
Related A
Left ventricular hypertrophy in patients with autonomic failure.
Maule S, Milan A, Grosso T, Veglio F.
Autonomic Unit and Hypertension Unit, Department of Medicine and Experimental Oncology, S.
Hospital, University of Turin, Turin, Italy. simmaule@tin.it
BACKGROUND: In autonomic failure (AF), supine hypertension may predispose patients to enddamage. The pathophysiology of hypertensive heart disease in AF is not known. The aim of the pr
study was to evaluate the prevalence and predisposing factors of left ventricular hypertrophy (LVH
patients with AF. METHODS: We studied 25 patients with AF (67 +/- 8 years); 80% were being t
orthostatic hypotension. Twenty patients with essential hypertension (68 +/- 6 years) were conside
control group. All subjects underwent echocardiography for measurement of left ventricular mass
The patients with AF underwent a 24-h BP monitoring and long-term blood pressure (BP) variabil
calculated as standard deviation (SD) of the average of the half-hour mean values. RESULTS: The
comparable in patients with AF and hypertensive controls (145 +/- 35 g/m2 v 127 +/- 32 g/m2, P =
proportion of patients with LVH is similar in both populations (AF 80%, hypertensive 70%). The
with AF were divided into two groups, with and without LVH. The SDs are significantly higher in
patients with LVH than in those with normal LVM (SD 24-h systolic BP: 22 +/- 4 v 14 +/- 1 mm H
.001). CONCLUSIONS: A high proportion of patients with AF show LVH. The LVM values are
comparable with those of patients with essential hypertension. The development of LVH seems to
on high BP variability, characteristic of AF patients. Detection of LVH may help in the choice of t
for orthostatic hypotension and in the prevention of heart failure.
Publication Types:

Evaluation Studies
PMID: 17027826 [PubMed - indexed for MEDLINE]
17: Am J Hypertens. 2006 Aug;19(8):877-8.
Erratum in:

Am J Hypertens. 2006 Aug;19(8):876.
Related A
Comment on:

Am J Hypertens. 2006 Mar;19(3):286-92.
Bone mineral content and blood pressure: What is the pathophysiologic link?
Titze J.
Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nurembe
Erlangen, Germany. jus.titze@t-online.de <jus.titze@t-online.de>
Publication Types:

Comment
PMID: 16876694 [PubMed - indexed for MEDLINE]
18: Am J Hypertens. 2006 Aug;19(8):796-800.
Related A
Long-term prognostic value of resting heart rate in subjects with prehypertension
King DE, Everett CJ, Mainous AG 3rd, Liszka HA.
Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolin
kingde@musc.edu <kingde@musc.edu>
BACKGROUND: Increased resting heart rate increases cardiovascular risk in individuals with
hypertension. The extent to which such risk extends to people with prehypertension is not known.
purpose of this study was to determine whether elevated resting heart rate contributes to increased
heart disease (CHD) risk in people with prehypertension. METHODS: The cohort for the current s
consisted of 3275 persons from the Atherosclerosis Risk in Communities (ARIC) study, 45 to 64 y
in 1986 to 1989, with a mean follow-up of 10.1 years. The primary outcomes were CHD and all-c
mortality. RESULTS: Individuals with prehypertension and elevated resting heart rate had 50% hi
cause mortality than people with prehypertension and lower resting heart rate (hazard ratio [HR] 1
confidence interval [CI] 1.0-2.15), which was essentially unchanged after controlling for age, ethn
gender, diabetes, smoking status, LDL-cholesterol, exercise, and use of antilipemic agents (P < .01
Similarly, in unadjusted analyses, CHD risk was 49% higher for people with increased heart rate (
95% CI 1.03-2.14). In adjusted analyses, elevated resting heart rate remained a factor in increased
CHD in women (adjusted HR 2.18, 95% CI 1.08-4.42), but not in men. CONCLUSIONS: Resting
is an easily accessible tool that may be helpful for stratifying CHD and mortality risk in people wi
prehypertension.
Publication Types:


Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.
PMID: 16876677 [PubMed - indexed for MEDLINE]
19: BMJ. 2006 Nov 18;333(7577):1047. Epub 2006 Oct 24.
Related A
Comment in:

BMJ. 2006 Nov 18;333(7577):1030-1.
Screening strategies for chronic kidney disease in the general population: follow-u
cross sectional health survey.
Hallan SI, Dahl K, Oien CM, Grootendorst DC, Aasberg A, Holmen J, Dekker FW.
Department of Cancer Research and Molecular Biology, Faculty of Medicine, Norwegian Univers
Science and Technology, 7006 Trondheim, Norway. stein.hallan@ntnu.no
OBJECTIVE: To find an effective screening strategy for detecting patients with chronic kidney di
to describe the natural course of the disease. DESIGN: Eight year follow-up of a cross sectional he
survey (the HUNT II study). SETTING: Nord-Trondelag County, Norway PARTICIPANTS: 65,6
(70.6 % of all adults aged >or=20 in the county). MAIN OUTCOME MEASURES: Incident end s
disease (ESRD) and cardiovascular mortality monitored by individual linkage to central registries.
RESULTS: 3069/65,604 (4.7%) people had chronic kidney disease (estimated glomerular filtratio
ml/min/1.73 m(2)), so we would need to screen 20.6 people (95% confidence interval 20.0 to 21.2
identify one case. Restriction of screening to those with hypertension, diabetes, or age >55 would
93.2% (92.4% to 94.0%) of patients with chronic kidney disease, with a number needed to screen
to 9.0). Restriction of screening according to guidelines of the United States kidney disease outcom
quality initiative (US KDOQI) gave similar results, but restriction according to the United Kingdo
chronic kidney disease guidelines detected only 60.9% (59.1% to 62.8%) of cases. Screening only
with previously known diabetes or hypertension detected 44.2% (42.7% to 45.7%) of all cases, wi
number needed to screen of six. During the eight year follow-up only 38 of the 3069 people with c
kidney disease progressed to end stage renal disease, and the risk was especially low in people wit
diabetes or hypertension, women, and those aged >or=70 or with a glomerular filtration rate 45-59
ml/min/1.73 m(2) at screening. In contrast, there was a high cardiovascular mortality: 3.5, 7.4, and
deaths per 100 person years among people with a glomerular filtration rate 45-59, 30-44, and <30
ml/min/1.73 m(2), respectively. CONCLUSION: Screening people with hypertension, diabetes me
age >55 was the most effective strategy to detect patients with chronic kidney disease, but the risk
stage renal disease among those detected was low.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17062598 [PubMed - indexed for MEDLINE]
20: Circulation. 2006 Nov 21;114(21):2240-50. Epub 2006 Nov 6.
Related A
Regulated overexpression of the A1-adenosine receptor in mice results in adverse
reversible changes in cardiac morphology and function.
Funakoshi H, Chan TO, Good JC, Libonati JR, Piuhola J, Chen X, MacDonnell SM, Lee LL
Herrmann DE, Zhang J, Martini J, Palmer TM, Sanbe A, Robbins J, Houser SR, Koch WJ,
AM.
Center for Translational Medicine, Department of Medicine, Jefferson Medical College, Philadelp
19107, USA.
BACKGROUND: Both the A1- and A3-adenosine receptors (ARs) have been implicated in media
cardioprotective effects of adenosine. Paradoxically, overexpression of both A1-AR and A3-AR is
associated with changes in the cardiac phenotype. To evaluate the temporal relationship between A
signaling and cardiac remodeling, we studied the effects of controlled overexpression of the A1-A
cardiac-specific and tetracycline-transactivating factor-regulated promoter. METHODS AND RES
Constitutive A1-AR overexpression caused the development of cardiac dilatation and death within
weeks. These mice developed diminished ventricular function and decreased heart rate. In contras
A1-AR expression was delayed until 3 weeks of age, mice remained phenotypically normal at 6 w
>90% of the mice survived at 30 weeks. However, late induction of A1-AR still caused mild
cardiomyopathy at older ages (20 weeks) and accelerated cardiac hypertrophy and the developmen
dilatation after pressure overload. These changes were accompanied by gene expression changes a
with cardiomyopathy and fibrosis and by decreased Akt phosphorylation. Discontinuation of A1-A
induction mitigated cardiac dysfunction and significantly improved survival rate. CONCLUSIONS
data suggest that robust constitutive myocardial A1-AR overexpression induces a dilated cardiomy
whereas delaying A1-AR expression until adulthood ameliorated but did not eliminate the develop
cardiac pathology. Thus, the inducible A1-AR transgenic mouse model provides novel insights int
of adenosine signaling in heart failure and illustrates the potentially deleterious consequences of se
versus nonselective activation of adenosine-signaling pathways in the heart.
Publication Types:


Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
PMID: 17088462 [PubMed - indexed for MEDLINE]
21: Circulation. 2006 Nov 7;114(19):2034-9. Epub 2006 Oct 30.
Related A
Creatine kinase activity is associated with blood pressure.
Brewster LM, Mairuhu G, Bindraban NR, Koopmans RP, Clark JF, van Montfrans GA.
Department of Internal Medicine, F4-222, Academic Medical Center, Meibergdreef 9, 1105 AZ,
Amsterdam, The Netherlands. mail@lizzybrewster.net
BACKGROUND: We previously hypothesized that high activity of creatine kinase, the central reg
enzyme of energy metabolism, facilitates the development of high blood pressure. Creatine kinase
provides adenosine triphosphate to highly energy-demanding processes, including cardiovascular
contraction, and antagonizes nitric oxide-mediated functions. Relatively high activity of the enzym
particularly in resistance arteries, is thought to enhance pressor responses and increase blood press
Tissue creatine kinase activity is reported to be high in black people, a population subgroup with g
hypertension risk; the proposed effects of high creatine kinase activity, however, are not "race dep
We therefore assessed whether creatine kinase is associated with blood pressure in a multiethnic p
METHODS AND RESULTS: We analyzed a stratified random sample of the population of Amste
The Netherlands, consisting of 1444 citizens (503 white European, 292 South Asian, 580 black, an
other ethnicity) aged 34 to 60 years. We used linear regression analysis to investigate the associati
between blood pressure and normal serum creatine kinase after rest, as a substitute measure of tiss
activity. Creatine kinase was independently associated with blood pressure, with an increase in sys
diastolic pressure, respectively, of 8.0 (95% CI, 3.3 to 12.7) and 4.7 (95% CI, 1.9 to 7.5) mm Hg p
creatine kinase increase after adjustment for age, sex, body mass index, and ethnicity. CONCLUS
Creatine kinase is associated with blood pressure. Further studies are needed to explore the nature
association, including how variation in cardiovascular creatine kinase activity may affect pressor r
Publication Types:

Comparative Study
PMID: 17075013 [PubMed - indexed for MEDLINE]
22: Clin Cardiol. 2006 Aug;29(8):345-51.
Related A
Validation of a new index for estimating arterial stiffness: measurement of the QP
interval by Doppler ultrasound.
Lee MY, Chu CS, Lee KT, Wu CM, Su HM, Lin SJ, Sheu SH, Lai WT.
Division of Cardiology, Department of Internal Medicine, Kaohsiung Municipal United Hospital,
BACKGROUND: Pulse wave velocity (PWV), a relevant indicator of arterial stiffness, can be me
noninvasively with a variety of automatic devices, but most are complexly equipped. We develope
index for estimating arterial stiffness as "QPV interval," which was determined by means of surfac
electrocardiogram and Doppler ultrasound of the brachial artery simultaneously. HYPOTHESIS: T
aimed to validate the QPV interval as an exact and convenient index for estimation of arterial stiff
METHODS: Forty-seven patients with untreated essential hypertension and 19 normotensive subj
enrolled. Brachial-ankle PWV (baPWV) was measured using an automatic volume-plethysmograp
apparatus, and Doppler ultrasound was implemented sequentially to measure the QPV interval in e
subject. Clinical biochemistry and echocardiography were performed on the same day. RESULTS
baPWV was significantly higher in hypertensive patients than in normotensive subjects (p = 0.002
mean QPV interval was significantly shorter in hypertensive patients than in the normotensive gro
0.019). A simple regression analysis demonstrated an inverse correlation between the QPV interva
baPWV (r = -0.671, p < 0.001) in all enrolled subjects. In a stepwise regression model that adjuste
systolic blood pressure, and other determinants of baPWV, the negative association remained betw
QPV interval and baPWV (p < 0.001). CONCLUSION: The QPV interval correlates inversely wit
independent of age and other determinants of baPWV; hence, the QPV interval can serve as a simp
convenient index for assessing arterial stiffness in clinical practice.
Publication Types:


Research Support, Non-U.S. Gov't
Validation Studies
PMID: 16933575 [PubMed - indexed for MEDLINE]
23: Eur Heart J. 2006 Dec 12; [Epub ahead of print]
Related A
N-terminal brain natriuretic peptide in scleroderma-associated pulmonary arteria
hypertension.
Mathai SC, Hassoun PM.
Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 East Monument Street, B
Maryland 21205, USA. smathai4@jhmi.edu.
PMID: 17164254 [PubMed - as supplied by publisher]
24: Hypertension. 2006 Dec 18; [Epub ahead of print]
Related A
Left Atrial Size and Risk of Major Cardiovascular Events During Antihypertensiv
Treatment. Losartan Intervention for Endpoint Reduction in Hypertension Trial.
Gerdts E, Wachtell K, Omvik P, Otterstad JE, Oikarinen L, Boman K, Dahlof B, Devereux R
Institute of Medicine, University of Bergen, Bergen, Norway; the Department of Medicine, Copen
County University Hospital, Glostrup, Denmark; the Department of Medicine, Vestfold Central H
Tonsberg, Norway; the Department of Cardiology, Helsinki University Central Hospital, Helsinki
the Department of Medicine, Skelleftea Hospital and Umea University, Skelleftea, Sweden; the D
of Medicine, Sahlgrenska University Hospital/Ostra, Gothenburg, Sweden; and the Department of
Weill Medical College of Cornell University, New York, NY.
The influence of left atrial size on cardiovascular events during antihypertensive treatment has not
reported previously from a long-term, prospective, randomized hypertension treatment trial. We re
left atrial diameter by annual echocardiography and cardiovascular events in 881 hypertensive pat
women) with electrocardiographic left ventricular hypertrophy aged 55 to 80 (mean: 66) years dur
mean of 4.8 years of randomized losartan- or atenolol-based treatment in the Losartan Intervention
Endpoint Reduction in Hypertension Study. During follow-up, a total of 88 primary end points (co
cardiovascular death, myocardial infarction, or stroke) occurred. In Cox regression, baseline left a
diameter/height predicted incidence of cardiovascular events (hazard ratio: 1.98 per cm/m [95% C
3.83 per cm/m]; P=0.042) adjusted for significant effects of Framingham risk score and history of
fibrillation. Greater left atrial diameter reduction during follow-up was associated with greater red
left ventricular hypertrophy, absence of new-onset atrial fibrillation or mitral regurgitation during
and losartan-based treatment (B=-0.13+/-0.03 cm/m; P<0.001) in multiple linear regression, adjus
baseline left atrial diameter/height. However, in time-varying Cox regression analysis, left atrial d
reduction was not independent of left ventricular hypertrophy regression in predicting cardiovascu
during follow-up. In conclusion, left atrial diameter/height predicts risk of cardiovascular events
independent of other clinical risk factors in hypertensive patients with left ventricular hypertrophy
be useful in pretreatment clinical assessment of cardiovascular risk in these patients.
PMID: 17178978 [PubMed - as supplied by publisher]
25: Hypertension. 2006 Dec 18; [Epub ahead of print]
Related A
Low-Dose Quadruple Antihypertensive Combination. More Efficacious Than Indi
Agents-A Preliminary Report.
Mahmud A, Feely J.
Department of Pharmacology and Therapeutics, Trinity College Dublin, Centre for Health Science
Ireland; and the Hypertension Clinic, St James's Hospital, Dublin, Ireland.
Increasingly combined antihypertensive agents are being used in practice to enhance control and i
compliance. To determine whether a capsule containing a quarter of the standard dose of 4 antihyp
agents has greater efficacy than the standard dose of each individually, we prospectively randomiz
untreated white hypertensive patients (55% male) aged 50+/-1 years (mean+/-SEM), with mean bl
pressure 160+/-1/96+/-1 mm Hg. Patients received amlodipine (5 mg; n=22), atenolol (50 mg; n=2
bendroflumethiazide (2.5 mg; n=22), captopril (50 mg twice daily; n=22) or a capsule containing e
4 above at one-quarter dosage (n=22) in a parallel group design for 4 weeks. Blood pressure was m
using a semiautomated device (Omron 705), and the reduction in mean arterial pressure with the c
preparation was compared with that of the individual components. Statistical analysis used ANOV
Tukey-Kramer honestly significant difference for multiple comparisons. The reduction in mean ar
pressure with the combination (19+/-2 mm Hg) was significantly greater than that with individual
amlodipine (10+/-2 mm Hg; P<0.005), atenolol (10+/-2 mm Hg; P<0.005), bendroflumethiazide (6
Hg; P<0.005), and captopril (11+/-1 mm Hg; P<0.01). In addition, the percentage reduction in sys
(18+/-1 mm Hg; P<0.005) and diastolic (17+/-2 mm Hg; P=0.06) blood pressure was greater with
combination. More patients achieved a blood pressure of <140/90 mm Hg with the combination (6
any individual drug (15% to 45%; P<0.05). A low-dose combination of 4 agents representing 4 cla
standard antihypertensive agents was more efficacious than a standard single dose of each agent
individually.
PMID: 17178976 [PubMed - as supplied by publisher]
26: Hypertension. 2006 Dec 18; [Epub ahead of print]
Related A
Chronic Treatment With Long-Acting Nifedipine Reduces Vasoconstriction to En
1 in Essential Hypertension.
Sudano I, Virdis A, Taddei S, Spieker L, Corti R, Noll G, Salvetti A, Luscher TF.
Cardiovascular Center, Cardiology, University Hospital of Zurich, Zurich, Switzerland; Internal M
Department, University of Pisa, Pisa, Italy; and the Center for Integrative Human Physiology, Uni
Zurich, Zurich, Switzerland.
Essential hypertension is associated with enhanced biological activity of endothelin-1 (ET-1) and
endothelium-dependent vasodilatation. Dihydropyridine calcium antagonists have antioxidant acti
vitro, and they improve endothelial function in vivo. We tested whether calcium antagonists also i
the biological activity of ET-1 in essential hypertensive (EH) patients in the presence and absence
hypercholesterolemia. In 9 healthy subjects (normotensive [NT] subjects, age: 48.3+/-7.6 years; bl
pressure: 118+/-8.6/69+/-5.4 mm Hg) and 21 EH subjects (age: 50.0+/-7.8 years; blood pressure: 1
5.4/103.8+/-4.4 mm Hg), we studied forearm blood flow and its modification induced by intrabrac
administration of ET-1, phenylephrine, acetylcholine, and sodium nitroprusside at baseline and aft
weeks of treatment with a nifedipine gastrointestinal therapeutic system (30 to 60 mg per day). At
the first dose of ET-1 (0.5 microg/100 mL of forearm tissue per minute) caused a slight vasodilata
but not in EH subjects, whereas the following higher doses caused a comparable dose-dependent
vasoconstriction in EH and NT subjects. The effect of acetylcholine was significantly reduced in E
compared with NT subjects. In contrast, sodium nitroprusside and phenylephrine had similar effec
and EH subjects. After chronic treatment with the nifedipine gastrointestinal therapeutic system, th
vasoconstrictor effect induced by both ET-1 and phenylephrine was significantly blunted, whereas
response to acetylcholine was significantly increased and the vasodilation to sodium nitroprusside
unchanged. Hypercholesterolemic EH subjects showed a further reduced response to acetylcholine
compared with normocholesterolemic EH subjects, and the nifedipine gastrointestinal therapeutic
restored the vasodilation to acetylcholine in this subgroup. In conclusion, in EH subjects, chronic
with a long-acting dihydropyridine calcium antagonist not only exhibits a blood pressure-lowering
also reduces ET-1-induced vasoconstriction and improves endothelium-dependent vasodilation. T
vasculoprotective effects may importantly contribute to a reduction in major clinical events seen d
treatment with these compounds.
PMID: 17178974 [PubMed - as supplied by publisher]
27: Hypertension. 2007 Jan;49(1):19-20. Epub 2006 Dec 11.
Hypertension control: trends, approaches, and goals.
Kotchen TA.
Publication Types:



Comment
Editorial
Research Support, N.I.H., Extramural
PMID: 17159090 [PubMed - in process]
Related A
28: Hypertension. 2006 Dec 11; [Epub ahead of print]
Related A
Comparison of Interleukin-6 and C-Reactive Protein for the Risk of Developing
Hypertension in Women.
Sesso HD, Wang L, Buring JE, Ridker PM, Gaziano JM.
Divisions of Preventive Medicine, Aging, and Cardiovascular Medicine, Department of Medicine,
and Women's Hospital and Harvard Medical School, Boston, Mass; and the Department of Epidem
Harvard School of Public Health, Boston, Mass.
Although markers of systemic inflammation may have a role in the development of hypertension,
clinical data remain limited. We, therefore, examined interleukin (IL)-6 and C-reactive protein (CR
nested case-control study of 400 women developing hypertension and an equal number of age-ma
normotensive control subjects during 10 years of follow-up as part of the Women's Health Study.
women initially had nonhypertensive blood pressure values and no history of diagnosis or treatme
Subjects provided self-reported risk factors, and IL-6 and CRP were measured from baseline blood
subjects reported elevated systolic (>/=140 mm Hg) or diastolic (>/=90 mm Hg) blood pressure, n
diagnosed hypertension, or initiating antihypertensive treatment during follow-up. In crude-match
IL-6 and CRP quartiles were each strongly associated with hypertension risk (both Ps for trend <0
multivariate models, the linear trends became nonsignificant, and the relative risks (95% CIs) of
hypertension for IL-6 reduced to 1.00 (ref), 1.29 (0.76 to 2.19), 2.14 (1.23 to 3.73), and 1.70 (0.92
and for CRP were 1.00 (ref), 2.09 (1.16 to 3.76), 2.51 (1.42 to 4.44), and 2.44 (1.29 to 4.64), prim
because of confounding by body mass index. Simultaneous adjustment for IL-6 and CRP modestly
attenuated both sets of relative risks, although more for IL-6. Finally, there was no effect modifica
baseline blood pressure or other risk factors (all Ps for interaction >0.05). Therefore, after multiva
adjustment and strong confounding by body mass index, IL-6 was weakly associated and CRP stro
associated with hypertension risk. In models simultaneously examining IL-6 and CRP, only CRP r
strongly associated with an increased risk of hypertension.
PMID: 17159088 [PubMed - as supplied by publisher]
29: Hypertension. 2007 Jan;49(1):69-75. Epub 2006 Dec 11.
Related A
Prevalence, awareness, treatment, and control of hypertension among United Stat
1999-2004.
Ong KL, Cheung BM, Man YB, Lau CP, Lam KS.
Department of Medicine and the Research Centre of Heart, Brain, Hormone and Healthy Aging, U
of Hong Kong, Hong Kong.
Detection of hypertension and blood pressure control are critically important for reducing the risk
attacks and strokes. We analyzed the trends in the prevalence, awareness, treatment, and control o
hypertension in the United States in the period 1999-2004. We used the National Health and Nutri
Examination Survey 1999-2004 database. Blood pressure information on 14 653 individuals (4749
2000, 5032 in 2001-2002, and 4872 in 2003-2004) aged >or=18 years was used. Hypertension wa
as blood pressure >or=140/90 mm Hg or taking antihypertensive medications. The prevalence of
hypertension in 2003-2004 was 7.3+/-0.9%, 32.6+/-2.0%, and 66.3+/-1.8% in the 18 to 39, 40 to 5
>or=60 age groups, respectively. The overall prevalence was 29.3%. When compared with 1999-2
were nonsignificant increases in the overall prevalence, awareness, and treatment rates of hyperten
blood pressure control rate was 29.2+/-2.3% in 1999-2000 and 36.8+/-2.3% in 2003-2004. The ag
increase in control rate was 8.1% (95% CI: 2.4 to 13.8%; P=0.006). The control rates increased sig
in both sexes, non-Hispanic blacks, and Mexican Americans. Among the >or=60 age group, the aw
treatment, and control rates of hypertension had all increased significantly (P<or=0.01). The impro
blood pressure control is encouraging, although the prevalence of hypertension has not declined.
PMID: 17159087 [PubMed - in process]
30: Hypertension. 2006 Dec 11; [Epub ahead of print]
Related A
Association of Adrenal Steroids With Hypertension and the Metabolic Syndrome
Blacks.
Kidambi S, Kotchen JM, Grim CE, Raff H, Mao J, Singh RJ, Kotchen TA.
Medical College of Wisconsin, Milwaukee; Aurora St Luke's Medical Center, Milwaukee, Wis; an
Foundation and Clinic, Rochester, Minn.
Blacks have a high prevalence of hypertension and adrenal cortical adenomas/hyperplasia. We eva
hypothesis that adrenal steroids are associated with hypertension and the metabolic syndrome in b
Ambulatory blood pressures, anthropometric measurements, and measurements of plasma renin ac
(PRA), aldosterone, fasting lipids, glucose, and insulin were obtained in 397 subjects (46% hypert
50% female) after discontinuing antihypertensive and lipid-lowering medications. Hypertension w
as average ambulatory blood pressure >130/85 mm Hg. Late-night and early morning salivary cor
hour urine-free cortisol, and cortisone excretion were measured in a consecutive subsample of 97
(40% hypertensive and 52% female). Compared with normotensive subjects, hypertensive subject
greater waist circumference and unfavorable lipid profiles, were more insulin resistant, and had lo
and higher plasma aldosterone and both late-night and early morning salivary cortisol concentratio
Twenty-four-hour urine-free cortisol and cortisone did not differ. Overall, ambulatory blood press
positively correlated with plasma aldosterone (r=-0.22; P<0.0001) and late-night salivary cortisol
P=0.03) and inversely correlated with PRA (r=0.21; P<0.001). Plasma aldosterone correlated sign
with waist circumference, total cholesterol, triglycerides, insulin, and the insulin-resistance index.
Adult Treatment Panel III criteria, 17% of all of the subjects were classified as having the metabol
syndrome. Plasma aldosterone levels, but not PRA, were elevated in subjects with the metabolic s
(P=0.0002). The association of aldosterone with blood pressure, waist circumference, and insulin
suggests that aldosterone may contribute to obesity-related hypertension in blacks. In addition, we
that relatively high aldosterone and low PRA in these hypertensive individuals may reflect a mild
primary aldosteronism.
PMID: 17159085 [PubMed - as supplied by publisher]
31: Hypertension. 2006 Dec 11; [Epub ahead of print]
Related A
Angiotensin Type 2 Receptor in Resistance Arteries of Type 2 Diabetic Hypertensi
Patients.
Savoia C, Touyz RM, Volpe M, Schiffrin EL.
Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, McG
University, Montreal, Quebec, Canada; Kidney Research Center, Ontario Health Research Institut
University of Ottawa, Ottawa, Ontario, Canada; Division of Cardiology, 2nd Faculty of Medicine,
University "La Sapienza," Ospedale Sant'Andrea and IRCCS Neuromed, Pozzilli, Italy.
The role of angiotensin type 2 receptor (AT2R) on vascular responses to angiotensin II in humans
unclear. In this study we explored whether AT2R is expressed and functionally active on peripher
resistance arteries of hypertensive diabetic patients treated for 1 year with either the angiotensin re
blocker valsartan or the beta-blocker atenolol. Twenty-six hypertensive type 2 diabetic patients tre
oral hypoglycemic and antihypertensive agents (not receiving angiotensin receptor blockers or bet
blockers) were randomly assigned to double-blind treatment for 1 year with valsartan or atenolol o
added to their previous therapy in a clinical trial that we reported recently and compared with 10 n
subjects. Resistance arteries dissected from gluteal subcutaneous tissues were assessed on a pressu
myograph. Vasomotor response curves to angiotensin II (1 nmol/L to 1 micromol/L) were perform
norepinephrine precontracted vessels in the presence of valsartan (10 micromol/L) with or without
AT2R inhibitor PD123319 (1 micromol/L). AT2R expression was evaluated by confocal microsco
1 year of treatment, systolic and diastolic blood pressure was controlled and comparable in the val
atenolol groups. Angiotensin II evoked a significant vasodilatory response only on resistance arter
patients treated with valsartan, effect blocked by PD123319. AT2R expression was 4-fold higher i
arteries of valsartan-treated patients. In conclusion, AT2Rs are upregulated and contribute to angio
induced vasodilation in resistance arteries of hypertensive diabetic patients treated with angiotensi
receptor blockers and may mediate, in part, vascular actions of these drugs in high cardiovascular
patients.
PMID: 17159079 [PubMed - as supplied by publisher]
32: Hypertension. 2006 Dec;48(6):1066-71. Epub 2006 Oct 23.
Related A
NO synthase uncoupling in the kidney of Dahl S rats: role of dihydrobiopterin.
Taylor NE, Maier KG, Roman RJ, Cowley AW Jr.
Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA. ntaylor@
NO synthase (NOS) can paradoxically contribute to the production of reactive oxygen species whe
arginine or the cofactor R-tetrahydrobiopterin (BH(4)) becomes limited. The present study examin
whether NOS contributes to superoxide production in kidneys of hypertensive Dahl salt-sensitive
compared with an inbred consomic control strain (SS-13(BN)) and tested the hypothesis that eleva
dihydrobiopterin (BH(2)) levels are importantly involved in this process. This was assessed by det
the effects of l-nitroarginine methyl ester (l-NAME) inhibition of NOS on superoxide production a
comparing tissue concentrations of BH(4) and BH(2). A reverse-phase high-performance liquid
chromatography method was applied for direct measurements of BH(4) and BH(2) using (S)tetrahydrobiopterin as an internal standard. Superoxide concentrations were measured in vivo from
medullary microdialysis fluid using dihydroethidine and in vitro using lucigenin. The results indic
following: (1) that superoxide levels were elevated in the outer medulla of SS rats fed a 4% salt di
could be inhibited by l-NAME. In contrast, l-NAME resulted in elevated superoxide production in
SS-13(BN) rats because of higher NOS activity; (2) SS rats showed a reduced ratio of BH(4)/BH(
outer medulla that was driven by increased concentrations of BH(2); and (3) lower superoxide dism
and catalase activities contributed to elevated reactive oxygen species in SS samples. Based on the
BH(4) to BH(2) and the observation of l-NAME inhibitable superoxide production, we conclude t
uncoupling occurs in the renal medulla of hypertensive SS rats fed a high-salt diet.
Publication Types:


Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
PMID: 17060509 [PubMed - indexed for MEDLINE]
33: Hypertension. 2006 Dec;48(6):e108; author reply e109. Epub 2006 Oct 16.
Related A
Comment on:


Hypertension. 2006 Mar;47(3):359-64.
Hypertension. 2006 Mar;47(3):365-70.
Correlating ambulatory blood pressure measurements with arterial stiffness: a co
inconsistency?
Gavish B.
Publication Types:


Comment
Letter
PMID: 17043160 [PubMed - indexed for MEDLINE]
34: Hypertension. 2006 Dec;48(6):1029-30. Epub 2006 Oct 16.
Comment on:

Hypertension. 2006 Dec;48(6):1160-8.
Related A
Atrial peptides modify the effect of marinobufagenin on sodium pumps: implicatio
blood pressure control.
Buckalew VM.
Publication Types:


Comment
Editorial
PMID: 17043156 [PubMed - indexed for MEDLINE]
35: Hypertension. 2006 Dec;48(6):e115-6; author reply e117. Epub 2006 Oct 9.
Related A
Comment on:

Hypertension. 2006 Jul;48(1):134-40.
Blood pressure in mutant rats lacking the 5-hydroxytryptamine transporter.
Homberg J, Mudde J, Braam B, Ellenbroek B, Cuppen E, Joles JA.
Publication Types:


Comment
Letter
PMID: 17030677 [PubMed - indexed for MEDLINE]
36: Hypertension. 2006 Nov;48(5):e104; author reply e105. Epub 2006 Oct 2.
Comment on:

Hypertension. 2006 Apr;47(4):771-7.
Reduction of blood pressure levels study group.
Mann SJ.
Publication Types:

Comment
Related A

Letter
PMID: 17015771 [PubMed - indexed for MEDLINE]
37: Hypertension. 2006 Nov;48(5):832-3. Epub 2006 Oct 2.
Related A
Comment on:

Hypertension. 2006 Nov;48(5):870-6.
Predictors of the evolution of microalbuminuria.
Ruilope LM, Segura J.
Publication Types:


Comment
Editorial
PMID: 17015769 [PubMed - indexed for MEDLINE]
38: Hypertension. 2006 Nov;48(5):914-20. Epub 2006 Sep 25.
Related A
Circulating activities of angiotensin-converting enzyme, its homolog, angiotensinconverting enzyme 2, and neprilysin in a family study.
Rice GI, Jones AL, Grant PJ, Carter AM, Turner AJ, Hooper NM.
Proteolysis Research Group, Institute of Molecular and Cellular Biology, Faculty of Biological Sc
University of Leeds, Leeds, LS2 9JT United Kingdom. bmbgir@bmb.leeds.ac.uk
The renin-angiotensin system is a key regulator of blood pressure (BP), with inhibitors of angioten
converting enzyme (ACE) used clinically to treat hypertension and other cardiovascular condition
a newly identified member of this system, which converts angiotensin II to angiotensin, and of wh
occurrence in plasma has not been investigated. The aim of this study was to determine the heritab
circulating ACE, ACE2, and neprilysin (NEP), which may also be a regulator of BP, in a family st
to determine covariates that contribute to the variation in plasma activity. ACE, ACE2, and NEP a
were measured in plasma from 534 subjects in the Leeds Family Study using selective fluorogenic
substrates. Genetic factors accounted for 24.5%, 67%, and 22.7% of the phenotypic variation in ci
ACE, ACE2, and NEP, respectively. ACE insertion/deletion polymorphism and other measured co
accounted for 23.8% of variance in circulating ACE. High-density lipoprotein cholesterol was a si
determinant of circulating ACE2. Measured covariates accounted for 17.3% of variation in circula
ACE and NEP were associated with systolic and diastolic BP in univariate analyses; however, onl
was independently associated with systolic and diastolic BP after accounting for covariates and sh
childhood household.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17000927 [PubMed - indexed for MEDLINE]
39: Hypertension. 2006 Nov;48(5):861-9. Epub 2006 Sep 25.
Related A
Comment in:

Hypertension. 2006 Nov;48(5):818-9.
Importance of salt in determining blood pressure in children: meta-analysis of con
trials.
He FJ, MacGregor GA.
Blood Pressure Unit, Cardiac and Vascular Sciences, St George's University of London, Cranmer
London, SW17 0RE, United Kingdom. fhe@sgul.ac.uk
To assess the effect of reducing salt intake on blood pressure in children, we carried out a meta-an
controlled trials. Trials were included if participants were children (< or = 18 years), and duration
reduction must have been for > or = 2 weeks. Mean effect size was calculated using a fixed-effect
because there was no significant heterogeneity. Ten trials of children and adolescents with 966 par
were included (median age: 13 years; range: 8 to 16 years; median duration: 4 weeks; range: 2 wee
years). Salt intake was reduced by 42% (interquartile range [IQR]: 7% to 58%). There were signif
reductions in blood pressure: systolic: -1.17 mm Hg (95% CI: -1.78 to -0.56 mm Hg; P<0.001); di
1.29 mm Hg (95% CI: -1.94 to -0.65 mm Hg; P<0.0001). Three trials of infants with 551 participa
included (median duration: 20 weeks; range: 8 weeks to 6 months). Salt intake was reduced by 54
51% to 79%). There was a significant reduction in systolic blood pressure: -2.47 mm Hg (95% CI:
0.94 mm Hg; P<0.01). This is the first meta-analysis of salt reduction in children, and it demonstra
modest reduction in salt intake causes immediate falls in blood pressure and, if continued, may we
the subsequent rise in blood pressure with age. This would result in major reductions in cardiovasc
disease. These results in conjunction with other evidence provide strong support for a reduction in
intake in children.
Publication Types:
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
Meta-Analysis
Review
PMID: 17000923 [PubMed - indexed for MEDLINE]
40: Hypertension. 2006 Nov;48(5):812-4. Epub 2006 Sep 18.
Related A
Prehypertension revisited.
Chobanian AV.
Publication Types:


Editorial
Review
PMID: 16982962 [PubMed - indexed for MEDLINE]
41: Hypertension. 2006 Nov;48(5):877-82. Epub 2006 Sep 18.
Related A
Predicting stroke using 4 ambulatory blood pressure monitoring-derived blood pr
indices: the Ohasama Study.
Inoue R, Ohkubo T, Kikuya M, Metoki H, Asayama K, Obara T, Hoshi H, Hashimoto J, Tot
Satoh H, Kondo Y, Imai Y.
Comprehensive Research and Education Center for Planning of Drug Development and Clinical E
Tohoku University Graduate School of Pharmaceutical Science, 1-1 Seiryo-cho, Aoba-ku, Sendai,
8574, Japan.
We investigated the association between stroke and blood pressure (BP) indices (systolic BP [SBP
diastolic BP [DBP], mean BP [MBP], and pulse pressure [PP]) determined by ambulatory BP mon
The predictive power for stroke of these indices was compared in the general Japanese population
obtained ambulatory BP data in 1271 subjects (40% men) aged > or = 40 (mean: 61) years. During
follow-up of 11 years, 113 strokes were observed. The multivariate adjusted relative hazard and li
ratio for a 1-SD increase for each BP index was determined by Cox proportional hazard regression
Comparison of the likelihood ratio between Cox models including 2 indices and those including 1
indicated that PP was significantly less informative than other indices (P<0.01 when adding MBP,
DBP to the PP model; P>0.09 when adding PP to the model including another index). However, a
removing age from covariates, PP became more informative than DBP and MBP (P<0.0001 when
to the MBP or DBP model, whereas SBP was more informative than PP even after removing age;
when adding SBP to the PP model). In conclusion, PP was the weakest predictor of stroke. Exclus
from covariates increased the predictive power of PP, suggesting that the stroke risk associated wi
reflected the risk of aging per se.
Publication Types:


Comparative Study
Randomized Controlled Trial

Research Support, Non-U.S. Gov't
PMID: 16982961 [PubMed - indexed for MEDLINE]
42: Hypertension. 2006 Nov;48(5):988-93. Epub 2006 Sep 18.
Related A
Insulin resistance and obesity in a mouse model of systemic lupus erythematosus.
Ryan MJ, McLemore GR Jr, Hendrix ST.
Department of Physiology and Biophysics, University of Mississippi Medical Center, 2500 North
Jackson, MS 39216, USA. mjryan@physiology.umsmed.edu
Accumulating data indicate that metabolic syndrome is an inflammatory condition. Systemic lupu
erythematosus (SLE) is an autoimmune disorder associated with nephritis and cardiovascular dise
Evidence suggests that individuals with SLE are at risk for developing insulin resistance; however
not been directly examined. Using an established mouse strain with SLE (NZBWF1), we examine
SLE is associated with increased body weight and fat deposition. Mean arterial pressure was signi
increased (140+/-4 versus 114+/-2 mm Hg; n > or = 5) in SLE mice by 36 weeks of age compared
control mice (NZW/LacJ). Body weight in SLE mice was higher at each age compared with contro
12%, 22%, and 34% (n > 30). Visceral adipose tissue weight was increased in SLE by 44%, 74%,
at 8, 20, and 36 weeks, respectively (n > or = 12). Plasma leptin was increased in SLE mice (8.6+/
versus 24.7+/-2.2 ng/mL; n = 5), and renal and adipose tissue exhibited macrophage infiltration. F
insulin was higher in SLE mice (0.6+/-0.1 versus 1.4+/-0.3 ng/mL; n > or = 10), but fasted glucose
different (94+/-5 versus 80+/-9; n > or = 9). A glucose tolerance test caused a significantly greater
longer increase in blood glucose from mice with SLE compared with control mice. Food intake wa
different between control and SLE mice. However, mice with SLE demonstrated lower levels of n
activity than controls. These data show that the NZBWF1 strain may be an important model to stu
effects of obesity and insulin resistance on SLE-associated hypertension.
Publication Types:


Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
PMID: 16982954 [PubMed - indexed for MEDLINE]
43: J Am Coll Cardiol. 2006 Dec 19;48(12):2546-52. Epub 2006 Nov 28.
Related A
Complications of right heart catheterization procedures in patients with pulmonar
hypertension in experienced centers.
Hoeper MM, Lee SH, Voswinckel R, Palazzini M, Jais X, Marinelli A, Barst RJ, Ghofrani H
ZC, Opitz C, Seyfarth HJ, Halank M, McLaughlin V, Oudiz RJ, Ewert R, Wilkens H, Kluge
Bremer HC, Baroke E, Rubin LJ.
Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany. hoeper.mar
hannover.de
OBJECTIVES: This study sought to assess the risks associated with right heart catheter procedure
patients with pulmonary hypertension. BACKGROUND: Right heart catheterization, pulmonary
vasoreactivity testing, and pulmonary angiography are established diagnostic tools in patients with
pulmonary hypertension, but the risks associated with these procedures have not been systematica
evaluated in a multicenter study. METHODS: We performed a multicenter 5-year retrospective an
prospective evaluation of serious adverse events related to right heart catheter procedures in patien
pulmonary hypertension, as defined by a mean pulmonary artery pressure >25 mm Hg at rest, und
right heart catheterization with or without pulmonary vasoreactivity testing or pulmonary angiogra
RESULTS: During the retrospective period, 5,727 right heart catheter procedures were reported, a
were reported from the prospective period, for a total of 7,218 right heart catheter procedures perf
The results from the retrospective and the prospective analyses were almost identical. The overall
serious adverse events was 76 (1.1%, 95% confidence interval 0.8% to 1.3%). The most frequent
complications were related to venous access (e.g., hematoma, pneumothorax), followed by arrhyth
hypotensive episodes related to vagal reactions or pulmonary vasoreactivity testing. The vast majo
these complications were mild to moderate in intensity and resolved either spontaneously or after
appropriate intervention. Four fatal events were recorded in association with any of the catheter pr
resulting in an overall procedure-related mortality of 0.055% (95% confidence interval 0.01% to 0
CONCLUSIONS: When performed in experienced centers, right heart catheter procedures in patie
pulmonary hypertension are associated with low morbidity and mortality rates.
PMID: 17174196 [PubMed - in process]
44: J Am Coll Cardiol. 2006 Dec 5;48(11):2293-300. Epub 2006 Nov 13.
Related A
A prospective study of the prevalence of primary aldosteronism in 1,125 hyperten
patients.
Rossi GP, Bernini G, Caliumi C, Desideri G, Fabris B, Ferri C, Ganzaroli C, Giacchetti G, L
Maccario M, Mallamaci F, Mannelli M, Mattarello MJ, Moretti A, Palumbo G, Parenti G, P
Semplicini A, Rizzoni D, Rossi E, Boscaro M, Pessina AC, Mantero F; PAPY Study Investiga
For a list of author affiliations, please see the.
OBJECTIVES: We prospectively investigated the prevalence of curable forms of primary aldoster
(PA) in newly diagnosed hypertensive patients. BACKGROUND: The prevalence of curable form
currently unknown, although retrospective data suggest that it is not as low as commonly perceive
METHODS: Consecutive hypertensive patients referred to 14 hypertension centers underwent a d
protocol composed of measurement of Na+ and K+ in serum and 24-h urine, sitting plasma renin a
and aldosterone at baseline and after 50 mg captopril. The patients with an aldosterone/renin ratio
baseline, and/or >30 after captopril, and/or a probability of PA (by a logistic discriminant function
=50% underwent imaging tests and adrenal vein sampling (AVS) or adrenocortical scintigraphy to
the underlying adrenal pathology. An aldosterone-producing adenoma (APA) was diagnosed in pa
in addition to excess autonomous aldosterone secretion showed: 1) lateralized aldosterone secretio
or adrenocortical scintigraphy, 2) adenoma at surgery and pathology, and 3) a blood pressure decr
adrenalectomy. Evidence of excess autonomous aldosterone secretion without such criteria led to
diagnosis of idiopathic hyperaldosteronism (IHA). RESULTS: A total of 1,180 patients (age 46 +/
years) were enrolled; a conclusive diagnosis was attained in 1,125 (95.3%). Of these, 54 (4.8%) ha
and 72 (6.4%) had an IHA. There were more APA (62.5%) and fewer IHA cases (37.5%) at cente
AVS was available (p = 0.002); the opposite occurred where AVS was unavailable. CONCLUSIO
newly diagnosed hypertensive patients referred to hypertension centers, the prevalence of APA is
(4.8%). The availability of AVS is essential for an accurate identification of the adrenocortical pat
underlying PA.
PMID: 17161262 [PubMed - in process]
45: J Am Coll Cardiol. 2006 Nov 7;48(9):1856-8. Epub 2006 Oct 17.
Related A
Comment on:

J Am Coll Cardiol. 2006 Nov 7;48(9):1851-5.
Physiologic assessment of renal artery stenosis: will history repeat itself?
Fearon WF.
Publication Types:



Comment
Editorial
Research Support, N.I.H., Extramural
PMID: 17084262 [PubMed - indexed for MEDLINE]
46: J Am Coll Cardiol. 2006 Nov 7;48(9):1851-5. Epub 2006 Oct 17.
Related A
Comment in:

J Am Coll Cardiol. 2006 Nov 7;48(9):1856-8.
Assessment of renal artery stenosis severity by pressure gradient measurements.
De Bruyne B, Manoharan G, Pijls NH, Verhamme K, Madaric J, Bartunek J, Vanderheyden
Heyndrickx GR.
Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium. bernard.de.bruyne@olvz-aalst.be
OBJECTIVES: The purpose of this study was to define "significant" renal artery stenosis (i.e., a st
able to induce arterial hypertension). BACKGROUND: The degree of renal artery stenosis that jus
attempt at revascularization is unknown. METHODS: In 15 patients, transstenotic pressure measu
were obtained before and after unilateral stenting. After stenting, graded stenoses were created in t
segment by progressive inflation of a balloon catheter. Stenosis severity was expressed as the ratio
pressure (P(d)) corrected for aortic pressure (P(a)). Balloon inflation pressure was adjusted to crea
degrees of stenosis (P(d)/P(a) from 1.0 to 0.5, each step during 10 min). Plasma renin concentratio
measured at the end of each step in the aorta and in both renal veins. RESULTS: For a P(d)/P(a) ra
no significant change in plasma renin concentration was observed. However, when P(d)/P(a) beca
a significant increase in renin was observed in the renal vein of the stenotic kidney, finally reachin
maximal increase of 346 +/- 145% for P(d)/P(a) of 0.50 (p = 0.006). These values returned to base
the stenosis was relieved. In addition, plasma renin concentration increased significantly in the vei
non-stenotic kidney (p = 0.02). CONCLUSIONS: In renal artery stenoses, a P(d)/P(a) ratio of 0.90
considered a threshold value below which the stenosis is likely responsible for an up-regulation of
production and, thus, for renovascular hypertension. These findings might contribute to better pati
selection for renal angioplasty.
Publication Types:

Comparative Study
PMID: 17084261 [PubMed - indexed for MEDLINE]
47: J Hum Hypertens. 2006 Dec 14; [Epub ahead of print]
Related A
Reverse white-coat effect as an independent risk for left ventricular concentric
hypertrophy in patients with treated essential hypertension.
Tomiyama M, Horio T, Kamide K, Nakamura S, Yoshihara F, Nakata H, Nakahama H, Kaw
1Division of Hypertension and Nephrology, Department of Medicine, National Cardiovascular Ce
Suita, Japan.
Recent studies have shown that the converse phenomenon of white-coat hypertension called 'rever
coat hypertension' or 'masked hypertension' is associated with poor cardiovascular prognosis. We
the hypothesis that this phenomenon may specifically influence left ventricular (LV) structure in t
hypertensive patients. A total of 272 outpatients (mean age, 65 years) with chronically treated esse
hypertension and without remarkable white-coat effect were enrolled. Patients were classified into
groups according to office and daytime ambulatory systolic blood pressure (SBP); that is subjects
(Group 1: office SBP >/=daytime SBP, n=149) and with reverse white-coat effect (Group 2: office
SBP<daytime SBP, n=123). LV mass index and relative wall thickness were echocardiographicall
determined. In all subjects, LV mass index and relative wall thickness were positively correlated w
daytime and 24-h SBP, but not with office SBP. In addition, these two indices were inversely corr
with office - daytime SBP difference. LV mass index (136+/-31 and 115+/-28 g/m(2), mean+/-s.d
relative wall thickness (0.49+/-0.09 and 0.46+/-0.07) were significantly greater in Group 2 than in
As for LV geometric patterns, Group 2 had a significantly higher rate of concentric hypertrophy co
with Group 1 (48 and 28%). Multivariate analyses revealed that the presence of reverse white-coa
was a predictor for LV concentric hypertrophy, independent of age, sex, hypertension duration,
antihypertensive treatment and ambulatory blood pressure levels. Our findings demonstrate that re
white-coat effect is an independent risk factor for LV hypertrophy, especially concentric hypertrop
treated hypertensive patients.Journal of Human Hypertension advance online publication, 14 Dece
2006; doi:10.1038/sj.jhh.1002127.
PMID: 17167525 [PubMed - as supplied by publisher]
48: J Hum Hypertens. 2006 Dec 14; [Epub ahead of print]
Related A
Plasma levels of complement C3 is associated with development of hypertension: a
longitudinal cohort study.
Engstrom G, Hedblad B, Berglund G, Janzon L, Lindgarde F.
1Department of Clinical Science, Malmo University Hospital, Lund University, Malmo, Sweden.
Hypertension has been associated with raised plasma levels of complement factor 3 and 4 (C3 and
nature of this association is unclear. This population-based longitudinal study explored whether C
associated with development of hypertension. Blood pressure and plasma levels of C3 and C4 wer
determined in 2178 healthy men, aged 35-50 years, initially without treatment for hypertension. In
hypertension and blood pressure increase over 15.7 (+/-2.2) years follow-up was studied in relatio
and C4 at baseline. Among men with initially normal blood pressure (<160/95 mm Hg), incidence
hypertension (>/=160/95 mm Hg or treatment) was 32, 42, 37 and 47%, respectively, for men with
first, second, third and fourth quartile (trend: P=0.001). This relationship remained significant afte
adjustment for confounding factors. Among men without blood pressure treatment, systolic BP inc
(mean+standard error, adjusted for age, initial blood pressure and follow-up time) was 17.5+0.8, 1
19.8+0.8 and 20.8+0.8 mm Hg, respectively, in the C3 quartiles (trend: P=0.004). C3 was not asso
diastolic blood pressure at follow-up. Although C4 was associated with blood pressure at the base
examination, there was no relationship between C4 and development of hypertension or future blo
pressure increase. It is concluded that C3 in plasma is associated with future blood pressure increa
development of hypertension.Journal of Human Hypertension advance online publication, 14 Dec
2006; doi:10.1038/sj.jhh.1002129.
PMID: 17167524 [PubMed - as supplied by publisher]
49: J Hum Hypertens. 2006 Dec 14; [Epub ahead of print]
Related A
Impacts of diabetes and hypertension on the risk of hospitalization among less edu
people.
Lin M, Chen Y, Sigal RJ.
1Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Otta
Ontario, Canada.
Coexisting hypertension increases the morbidity and mortality associated with diabetes, and may b
in less educated people. We analysed data from 49 904 Canadians 40-64 years of age who particip
Canadian Community Health Survey, 2000-2001. Multiple classification analysis was used to adju
covariates. Population weight and design effect of the survey were taken into account in the analys
association between hypertension and hospitalization varied according to diabetes and education. T
adjusted difference in hospitalization incidence attributable to hypertension was significantly high
lower education group than the higher education group, and such a pattern tended to be more pron
among diabetic people. The adjusted incidence difference attributable to hypertension was higher
diabetic group (8.8, 95% confidence interval (CI): 4.6, 13.0%) than in the non-diabetic group (4.6,
3.6, 5.6%) for people with low education, but was similar for those with well-educated people. Po
reasons for the modifying effect of education on the relationship among hypertension, diabetes and
hospitalization were discussed.Journal of Human Hypertension advance online publication, 14 De
2006; doi:10.1038/sj.jhh.1002131.
PMID: 17167523 [PubMed - as supplied by publisher]
Related A
50: J Hum Hypertens. 2006 Dec 14; [Epub ahead of print]
The effect of gender on the sympathetic nerve hyperactivity of essential hypertens
Hogarth AJ, Mackintosh AF, Mary DA.
1The Department of Cardiology, St James's University Hospital, Leeds, UK.
We planned to determine whether or not there is a difference in the level of muscle sympathetic ne
activity (MSNA) between hypertensive women and hypertensive men. Sympathetic activation of e
hypertension (EHT) has been associated with increased cardiovascular events, which are known to
likely to occur in women than in men. Normal women have been reported to have less sympatheti
activity than men, but no reported data are available regarding gender differences in sympathetic a
hypertensive subjects. We examined 36 patients with untreated and uncomplicated EHT comprisin
women and 18 men, and 36 normal controls comprising 18 women and 18 men. MSNA was quant
the mean frequency of single units and as multiunit bursts using the technique of microneurograph
hypertensive groups had greater sympathetic nerve activity than the control groups. Female hypert
had lower (P<0.001) single unit hyperactivity (56+/-1.7 impulses/100 cardiac beats) than male hyp
(72+/-1.7 impulses/100 cardiac beats). Normotensive females had lower (P<0.01) single unit activ
3.6 impulses/100 cardiac beats) than normotensive males (56+/-4.6 impulses/100 cardiac beats). S
results were obtained for the frequency of multiunit burst activity. Hypertension in women is asso
with a lower level of central sympathetic hyperactivity than in men. It is suggested that this may a
partly explain the observed lower hypertension-related cardiovascular events in women than in me
addition, the findings may have implications for gender-specific management of hypertension.Jou
Human Hypertension advance online publication, 14 December 2006; doi:10.1038/sj.jhh.1002132
PMID: 17167522 [PubMed - as supplied by publisher]
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51: J Hum Hypertens. 2006 Sep;20(9):693-700. Epub 2006
May 18.
Related Articles, Links
Rationale and design of a study to evaluate management of
proteinuria in patients at high risk for vascular events: the
IMPROVE trial.
Bakris GL, Ruilope L, Locatelli F, Ptaszynska A, Pieske B, Raz I, Voors AA,
Dechamplain J, Weber MA.
Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
60612, USA. gbarkis@earthlink.net
Declining kidney function predicts increasing cardiovascular risk in people with
hypertension. Microalbuminuria is a marker for cardiovascular risk and declining
kidney function. Agents that block the renin-angiotensin-aldosterone system
(RAAS), notably angiotensin-converting enzyme (ACE) inhibitors and
angiotensin receptor blockers (ARBs), reduce proteinuria and microalbuminuria,
lower blood pressure and slow the progression of proteinuric kidney disease.
Evidence is accumulating that the combination of an ACE inhibitor and an ARB is
the optimal means of RAAS blockade in this setting, slowing the progression of
nephropathy independently of blood pressure lowering to a greater degree than
can be achieved using maximum approved doses of either agent alone. However,
the emerging therapeutic potential of ACE inhibitor/ARB combination therapy in
hypertensive kidney disease requires further characterization. The Irbesartan in the
Management of PROteinuric patients at high risk for Vascular Events trial aims to
determine definitively whether the combination therapy of an ARB, irbesartan and
an ACE inhibitor, ramipril, is more effective than ramipril alone in reducing the
urinary albumin excretion rate in patients at high cardiovascular risk with
hypertension and proteinuria or microalbuminuria.
Publication Types:


Multicenter Study
Randomized Controlled Trial
PMID: 16710287 [PubMed - indexed for MEDLINE]
52: J Hum Hypertens. 2006 Sep;20(9):684-92. Epub 2006 Apr 20.
Related Articles, Links
Association between the Pro12Ala variant of the peroxisome
proliferator-activated receptor-gamma2 gene and increased 24-h
diastolic blood pressure in obese patients with type II diabetes.
Stefanski A, Majkowska L, Ciechanowicz A, Frankow M, Safranow K,
Parczewski M, Moleda P, Pilarska K.
Department of Endocrinology, Hypertension and Metabolic Diseases, Pomeranian
Medical University, Szczecin, Poland. stefend@sci.pam.szczecin.pl
The aim of the study was to examine an association between the Pro12Ala
polymorphism of the peroxisome proliferator-activated receptor (PPAR)-gamma2
gene and blood pressure values assessed by 24-h ambulatory blood pressure
monitoring (ABPM) in obese patients with long-lasting type II diabetes. Two
hundred and fourteen obese patients (95 men and 119 women) with above 10-year
history of type II diabetes were recruited for the study. In all the patients, ABPM
was performed and other parameters, including age, body mass index (BMI),
waist/hip ratio (WHR), haemoglobin A1c (HbA(1c)), serum lipids and creatinine
were also evaluated. The Pro12Ala polymorphism was analysed by polymerase
chain reaction-restriction fragment length polymorphism. Two subgroups of
patients were compared: (a) Pro/Pro: homozygotic Pro/Pro (n=154) and (b) Ala:
Ala allele carriers (Ala/Ala+Ala/Pro) (n=60). The studied groups were not
different when age, BMI, WHR, HbA(1c), lipids, creatinine and frequency of
hypertension were compared. A similar ratio of patients from both groups were
treated with angiotensin-converting enzyme inhibitors, calcium channel blockers,
diuretics, beta-blockers and alpha-blockers. A difference was observed in a mean
24-h (Ala: 71.9+/-8.1 vs Pro/Pro: 69.4+/-7.8 mm Hg, P=0.034) and a mean night
time (Ala: 67.1+/-7.8 vs Pro/Pro: 64.5+/-8.4 mm Hg, P=0.025) diastolic blood
pressure, which was significantly higher in patients with Ala variant. There was
also a trend towards a higher mean daytime diastolic blood pressure in this group.
It seems that the Pro12Ala variant is associated with an increased mean 24-h
diastolic blood pressure in obese diabetic patients. Different reaction for
antihypertensive medication depending on a variant of the PPAR-gamma2 gene
should also be considered as a possible cause of the presented results.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 16625233 [PubMed - indexed for MEDLINE]
53: J Hum Hypertens. 2006 Sep;20(9):635-7. Epub 2006 Apr 13.
Related Articles, Links
Blood pressure control in the setting of diabetes mellitus: new
targets, new hope for improvement?
Varughese GI, Patel JV, Lip GY.
University Department of Medicine, City Hospital, Birmingham, UK.
PMID: 16617307 [PubMed - indexed for MEDLINE]
54: J Hypertens. 2006 Nov;24(11):2239-46.
Related Articles, Links
Central receptors mediating the cardiovascular actions of
melanocyte stimulating hormones.
Ni XP, Butler AA, Cone RD, Humphreys MH.
Division of Nephrology, San Francisco General Hospital and University of
California San Francisco, San Francisco, California 94143-1341, USA.
OBJECTIVE: Alpha and gamma-melanocyte stimulating hormones (MSH) are
peptides that possess potent hypertensinogenic actions when injected
intravenously or intracerebroventricularly. We sought to define the central
receptor(s) mediating these cardiovascular actions. METHODS: We gave bolus
injections of synthetic alpha or gamma-MSH intravenously or
intracerebroventricularly to anesthetized wild-type (Mc3r+/+, Mc4r+/+) mice and
mice with targeted disruption of the gamma-MSH receptor (Mc3r-/-) or the
melanocortin 4 receptor (Mc4r-/-). RESULTS: Gamma-MSH injected
intravenously increased mean arterial pressure (MAP) and heart rate (HR) dosedependently, with the effect being evident at 10 mol/kg; the maximum increase, at
10 mol/kg, was 38 mmHg in both strains from similar control MAP. Parallel
increases in HR also occurred. Injection of the sodium channel blocker, benzamil,
4 microg/kg intracerebroventricularly, before intravenous gamma-MSH
completely prevented the increases in MAP and HR in both strains. Injection of 2
x 10 mol/g body weight alpha-MSH intravenously had no effect on MAP or HR in
Mc4r wild-type or -/- mice. However, the same dose given
intracerebroventricularly to wild-type mice increased MAP from 76 +/- 4 to 95 +/5 mmHg at 10 min (P < 0.01) and HR from 416 +/- 15 to 480 +/- 15 beats/min (P
< 0.01). In Mc4r-/- mice, the intracerebroventricular administration of the peptide
did not alter these variables, in contrast to the results in wild-type mice.
CONCLUSION: Both MSH peptides exert their hypertensinogenic effects through
central sites of action, which probably reflect the activation of sympathetic
outflow. The actions of intracerebroventricular alpha-MSH appear to be mediated
via Mc4r, whereas those of gamma-MSH are independent of its receptor Mc3r, but
reflect the activation of a sodium channel in the central nervous system. These
results help to reconcile the hypertensive action of gamma-MSH injections with
the hypertension observed in states of gamma-MSH deficiency.
Publication Types:

Research Support, N.I.H., Extramural
PMID: 17053546 [PubMed - indexed for MEDLINE]
55: J Hypertens. 2006 Nov;24(11):2199-205.
Related Articles, Links
Interaction between CYP1A1 T3801C and AHR G1661A
polymorphisms according to smoking status on blood pressure in the
Stanislas cohort.
Gambier N, Marteau JB, Batt AM, Marie B, Thompson A, Siest G, Foernzler
D, Visvikis-Siest S.
INSERM U525, Faculte de Pharmacie, Universite Henri Poincare Nancy 1,
Nancy, France.
BACKGROUND: CYP1A1, one of the key enzymes in detoxifying toxic
components produced during cigarette smoking, is regulated by aromatic
hydrocarbon receptor (AHR). A CYP1A1 T3801C polymorphism, associated with
a higher CYP1A1 inducibility and enhanced catalytic activity, has been linked to
stroke, triple vessel disease and may, therefore, be associated with blood pressure
(BP). The relation of the widely studied G1661A polymorphism of the human
AHR gene with BP is unknown. OBJECTIVES: To investigate the genetic
influence of CYP1A1 T3801C and AHR G1661A polymorphisms on BP in
relation to tobacco consumption. DESIGN AND PARTICIPANTS: Study
participants were selected from a French longitudinal cohort of volunteers for a
free health check-up. These individuals (302 men and 311 women) were not
taking medication that can affect blood pressure. Information about active
smoking status was obtained by a self-administered questionnaire. RESULTS:
After multiple regression analysis, systolic blood pressure (SBP) and diastolic
blood pressure (DBP) did not differ significantly according to their tobacco status
excepted for DBP in men. In addition, neither CYP1A1 T3801C nor AHR
G1661A polymorphism was linked to blood pressure. However, systolic and
diastolic blood pressures differed significantly according to CYP1A1 T3801C
genotype between ex-smokers and smokers. Finally, the interaction between
CYP1A1 T3801C and AHR G1661A polymorphisms explained a significant
difference of SBP and DBP between carriers of both CYP1A1-C3801 and AHRA1661 alleles. CONCLUSION: This study is the first to show an interaction
between the CYP1A1 T3801C and AHR G1661A polymorphisms. This
interaction could explain the difference in blood pressure level between smokers
and non-smokers/ex-smokers but needs to be confirmed in a large sample.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17053541 [PubMed - indexed for MEDLINE]
56: J Hypertens. 2006 Nov;24(11):2183-9.
Related Articles, Links
Introversion associated with large differences between screening
blood pressure and home blood pressure measurement: The
Ohasama study.
Hozawa A, Ohkubo T, Obara T, Metoki H, Kikuya M, Asayama K, Totsune
K, Hashimoto J, Hoshi H, Arai Y, Satoh H, Hosokawa T, Imai Y.
Department of Health Science, Shiga University of Medical Science, Shiga, Japan.
hozawa-thk@umin.ac.jp
OBJECTIVE: To explore the effect of personality on screening blood pressures
measured in clinical settings and home blood pressure measurements.
METHODS: From 1997 to 1999, 699 participants underwent screening and home
blood pressure measurements and completed the Japanese version of the shortform Eysenck personality questionnaire. An increased screening blood pressure
was defined as screening blood pressure > or = 140/90 mmHg and an increased
home blood pressure was defined as home blood pressure > or = 135/85 mmHg.
RESULTS: Participants with lower extroversion scores (i.e., introversion) showed
a greater difference between screening and home systolic blood pressure. The
association between introversion and differences was statistically significant, even
after adjustment for other possible factors (younger age, female, wide screening
pulse pressure, never smoked, and no antihypertensive medication). The adjusted
means of SBP differences were 7.3 and 4.4 mmHg among the lowest and highest
extroversion quartiles, respectively (P for trend = 0.02). Other personality scores
(psychoticism or neuroticism) were not associated with screening and home blood
pressure differences. The incorporation of an extroversion score in the basic model
consisting of the above factors that affected the difference between screening and
home blood pressure slightly improved the prediction of a high home blood
pressure. The area under the receiver operating characteristic curve increased by
0.037 among participants with high screening blood pressure and 0.006 for those
with normal screening blood pressure compared with the basic model.
CONCLUSION: Physicians may need to be aware of 'introverted' patients who
have high blood pressure in clinic settings, because they have the potential for
'white-coat' hypertension.
Publication Types:


Evaluation Studies
Research Support, Non-U.S. Gov't
PMID: 17053539 [PubMed - indexed for MEDLINE]
57: JAMA. 2006 Dec 20;296(23):2787-8.
Drug therapy for prehypertension questioned.
Mitka M.
Publication Types:

News
Related Articles, Links
1: Am J Cardiol. 2006 Dec 15;98(12):1652-5. Epub 2006 Oct 27.
Related Articles, Links
Usefulness of regional myocardial performance index to diagnose
pulmonary embolism in patients with echocardiographic signs of
pulmonary hypertension.
Hsiao SH, Yang SH, Wang WC, Lee CY, Lin SK, Liu CP.
Cardiovascular Center, Department of Internal Medicine, Kaohsiung Veterans
General Hospital, Kaohsiung, Taiwan.
In this study, myocardial performance index (MPI) was used to identify
pulmonary embolism (PE) in patients with echocardiographic signs of pulmonary
hypertension. One hundred patients with echocardiographic signs of pulmonary
hypertension were enrolled in this study after informed consent was obtained. All
patients underwent multidetector-row computed tomography of the chest, and PE
was found in 50 patients. Another 100 patients without any cardiopulmonary
distress or echocardiographic signs of pulmonary hypertension served as the
control group. All cohorts were enrolled after the exclusion of (1) any rhythm
other than sinus rhythm; (2) complete bundle branch block; (3) ischemic heart
disease proved by stress test, perfusion scan, or coronary angiography; (4) a left
ventricular (LV) ejection fraction <50%; and (5) inadequate echocardiograms.
Routine echocardiography and tissue Doppler imaging were performed, including
the MPIs of the right and left ventricles. The right ventricular (RV) MPI was
significantly higher in patients with PE than in others (p <0.0001). Patients
without PE had concordant changes in the RV and LV MPIs. In patients with
acute PE, the RV MPI became higher, but the LV MPI was relatively constant.
Using the RV MPI divided by the LV MPI (the V index), PE could be
distinguished in patients with echocardiographic signs of pulmonary hypertension.
By receiver-operating characteristic curve analysis, the V index >1.2 identified PE
with sensitivity of 82% and specificity of 83%. In conclusion, the V index is a
useful parameter to assess the possibility of PE in patients with echocardiographic
signs of pulmonary hypertension.
PMID: 17145228 [PubMed - in process]
2: Am J Cardiol. 2006 Dec 15;98(12):1616-1621. Epub 2006 Oct
23.
Related Articles,
Links
Dietary Magnesium Intake and Risk of Incident Hypertension
Among Middle-Aged and Older US Women in a 10-Year Follow-Up
Study.
Song Y, Sesso HD, Manson JE, Cook NR, Buring JE, Liu S.
Division of Preventive Medicine, Department of Medicine, Brigham and Women's
Hospital and Harvard Medical School, Boston, Massachusetts.
To assess the hypothesis that magnesium intake is beneficial in the primary
prevention of hypertension, 28,349 female United States health professionals aged
>/=45 years participating in the Women's Health Study (WHS), who initially
reported normal blood pressure (systolic blood pressure <140 mm Hg, diastolic
blood pressure <90 mm Hg, no history of hypertension or antihypertensive
medications), were prospectively studied. A semi-quantitative food frequency
questionnaire was used to estimate magnesium intake. During a median follow-up
of 9.8 years, 8,544 women developed incident hypertension. After adjustment for
age and randomized treatment, magnesium intake was inversely associated with
the risk for developing hypertension; women in the highest quintile (median 434
mg/day) had a decreased risk for hypertension (relative risk 0.87, 95% confidence
interval [CI] 0.81 to 0.93, p for trend <0.0001) compared with those in the lowest
quintile (median 256 mg/day). This inverse association was attenuated but
remained significant after further adjustment for known risk factors. In the fully
adjusted model, the relative risks were 1.00 (95% CI 0.95 to 1.10), 1.02 (95% CI
0.95 to 1.10), 0.96 (95% CI 0.89 to 1.03), and 0.93 (95% CI 0.86 to 1.02) (p for
trend = 0.03). Similar associations were observed for women who never smoked
and reported no history of high cholesterol or diabetes at baseline. In conclusion,
the results suggest that higher intake of dietary magnesium may have a modest
effect on the development of hypertension in women.
PMID: 17145221 [PubMed - as supplied by publisher]
3: Hypertension. 2007 Jan;49(1):1-4. Epub 2006 Dec 4.
Related Articles, Links
Integrins, vascular remodeling, and hypertension.
Heerkens EH, Izzard AS, Heagerty AM.
Division of Cardiovascular and Endocrine Sciences, Faculty of Medical and
Human Sciences, University of Manchester, United Kingdom.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17145983 [PubMed - in process]
4: Hypertension. 2006 Dec 4; [Epub ahead of print]
Related Articles, Links
Clinical Trials for Hypertension. Expectations Fulfilled and
Unfulfilled.
Kaplan NM.
Hypertension Division, Department of Internal Medicine, University of Texas,
Southwestern Medical School, Dallas.
PMID: 17145982 [PubMed - as supplied by publisher]
5: Hypertension. 2006 Dec 4; [Epub ahead of print]
Related Articles, Links
Chronic Hypertension Enhances the Postsynaptic Effect of Baclofen
in the Nucleus Tractus Solitarius.
Zhang W, Herrera-Rosales M, Mifflin S.
Department of Pharmacology, University of Texas Health Science Center at San
Antonio.
Microinjection of the inhibitory neurotransmitter gamma-aminobutyric acid Bsubtype receptor agonist baclofen into the nucleus tractus solitarius increases
arterial blood pressure and sympathetic nerve discharge. The baclofen-induced
pressor response is enhanced in chronic hypertension. We hypothesized that a
postsynaptic mechanism contributes to the enhanced responses to baclofen in
hypertension. We investigated the postsynaptic effect of baclofen on second-order
baroreceptor neurons, identified by 1,1'-dilinoleyl-3,3,3',3'-tetramethylindocarbocyanine, 4-chlorobenzenesulphonate labeling of the aortic nerve,
in nucleus tractus solitarius slices from sham-operated normotensive and unilateral
nephrectomized, renal-wrap hypertensive rats. After 4 weeks, arterial blood
pressure was 153+/-7 mm Hg in hypertensive rats (n=9) and 93+/-3 mm Hg in
normotensive rats (n=8; P<0.05). There was no difference in resting membrane
potential (54.5+/-0.7 versus 53.3+/-0.6 mV) or input resistance (1.07+/-0.11
versus 1.03+/-0.11 GOmega) between hypertensive and normotensive neurons
(both n=18). Baclofen induced a net outward current in nucleus tractus solitarius
neurons in the presence of 1 micromol/L tetrodotoxin. The EC50 of the baclofen
effect was greater in normotensive cells (9.1+/-3.2 micromol/L; n=5) than
hypertensive cells (3.0+/-0.5 micromol/L; n=7; P<0.05), and baclofen (10
micromol/L) induced a greater decrease in input resistance in hypertensive cells
(61+/-2%; n=6) than in normotensive cells (45+/-4%; n=9; P<0.05). Both
potassium and calcium channels were involved in the baclofen-evoked whole-cell
current. The results suggest an enhanced postsynaptic response to activation of
inhibitory neurotransmitter gamma-aminobutyric acid B-subtype receptors in
second-order baroreceptor neurons in the nucleus tractus solitarius in renal-wrap
hypertensive rats. This enhanced inhibition could alter baroreflex function in
chronic hypertension.
PMID: 17145979 [PubMed - as supplied by publisher]
6: Hypertension. 2006 Dec 4; [Epub ahead of print]
Related Articles, Links
Response to Hasty Conclusion About Acupuncture for
Hypertension?
Kaplan NM.
University of Texas Southwestern Medical School, Dallas, Texas.
PMID: 17145978 [PubMed - as supplied by publisher]
Related Articles,
Links
7: Hypertension. 2007 Jan;49(1):E5; author reply E6. Epub 2006
Dec 4.
Hasty conclusion about acupuncture for hypertension?
Moffet HH.
Publication Types:


Comment
Letter
PMID: 17145977 [PubMed - in process]
8: J Hypertens. 2007 Jan;25(1):241-6.
Related Articles, Links
Effect of device-guided breathing exercises on blood pressure in
hypertensive patients with type 2 diabetes mellitus: a randomized
controlled trial.
Logtenberg SJ, Kleefstra N, Houweling ST, Groenier KH, Bilo HJ.
aDepartment of Internal Medicine, Isala Clinics, Zwolle bLangerhans Medical
Research Group, The Netherlands cDepartment of General Practice, University
Medical Centre Groningen, Groningen, The Netherlands.
OBJECTIVE: In patients with type 2 diabetes mellitus (DM2), it is hard to reach
treatment objectives for blood pressure (BP) with classical treatment options.
Recently, reducing breathing frequency has been advocated as a method to reduce
BP. We examined if an electronic device such as Resperate, by reducing breathing
frequency, would lead to BP reduction in a population of patients with DM2 and
hypertension. Our secondary objective was to study the effect of this device on
quality of life (QOL). METHODS: A randomized, single-blind, controlled trial
was conducted over a period of 8 weeks to evaluate the effect of this therapy on
BP and QOL. The control group listened to music and used no other therapeutic
device. BP and QOL changes were studied in 30 patients with DM2 and
hypertension. RESULTS: There was no significant difference in change in BP
between groups; -7.5 [95% confidence interval (CI) -12.7, -2.3]/-1.0 (95% CI -5.5,
3.6) mmHg in the intervention group and -12.2 (95% CI -17.4, -7.0)/-5.5 (95% CI
-9.7, -1.4) mmHg in the control group. Whether or not the target breathing
frequency of 10 breaths/min was reached did not affect BP. There were no
significant changes in QOL. CONCLUSIONS: The effects of Resperate on BP
and QOL were not significantly different from those found in the control group.
Furthermore, 40% of patients did not reach the target breathing frequency, making
this device less suitable for clinical practice in patients with DM2.
PMID: 17143197 [PubMed - in process]
9: J Hypertens. 2007 Jan;25(1):217-226.
Related Articles, Links
Renin inhibition with aliskiren provides additive antihypertensive
efficacy when used in combination with hydrochlorothiazide.
Villamil A, Chrysant SG, Calhoun D, Schober B, Hsu H, MatriscianoDimichino L, Zhang J.
aFundapres, Las-Heras 2910-Piso 1A, Buenos Aires, Argentina bOklahoma
Cardiovascular and Hypertension Center and the University of Oklahoma,
Oklahoma City, Oklahoma cVascular Biology and Hypertension Program,
University of Alabama at Birmingham, Alabama dNovartis Pharmaceuticals
Corporation, East Hanover, New Jersey, USA.
OBJECTIVES: Aliskiren is a novel, orally active renin inhibitor. Its
antihypertensive efficacy and safety, alone and in combination with
hydrochlorothiazide (HCTZ), were investigated in an 8-week, double-blind,
placebo-controlled trial in hypertensive patients. The effects of these treatments on
plasma renin activity (PRA) were also assessed. METHODS: A total of 2776
patients aged >/= 18 years with mean sitting diastolic blood pressure (MSDBP)
95-109 mmHg were randomized to receive once-daily treatment with aliskiren
(75, 150 or 300 mg), HCTZ (6.25, 12.5 or 25 mg), the combination of aliskiren
and HCTZ, or placebo, in a factorial design. The primary endpoint was the change
in MSDBP from baseline to week 8. PRA was assessed at these timepoints at
selected study centers. RESULTS: Aliskiren monotherapy was superior to placebo
(P < 0.001; overall Dunnett's test) in reducing MSDBP and mean sitting systolic
blood pressure (MSSBP). Combination treatment was superior to both component
monotherapies in reducing BP (maximum MSSBP/MSDBP reduction of 21.2/14.3
mmHg from baseline with aliskiren/HCTZ 300/25 mg), and resulted in more
responders (patients with MSDBP < 90 mmHg and/or >/= 10 mmHg reduction)
and better control rates (patients achieving MSSBP/MSDBP < 140/90 mmHg)
than either monotherapy. Aliskiren monotherapy reduced PRA by up to 65% from
baseline. Although HCTZ monotherapy increased PRA by up to 72%, PRA
decreased in all of the combination therapy groups. All active treatments were
well tolerated. CONCLUSIONS: Aliskiren monotherapy demonstrated significant
BP lowering, and its effect was considerably greater when combined with HCTZ.
Renin inhibition with aliskiren neutralized the compensatory rise in PRA induced
by HCTZ.
PMID: 17143194 [PubMed - as supplied by publisher]
10: J Hypertens. 2007 Jan;25(1):207-15.
Related Articles, Links
Transient AT1 receptor-inhibition in prehypertensive spontaneously
hypertensive rats results in maintained cardiac protection until
advanced age.
Baumann M, Janssen BJ, Hermans JR, Peutz-Kootstra C, Witzke O, Smits
JF, Struijker Boudier HA.
aDepartment of Pharmacology and Toxicology, University Maastricht, The
Netherlands bDepartment of Pathology, Academic Hospital Maastricht, The
Netherlands cDepartment of Nephrology, Academic Hospital Essen, Germany.
OBJECTIVE: In young spontaneously hypertensive rats (SHR), transient
angiotensin II type 1 receptor (AT1R) blockade decreases blood pressure for a
prolonged period. We tested the hypothesis that transient AT1R blockade in SHR
leads to cardiac protection until advanced age. METHOD: Wistar-Kyoto rats,
SHR and transiently losartan-treated SHR (SHR-Los) (20 mg/kg per day; weeks
4-8 of age) were followed up until week 72 (n = 9 each group), including repeated
echocardiography, radiotelemetric investigations and 24-h urine collection. Endpoint measurements comprised left ventricular function parameters, left
ventricular histomorphology and molecular biology (types I and III collagen, brain
natriuretic peptide, AT1R mRNA) as well as renal morphology. RESULTS:
Prehypertensive treatment with losartan, but not with the general vasodilator
hydralazine, reduced blood pressure until age 48 weeks. In untreated SHR, the
end-diastolic volume increased from week 36 and the left ventricular ejection
fraction fell from week 48. In contrast, age-related changes in end-diastolic
volume and ejection fraction were comparable in SHR-Los and Wistar-Kyoto rats
up to age 60 weeks. At age 72 weeks, the ejection fraction was reduced in SHRLos but higher than that in untreated SHR (ejection fraction: Wistar-Kyoto rats, 58
+/- 3%; SHR, 39 +/- 3%; SHR-Los, 46 +/- 3%; P < 0.01 and P < 0.05,
respectively). The heart weight/body weight ratio (SHR-Los, 4.7 +/- 0.1 g/kg;
SHR, 5.2 +/- 0.2 g/kg) and cardiac brain natriuretic peptide mRNA levels were
improved by treatment. Left ventricular histomorphology and 24-h albuminuria
were significantly improved in SHR-Los (41 +/- 5 mg/day; SHR, 80 +/- 22
mg/day; P < 0.05). CONCLUSION: In young SHR, transient AT1R blockade, not
blood pressure lowering, attenuates the development of hypertension and exerts
cardioprotective effects up to age 72 weeks.
PMID: 17143193 [PubMed - in process]
11: J Hypertens. 2007 Jan;25(1):169-175.
Related Articles, Links
Long-term calcium antagonist treatment of human hypertension
with mibefradil or amlodipine increases sympathetic nerve activity.
Lindqvist M, Kahan T, Melcher A, Ekholm M, Hjemdahl P.
aKarolinska Institutet, Department of Clinical Sciences, Danderyd Hospital,
Division of Clinical Physiology, Sweden bKarolinska Institutet, Department of
Clinical Sciences, Danderyd Hospital, Division of Internal Medicine, Sweden
cDepartment of Medicine, Clinical Pharmacology Unit, Karolinska University
Hospital (Solna), Stockholm, Sweden.
OBJECTIVES: Calcium antagonists are vasodilating drugs, which may cause
reflex activation of the sympathetic nervous system with potentially untoward
effects. We studied the effects of long-term treatment with amlodipine, a longacting dihydropyridine-type calcium antagonist, and mibefradil, a
phenylalkylamine-type calcium antagonist, on sympathetic nerve activity.
METHODS: Fourteen patients with primary hypertension participated in a doubleblind, cross-over study comparing the effects of 6 weeks of treatment with
mibefradil 100 mg daily and amlodipine 10 mg daily. Heart rate, direct arterial
blood pressure and cardiac output by echocardiography were registered. Global
sympathetic activity was estimated using a [H]noradrenaline isotope dilution
method with arterial and venous sampling; cardiac sympathetic activity was
assessed indirectly by heart rate variability and tissue velocity echocardiography.
RESULTS: Both drugs lowered mean arterial pressure; the decrease was more
pronounced with mibefradil (from 118 +/- 3 to 99 +/- 2 mmHg, compared to 118
+/- 3 to 104 +/- 2 mmHg for amlodipine, P < 0.01 between drugs). Mibefradil
decreased heart rate (66 +/- 2 to 57 +/- 2 bpm), whereas amlodipine caused a slight
increase (66 +/- 2 to 70 +/- 2 bpm; P < 0.001 between drugs) and tended to
increase cardiac output. Noradrenaline spillover increased similarly with the two
drugs, from 3.44 +/- 0.27 to 5.20 +/- 0.48 nmol/min per m (P < 0.01) during
mibefradil and to 5.72 +/- 0.49 nmol/min per m (P < 0.001) during amlodipine.
There were minor effects on cardiac sympatho-vagal balance, but systolic and
diastolic myocardial velocities were increased similarly by both drugs.
CONCLUSIONS: Mibefradil and amlodipine treatment increase global
sympathetic nerve activity similarly during long-term treatment, despite opposite
effects on heart rate. Increases in myocardial velocities suggest concomitant
cardiac sympathetic activation.
PMID: 17143189 [PubMed - as supplied by publisher]
12: J Hypertens. 2007 Jan;25(1):163-168.
Related Articles, Links
Baroreflex effectiveness index and baroreflex sensitivity predict allcause mortality and sudden death in hypertensive patients with
chronic renal failure.
Johansson M, Gao SA, Friberg P, Annerstedt M, Carlstrom J, Ivarsson T,
Jensen G, Ljungman S, Mathillas O, Nielsen FD, Strombom U.
aDepartments of Clinical Physiology, Sweden bNephrology, Sahlgrenska
University Hospital, Goteborg, Sweden cDepartments of Nephrology, Norra
Alvsborg Hospital, Trollhattan, Sweden dSkovde Hospital, Skovde, Sweden
eLundby Hospital, Goteborg, Sweden fBoras County Hospital, Boras, Sweden
gVarberg Hospital, Varberg, Sweden.
OBJECTIVES: Impaired arterial baroreflex sensitivity (BRS) has been associated
with cardiac mortality and non-fatal cardiac arrests after a myocardial infarction.
Patients with chronic renal failure (CRF) have a poor prognosis because of
cardiovascular diseases, and sudden death is common. The aim of this study was
to assess whether BRS or the baroreflex effectiveness index (BEI), a novel index
reflecting the number of times the baroreflex is active in controlling the heart rate
in response to blood pressure fluctuations, is associated with prognosis in CRF.
METHODS: Hypertensive patients with CRF who were treated conservatively, by
haemodialysis or peritoneal dialysis were studied. Electrocardiogram and beat-tobeat blood pressures were recorded continuously and BRS and BEI were
calculated. Patients were then followed prospectively for 41 +/- 15 months (range
1-64). RESULTS: During follow-up 69 patients died. Cardiovascular diseases and
uraemia accounted for the majority of deaths (60 and 20%, respectively), whereas
sudden death occurred in 15 patients. In adjunct with established risk factors such
as age, diabetes, congestive heart failure and diastolic blood pressure, reduced BEI
was an independent predictor of all-cause mortality among CRF patients [relative
risk (RR) 0.50, 95% confidence interval (CI) 0.33-0.71 for an increase of one
standard deviation in BEI, P < 0.001]. Diabetes and reduced BRS were
independent predictors of sudden death (RR 0.29, 95% CI 0.09-0.86 for an
increase of one standard deviation in BRS, P = 0.022). CONCLUSIONS: Both
BEI and BRS convey prognostic information that may have clinical implications
for patients with cardiovascular diseases in general.
PMID: 17143188 [PubMed - as supplied by publisher]
13: J Hypertens. 2007 Jan;25(1):141-146.
Related Articles, Links
The incremental effect of obstructive sleep apnoea syndrome on
arterial stiffness in newly diagnosed essential hypertensive subjects.
Tsioufis C, Thomopoulos K, Dimitriadis K, Amfilochiou A, Tousoulis D,
Alchanatis M, Stefanadis C, Kallikazaros I.
aDepartment of Cardiology, Hippokration Hospital, Athens, Greece bFirst
Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece
cSleep Unit, Sismanogleio Hospital, Athens, Greece dDepartment of Respiratory
Medicine, University of Athens, Sotiria Hospital, Athens, Greece.
OBJECTIVE: Although obstructive sleep apnoea syndrome (OSAS) is
accompanied by an increased atherosclerotic cardiovascular disease burden, its
relationship with arterial stiffness is not yet well determined. We investigated
whether essential hypertensive individuals with OSAS are characterized by
increased arterial stiffness. METHODS: Our study population consisted of 46
consecutive patients with newly diagnosed untreated stage I-II essential
hypertension suffering from OSAS (35 men, aged 49 +/- 8 years) and 53
hypertensive individuals without OSAS, matched for age, sex, and smoking status.
All subjects underwent polysomnography, echocardiography and aortic stiffness
evaluation by means of carotid-femoral pulse wave velocity (c-fPWV)
measurements. RESULTS: Hypertensive subjects with OSAS [apnoea/hypopnoea
index (AHI) >/= 5] compared with hypertensive subjects without OSAS (AHI < 5)
demonstrated increased levels of body mass index (31.4 +/- 4 versus 29.3 +/- 4
kg/m, P = 0.015), office systolic/diastolic blood pressure (151/99 versus 145/94
mmHg, respectively, P < 0.05, for both cases) and relative wall thickness (RWT;
0.46 +/- 0.06 versus 0.42 +/- 0.07, P = 0.010). Hypertensive subjects with OSAS
compared with those without OSAS had significantly increased c-fPWV by 9%
(8.56 +/- 0.49 versus 7.85 +/- 0.93 m/s, P = 0.001) and this difference remained
significant even after adjustment for confounders (P = 0.04). In the total study
population, c-fPWV was correlated with age (r = 0.35, P = 0.015), office systolic
blood pressure (r = 0.30, P = 0.007), RWT (r = 0.30, P = 0.03), logAHI (r = 0.389,
P = 0.0001) and minimum oxygen saturation (r = -0.418, P = 0.0001).
CONCLUSIONS: OSAS has a significant incremental effect on aortic stiffening
in the setting of middle-aged essential hypertensive subjects. This finding suggests
that the presence of OSAS in a hypertensive patient accelerates vascular damage,
increasing cardiovascular risk.
PMID: 17143185 [PubMed - as supplied by publisher]
14: J Hypertens. 2007 Jan;25(1):127-132.
Related Articles, Links
Endothelial progenitor cells in patients with essential hypertension.
Delva P, Degan M, Vallerio P, Arosio E, Minuz P, Amen G, Chio MD, Lechi
A.
aDepartment of Biomedical and Surgical Sciences, Section of Medicina Interna C,
Italy bSection of Cardiovascular Rehabilitation, Italy cDepartment of Medicine
and Public Health, Section of Pharmacology, University of Verona, Policlinico
G.B. Rossi, 37134 Verona, Italy.
OBJECTIVE(S): The eventual role of blood pressure on the endothelial progenitor
cell (EPC) has rarely been evaluated and data collected so far relate to patients
with co-existing coronary heart disease. METHODS: We have studied the number
and functional activity of EPC as well as the number of EPC endothelial colonyforming units (CFU) in a carefully selected group of 36 patients with essential
hypertension and 24 normotensive control subjects. RESULTS: In patients with
essential hypertension, the EPC number was not statistically different from that
found in control subjects (mean +/- SD, essential hypertension 58 +/- 29, controls
53 +/- 20; EPC/high power field). CFU per well were not statistically different in
patients with essential hypertension compared with normotensive controls (mean
+/- SD, patients with essential hypertension 2.4 +/- 2.6, normotensive controls 3
+/- 3.3 CFU/well). In essential hypertension patients, the EPC number was
inversely correlated with both total (R = 0.635, P < 0.0001) and low-density
lipoprotein (LDL)-cholesterol (R = 0.486, P < 0.05). Neither the EPC number nor
the EPC CFU were correlated with age, systolic blood pressure, diastolic blood
pressure, body mass index, lipoprotein(a), high-sensitivity C-reactive protein or
homocysteine. CONCLUSIONS: The present study shows that essential
hypertension is not characterized by the altered number or functional activity of
EPC. Plasma total and LDL-cholesterol are independent predictors of reduced
numbers of circulating EPC in essential hypertension patients. The absence of any
correlation between the characteristics of EPC and several markers predictive of
cardiovascular damage merits further investigation.
PMID: 17143183 [PubMed - as supplied by publisher]
15: J Hypertens. 2007 Jan;25(1):111-6.
Related Articles, Links
The functional variant of the CLC-Kb channel T481S is not
associated with blood pressure or hypertension in Swedes.
Fava C, Montagnana M, Almgren P, Rosberg L, Guidi GC, Berglund G,
Melander O.
aDepartment of Clinical Sciences, Lund University, University Hospital of
Malmo, Sweden bDepartment of Biomedical and Surgical Sciences, Italy
cDepartment of Morphological-Biomedical Sciences, University Hospital of
Verona, Italy.
OBJECTIVE: A common threonine481serine polymorphism (T481S) has been
shown in vitro to strongly activate the chloride channel Kb (CLC-Kb) expressed in
the kidney, and the 481S allele has been associated with human hypertension. The
study aim was to evaluate the association of the T481S polymorphism with blood
pressure (BP) levels and the BP progression rate in Swedes. DESIGN AND
METHODS: The cardiovascular cohort of the Malmo Diet and Cancer (MDC)
study is a population surveyed in 1991-1996 (n = 6103, DNA available on n =
6055), 53% of whom had also been examined 11 +/- 4.4 years earlier in the
Malmo Preventive Project (MPP). Hypertension was defined as having BP above
140/90 mmHg or being on antihypertensive therapy (AHT). Carriers of one or two
copies of the 481S allele were compared with T481T homozygotes (noncarriers).
RESULTS: Among individuals without AHT in the MDC study (n = 4988) there
was no difference between carriers (n = 1164, 23%) and noncarriers (n = 3824,
77%) in systolic BP (139.3 +/- 8.3 vs 139.2 +/- 8.3 mmHg, P = 0.82) or diastolic
BP (86.0 +/- 9.1 vs 86.0 +/- 9.2 mmHg, P = 0.95). In subjects free from AHT at
the MPP and MDC studies (n = 2627) there was no difference between carriers (n
= 607, 23%) and noncarriers (n = 2020, 77%) in progression of systolic BP (2.1
+/- 2.6 vs 2.0 +/- 2.8 mmHg/year, P = 0.72) or diastolic BP (0.57 +/- 1.4 vs 0.58
+/- 1.6 mmHg/year, P = 0.85) from MPP to MDC. Multivariate analysis gave no
support of interaction between the CLC-Kb T481S polymorphism, gender, age or
body mass index regarding their effect on BP. CONCLUSION: Our data do not
support a role of the CLC-Kb T481S polymorphism in BP regulation in Swedes.
PMID: 17143181 [PubMed - in process]
16: J Hypertens. 2007 Jan;25(1):103-10.
Related Articles, Links
Association of genetic polymorphisms of ACADSB and COMT with
human hypertension.
Kamide K, Kokubo Y, Yang J, Matayoshi T, Inamoto N, Takiuchi S, Horio T,
Miwa Y, Yoshii M, Tomoike H, Tanaka C, Banno M, Okuda T, Kawano Y,
Miyata T.
aDivision of Hypertension and Nephrology, Japan bDivision of Preventive
Cardiology, Japan cResearch Institute, National Cardiovascular Center, Suita,
Osaka, Japan.
OBJECTIVES: Genetically hypertensive rats provide an excellent model to
investigate the genetic mechanisms of hypertension. We previously identified
three differentially expressed genes, Acadsb (short/branched chain acyl-CoA
dehydrogenase), Comt (catecholamine-O-methyltransferase), and Pnpo
(pyridoxine 5'-phosphate oxidase), in hypertensive and normotensive rat kidneys
as potential susceptibility genes for rat hypertension. We examined the association
of human homologues of these genes with human hypertension. METHODS: We
sequenced three genes using samples from 48 or 96 hypertensive patients,
identified single nucleotide polymorphisms, and genotyped them in a populationbased sample of 1818 Japanese individuals (771 hypertensive individuals and
1047 controls). RESULTS: After adjustments for age, body mass index, present
illness (hyperlipidaemia, diabetes mellitus), and lifestyle (smoking, alcohol
consumption), multivariate logistic regression analysis revealed that -512A>G in
ACADSB was associated with hypertension in women (AA vs AG + GG: odds
ratio = 0.70, 95% confidence interval = 0.53-0.94). This single nucleotide
polymorphism was in tight linkage disequilibrium with -254G>A. Furthermore, 1187G>C in COMT was associated with hypertension in men (GG vs CG + CC:
odds ratio = 0.69, 95% confidence interval = 0.52-0.93) and was in tight linkage
disequilibrium with 186C>T. After adjustments described above, -512 A>G and 254G>A in ACADSB were associated with variations in systolic blood pressure.
ACADSB was in tight linkage disequilibrium with MGC35392 across a distance
of 18.3 kb. COMT was not in linkage disequilibrium with any adjacent genes.
Analysis indicated that two haplotypes of COMT were significantly associated
with hypertension in men. CONCLUSION: Our study suggests the possible
involvement of genetic polymorphisms in ACADSB and COMT in essential
hypertension in the Japanese population.
PMID: 17143180 [PubMed - in process]
17: J Hypertens. 2007 Jan;25(1):95-102.
Related Articles, Links
Rat chromosome 19 transfer from SHR ameliorates hypertension,
salt-sensitivity, cardiovascular and renal organ damage in saltsensitive Dahl rats.
Wendt N, Schulz A, Siegel AK, Weiss J, Wehland M, Sietmann A, Kossmehl
P, Grimm D, Stoll M, Kreutz R.
aInstitut fur Klinische Pharmakologie und Toxikologie, Campus Benjamin
Franklin, Charite - Universitatsmedizin Berlin, Berlin, Germany bLeibniz-Institut
fur Arterioskleroseforschung, Munster, Germany *Both authors contributed
equally to this work.
OBJECTIVES: Unlike Dahl salt-sensitive (SS) rats, some strains of spontaneously
hypertensive (SHR) rats develop only minor organ damage even when exposed to
high-salt diet. In previous linkage studies, we identified quantitative trait loci on
rat chromosome 19 (RNO19) linked to the SHR allele suggesting a protective
effect against salt-induced hypertensive organ damage in SS. METHODS: To test
the relevance of this finding, we generated and characterized a consomic strain
SS-19 in which RNO19 from SHR was introgressed into the susceptible
background of SS. We compared the effects of low-salt (0.2% NaCl) and high-salt
(4% NaCl) diet exposure for 8 weeks on the development of hypertension and
target organ damage in male consomic and SS animals (n = 14-20, each).
RESULTS: Systolic blood pressure, relative left ventricular weight and urinary
protein excretion were significantly lower in SS-19 compared to SS under both
low-salt and high-salt diet (P < 0.05, respectively). Left ventricular atrial
natriuretic peptide mRNA expression showed a more pronounced 4.5-fold
increase in SS compared to SS-19 (two-fold) after high-salt (P < 0.05). In
comparison to low diet, high-salt exposure induced a significant increase in
vascular aortic hypertrophy index, left ventricular interstitial fibrosis (+210%) and
perivascular fibrosis (+195%) in SS but not in consomic SS-19 (P < 0.05,
respectively). CONCLUSIONS: These results demonstrate a strong protective
effect of RNO19 from SHR on the development of hypertension, salt-sensitivity,
cardiovascular and renal organ damage in SS. In particular, we demonstrate a
genetic effect protecting against the development of cardiac fibrosis in saltsensitive hypertension.
PMID: 17143179 [PubMed - in process]
18: J Hypertens. 2007 Jan;25(1):87-93.
Related Articles, Links
Arterial stiffness and progression to hypertension in Japanese male
subjects with high normal blood pressure.
Yambe M, Tomiyama H, Yamada J, Koji Y, Motobe K, Shiina K, Yamamoto
Y, Yamashina A.
aSecond Department of Internal Medicine, Tokyo Medical University, Japan
bHealth Care Center, Kajima Corporation, Tokyo, Japan.
OBJECTIVES: This observational study was conducted to compare the
significance of the relationship between arterial stiffness and progression to higher
blood pressure categories among middle-aged Japanese men with high normal
blood pressure (HNP), normal blood pressure (NRP) and optimal blood pressure
(OPP). METHODS AND RESULTS: During the 3-year observational period, 100
subjects with HNP developed hypertension (n = 475; 42 +/- 9 years), and 175 of
those with normal NRP (n = 581; 41 +/- 8 years) and 249 of those with OPP (n =
702; 39 +/- 8 years) showed progression to higher blood pressure categories. A
binary logistic regression analysis adjusted for known risk factors revealed that
values of the brachial-ankle pulse wave velocity, a surrogate marker of arterial
stiffness, in the highest quartile, as compared with those in the lowest quartile,
obtained at the start of the study were significantly predictive of the progression to
hypertension [adjusted odds ratio = 9.4 (95% confidence interval, 3.0-29.8), P <
0.01]. The predictive value of this parameter for progression to higher blood
pressure categories in subjects with HNP was more significant than that in those
with NRP or OPP. CONCLUSIONS: Increased arterial stiffness and elevated
blood pressure may be mutually causally related, and it appears that the
significance of this relationship may increase with increasing blood pressure, even
in subjects without hypertension. Assessment of arterial stiffness may be more
reliable for predicting the progression to hypertension in cases of HNP than in
cases with NRP or OPP.
PMID: 17143178 [PubMed - in process]
19: J Hypertens. 2007 Jan;25(1):73-79.
Related Articles, Links
Hypertension: its prevalence and population-attributable fraction
for mortality from cardiovascular disease in the Asia-Pacific region.
Martiniuk AL, Lee CM, Lawes CM, Ueshima H, Suh I, Lam TH, Gu D,
Feigin V, Jamrozik K, Ohkubo T, Woodward M; for the Asia-Pacific Cohort
Studies Collaboration.
aThe George Institute for International Health, Sydney, Australia bUniversity of
Auckland, Auckland, New Zealand cShiga University of Medical Science, Shiga,
Japan dYonsei University College of Medicine, Seoul, Korea eUniversity of Hong
Kong, Hong Kong fChinese Academy of Medical Sciences, Beijing, China
gUniversity of Queensland, Brisbane, Australia hTohoku University, Sendai,
Japan *Details of the Asia-Pacific Cohort Studies Collaboration are given in the
Appendix.
OBJECTIVE: About half of the world's burden of cardiovascular disease is carried
by countries in the Asia-Pacific region. This study aimed to quantify the
contribution of hypertension to cardiovascular diseases (CVD) at the country
level, by calculating the sex-specific, population-attributable fractions (PAFs) for
fatal ischaemic heart disease (IHD) and stroke (haemorrhagic and ischaemic) for
the World Health Organization Western Pacific and South-east Asian regions.
METHODS: The most recent sex-specific prevalence data on hypertension were
sought. Age-adjusted hazard ratio (HR) estimates for fatal IHD and stroke
associated with hypertension were obtained using Cox analyses of individual
participant cohort data from 600 000 adult participants in the Asia-Pacific Cohort
Studies Collaboration. HR estimates and prevalence were then used to calculate
sex-specific PAFs for fatal IHD and stroke, by country. RESULTS: In 15
countries with available data, the prevalence of hypertension ranged from 5-47%
in men and from 7-38% in women. Overall, the fraction of IHD attributable to
hypertension ranged from 4-28% in men and from 8-39% in women.
Corresponding ranges for haemorrhagic stroke were 18-66% and 15-49%, and for
ischaemic stroke were 8-44% and 12-45%. CONCLUSIONS: In the Asia-Pacific
region, up to 66% of some subtypes of CVD can be attributed to hypertension,
underscoring the immense impact that blood pressure- lowering strategies could
have in this populous region.
PMID: 17143176 [PubMed - as supplied by publisher]
20: J Hypertens. 2007 Jan;25(1):63-72.
Related Articles, Links
A vaccine for hypertension based on virus-like particles: preclinical
efficacy and phase I safety and immunogenicity.
Ambuhl PM, Tissot AC, Fulurija A, Maurer P, Nussberger J, Sabat R, Nief
V, Schellekens C, Sladko K, Roubicek K, Pfister T, Rettenbacher M, Volk
HD, Wagner F, Muller P, Jennings GT, Bachmann MF.
aRenal Division, University Hospital, Zurich, Switzerland bCytos Biotechnology
AG, Zurich-Schlieren, Switzerland cDivision of Angiology and Hypertension,
CHUV, Lausanne, Switzerland dInterdisciplinary group of Molecular
Immunopathology, Dermatology/Medical Immunology, Berlin eInstitute of
Medical Immunology, Charite, Berlin fCharite Research Organisation, Berlin,
Germany *The first three authors contributed equally to this work.
BACKGROUND: Despite the availability of efficacious drugs, the success of
treating hypertension is limited by patients' inconsistent drug intake. Immunization
against angiotensin II may offer a valuable alternative to conventional drugs for
the treatment of hypertension, because vaccines induce relatively long-lasting
effects and do not require daily dosing. Here we describe the preclinical
development and the phase I clinical trial testing of a virus-like particle (VLP)based antihypertensive vaccine. METHODS AND RESULTS: An angiotensin IIderived peptide was conjugated to the VLP Qbeta (AngQb). AngQb was highly
immunogenic in mice and rats. To test for efficacy, spontaneously hypertensive
rats (SHR) were immunized with 400 mug AngQb or VLP alone. Group mean
systolic blood pressure (SBP) was reduced by up to 21 mmHg (159 +/- 2 versus
180 +/- 5 mmHg, P < 0.001), and total angiotensin II levels (antibody-bound and
free) were increased ninefold (85 +/- 20 versus 9 +/- 1 pmol/l, P = 0.002)
compared with VLP controls. SHR treated with the angiotensin-converting
enzyme (ACE) inhibitor ramipril (1 mg/kg per day by mouth) reached an SBP of
155 +/- 2 mmHg. Twelve healthy volunteers of a placebo-controlled randomized
phase I trial were injected once with 100 mug AngQb. Angiotensin II-specific
antibodies were raised in all subjects (100% responder rate) and AngQb was well
tolerated. CONCLUSIONS: AngQb reduces blood pressure in SHR to levels
obtained with an ACE inhibitor, and is immunogenic and well tolerated in
humans. Therefore, vaccination against angiotensin II has the potential to become
a useful antihypertensive treatment providing long-lasting effects and improving
patient compliance.
PMID: 17143175 [PubMed - as supplied by publisher]
21: J Hypertens. 2007 Jan;25(1):57-61.
Related Articles, Links
Device-guided slow breathing as a non-pharmacological approach to
antihypertensive treatment: efficacy, problems and perspectives.
Parati G, Carretta R.
aDepartment of Clinical Medicine and Prevention, University of Milano-Bicocca
and Department of Cardiology, San Luca Hospital, IRCCS, Istituto Auxologico
Italiano, Milan, Italy bDepartment of Clinical Medicine and Neurology, Ospedale
di Gattinara, Trieste, Italy.
PMID: 17143174 [PubMed - as supplied by publisher]
22: J Hypertens. 2007 Jan;25(1):41-6.
Related Articles, Links
A vaccine for hypertension.
Menard J.
Faculty of Medicine Rene Descartes, University Paris 5, Paris, France.
PMID: 17143170 [PubMed - in process]
23: J Hypertens. 2007 Jan;25(1):25-35.
Related Articles, Links
Novel therapies blocking the renin-angiotensin-aldosterone system in
the management of hypertension and related disorders.
Krum H, Gilbert RE.
aDepartment of Epidemiology and Preventive Medicine, Monash University,
Melbourne, Australia bDepartment of Medicine, University of Toronto, St
Michael's Hospital, Ontario, Canada cDepartment of Medicine, University of
Melbourne, St Vincent's Hospital, Melbourne, Australia.
Although significant advances have been made in the therapeutic blockade of the
renin-angiotensin-aldosterone system (RAAS) using angiotensin-converting
enzyme (ACE) inhibitors, angiotensin receptor blockers and non-selective
aldosterone receptor antagonists, there is a clear need for both additional blocking
strategies and enhancements of current therapeutic approaches. Vasopeptidase
inhibition may still find a role despite the small incremental value of this approach
and the obvious issue of kinin-mediated adverse effects still to be fully addressed.
Blockade of the RAAS upstream using renin inhibitors as well as the greater
selectivity of aldosterone blockade using selective aldosterone blockers such as
eplerenone are also novel approaches. Not yet in clinical use but certainly an
attractive therapeutic target is angiotensin II growth factor receptor
transactivation, with selective inhibitors having been developed for various
specific kinase pathways. Finally, ACE2 augmentation, antisense gene strategies,
and vaccination against the renin-angiotensin system should still be considered
experimental, but have significant appeal as additional approaches to the blockade
of this system.
PMID: 17143168 [PubMed - as supplied by publisher]
24: J Hypertens. 2007 Jan;25(1):15-23.
Related Articles, Links
Prevention of new-onset atrial fibrillation and its predictors with
angiotensin II-receptor blockers in the treatment of hypertension
and heart failure.
Aksnes TA, Flaa A, Strand A, Kjeldsen SE.
aDepartments of Cardiology, Norway bAcute Medicine, Ullevaal University
Hospital, Oslo, Norway *These authors contributed equally to this work.
Atrial fibrillation is the most frequent occurring sustained cardiac arrhythmia and
it is related to common cardiac disease conditions. Hypertension increases the risk
of atrial fibrillation by approximately two-fold and, because of the high prevalence
of hypertension, it accounts for more cases of atrial fibrillation than any other risk
factor. In recent years, there are two large hypertension trials (LIFE and VALUE)
and two large heart failure trials (CHARM and Val-HeFT) reporting the beneficial
effect of angiotensin II-receptor blockers (ARBs) on new-onset atrial fibrillation,
beyond the blood pressure-lowering effect. Blockade of the renin-angiotensin
system may prevent left atrial dilatation, atrial fibrosis, dysfunction and
conduction velocity slowing. Some studies also indicate direct anti-arrhythmic
properties. This review aims to consider the preventive effect of ARBs on newonset atrial fibrillation observed in recent reports from these trials, and to discuss
possible mechanisms of the beneficial effect of angiotensin II-receptor blockade.
PMID: 17143167 [PubMed - in process]
25: J Hypertens. 2007 Jan;25(1):5-13.
Related Articles, Links
Association of the C-344T aldosterone synthase gene variant with
essential hypertension: a meta-analysis.
Sookoian S, Gianotti TF, Gonzalez CD, Pirola CJ.
aCardiologia Molecular, Instituto de Investigaciones Medicas, A. Lanari,
Argentina bDepartamento de Farmacologia, Facultad de Medicina, Universidad de
Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina.
BACKGROUND: The CYP11B2 gene (CYP11B2) encoding aldosterone synthase
has been associated with essential hypertension and some, but not all, studies have
reported that the C-344T variant may influence the risk of the disease.
OBJECTIVE: We performed a systematic review of the literature by means of a
meta-analysis to evaluate the influence of the C-344T CYP11B2 polymorphism on
arterial hypertension and intermediate phenotypes. METHODS: From 485 reports,
we included 42 observational studies, case-control and cohort at baseline. Fixed
and random effect models were used to pool data from individual studies.
RESULTS: From 19 heterogeneous studies including 5343 essential hypertensive
and 5882 control subjects, we found a significant association between
hypertension and the C-344T variant in fixed but not in random effect models [for
homozygous CC: odds ratio (OR), 0.834; 95% confidence interval (CI), 0.7600.914; P < 0.0001, n = 11 225]. Besides, homozygous CC subjects had lower
plasma renin activity (D, -0.161; 95% CI, -0.279 to -0.043; P < 0.01, n = 1428) but
no difference in plasma aldosterone levels (D, -0.006; 95% CI, -0.081 to 0.07; P =
0.88, n = 2872). Limiting the quantitative analysis of blood pressure to 13 studies
including only untreated individuals, no significant association was found for
systolic arterial blood pressure (D, 0.042; 95% CI, -0.057 to 0.141; P = 0.41, n =
1775) and diastolic arterial blood pressure (D, 0.026; 95% CI, -0.073 to 0.125; P =
0.61, n = 1775). CONCLUSION: Homozygous individuals for the -344C
CYP11B2 allele are at 17% lower risk of hypertension with respect to
homozygous TT subjects.
PMID: 17143166 [PubMed - in process]
26: J Hypertens. 2007 Jan;25(1):1-3.
Related Articles, Links
Where is hypertension research going?
Zanchetti A.
Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Universita di
Milano, Ospedale Maggiore and Istituto Auxologico Italiano, Milan, Italy.
18 2006 06:34:27
1: Circulation. 2006 Nov 28;114(22):f186-7.
Hypertension in pregnancy: a Russian initiative.
Related Articles, Links
Polak M.
PMID: 17133667 [PubMed - in process]
2: Hypertension. 2007 Jan;49(1):232-6. Epub 2006 Nov 27.
Related Articles, Links
Effect of tryptophan hydroxylase 1 deficiency on the development of
hypoxia-induced pulmonary hypertension.
Morecroft I, Dempsie Y, Bader M, Walther DJ, Kotnik K, Loughlin L, Nilsen M,
MacLean MR.
Division of Neuroscience and Biomedical Systems, Faculty of Biomedical and Life
Sciences, Glasgow University, Glasgow, Scotland.
Tryptophan hydroxylase 1 catalyzes the rate-limiting step in the synthesis of serotonin in
the periphery. Recently, it has been shown that expression of the tryptophan hydroxylase 1
gene is increased in lungs and pulmonary endothelial cells from patients with idiopathic
pulmonary arterial hypertension. Here we investigated the effect of genetic deletion of
tryptophan hydroxylase 1 on hypoxia-induced pulmonary arterial hypertension in mice by
measuring pulmonary hemodynamics and pulmonary vascular remodeling before and after
2 weeks of hypoxia. In wild-type mice, hypoxia increased right ventricular pressure and
pulmonary vascular remodeling. These effects of hypoxia were attenuated in the tryptophan
hydroxylase 1-/-mice. Hypoxia increased right ventricular hypertrophy in both wild-type
and tryptophan hydroxylase 1-/-mice suggesting that in vivo peripheral serotonin has a
differential effect on the pulmonary vasculature and right ventricular hypertrophy.
Contractile responses to serotonin were increased in pulmonary arteries from tryptophan
hydroxylase 1-/-mice. Hypoxia increased serotonin-mediated contraction in vessels from
the wild-type mice, but this was not further increased by hypoxia in the tryptophan
hydroxylase 1-/-mice. In conclusion, these results indicate that tryptophan hydroxylase 1
and peripheral serotonin play an essential role in the development of hypoxia-induced
elevations in pulmonary pressures and hypoxia-induced pulmonary vascular remodeling. In
addition, the results suggest that, in mice, serotonin has differential effects on the
pulmonary vasculature and right ventricular hypertrophy.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17130306 [PubMed - in process]
3: Hypertension. 2007 Jan;49(1):13-4. Epub 2006 Nov 27.
Related Articles, Links
How do you define "hypertension" in a patient with type 1 diabetes?
Weir MR.
Publication Types:


Comment
Editorial
PMID: 17130305 [PubMed - in process]
4: J Hum Hypertens. 2006 Nov 30; [Epub ahead of print]
Related Articles, Links
Relationship between blood pressure parameters and pulse wave velocity in
normotensive and hypertensive subjects: invasive study.
Kim EJ, Park CG, Park JS, Suh SY, Choi CU, Kim JW, Kim SH, Lim HE, Rha SW,
Seo HS, Oh DJ.
1Division of Cardiology, Department of Internal Medicine, Korea University Guro
Hospital, Guro-gu, Seoul, Republic of Korea.
Blood pressure (BP) is one of the most important contributing factors to pulse wave
velocity (PWV), a classic measure of arterial stiffness. Although there have been many noninvasive studies to show the relation between arterial stiffness and BP, the results are
controversial. The aim of this study is to evaluate the role of BP as an influencing factor on
PWV using invasive method. We observed 174 normotensive and untreated hypertensive
subjects using coronary angiography. Arterial stiffness was assessed through aorto-femoral
PWV by foot-to-foot velocity method using fluid-filled system. And BP was measured by
pressure wave at the right common femoral artery. From univariate analysis, age, diabetes
mellitus (DM), hypertension, waist, waist-to-hip ratio, total cholesterol-to-high-density
lipoprotein cholesterol ratio, systolic BP (SBP), pulse pressure (PP) and mean arterial
pressure (MAP) showed significant association with PWV. To avoid multiple colinearity
among SBP, PP and MAP, we performed multiple regression analysis predicting PWV
thrice. Age, DM and each BP were significantly and consistently correlated to PWV. In the
first and third modules, compared to age, SBP and MAP were less strong predictors,
respectively. However, PP was the stronger predictor than age and DM in the second
module. Lastly, we simultaneously forced MAP and PP with other variables in the fourth
multivariate analysis. Age, DM and PP remained significantly correlated with PWV, but the
significance of MAP was lost. This is the first invasive study to suggest that PP has the
strongest correlation with PWV among a variety of BP parameters.Journal of Human
Hypertension advance online publication, 30 November 2006; doi:10.1038/sj.jhh.1002120.
PMID: 17136108 [PubMed - as supplied by publisher]
5: J Hum Hypertens. 2006 Nov 30; [Epub ahead of print]
Related Articles, Links
Awareness, treatment and control of hypertension: the 'rule of halves' in an
era of risk-based treatment of hypertension.
Scheltens T, Bots ML, Numans ME, Grobbee DE, Hoes AW.
1Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht,
Utrecht, The Netherlands.
Detection, treatment and control of high blood pressure in many populations are
insufficient. We reported current prevalence, awareness, treatment and control of
hypertension in the Netherlands and compared the findings with other studies. Furthermore,
we related actual treatment of hypertension to estimated absolute 10-year cardiovascular
risk, as according to current guidelines on this subject, initiation of blood pressure-lowering
treatment depends on the level of cardiovascular risk. The Utrecht Health Project is a
prospective cohort study in a suburb of Utrecht. Information on medical history, life style
and measurements of blood pressure, cholesterol and glucose of the first 4950 participants
of the study was obtained. Cardiovascular risks were calculated using the Framingham risk
function. Prevalence of hypertension was 23.3%. Among those with hypertension, 33.7%
was aware of the condition. Of those aware, 59.4% was treated. Of those treated, 41.9% had
blood pressure below the recommended level. In half of those aware of their hypertension,
and a calculated cardiovascular risk less than 10%, treatment of hypertension was started
unnecessary. Of those aware of their hypertension with a calculated cardiovascular 10 years
risk exceeding the treatment threshold of 20%, treatment was absent in 33.6%. Awareness
and control of hypertension are still inadequate in the Netherlands and comparable with
other European countries. Management of hypertension is too often not risk-based despite
recommendations in guidelines on prevention of cardiovascular diseases available since
2000.Journal of Human Hypertension advance online publication, 30 November 2006;
doi:10.1038/sj.jhh.1002123.
PMID: 17136106 [PubMed - as supplied by publisher]
6: J Hum Hypertens. 2006 Nov 30; [Epub ahead of print]
Related Articles, Links
Neurovascular compression in essential hypertension: cause, consequence or
unrelated finding?
Ceral J, Zizka J, Elias P, Solar M, Klzo L, Reissigova J.
1Department of Medicine, Faculty of Medicine and University Hospital Hradec Kralove,
Charles University in Prague, Hradec Kralove, Czech Republic.
1: Hypertension. 2007 Jan;49(1):209-14. Epub 2006 Nov 20.
Related Articles, Links
Novel digitalis-like factor, marinobufotoxin, isolated from cultured
Y-1 cells, and its hypertensive effect in rats.
Yoshika M, Komiyama Y, Konishi M, Akizawa T, Kobayashi T, Date M,
Kobatake S, Masuda M, Masaki H, Takahashi H.
Department of Clinical Sciences and Laboratory Medicine, Kansai Medical
University, Fumizonocho, Moriguchi, Osaka 570-8507, Japan.
Marinobufagenin and telecinobufagin have been identified as digitalis-like factors
in mammals. In toads, marinobufagenin-related compounds, such as
marinobufotoxin (MBT), have been isolated in some tissues but not in mammals,
and its biological action has not been elucidated. Herein, we aimed to explore the
possible production and/or secretion of MBT and the biological action in rats.
First, the MBT in culture supernatant of the adrenocortical-originated cell line Y1 was analyzed by high-performance liquid chromatography and sensitive ELISA
for marinobufagenin-like immunoreactivity. Moreover, the structural information
was obtained by mass spectrometry. To determine the biological action, MBT
(9.6 and 0.96 microg/kg per day) was intraperitoneally infused via an osmotic
minipump for 1 week. Blood pressure and renal excretion of marinobufageninlike immunoreactivity were measured. Marinobufagenin-like immunoreactivity
was found in Y-1 cell culture media, and the concentration increased until 24
hours. The structural analysis suggested that marinobufagenin-like
immunoreactivities were marinobufagenin and MBT, and tandem mass spectrum
analysis revealed them with the specific daughter ions. The highest sensitive
ELISA-positive peak of marinobufagenin-like immunoreactivity in the media was
MBT. Continuous administration of MBT in rats for 1 week significantly
increased systolic blood pressure and renal excretion of marinobufagenin-like
immunoreactivity compared with control rats (135+/-3.0 versus 126+/-2.0 mm Hg
and 1.41+/-0.286 versus 0.34+/-0.064 ng/day, respectively). These data suggest
that MBT, arginine-suberoyl ester of marinobufagenin, can be a novel digitalislike factor with hypertensive action and is secreted from the adrenocortical cells.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17116763 [PubMed - in process]
2: Hypertension. 2007 Jan;49(1):5-6. Epub 2006 Nov 20.
Related Articles, Links
Adrenergic overdrive as the link among hypertension, obesity, and
impaired thermogenesis: lights and shadows.
Grassi G.
Publication Types:


Comment
Editorial
PMID: 17116757 [PubMed - in process]
Related Articles, Links
3: N Engl J Med. 2006 Nov 23;355(21):2237-45.
Case records of the Massachusetts General Hospital. Case 36-2006.
A 35-year-old pregnant woman with new hypertension.
Klibanski A, Stephen AE, Greene MF, Blake MA, Wu CL.
Neuroendocrine Unit, Massachusetts General Hospital, USA.
Publication Types:


Case Reports
Clinical Conference
.
1:Am J.
Hypertens.
2006
Jul;19(7):76873.
Related Articles,
Links
Interaction of grapefruit juice and calcium channel blockers.
Sica DA.
Department of Clinical Pharmacology and Hypertension, Division of Nephrology, Medical
College of Virginia of Virginia Commonwealth University, Richmond, Virginia, USA.
dsica@hsc.vcu.edu
Drug-drug interactions are commonly recognized occurrences in the hypertensive
population. Drug-nutrient interactions, however, are less well appreciated. The grapefruit
juice-calcium channel blocker interaction is one that has been known since 1989. The basis
for this interaction has been diligently explored and appears to relate to both flavanoid and
nonflavanoid components of grapefruit juice interfering with enterocyte CYP3A4 activity.
In the process, presystemic clearance of susceptible drugs decreases and bioavailability
increases. A number of calcium channel blockers are prone to this interaction, with the most
prominent interaction occurring with felodipine. The calcium channel blocker and
grapefruit juice interaction should be incorporated into the knowledge base of rational
therapeutics for the prescribing physician.
Publication Types:

Review
PMID: 16814135 [PubMed - indexed for MEDLINE]
2: Am J Hypertens. 2006 Jul;19(7):756-63.
Related Articles, Links
Duplex ultrasound and renin ratio predict treatment failure after
revascularization for renal artery stenosis.
Voiculescu A, Schmitz M, Plum J, Hollenbeck M, Vupora S, Jung G, Modder U,
Pfeiffer T, Sandmann W, Willers R, Grabensee B.
Department of Nephrology, Center for Coordination of Clinical Studies, University of
Duesseldorf, Duesseldorf, Germany. voicules@uni-duesseldorf.de
BACKGROUND: The aim of this study was to find predictors to identify patients with
hypertension who will not improve after removal of renal artery stenosis (RAS).
METHODS: Prospective study of patients with unilateral stenosis (>60% diameter
reduction) and hypertension in 24-h measurements despite antihypertensive drugs, who
underwent revascularization (surgery/angioplasty). Examinations were performed before
treatment and after 3 and 6 months after exclusion of restenosis. Studies included 24-h
blood pressure, creatinine clearance, 99Tc MAG3 scintigraphy, and measurements of renal
vein plasma renin activity (PRA). Intrarenal resistance indices (RI) were determined with
duplex ultrasound before and 30 min after administration of intravenous enalaprilat.
Improvement of hypertension was defined by a score consisting of 24-h mean arterial
pressure and the number of antihypertensive drugs. RESULTS: From December 2000 to
December 2003, 50 patients completed the study. Improvement of hypertension was
observed in 18 patients (36%). Comparison between responders (n = 18) and nonresponders
(n = 32) revealed significant differences only for RI and PRA measurements. The largest
area under the curve in receiver-operating characteristic (ROC) analysis for prediction of no
improvement of hypertension was found for RI (stenosis side), which was nearly identical
for measurements before and after administration of angiotensin-converting enzyme (ACE)
inhibitor. The highest sensitivities and specificities predicting which patients will not
improve were found for RIs > or = 0.55. The highest univariate odds ratio (OR 44,
confidence interval [CI] 4.8-404) was found for the parameters of RI > or = 0.55 and a
renin ratio of <1:1.5. CONCLUSIONS: Resistance indices of the poststenotic kidney above
0.55 and a negative renin ratio can predict a poor outcome concerning arterial blood
pressure response after restoration of renal blood flow for unilateral renal artery stenosis.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 16814133 [PubMed - indexed for MEDLINE]
3: Am J Hypertens. 2006 Jul;19(7):737-43.
Related Articles, Links
Effect of education on blood pressure control in elderly persons: a
randomized controlled trial.
Figar S, Galarza C, Petrlik E, Hornstein L, Rodriguez Loria G, Waisman G, Rada M,
Soriano ER, de Quiros FG.
Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
silvana.figar@hospitalitaliano.org.ar
BACKGROUND: It is not clear which educational strategy is most effective in helping
patients to change their lifestyles. This study compared the efficacy of two different
educational models on reducing blood pressure (BP). METHODS: This was a randomized
controlled trial in ambulatory hypertensive patients >65 years of age. Workshops that aimed
to develop self-management and patient empowerment (PEM) were compared to
workshops that used a compliance-based model (CEM). The primary outcome was change
in systolic BP at 3 months compared with basal values between groups (net reduction),
measured by 24-h ambulatory BP monitoring. RESULTS: A total of 30 patients were
educated with PEM and 30 others with CM. Both groups were statistically similar with
regard to age (67 v 70 years), systolic BP (157 v 156 mm Hg) and diastolic BP (88 v 88 mm
Hg), diabetes (23% v 31%), and basal natriuresis 116 v 121 mEq/day). There were more
women in the PEM group (57% v 30%). The PEM group showed a significant reduction of
8 mm Hg (95% confidence interval [CI] 2 to 15), whereas the CM group showed a
reduction of 3 mm Hg (95% CI -3 to 8), with a net reduction of 6 (95% CI -3 to 14). Mean
net night-time systolic BP reduction was 12 mm Hg (95% CI 2 to 22). BP control was 70%
in PEM group vs 45% in CM group (P = 0.045). The relative odds ratio for BP control for
the PEM group after adjustment for age, sex, diabetes, basal blood pressure and changes in
pharmacological treatment was 3.7 (95% CI 1.05 to 13.1). CONCLUSION: Based on these
study results, the self-management education model was significantly more effective than
the compliance-based model in BP control.
Publication Types:


Comparative Study
Randomized Controlled Trial
PMID: 16814130 [PubMed - indexed for MEDLINE]
4: Am J Hypertens. 2006 Jul;19(7):718-27.
Related Articles, Links
Regulation of angiogenic factors in angiotensin II infusion model in
association with tubulointerstitial injuries.
Kitayama H, Maeshima Y, Takazawa Y, Yamamoto Y, Wu Y, Ichinose K, Hirokoshi
K, Sugiyama H, Yamasaki Y, Makino H.
Department of Medicine and Clinical Science, Okayama University Graduate School of
Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
BACKGROUND: Among various angiogenic factors, vascular endothelial growth factor
(VEGF), angiopoietin-1 (Ang1), and angiopoietin-2 (Ang2) play crucial roles in regulating
angiogenesis and vascular integrity. Infusion of angiotensin-II (ang II) induces hypertension
and focal renal tubulointerstitial injuries. In the present study we investigated the renal
expression of VEGF, Ang1, Ang2, and corresponding receptors in association with
tubulointerstitial lesions in a rat ang II infusion model. METHODS: Male Sprague-Dawley
(SD) rats received an infusion of ang II or norepinephrine (NE) through osmotic minipumps
for 14 days. Angiotensin II type 1 (AT1) or type 2 (AT2) receptor antagonist (losartan or
PD123319, respectively) or hydralazine was co-administered. RESULTS: Interstitial
fibrosis, infiltration of monocyte/macrophage, and peritubular capillary rarefaction induced
by ang II was significantly attenuated in the losartan- or PD123319-treated groups.
Immunoreactivity of VEGF and Ang1 in cortical tubules was increased by ang II and was
attenuated by losartan or PD123319. The increase of VEGF induced by ang II was
suppressed by losartan, and the increase of Ang1 induced by ang II was inhibited by
PD123319 as detected by immunoblot. The increase of flk-1 and flt-1 (VEGF receptors)
and tie-2 (Ang1 receptor) induced by ang II was significantly suppressed by PD123319.
These alterations were not observed in hydralazine plus ang II or NE-infused animals.
CONCLUSIONS: These results demonstrate that an infusion of ang II induced the
expression of VEGF mainly through AT1 receptors, and increased the expression of VEGF
receptors, tie-2, and Ang1/Ang2 ratio mainly through AT2 receptors. The increase of
VEGF/flk-1/flt-1 may be associated with vascular permeability, monocyte/macrophage
infiltration, and rarefaction of peritubular capillaries, and the increase of the Ang1/Ang2
ratio may be a compensatory mechanism counteracting the permeability inducing effect of
VEGF after ang II infusion.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 16814127 [PubMed - indexed for MEDLINE]
5: Am J Hypertens. 2006 Jul;19(7):713-7.
Related Articles, Links
How long shall the patient rest before clinic blood pressure measurement?
Sala C, Santin E, Rescaldani M, Magrini F.
Istituto Medicina Cardiovascolare, Universita di Milano, Centro Interuniversitario di
Fisiologia Clinica e Ipertensione-Fondazione Policlinico, Italy. carla.sala@unimi.it
BACKGROUND: The optimal time at rest before clinic blood pressure (BP) measurement
is still undefined. In this study in patients with essential hypertension, the time course of the
hemodynamic changes during a 16-min rest in the chair-seated position was evaluated and
compared with that observed in a stabilized postural condition, such as after a prolonged
supine rest. METHODS: In 55 untreated essential hypertensive patients, BP, heart rate,
stroke volume (impedance cardiography), and systemic vascular resistances were measured
every other minute during a 16-min rest in the chair-seated position and, in random
sequence, in the last 16 min of a 60-min supine rest. RESULTS: Overall, systolic BP (SBP)
and diastolic BP (DBP) decreased by 11.6 and 4.3 mm Hg, respectively, during the chairseated rest; only a 1.8-mm Hg decrease in SBP was observed in the control supine study.
The chair-seated fall in BP was associated with a decrease in systemic vascular resistances,
in the absence of significant changes in cardiac index. From the logarithmic curve of SBP
and DBP decrements, a half-time of 5.8 and 5.5 min respectively, was calculated.
Decrements in SBP, but not DBP, were inversely related to the corresponding baseline
values. CONCLUSIONS: In untreated essential hypertensive patients a significant decrease
in SBP and DBP associated with a systemic vasodilation was observed during a 16-min rest
in the chair-seated position. Because approximately 75% of the spontaneous fall in BP
occurred within 10 min, it appears that this time at rest before clinic BP evaluation could
improve the precision and accuracy of the measurement.
PMID: 16814126 [PubMed - indexed for MEDLINE]
6: Am J Hypertens. 2006 Jul;19(7):708-12.
Related Articles, Links
Prehypertension and obesity in adolescents: a population study.
Israeli E, Schochat T, Korzets Z, Tekes-Manova D, Bernheim J, Golan E.
Medical Corps, Department of Internal Medicine, Hadassah University Hospital, Jerusalem.
BACKGROUND: Current blood pressure (BP) classification is based on the recent
recommendations of the Joint National Committee on Prevention, Detection, Evaluation
and Treatment of High Blood Pressure (JNC-7) and the 2003 European Society of
Hypertension-European Society of Cardiology Guidelines for the Management of Arterial
Hypertension. The JNC-7 introduced a new concept, prehypertension, and recommended
health-promoting lifestyle modifications for these individuals. Obesity is also recognized as
a major risk factor for the development of hypertension. We aimed to determine the
prevalence of hypertension and obesity in a large cohort of adolescents and to assess
whether prehypertension and body mass index (BMI) increase with increasing age.
METHODS: A cross-sectional population-based study was performed using data collected
during 1996 to 2002 in an army recruitment examination of 560,588 Israeli individuals 16.5
to 19 years of age. The subjects were divided according to gender and stratified by
increasing 6-month intervals into five groups. Prehypertension was defined as BP 120 to
139 / 80 to 89 mm Hg. Overweight was defined as BMI 25 to < or = 30 and obesity as BMI
>30 kg/m2. RESULTS: Mean systolic BP (SBP) and diastolic BP (DBP) were significantly
higher in male subjects for all groups. By applying the JNC-7 criteria, 56.8% of male
subjects and 35.8% of female subjects would be considered prehypertensive. There was a
statistically significant increase in the mean SBP and DBP with age and BMI. Among male
subjects 10.9% were overweight and 3.3% were obese; among female subjects, 11.1% were
overweight and 3.2% were obese. The BMI did not increase with increasing age. The
prevalence of prehypertension was significantly higher in obese subjects. CONCLUSIONS:
Prehypertension is very common among Israeli adolescents. A substantial number of
adolescents exhibit a BMI greater than normal. As both of these factors are known to be
asssociated with increased cardiovascular risk, early institution of healthful lifestyle
changes in a large proportion of this age group is recommended.
PMID: 16814125 [PubMed - indexed for MEDLINE]
7: Am J Hypertens. 2006 Jul;19(7):659.
Related Articles, Links
Comment on:

Am J Hypertens. 2005 Feb;18(2 Pt 1):244-8.
Whither conventional blood pressure measurement?
O'Brien E.
Publication Types:


Comment
Editorial
PMID: 16814116 [PubMed - indexed for MEDLINE]
8: Arch Intern Med. 2006 Nov 13;166(20):2191-201.
Related Articles, Links
Fasting glucose levels and incident diabetes mellitus in older nondiabetic
adults randomized to receive 3 different classes of antihypertensive
treatment: a report from the Antihypertensive and Lipid-Lowering
Treatment to Prevent Heart Attack Trial (ALLHAT).
Barzilay JI, Davis BR, Cutler JA, Pressel SL, Whelton PK, Basile J, Margolis KL,
Ong ST, Sadler LS, Summerson J; ALLHAT Collaborative Research Group.
Kaiser Permanente of Georgia , USA.
BACKGROUND: Elevated blood glucose levels are reported with thiazide-type diuretic
treatment of hypertension. The significance of this finding is uncertain. Our objectives were
to compare the effect of first-step antihypertensive drug therapy with thiazide-type diuretic,
calcium-channel blocker, or angiotensin-converting enzyme inhibitor on fasting glucose
(FG) levels and to determine cardiovascular and renal disease risks associated with elevated
FG levels and incident diabetes mellitus (DM) in 3 treatment groups. METHODS: We
performed post hoc subgroup analyses from the Antihypertensive and Lipid-Lowering
Treatment to Prevent Heart Attack Trial (ALLHAT) among nondiabetic participants who
were randomized to receive treatment with chlorthalidone (n = 8419), amlodipine (n =
4958), or lisinopril (n = 5034) and observed for a mean of 4.9 years. RESULTS: Mean FG
levels increased during follow-up in all treatment groups. At year 2, those randomized to
the chlorthalidone group had the greatest increase (+8.5 mg/dL [0.47 mmol/L] vs +5.5
mg/dL [0.31 mmol/L] for amlodipine and +3.5 mg/dL [0.19 mmol/L] for lisinopril). The
odds ratios for developing DM with lisinopril (0.55 [95% confidence interval, 0.43-0.70])
or amlodipine (0.73 [95% confidence interval, 0.58-0.91]) vs chlorthalidone at 2 years were
significantly lower than 1.0 (P<.01). There was no significant association of FG level
change at 2 years with subsequent coronary heart disease, stroke, cardiovascular disease,
total mortality, or end-stage renal disease. There was no significant association of incident
DM at 2 years with clinical outcomes, except for coronary heart disease (risk ratio, 1.64; P
= .006), but the risk ratio was lower and nonsignificant in the chlorthalidone group (risk
ratio, 1.46; P = .14). CONCLUSIONS: Fasting glucose levels increase in older adults with
hypertension regardless of treatment type. For those taking chlorthalidone vs other
medications, the risk of developing FG levels higher than 125 mg/dL (6.9 mmol/L) is
modestly greater, but there is no conclusive or consistent evidence that this diureticassociated increase in DM risk increases the risk of clinical events.
Publication Types:


Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
PMID: 17101936 [PubMed - in process]
9: BMJ. 2006 Nov 11;333(7576):1009-11.
Related Articles, Links
ABC of obesity. Risk factors for diabetes and coronary heart disease.
Wild SH, Byrne CD.
University of Edinburgh.
Publication Types:

Review
PMID: 17095784 [PubMed - indexed for MEDLINE]
10: BMJ. 2006 Nov 11;333(7576):988.
Related Articles, Links
Guidelines on treating risk factors turn healthy people into patients, doctors
say.
Christie B.
Publication Types:

News
PMID: 17095774 [PubMed - indexed for MEDLINE]
11: Eur Heart J. 2006 Dec;27(24):2919-20. Epub 2006 Nov 15.
Related Articles, Links
Hypertension begets hypertrophy begets atrial fibrillation? Insights from yet
another sheep model.
Kirchhof P, Schotten U.
Department of Cardiology and Angiology, University Hospital Munster and IZKF Munster,
Munster, Germany.
PMID: 17107975 [PubMed - in process]
12: J Hum Hypertens. 2006 Nov 16; [Epub ahead of print]
Related Articles, Links
The prevalence and risk factors associated with isolated untreated systolic
hypertension in Korea: The Korean National Health and Nutrition Survey
2001.
Kim JA, Kim SM, Choi YS, Yoon D, Lee JS, Park HS, Kim HA, Lee J, Oh HJ, Choi
KM.
1Department of Family Medicine, Cheil General Hospital and Women's Health Care
Center, Seoul, Korea.
Although isolated systolic hypertension (ISH) increases the risk of coronary heart disease
and stroke, more than any other hypertension subtype, the prevalence and risk factors
associated with ISH in the Korean population are not known. The 2001 Korean National
Health and Nutrition Survey was a cross-sectional and nationally representative survey
conducted in 2001. The prevalence of ISH by age and body mass index (BMI) was
examined in 6601 Korean adults over 20 years of age. After adjusting for age, 4.32+/0.32% of Korean adults had ISH, 5.28+/-0.37% had isolated diastolic hypertension and
5.82+/-0.36% had systolic/diastolic hypertension. The overall prevalence of ISH was found
to increase directly with advancing age and increasing BMI. Although the ISH was found to
be more common in men overall (4.81+/-0.50% in men, 4.12+/-0.37% in women), it was
more common in women over 70 years of age. Independent variables associated with risk
for ISH included advanced age, BMI, triglyceride (TG) levels, monthly income and alcohol
intake. However, gender, fasting blood glucose, total cholesterol and high-density
lipoprotein cholesterol levels, residential area, education level and smoking were found not
to be significantly associated with ISH risk. The findings of the present study demonstrate
that the prevalence of untreated ISH in Korea was lower than in Western countries. Age,
BMI, TG levels, monthly income and alcohol intake were associated with ISH.Journal of
Human Hypertension advance online publication, 16 November 2006;
doi:10.1038/sj.jhh.1002119.
PMID: 17108991 [PubMed - as supplied by publisher]
1: Am J Cardiol. 2006 Oct 1;98(7):991-2. Epub 2006 Jul 26.
Related Articles, Links
Comment on:

Am J Cardiol. 2006 May 1;97(9):1346-50.
C-reactive protein and lone atrial fibrillation: potential confounders.
Boos CJ, Lip GY.
Publication Types:


Comment
Letter
PMID: 16996892 [PubMed - indexed for MEDLINE]
2: Am J Cardiol. 2006 Oct 1;98(7):938-43. Epub 2006 Aug 8.
Related Articles, Links
Peak systolic blood pressure on a graded maximal exercise test and
the blood pressure response to an acute bout of submaximal
exercise.
Syme AN, Blanchard BE, Guidry MA, Taylor AW, Vanheest JL, Hasson S,
Thompson PD, Pescatello LS.
University of Connecticut, Storrs, Connecticut, USA.
Blood pressure (BP) is immediately reduced after aerobic exercise (postexercise
hypotension [PEH]). Whether peak systolic BP on a maximal graded exercise
stress test (GEST) relates to PEH is not known. This study examined associations
between peak systolic BP on a GEST and PEH. Subjects were 50 men (mean +/SEM age 43.8 +/- 1.3 years) with elevated BP (145.3 +/- 1.5/85.9 +/-1.1 mm Hg).
Men completed a GEST and 3 experiments: nonexercise control and 2 cycle bouts
at 40% (LIGHT) and 60% (MODERATE) of maximal oxygen consumption.
After the experiments, subjects left the laboratory wearing ambulatory BP
monitors. Peak systolic BP on a GEST was categorized into tertiles: low (n = 17,
197.4 +/- 2.0 mm Hg), medium (n = 16, 218.4 +/- 1.4 mm Hg), and high (n = 17,
248.9 +/- 2.8 mm Hg). Repeated-measures analysis of variance tested if BP
differed over time and among experimental conditions and peak systolic BP
groups. In men with high peak systolic BP, systolic BP was reduced by 7.3 +/- 2.6
mm Hg after LIGHT and by 5.0 +/- 2.2 mm Hg after MODERATE compared
with nonexercise control over 10 hours, with the more apparent effects seen after
LIGHT (p <0.05). In men with low peak systolic BP, systolic BP was reduced by
6.3 +/- 2.3 mm Hg after MODERATE compared with nonexercise control over 10
hours (p <0.05). In men with medium peak systolic BP, systolic BP was not
different after exercise compared with nonexercise control over 10 hours (p
>or=0.05). Men with high peak systolic BP had decreased systolic BP to the
greatest extent after LIGHT, whereas men with low peak systolic BP reduced
systolic BP after MODERATE. In conclusion, the findings of this study suggest
that peak systolic BP on a GEST may be used to characterize which men with
hypertension will have decreased systolic BP after acute submaximal aerobic
exercise.
Publication Types:



Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
PMID: 16996879 [PubMed - indexed for MEDLINE]
3: Am J Cardiol. 2006 Oct 1;98(7):895-901. Epub 2006 Aug 7.
Related Articles, Links
Three-year clinical follow-up of the unrestricted use of sirolimuseluting stents as part of the Rapamycin-Eluting Stent Evaluated at
Rotterdam Cardiology Hospital (RESEARCH) registry.
Daemen J, Ong AT, Stefanini GG, Tsuchida K, Spindler H, Sianos G, de
Jaegere PP, van Domburg RT, Serruys PW.
The Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
Sirolimus-eluting stents (SESs) have been shown to decrease restenosis compared
with bare metal stents (BMSs). Currently, there are limited data on the long-term
efficacy of these devices in a real-world patient population. Furthermore, the
potential of a late restenotic phenomenon has not yet been excluded. From April
to October 2002, 508 consecutive patients with de novo lesions exclusively
treated with SESs were enrolled and compared with 450 patients treated with
BMSs in the preceding 6 months (control group). Patients in the SES group more
frequently had multivessel disease and type C lesions, received more stents, and
had more bifurcation stenting. After 3 years, the cumulative incidence of major
adverse cardiac events (comprising death, myocardial infarction, and target vessel
revascularization) was significantly lower in the SES group compared with the
pre-SES group (18.9% vs 24.7%, hazards ratio 0.73, 95% confidence interval 0.56
to 0.96, p = 0.026). The 3-year risk of target lesion revascularization was 7.5% in
the SES group versus 12.6% in the pre-SES group (hazards ratio 0.57, 95%
confidence interval 0.38 to 0.87, p = 0.01). In conclusion, the unrestricted use of
SESs is safe and superior to the use of BMSs. The beneficial effects, reported
after 1 and 2 years in reducing major adverse cardiac events, persisted with no
evidence of a clinical late restenotic "catch-up" phenomenon.
PMID: 16996869 [PubMed - indexed for MEDLINE]
4: Am J Cardiol. 2006 Oct 1;98(7):857-60. Epub 2006 Aug 4.
Related Articles, Links
A comparative analysis of short- and long-term outcomes after
ventricular fibrillation out-of-hospital cardiac arrest in patients with
ischemic and nonischemic heart disease.
Bunch TJ, Kottke TE, Lopez-Jimenez F, Mahapatra S, Elesber AA, White
RD.
Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo
Clinic, Rochester, Minnesota, USA.
Although ventricular fibrillation (VF) out-of-hospital cardiac arrest (OHCA)
occurs primarily in the setting of severe ischemic heart disease (IHD), a
significant proportion of events occurs in patients who do not have severe IHD.
The relative effect of IHD on survival after VF OHCA is unknown. All residents
of Rochester, Minnesota, who presented with a VF OHCA from November 1990
to December 2004, treated by emergency medical services, were included in the
study. During the study, emergency medical services treated 208 patients (64.1
+/- 13.6 years of age) for VF OHCA, with an average call-to-shock time of 6.3 +/1.8 minutes. Of these patients, 156 had IHD and 39 had non-IHD. In 13, the
underlying heart disease was unknown. Eighty-seven patients (41.8%) survived to
hospital discharge with neurologic recovery (66 with IDH [42%] vs 21 with nonIHD [54%], p = 0.211)]. Five-year survival was 79 +/- 6% for patients with IHD
versus 100% for those with non-IHD (p = 0.047). After adjustment for other
patient characteristics, IHD was not predictive of 5-year survival (hazard ratio
[HR] 2.2, 95% confidence interval [CI] 0.7 to 9.8, p = 0.177). Variables
associated with poor outcomes included age >65 years (HR 4.9, 95% CI 2.0 to
13.4, p = 0.0003), ejection fraction <0.35% (HR 3.0, 95% CI 1.3 to 7.3, p =
0.012), and hypertension (HR 4.9, 95% CI 1.4 to 16.3, p = 0.001). In patients with
IHD, use of an implantable cardioverter-defibrillator (HR 0.32, 95% CI 0.16 to
0.88, p = 0.024) and statin therapy (HR 0.68, 95% CI 0.17 to 0.73, p = 0.001)
were associated with decreased mortality. In conclusion, compared with patients
with non-IHD, those with IHD had similar short- and long-term survival rates.
Long-term survival in patients with IHD was primarily influenced by other comorbid conditions. Nonetheless, in patients with IHD, use of an implantable
cardioverter-defibrillator and statin therapy were associated with higher long-term
survival rates.
Publication Types:


Comparative Study
Research Support, Non-U.S. Gov't
PMID: 16996862 [PubMed - indexed for MEDLINE]
5: Circulation. 2006 Oct 24;114(17):1863-72.
Related Articles, Links
Triggering of acute cardiovascular disease and potential preventive
strategies.
Tofler GH, Muller JE.
Cardiology Department, Royal North Shore Hospital, Sydney, Australia.
gtofler@nsccahs.health.nsw.gov.au
Publication Types:

Review
PMID: 17060396 [PubMed - indexed for MEDLINE]
6: Circulation. 2006 Oct 24;114(17):1892-5. Epub 2006 Oct 9.
Related Articles, Links
Indications for renal arteriography at the time of coronary
arteriography: a science advisory from the American Heart
Association Committee on Diagnostic and Interventional Cardiac
Catheterization, Council on Clinical Cardiology, and the Councils
on Cardiovascular Radiology and Intervention and on Kidney in
Cardiovascular Disease.
White CJ, Jaff MR, Haskal ZJ, Jones DJ, Olin JW, Rocha-Singh KJ,
Rosenfield KA, Rundback JH, Linas SL; American Heart Association
Committee on Diagnostic and Interventional Cardiac Catheterization,
Council on Clinical Cardiology; American Heart Association Council on
Cardiovascular Radiology and Intervention; American Heart Association
Council on Kidney in Cardiovascular Disease.
Atherosclerotic renal artery stenosis is commonly present in patients with
clinically manifest atherosclerosis in other vascular beds and is independently
associated with increased cardiovascular morbidity and mortality. Screening tests
such as renal angiography should be selectively applied to patients at high risk for
renal artery stenosis who are potential candidates for revascularization. This
multispecialty consensus document describes the rationale for patient selection for
screening renal angiography at the time of cardiac catheterization.
Publication Types:

Practice Guideline
PMID: 17030686 [PubMed - indexed for MEDLINE]
7: Hypertension. 2006 Nov 6; [Epub ahead of print]
Related Articles, Links
Response to Endothelial Nitric Oxide Synthase Polymorphisms and
Susceptibility to Hypertension: Genotype Versus Haplotype
Analysis.
Zintzaras E, Kitsios G, Stefanidis I.
Department of Biomathematics, University of Thessaly School of Medicine,
Papakyriazi, Greece.
PMID: 17088443 [PubMed - as supplied by publisher]
8: Hypertension. 2007 Jan;49(1):E1; author reply E2. Epub 2006
Nov 6.
Related Articles,
Links
Endothelial nitric oxide synthase polymorphisms and susceptibility
to hypertension: genotype versus haplotype analysis.
Tanus-Santos JE, Casella-Filho A.
Publication Types:


Comment
Letter
PMID: 17088442 [PubMed - in process]
9: J Hum Hypertens. 2006 Nov 9; [Epub ahead of print]
Related Articles, Links
Plasma visfatin levels in young male patients with uncomplicated
and newly diagnosed hypertension.
Dogru T, Sonmez A, Tasci I, Yilmaz MI, Erdem G, Erturk H, Bingol N, Kilic
S, Ozgurtas T.
1Department of Internal Medicine, Gulhane School of Medicine, Etlik, Ankara,
Turkey.
PMID: 17096008 [PubMed - as supplied by publisher]
10: Stroke. 2006 Dec;37(12):2946-50. Epub 2006 Nov 9.
Related Articles, Links
Hypertensive intracerebral hemorrhage in young people: previously
unnoticed age-related clinical differences.
Ruiz-Sandoval JL, Romero-Vargas S, Chiquete E, Padilla-Martinez JJ,
Villarreal-Careaga J, Cantu C, Arauz A, Barinagarrementeria F.
Servicio de Neurologia y Neurocirugia, Hospital Civil de Guadalajara Fray
Antonio Alcalde, Hospital 278, Guadalajara, Jalisco, Mexico CP44280.
jorusan@mexis.com
BACKGROUND AND PURPOSE: Hypertensive intracerebral hemorrhage (ICH)
in young people has been the object of only succinct analyses. Therefore, it is
unclear whether extrapolation of the information obtained from older patients is
also valid for the young. Here we describe young persons with hypertensive ICH
and compare them with their older counterparts to determine whether age-related
clinical differences exist. METHODS: From 1988 to 2004, we studied 35
consecutive young patients with ICH (60% men; mean age, 33 years; range, 15 to
40 years) for whom the etiology of the brain hemorrhage was hypertension. For
clinical comparisons, sex-matched persons with hypertensive ICH, aged >40
years, were randomly selected by a factor of 3:1 (n=105). RESULTS: Essential
hypertension was present in 26 (74%) young patients and secondary hypertension
in 9 (26%), with renovascular hypertension being the most common cause (n=5,
55%). Compared with older patients, the young had higher blood pressures,
smaller hemorrhage volumes, lower rates of ventricular extensions (for all,
P<0.05), and different distribution pattern of ICHs (P=0.05), without cerebellar
and lobar locations. Thirty-day mortality was markedly lower in the young than in
older persons (P=0.001), nevertheless at the expense of more incapacitating
disabilities. CONCLUSIONS: Young people presenting with hypertensive ICH
differ in clinical characteristics and have a different prognosis when compared
with their older counterparts. These findings suggest underlying age-related
differences in disease pathogenesis.
Publication Types:

Comparative Study
PMID: 17095739 [PubMed - indexed for MEDLINE]
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Dec 18 2006 06:34:27
06:34:27
6 06:34:27
1: Am J Cardiol. 2006 Oct 1;98(7):991-2. Epub 2006
Jul 26.
Related Articles,
Links
Comment on:

Am J Cardiol. 2006 May 1;97(9):1346-50.
C-reactive protein and lone atrial fibrillation: potential
confounders.
Boos CJ, Lip GY.
Publication Types:


Comment
Letter
PMID: 16996892 [PubMed - indexed for MEDLINE]
2: Am J Cardiol. 2006 Oct 1;98(7):938-43. Epub 2006
Aug 8.
Related Articles,
Links
Peak systolic blood pressure on a graded maximal
exercise test and the blood pressure response to an acute
bout of submaximal exercise.
Syme AN, Blanchard BE, Guidry MA, Taylor AW, Vanheest
JL, Hasson S, Thompson PD, Pescatello LS.
University of Connecticut, Storrs, Connecticut, USA.
Blood pressure (BP) is immediately reduced after aerobic exercise
(postexercise hypotension [PEH]). Whether peak systolic BP on a
maximal graded exercise stress test (GEST) relates to PEH is not
known. This study examined associations between peak systolic BP
on a GEST and PEH. Subjects were 50 men (mean +/- SEM age
43.8 +/- 1.3 years) with elevated BP (145.3 +/- 1.5/85.9 +/-1.1 mm
Hg). Men completed a GEST and 3 experiments: nonexercise
control and 2 cycle bouts at 40% (LIGHT) and 60% (MODERATE)
of maximal oxygen consumption. After the experiments, subjects
left the laboratory wearing ambulatory BP monitors. Peak systolic
BP on a GEST was categorized into tertiles: low (n = 17, 197.4 +/2.0 mm Hg), medium (n = 16, 218.4 +/- 1.4 mm Hg), and high (n =
17, 248.9 +/- 2.8 mm Hg). Repeated-measures analysis of variance
tested if BP differed over time and among experimental conditions
and peak systolic BP groups. In men with high peak systolic BP,
systolic BP was reduced by 7.3 +/- 2.6 mm Hg after LIGHT and by
5.0 +/- 2.2 mm Hg after MODERATE compared with nonexercise
control over 10 hours, with the more apparent effects seen after
LIGHT (p <0.05). In men with low peak systolic BP, systolic BP
was reduced by 6.3 +/- 2.3 mm Hg after MODERATE compared
with nonexercise control over 10 hours (p <0.05). In men with
medium peak systolic BP, systolic BP was not different after
exercise compared with nonexercise control over 10 hours (p
>or=0.05). Men with high peak systolic BP had decreased systolic
BP to the greatest extent after LIGHT, whereas men with low peak
systolic BP reduced systolic BP after MODERATE. In conclusion,
the findings of this study suggest that peak systolic BP on a GEST
may be used to characterize which men with hypertension will have
decreased systolic BP after acute submaximal aerobic exercise.
Publication Types:



Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
PMID: 16996879 [PubMed - indexed for MEDLINE]
3: Am J Cardiol. 2006 Oct 1;98(7):895-901. Epub
Related Articles,
Links
2006 Aug 7.
Three-year clinical follow-up of the unrestricted use of
sirolimus-eluting stents as part of the Rapamycin-Eluting
Stent Evaluated at Rotterdam Cardiology Hospital
(RESEARCH) registry.
Daemen J, Ong AT, Stefanini GG, Tsuchida K, Spindler H,
Sianos G, de Jaegere PP, van Domburg RT, Serruys PW.
The Thoraxcenter, Erasmus Medical Center, Rotterdam, The
Netherlands.
Sirolimus-eluting stents (SESs) have been shown to decrease
restenosis compared with bare metal stents (BMSs). Currently, there
are limited data on the long-term efficacy of these devices in a realworld patient population. Furthermore, the potential of a late
restenotic phenomenon has not yet been excluded. From April to
October 2002, 508 consecutive patients with de novo lesions
exclusively treated with SESs were enrolled and compared with 450
patients treated with BMSs in the preceding 6 months (control
group). Patients in the SES group more frequently had multivessel
disease and type C lesions, received more stents, and had more
bifurcation stenting. After 3 years, the cumulative incidence of
major adverse cardiac events (comprising death, myocardial
infarction, and target vessel revascularization) was significantly
lower in the SES group compared with the pre-SES group (18.9% vs
24.7%, hazards ratio 0.73, 95% confidence interval 0.56 to 0.96, p =
0.026). The 3-year risk of target lesion revascularization was 7.5%
in the SES group versus 12.6% in the pre-SES group (hazards ratio
0.57, 95% confidence interval 0.38 to 0.87, p = 0.01). In conclusion,
the unrestricted use of SESs is safe and superior to the use of BMSs.
The beneficial effects, reported after 1 and 2 years in reducing major
adverse cardiac events, persisted with no evidence of a clinical late
restenotic "catch-up" phenomenon.
PMID: 16996869 [PubMed - indexed for MEDLINE]
4: Am J Cardiol. 2006 Oct 1;98(7):857-60. Epub 2006
Aug 4.
Related Articles,
Links
A comparative analysis of short- and long-term outcomes
after ventricular fibrillation out-of-hospital cardiac
arrest in patients with ischemic and nonischemic heart
disease.
Bunch TJ, Kottke TE, Lopez-Jimenez F, Mahapatra S, Elesber
AA, White RD.
Division of Cardiovascular Diseases, Department of Internal
Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Although ventricular fibrillation (VF) out-of-hospital cardiac arrest
(OHCA) occurs primarily in the setting of severe ischemic heart
disease (IHD), a significant proportion of events occurs in patients
who do not have severe IHD. The relative effect of IHD on survival
after VF OHCA is unknown. All residents of Rochester, Minnesota,
who presented with a VF OHCA from November 1990 to December
2004, treated by emergency medical services, were included in the
study. During the study, emergency medical services treated 208
patients (64.1 +/- 13.6 years of age) for VF OHCA, with an average
call-to-shock time of 6.3 +/- 1.8 minutes. Of these patients, 156 had
IHD and 39 had non-IHD. In 13, the underlying heart disease was
unknown. Eighty-seven patients (41.8%) survived to hospital
discharge with neurologic recovery (66 with IDH [42%] vs 21 with
non-IHD [54%], p = 0.211)]. Five-year survival was 79 +/- 6% for
patients with IHD versus 100% for those with non-IHD (p = 0.047).
After adjustment for other patient characteristics, IHD was not
predictive of 5-year survival (hazard ratio [HR] 2.2, 95% confidence
interval [CI] 0.7 to 9.8, p = 0.177). Variables associated with poor
outcomes included age >65 years (HR 4.9, 95% CI 2.0 to 13.4, p =
0.0003), ejection fraction <0.35% (HR 3.0, 95% CI 1.3 to 7.3, p =
0.012), and hypertension (HR 4.9, 95% CI 1.4 to 16.3, p = 0.001). In
patients with IHD, use of an implantable cardioverter-defibrillator
(HR 0.32, 95% CI 0.16 to 0.88, p = 0.024) and statin therapy (HR
0.68, 95% CI 0.17 to 0.73, p = 0.001) were associated with
decreased mortality. In conclusion, compared with patients with
non-IHD, those with IHD had similar short- and long-term survival
rates. Long-term survival in patients with IHD was primarily
influenced by other co-morbid conditions. Nonetheless, in patients
with IHD, use of an implantable cardioverter-defibrillator and statin
therapy were associated with higher long-term survival rates.
Publication Types:


Comparative Study
Research Support, Non-U.S. Gov't
PMID: 16996862 [PubMed - indexed for MEDLINE]
5: Circulation. 2006 Oct 24;114(17):1863-72.
Related Articles, Links
Triggering of acute cardiovascular disease and potential
preventive strategies.
Tofler GH, Muller JE.
Cardiology Department, Royal North Shore Hospital, Sydney,
Australia. gtofler@nsccahs.health.nsw.gov.au
Publication Types:

Review
PMID: 17060396 [PubMed - indexed for MEDLINE]
6: Circulation. 2006 Oct 24;114(17):1892-5. Epub
2006 Oct 9.
Related Articles,
Links
Indications for renal arteriography at the time of
coronary arteriography: a science advisory from the
American Heart Association Committee on Diagnostic
and Interventional Cardiac Catheterization, Council on
Clinical Cardiology, and the Councils on Cardiovascular
Radiology and Intervention and on Kidney in
Cardiovascular Disease.
White CJ, Jaff MR, Haskal ZJ, Jones DJ, Olin JW, RochaSingh KJ, Rosenfield KA, Rundback JH, Linas SL; American
Heart Association Committee on Diagnostic and Interventional
Cardiac Catheterization, Council on Clinical Cardiology;
American Heart Association Council on Cardiovascular
Radiology and Intervention; American Heart Association
Council on Kidney in Cardiovascular Disease.
Atherosclerotic renal artery stenosis is commonly present in patients
with clinically manifest atherosclerosis in other vascular beds and is
independently associated with increased cardiovascular morbidity
and mortality. Screening tests such as renal angiography should be
selectively applied to patients at high risk for renal artery stenosis
who are potential candidates for revascularization. This
multispecialty consensus document describes the rationale for
patient selection for screening renal angiography at the time of
cardiac catheterization.
Publication Types:

Practice Guideline
PMID: 17030686 [PubMed - indexed for MEDLINE]
7: Hypertension. 2006 Nov 6; [Epub ahead of print]
Related Articles, Links
Response to Endothelial Nitric Oxide Synthase
Polymorphisms and Susceptibility to Hypertension:
Genotype Versus Haplotype Analysis.
Zintzaras E, Kitsios G, Stefanidis I.
Department of Biomathematics, University of Thessaly School of
Medicine, Papakyriazi, Greece.
PMID: 17088443 [PubMed - as supplied by publisher]
8: Hypertension. 2007 Jan;49(1):E1; author reply E2.
Epub 2006 Nov 6.
Related Articles,
Links
Endothelial nitric oxide synthase polymorphisms and
susceptibility to hypertension: genotype versus haplotype
analysis.
Tanus-Santos JE, Casella-Filho A.
Publication Types:


Comment
Letter
PMID: 17088442 [PubMed - in process]
9: J Hum Hypertens. 2006 Nov 9; [Epub ahead of
print]
Related Articles,
Links
Plasma visfatin levels in young male patients with
uncomplicated and newly diagnosed hypertension.
Dogru T, Sonmez A, Tasci I, Yilmaz MI, Erdem G, Erturk H,
Bingol N, Kilic S, Ozgurtas T.
1Department of Internal Medicine, Gulhane School of Medicine,
Etlik, Ankara, Turkey.
PMID: 17096008 [PubMed - as supplied by publisher]
10: Stroke. 2006 Dec;37(12):2946-50. Epub 2006
Nov 9.
Related Articles,
Links
Hypertensive intracerebral hemorrhage in young people:
previously unnoticed age-related clinical differences.
Ruiz-Sandoval JL, Romero-Vargas S, Chiquete E, PadillaMartinez JJ, Villarreal-Careaga J, Cantu C, Arauz A,
Barinagarrementeria F.
Servicio de Neurologia y Neurocirugia, Hospital Civil de
Guadalajara Fray Antonio Alcalde, Hospital 278, Guadalajara,
Jalisco, Mexico CP44280. jorusan@mexis.com
BACKGROUND AND PURPOSE: Hypertensive intracerebral
hemorrhage (ICH) in young people has been the object of only
succinct analyses. Therefore, it is unclear whether extrapolation of
the information obtained from older patients is also valid for the
young. Here we describe young persons with hypertensive ICH and
compare them with their older counterparts to determine whether
age-related clinical differences exist. METHODS: From 1988 to
2004, we studied 35 consecutive young patients with ICH (60%
men; mean age, 33 years; range, 15 to 40 years) for whom the
etiology of the brain hemorrhage was hypertension. For clinical
comparisons, sex-matched persons with hypertensive ICH, aged >40
years, were randomly selected by a factor of 3:1 (n=105).
RESULTS: Essential hypertension was present in 26 (74%) young
patients and secondary hypertension in 9 (26%), with renovascular
hypertension being the most common cause (n=5, 55%). Compared
with older patients, the young had higher blood pressures, smaller
hemorrhage volumes, lower rates of ventricular extensions (for all,
P<0.05), and different distribution pattern of ICHs (P=0.05), without
cerebellar and lobar locations. Thirty-day mortality was markedly
lower in the young than in older persons (P=0.001), nevertheless at
the expense of more incapacitating disabilities. CONCLUSIONS:
Young people presenting with hypertensive ICH differ in clinical
characteristics and have a different prognosis when compared with
their older counterparts. These findings suggest underlying agerelated differences in disease pathogenesis.
Publication Types:

Comparative Study
PMID: 17095739 [PubMed - indexed for MEDLINE]
1: Am J Hypertens. 2006 Nov;19(11):1190-6.
Related Articles, Links
Medication adherence and persistence as the cornerstone of effective
antihypertensive therapy.
Burnier M.
Service de Nephrologie et Consultation d'Hypertension, Centre Hospitalier
Universitaire Vaudois (CHUV), Lausanne, Switzerland.
michel.burnier@hospvd.ch
Achieving optimal outcomes in the treatment of hypertension--a prevalent and
largely asymptomatic disease--necessitates that patients take their medications not
only properly (medication adherence) but also continue to do so throughout longterm treatment (persistence). However, poor medication-taking behavior is a major
problem among patients with hypertension, and has been identified as one of the
main causes of failure to achieve adequate control of blood pressure (BP). In turn,
patients with hypertension who have uncontrolled BP as a result of their poor
medication-taking behavior remain at risk for serious morbidity and mortality (eg,
stroke, myocardial infarction, and kidney failure), thereby accounting for a
significant cost burden through avoidable hospital admissions, premature deaths,
work absenteeism, and reduced productivity. Improving medication-taking
behavior during antihypertensive therapy therefore represents an important
potential source of health and economic improvement. Whereas many factors may
contribute to poor medication-taking behavior, the complexity of dosage regimens
and the side effect profiles of drugs probably have the greatest therapy-related
influence. Central to any strategy aimed at improving outcomes for patients with
hypertension, therefore, are efficacious antihypertensive agents that facilitate good
medication-taking behavior through simplified dosing and placebo-like tolerability,
along with the development of programs to detect poor medication adherence and
to support long-term medication persistence in daily practice.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17070434 [PubMed - in process]
2: Am J Hypertens. 2006 Nov;19(11):1183-9.
Related Articles, Links
Microalbuminuria, blood pressure load, and systemic vascular
permeability in primary hypertension.
Viazzi F, Leoncini G, Ratto E, Vaccaro V, Tomolillo C, Falqui V, Parodi A,
Conti N, Deferrari G, Pontremoli R.
Department of Internal Medicine and Cardionephrology, Azienda Universitaria
Ospedale San Martino, University of Genoa, Genoa, Italy.
BACKGROUND: Microalbuminuria, a powerful predictor of cardiovascular
events, is thought to reflect widespread subclinical vascular abnormalities. To
explore the pathogenesis of increased urinary albumin excretion in primary
hypertension we evaluated systemic capillary permeability and ambulatory blood
pressure (BP) measurement in two groups of matched untreated patients with (n =
11) and without (n = 29) microalbuminuria. METHODS: Albuminuria was
measured as the mean of albumin-to-creatinine ratio (ACR) in three
nonconsecutive first morning urine samples. Systemic capillary permeability was
evaluated by transcapillary escape rate of albumin (TERalb) (ie, the 1-h decline
rate of intravenous (125)I-albumin). Twenty-four-hour ambulatory BP, renal
hemodynamics, and hormones of the renin-angiotensin-aldosterone system
(RAAS) were also assessed. RESULTS: Patients with microalbuminuria showed
greater body mass index (BMI) (P < .04), higher 24-h systolic and diastolic BP
levels (P = .02), and higher capillary permeability to albumin (P < .02) as
compared to normoalbuminurics. Renal hemodynamics and RAAS hormones were
similar in the two groups. Univariate analysis showed that urinary ACR was related
to ambulatory pressure components (P < .02), TERalb (r = 0.31, P < .05), smoking
habits (r = 0.36, P = .02), and left ventricular mass index (LVMI) (r = 0.57, P <
.001) among the whole study group. Logistic regression analysis showed that each
1% increment in TERalb or 10 mm Hg increase in systolic BP entailed an almost
three times higher risk of having microalbuminuria. CONCLUSIONS:
Microalbuminuria is associated with greater systemic BP load and increased
vascular permeability in patients with primary hypertension.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17070433 [PubMed - in process]
3: Am J Hypertens. 2006 Nov;19(11):1166.
Related Articles, Links
Reporting association to hypertension. Rare genotypes with
protective effects or common genotypes increasing risk.
Wilk JB.
Boston University School of Medicine, Boston, Massachusetts 02118, USA.
jwilk@bu.edu
Publication Types:

Comment
PMID: 17070429 [PubMed - in process]
4: Am J Hypertens. 2006 Nov;19(11):1158-65.
Related Articles, Links
Assessment of the genetic component of hypertension.
Yamada Y, Matsuo H, Segawa T, Watanabe S, Kato K, Hibino T, Yokoi K,
Ichihara S, Metoki N, Yoshida H, Satoh K, Nozawa Y.
Department of Human Functional Genomics, Life Science Research Center, Mie
University, Tsu, Japan. yamada@gene.mie-u.ac.jp
BACKGROUND: Although genetic epidemiologic studies have suggested that
several genetic variants increase the risk for hypertension, the genes that underlie
genetic susceptibility to this condition remain to be identified definitively. We have
now performed a large-scale association study to identify gene polymorphisms for
reliable assessment of the genetic component of hypertension. METHODS: The
study population comprised 4853 unrelated Japanese individuals, including 2818
subjects with hypertension (1677 men, 1141 women) and 2035 controls (1011 men,
1024 women). The genotypes for 150 polymorphisms of 128 candidate genes were
determined with a method that combines the polymerase chain reaction and
sequence-specific oligonucleotide probes with suspension array technology.
RESULTS: Multivariable logistic regression analysis with adjustment for age, sex,
body mass index, and the prevalence of smoking revealed that four polymorphisms
(1648G-->A in ITGA2, -30G-->A in GCK, A-->G in SAH, and 1117C-->A in
PTGIS) were significantly (P < .01) associated with hypertension. A stepwise
forward selection procedure demonstrated that ITGA2, GCK, and PTGIS
genotypes significantly affected the prevalence of hypertension. Combined
genotype analysis of these polymorphisms yielded a lowest odds ratio of 0.47 for
the genotypes of AA or AG for ITGA2, GA or AA for GCK, and CC for PTGIS,
which were present in 1.1% and 2.0% of hypertensive and control individuals,
respectively. CONCLUSIONS: These results suggest that the genotypes for
ITGA2, GCK, and PTGIS may prove reliable for the assessment of the genetic
component of hypertension. Determination of the combined genotypes for these
genes may contribute to personalized prevention of this condition.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17070428 [PubMed - in process]
5: Am J Hypertens. 2006 Nov;19(11):1156-7.
Related Articles, Links
Is echocardiography essential in the management of newly diagnosed
hypertension?
Bella JN, Devereux RB.
Division of Cardiology, Department of Medicine, Bronx-Lebanon Hospital
Center/Albert Einstein College of Medicine, Bronx, New York 10457, USA.
jbella@bronxleb.org
Publication Types:

Comment
PMID: 17070427 [PubMed - in process]
6: Am J Hypertens. 2006 Nov;19(11):1150-5.
Related Articles, Links
Impact of baseline echocardiography on treatment outcome in
primary care patients with newly detected arterial hypertension: a
randomized trial.
Martina B, Nordmann A, Dieterle T, Sigle JP, Bengel G, Kiefer G, Battegay E.
Medical Outpatient Department, and Basel Institute for Clinical Epidemiology,
University Hospital Basel, Basel, Switzerland. bmartina@uhbs.ch
BACKGROUND: The objective of this study was to test whether baseline
echocardiography in newly detected hypertension improves left ventricular mass
index and blood pressure control. This is a randomized trial with primary care
patients. METHODS: After routine clinical work-up 177 consecutive patients with
newly detected hypertension were randomized according to result of their
echocardiogram (echo group and control group). Treating physicians were
encouraged to prescribe angiotensin II receptor antagonist therapy for patients with
evidence of hypertensive target organ damage. Mean blood pressure (BP) and
echocardiographic left ventricular mass index were measured at baseline and after
6 months of therapy in both groups. RESULTS: More patients with hypertensive
target organ damage were identified in the echo group as compared to the control
group (58 of 91 [64%] v 42 of 86 [49%] patients (difference 15%, 95% CI 1%29%). In the echo group, 41 patients (45%) received angiotensin II receptor
antagonist therapy as compared to 27 patients (31%) in the control group
(difference 14%, 95% CI 0-28%). After 6 months, there were no differences in
mean left ventricular mass index, mean diastolic 24-h ambulatory BP monitoring,
or mean systolic and diastolic office BP between the two groups.
CONCLUSIONS: In patients with newly detected hypertension, baseline
echocardiography detects more patients with hypertensive target organ damage, but
does not lead to a reduction in left ventricular mass index or improved BP control
after 6 months of therapy.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17070426 [PubMed - in process]
7: Am J Hypertens. 2006 Nov;19(11):1135-43.
Related Articles, Links
Long-term inhibition of the central alpha(2B)-adrenergic receptor
gene via recombinant AAV-delivered antisense in hypertensive rats.
Shenouda SM, Johns C, Gavras I, Gavras H.
Hypertension and Atherosclerosis Section of the Department of Medicine, Boston
University School of Medicine, Boston, Massachusetts 02118, USA.
sherene@bu.edu
BACKGROUND: Salt-induced hypertension is mediated via the alpha(2B)adrenergic receptor (AR) subtype. In alpha(2B)-AR gene knockout mice, blood
pressure (BP) does not rise with salt loading, and in rats with salt-induced
hypertension, BP decreases transiently with antisense (AS) treatment targeting the
alpha(2B)-AR gene. The present experiments were designed to explore the
possibility of gene transfection in the brain by intracerebroventricular (ICV)
delivery of AS-DNA via adeno-associated virus (AAV) to prolong alpha(2B)-AR
inhibition and hence reversal of salt-dependent hypertension. METHODS: A
recombinant AAV (rAAV) vector preparation encoding the alpha(2B)-AS
fragment (previously tested in vitro for inhibition of alpha(2B)-AR protein
production in cells) and containing green fluorescence protein (GFP) for
visualization was injected ICV into subtotally nephrectomized, salt-fed rats.
Control rats received rAAV-GFP (n = 8 per group). RESULTS: We observed that
BP rose from a baseline of 120 +/- 10 to 184 +/- 12 mm Hg. Injection of rAAValpha(2B)-AS produced a 35 +/- 12 mm Hg fall in BP, lasting without evidence of
diminishing for at least 16 days, whereas rAAV-GFP-injected rats showed a
continued rise in BP. Rats treated with rAAV-alpha(2B)-AS treated had a 45% to
65% decrease in alpha(2B)-AR protein levels in key regulatory regions of the
brain. Neither group had signs of immunologic response to the virus injection.
CONCLUSIONS: These results indicate that our construct, when given by ICV
means, could reach multiple sites of the central nervous system relevant to BP
regulation and could safely inhibit the central alpha(2B)-adrenergic receptor,
thereby achieving prolonged reversal of salt-induced hypertension.
Publication Types:

Research Support, N.I.H., Extramural

Research Support, Non-U.S. Gov't
PMID: 17070424 [PubMed - in process]
8: Am J Hypertens. 2006 Nov;19(11):1118-24.
Related Articles, Links
Directly measured insulin resistance and the assessment of clustered
cardiovascular risks in hypertension.
Lin MW, Hwu CM, Huang YH, Sheu WH, Shih KC, Chiang FT, Olshen R,
Chen YD, Curb JD, Rodriguez B, Ho LT; SAPPHIRe Study Group.
Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei,
Taiwan.
BACKGROUND: The purpose of the study was to use factor analysis to
investigate the contribution of a directly measured insulin sensitivity index, steadystate plasma glucose (SSPG) from insulin suppression test (IST), to a clustering of
cardiovascular risk factors in hypertensive subjects. METHODS: A total of 204
nondiabetic hypertensive patients who received IST for SSPG were included for
current analysis. Factor analysis was performed to explore the contribution of
SSPG as additional information to a clustering of risk factors in these subjects.
RESULTS: In factor analysis, SSPG aggregated with metabolic variables in an
obesity-hyperinsulinemia domain that included two factors: one with positive
loadings for SSPG, 2-h glucose, and Log 2-h insulin; and the other with positive
loadings for body mass index, waist circumference, and fasting glucose. Fasting
insulin linked the two factors together and explained 38.3% of the total variance.
Systolic and diastolic blood pressures were loaded on a blood pressure domain
separately. The third domain consisted of two factors: one with positive loadings
for Log triglycerides and negative loading for high-density lipoprotein cholesterol;
and the other with positive loadings for Log triglycerides and non-high-density
lipoprotein cholesterol. The model loaded without SSPG explained a proportion of
the total variance (78.5%) similar to that achieved with the model loaded with
SSPG (77.1%). CONCLUSIONS: Directly measured insulin sensitivity index
SSPG clustered with 2-h glucose and Log 2-h insulin in factor analysis in a cohort
consisting entirely of hypertensive subjects. However, the contribution of SSPG as
additional information to explain the total variance seems to be insignificant.
Publication Types:


Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
PMID: 17070421 [PubMed - in process]
9: Am J Hypertens. 2006 Nov;19(11):1103-9.
Related Articles, Links
Effect of body weight loss on blood pressure after 6 years of follow-up
in stage 1 hypertension.
Winnicki M, Bonso E, Dorigatti F, Longo D, Zaetta V, Mattarei M, D'Este D,
Laurini G, Pessina AC, Palatini P.
University of Padova, Padova, Italy. mikolaj_winnicki@yahoo.com
BACKGROUND: Although it is known that weight reduction reduces blood
pressure (BP) in overweight patients, the optimal body weight (BW) loss in terms
of BP response is not yet established. We evaluated the relationship between
decrease in BW and BP over time in 796 stage 1 hypertensives. METHODS: The
166 subjects who lost BW were divided into four groups according to percent of
BW loss at the end of a 74-month follow-up (G1, >2% to 5%, G2, >5% to 9%, G3,
>9% to 13%, and G4, >13%) and were compared to the 219 subjects without
changes in BW (G0, -2% to +2%). The BW increased (>2%) in the remaining 411
subjects. RESULTS: Among subjects with BW loss there was a progressive
decrease in final systolic BP associated with BW loss category up to G3 (P = .007),
therefore at the end of follow-up G3 had systolic BP 6.2 mm Hg lower than G0 (P
= .06). However, among G3 and G4 subjects systolic BP decrease was almost
identical (-6.2 nu -5.7 mm Hg, respectively, P = not significant). Similar results
were obtained for diastolic BP, which declined up to G3 (P = .013). G3 had final
diastolic BP 3.6 mm Hg lower than G0 (P = .037), whereas change in diastolic BP
in G4 subjects was similar to that in G0 (-0.9 nu +0.1 mm Hg, respectively, P = not
significant). Similar results were obtained in the group with body mass index
(BMI) >27 kg/m(2). CONCLUSIONS: Our results indicate that in stage 1
hypertensives followed for more than 6 years the dose-response relationship
between BW loss and decrease in BP is not linear irrespective of initial BW. The
BW loss >13% of initial weight did not elicit additional BP decrease.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17070419 [PubMed - in process]
10: Am J Hypertens. 2006 Nov;19(11):1098-100.
Related Articles, Links
A specialist in clinical hypertension critiques the trophy trial.
Meltzer JI.
Publication Types:

Editorial
PMID: 17070417 [PubMed - in process]
11: Am J Hypertens. 2006 Nov;19(11):1095-7.
Related Articles, Links
Studying interventions to prevent the progression from
prehypertension to hypertension: does TROPHY win the prize?
Persell SD, Baker DW.
Publication Types:

Editorial
PMID: 17070416 [PubMed - in process]
12: Arch Intern Med. 2006 Sep 25;166(17):1884-91.
Related Articles, Links
Cardiovascular disease risk factors in chronic kidney disease: overall
burden and rates of treatment and control.
Parikh NI, Hwang SJ, Larson MG, Meigs JB, Levy D, Fox CS.
National Heart, Lung, and Blood Institute's Framingham Heart Study,
Framingham, Mass, USA.
BACKGROUND: Mild to moderate chronic kidney disease (CKD) is associated
with increased risk for cardiovascular disease. The burden of cardiovascular
disease risk factors in this setting is not well described. METHODS: We compared
the age- and sex-adjusted prevalence of cardiovascular disease risk factors and
their treatment and control among persons with and without CKD in 3258
Framingham offspring cohort members who attended the seventh examination
cycle (1998-2001). Glomerular filtration rate (GFR) was estimated using the
simplified Modification of Diet in Renal Disease Study equation. We defined CKD
as a GFR of less than 59 mL/min per 1.73 m(2) in women and less than 64 mL/min
per 1.73 m(2) in men. RESULTS: Those with CKD were older, more likely to be
obese (33.5% vs 29.3%; P=.02), and more likely to have low levels of high-density
lipoprotein cholesterol (45.2% vs 29.4%; P<.001) and high triglyceride levels
(39.9% vs 29.8%; P<.001). Those with CKD had a higher prevalence of
hypertension (71.2% vs 42.7%; P<.001) and hypertension treatment (86.0% vs
72.5%; P<.001), but were less likely to achieve optimal blood pressure control
(27.0% vs 45.5%; P<.001). Participants with CKD had a higher prevalence of
elevated low-density lipoprotein cholesterol levels (60.5% vs 44.7%; P=.06) and
lipid-lowering therapy (57.1% vs 42.6%; P=.09), although this was not statistically
significant. A greater proportion of individuals with CKD than those without had
diabetes (23.5% vs 11.9%; P=.02) and were receiving diabetes treatment (63.6% vs
46.9%; P=.05), but were less likely to achieve a hemoglobin A(1c) level of less
than 7% (43.8% vs 59.4%; P=.03). CONCLUSIONS: Chronic kidney disease is
associated with a significant burden of cardiovascular disease risk factors in the
community. The diagnosis of CKD should alert the practitioner to look for
potentially modifiable cardiovascular risk factors.
Publication Types:


Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
PMID: 17000946 [PubMed - indexed for MEDLINE]
13: BMJ. 2006 Oct 28;333(7574):896-9.
Related Articles, Links
Monitoring renal function in hypertension.
Martin U, Coleman JJ.
Department of Clinical Pharmacology, Division of Medical Sciences, University of
Birmingham, Birmingham B15 2TH. u.martin@bham.ac.uk
Publication Types:


Case Reports
Review
PMID: 17068035 [PubMed - indexed for MEDLINE]
14: J Hum Hypertens. 2007 Jan;21(1):94-5. Epub 2006 Nov 2.
Related Articles, Links
Influence of age and sex on prevalence of masked hypertension
determined from home blood pressure measurements.
Kawabe H, Saito I.
1Department of Internal Medicine, Health Center, Keio University, Tokyo, Japan.
PMID: 17082798 [PubMed - in process]
15: J Hypertens. 2006 Dec;24(12):2482-5.
Related Articles, Links
European Society of Hypertension Scientific Newsletter: treatment of
hypertensive urgencies and emergencies.
Rosei EA, Salvetti M, Farsang C.
Department of Internal Medicine, University of Brescia, Italy.
agabiti@med.unibs.it
PMID: 17082737 [PubMed - in process]
16: J Hypertens. 2006 Dec;24(12):2478-82.
Related Articles, Links
European Society of Hypertension Scientific Newsletter: update on
hypertension management: prevention of type 2 diabetes mellitus
with antihypertensive drugs.
Nilsson PM, Cifkova R, Kjeldsen SE, Mancia G.
Department of Medicine, University Hospital, Malmo, Sweden.
peter.nilsson@med.lu.se
PMID: 17082736 [PubMed - in process]
17: J Hypertens. 2006 Dec;24(12):2477-8.
Related Articles, Links
European Society of Hypertension Scientific Newsletter: control of
hypertension in patients with peripheral artery disease.
Clement DL.
University of Ghent, University Hospital, Ghent, Belgium.
denis.clement@skynet.be
PMID: 17082735 [PubMed - in process]
18: J Hypertens. 2006 Dec;24(12):2465-72.
Related Articles, Links
AT1 receptor blockade is superior to conventional triple therapy in
protecting against end-organ damage in Cyp1a1-Ren-2 transgenic
rats with inducible hypertension.
Vanourkova Z, Kramer HJ, Huskova Z, Vaneckova I, Opocensky M,
Chabova VC, Tesar V, Skaroupkova P, Thumova M, Dohnalova M, Mullins
JJ, Cervenka L.
Center for Experimental Medicine, Institute for Clinical and Experimental
Medicine, Prague, Germany.
OBJECTIVE: In the present study we compared the effects of treatment with the
AT1 receptor antagonist candesartan and of 'triple therapy' (hydralazine,
hydrochlorothiazide, reserpine) on the course of blood pressure, cardiac
hypertrophy and angiotensin II concentrations after induction of hypertension in
transgenic rats with inducible expression of the mouse renin gene (Cyp1a1-Ren-2
rats). METHODS: Hypertension was induced in Cyp1a1-Ren-2 rats through
dietary administration of the natural xenobiotic indole-3-carbinol (I3C, 0.3%) for 4
days. Starting on the day before administration of I3C, rats were treated either with
candesartan or received triple therapy for 9 days. Systolic blood pressure was
measured in conscious animals. Rats were decapitated and angiotensin II levels in
plasma and in whole kidney and left ventricular tissues were determined by
radioimmunoassay. RESULTS: Administration of I3C resulted in the development
of severe hypertension and cardiac hypertrophy that was accompanied by marked
elevations of plasma and tissue angiotensin II concentrations. Candesartan
treatment prevented the development of hypertension and cardiac hypertrophy and
was associated with a reduction of tissue angiotensin II concentrations. In contrast,
triple therapy, despite maintaining systolic blood pressure in the normotensive
range, did not prevent the development of cardiac hypertrophy and tissue
angiotensin II augmentations. CONCLUSIONS: Our findings indicate that
hypertension in Cyp1a1-Ren-2 rats is a clearly angiotensin II-dependent model of
hypertension with elevated circulating and tissue angiotensin II concentrations, and
that antihypertensive treatment with AT1 receptor blockade is superior to
conventional triple therapy in effective protection against hypertension-induced
end-organ damage in this rat model.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17082731 [PubMed - in process]
19: J Hypertens. 2006 Dec;24(12):2459-64.
Related Articles, Links
QT interval in patients with primary aldosteronism and low-renin
essential hypertension.
Maule S, Mulatero P, Milan A, Leotta G, Caserta M, Bertello C, Rabbia F,
Veglio F.
Autonomic Unit and Hypertension Unit, Department of Medicine and
Experimental Oncology, S. Vito Hospital, University of Turin, Turin, Italy.
simmaule@tin.it
INTRODUCTION: QT interval prolongation increases the risk of sudden death in
several medical conditions. Patients with primary aldosteronism and salt-sensitive
hypertension experience more cardiovascular events than those with normal-renin
essential hypertension. QT interval prolongation might represent one of the risk
factors for cardiovascular events in these patients. The aim of the present study was
to evaluate the QT interval in patients with primary aldosteronism and low-renin
essential hypertension (LREH). METHODS: Twenty-seven patients with primary
aldosteronism, 17 patients with LREH, 117 patients with essential hypertension
and 25 healthy individuals were studied. Plasma aldosterone, plasma renin activity,
and aldosterone to plasma renin activity ratio (ARR) were determined. Corrected
QT intervals (QTcs) were measured from a 12-lead electrocardiogram. RESULTS:
The QTc was longer in primary aldosteronism (434 +/- 23 ms) and LREH (430 +/18 ms) compared with essential hypertension (419 +/- 22 ms) and healthy controls
(412 +/- 19 ms) (P = 0.0004). The prevalence of QTc longer than 440 ms was
higher in primary aldosteronism (48%) and LREH (23%) compared with essential
hypertension (11%) and healthy controls (4%) (P < 0.0001). QTc correlated with
plasma aldosterone (P = 0.01), ARR (P = 0.02), and diastolic blood pressure (P =
0.01). ARR (P = 0.01) and systolic blood pressure (P = 0.01) were identified as
independent predictors of QTc. CONCLUSIONS: We postulate that the elevated
aldosterone secretion contributes to the prolongation of the QT interval in patients
with primary aldosteronism and LREH through both a depletion of intracellular
potassium concentration and higher blood pressure values. QTc measurement
might represent one simple, non-invasive and reproducible index to characterize
the cardiovascular risk in patients with primary aldosteronism and LREH.
PMID: 17082730 [PubMed - in process]
20: J Hypertens. 2006 Dec;24(12):2437-43.
Related Articles, Links
Baroreflex sensitivity improvement is associated with decreased
oxidative stress in trained spontaneously hypertensive rat.
Bertagnolli M, Campos C, Schenkel PC, de Oliveira VL, De Angelis K, BelloKlein A, Rigatto K, Irigoyen MC.
Laboratory of Cardiovascular Physiology, Department of Physiology, Basic and
Health Science Institute, Federal University of Rio Grande do Sul, Porto Alegre,
RS, Brazil.
BACKGROUND: Baroreflex sensitivity (BRS) impairment has been associated
with endothelial dysfunction and oxidative stress. METHODS: Because exercise
training could improve endothelial function in spontaneously hypertensive rats
(SHR), the effect of moderate exercise training on oxidative stress and BRS was
investigated. Groups were divided into sedentary and trained Wistar-Kyoto rats (SWK, n = 7 and T-WK, n = 6) and SHR (S-SHR and T-SHR, n = 9 each). Exercise
training was performed on a treadmill (5 days/week, 60 min, 10 weeks), and the
lactate threshold (20 m/min) was used to determine moderate intensity. RESULTS:
Exercise training reduced mean arterial pressure in WK and SHR (S-WK 127 +/- 4,
T-WK 105 +/- 5, S-SHR 169 +/- 4 versus T-SHR 140 +/- 4 mmHg; P < 0.01).
Baroreflex bradycardic (S-WK -1.89 +/- 0.15, T-WK -2.11 +/- 0.37, S-SHR -0.80
+/- 0.09 versus T-SHR -1.29 +/- 0.10 bpm/mmHg; P < 0.0001) and tachycardic (SWK 2.57 +/- 0.19, T-WK 2.73 +/- 0.21, S-SHR 1.18 +/- 0.07 versus T-SHR 2.02
+/- 0.10 bpm/mmHg; P < 0.0001) responses were significantly different between
groups. Lipoperoxidation in erythrocytes (S-WK 11 320 +/- 739, T-WK 10 397 +/765, S-SHR 20 511 +/- 1627 versus T-SHR 10 211 +/- 589 counts per second
(cps)/mg haemoglobin; P < 0.0001) and aortas (S-WK 12 424 +/- 2219, T-WK
7917 +/- 726, S-SHR 26 957 +/- 1772 versus T-SHR 17 777 +/- 1923 cps/mg
protein; P < 0.0001) was reduced in T-SHR compared with S-SHR. Inverse
correlations were observed between both bradycardic and tachycardic responses
and lipoperoxidation in erythrocytes (r = 0.56 and r = -0.77, respectively; P < 0.01)
and aortas (r = 0.77 and r = -0.80, respectively; P < 0.0001). CONCLUSION: Our
results indicate that exercise training decreases oxidative stress, which is related to
an improvement in BRS in SHR.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17082727 [PubMed - in process]
21: J Hypertens. 2006 Dec;24(12):2417-22.
Related Articles, Links
Angiotensin II/AT2 receptor-induced vasodilation in stroke-prone
spontaneously hypertensive rats involves nitric oxide and cGMPdependent protein kinase.
Savoia C, Ebrahimian T, He Y, Gratton JP, Schiffrin EL, Touyz RM.
Lady Davis Institute for Medical Research, SMBD Jewish General Hospital,
McGill University, Montreal, Quebec, Canada.
BACKGROUND: Angiotensin II (Ang II) induces vasodilation, in part, through
angiotensin type 2 receptor (AT2R)-induced actions in conditions associated with
angiotensin type 1 receptor (AT1R) blockade and AT2R upregulation. Ang
II/AT2R-induced vasodilation involves nitric oxide (NO)-cyclic guanosine
monophosphate (cGMP)-dependent processes. We previously demonstrated that
AT2R-mediated effects involve inhibition of the RhoA/Rho kinase pathway.
However, molecular mechanisms underlying this phenomenon are unknown.
AIMS: In the present in-vivo study we tested the hypothesis that AT2R-elicited
vasodilation is associated with nitric oxide synthase (NOS) activation and NO
production, and that a cGMP-dependent protein kinase (cGKI), which inactivates
RhoA, is upregulated when stroke-prone spontaneously hypertensive rats (SHRSP)
are treated with AT1R blockers. METHODS: SHRSP and Wistar-Kyoto (WKY)
rats were treated with the AT1R blocker valsartan for 14 days. Dilatory responses
to Ang II with or without the NOS inhibitor N-nitro-L-arginine methyl ester (LNAME) were performed in norepinephrine-precontracted vessels in the presence of
valsartan. Expression of AT2R, endothelial NOS (eNOS) and cGKI was assessed
by immunoblotting. NO bioavailability and NAD(P)H oxidase activity were
evaluated by chemiluminescence. RESULTS: Ang II elicited vasodilation in
valsartan-treated SHRSP. L-NAME inhibited this effect, indicating a role for NO.
eNOS expression and NO concentration were increased twofold by valsartan, only
in SHRSP. Expression of cGKI was reduced in SHRSP and restored after valsartan
treatment. NAD(P)H oxidase activity was approximately threefold higher in
SHRSP versus WKY (P < 0.05) and reduced by valsartan. CONCLUSIONS: Ang
II, via AT2R, facilitates vasodilation through NOS/NO-mediated pathways and
downregulation of cGKI after chronic AT1R antagonism. These effects may
contribute in part to beneficial actions of AT1R blockers in the treatment of
hypertension.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17082724 [PubMed - in process]
22: J Hypertens. 2006 Dec;24(12):2393-7.
Related Articles, Links
Endothelial nitric oxide synthase haplotypes are related to blood
pressure elevation, but not to resistance to antihypertensive drug
therapy.
Sandrim VC, Yugar-Toledo JC, Desta Z, Flockhart DA, Moreno H Jr, TanusSantos JE.
Department of Pharmacology, Faculty of Medicine of Ribeirao Preto, University of
Sao Paulo, Ribeirao Preto, Brazil.
OBJECTIVES: Most hypertensive patients require two or more drugs to control
arterial blood pressure effectively. Although endothelial nitric oxide synthase
(eNOS) haplotypes have been associated with hypertension, it is unknown whether
eNOS genotypes/haplotypes are associated with resistance to antihypertensive
therapy. METHODS: We studied the distribution of three eNOS genetic
polymorphisms: single nucleotide polymorphisms in the promoter region (T(786)C), and in exon 7 (Glu298Asp), and a variable number of tandem repeats in
intron 4 (b/a). Genotypes were determined for 111 normotensive controls (NT),
116 hypertensive individuals who were well controlled (HT), and 100 hypertensive
individuals who were resistant to conventional antihypertensive therapy (RHT).
We also compared the distribution of eNOS haplotypes in the three groups of
subjects. RESULTS: No differences were found in genotype or allele distribution
among the three groups (all P > 0.05). Conversely, the 'C Glu b' haplotype was
more commonly found in the NT than in the HT or RHT groups (21 versus 8 and
7%, respectively; both P < 0.00625). In addition, the 'C Asp b' haplotype was more
commonly found in the HT or RHT groups than in the NT group (22 and 20%,
respectively, versus 8%; both P < 0.00625). The distribution of eNOS haplotypes
was not significantly different in the HT and RHT groups (P > 0.05).
CONCLUSIONS: Whereas our findings suggest a protective effect for the 'C Glu
b' haplotype against hypertension and that the 'C Asp b' haplotype increases the
susceptibility to hypertension, our results suggest that eNOS haplotypes are not
associated with resistance to antihypertensive therapy.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17082721 [PubMed - in process]
23: J Hypertens. 2006 Dec;24(12):2387-92.
Related Articles, Links
Female sexual dysfunction in essential hypertension: a common
problem being uncovered.
Doumas M, Tsiodras S, Tsakiris A, Douma S, Chounta A, Papadopoulos A,
Kanellakopoulou K, Giamarellou H.
Hypertension Outpatient Clinic, 4th Department of Internal Medicine, University
of Athens, Attikon Hospital, Greece. michalisdoumas@yahoo.co.uk
OBJECTIVES: Female sexual dysfunction (FSD) is increasingly attracting more
scientific and public interest, and represents a poorly investigated issue in patients
with essential hypertension. We evaluated the prevalence of sexual dysfunction in
hypertensive women compared with normotensive women according to age,
hypertension severity, hypertension duration, and antihypertensive treatment.
METHODS: The study population consisted of consecutive, sexually active
women attending an outpatient hypertension clinic. The Female Sexual Function
Index (FSFI questionnaire) was used to evaluate FSD. Univariate and multivariate
analyses were used to evaluate predictors of FSD. RESULTS: Four hundred and
seventeen women were studied. From them, 216 women had arterial hypertension
(136 treated, 80 untreated) and 201 were normotensive. Sexual dysfunction was
found in 42.1% of hypertensive women compared with 19.4% of normotensive
women (odds ratio, 3.2; 95% confidence interval, 1.9-4.7; P < 0.001). Systolic
blood pressure levels were significantly related to FSFI score (r = -0.67, P <
0.001). Successful control of hypertension was related to lower prevalence of FSD.
Increasing age (beta = -0.187, P = 0.001), increasing systolic blood pressure (beta
= -0.687, P < 0.001), and beta-blocker administration (beta = -0.162, P = 0.001)
were significant predictors of sexual dysfunction in this patient population.
CONCLUSIONS: FSD is more prevalent in women with essential hypertension
compared with women with normal blood pressure, and its prevalence declines
with adequate blood pressure control. Adequate control of hypertension with
medication not affecting sexual function can have a great impact on the quality of
life of hypertensive patients. Physicians should recognize and properly manage
FSD in hypertensive women.
PMID: 17082720 [PubMed - in process]
24: J Hypertens. 2006 Dec;24(12):2365-70.
Related Articles, Links
Predictive factors for masked hypertension within a population of
controlled hypertensives.
Mallion JM, Clerson P, Bobrie G, Genes N, Vaisse B, Chatellier G.
Service de Cardiologie et hypertension arterielle, CHU, Grenoble, Roubaix, HEGP,
Paris, France. jmmallion@chu-grenoble.fr
CONTEXT: Prevalence of masked hypertension (MH) is far from negligible
reaching 40% in some studies. The SHEAF study (Self measurement of blood
pressure at Home in the Elderly: Assessment and Follow-Up) and others clearly
showed that masked hypertension (MH) as detected by home blood pressure
measurement (HBPM) is associated with poor cardiovascular prognosis.
OBJECTIVE: Systematic HBPM to detect MH is not yet routine. The aim of this
work is to better define the clinical profile of masked hypertensives within a
population with controlled office blood pressure (BP) and the factors associated
with a higher prevalence of MH. MATERIALS AND METHODS: BP was
measured at the clinic by the doctor and at home by the patient himself. Risk
factors for MH were analysed in a cohort of 1150 treated hypertensive patients
over the age of 60 (mean age 70 +/- 6.5, 48.9% men) with controlled office BP.
(SBP < 140 mmHg and DBP < 90 mmHg). RESULTS: 463 patients (40%) were
masked hypertensives (SBP > or = 135 mmHg or DBP > or = 85 mmHg at home).
Three parameters were associated with MH (odds ratio OR): office SBP (OR =
1.110), male gender (OR = 2.214) and age (OR = 1.031). Decision trees showed a
130 mmHg SBP was an efficient threshold to propose HBPM with a higher
probability to detect MH. Subsequent variables were male gender and age over 70
in males. CONCLUSION: To detect masked hypertension, it would be logical to
first of all select patients whose office SBP is between 130 and 140 mmHg.
PMID: 17082717 [PubMed - in process]
25: J Hypertens. 2006 Dec;24(12):2355-6.
Related Articles, Links
NKCC2: the link between nitric oxide inhibition and hypertension?
Ashton N.
Publication Types:


Comment
Editorial
PMID: 17082715 [PubMed - in process]
26: J Hypertens. 2006 May;24(5):981-2.
Related Articles, Links
Comment on:


J Hypertens. 2006 Mar;24(3):413-22.
J Hypertens. 2006 Mar;24(3):423-30.
Estimation of attributable burden of disease: authors' reply.
Gueyffier F, Wright JM.
Publication Types:



Comment
Comparative Study
Letter
PMID: 16612262 [PubMed - indexed for MEDLINE]
27: J Hypertens. 2006 May;24(5):973-9.
Related Articles, Links
Blood pressure normalization is associated with normal left
ventricular mass but not carotid geometry: the ICARe Dicomano
Study.
Pini R, Cavallini MC, Stagliano L, Tarantini F, Marchionni N, Di Bari M,
Devereux RB, Masotti G, Roman MJ.
Department of Critical Care Medicine and Surgery - Unit of Gerontology and
Geriatrics, University of Firenze and the Azienda Ospedaliero-Universitaria
Careggi, Firenze, Italy. rpini@unifi.it
OBJECTIVE: While many studies have examined the relation between
antihypertensive treatment and ventricular hypertrophy, relatively few data are
available regarding changes in arterial structure due to blood pressure reduction.
Therefore, we compared normotensive to untreated hypertensive subjects to
uncontrolled (treated with elevated blood pressure values) or controlled (treated
with normal blood pressure values) hypertensive older subjects. PATIENTS:
Community-dwellers (age >or= 65 years) of a small town in Italy (Dicomano)
underwent extensive clinical examination, echocardiography, carotid
ultrasonography, and applanation tonometry. Of the 614 participants, 173 subjects
were normotensive; among the hypertensive subjects, 225 were untreated (51%),
177 (40%) were uncontrolled, and only 39 (9%) were controlled. RESULTS: The
majority of treated hypertensive subjects were on monotherapy (82%). Subjects
with a history of coronary artery disease or stroke were more frequently treated.
Controlled hypertensives had left ventricular mass index similar to normotensives
but lower than uncontrolled and untreated hypertensives. There were no differences
among the three hypertensive groups in carotid artery structure. Only the pressureindependent stiffness index was reduced in the treated hypertensive subjects
compared to untreated hypertensives, with no difference between controlled and
uncontrolled subjects. CONCLUSIONS: In our community-based, older
population, antihypertensive treatment was associated with a normal left
ventricular mass only when blood pressure was well controlled. In contrast, carotid
artery remodeling and atherosclerosis were independent of antihypertensive
treatment as well as of achievement of satisfactory blood pressure control.
However, antihypertensive treatment was associated with significantly higher
carotid compliance even in the absence of detectable changes in carotid structure.
Publication Types:


Comparative Study
Research Support, Non-U.S. Gov't
PMID: 16612261 [PubMed - indexed for MEDLINE]
28: J Hypertens. 2006 May;24(5):939-45.
Related Articles, Links
Comment in:

J Hypertens. 2006 Jun;24(6):1023-5.
The effect of sodium and angiotensin-converting enzyme inhibition
on the classic circulating renin-angiotensin system in autosomaldominant polycystic kidney disease patients.
Doulton TW, Saggar-Malik AK, He FJ, Carney C, Markandu ND, Sagnella
GA, MacGregor GA.
Blood Pressure Unit, Department of Cardiac and Vascular Sciences, UK.
BACKGROUND: It has been suggested that inappropriate stimulation of the reninangiotensin system (RAS) is responsible for the increase in blood pressure that
occurs in autosomal-dominant polycystic kidney disease (ADPKD) before the
development of renal failure. However, the interpretation of previous studies in
ADPKD patients is confounded by inadequate matching with control populations
for blood pressure and renal function, or failure to control the sodium intake of
participants. METHODS: A double-blind, placebo-controlled study of two
different sodium intakes (350 and 50 mmol/day for 5 days) in a group of 11
hypertensive ADPKD patients and eight matched control subjects with essential
hypertension. In addition, blood pressure and hormonal responses were measured
after the administration of the angiotensin-converting enzyme inhibitor enalapril
for 3 days. RESULTS: Blood pressure and hormonal responses of the RAS after a
reduction in sodium intake and after the administration of enalapril were identical
in ADPKD patients and controls. CONCLUSIONS: Activation of the classic
circulating RAS is no greater in hypertensive ADPKD patients than in individuals
with essential hypertension.
Publication Types:



Comparative Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
PMID: 16612257 [PubMed - indexed for MEDLINE]
29: J Hypertens. 2006 May;24(5):861-5.
Related Articles, Links
How should patients treated with alpha-blockers be followed?
Insights from an ambulatory blood pressure monitoring database.
Ben-Dov IZ, Ben-Arie L, Mekler J, Bursztyn M.
Department of Internal Medicine, Hadassah - Hebrew University Medical Center,
Mount-Scopus Campus, Jerusalem 91240, Israel. vp02292@netvision.net.il
OBJECTIVE: Adrenergic alpha-antagonists have been suggested to confer lesser
protection, compared to diuretics, when used as first agents for hypertension.
While differences in clinic blood pressure may be partly responsible, this
inferiority is unexpected in light of the metabolic advantages of alpha-blockade.
The aim of this study was to evaluate the relationship between use of alphablockers and blood pressure dipping. METHODS: A database of a 24-h ambulatory
monitoring service was cross-sectionally evaluated for associations between
antihypertensives and dipping. There were 681 treated subjects during a 3-year
period (age 63 +/- 14, 57% female). RESULTS: Overall, 78 of 681 treated
hypertensive subjects used alpha-blockers (11%). Nine per cent of dippers and
16% of nondippers were treated with alpha-blockade, odds ratio 2.0. Whereas
clinic, 24-h, and awake blood pressures were similar in alpha-blocker users and
nonusers, sleep blood pressure was significantly higher in the former group.
Furthermore, significantly fewer subjects given alpha-blockers had a controlled
sleep blood pressure. Among alpha-blocker nonusers sleep blood pressure was the
best controlled category, whereas in alpha-blocker users manual blood pressure had
the highest rate of control. Generally, accounting for covariates of alpha-blockade
(age, gender, diabetes, total number of medications) did not influence the abovementioned trends. Finally, a limited negative dose-response relationship between
alpha-blockade and dipping magnitude was also noticed. CONCLUSIONS: We
found a significant negative association between adrenergic alpha-blockade and the
magnitude of sleep-related blood pressure decline. Awaiting results from
interventional studies, this may suggest a need to perform ambulatory monitoring
in patients given alpha-blocking agents (or at least supine and standing
measurements), and may partially clarify the inferiority of doxazosin in the
Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial
(ALLHAT).
Publication Types:

Comparative Study
PMID: 16612247 [PubMed - indexed for MEDLINE]
30: J Hypertens. 2006 May;24(5):819-20.
Related Articles, Links
Comment on:

J Hypertens. 2006 May;24(5):931-7.
Adducin and microalbuminuria: a complex association.
Yagil Y, Yagil C.
Publication Types:



Comment
Comparative Study
Editorial
PMID: 16612241 [PubMed - indexed for MEDLINE]
31: J Hypertens. 2006 May;24(5):815-7.
Related Articles, Links
Comment on:

J Hypertens. 2006 May;24(5):905-13.
Sympathetic overdrive as an independent predictor of left ventricular
hypertrophy: prospective evidence.
Grassi G.
Publication Types:


Comment
Comparative Study

Editorial
PMID: 16612240 [PubMed - indexed for MEDLINE]
32: J Hypertens. 2006 May;24(5):811-2.
Related Articles, Links
Comment on:

J Hypertens. 2006 May;24(5):845-9.
Does blood pressure control require a Cuban-style revolution?
Alderman MH.
Publication Types:



Comment
Comparative Study
Editorial
PMID: 16612238 [PubMed - indexed for MEDLINE]
33: Lancet. 2006 Oct 21;368(9545):1449-56.
Related Articles, Links
Erratum in:

Lancet. 2006 Dec 16;368(9553):2124.
Oral renin inhibitors.
Staessen JA, Li Y, Richart T.
Studies Coordinating Centre, Division of Hypertension and Cardiovascular
Rehabilitation, Department of Cardiovascular Diseases, University of Leuven,
Leuven, Belgium. jan.staessen@med.kuleuven.be
Use of drugs that inhibit the renin-angiotensin system is an effective way to
intervene in the pathogenesis of cardiovascular and renal disorders. The idea of
blocking the renin system at its origin by inhibition of renin has existed for more
than 30 years. Renin inhibition suppresses the generation of the active peptide
angiotensin II. The first generation of orally active renin inhibitors were never used
clinically because of low bioavailability and weak blood-pressure-lowering
activity. At present, aliskiren is the first non-peptide orally active renin inhibitor to
progress to phase-III clinical trials. It might become the first renin inhibitor with
indications for the treatment of hypertension and cardiovascular and renal
disorders. Novel compounds with improved oral bioavailability, specificity, and
efficacy are now in preclinical development. This Review summarises the
development of oral renin inhibitors and their pharmacokinetic and
pharmacodynamic properties, with a focus on aliskiren.
Publication Types:

Review
PMID: 17055947 [PubMed - indexed for MEDLINE]
34: N Engl J Med. 2006 Nov 2;355(18):1934; author reply 1934.
Related Articles, Links
Comment on:

N Engl J Med. 2006 Jul 27;355(4):385-92.
Resistant or difficult-to-control hypertension.
Chandran P.
Publication Types:


Comment
Letter
PMID: 17079772 [PubMed - indexed for MEDLINE]
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Dec 18 2006 06:34:27
1: Am J Hypertens. 2006 Nov;19(11):1190-6.
Related Articles, Links
Medication adherence and persistence as the cornerstone of effective
antihypertensive therapy.
Burnier M.
Service de Nephrologie et Consultation d'Hypertension, Centre Hospitalier
Universitaire Vaudois (CHUV), Lausanne, Switzerland.
michel.burnier@hospvd.ch
Achieving optimal outcomes in the treatment of hypertension--a prevalent and
largely asymptomatic disease--necessitates that patients take their medications not
only properly (medication adherence) but also continue to do so throughout longterm treatment (persistence). However, poor medication-taking behavior is a major
problem among patients with hypertension, and has been identified as one of the
main causes of failure to achieve adequate control of blood pressure (BP). In turn,
patients with hypertension who have uncontrolled BP as a result of their poor
medication-taking behavior remain at risk for serious morbidity and mortality (eg,
stroke, myocardial infarction, and kidney failure), thereby accounting for a
significant cost burden through avoidable hospital admissions, premature deaths,
work absenteeism, and reduced productivity. Improving medication-taking
behavior during antihypertensive therapy therefore represents an important
potential source of health and economic improvement. Whereas many factors may
contribute to poor medication-taking behavior, the complexity of dosage regimens
and the side effect profiles of drugs probably have the greatest therapy-related
influence. Central to any strategy aimed at improving outcomes for patients with
hypertension, therefore, are efficacious antihypertensive agents that facilitate good
medication-taking behavior through simplified dosing and placebo-like tolerability,
along with the development of programs to detect poor medication adherence and
to support long-term medication persistence in daily practice.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17070434 [PubMed - in process]
2: Am J Hypertens. 2006 Nov;19(11):1183-9.
Related Articles, Links
Microalbuminuria, blood pressure load, and systemic vascular
permeability in primary hypertension.
Viazzi F, Leoncini G, Ratto E, Vaccaro V, Tomolillo C, Falqui V, Parodi A,
Conti N, Deferrari G, Pontremoli R.
Department of Internal Medicine and Cardionephrology, Azienda Universitaria
Ospedale San Martino, University of Genoa, Genoa, Italy.
BACKGROUND: Microalbuminuria, a powerful predictor of cardiovascular
events, is thought to reflect widespread subclinical vascular abnormalities. To
explore the pathogenesis of increased urinary albumin excretion in primary
hypertension we evaluated systemic capillary permeability and ambulatory blood
pressure (BP) measurement in two groups of matched untreated patients with (n =
11) and without (n = 29) microalbuminuria. METHODS: Albuminuria was
measured as the mean of albumin-to-creatinine ratio (ACR) in three
nonconsecutive first morning urine samples. Systemic capillary permeability was
evaluated by transcapillary escape rate of albumin (TERalb) (ie, the 1-h decline
rate of intravenous (125)I-albumin). Twenty-four-hour ambulatory BP, renal
hemodynamics, and hormones of the renin-angiotensin-aldosterone system
(RAAS) were also assessed. RESULTS: Patients with microalbuminuria showed
greater body mass index (BMI) (P < .04), higher 24-h systolic and diastolic BP
levels (P = .02), and higher capillary permeability to albumin (P < .02) as
compared to normoalbuminurics. Renal hemodynamics and RAAS hormones were
similar in the two groups. Univariate analysis showed that urinary ACR was related
to ambulatory pressure components (P < .02), TERalb (r = 0.31, P < .05), smoking
habits (r = 0.36, P = .02), and left ventricular mass index (LVMI) (r = 0.57, P <
.001) among the whole study group. Logistic regression analysis showed that each
1% increment in TERalb or 10 mm Hg increase in systolic BP entailed an almost
three times higher risk of having microalbuminuria. CONCLUSIONS:
Microalbuminuria is associated with greater systemic BP load and increased
vascular permeability in patients with primary hypertension.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17070433 [PubMed - in process]
3: Am J Hypertens. 2006 Nov;19(11):1166.
Related Articles, Links
Reporting association to hypertension. Rare genotypes with
protective effects or common genotypes increasing risk.
Wilk JB.
Boston University School of Medicine, Boston, Massachusetts 02118, USA.
jwilk@bu.edu
Publication Types:

Comment
PMID: 17070429 [PubMed - in process]
4: Am J Hypertens. 2006 Nov;19(11):1158-65.
Related Articles, Links
Assessment of the genetic component of hypertension.
Yamada Y, Matsuo H, Segawa T, Watanabe S, Kato K, Hibino T, Yokoi K,
Ichihara S, Metoki N, Yoshida H, Satoh K, Nozawa Y.
Department of Human Functional Genomics, Life Science Research Center, Mie
University, Tsu, Japan. yamada@gene.mie-u.ac.jp
BACKGROUND: Although genetic epidemiologic studies have suggested that
several genetic variants increase the risk for hypertension, the genes that underlie
genetic susceptibility to this condition remain to be identified definitively. We have
now performed a large-scale association study to identify gene polymorphisms for
reliable assessment of the genetic component of hypertension. METHODS: The
study population comprised 4853 unrelated Japanese individuals, including 2818
subjects with hypertension (1677 men, 1141 women) and 2035 controls (1011 men,
1024 women). The genotypes for 150 polymorphisms of 128 candidate genes were
determined with a method that combines the polymerase chain reaction and
sequence-specific oligonucleotide probes with suspension array technology.
RESULTS: Multivariable logistic regression analysis with adjustment for age, sex,
body mass index, and the prevalence of smoking revealed that four polymorphisms
(1648G-->A in ITGA2, -30G-->A in GCK, A-->G in SAH, and 1117C-->A in
PTGIS) were significantly (P < .01) associated with hypertension. A stepwise
forward selection procedure demonstrated that ITGA2, GCK, and PTGIS
genotypes significantly affected the prevalence of hypertension. Combined
genotype analysis of these polymorphisms yielded a lowest odds ratio of 0.47 for
the genotypes of AA or AG for ITGA2, GA or AA for GCK, and CC for PTGIS,
which were present in 1.1% and 2.0% of hypertensive and control individuals,
respectively. CONCLUSIONS: These results suggest that the genotypes for
ITGA2, GCK, and PTGIS may prove reliable for the assessment of the genetic
component of hypertension. Determination of the combined genotypes for these
genes may contribute to personalized prevention of this condition.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17070428 [PubMed - in process]
5: Am J Hypertens. 2006 Nov;19(11):1156-7.
Related Articles, Links
Is echocardiography essential in the management of newly diagnosed
hypertension?
Bella JN, Devereux RB.
Division of Cardiology, Department of Medicine, Bronx-Lebanon Hospital
Center/Albert Einstein College of Medicine, Bronx, New York 10457, USA.
jbella@bronxleb.org
Publication Types:

Comment
PMID: 17070427 [PubMed - in process]
6: Am J Hypertens. 2006 Nov;19(11):1150-5.
Related Articles, Links
Impact of baseline echocardiography on treatment outcome in
primary care patients with newly detected arterial hypertension: a
randomized trial.
Martina B, Nordmann A, Dieterle T, Sigle JP, Bengel G, Kiefer G, Battegay E.
Medical Outpatient Department, and Basel Institute for Clinical Epidemiology,
University Hospital Basel, Basel, Switzerland. bmartina@uhbs.ch
BACKGROUND: The objective of this study was to test whether baseline
echocardiography in newly detected hypertension improves left ventricular mass
index and blood pressure control. This is a randomized trial with primary care
patients. METHODS: After routine clinical work-up 177 consecutive patients with
newly detected hypertension were randomized according to result of their
echocardiogram (echo group and control group). Treating physicians were
encouraged to prescribe angiotensin II receptor antagonist therapy for patients with
evidence of hypertensive target organ damage. Mean blood pressure (BP) and
echocardiographic left ventricular mass index were measured at baseline and after
6 months of therapy in both groups. RESULTS: More patients with hypertensive
target organ damage were identified in the echo group as compared to the control
group (58 of 91 [64%] v 42 of 86 [49%] patients (difference 15%, 95% CI 1%29%). In the echo group, 41 patients (45%) received angiotensin II receptor
antagonist therapy as compared to 27 patients (31%) in the control group
(difference 14%, 95% CI 0-28%). After 6 months, there were no differences in
mean left ventricular mass index, mean diastolic 24-h ambulatory BP monitoring,
or mean systolic and diastolic office BP between the two groups.
CONCLUSIONS: In patients with newly detected hypertension, baseline
echocardiography detects more patients with hypertensive target organ damage, but
does not lead to a reduction in left ventricular mass index or improved BP control
after 6 months of therapy.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17070426 [PubMed - in process]
7: Am J Hypertens. 2006 Nov;19(11):1135-43.
Related Articles, Links
Long-term inhibition of the central alpha(2B)-adrenergic receptor
gene via recombinant AAV-delivered antisense in hypertensive rats.
Shenouda SM, Johns C, Gavras I, Gavras H.
Hypertension and Atherosclerosis Section of the Department of Medicine, Boston
University School of Medicine, Boston, Massachusetts 02118, USA.
sherene@bu.edu
BACKGROUND: Salt-induced hypertension is mediated via the alpha(2B)adrenergic receptor (AR) subtype. In alpha(2B)-AR gene knockout mice, blood
pressure (BP) does not rise with salt loading, and in rats with salt-induced
hypertension, BP decreases transiently with antisense (AS) treatment targeting the
alpha(2B)-AR gene. The present experiments were designed to explore the
possibility of gene transfection in the brain by intracerebroventricular (ICV)
delivery of AS-DNA via adeno-associated virus (AAV) to prolong alpha(2B)-AR
inhibition and hence reversal of salt-dependent hypertension. METHODS: A
recombinant AAV (rAAV) vector preparation encoding the alpha(2B)-AS
fragment (previously tested in vitro for inhibition of alpha(2B)-AR protein
production in cells) and containing green fluorescence protein (GFP) for
visualization was injected ICV into subtotally nephrectomized, salt-fed rats.
Control rats received rAAV-GFP (n = 8 per group). RESULTS: We observed that
BP rose from a baseline of 120 +/- 10 to 184 +/- 12 mm Hg. Injection of rAAValpha(2B)-AS produced a 35 +/- 12 mm Hg fall in BP, lasting without evidence of
diminishing for at least 16 days, whereas rAAV-GFP-injected rats showed a
continued rise in BP. Rats treated with rAAV-alpha(2B)-AS treated had a 45% to
65% decrease in alpha(2B)-AR protein levels in key regulatory regions of the
brain. Neither group had signs of immunologic response to the virus injection.
CONCLUSIONS: These results indicate that our construct, when given by ICV
means, could reach multiple sites of the central nervous system relevant to BP
regulation and could safely inhibit the central alpha(2B)-adrenergic receptor,
thereby achieving prolonged reversal of salt-induced hypertension.
Publication Types:

Research Support, N.I.H., Extramural

Research Support, Non-U.S. Gov't
PMID: 17070424 [PubMed - in process]
8: Am J Hypertens. 2006 Nov;19(11):1118-24.
Related Articles, Links
Directly measured insulin resistance and the assessment of clustered
cardiovascular risks in hypertension.
Lin MW, Hwu CM, Huang YH, Sheu WH, Shih KC, Chiang FT, Olshen R,
Chen YD, Curb JD, Rodriguez B, Ho LT; SAPPHIRe Study Group.
Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei,
Taiwan.
BACKGROUND: The purpose of the study was to use factor analysis to
investigate the contribution of a directly measured insulin sensitivity index, steadystate plasma glucose (SSPG) from insulin suppression test (IST), to a clustering of
cardiovascular risk factors in hypertensive subjects. METHODS: A total of 204
nondiabetic hypertensive patients who received IST for SSPG were included for
current analysis. Factor analysis was performed to explore the contribution of
SSPG as additional information to a clustering of risk factors in these subjects.
RESULTS: In factor analysis, SSPG aggregated with metabolic variables in an
obesity-hyperinsulinemia domain that included two factors: one with positive
loadings for SSPG, 2-h glucose, and Log 2-h insulin; and the other with positive
loadings for body mass index, waist circumference, and fasting glucose. Fasting
insulin linked the two factors together and explained 38.3% of the total variance.
Systolic and diastolic blood pressures were loaded on a blood pressure domain
separately. The third domain consisted of two factors: one with positive loadings
for Log triglycerides and negative loading for high-density lipoprotein cholesterol;
and the other with positive loadings for Log triglycerides and non-high-density
lipoprotein cholesterol. The model loaded without SSPG explained a proportion of
the total variance (78.5%) similar to that achieved with the model loaded with
SSPG (77.1%). CONCLUSIONS: Directly measured insulin sensitivity index
SSPG clustered with 2-h glucose and Log 2-h insulin in factor analysis in a cohort
consisting entirely of hypertensive subjects. However, the contribution of SSPG as
additional information to explain the total variance seems to be insignificant.
Publication Types:


Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
PMID: 17070421 [PubMed - in process]
9: Am J Hypertens. 2006 Nov;19(11):1103-9.
Related Articles, Links
Effect of body weight loss on blood pressure after 6 years of follow-up
in stage 1 hypertension.
Winnicki M, Bonso E, Dorigatti F, Longo D, Zaetta V, Mattarei M, D'Este D,
Laurini G, Pessina AC, Palatini P.
University of Padova, Padova, Italy. mikolaj_winnicki@yahoo.com
BACKGROUND: Although it is known that weight reduction reduces blood
pressure (BP) in overweight patients, the optimal body weight (BW) loss in terms
of BP response is not yet established. We evaluated the relationship between
decrease in BW and BP over time in 796 stage 1 hypertensives. METHODS: The
166 subjects who lost BW were divided into four groups according to percent of
BW loss at the end of a 74-month follow-up (G1, >2% to 5%, G2, >5% to 9%, G3,
>9% to 13%, and G4, >13%) and were compared to the 219 subjects without
changes in BW (G0, -2% to +2%). The BW increased (>2%) in the remaining 411
subjects. RESULTS: Among subjects with BW loss there was a progressive
decrease in final systolic BP associated with BW loss category up to G3 (P = .007),
therefore at the end of follow-up G3 had systolic BP 6.2 mm Hg lower than G0 (P
= .06). However, among G3 and G4 subjects systolic BP decrease was almost
identical (-6.2 nu -5.7 mm Hg, respectively, P = not significant). Similar results
were obtained for diastolic BP, which declined up to G3 (P = .013). G3 had final
diastolic BP 3.6 mm Hg lower than G0 (P = .037), whereas change in diastolic BP
in G4 subjects was similar to that in G0 (-0.9 nu +0.1 mm Hg, respectively, P = not
significant). Similar results were obtained in the group with body mass index
(BMI) >27 kg/m(2). CONCLUSIONS: Our results indicate that in stage 1
hypertensives followed for more than 6 years the dose-response relationship
between BW loss and decrease in BP is not linear irrespective of initial BW. The
BW loss >13% of initial weight did not elicit additional BP decrease.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17070419 [PubMed - in process]
10: Am J Hypertens. 2006 Nov;19(11):1098-100.
Related Articles, Links
A specialist in clinical hypertension critiques the trophy trial.
Meltzer JI.
Publication Types:

Editorial
PMID: 17070417 [PubMed - in process]
11: Am J Hypertens. 2006 Nov;19(11):1095-7.
Related Articles, Links
Studying interventions to prevent the progression from
prehypertension to hypertension: does TROPHY win the prize?
Persell SD, Baker DW.
Publication Types:

Editorial
PMID: 17070416 [PubMed - in process]
12: Arch Intern Med. 2006 Sep 25;166(17):1884-91.
Related Articles, Links
Cardiovascular disease risk factors in chronic kidney disease: overall
burden and rates of treatment and control.
Parikh NI, Hwang SJ, Larson MG, Meigs JB, Levy D, Fox CS.
National Heart, Lung, and Blood Institute's Framingham Heart Study,
Framingham, Mass, USA.
BACKGROUND: Mild to moderate chronic kidney disease (CKD) is associated
with increased risk for cardiovascular disease. The burden of cardiovascular
disease risk factors in this setting is not well described. METHODS: We compared
the age- and sex-adjusted prevalence of cardiovascular disease risk factors and
their treatment and control among persons with and without CKD in 3258
Framingham offspring cohort members who attended the seventh examination
cycle (1998-2001). Glomerular filtration rate (GFR) was estimated using the
simplified Modification of Diet in Renal Disease Study equation. We defined CKD
as a GFR of less than 59 mL/min per 1.73 m(2) in women and less than 64 mL/min
per 1.73 m(2) in men. RESULTS: Those with CKD were older, more likely to be
obese (33.5% vs 29.3%; P=.02), and more likely to have low levels of high-density
lipoprotein cholesterol (45.2% vs 29.4%; P<.001) and high triglyceride levels
(39.9% vs 29.8%; P<.001). Those with CKD had a higher prevalence of
hypertension (71.2% vs 42.7%; P<.001) and hypertension treatment (86.0% vs
72.5%; P<.001), but were less likely to achieve optimal blood pressure control
(27.0% vs 45.5%; P<.001). Participants with CKD had a higher prevalence of
elevated low-density lipoprotein cholesterol levels (60.5% vs 44.7%; P=.06) and
lipid-lowering therapy (57.1% vs 42.6%; P=.09), although this was not statistically
significant. A greater proportion of individuals with CKD than those without had
diabetes (23.5% vs 11.9%; P=.02) and were receiving diabetes treatment (63.6% vs
46.9%; P=.05), but were less likely to achieve a hemoglobin A(1c) level of less
than 7% (43.8% vs 59.4%; P=.03). CONCLUSIONS: Chronic kidney disease is
associated with a significant burden of cardiovascular disease risk factors in the
community. The diagnosis of CKD should alert the practitioner to look for
potentially modifiable cardiovascular risk factors.
Publication Types:


Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
PMID: 17000946 [PubMed - indexed for MEDLINE]
13: BMJ. 2006 Oct 28;333(7574):896-9.
Related Articles, Links
Monitoring renal function in hypertension.
Martin U, Coleman JJ.
Department of Clinical Pharmacology, Division of Medical Sciences, University of
Birmingham, Birmingham B15 2TH. u.martin@bham.ac.uk
Publication Types:


Case Reports
Review
PMID: 17068035 [PubMed - indexed for MEDLINE]
14: J Hum Hypertens. 2007 Jan;21(1):94-5. Epub 2006 Nov 2.
Related Articles, Links
Influence of age and sex on prevalence of masked hypertension
determined from home blood pressure measurements.
Kawabe H, Saito I.
1Department of Internal Medicine, Health Center, Keio University, Tokyo, Japan.
PMID: 17082798 [PubMed - in process]
15: J Hypertens. 2006 Dec;24(12):2482-5.
Related Articles, Links
European Society of Hypertension Scientific Newsletter: treatment of
hypertensive urgencies and emergencies.
Rosei EA, Salvetti M, Farsang C.
Department of Internal Medicine, University of Brescia, Italy.
agabiti@med.unibs.it
PMID: 17082737 [PubMed - in process]
16: J Hypertens. 2006 Dec;24(12):2478-82.
Related Articles, Links
European Society of Hypertension Scientific Newsletter: update on
hypertension management: prevention of type 2 diabetes mellitus
with antihypertensive drugs.
Nilsson PM, Cifkova R, Kjeldsen SE, Mancia G.
Department of Medicine, University Hospital, Malmo, Sweden.
peter.nilsson@med.lu.se
PMID: 17082736 [PubMed - in process]
17: J Hypertens. 2006 Dec;24(12):2477-8.
Related Articles, Links
European Society of Hypertension Scientific Newsletter: control of
hypertension in patients with peripheral artery disease.
Clement DL.
University of Ghent, University Hospital, Ghent, Belgium.
denis.clement@skynet.be
PMID: 17082735 [PubMed - in process]
18: J Hypertens. 2006 Dec;24(12):2465-72.
Related Articles, Links
AT1 receptor blockade is superior to conventional triple therapy in
protecting against end-organ damage in Cyp1a1-Ren-2 transgenic
rats with inducible hypertension.
Vanourkova Z, Kramer HJ, Huskova Z, Vaneckova I, Opocensky M,
Chabova VC, Tesar V, Skaroupkova P, Thumova M, Dohnalova M, Mullins
JJ, Cervenka L.
Center for Experimental Medicine, Institute for Clinical and Experimental
Medicine, Prague, Germany.
OBJECTIVE: In the present study we compared the effects of treatment with the
AT1 receptor antagonist candesartan and of 'triple therapy' (hydralazine,
hydrochlorothiazide, reserpine) on the course of blood pressure, cardiac
hypertrophy and angiotensin II concentrations after induction of hypertension in
transgenic rats with inducible expression of the mouse renin gene (Cyp1a1-Ren-2
rats). METHODS: Hypertension was induced in Cyp1a1-Ren-2 rats through
dietary administration of the natural xenobiotic indole-3-carbinol (I3C, 0.3%) for 4
days. Starting on the day before administration of I3C, rats were treated either with
candesartan or received triple therapy for 9 days. Systolic blood pressure was
measured in conscious animals. Rats were decapitated and angiotensin II levels in
plasma and in whole kidney and left ventricular tissues were determined by
radioimmunoassay. RESULTS: Administration of I3C resulted in the development
of severe hypertension and cardiac hypertrophy that was accompanied by marked
elevations of plasma and tissue angiotensin II concentrations. Candesartan
treatment prevented the development of hypertension and cardiac hypertrophy and
was associated with a reduction of tissue angiotensin II concentrations. In contrast,
triple therapy, despite maintaining systolic blood pressure in the normotensive
range, did not prevent the development of cardiac hypertrophy and tissue
angiotensin II augmentations. CONCLUSIONS: Our findings indicate that
hypertension in Cyp1a1-Ren-2 rats is a clearly angiotensin II-dependent model of
hypertension with elevated circulating and tissue angiotensin II concentrations, and
that antihypertensive treatment with AT1 receptor blockade is superior to
conventional triple therapy in effective protection against hypertension-induced
end-organ damage in this rat model.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17082731 [PubMed - in process]
19: J Hypertens. 2006 Dec;24(12):2459-64.
Related Articles, Links
QT interval in patients with primary aldosteronism and low-renin
essential hypertension.
Maule S, Mulatero P, Milan A, Leotta G, Caserta M, Bertello C, Rabbia F,
Veglio F.
Autonomic Unit and Hypertension Unit, Department of Medicine and
Experimental Oncology, S. Vito Hospital, University of Turin, Turin, Italy.
simmaule@tin.it
INTRODUCTION: QT interval prolongation increases the risk of sudden death in
several medical conditions. Patients with primary aldosteronism and salt-sensitive
hypertension experience more cardiovascular events than those with normal-renin
essential hypertension. QT interval prolongation might represent one of the risk
factors for cardiovascular events in these patients. The aim of the present study was
to evaluate the QT interval in patients with primary aldosteronism and low-renin
essential hypertension (LREH). METHODS: Twenty-seven patients with primary
aldosteronism, 17 patients with LREH, 117 patients with essential hypertension
and 25 healthy individuals were studied. Plasma aldosterone, plasma renin activity,
and aldosterone to plasma renin activity ratio (ARR) were determined. Corrected
QT intervals (QTcs) were measured from a 12-lead electrocardiogram. RESULTS:
The QTc was longer in primary aldosteronism (434 +/- 23 ms) and LREH (430 +/18 ms) compared with essential hypertension (419 +/- 22 ms) and healthy controls
(412 +/- 19 ms) (P = 0.0004). The prevalence of QTc longer than 440 ms was
higher in primary aldosteronism (48%) and LREH (23%) compared with essential
hypertension (11%) and healthy controls (4%) (P < 0.0001). QTc correlated with
plasma aldosterone (P = 0.01), ARR (P = 0.02), and diastolic blood pressure (P =
0.01). ARR (P = 0.01) and systolic blood pressure (P = 0.01) were identified as
independent predictors of QTc. CONCLUSIONS: We postulate that the elevated
aldosterone secretion contributes to the prolongation of the QT interval in patients
with primary aldosteronism and LREH through both a depletion of intracellular
potassium concentration and higher blood pressure values. QTc measurement
might represent one simple, non-invasive and reproducible index to characterize
the cardiovascular risk in patients with primary aldosteronism and LREH.
PMID: 17082730 [PubMed - in process]
20: J Hypertens. 2006 Dec;24(12):2437-43.
Related Articles, Links
Baroreflex sensitivity improvement is associated with decreased
oxidative stress in trained spontaneously hypertensive rat.
Bertagnolli M, Campos C, Schenkel PC, de Oliveira VL, De Angelis K, BelloKlein A, Rigatto K, Irigoyen MC.
Laboratory of Cardiovascular Physiology, Department of Physiology, Basic and
Health Science Institute, Federal University of Rio Grande do Sul, Porto Alegre,
RS, Brazil.
BACKGROUND: Baroreflex sensitivity (BRS) impairment has been associated
with endothelial dysfunction and oxidative stress. METHODS: Because exercise
training could improve endothelial function in spontaneously hypertensive rats
(SHR), the effect of moderate exercise training on oxidative stress and BRS was
investigated. Groups were divided into sedentary and trained Wistar-Kyoto rats (SWK, n = 7 and T-WK, n = 6) and SHR (S-SHR and T-SHR, n = 9 each). Exercise
training was performed on a treadmill (5 days/week, 60 min, 10 weeks), and the
lactate threshold (20 m/min) was used to determine moderate intensity. RESULTS:
Exercise training reduced mean arterial pressure in WK and SHR (S-WK 127 +/- 4,
T-WK 105 +/- 5, S-SHR 169 +/- 4 versus T-SHR 140 +/- 4 mmHg; P < 0.01).
Baroreflex bradycardic (S-WK -1.89 +/- 0.15, T-WK -2.11 +/- 0.37, S-SHR -0.80
+/- 0.09 versus T-SHR -1.29 +/- 0.10 bpm/mmHg; P < 0.0001) and tachycardic (SWK 2.57 +/- 0.19, T-WK 2.73 +/- 0.21, S-SHR 1.18 +/- 0.07 versus T-SHR 2.02
+/- 0.10 bpm/mmHg; P < 0.0001) responses were significantly different between
groups. Lipoperoxidation in erythrocytes (S-WK 11 320 +/- 739, T-WK 10 397 +/765, S-SHR 20 511 +/- 1627 versus T-SHR 10 211 +/- 589 counts per second
(cps)/mg haemoglobin; P < 0.0001) and aortas (S-WK 12 424 +/- 2219, T-WK
7917 +/- 726, S-SHR 26 957 +/- 1772 versus T-SHR 17 777 +/- 1923 cps/mg
protein; P < 0.0001) was reduced in T-SHR compared with S-SHR. Inverse
correlations were observed between both bradycardic and tachycardic responses
and lipoperoxidation in erythrocytes (r = 0.56 and r = -0.77, respectively; P < 0.01)
and aortas (r = 0.77 and r = -0.80, respectively; P < 0.0001). CONCLUSION: Our
results indicate that exercise training decreases oxidative stress, which is related to
an improvement in BRS in SHR.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17082727 [PubMed - in process]
21: J Hypertens. 2006 Dec;24(12):2417-22.
Related Articles, Links
Angiotensin II/AT2 receptor-induced vasodilation in stroke-prone
spontaneously hypertensive rats involves nitric oxide and cGMPdependent protein kinase.
Savoia C, Ebrahimian T, He Y, Gratton JP, Schiffrin EL, Touyz RM.
Lady Davis Institute for Medical Research, SMBD Jewish General Hospital,
McGill University, Montreal, Quebec, Canada.
BACKGROUND: Angiotensin II (Ang II) induces vasodilation, in part, through
angiotensin type 2 receptor (AT2R)-induced actions in conditions associated with
angiotensin type 1 receptor (AT1R) blockade and AT2R upregulation. Ang
II/AT2R-induced vasodilation involves nitric oxide (NO)-cyclic guanosine
monophosphate (cGMP)-dependent processes. We previously demonstrated that
AT2R-mediated effects involve inhibition of the RhoA/Rho kinase pathway.
However, molecular mechanisms underlying this phenomenon are unknown.
AIMS: In the present in-vivo study we tested the hypothesis that AT2R-elicited
vasodilation is associated with nitric oxide synthase (NOS) activation and NO
production, and that a cGMP-dependent protein kinase (cGKI), which inactivates
RhoA, is upregulated when stroke-prone spontaneously hypertensive rats (SHRSP)
are treated with AT1R blockers. METHODS: SHRSP and Wistar-Kyoto (WKY)
rats were treated with the AT1R blocker valsartan for 14 days. Dilatory responses
to Ang II with or without the NOS inhibitor N-nitro-L-arginine methyl ester (LNAME) were performed in norepinephrine-precontracted vessels in the presence of
valsartan. Expression of AT2R, endothelial NOS (eNOS) and cGKI was assessed
by immunoblotting. NO bioavailability and NAD(P)H oxidase activity were
evaluated by chemiluminescence. RESULTS: Ang II elicited vasodilation in
valsartan-treated SHRSP. L-NAME inhibited this effect, indicating a role for NO.
eNOS expression and NO concentration were increased twofold by valsartan, only
in SHRSP. Expression of cGKI was reduced in SHRSP and restored after valsartan
treatment. NAD(P)H oxidase activity was approximately threefold higher in
SHRSP versus WKY (P < 0.05) and reduced by valsartan. CONCLUSIONS: Ang
II, via AT2R, facilitates vasodilation through NOS/NO-mediated pathways and
downregulation of cGKI after chronic AT1R antagonism. These effects may
contribute in part to beneficial actions of AT1R blockers in the treatment of
hypertension.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17082724 [PubMed - in process]
22: J Hypertens. 2006 Dec;24(12):2393-7.
Related Articles, Links
Endothelial nitric oxide synthase haplotypes are related to blood
pressure elevation, but not to resistance to antihypertensive drug
therapy.
Sandrim VC, Yugar-Toledo JC, Desta Z, Flockhart DA, Moreno H Jr, TanusSantos JE.
Department of Pharmacology, Faculty of Medicine of Ribeirao Preto, University of
Sao Paulo, Ribeirao Preto, Brazil.
OBJECTIVES: Most hypertensive patients require two or more drugs to control
arterial blood pressure effectively. Although endothelial nitric oxide synthase
(eNOS) haplotypes have been associated with hypertension, it is unknown whether
eNOS genotypes/haplotypes are associated with resistance to antihypertensive
therapy. METHODS: We studied the distribution of three eNOS genetic
polymorphisms: single nucleotide polymorphisms in the promoter region (T(786)C), and in exon 7 (Glu298Asp), and a variable number of tandem repeats in
intron 4 (b/a). Genotypes were determined for 111 normotensive controls (NT),
116 hypertensive individuals who were well controlled (HT), and 100 hypertensive
individuals who were resistant to conventional antihypertensive therapy (RHT).
We also compared the distribution of eNOS haplotypes in the three groups of
subjects. RESULTS: No differences were found in genotype or allele distribution
among the three groups (all P > 0.05). Conversely, the 'C Glu b' haplotype was
more commonly found in the NT than in the HT or RHT groups (21 versus 8 and
7%, respectively; both P < 0.00625). In addition, the 'C Asp b' haplotype was more
commonly found in the HT or RHT groups than in the NT group (22 and 20%,
respectively, versus 8%; both P < 0.00625). The distribution of eNOS haplotypes
was not significantly different in the HT and RHT groups (P > 0.05).
CONCLUSIONS: Whereas our findings suggest a protective effect for the 'C Glu
b' haplotype against hypertension and that the 'C Asp b' haplotype increases the
susceptibility to hypertension, our results suggest that eNOS haplotypes are not
associated with resistance to antihypertensive therapy.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17082721 [PubMed - in process]
23: J Hypertens. 2006 Dec;24(12):2387-92.
Related Articles, Links
Female sexual dysfunction in essential hypertension: a common
problem being uncovered.
Doumas M, Tsiodras S, Tsakiris A, Douma S, Chounta A, Papadopoulos A,
Kanellakopoulou K, Giamarellou H.
Hypertension Outpatient Clinic, 4th Department of Internal Medicine, University
of Athens, Attikon Hospital, Greece. michalisdoumas@yahoo.co.uk
OBJECTIVES: Female sexual dysfunction (FSD) is increasingly attracting more
scientific and public interest, and represents a poorly investigated issue in patients
with essential hypertension. We evaluated the prevalence of sexual dysfunction in
hypertensive women compared with normotensive women according to age,
hypertension severity, hypertension duration, and antihypertensive treatment.
METHODS: The study population consisted of consecutive, sexually active
women attending an outpatient hypertension clinic. The Female Sexual Function
Index (FSFI questionnaire) was used to evaluate FSD. Univariate and multivariate
analyses were used to evaluate predictors of FSD. RESULTS: Four hundred and
seventeen women were studied. From them, 216 women had arterial hypertension
(136 treated, 80 untreated) and 201 were normotensive. Sexual dysfunction was
found in 42.1% of hypertensive women compared with 19.4% of normotensive
women (odds ratio, 3.2; 95% confidence interval, 1.9-4.7; P < 0.001). Systolic
blood pressure levels were significantly related to FSFI score (r = -0.67, P <
0.001). Successful control of hypertension was related to lower prevalence of FSD.
Increasing age (beta = -0.187, P = 0.001), increasing systolic blood pressure (beta
= -0.687, P < 0.001), and beta-blocker administration (beta = -0.162, P = 0.001)
were significant predictors of sexual dysfunction in this patient population.
CONCLUSIONS: FSD is more prevalent in women with essential hypertension
compared with women with normal blood pressure, and its prevalence declines
with adequate blood pressure control. Adequate control of hypertension with
medication not affecting sexual function can have a great impact on the quality of
life of hypertensive patients. Physicians should recognize and properly manage
FSD in hypertensive women.
PMID: 17082720 [PubMed - in process]
24: J Hypertens. 2006 Dec;24(12):2365-70.
Related Articles, Links
Predictive factors for masked hypertension within a population of
controlled hypertensives.
Mallion JM, Clerson P, Bobrie G, Genes N, Vaisse B, Chatellier G.
Service de Cardiologie et hypertension arterielle, CHU, Grenoble, Roubaix, HEGP,
Paris, France. jmmallion@chu-grenoble.fr
CONTEXT: Prevalence of masked hypertension (MH) is far from negligible
reaching 40% in some studies. The SHEAF study (Self measurement of blood
pressure at Home in the Elderly: Assessment and Follow-Up) and others clearly
showed that masked hypertension (MH) as detected by home blood pressure
measurement (HBPM) is associated with poor cardiovascular prognosis.
OBJECTIVE: Systematic HBPM to detect MH is not yet routine. The aim of this
work is to better define the clinical profile of masked hypertensives within a
population with controlled office blood pressure (BP) and the factors associated
with a higher prevalence of MH. MATERIALS AND METHODS: BP was
measured at the clinic by the doctor and at home by the patient himself. Risk
factors for MH were analysed in a cohort of 1150 treated hypertensive patients
over the age of 60 (mean age 70 +/- 6.5, 48.9% men) with controlled office BP.
(SBP < 140 mmHg and DBP < 90 mmHg). RESULTS: 463 patients (40%) were
masked hypertensives (SBP > or = 135 mmHg or DBP > or = 85 mmHg at home).
Three parameters were associated with MH (odds ratio OR): office SBP (OR =
1.110), male gender (OR = 2.214) and age (OR = 1.031). Decision trees showed a
130 mmHg SBP was an efficient threshold to propose HBPM with a higher
probability to detect MH. Subsequent variables were male gender and age over 70
in males. CONCLUSION: To detect masked hypertension, it would be logical to
first of all select patients whose office SBP is between 130 and 140 mmHg.
PMID: 17082717 [PubMed - in process]
25: J Hypertens. 2006 Dec;24(12):2355-6.
Related Articles, Links
NKCC2: the link between nitric oxide inhibition and hypertension?
Ashton N.
Publication Types:


Comment
Editorial
PMID: 17082715 [PubMed - in process]
26: J Hypertens. 2006 May;24(5):981-2.
Related Articles, Links
Comment on:


J Hypertens. 2006 Mar;24(3):413-22.
J Hypertens. 2006 Mar;24(3):423-30.
Estimation of attributable burden of disease: authors' reply.
Gueyffier F, Wright JM.
Publication Types:



Comment
Comparative Study
Letter
PMID: 16612262 [PubMed - indexed for MEDLINE]
27: J Hypertens. 2006 May;24(5):973-9.
Related Articles, Links
Blood pressure normalization is associated with normal left
ventricular mass but not carotid geometry: the ICARe Dicomano
Study.
Pini R, Cavallini MC, Stagliano L, Tarantini F, Marchionni N, Di Bari M,
Devereux RB, Masotti G, Roman MJ.
Department of Critical Care Medicine and Surgery - Unit of Gerontology and
Geriatrics, University of Firenze and the Azienda Ospedaliero-Universitaria
Careggi, Firenze, Italy. rpini@unifi.it
OBJECTIVE: While many studies have examined the relation between
antihypertensive treatment and ventricular hypertrophy, relatively few data are
available regarding changes in arterial structure due to blood pressure reduction.
Therefore, we compared normotensive to untreated hypertensive subjects to
uncontrolled (treated with elevated blood pressure values) or controlled (treated
with normal blood pressure values) hypertensive older subjects. PATIENTS:
Community-dwellers (age >or= 65 years) of a small town in Italy (Dicomano)
underwent extensive clinical examination, echocardiography, carotid
ultrasonography, and applanation tonometry. Of the 614 participants, 173 subjects
were normotensive; among the hypertensive subjects, 225 were untreated (51%),
177 (40%) were uncontrolled, and only 39 (9%) were controlled. RESULTS: The
majority of treated hypertensive subjects were on monotherapy (82%). Subjects
with a history of coronary artery disease or stroke were more frequently treated.
Controlled hypertensives had left ventricular mass index similar to normotensives
but lower than uncontrolled and untreated hypertensives. There were no differences
among the three hypertensive groups in carotid artery structure. Only the pressureindependent stiffness index was reduced in the treated hypertensive subjects
compared to untreated hypertensives, with no difference between controlled and
uncontrolled subjects. CONCLUSIONS: In our community-based, older
population, antihypertensive treatment was associated with a normal left
ventricular mass only when blood pressure was well controlled. In contrast, carotid
artery remodeling and atherosclerosis were independent of antihypertensive
treatment as well as of achievement of satisfactory blood pressure control.
However, antihypertensive treatment was associated with significantly higher
carotid compliance even in the absence of detectable changes in carotid structure.
Publication Types:


Comparative Study
Research Support, Non-U.S. Gov't
PMID: 16612261 [PubMed - indexed for MEDLINE]
28: J Hypertens. 2006 May;24(5):939-45.
Related Articles, Links
Comment in:

J Hypertens. 2006 Jun;24(6):1023-5.
The effect of sodium and angiotensin-converting enzyme inhibition
on the classic circulating renin-angiotensin system in autosomaldominant polycystic kidney disease patients.
Doulton TW, Saggar-Malik AK, He FJ, Carney C, Markandu ND, Sagnella
GA, MacGregor GA.
Blood Pressure Unit, Department of Cardiac and Vascular Sciences, UK.
BACKGROUND: It has been suggested that inappropriate stimulation of the reninangiotensin system (RAS) is responsible for the increase in blood pressure that
occurs in autosomal-dominant polycystic kidney disease (ADPKD) before the
development of renal failure. However, the interpretation of previous studies in
ADPKD patients is confounded by inadequate matching with control populations
for blood pressure and renal function, or failure to control the sodium intake of
participants. METHODS: A double-blind, placebo-controlled study of two
different sodium intakes (350 and 50 mmol/day for 5 days) in a group of 11
hypertensive ADPKD patients and eight matched control subjects with essential
hypertension. In addition, blood pressure and hormonal responses were measured
after the administration of the angiotensin-converting enzyme inhibitor enalapril
for 3 days. RESULTS: Blood pressure and hormonal responses of the RAS after a
reduction in sodium intake and after the administration of enalapril were identical
in ADPKD patients and controls. CONCLUSIONS: Activation of the classic
circulating RAS is no greater in hypertensive ADPKD patients than in individuals
with essential hypertension.
Publication Types:



Comparative Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
PMID: 16612257 [PubMed - indexed for MEDLINE]
29: J Hypertens. 2006 May;24(5):861-5.
Related Articles, Links
How should patients treated with alpha-blockers be followed?
Insights from an ambulatory blood pressure monitoring database.
Ben-Dov IZ, Ben-Arie L, Mekler J, Bursztyn M.
Department of Internal Medicine, Hadassah - Hebrew University Medical Center,
Mount-Scopus Campus, Jerusalem 91240, Israel. vp02292@netvision.net.il
OBJECTIVE: Adrenergic alpha-antagonists have been suggested to confer lesser
protection, compared to diuretics, when used as first agents for hypertension.
While differences in clinic blood pressure may be partly responsible, this
inferiority is unexpected in light of the metabolic advantages of alpha-blockade.
The aim of this study was to evaluate the relationship between use of alphablockers and blood pressure dipping. METHODS: A database of a 24-h ambulatory
monitoring service was cross-sectionally evaluated for associations between
antihypertensives and dipping. There were 681 treated subjects during a 3-year
period (age 63 +/- 14, 57% female). RESULTS: Overall, 78 of 681 treated
hypertensive subjects used alpha-blockers (11%). Nine per cent of dippers and
16% of nondippers were treated with alpha-blockade, odds ratio 2.0. Whereas
clinic, 24-h, and awake blood pressures were similar in alpha-blocker users and
nonusers, sleep blood pressure was significantly higher in the former group.
Furthermore, significantly fewer subjects given alpha-blockers had a controlled
sleep blood pressure. Among alpha-blocker nonusers sleep blood pressure was the
best controlled category, whereas in alpha-blocker users manual blood pressure had
the highest rate of control. Generally, accounting for covariates of alpha-blockade
(age, gender, diabetes, total number of medications) did not influence the abovementioned trends. Finally, a limited negative dose-response relationship between
alpha-blockade and dipping magnitude was also noticed. CONCLUSIONS: We
found a significant negative association between adrenergic alpha-blockade and the
magnitude of sleep-related blood pressure decline. Awaiting results from
interventional studies, this may suggest a need to perform ambulatory monitoring
in patients given alpha-blocking agents (or at least supine and standing
measurements), and may partially clarify the inferiority of doxazosin in the
Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial
(ALLHAT).
Publication Types:

Comparative Study
PMID: 16612247 [PubMed - indexed for MEDLINE]
30: J Hypertens. 2006 May;24(5):819-20.
Related Articles, Links
Comment on:

J Hypertens. 2006 May;24(5):931-7.
Adducin and microalbuminuria: a complex association.
Yagil Y, Yagil C.
Publication Types:



Comment
Comparative Study
Editorial
PMID: 16612241 [PubMed - indexed for MEDLINE]
31: J Hypertens. 2006 May;24(5):815-7.
Related Articles, Links
Comment on:

J Hypertens. 2006 May;24(5):905-13.
Sympathetic overdrive as an independent predictor of left ventricular
hypertrophy: prospective evidence.
Grassi G.
Publication Types:


Comment
Comparative Study

Editorial
PMID: 16612240 [PubMed - indexed for MEDLINE]
32: J Hypertens. 2006 May;24(5):811-2.
Related Articles, Links
Comment on:

J Hypertens. 2006 May;24(5):845-9.
Does blood pressure control require a Cuban-style revolution?
Alderman MH.
Publication Types:



Comment
Comparative Study
Editorial
PMID: 16612238 [PubMed - indexed for MEDLINE]
33: Lancet. 2006 Oct 21;368(9545):1449-56.
Related Articles, Links
Erratum in:

Lancet. 2006 Dec 16;368(9553):2124.
Oral renin inhibitors.
Staessen JA, Li Y, Richart T.
Studies Coordinating Centre, Division of Hypertension and Cardiovascular
Rehabilitation, Department of Cardiovascular Diseases, University of Leuven,
Leuven, Belgium. jan.staessen@med.kuleuven.be
Use of drugs that inhibit the renin-angiotensin system is an effective way to
intervene in the pathogenesis of cardiovascular and renal disorders. The idea of
blocking the renin system at its origin by inhibition of renin has existed for more
than 30 years. Renin inhibition suppresses the generation of the active peptide
angiotensin II. The first generation of orally active renin inhibitors were never used
clinically because of low bioavailability and weak blood-pressure-lowering
activity. At present, aliskiren is the first non-peptide orally active renin inhibitor to
progress to phase-III clinical trials. It might become the first renin inhibitor with
indications for the treatment of hypertension and cardiovascular and renal
disorders. Novel compounds with improved oral bioavailability, specificity, and
efficacy are now in preclinical development. This Review summarises the
development of oral renin inhibitors and their pharmacokinetic and
pharmacodynamic properties, with a focus on aliskiren.
Publication Types:

Review
PMID: 17055947 [PubMed - indexed for MEDLINE]
34: N Engl J Med. 2006 Nov 2;355(18):1934; author reply 1934.
Related Articles, Links
Comment on:

N Engl J Med. 2006 Jul 27;355(4):385-92.
Resistant or difficult-to-control hypertension.
Chandran P.
Publication Types:


Comment
Letter
PMID: 17079772 [PubMed - indexed for MEDLINE]
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1: Am J Med. 2007 Jan;120(1):26-32.
Related Articles, Links
Antihypertensive medication adherence in the
Department of Veterans Affairs.
Siegel D, Lopez J, Meier J.
Medical Service, VA Northern California Health Care System,
Martinez, Calif, USA. david.siegel@med.va.gov
PURPOSE: Adherence measures the extent to which patients take
medications as prescribed by their health care provider. The control
of hypertension is dependent on medication adherence and may vary
on the basis of antihypertensive medication class and other factors.
METHODS: The Department of Veterans Affairs' automated
pharmacy database captures pharmacy medication use; International
Classification of Diseases, 9th Revision, diagnostic codes; and
laboratory and patient demographic data on a monthly basis.
Hypertensive patients who used thiazide diuretics, beta-blockers,
angiotensin-converting enzyme inhibitors, angiotensin receptor
blockers, calcium channel antagonists, and alpha-blockers from July
2002 to December 2003 were studied. The first date of prescription
filling for each patient within the date range was the index date from
which fill and refill dates were collected for up to 18 months to
calculate medication possession ratios and days out of medication
ratios. Patients were categorized as adherent if the medication
possession ratio was 80% or greater. Logistic regression was used to
study the association of medication class, age, gender, ethnicity,
Veterans Affairs facility, and co-diagnosis with diabetes,
schizophrenia/psychosis, depression, and dementia with medication
adherence. RESULTS: We studied 40,492 hypertensive patients
taking at least one antihypertensive drug class. The average age per
class ranged from 67.4 to 72.9 years; 96% were male; and 51% were
white, 8% were African-American, 4% were Asian-American, and
3% were Hispanic. Unadjusted adherence rates based on the
medication possession ratio ranged from 78.3% for thiazide diuretics
to 83.6% for angiotensin receptor blockers (P<.001). The number of
medications (either total or antihypertensive) and age were
independent predictors of better adherence. Black ethnicity and
depression were associated with worse adherence. CONCLUSIONS:
Adherence rates with all antihypertensive medications were high.
Although there were statistical differences by drug class, these
differences were small. Ethnicity and depression identified groups
that might benefit from programs to improve adherence.
PMID: 17208076 [PubMed - in process]
2: Circulation. 2007 Jan 23;115(3):333-44. Epub 2007
Jan 8.
Related Articles,
Links
Accelerated mitochondrial adenosine
diphosphate/adenosine triphosphate transport improves
hypertension-induced heart disease.
Walther T, Tschope C, Sterner-Kock A, Westermann D,
Heringer-Walther S, Riad A, Nikolic A, Wang Y, Ebermann L,
Siems WE, Bader M, Shakibaei M, Schultheiss HP, Dorner A.
Charite-Universitatsmedizin, Campus Benjamin Franklin,
Department of Cardiology and Pneumonology, Hindenburgdamm
30, 12200 Berlin, Germany. thomas.walther@charite.de
BACKGROUND: Strong evidence suggests that mitochondrial
malfunction, which leads to disturbed energy metabolism and
stimulated apoptosis, is a linchpin in the induction and manifestation
of cardiac failure. An adequate exchange of ATP and ADP over the
inner mitochondrial membrane by the adenine nucleotide translocase
(ANT) is thereby essential to guarantee the cellular energy supply.
METHODS AND RESULTS: To explore the effect of an
ameliorated mitochondrial ATP/ADP transportation on cardiac
dysfunction, we generated transgenic rats overexpressing ANT1 in
the heart (ANT rats) and crossed them with renin-overexpressing
rats (REN rats) suffering from hypertension-induced cardiac
insufficiency. Cardiac-specific ANT1 overexpression resulted in a
higher ATP/ADP transportation and elevated activities of respiratory
chain complexes. Increased ANT activity in double-transgenic
(ANT/REN) animals did not influence excessive hypertension seen
in REN rats. Hypertension-induced cardiac hypertrophy in the REN
rats was prevented by parallel ANT1 overexpression, however, and
left ventricular function remarkably improved. The ANT1
overexpression led to a reduction in fibrosis and an improvement in
cardiac tissue architecture. Consequently, the survival rate of
ANT/REN rats was enhanced. Further investigations into the
cardioprotective mechanism of ANT1 overexpression revealed
improved mitochondrial structure and function and significantly
reduced apoptosis in ANT/REN rats, shown by lowered
cytosolic/mitochondrial cytochrome c ratio, reduced caspase 3 level,
and prevented DNA degradation. CONCLUSIONS: Myocardial
ANT1 overexpression protects against hypertension-induced cardiac
pathology. Thus, the improvement in mitochondrial function may be
a basic principle for new strategies in treating heart disease.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17210842 [PubMed - in process]
3: Circulation. 2007 Jan 16;115(2):221-7. Epub 2007
Jan 8.
Related Articles,
Links
Cardiac and systemic hemodynamic characteristics of
hypertension and prehypertension in adolescents and
young adults: the Strong Heart Study.
Drukteinis JS, Roman MJ, Fabsitz RR, Lee ET, Best LG,
Russell M, Devereux RB.
Weill Medical College of Cornell University, New York, NY, USA.
BACKGROUND: The epidemic of overweight is increasing the
prevalence of both prehypertension and early-onset hypertension,
but few population-based data exist on their impact on cardiac
structure and function in adolescents and young adults. METHODS
AND RESULTS: We analyzed clinical characteristics,
hemodynamic parameters, and left ventricular structure and function
in 1940 participants, 14 to 39 years of age, in the Strong Heart
Study. Hypertension occurred in 294 participants (15%), who were
more often men (70% versus 30%), older (age, 31+/-7 versus 25+/-8
years), and more commonly diabetic (23% versus 4.5%; all
P<0.001) than their normotensive counterparts. Prehypertension
occurred in 675 (35%) of participants with similar trends in gender,
age, and diabetes status. After adjustment for covariates, both
hypertensive and prehypertensive participants had higher left
ventricular wall thickness (0.83 and 0.78 versus 0.72 cm), left
ventricular mass (182 and 161 versus 137 g), and relative wall
thickness (0.30 and 0.29 versus 0.28 cm) and 3- and 2-fold-higher
prevalences of left ventricular hypertrophy than their normotensive
counterparts (all P<0.001). Hypertension and prehypertension also
were associated with higher mean pulse pressure/stroke volume
index (1.24 and 1.15 versus 1.02 mm Hg/mL x m2) and total
peripheral resistance index (3027 and 2805 versus 2566 dynes x s x
cm(-5) x m2; all P<0.001). CONCLUSIONS: In a population with
high prevalences of obesity and diabetes, hypertension and
prehypertension are associated with increases in both cardiac output
and peripheral resistance index. Despite the young age of
participants with hypertension and prehypertension, they had
prognostically adverse preclinical cardiovascular disease, including
left ventricular hypertrophy and evidence of increased arterial
stiffness.
Publication Types:

Research Support, N.I.H., Extramural
PMID: 17210838 [PubMed - in process]
4: Hypertension. 2007 Feb;49(2):380-8. Epub 2007
Jan 8.
Related Articles,
Links
Gene transfer of neuronal nitric oxide synthase into
intracardiac Ganglia reverses vagal impairment in
hypertensive rats.
Heaton DA, Li D, Almond SC, Dawson TA, Wang L, Channon
KM, Paterson DJ.
Burdon Sanderson Cardiac Science Centre, Department of
Physiology, Anatomy and Genetics, University of Oxford, Oxford,
United Kingdom.
Hypertension is associated with reduced cardiac vagal activity and
decreased atrial guanylate cyclase and cGMP levels. Neuronal
production of NO facilitates cardiac parasympathetic transmission,
although oxidative stress caused by hypertension may disrupt this
pathway. We tested the hypothesis that peripheral vagal
responsiveness is attenuated in the spontaneously hypertensive rat
(SHR) because of impaired NO-cGMP signaling and that gene
transfer of neuronal NO synthase (nNOS) into cholinergic
intracardiac ganglia can restore neural function. Cardiac vagal heart
rate responses in the isolated SHR atrial/right vagus preparation
were significantly attenuated compared with age-matched
normotensive Wistar-Kyoto rats. [(3)H] acetylcholine release was
also significantly lower in the SHR. The NO donor, sodium
nitroprusside, augmented vagal responses to nerve stimulation and
[(3)H] acetylcholine release in the Wistar-Kyoto rat, whereas the
soluble guanylate cyclase inhibitor 1H-(1,2,4)oxadiazolo(4,3a)quinoxaline-1-one attenuated [(3)H] acetylcholine release in
Wistar-Kyoto atria. No effects of sodium nitroprusside or 1H(1,2,4)oxadiazolo(4,3-a)quinoxaline-1-one were seen in the SHR
during nerve stimulation. In contrast, SHR atria were
hyperresponsive to carbachol-induced bradycardia, with elevated
production of atrial cGMP. After gene transfer of adenoviral nNOS
into the right atrium, vagal responsiveness in vivo was significantly
increased in the SHR compared with transfection with adenoviral
enhanced green fluorescent protein. Atrial nNOS activity was
increased after gene transfer of adenoviral nNOS, as was expression
of alpha(1)-soluble guanylate cyclase in both groups compared with
adenoviral enhanced green fluorescent protein. In conclusion, a
significant component of cardiac vagal dysfunction in hypertension
is attributed to an impairment of the postganglionic presynaptic NOcGMP pathway and that overexpression of nNOS can reverse this
neural phenotype.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17210833 [PubMed - in process]
5: J Am Coll Cardiol. 2006 Dec 5;48(11):2340-7. Epub
2006 Oct 16.
Related Articles,
Links
A randomized trial of circumferential pulmonary vein
ablation versus antiarrhythmic drug therapy in
paroxysmal atrial fibrillation: the APAF Study.
Pappone C, Augello G, Sala S, Gugliotta F, Vicedomini G,
Gulletta S, Paglino G, Mazzone P, Sora N, Greiss I,
Santagostino A, LiVolsi L, Pappone N, Radinovic A, Manguso F,
Santinelli V.
Division of Cardiac Pacing and Electrophysiology, San Raffaele
University Hospital, Milan, Italy. carlo.pappone@hsr.it
OBJECTIVES: We compared ablation strategy with antiarrhythmic
drug therapy (ADT) in patients with paroxysmal atrial fibrillation
(PAF). BACKGROUND: Atrial fibrillation (AF) ablation strategy is
superior to ADT in patients with an initial history of PAF, but its
role in patients with a long history of AF as compared with ADT
remains a challenge. METHODS: One hundred ninety-eight patients
(age, 56 +/- 10 years) with PAF of 6 +/- 5 years' duration (mean AF
episodes 3.4/month) who had failed ADT were randomized to AF
ablation by circumferential pulmonary vein ablation (CPVA) or to
the maximum tolerable doses of another ADT, which included
flecainide, sotalol, and amiodarone. Crossover to CPVA was
allowed after 3 months of ADT. RESULTS: By Kaplan-Meier
analysis, 86% of patients in the CPVA group and 22% of those in
the ADT group who did not require a second ADT were free from
recurrent atrial tachyarrhythmias (AT) (p < 0.001); a repeat ablation
was performed in 9% of patients in the CPVA group for recurrent
AF (6%) or atrial tachycardia (3%). At 1 year, 93% and 35% of the
CPVA and ADT groups, respectively, were AT-free. Ejection
fraction, hypertension, and age independently predicted AF
recurrences in the ADT group. Circumferential pulmonary vein
ablation was associated with fewer cardiovascular hospitalizations
(p < 0.01). One transient ischemic attack and 1 pericardial effusion
occurred in the CPVA group; side effects of ADT were observed in
23 patients. CONCLUSIONS: Circumferential pulmonary vein
ablation is more successful than ADT for prevention of PAF with
few complications. Atrial fibrillation ablation warrants consideration
in selected patients in whom ADT had already failed and
maintenance of sinus rhythm is desired. (A Controlled Randomized
Trial of CPVA Versus Antiarrhythmic Drug Therapy in for
Paroxysmal AF: APAF/01; http://clinicaltrials.gov/ct/show;
NCT00340314).
Publication Types:

Randomized Controlled Trial
PMID: 17161267 [PubMed - indexed for MEDLINE]
6: J Hum Hypertens. 2007 Jan 11; [Epub ahead of
print]
Related Articles,
Links
Both angiotensinogen M235T and alpha-adducin G460W
polymorphisms are associated with hypertension in the
Japanese population.
Nakamura Y, Tabara Y, Miki T, Tamaki S, Kita Y, Okamura T,
Ueshima H.
1Cardiovascular Epidemiology, Kyoto Women's University,
Higashiyama-ku, Kyoto, Japan.
PMID: 17215849 [PubMed - as supplied by publisher]
7: J Hum Hypertens. 2007 Jan 11; [Epub ahead of
print]
Related Articles,
Links
Effect of valsartan addition to amlodipine on ankle
oedema and subcutaneous tissue pressure in hypertensive
patients.
Fogari R, Zoppi A, Derosa G, Mugellini A, Lazzari P, Rinaldi A,
Fogari E, Preti P.
1Dipartimento di Medicina Interna, Clinica Medica II, IRCCS
Policlinico S Matteo, Universita di Pavia, Pavia, Italy.
The aim of this study was to assess the effect of valsartan addition to
amlodipine on ankle foot volume (AFV) and pretibial subcutaneous
tissue pressure (PSTP), two objective measures of ankle oedema.
After a 4-week placebo period, 80 grade 1-2 hypertensive patients
(diastolic blood pressure (DBP)>90 mm Hg and <110 systolic blood
pressure (SBP)>140 mm Hg) were randomized to amlodipine 10 mg
or valsartan 160 mg or amlodipine 10 mg plus valsartan 160 mg for
6 weeks according to an open-label, blinded end point, crossover
design. At the end of the placebo period and of each treatment
period, blood pressure, AFV and PSTP were evaluated. AFV was
measured using the principle of water displacement. PSTP was
assessed connecting the subcutaneous pretibial interstitial
environment with a water manometer. Both amlodipine and
valsartan monotherapy significantly reduced SBP (-16.9 and -14.5
mm Hg, respectively, P<0.01 vs baseline), and DBP (-12.9 and -10.2
mm Hg, respectively, P<0.01 vs baseline) but the reduction was
greater with the combination (-22.9 mm Hg for SBP, P<0.01 vs
monotherapy; -16.8 mm Hg for DBP, P<0.01 vs monotherapy).
Amlodipine monotherapy significantly increased both AFV (+23%,
P<0.01 vs baseline) and PSTP (+75.5%, P<0.001 vs baseline)
whereas valsartan monotherapy did not influence them. As
compared to amlodipine alone, the combination produced a less
marked increase in AFV (+6.8%, P<0.01 vs amlodipine) and PSTP
(+23.2%, P<0.001 vs amlodipine). Ankle oedema was clinically
evident in 24 patients with amlodipine and in six patients with the
combination. These results suggest that angiotensin receptor
blockers partially counteract the microcirculatory changes
responsible for calcium channel blockers induced oedema
formation.Journal of Human Hypertension advance online
publication, 11 January 2007; doi:10.1038/sj.jhh.1002140.
PMID: 17215848 [PubMed - as supplied by publisher]
8: J Hypertens. 2007 Feb;25(2):471-477.
Related Articles, Links
Effects of growth hormone and insulin-like growth
factor-1 on cardiac hypertrophy of hypertensive patients.
Sesti G, Sciacqua A, Scozzafava A, Vatrano M, Angotti E,
Ruberto C, Santillo E, Parlato G, Perticone F.
aUnit of Internal Medicine bChemistry and Clinical Chemistry Unit,
Department of Experimental and Clinical Medicine 'G. Salvatore',
University Magna Graecia of Catanzaro, Italy.
OBJECTIVES: Growth hormone (GH) and insulin-like growth
factor-1 (IGF-1) interfere with cardiac mass (left ventricular mass;
LVM) development. We investigated the role of the GH/IGF-1 axis
on LVM and ventricular geometry in a group of 230 never-treated
hypertensive patients. METHODS: Partition values for left
ventricular hypertrophy (LVH) were 125 g/m for both women and
men. Insulin resistance was estimated by the homeostasis model
assessment (HOMA) index. RESULTS: A significant inverse
correlation was observed between IGF-1 and both fasting insulin (r
= -0.249; P < 0.0001) and GH (r = -0.218; P < 0.0001). Systolic
blood pressure (157.3 +/- 13.6 versus 149.4 +/- 12.8 mmHg; P <
0.001), fasting insulin (17.4 +/- 8.5 versus 11.4 +/- 6.0 muU/l; P <
0.0001), HOMA (4.4 +/- 2.3 versus 2.9 +/- 1.6; P < 0.0001) and GH
(1.0 +/- 1.0 versus 0.4 +/- 0.5 ng/ml; P < 0.0001) were significantly
higher in patients with LVH; on the contrary, IGF-1 values (119.1
+/- 47.8 versus 160.1 +/- 75.5 ng/ml; P < 0.0001) were higher in
patients without LVH. In a logistic regression analysis, the strongest
independent predictors of LVH were GH [relative risk (RR) =
2.078; 95% confidence interval (CI) = 1.364-3.163], HOMA (RR =
1.345; 95% CI = 1.133-1.596), IGF-1 (RR = 0.993; 95% CI = 0.9980.999) and systolic blood pressure (RR = 1.036; 95% CI = 1.0131.060). IGF-1 showed an opposite trend in patients with eccentric
and concentric hypertrophy. CONCLUSIONS: Present data
demonstrate that the increase in LVM prevalent in human essential
hypertension is directly associated with serum GH levels and
inversely related to circulating IGF-1.
PMID: 17211256 [PubMed - as supplied by publisher]
9: J Hypertens. 2007 Feb;25(2):455-461.
Related Articles, Links
Therapeutic effects of angiotensin II type 1 receptor
blocker at an advanced stage of hypertensive diastolic
heart failure.
Nishio M, Sakata Y, Mano T, Yoshida J, Ohtani T, Takeda Y,
Miwa T, Masuyama T, Yamamoto K, Hori M.
aDepartment of Cardiovascular Medicine, Osaka University
Graduate School of Medicine, Suita bGenome Information Research
Center, Osaka University, Suita cCardiovascular Division,
Department of Internal Medicine, Hyogo College of Medicine,
Nishinomiya, Japan.
OBJECTIVE: Angiotensin II type 1 receptor blocker (ARB) is
increasingly prescribed for the treatment of systolic heart failure
with a growing body of clinical evidence. The roles of ARB,
however, remain to be clarified in the treatment of diastolic heart
failure (DHF), particularly at its advanced stage. This experimental
study investigated the effects of ARB administered at an advanced
stage of hypertensive DHF. METHODS: Dahl salt-sensitive rats fed
an 8% NaCl diet from age 7 weeks represent overt DHF at age 20
weeks, as noted in previous studies (hypertensive DHF model). The
DHF model rats were randomly divided into two groups at age 17
weeks when left ventricular diastolic dysfunction, hypertrophy,
fibrosis, macrophage infiltration and reactive oxygen species
generation were already augmented; six rats treated for 3 weeks with
a subdepressor dose of ARB (olmesartan 0.6 mg/kg per day), and six
untreated rats. RESULTS: The 3-week administration of ARB
significantly decreased the left ventricular end-diastolic pressure in
association with attenuation of left ventricular hypertrophy, fibrosis
and diastolic dysfunction. Macrophage infiltration was attenuated
with decreased gene expression of transforming growth factor-beta1
and monocyte chemoattractant protein-1 in the left ventricular
myocardium of the ARB-treated rats. The production of reactive
oxygen species also decreased with NADPH oxidase activity.
CONCLUSIONS: ARB provides beneficial effects in hypertensive
DHF independent of its antihypertensive effects even if initiated at
an advanced stage. The beneficial effects are at least partly
attributed to the attenuation of inflammatory changes and oxidative
stress through the suppression of cytokine and chemokine
production and of NADPH oxidase activity.
PMID: 17211254 [PubMed - as supplied by publisher]
10: J Hypertens. 2007 Feb;25(2):429-38.
Related Articles, Links
Neonatal streptozotocin-induced glucose intolerance:
different consequences in Lyon normotensive and
hypertensive rats.
Emonnot L, Cohen R, Lo M.
aDepartement de Physiologie et Pharmacologie Clinique - EA3995
bLaboratoire des Biomateriaux et Remodelage Matriciels - EA3090,
Faculte de Pharmacie, Universite Lyon 1, France.
BACKGROUND: Lyon hypertensive (LH) rats exhibit a mild
hypertension associated with excessive body weight, spontaneous
hyperlipidemia, elevated insulin/glucose ratio and exaggerated
urinary protein excretion. AIMS: We aimed to develop, in LH rats
and their normotensive control (LL) rats, a moderate non-insulindependent diabetic model to study the different consequences on
metabolic and renal functions. METHODS: Non-insulin-dependent
diabetes was induced by intraperitoneal injection of streptozotocin
(STZ) at 2 days of age (50, 75 or 100 mg/kg for LH and 75, 100 or
125 mg/kg for LL rats). The evolution, with age, of glycemia,
glucose tolerance (glucose 2 g/kg by gavage), blood pressure,
plasma lipids and urinary protein and albumin excretions were
studied in control and STZ-treated LH and LL rats. RESULTS:
Although fasting glycemia was not significantly changed, the
neonatal administration of STZ increased non-fasting glycemia and
induced a marked glucose intolerance that were comparable between
LH rats receiving 75 mg/kg and LL rats receiving 100 mg/kg of
STZ. Interestingly, in treated LH rats only, the impaired glucose
tolerance was accompanied by further metabolic and renal
dysfunctions characterized by additional increases in plasma
cholesterol (+28%) and triglycerides (+105%) and accelerated
progression of proteinuria (+36%) and albuminuria (+48%).
CONCLUSIONS: These observations indicate that susceptibility to
diabetic metabolic disorders and renal diseases may be linked to the
genetic predisposition to hypertension. This new model offers a
reasonable reflection of the human situation, where hypertension
and non-insulin-dependent diabetes often coincide, suitable for
molecular, biochemical and pharmacological investigations.
PMID: 17211251 [PubMed - in process]
11: J Hypertens. 2007 Feb;25(2):423-8.
Related Articles, Links
C-reactive protein and intercellular adhesion molecule-1
are stronger predictors of oxidant stress than blood
pressure in established hypertension.
Cottone S, Mule G, Nardi E, Vadala A, Lorito MC, Guarneri M,
Arsena R, Palermo A, Cerasola G.
Cattedra di Medicina Interna, Divisione di Medicina Interna,
Nefrologia ed Ipertensione Dipartimento di Medicina Interna,
Malattie Cardiovascolari e Nefrourologiche, Universita di Palermo,
Italy.
BACKGROUND: Oxidant stress is implicated in the pathogenesis
of atherosclerosis in cardiovascular diseases. Our aim was to test
oxidative stress, as 8-iso-prostaglandin F2alpha (8-iso-PGF2alpha),
and its relationship with inflammation markers C-reactive protein
(CRP) and tumour necrosis factor-alpha (TNFalpha), and
endothelial activation assayed as soluble intercellular adhesion
molecule (ICAM)-1 and vascular cell adhesion molecule (VCAM)-1
in essential hypertension. METHODS: In 216 essential hypertensive
patients and 55 healthy control individuals, plasma levels of highsensitivity CRP and TNFalpha, 8-iso-PGF2alpha, ICAM-1 and
VCAM-1 were measured in basal conditions. Moreover, basal and
24-h ambulatory blood pressure monitoring measurements were
obtained. RESULTS: Essential hypertensive patients showed higher
levels of 8-iso-PGF2alpha (P < 0.0001), high-sensitivity CRP,
TNFalpha, ICAM-1 and VCAM-1 (P < 0.001, respectively) than
control individuals. In control individuals, 8-iso-PGF2alpha
correlated only with high-sensitivity CRP (P < 0.001). In essential
hypertensive patients, 8-iso-PGF2alpha correlated with highsensitivity CRP (P < 0.000001), TNFalpha (P < 0.0001), ICAM-1 (P
< 0.000001), VCAM-1 (P < 0.0001) and blood pressure. The
multiple regression analysis considering 8-iso-PGF2alpha as the
dependent variable showed that in essential hypertensive patients the
independent predictors of 8-iso-PGF2alpha were ICAM-1, highsensitivity CRP (P < 0.00001, respectively), and TNFalpha (P =
0.028). CONCLUSION: Our findings demonstrate that oxidant
stress is increased in essential hypertension, and relates to
inflammation and endothelial activation. Factors other than blood
pressure are stronger predictors of oxidant stress.
PMID: 17211250 [PubMed - in process]
12: J Hypertens. 2007 Feb;25(2):415-421.
Related Articles, Links
Increased oxidative stress impairs endothelial
modulation of contractions in arteries from
spontaneously hypertensive rats.
Miyagawa K, Ohashi M, Yamashita S, Kojima M, Sato K, Ueda
R, Dohi Y.
aDepartment of Internal Medicine, Nagoya Koseiin Geriatric
Hospital, Nagoya bDepartment of Internal Medicine, Komono Kosei
Hospital, Komono cDepartment of Internal Medicine, Johoku
Hospital, Nagoya dInternal Medicine and Molecular Science,
Graduate School of Medical Sciences, Nagoya City University,
Nagoya, Japan.
OBJECTIVES: The endothelium modulates vascular contractions.
We investigated the effects of oxidative stress on endothelial
modulation of contractions in hypertension. METHODS: Changes in
isometric tension of femoral arterial rings from spontaneously
hypertensive (SHR) and Wistar-Kyoto (WKY) rats were recorded.
RESULTS: The contractile response to norepinephrine of arteries
with endothelium was greater in SHR than in WKY rats (P <
0.0001). Endothelium removal augmented the norepinephrineinduced contraction (P < 0.05). The augmentation was more
pronounced in WKY than in SHR, which resulted in comparable
contraction of arteries without endothelium in both strains. N-nitroL-arginine methyl ester (100 mumol/l) mimicked the effect of
endothelium removal. Production of nitric oxide (NO, assessed by
measuring nitrite/nitrate concentrations) during the contraction was
not different between SHR and WKY. Vitamin C suppressed the
contraction of arteries with endothelium from SHR but not from
WKY (P < 0.05). Diphenyleneiodonium and apocynin, inhibitors of
nicotinamide adenine dinucleotide/nicotinamide adenine
dinucleotide phosphate (NADH/NADPH) oxidase, attenuated the
contraction of arteries with endothelium from SHR (P < 0.001) but
not WKY, but did not affect contractions induced by serotonin.
Superoxide generated by xanthine oxidase/hypoxanthine enhanced
the norepinephrine-induced contraction of arteries with endothelium
from WKY (P < 0.0001), and this effect was reversed by vitamin C.
CONCLUSIONS: In rat femoral arteries, NO released from the
endothelium modulates vascular contraction. In SHR, production of
superoxide by NADH/NADPH oxidase, which may be activated by
norepinephrine, is enhanced, resulting in the inactivation of NO and
impairment of endothelial modulation of vascular contractions.
Vascular oxidative stress may contribute to the altered circulation in
hypertension by impairing endothelial modulation of vascular
contractions.
PMID: 17211249 [PubMed - as supplied by publisher]
13: J Hypertens. 2007 Feb;25(2):361-6.
Related Articles, Links
Ramipril dose-dependently increases nitric oxide
availability in the radial artery of essential hypertension
patients.
Ghiadoni L, Versari D, Magagna A, Kardasz I, Plantinga Y,
Giannarelli C, Taddei S, Salvetti A.
Department of Internal Medicine, University of Pisa, Pisa, Italy.
DESIGN AND PARTICIPANTS: A double-blind, crossover,
randomized study was designed to evaluate the effect of 3-month
treatment with a lower versus a higher antihypertensive dosage of
ramipril (5 or 10 mg/day) on nitric oxide (NO)-dependent
vasodilation in 46 untreated patients with essential hypertension.
Radial artery flow-mediated dilation (FMD), before and after the
intra-arterial infusion of N-monomethyl-L-arginine (L-NMMA), to
block NO synthase, and the response to sublingual glyceril trinitrate
(GTN, 25 mug) were measured at baseline and after the two
treatment periods as a change in artery diameter (computerized
system from ultrasound scans). Plasma angiotensin II and oxidative
stress markers were also assessed. RESULTS: FMD was
significantly (P < 0.01) lower in hypertensive patients (4.6 +/- 1.8%)
than in normotensive subjects (7.1 +/- 2.6%), whereas the response
to GTN was similar. L-NMMA significantly (P < 0.001) inhibited
FMD in normotensive but not in hypertensive subjects. Mean 24-h
ambulatory blood pressure, plasma angiotensin II and oxidative
stress marker levels were similarly reduced at the end of the two
treatment periods. Both dosages of ramipril significantly (P < 0.001)
increased FMD (5 mg: 5.9 +/- 2.1%; 10 mg: 6.3 +/- 2.4%) without
modifying the response to GTN. However, compared with baseline
(11 +/- 19%), the inhibiting effect of L-NMMA on FMD (NOdependent FMD) was significantly (P < 0.01) greater with ramipril
10 mg (49 +/- 12%) than 5 mg per day (38 +/- 15%). The
improvement in FMD and NO-dependent FMD was not related to
changes in plasma levels of angiotensin II or markers of oxidative
stress. CONCLUSION: Treatment with ramipril at a higher dosage
induced a greater improvement in NO-dependent vasodilation
compared with the lower antihypertensive dosage in hypertensive
patients.
PMID: 17211242 [PubMed - in process]
14: J Hypertens. 2007 Feb;25(2):345-359.
Related Articles, Links
Depolarization evoked by acetylcholine in mesenteric
arteries of hypertensive rats attenuates endotheliumdependent hyperpolarizing factor.
Goto K, Edwards FR, Hill CE.
Division of Neuroscience, John Curtin School of Medical Research,
Australian National University, Canberra, Australia *Present
address: Kenichi Goto, Department of Medicine and Clinical
Science, Graduate School of Medical Sciences, Kyushu University,
Fukuoka, Japan.
OBJECTIVE: During blockade of endothelium-dependent
hyperpolarizing factor (EDHF), acetylcholine evoked larger and
faster depolarization in mesenteric arteries of spontaneously
hypertensive rats (SHR) than normotensive Wistar-Kyoto (WKY)
rats. We studied the mechanism underlying this response and its role
in the attenuation of EDHF. METHODS: Electrophysiology,
computational modelling and myography were used to study
changes in membrane potential and effects on contractility.
RESULTS: The large acetylcholine-evoked depolarization in SHR
was accompanied by contraction, but this was not seen in WKY rats.
The depolarization depended on release of intracellular Ca but was
unaffected by nonselective cation channel inhibitors, gadolinium,
lanthanum or amiloride. The depolarization was significantly
reduced by the Ca-dependent Cl channel inhibitors, niflumic acid or
flufenamic acid, or alterations in Cl gradients using bumetanide
(Na/K/Cl transporter inhibitor) or external Cl replacement with
isethionate. These drugs altered the time course of EDHF-evoked
hyperpolarizations in SHR, making them indistinguishable from
those in WKY rats. EDHF-induced relaxation was less sensitive to
acetylcholine in SHR than in WKY rats, but this difference was
eliminated following artery pretreatment with bumetanide.
Computational modelling in which the SHR fast depolarizing
response was selectively modulated mimicked physiologically
acquired results obtained in SHR and WKY rats during Cl-channel
blockade. CONCLUSIONS: Acetylcholine evokes a fast
depolarization in SHR but not in WKY rats, mediated by the
opening of Ca-dependent Cl channels. The depolarization is
responsible for a constriction that reduces EDHF-mediated
relaxation. Data suggest that Ca-dependent Cl channels may provide
a novel therapeutic target for improvement of endothelial
dysfunction during hypertension.
PMID: 17211241 [PubMed - as supplied by publisher]
15: J Hypertens. 2007 Feb;25(2):321-327.
Related Articles, Links
Detection of carotid atherosclerosis in individuals with
masked hypertension and white-coat hypertension by
self-measured blood pressure at home: The Ohasama
Study.
Hara A, Ohkubo T, Kikuya M, Shintani Y, Obara T, Metoki H,
Inoue R, Asayama K, Hashimoto T, Harasawa T, Aono Y, Otani
H, Tanaka K, Hashimoto J, Totsune K, Hoshi H, Satoh H, Imai
Y.
aDepartment of Clinical Pharmacology and Therapeutics
bDepartment of Planning for Drug Development and Clinical
Evaluation cDepartment of Environmental Health Sciences, Tohoku
University Graduate School of Pharmaceutical Sciences and
Medicine, Sendai dTohoku University 21st Century COE Program
'Comprehensive Research and Education Center for Planning of
Drug Development and Clinical Evaluation', Sendai eOhasama
Hospital, Iwate, Japan.
OBJECTIVE: To investigate carotid atherosclerosis in individuals
with masked hypertension (MHT) and white-coat hypertension
(WCHT) in a general population. METHODS: Self-measurement of
blood pressure at home (HBP) and casual blood pressure (CBP)
measurements were recorded in 812 individuals aged at least 55
years (mean 66.4 years) from the general Japanese population. The
intima-media thickness (IMT) of the near and far wall of both
common carotid arteries was measured and averaged. The
relationships between carotid atherosclerosis (IMT and plaque) and
the four blood pressure groups (sustained normal blood pressure:
HBP < 135/85 mmHg, CBP < 140/90 mmHg; WCHT: HBP <
135/85 mmHg, CBP >/= 140/90 mmHg; MHT: HBP >/= 135/85
mmHg, CBP < 140/90 mmHg; sustained hypertension: HBP >/=
135/85 mmHg, CBP >/= 140/90 mmHg) were examined using
multivariate analysis adjusted for possible confounding factors.
RESULTS: Adjusted IMT in individuals with sustained
hypertension [0.77 mm; 95% confidence interval (CI) 0.75 to 0.79
mm] and MHT (0.77 mm; 95% CI 0.73 to 0.80 mm) was
significantly greater than in those with sustained normal blood
pressure (0.71 mm; 95% CI 0.69 to 0.72 mm) and WCHT (0.72 mm;
95% CI 0.71 to 0.74 mm) (P < 0.0001). The odds ratios for the
presence of plaques in all four groups were similar to the trends in
IMT. CONCLUSIONS: Our findings imply that CBP measurements
alone are insufficient to distinguish individuals at high risk of
carotid atherosclerosis from those at low risk. However, these
individuals do have distinct HBP measurements, suggesting that
HBP measurement could become a valuable tool for predicting
carotid atherosclerosis.
PMID: 17211239 [PubMed - as supplied by publisher]
16: J Hypertens. 2007 Feb;25(2):315-320.
Related Articles, Links
How reliable is isolated clinical hypertension defined by a
single 24-h ambulatory blood pressure monitoring?
Cuspidi C, Meani S, Sala C, Valerio C, Fusi V, Zanchetti A,
Mancia G.
aDepartment of Clinical Medicine and Prevention, University of
Milano-Bicocca, Milan bPoliclinico di Monza, Milan cCentro
Interuniversitario di Fisiologia Clinica e Ipertensione, Universita di
Milano, Milan dIstituto di Medicina Cardiovascolare Ospedale,
Maggiore Policlinico Mangiagalli e Regina Elena, Milan eIstituto
Auxologico, Milan, Italy.
BACKGROUND: Isolated clinical hypertension (ICH) is
characterized by a persistently elevated clinic blood pressure in the
presence of a normal day-time or 24-h ambulatory blood pressure
(ABP). This definition is based on a single ABP monitoring
(ABPM) and little attention has been focused on the reproducibility
of this condition. OBJECTIVE: To investigate the reliability of the
criteria currently recommended by major hypertension guidelines to
detect ICH based on a single 24-h ABPM session. METHODS: A
total of 611 never-treated grade 1 and 2 hypertensive patients (mean
age 46 +/- 12 years) referred for the first time to our out-patient
clinic, underwent repeated clinic blood pressure measurements,
routine investigations, two 24-h periods of ABPM 1-4 weeks apart,
cardiac and carotid ultrasound examinations. ABPM was always
performed over a working day and the same daily activities were
recommended during the two periods. ICH was diagnosed by the
following criteria: (i) mean daytime values < 135/85 mmHg or (ii)
mean 24-h blood pressure values < 125/80 mmHg during the first
ABPM. RESULTS: The overall prevalence of ICH was 7.1%
according to criterion (i) and 5.4% according to criterion (ii).
Twenty (46.6%) of the 43 patients with mean daytime blood
pressure values < 135/85 mmHg during the first ABPM, exceeded
this cut-off value during the second ABPM period. Twenty-two
(66.6%) of the 33 patients with mean 24-h blood pressure values <
120/80 mmHg during the first ABPM did not confirm a normal
blood pressure profile during the second ABPM recording.
Cardiovascular involvement was significantly lower in subjects with
persistent normal ABP compared to those with non-reproducible
ICH pattern or sustained hypertensives. CONCLUSIONS: These
findings clearly indicate that: (i) the classification of ICH on the
basis of a single ABPM, using the cut-offs suggested by major
hypertension guidelines, has a limited short-term reproducibility and
(ii) repeated ABPM recordings should be recommended to correctly
diagnose patients with ICH and improve cardiovascular risk
stratification.
PMID: 17211238 [PubMed - as supplied by publisher]
17: J Hypertens. 2007 Feb;25(2):299-305.
Related Articles, Links
Trends in lifestyle factors affecting blood pressure in
hypertensive and normotensive Finns during 1982-2002.
Kastarinen M, Laatikainen T, Salomaa V, Jousilahti P,
Antikainen R, Tuomilehto J, Nissinen A, Vartiainen E.
aDepartment of Internal Medicine, Kuopio University Hospital,
Kuopio, Finland bDepartment of Internal Medicine, University of
Oulu, Oulu, Finland cDepartment of Epidemiology and Health
Promotion, National Public Health Institute, Helsinki, Finland
dSchool of Public Health, University of Tampere, Tampere, Finland
eOulu City Hospital, Oulu, Finland fDepartment of Public Health,
University of Helsinki, Helsinki, Finland gSouth Ostrobothnia
Central Hospital, Seinajoki, Finland hDepartment of Neuroscience
and Neurology, University of Kuopio, Finland.
OBJECTIVE: To assess the trends in blood pressure (BP) affecting
lifestyle factors in hypertensive and normotensive Finns from 1982
to 2002. DESIGN AND SETTING: Five independent crosssectional population surveys conducted in 1982, 1987, 1992, 1997
and 2002 in the provinces of North Karelia and Kuopio in eastern
Finland and the region of Turku-Loimaa in southwestern Finland.
PARTICIPANTS: Stratified random samples of men and women
aged 25-64 years were drawn from the national population register.
The participants (n = 28 235) were classified into four groups
according to their BP level and treatment status: normotensive,
unaware hypertensive, aware but untreated hypertensive, and treated
hypertensive subjects. MAIN OUTCOME MEASURES: Alcohol
intake, body mass index (BMI), 24-h urinary sodium and potassium
excretion (a subsample of 5849 subjects) and the proportion of
subjects with leisure-time physical activity (LTPA) at least three
times a week. RESULTS: Mean BMI increased significantly in all
groups except in untreated hypertensive women. Alcohol intake
increased in all men but especially in hypertensive women (P <
0.001). The 24-h urinary sodium excretion decreased significantly in
all BP groups. The proportion of subjects with a recommended level
of LTPA increased significantly and similarly in all BP groups (P <
0.001). CONCLUSIONS: The unfavourable trends observed in
mean BMI and alcohol intake in the entire population should be
reversed in order to decrease the frequency of hypertension in
Finland. The health behaviours of hypertensive subjects should be
carefully monitored and modified in a more systematic and efficient
way than at present.
PMID: 17211236 [PubMed - as supplied by publisher]
18: J Hypertens. 2007 Feb;25(2):275-9.
Related Articles, Links
Masked hypertension: an independent predictor of organ
damage.
Cuspidi C, Parati G.
aDepartment of Clinical Medicine and Prevention, University of
Milano-Bicocca bPoliclinico di Monza cDepartment of Cardiology,
S. Luca Hospital, IRCCS Istituto Auxologico, Milano, Italy.
PMID: 17211231 [PubMed - in process]
19: JAMA. 2007 Jan 3;297(1):40; author reply 40-1.
Related Articles, Links
Comment on:

JAMA. 2006 Sep 13;296(10):1242-8.
Left ventricular hypertrophy regression and atrial
fibrillation incidence.
Hyman MH.
Publication Types:


Comment
Letter
1: Hypertension. 2007 Feb;49(2):298-303. Epub 2006 Dec 26.
Related Articles, Links
Hyperuricemia and incidence of hypertension among men
without metabolic syndrome.
Krishnan E, Kwoh CK, Schumacher HR, Kuller L.
School of Medicine, University of Pittsburgh, Pittsburgh, Pa., USA.
arthritis.MD@gmail.com
The aim of this project was to study the risk of developing hypertension over a
6-year follow-up in normotensive men with baseline hyperuricemia (serum
uric acid >7.0 mg/dL) but without diabetes/glucose intolerance or metabolic
syndrome. We analyzed the data on men without metabolic syndrome or
hypertension at baseline from the Multiple Risk Factor Intervention Trial.
These men (n=3073; age: 35 to 57 years) were followed for an average of 6
years by annual examinations. Follow-up blood pressure among those with
baseline was consistently higher than among those with normal serum uric
acid concentration. We used Cox regression models for adjustment for the
effects of serum creatinine, body mass index, age, blood pressure, proteinuria,
serum cholesterol and triglycerides, alcohol and tobacco use, risk factor
interventions, and use of diuretics. In these models, normotensive men with
baseline hyperuricemia had an 80% excess risk for incident hypertension
(hazard ratio: 1.81; 95% CI: 1.59 to 2.07) compared with those who did not.
Each unit increase in serum uric acid was associated with a 9% increase in the
risk for incident hypertension (hazard ratio: 1.09; 95% CI: 1.02 to 1.17). We
conclude that the hyperuricemia-hypertension risk relationship is present
among normotensive middle-aged men without diabetes/glucose intolerance or
metabolic syndrome.
Publication Types:


Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
PMID: 17190877 [PubMed - in process]
2: Hypertension. 2006 Dec 26; [Epub ahead of print]
Related Articles, Links
Identification of Active Central Nervous System Sites in Renal
Wrap Hypertensive Rats.
Cunningham JT, Herrera-Rosales M, Martinez MA, Mifflin S.
Department of Pharmacology, University of Texas Health Science Center at
San Antonio.
To identify central neurons participating in cardiovascular regulation in
hypertension, we studied Fos staining, a marker for synaptically activated
neurons, in adult male normotensive and hypertensive (HT) rats. At 1 and 4
weeks after induction of unilateral nephrectomy, renal wrap hypertension
mean arterial pressure was 138+/-4 mm Hg (n=6) in 1-week HT rats and
159+/-6 mm Hg (n=6) in 4-week HT rats. Mean arterial pressure was 103+/-2
mm Hg (n=6) in sham-operated, normotensive rats. Mean arterial pressure was
greater in both HT groups compared with normotensive rats, and the mean
arterial pressure in 4-week HT rats was greater than that in 1-week HT rats.
Rats were anesthetized and perfused, brains sectioned and processed using a
Fos antibody, and the number of Fos immunoreactive neurons counted in
sections through various brain regions. Hypertension of 1 or 4 weeks did not
alter the number of Fos immunoreactive neurons in the area postrema, the
supraoptic nucleus, and the median preoptic nucleus. The number of Fos
immunoreactive neurons was increased after 1 and 4 weeks in the nucleus of
the solitary tract, both the caudal and ventral lateral medulla, and the organum
vasculosum of the lamina terminalis. In addition, after 4 weeks of HT, the
number of Fos immunoreactive neurons was increased in the parabrachial
nucleus and the paraventricular nucleus of the hypothalamus. The results
indicate central regions active in acute and chronic HT rats and suggest certain
areas that may be differentially activated depending on the duration of the
hypertension.
PMID: 17190876 [PubMed - as supplied by publisher]
3: Hypertension. 2006 Dec 26; [Epub ahead of print]
Related Articles, Links
Reactive Oxygen Species-Dependent Hypertension in Dopamine
D2 Receptor-Deficient Mice.
Armando I, Wang X, Villar VA, Jones JE, Asico LD, Escano C, Jose PA.
Department of Pediatrics and Physiology and Biophysics, Georgetown
University Medical Center, Washington, DC.
Dysfunction of D2-like receptors has been reported in essential hypertension.
Disruption of D2R in mice (D2(-/-)) results in high blood pressure, and several
D2R polymorphisms are associated with decreased D2R expression. Because
D2R agonists have antioxidant activity, we hypothesized that increased blood
pressure in D2(-/-) is related to increased oxidative stress. D2(-/-) mice had
increased urinary excretion of 8-isoprostane, a parameter of oxidative stress;
increased activity of reduced nicotinamide-adenine dinucleotide phosphate
oxidase in renal cortex; increased expression of the reduced nicotinamideadenine dinucleotide phosphate oxidase subunits Nox1, Nox2, and Nox4; and
decreased expression of the antioxidant enzyme heme-oxygenase-2 in the
kidneys, suggesting that regulation of reactive oxygen species (ROS)
production by D2R involves both pro-oxidant and antioxidant systems.
Apocynin, a reduced nicotinamide-adenine dinucleotide phosphate oxidase
inhibitor, or hemin, an inducer of heme oxigenase-1, normalized the blood
pressure in D2(-/-) mice. Because D2Rs in the adrenal gland are implicated in
aldosterone regulation, we evaluated whether alterations in aldosterone
secretion contribute to ROS production in this model. Urinary aldosterone was
increased in D2(-/-) mice and its response to a high-sodium diet was impaired.
Spirolactone normalized the blood pressure in D2(-/-) mice and the renal
expression of Nox1 and Nox4, indicating that the increased blood pressure and
ROS production are, in part, mediated by impaired aldosterone regulation.
However, spironolactone did not normalize the excretion of 8-isoprostane and
had no effect on expression of Nox2 or heme-oxygenase-2. Our results show
that the D2R is involved in the regulation of ROS production and that, by
direct and indirect mechanisms, altered D2R function may result in ROSdependent hypertension.
PMID: 17190875 [PubMed - as supplied by publisher]
4: Hypertension. 2006 Dec 26; [Epub ahead of print]
Related Articles, Links
Neurons of the Rostral Ventrolateral Medulla Contribute to
Obesity-Induced Hypertension in Rats.
Stocker SD, Meador R, Adams JM.
Department of Physiology, University of Kentucky College of Medicine,
Lexington.
Activation of the sympathetic nervous system contributes to the pathogenesis
of obesity-induced hypertension. The present study sought to determine
whether sympathetic regulatory neurons of the rostral ventrolateral medulla
contribute to the elevated blood pressure in obese rats. Male Sprague-Dawley
rats (350 to 425 g) were placed on a moderately high-fat diet (32% kcal as fat)
or a low-fat (LF) diet (10.6% kcal as fat). After 13 weeks, rats fed the
moderately high-fat diet segregated into obesity-prone (OP) and obesityresistant (OR) groups based on their body weight (OP: 839+/-22 g; OR:
668+/-15 g; LF: 680+/-18 g; n=15 for all groups; P<0.01). Under isoflurane
anesthesia, baseline mean arterial blood pressure was significantly elevated in
the OP rats versus the OR and LF rats (OP: 108+/-2 mm Hg; OR: 100+/-2 mm
Hg; LF: 97+/-3 mm Hg; n=7; P<0.05). Inhibition of the rostral ventrolateral
medulla with bilateral microinjection of the GABAA receptor agonist
muscimol (200 pmol/100 nL) decreased mean arterial blood pressure to
similar levels across the groups (OP: 49+/-1 mm Hg; OR: 50+/-2 mm Hg; LF:
49+/-1 mm Hg), but the magnitude of this decrease was significantly greater in
the OP versus the OR and LF rats (OP: -58+/-2 mm Hg; OR: -49+/-1 mm Hg;
LF: -48+/-3 mm Hg; P<0.01). These differences in mean arterial blood
pressure cannot be explained by changes in vascular reactivity as the ED50 in
response to phenylephrine and norepinephrine was similar across the groups.
The present findings suggest that the elevated sympathetic nerve activity and
arterial blood pressure in obese rats depends on the tonic activity of rostral
ventrolateral medulla sympathetic neurons.
PMID: 17190873 [PubMed - as supplied by publisher]
5: Hypertension. 2007 Feb;49(2):260-5. Epub 2006 Dec 26.
Related Articles, Links
Evolution and hypertension.
Weder AB.
Publication Types:

Editorial
PMID: 17190870 [PubMed - in process]
6: J Hum Hypertens. 2006 Oct;20(10):733-41. Epub 2006 Jul
20.
Related Articles,
Links
The detection, treatment and control of high blood pressure in
older British adults: cross-sectional findings from the British
Women's Heart and Health Study and the British Regional Heart
Study.
Patel R, Lawlor DA, Whincup P, Montaner D, Papacosta O, Brindle P,
Ebrahim S.
Department of Social Medicine, University of Bristol, Bristol, UK.
rita.patel@bristol.ac.uk
Among older people, the detection and control of hypertension is particularly
important to reduce cardiovascular disease risk. This cross-sectional survey
aimed to describe the detection, treatment and control of hypertension in older
British adults. A total of 3059 women and 3007 men aged 60-79 years were
randomly selected from general practice age/sex registers in 24 British towns
and examined from 1998 to 2001. Of these, 52.6% women and 47.9% men
had at least one indicator of hypertension (high blood pressure on
examination, or taking antihypertensive medication or recalled a doctor
diagnosis of high blood pressure). Among women, 50% of those with any
indication of hypertension were on treatment and 29% were well controlled,
and among men 45% were on treatment and 16% were well controlled. With
the exception of alcohol use in men (adjusted odds ratio 0.67 (0.46, 0.98)),
socioeconomic factors, area of residence and behavioural risk factors were not
associated with good control among those with hypertension in either sex. Of
those on treatment, 20.7% of women and 28% of men were on two classes of
antihypertensive medication and 3.5 and 4.9%, respectively, were on three or
more classes of antihypertensive medication. Among those with a doctor
diagnosis of hypertension and taking antihypertensive medication, the
proportion with well controlled blood pressure did not differ between those on
more than one antihypertensive and those on just one in either sex. We
conclude that targets of good control are rarely met in older individuals, who
would benefit from the associated reduction in cardiovascular disease risk.
Publication Types:


Randomized Controlled Trial
Research Support, Non-U.S. Gov't
PMID: 16855626 [PubMed - indexed for MEDLINE]
7: J Hum Hypertens. 2006 Oct;20(10):749-56. Epub 2006 Jul
20.
Related Articles,
Links
Determinants of arterial stiffness in an apparently healthy
population over 60 years.
Alecu C, Gueguen R, Aubry C, Salvi P, Perret-Guillaume C, Ducrocq X,
Vespignani H, Benetos A.
Department of Neurology, University of Nancy, Nancy, France.
Arterial stiffness assessed by the pulse wave velocity (PWV), a non-invasive
and reproducible method, predicts cardiovascular morbidity and mortality. The
main determinants of arterial stiffness are well established in younger and
middle-aged populations, but much less in the elderly. The aim of this study
was to describe the determinants of arterial stiffness in elderly apparently
healthy subjects. The study included 221 voluntary subjects born before 1944
(mean age 67.4+/-5.0 years), who had a standard health check-up at the
'Centre de Medecine Preventive' of Nancy. Arterial stiffness was evaluated by
measuring the carotid-femoral PWV with the PulsePen automatic device.
Clinical and biological parameters were evaluated at the same day.
Measurements were valid and analysed in 207 subjects (94 women). Mean
PWV was 9.39+/-2.64 m/s. Men showed higher PWV values than women
(9.99+/-2.56 vs 8.66+/-2.56, P<0.001). In univariate analysis, PWV was
correlated with age (r=0.26, P<0.001) and mean arterial pressure (MAP)
(r=0.40, P<0.001), and these relationships were similar in men and women.
Subjects with hypertension (P<0.001), diabetes mellitus (P<0.001) and obesity
(P<0.01) had higher values of PWV. In multiple regression analysis, PWV
correlated positively and independently with age, male gender, MAP and
diabetes mellitus. In conclusion, in an apparently healthy elderly population,
the main determinants of arterial stiffness are the age, MAP, diabetes and
gender. Our study also shows that the gender-related differences in arterial
stiffness observed in middle-aged subjects are maintained in the elderly.
PMID: 16855622 [PubMed - indexed for MEDLINE]
8: J Hum Hypertens. 2006 Oct;20(10):742-8. Epub 2006 Jun
29.
Related Articles,
Links
A large-scale study on relationship between cerebral blood flow
velocity and blood pressure in a natural population.
Zhang P, Huang Y, Li Y, Lu M, Wu Y.
Department of Epidemiology, Cardiovascular Institute and Fuwai Hospital,
Chinese Academy of Medical Sciences, Beijing, China.
In order to verify the relationship between blood pressure and cerebral blood
flow velocity in sub-clinical natural population, 1294 middle-aged and old
Beijing rural residents were investigated in autumn 2002. For all subjects,
systolic blood flow velocities (V(s)) in common carotid artery (CCA), internal
carotid artery (ICA) and middle cerebral artery (MCA) were detected with
trans-cranial Doppler. Key factors such as anthropometry, medication use,
blood pressure and blood biochemical analysis were investigated at the same
time. After controlling for age, gender, diabetes, hypercholesterolaemia,
smoking and body mass index, multivariate analysis showed that systolic
blood pressure (SBP) correlated positively with V(s) at MCA and slight
negatively correlated with at CCA. As blood pressure rose by 10 mm Hg, the
V(s) at MCA increased by 1.63 cm/s. Duration of hypertension (HD)
negatively correlated with V(s) at MCA (P<0.01). The V(s) at MCA in earlystage and chronic hypertensive patients were 92.9+/-1.9 and 84.1+/-2.3 cm/s,
respectively. Antihypertensive treatment could modify the V(s) at MCA
towards a normal level by lowering blood pressure. In conclusion, the effect of
hypertension on cerebral blood flow is complex. V(s) at MCA positively
correlated with SBP, but negatively related to HD. Antihypertensive treatment
might be helpful to keep cerebral blood flow at a normal level.
Publication Types:

Clinical Trial
PMID: 16810278 [PubMed - indexed for MEDLINE]
9: J Hum Hypertens. 2006 Oct;20(10):772-9. Epub 2006 Jun 1. Related Articles, Links
NAD(P)H oxidase p22phox gene C242T polymorphism, nitric
oxide production, salt sensitivity and cardiovascular risk factors
in Hispanics.
Castejon AM, Bracero J, Hoffmann IS, Alfieri AB, Cubeddu LX.
Department of Pharmaceutical Sciences, Health Professions Division, College
of Pharmacy, NOVA Southeastern University (NSU), Fort Lauderdale, FL
33328, USA.
Mutations in the NAD(P)H oxidase gene may be associated with abnormal
superoxide generation, nitric oxide (NO) availability and cardiovascular
diseases. We investigated the prevalence of the NAD(P)H oxidase p22phox
gene C242T polymorphism, and its possible association with blood pressure,
NO production, salt sensitivity and cardiovascular risk factors in Hispanics.
Genotype frequencies were as follows: CC, 52.9%; CT, 40.3%; and TT, 6.8%.
There were no significant differences in systolic blood pressure, diastolic
blood pressure, age, weight, fasting and post-load glucose levels, LDL and
HDL cholesterol, triglyceride and urinary albumin levels in subjects with CC,
CT or the TT genotypes. Presence of the T allele was associated with
increased salt sensitivity in women, but not in men. NO metabolite excretion
was markedly decreased both in women and men with the TT genotype (CC:
868+/-79 micromol/day; CT: 839+/-75 micromol/day; TT: 534+/-78
micromol/day; P<0.05). In conclusion, the prevalence of the NAD(P)H
oxidase p22phox gene C242T polymorphism in Venezuelans was comparable
to that of Caucasians, but different from that of Chinese and Japanese.
Although the T allele was not associated with cardiovascular risk factors,
hyperinsulinaemia or hypertension, in women, it appeared to be a genetic
susceptibility factor for salt sensitivity. Both in women and men, the p22phox
gene may play a role in the genetic control of NO levels.
Publication Types:


Comparative Study
Research Support, Non-U.S. Gov't
PMID: 16738684 [PubMed - indexed for MEDLINE]
10: J Hum Hypertens. 2006 Jul;20(7):517-22. Epub 2006 Apr
13.
Related Articles,
Links
Can aneroid sphygmomanometers be used at altitude?
Kametas NA, McAuliffe F, Krampl E, Nicolaides KH, Shennan AH.
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital,
Denmark Hill, London, UK. n.kametas@btinternet.com
Mercury-independent devices are increasingly being used in clinical practice
as mercury will soon be removed from clinical use as a result of
environmental, health and safety concerns. The aim of this study was to
evaluate the accuracy of a portable aneroid device in an adult population at
high altitude by following the part of the protocol of the British Hypertension
Society regarding comparison between device and observer. We examined 10
subjects in Cerro de Pasco, Peru, which is situated 4370 m above sea level.
The aneroid device was initially calibrated at both high altitude and at sea
level to ensure optimal function. Validation of the device was undertaken at
high altitude by connecting it in parallel to two mercury sphygmomanometers.
Eleven sequential same-arm measurements were taken from each subject by
two trained observers, alternating between mercury sphygmomanometry and
the aneroid device. Simultaneous mercury readings were also recorded for
additional analysis. During calibration, all 60 comparisons between the
aneroid and mercury sphygmomanometers were within 3 mm Hg both at sea
level and at high altitude. At validation, the device achieved an A grade for
both systolic and diastolic pressures and also fulfilled the requirements of the
Association for the Advancement of Medical Instrumentation. The mean and
standard deviation for systolic and diastolic pressures, respectively, were -1.32
(4.3) mm Hg and 3.7 (4.7) mm Hg in sequential analysis and -0.7 (2.6) mm Hg
and -3.3 (2.7) mm Hg in simultaneous analysis. We conclude that the RiesterExacta portable aneroid device can be recommended for use in an adult
population at high altitude.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 16617312 [PubMed - indexed for MEDLINE]
11: J Hum Hypertens. 2006 Jul;20(7):540-2. Epub 2006 Mar
16.
Related Articles,
Links
Blood pressure control in a diabetic population assessed by
computer review.
Swislocki A, Noth RH, Volpp B, Meier J, Siegel D.
Publication Types:


Letter
Research Support, U.S. Gov't, Non-P.H.S.
PMID: 16543913 [PubMed - indexed for MEDLINE]
12: J Hum Hypertens. 2006 Jul;20(7):478-81. Epub 2006 Mar
16.
Comment on:
Related Articles,
Links

J Hum Hypertens. 2006 Jul;20(7):496-503.
Dual ACE/NEP inhibitors - more than playing the ACE card.
Jandeleit-Dahm KA.
Baker Heart Research Institute, Danielle Alberti JDRF Centre for Diabetes
Complications, Wynn Domain, Melbourne, Victoria, Australia.
Karin.jandeleit-dahm@baker.edu.au
Publication Types:

Comment
PMID: 16543904 [PubMed - indexed for MEDLINE]
1: Am Heart J. 2007 Jan;153(1):127-32.
Related Articles, Links
Incidence and clinical relevance of supraventricular
tachyarrhythmias in pulmonary hypertension.
Tongers J, Schwerdtfeger B, Klein G, Kempf T, Schaefer A, Knapp JM,
Niehaus M, Korte T, Hoeper MM.
Department of Cardiology and Angiology, Hannover Medical School, Hannover,
Germany.
BACKGROUND: In patients with severe pulmonary hypertension (PH), right
ventricular function is a main determinant of clinical stability and outcome.
Supraventricular tachyarrhythmias (SVTs) may compromise cardiac function and
threaten prognosis in patients with PH, but the incidence and clinical relevance of
SVTs in PH and chronic right ventricular failure have not been evaluated.
METHODS: In a 6-year retrospective single-center analysis, 231 consecutive
patients followed for pulmonary arterial hypertension, or inoperable chronic
thromboembolic PH were studied for SVTs. Analysis included incidence, clinical
consequences, treatment, and outcome. RESULTS: Thirty-one episodes of SVT
were observed in 27 of 231 patients (cumulative incidence 11.7%, annual risk
2.8% per patient), including atrial flutter (n = 15), atrial fibrillation (n = 13), and
AV nodal reentry tachycardia (n = 3). Supraventricular tachyarrhythmia onset was
almost invariably associated with marked clinical deterioration and right
ventricular failure (84% of SVT episodes). Outcome was strongly associated with
the type of SVT and restoration of sinus rhythm. During follow-up, cumulative
mortality was low (6.3%, follow-up 26 +/- 23 months) when sinus rhythm was
restored (all cases of AV nodal reentry tachycardia and atrial flutter). In contrast, 9
of 11 patients with sustained atrial fibrillation died from right ventricular failure
(cumulative mortality 82%, follow-up 11 +/- 8 months). CONCLUSIONS: In
patients with PH, SVTs constitute a relevant problem, often resulting in clinical
deterioration. Sustained atrial fibrillation may be associated with a high risk of
death from right ventricular failure.
PMID: 17174650 [PubMed - indexed for MEDLINE]
2: Am Heart J. 2007 Jan;153(1):54-8.
Related Articles, Links
Absence of an interaction between the angiotensin-converting
enzyme insertion-deletion polymorphism and pravastatin on
cardiovascular disease in high-risk hypertensive patients: the
Genetics of Hypertension-Associated Treatment (GenHAT) study.
Maitland-van der Zee AH, Boerwinkle E, Arnett DK, Davis BR, LeiendeckerFoster C, Miller MB, Klungel OH, Ford CE, Eckfeldt JH.
School of Public Health, University of Texas Health Science Center at Houston,
1200 Hermann Pressler, Houston TX, USA. a.h.maitland@pharm.uu.nl
BACKGROUND: The aim of this study was to determine whether the
angiotensin-converting enzyme (ACE) insertion-deletion (ID) polymorphism
interacts with pravastatin to modify the risk of coronary heart disease (CHD) and
other cardiovascular end points in a large clinical trial. METHODS: GenHAT is
an ancillary study of the ALLHAT. The ACE ID genotyped population in the
lipid-lowering arm of ALLHAT included 9467 participants randomly assigned to
pravastatin (n = 4741) or to usual care (n = 4726). The efficacy of pravastatin in
reducing the risk of primary outcome (all-cause mortality) and secondary
outcomes (fatal CHD and nonfatal myocardial infarction, cardiovascular disease
[CVD] mortality, CHD, stroke, other CVD, non-CVD mortality, stroke, and heart
failure) was compared between the genotype strata (dominant model ID + II vs
DD, additive model II vs ID vs DD), by examining an interaction term in a Cox
proportional hazards model. RESULTS: The relative risk of fatal CHD and
nonfatal myocardial infarction among subjects randomized to pravastatin
compared with subjects randomized to usual care was similar in subjects with the
II genotype (hazard ratio [HR] 0.84, 95% CI 0.59-1.18), the ID genotype (HR
0.84, 95% CI 0.68-1.03), and the DD genotype (HR 0.99, 95% CI 0.77-1.27).
CONCLUSIONS: We found no evidence that the ACE ID genotype was a major
modifier of the efficacy of pravastatin in reducing the risk of cardiovascular
events.
PMID: 17174637 [PubMed - indexed for MEDLINE]
3: Am Heart J. 2007 Jan;153(1):42-53.
Related Articles, Links
The Antihypertensive and Lipid Lowering Treatment to Prevent
Heart Attack Trial (ALLHAT) Heart Failure Validation Study:
diagnosis and prognosis.
Einhorn PT, Davis BR, Massie BM, Cushman WC, Piller LB, Simpson LM,
Levy D, Nwachuku CE, Black HR; ALLHAT Collaborative Research Group.
National Heart, Lung, and Blood Institute, Division of Epidemiology and Clinical
Applications, Bethesda, MD 20892-7936, USA. einhornp@mail.nih.gov
BACKGROUND: ALLHAT, a randomized, double-blind, active-controlled
hypertension treatment trial in 42,418 patients, reported that a thiazide-type
diuretic (chlorthalidone) was superior to a calcium channel blocker (amlodipine),
an angiotensin-converting enzyme inhibitor (lisinopril), and an alpha1-blocker
(doxazosin) in preventing the new onset of heart failure (HF). However, questions
have been raised regarding the validity of the HF diagnosis. METHODS: The
ALLHAT HF Validation Study was designed to validate and elucidate the
significance of HF events in ALLHAT. Records for 2778 HF hospitalizations in
1935 patients were centrally reviewed using several prespecified algorithms
(based on ALLHAT and Framingham criteria) and reviewers' global clinical
judgment. Percent agreement with diagnoses assigned by ALLHAT site
physicians, relative risks across randomized comparisons, incidence rates, and
mortality after HF hospitalization were evaluated for first events validated by each
of the criteria sets. RESULTS: Percent agreements with site physician diagnoses
were 71%, 80%, and 84% for ALLHAT, Framingham, and reviewers' judgment,
respectively. Using these 3 criteria, relative risks (95% CI) for new-onset HF
compared with chlorthalidone were, respectively, 1.46 (1.27-1.68), 1.42 (1.251.62), and 1.45 (1.28-1.64) for amlodipine; 1.18 (1.02-1.28), 1.13 (0.99-1.30), and
1.15 (1.01-1.32) for lisinopril; and 1.79 (1.51-2.11), 1.71 (1.46-2.00), and 1.80
(1.55-2.10) for doxazosin. CONCLUSIONS: An independent review of source
documentation showed a high degree of agreement with the HF diagnoses
assigned by site physicians and confirmed the higher risk of HF associated with
first-step therapy using amlodipine, lisinopril, or doxazosin compared with
chlorthalidone. Thiazide-type diuretics should be the preferred first-step therapy
for prevention of HF in high-risk patients with hypertension.
Publication Types:
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Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Validation Studies
PMID: 17174636 [PubMed - indexed for MEDLINE]
4: Am Heart J. 2006 Dec;152(6):1059-63.
Related Articles, Links
Antihypertensive therapy and regression of coronary artery disease:
insights from the Comparison of Amlodipine versus Enalapril to
Limit Occurrences of Thrombosis (CAMELOT) and Norvasc for
Regression of Manifest Atherosclerotic Lesions by Intravascular
Sonographic Evaluation (NORMALISE) trials.
Brener SJ, Ivanc TB, Poliszczuk R, Chen M, Tuzcu EM, Hu T, Frid DJ,
Nissen SE.
Department of Cardiovascular Medicine and Biostatistics, Cleveland Clinic
Foundation, Cleveland, OH 44195, USA. breners@ccf.org
BACKGROUND: In patients with coronary artery disease (CAD), therapies
designed to prevent clinical events are not always associated with significant
reduction in coronary obstruction, as measured by quantitative coronary
angiography. We set out to explore the relationship between quantitative coronary
angiography parameters, baseline characteristics, and clinical events in a large trial
of CAD regression with antihypertensive agents. METHODS AND RESULTS:
Patients randomized to amlodipine, enalapril, or placebo in the CAMELOT trial
were followed for 24 months for major ischemic events. Among 431 patients
participating in the angiographic and intravascular ultrasound substudy
NORMALISE, 298 (99 amlodipine, 96 enalapril, and 103 placebo) had complete
angiographic and intravascular ultrasound data. The patients did not differ
significantly with respect to baseline characteristics (except for diabetes) or extent
of CAD. After 24 months, the change in minimal lumen diameter (MLD) was 0.02 +/- 0.13 for amlodipine, -0.03 +/- 0.12 for enalapril, and -0.03 +/- 0.17 mm
for placebo (P = .40). Major ischemic events occurred in 20.2%, 24%, and 25.2%,
respectively (P = .68). There was no significant correlation between change in
MLD and age, sex, statin therapy, or systolic blood pressure at baseline. The
change in MLD did not differ in patients with and without cardiovascular events,
regardless of treatment assignment (P = .54). Only the extent of CAD was
independently predictive of ischemic events. CONCLUSION: As compared to
placebo, amlodipine treatment resulted in fewer ischemic events after 24 months
of therapy, but the clinical benefit was not associated with a commensurate
improvement in arterial lumen dimensions.
PMID: 17161053 [PubMed - indexed for MEDLINE]
5: Am Heart J. 2006 Nov;152(5):867-75.
Related Articles, Links
Examination of lower targets for low-density lipoprotein cholesterol
and blood pressure in diabetes--the Stop Atherosclerosis in Native
Diabetics Study (SANDS).
Russell M, Fleg JL, Galloway WJ, Henderson JA, Howard J, Lee ET, Poolaw
B, Ratner RE, Roman MJ, Silverman A, Stylianou M, Weir MR, Wilson C,
Yeh F, Zhu J, Howard BV.
Phoenix Indian Medical Center, Phoenix, AZ, USA.
Diabetes incidence is increasing rapidly in the United States. Diabetes increases
the risk for cardiovascular disease, the major cause of death in diabetic
individuals. The conventional cardiovascular risk factors of hyperlipidemia and
hypertension worsen diabetic vascular disease. Treatment targets for low-density
lipoprotein cholesterol (LDL-C) and blood pressure in diabetic individuals are
being debated. The SANDS is a randomized, open-label, 3-year trial to examine
the effects of aggressive LDL-C (goal <70 mg/dL) and blood pressure (BP) (goal
<115/75 mm Hg) reduction versus the standard goals of <100 mg/dL for LDL-C
and <130/85 mm Hg for BP. Five hundred forty-nine American-Indian men and
women >40 years old with type 2 diabetes were randomized to 1 of 2 groups.
Lipids and BP are managed using Food and Drug Administration-approved
medications in an algorithmic approach. The presence and progression of
atherosclerosis are evaluated by carotid ultrasonography; echocardiography
assesses cardiac function. The primary end point is the composite outcome of
change in carotid artery intimal medial thickness and fatal/nonfatal cardiovascular
events. These outcomes are combined by using a ranked analysis for carotid
thickness and assigning a "worst rank" for a cardiovascular event. Secondary end
points include carotid plaque score, left ventricular geometry and function, serum
C-reactive protein, and safety measures. Unique aspects of the study design and
analysis plan involve the use of a composite outcome and changes during the trial
of LDL-C treatment goals for participants with baseline or incident cardiovascular
disease in the conventional group because of changes in the standard of care.
Study results will further understanding of the effects of aggressive risk factor
reduction on atherosclerosis burden and cardiac function in diabetic individuals in
US populations and will help determine optimal LDL-C and BP treatment goals
for diabetic patients.
Publication Types:
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Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural
PMID: 17070147 [PubMed - indexed for MEDLINE]
6: Am J Cardiol. 2006 Oct 15;98(8):1018-21. Epub 2006 Aug 28.
Related Articles, Links
Comparison of 30-day outcomes in patients <75 years of age versus
>or=75 years of age with acute myocardial infarction treated by
primary coronary angioplasty.
Sakai K, Nakagawa Y, Soga Y, Ando K, Yokoi H, Iwabuchi M, Yasumoto H,
Nosaka H, Nobuyoshi M.
Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
We reviewed 1,087 consecutive patients treated by primary coronary angioplasty
for acute myocardial infarction; 309 were >or=75 and 778 were <75 years of age.
Compared with the younger group, the older group had higher 30-day (8.1% vs
4.0%, p = 0.0057) and cardiac (6.5% vs 3.6%, p = 0.038) mortality rates.
Successful reperfusion was achieved in the 2 groups at a similarly high rate
(91.6% and 92.9%, p = 0.45). Successful compared with unsuccessful angioplasty
decreased 30-day mortality rates in the older group (6.0% vs 30.8%, p <0.0001)
and in the younger group (3.2% vs 14.5%, p <0.0001). When reperfusion was
successful, the cardiac mortality rate in older patients was not significantly greater
than that in younger patients (4.6% vs 2.8%, p = 0.14). By multivariate analysis in
all 1,087 patients, overt cardiogenic shock on admission (odds ratio 44.7, 95%
confidence interval 22.0 to 91.1, p <0.0001) and unsuccessful reperfusion (odds
ratio 9.40, 95% confidence interval 4.11 to 21.5, p <0.0001) were found to be
independent predictors of 30-day mortality, whereas age >or=75 years (odds ratio
1.79, 95% confidence interval 0.91 to 3.50, p = 0.090) was not. In conclusion,
aggressive angioplasty in older patients improves prognosis.
Publication Types:

Comparative Study
PMID: 17027563 [PubMed - indexed for MEDLINE]
7: Am J Cardiol. 2006 Oct 15;98(8):1012-7. Epub 2006 Aug 22.
Related Articles, Links
Genotype-phenotype association of matrix metalloproteinase-3
polymorphism and its synergistic effect with smoking on the
occurrence of acute coronary syndrome.
Liu PY, Li YH, Chan SH, Lin LJ, Wu HL, Shi GY, Chen JH.
Division of Cardiology, Department of Internal Medicine, College of Medicine,
National Cheng Kung University, Tainan, Taiwan.
Matrix metalloproteinase-3 (MMP-3) degrades the extracellular matrix and may
contribute to the weakening of the plaque cap. To determine whether genotypephenotype associations differed in different categories of acute coronary
syndrome, we enrolled 650 consecutive Taiwanese patients diagnosed with acute
coronary syndrome. Genotypic analysis was done on DNA using polymerase
chain reaction and direct sequencing on the 5 adenines (5A)/6 adenines (6A; 1,171 bp) polymorphism in the MMP-3 gene promoter region. The frequency of
the 5A polymorphism was higher in patients with acute coronary syndrome,
especially in those with ST-elevation myocardial infarction (p <0.01). The number
of 5A allele polymorphisms was strongly associated with more complex coronary
angiography (diffuse score for 5A/5A vs 5A/6A vs 6A/6A, 6.6 +/- 1.2 vs 5.3 +/1.3 vs 4.6 +/- 1.1, all p values <0.05 in subgroup analysis) and higher plasma
MMP-3 activity in this acute coronary syndrome cohort (MMP-3 level for 6A/6A
vs 5A/6A vs 5A/5A, 21.0 +/- 2.2 vs 23.3 +/- 2.1 vs 27.9 +/- 2.2 ng/ml, all p values
<0.05 in subgroup analysis). Multiple logistic regression analysis showed that this
polymorphism, in addition to hypertension, diabetes, and a history of smoking,
was an independent risk factor (odds ratio 2.2, 95% confidence interval 1.1 to 4.3,
p = 0.02) for the occurrence of acute coronary syndrome. Further, carriers of this
polymorphism who smoked had a significantly increased (20-fold) risk of acute
coronary syndrome compared with nonsmoking noncarriers. In conclusion, the
MMP-3 5A/6A polymorphism is significantly associated with the occurrence of
acute coronary syndrome, MMP-3 activity, and severity of coronary
atherosclerosis. There is a synergistic effect between smoking and this genetic risk
factor for acute coronary syndrome.
Publication Types:
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Research Support, Non-U.S. Gov't
PMID: 17027562 [PubMed - indexed for MEDLINE]
8: Am J Hypertens. 2006 Dec;19(12):1293-9.
Related Articles, Links
Antihypertensive drugs and fibrinolytic function.
Fogari R, Zoppi A.
Department of Internal Medicine, University of Pavia, Clinica Medica II, IRCCS
Policlinico S. Matteo, Pavia, Italy. r.fogari@smatteo.pv.it
Impaired fibrinolytic function, characterized by increased plasminogen activator
inhibitor type 1 (PAI-1) levels and decreased tissue plasminogen activator (t-PA)
activity, has been found in patients with hypertension and may account in part for
the increased risk of atherosclerosis and its clinical complications in these patients.
Failure to correct this prothrombotic state may be one of the possible reasons for
the disappointing effect of antihypertensive treatment on the incidence of coronary
events. In this regard, data from the literature indicate that different
antihypertensive drugs may vary in their influence on fibrinolysis. Scarce and
conflicting data exist regarding the effects of diuretics and beta-blockers on the
fibrinolytic system. Angiotensin-converting enzyme (ACE) inhibitors (ACE-I)
have generally been shown to improve the fibrinolytic balance by reducing plasma
PAI-1 levels, calcium channel blockers (CCB) have been reported to increase t-PA
activity, and angiotensin receptor blockers (ARB) seem to be neutral in their
effect. Interesting data have been reported about the positive impact on
fibrinolysis of combining an ACE-I with a CCB, which resulted in a decrease of
PAI-1 caused by ACE inhibition, and an increase in t-PA resulting from calcium
channel blockade. The positive effect of ACE-I on the fibrinolytic system has
been related to: 1) inhibition of angiotensin II, which stimulates PAI-1 expression;
2) inhibition of degradation of bradykinin, a potent stmulus for tPA production;
and 3) improvement of insulin sensitivity. The mechanisms underlying the CCB
effect on t-PA are less clear, but a direct action of CCB on vascular endothelium
has been reported to play a major role. The greater improvement in the fibrinolytic
balance because of the combined action of ACE inhibition and Ca antagonism
represents a further indication to the use of combinations of ACE-I and CCB in
the treatment of hypertension.
PMID: 17161777 [PubMed - in process]
9: Am J Hypertens. 2006 Dec;19(12):1286-92.
Related Articles, Links
Antihypertensive and renal protective effects of Renin-Angiotensin
system blockade in uremic rats treated with erythropoietin.
Lebel M, Rodrigue ME, Agharazii M, Lariviere R.
Research Centre, CHUQ, L'Hotel-Dieu de Quebec Hospital and Department of
Medicine, Faculty of Medicine, Laval University, Quebec, Canada.
marcel.lebel@crhdq.ulaval.ca
BACKGROUND: Correcting anemia with recombinant human erythropoietin
(rhEPO) in chronic renal failure has been associated with an increased blood
pressure (BP), which may accelerate the decline in renal function. This has been
attributed, in part, to the activation of the renin-angiotensin system. The present
study was designed to investigate the protective effect of the angiotensin IIreceptor blocker losartan compared with the angiotensin-converting enzyme
inhibitor captopril and conventional triple therapy (TRx) in uremic rats receiving
rhEPO therapy. METHODS: Renal failure was induced by renal mass ablation
followed by a 3-week stabilization period. Uremic rats were then divided into five
groups with similar systolic BP: vehicle; rhEPO (100 U/kg, subcutaneously, three
times per week); rhEPO + losartan (20 mg/kg/d); rhEPO + captopril (20 mg/kg/d);
and rhEPO + TRx (reserpine 5 mg/L, hydralazine 80 mg/L, hydrochlorothiazide
20 mg/L). Systolic BP as well as blood and renal parameters were assessed before
and after a 3-week treatment period. Renal histology was evaluated at the end of
the study. RESULTS: The uremic rats developed hypertension, anemia,
proteinuria, and increased urinary endothelin-1 (ET-1) excretion. The rhEPO
corrected the anemia but aggravated the hypertension (P < .01), glomerular
sclerosis, tubular atrophy, and interstitial fibrosis. Treatment with losartan,
captopril, and the TRx prevented the rhEPO-induced increased in systolic BP. The
TRx was less effective in preventing histologic injuries despite similar systolic BP
reduction. CONCLUSIONS: Blockade of the renin-angiotensin system is highly
effective in preventing both hypertension and renal histologic damage in rhEPOtreated uremic rats and this benefit seems to extend beyond the antihypertensive
effect.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17161776 [PubMed - in process]
10: Am J Hypertens. 2006 Dec;19(12):1278-85.
Related Articles, Links
Angiotensinogen promoter sequence variants in essential
hypertension.
Velez DR, Guruju M, Vinukonda G, Prater A, Kumar A, Williams SM.
Center for Human Genetics Research, Vanderbilt University, Nashville,
Tennessee 37232, USA.
BACKGROUND: Essential hypertension is a complex multifactorial disease
caused by ill-defined genetic factors. The angiotensinogen (AGT) gene has been
implicated as a risk factor in essential hypertension. METHODS: To assess the
role of AGT in hypertension, we evaluated two polymorphisms (A-6G and C20A) in the 5' region of the gene that have been shown to have a role in
transcriptional regulation. A total of 463 subjects were studied: 243 African
Americans (26 male and 34 female normotensives, 66 male and 117 female
hypertensives) and 220 whites (35 male and 60 female normotensives, 55 male
and 70 female hypertensives). African American and white subjects were
examined individually, as significant differences in allele and genotype
frequencies were observed between these two cohorts. RESULTS: White female
hypertensives and normotensives differed significantly in genotype frequency at
C-20A (P = .02). No other single site comparisons were significantly different
between hypertensives and normotensives in either the white or African American
samples. Haplotype frequencies in white males also differed significantly between
phenotypic classes (P = .05). To evaluate the data further, we assessed all
polymorphic sites simultaneously by the examination of multisite interaction and
determined the single best genetic model for each population. A model that
included both sites and gender correctly predicted hypertension status in the white
population 59.1% of the time (P = .039). The model generated for the African
American population was not significant. CONCLUSIONS: Our results suggest
that a complex set of genetic factors interact with gender to predispose whites to
hypertension.
Publication Types:
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
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
PMID: 17161775 [PubMed - in process]
11: Am J Hypertens. 2006 Dec;19(12):1233-40.
Related Articles, Links
Cardiorenal protective effects of year-long antihypertensive therapy
with a Angiotensin-converting enzyme inhibitor or a calcium
channel blocker in spontaneously hypertensive rats.
Ishimitsu T, Honda T, Ohta S, Akashiba A, Takahashi T, Kameda T, Yoshii
M, Minami J, Takahashi M, Ono H, Matsuoka H.
Department of Hypetension and Cardiorenal Medicine, Dokkyo Medical
University, Mibu, Tochigi, Japan. isimitu@dokkyomed.ac.jp
BACKGROUND: The objective of this study was to evaluate the effect of yearlong antihypertensive therapy with a calcium channel blocker and an angiotensinconverting enzyme (ACE) inhibitor on cardiac and renal injury. METHODS: Male
15-week-old spontaneously hypertensive rats (SHR) were given either a normal
diet and normal drinking water (n = 10), a diet containing 0.05% nitrendipine (n =
10), or drinking water containing 50 mg/L of quinapril (n = 10). After 12 months
of antihypertensive treatment, cardiovascular organ injuries were evaluated.
RESULTS: Tail-cuff blood pressure (BP) at 12 months was significantly lower in
animals receiving nitrendipine or quinapril than in control animals (control, 231
+/- 2 mm Hg; nitrendipine, 194 +/- 3 mm Hg; quinapril, 191 +/- 3 mm Hg; P <
.001). Furthermore, aortic thickness was reduced by nitrendipine (-19%, P < .001)
or quinapril (-21%, P < .001), and cardiac ventricular weight was significantly
reduced by quinapril (-18%, P < .001) but not by nitrendipine (-5%, P = not
significant [NS]). Echocardiography at 12 months revealed that midwall fractional
shortening was higher in the quinapril group than in the control or the nitrendipine
groups (control, 9.3% +/- 0.5%; nitrendipine, 9.8% +/- 0.5%; quinapril, 10.6% +/0.6%; P < .05). Left ventricular hydroxyproline levels were lower in the
nitrendipine group (-21%, P < .01) and the quinapril group (-36%, P < .001) than
in the control animals. In control SHR, creatinine clearance began to decrease and
proteinuria began to increase at 6 to 9 months. Quinapril but not nitrendipine
attenuated these markers of renal impairment (creatinine clearance at 12 months:
control, 4.7 +/- 0.4 mL/min/kg; nitrendipine, 5.0 +/- 0.4 mL/min/kg; quinapril, 6.1
+/- 0.4 mL/min/kg; P < .05). Histologically, the glomerular injury score was lower
in the quinapril group than in the control or nitrendipine groups (control, 19
[range, 8 to 30]; nitrendipine, 18 [range, 9 to 32]; quinapril, 7 [range, 3 to 12]; P <
.01). CONCLUSIONS: It is suggested that year-long antihypertensive therapy
with an angiotensin-converting enzyme (ACE) inhibitor is superior to a calcium
channel blocker in terms of cardiorenal protection in SHR.
PMID: 17161768 [PubMed - in process]
12: Am J Hypertens. 2006 Dec;19(12):1226-32.
Related Articles, Links
In vivo and in vitro effects of nebivolol on penile structures in
hypertensive rats.
Toblli JE, Cao G, Casas G, Mazza ON.
Laboratory of Experimental Medicine, Hospital Aleman, Buenos Aires, Argentina.
jtobilli@hospitalaleman.com
BACKGROUND: Erectile dysfunction is associated with high blood pressure and
antihypertensive treatment, especially diuretics and traditional beta-blockers.
Nevertheless, new beta-blockers such as nebivolol present some differences with
respect to the classic beta-blockers. The aim of this study was to determine the
functional and morphologic effects of nebivolol on penile structures in
hypertensive rats. METHODS: During a 6-month period, male spontaneously
hypertensive rat (SHR) and Wistar-Kyoto (WKY) rats were studied. The groups
were as follows: 1) untreated SHR (Untreated-SHR); 2) SHR given nebivolol 10
mg/kg/day (SHR+N); 3) SHR given amlodipine 3 mg/kg/day (SHR+AML); and
4) untreated WKY (untreated-WKY). Cavernous smooth muscle (CSM) and
vascular smooth muscle (VSM) from cavernous arteries, as well as collagen type
III (COL III) in cavernous tissue, were evaluated. RESULTS: After 6 months,
SHR groups given nebivolol and amlodipine showed similar reductions in blood
pressure compared with untreated SHR. However, only SHR+N and control WKY
showed significantly lower values of CSM (P < 01), VSM (P < 01), and COL III
(P < 01) when compared with untreated SHR and SHR+AML. In addition SHR+N
showed a higher endothelial nitric oxide synthase expression in sinusoidal
endothelium compared with SHR, and SHR+AML (P < 01). In vitro studies
revealed that SHR+N displayed a better relaxation response to acetylcholine than
untreated-SHR and SHR+AML (P < 01). CONCLUSION: Nebivolol presented
equivalent BP control compared with amlodipine. However, only nebivolol
showed a significant better functional outcome with a protective role against
structural changes in erectile tissue that are caused by arterial hypertension.
PMID: 17161767 [PubMed - in process]
13: Am J Hypertens. 2006 Dec;19(12):1217-25.
Related Articles, Links
Factorial antihypertensive study of an extended-release metoprolol
and hydrochlorothiazide combination.
Papademetriou V, Hainer JW, Sugg J, Munzer D; ATTACH Study Group.
Hypertension Research, VA Medical Center and Georgetown University Medical
Center, Washington, DC 20422, USA. papavip@aol.com
BACKGROUND: To attain goal blood pressure (BP), many hypertensive patients
require combination antihypertensive therapy. Thiazide diuretic/beta-blocker
regimens lower BP, and clinical studies indicate that they reduce the risk for
cardiovascular consequences of hypertension. Fixed-dose combination tablets can
simplify multidrug treatment regimens. METHODS: This multicenter,
randomized, double-blind, placebo-controlled, unbalanced factorial study (N =
1571) was designed to determine whether hydrochlorothiazide (HCT) and
extended release (ER) metoprolol both contribute to an antihypertensive effect.
Hypertensive adults with sitting diastolic BP (SiDBP) 95 to 114 mm Hg and
systolic BP (SiSBP) <180 mm Hg received one of three hydrochlorothiazide doses
(6.25 mg, 12.5 mg, or 25 mg), one of four ER-metoprolol doses (25 mg, 50 mg,
100 mg, 200 mg), or one of nine of the combinations or placebo for 8 weeks.
RESULTS: Blood pressure decreased with all combinations (P < .001 v placebo);
reductions were dose related, ranging from 8.7 to 15.7 mm Hg (SiDBP) and 9.7 to
18.9 mm Hg (SiSBP) (model-derived values). Reductions with placebo were 5.3
(SiDBP) and 4.2 mm Hg (SiSBP). Both active agents contributed to the
combination effect (P = .0015 for SiDBP; P = .0006 for SiSBP). Several low-dose
combinations were approximately as effective as high doses of the individual
agents (differences within 1 to 2.5 mm Hg). The adverse event discontinuation
rate was 2.9%. Serum potassium decreased and uric acid increased with increasing
doses of HCT. CONCLUSIONS: Extended-release
metoprolol/hydrochlorothiazide is an effective antihypertensive combination that
offers additive antihypertensive contributions from both components.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17161766 [PubMed - in process]
14: Am J Hypertens. 2006 Dec;19(12):1213-6.
Related Articles, Links
Nitric oxide release is impaired in hypertensive individuals with
familial history of stroke.
Cosentino F, Francia P, Musumeci B, De Siati L, Rao MA, De Luca N, Balla
C, De Sensi F, Volpe M.
Division of Cardiology, 2(nd) Faculty of Medicine, University La Sapienza,
Rome, Italy.
BACKGROUND: A genetic origin of cerebrovascular accidents has long been
suspected on the basis of epidemiologic evidence and familial aggregation.
Nevertheless, the final phenotype is largely influenced by concomitant risk
factors. We aimed to investigate whether impairment of endothelium-dependent
vasodilation can be used as an informative intermediate vascular phenotype in
hypertensive patients with familial history of stroke. METHODS: Fourteen
hypertensive individuals, seven with familial history of stroke (FH+), seven
without familial history of stroke (FH-), and six normotensive volunteers (C) were
included in the study. High-resolution ultrasound and Doppler were used to
measure radial artery diameter and blood flow at rest, during reactive hyperemia,
and after intra-arterial infusion of N(G)-monomethyl-l-arginine (L-NMMA) to
inhibit NO synthase. RESULTS: Basal blood flow and diameter were comparable
in all groups. Flow-mediated dilation was impaired in FH+ (3.2% +/- 2%),
compared with FH- (9.6% +/- 1%; P = . 01) and C (15.9% +/- 3%; P = . 001). The
L-NMMA decreased basal flow in FH- (16.0 +/- 2 v 13.8 +/- 1 mL/min; P = . 04),
and C (23.3 +/- 2 v 16.5 +/- 2 mL/min, P = .003) but did not exert any significant
effect in FH+ subjects (16.4 +/- 3 v 15.8 +/- 2 mL/min, P = .77).
CONCLUSIONS: These findings demonstrate that NO bioavailability is reduced
in hypertensive subjects with familial history of stroke. Such a phenotype may
represent an early marker of susceptibility to cerebrovascular events in this
population.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17161765 [PubMed - in process]
15: Am J Hypertens. 2006 Dec;19(12):1197-8.
Related Articles, Links
Dr. Michael H. Alderman takes the helm as editor-in-chief of the
American journal of hypertension.
Laragh JH.
Publication Types:

Editorial
PMID: 17161762 [PubMed - in process]
16: Am J Hypertens. 2006 Oct;19(10):1049-54.
Related Articles, Links
Left ventricular hypertrophy in patients with autonomic failure.
Maule S, Milan A, Grosso T, Veglio F.
Autonomic Unit and Hypertension Unit, Department of Medicine and
Experimental Oncology, S. Vito Hospital, University of Turin, Turin, Italy.
simmaule@tin.it
BACKGROUND: In autonomic failure (AF), supine hypertension may predispose
patients to end-organ damage. The pathophysiology of hypertensive heart disease
in AF is not known. The aim of the present study was to evaluate the prevalence
and predisposing factors of left ventricular hypertrophy (LVH) in patients with
AF. METHODS: We studied 25 patients with AF (67 +/- 8 years); 80% were
being treated for orthostatic hypotension. Twenty patients with essential
hypertension (68 +/- 6 years) were considered as the control group. All subjects
underwent echocardiography for measurement of left ventricular mass (LVM).
The patients with AF underwent a 24-h BP monitoring and long-term blood
pressure (BP) variability was calculated as standard deviation (SD) of the average
of the half-hour mean values. RESULTS: The LVM is comparable in patients with
AF and hypertensive controls (145 +/- 35 g/m2 v 127 +/- 32 g/m2, P = .07). The
proportion of patients with LVH is similar in both populations (AF 80%,
hypertensive 70%). The patients with AF were divided into two groups, with and
without LVH. The SDs are significantly higher in AF patients with LVH than in
those with normal LVM (SD 24-h systolic BP: 22 +/- 4 v 14 +/- 1 mm Hg, P =
.001). CONCLUSIONS: A high proportion of patients with AF show LVH. The
LVM values are comparable with those of patients with essential hypertension.
The development of LVH seems to depend on high BP variability, characteristic
of AF patients. Detection of LVH may help in the choice of treatment for
orthostatic hypotension and in the prevention of heart failure.
Publication Types:

Evaluation Studies
PMID: 17027826 [PubMed - indexed for MEDLINE]
17: Am J Hypertens. 2006 Aug;19(8):877-8.
Related Articles, Links
Erratum in:

Am J Hypertens. 2006 Aug;19(8):876.
Comment on:

Am J Hypertens. 2006 Mar;19(3):286-92.
Bone mineral content and blood pressure: What is the
pathophysiologic link?
Titze J.
Department of Nephrology and Hypertension, Friedrich-Alexander-University
Erlangen-Nuremberg, Erlangen, Germany. jus.titze@t-online.de <jus.titze@tonline.de>
Publication Types:

Comment
PMID: 16876694 [PubMed - indexed for MEDLINE]
18: Am J Hypertens. 2006 Aug;19(8):796-800.
Related Articles, Links
Long-term prognostic value of resting heart rate in subjects with
prehypertension.
King DE, Everett CJ, Mainous AG 3rd, Liszka HA.
Department of Family Medicine, Medical University of South Carolina,
Charleston, South Carolina, USA. kingde@musc.edu <kingde@musc.edu>
BACKGROUND: Increased resting heart rate increases cardiovascular risk in
individuals with hypertension. The extent to which such risk extends to people
with prehypertension is not known. The purpose of this study was to determine
whether elevated resting heart rate contributes to increased coronary heart disease
(CHD) risk in people with prehypertension. METHODS: The cohort for the
current study consisted of 3275 persons from the Atherosclerosis Risk in
Communities (ARIC) study, 45 to 64 years old in 1986 to 1989, with a mean
follow-up of 10.1 years. The primary outcomes were CHD and all-cause mortality.
RESULTS: Individuals with prehypertension and elevated resting heart rate had
50% higher all-cause mortality than people with prehypertension and lower resting
heart rate (hazard ratio [HR] 1.50, 95% confidence interval [CI] 1.0-2.15), which
was essentially unchanged after controlling for age, ethnicity, gender, diabetes,
smoking status, LDL-cholesterol, exercise, and use of antilipemic agents (P < .01).
Similarly, in unadjusted analyses, CHD risk was 49% higher for people with
increased heart rate (HR 1.49, 95% CI 1.03-2.14). In adjusted analyses, elevated
resting heart rate remained a factor in increased risk of CHD in women (adjusted
HR 2.18, 95% CI 1.08-4.42), but not in men. CONCLUSIONS: Resting heart rate
is an easily accessible tool that may be helpful for stratifying CHD and mortality
risk in people with prehypertension.
Publication Types:


Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.
PMID: 16876677 [PubMed - indexed for MEDLINE]
19: BMJ. 2006 Nov 18;333(7577):1047. Epub 2006 Oct 24.
Related Articles, Links
Comment in:

BMJ. 2006 Nov 18;333(7577):1030-1.
Screening strategies for chronic kidney disease in the general
population: follow-up of cross sectional health survey.
Hallan SI, Dahl K, Oien CM, Grootendorst DC, Aasberg A, Holmen J,
Dekker FW.
Department of Cancer Research and Molecular Biology, Faculty of Medicine,
Norwegian University of Science and Technology, 7006 Trondheim, Norway.
stein.hallan@ntnu.no
OBJECTIVE: To find an effective screening strategy for detecting patients with
chronic kidney disease and to describe the natural course of the disease. DESIGN:
Eight year follow-up of a cross sectional health survey (the HUNT II study).
SETTING: Nord-Trondelag County, Norway PARTICIPANTS: 65,604 people
(70.6 % of all adults aged >or=20 in the county). MAIN OUTCOME
MEASURES: Incident end stage renal disease (ESRD) and cardiovascular
mortality monitored by individual linkage to central registries. RESULTS:
3069/65,604 (4.7%) people had chronic kidney disease (estimated glomerular
filtration rate <60 ml/min/1.73 m(2)), so we would need to screen 20.6 people
(95% confidence interval 20.0 to 21.2) to identify one case. Restriction of
screening to those with hypertension, diabetes, or age >55 would identify 93.2%
(92.4% to 94.0%) of patients with chronic kidney disease, with a number needed
to screen of 8.7 (8.5 to 9.0). Restriction of screening according to guidelines of the
United States kidney disease outcomes quality initiative (US KDOQI) gave
similar results, but restriction according to the United Kingdom's chronic kidney
disease guidelines detected only 60.9% (59.1% to 62.8%) of cases. Screening only
people with previously known diabetes or hypertension detected 44.2% (42.7% to
45.7%) of all cases, with a number needed to screen of six. During the eight year
follow-up only 38 of the 3069 people with chronic kidney disease progressed to
end stage renal disease, and the risk was especially low in people without diabetes
or hypertension, women, and those aged >or=70 or with a glomerular filtration
rate 45-59 ml/min/1.73 m(2) at screening. In contrast, there was a high
cardiovascular mortality: 3.5, 7.4, and 10.1 deaths per 100 person years among
people with a glomerular filtration rate 45-59, 30-44, and <30 ml/min/1.73 m(2),
respectively. CONCLUSION: Screening people with hypertension, diabetes
mellitus, or age >55 was the most effective strategy to detect patients with chronic
kidney disease, but the risk of end stage renal disease among those detected was
low.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17062598 [PubMed - indexed for MEDLINE]
20: Circulation. 2006 Nov 21;114(21):2240-50. Epub 2006 Nov 6.
Related Articles, Links
Regulated overexpression of the A1-adenosine receptor in mice
results in adverse but reversible changes in cardiac morphology and
function.
Funakoshi H, Chan TO, Good JC, Libonati JR, Piuhola J, Chen X,
MacDonnell SM, Lee LL, Herrmann DE, Zhang J, Martini J, Palmer TM,
Sanbe A, Robbins J, Houser SR, Koch WJ, Feldman AM.
Center for Translational Medicine, Department of Medicine, Jefferson Medical
College, Philadelphia, PA 19107, USA.
BACKGROUND: Both the A1- and A3-adenosine receptors (ARs) have been
implicated in mediating the cardioprotective effects of adenosine. Paradoxically,
overexpression of both A1-AR and A3-AR is associated with changes in the
cardiac phenotype. To evaluate the temporal relationship between AR signaling
and cardiac remodeling, we studied the effects of controlled overexpression of the
A1-AR using a cardiac-specific and tetracycline-transactivating factor-regulated
promoter. METHODS AND RESULTS: Constitutive A1-AR overexpression
caused the development of cardiac dilatation and death within 6 to 12 weeks.
These mice developed diminished ventricular function and decreased heart rate. In
contrast, when A1-AR expression was delayed until 3 weeks of age, mice
remained phenotypically normal at 6 weeks, and >90% of the mice survived at 30
weeks. However, late induction of A1-AR still caused mild cardiomyopathy at
older ages (20 weeks) and accelerated cardiac hypertrophy and the development of
dilatation after pressure overload. These changes were accompanied by gene
expression changes associated with cardiomyopathy and fibrosis and by decreased
Akt phosphorylation. Discontinuation of A1-AR induction mitigated cardiac
dysfunction and significantly improved survival rate. CONCLUSIONS: These
data suggest that robust constitutive myocardial A1-AR overexpression induces a
dilated cardiomyopathy, whereas delaying A1-AR expression until adulthood
ameliorated but did not eliminate the development of cardiac pathology. Thus, the
inducible A1-AR transgenic mouse model provides novel insights into the role of
adenosine signaling in heart failure and illustrates the potentially deleterious
consequences of selective versus nonselective activation of adenosine-signaling
pathways in the heart.
Publication Types:


Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
PMID: 17088462 [PubMed - indexed for MEDLINE]
21: Circulation. 2006 Nov 7;114(19):2034-9. Epub 2006 Oct 30.
Related Articles, Links
Creatine kinase activity is associated with blood pressure.
Brewster LM, Mairuhu G, Bindraban NR, Koopmans RP, Clark JF, van
Montfrans GA.
Department of Internal Medicine, F4-222, Academic Medical Center,
Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. mail@lizzybrewster.net
BACKGROUND: We previously hypothesized that high activity of creatine
kinase, the central regulatory enzyme of energy metabolism, facilitates the
development of high blood pressure. Creatine kinase rapidly provides adenosine
triphosphate to highly energy-demanding processes, including cardiovascular
contraction, and antagonizes nitric oxide-mediated functions. Relatively high
activity of the enzyme, particularly in resistance arteries, is thought to enhance
pressor responses and increase blood pressure. Tissue creatine kinase activity is
reported to be high in black people, a population subgroup with greater
hypertension risk; the proposed effects of high creatine kinase activity, however,
are not "race dependent." We therefore assessed whether creatine kinase is
associated with blood pressure in a multiethnic population. METHODS AND
RESULTS: We analyzed a stratified random sample of the population of
Amsterdam, The Netherlands, consisting of 1444 citizens (503 white European,
292 South Asian, 580 black, and 69 of other ethnicity) aged 34 to 60 years. We
used linear regression analysis to investigate the association between blood
pressure and normal serum creatine kinase after rest, as a substitute measure of
tissue activity. Creatine kinase was independently associated with blood pressure,
with an increase in systolic and diastolic pressure, respectively, of 8.0 (95% CI,
3.3 to 12.7) and 4.7 (95% CI, 1.9 to 7.5) mm Hg per log creatine kinase increase
after adjustment for age, sex, body mass index, and ethnicity. CONCLUSIONS:
Creatine kinase is associated with blood pressure. Further studies are needed to
explore the nature of this association, including how variation in cardiovascular
creatine kinase activity may affect pressor responses.
Publication Types:

Comparative Study
PMID: 17075013 [PubMed - indexed for MEDLINE]
22: Clin Cardiol. 2006 Aug;29(8):345-51.
Related Articles, Links
Validation of a new index for estimating arterial stiffness:
measurement of the QPV interval by Doppler ultrasound.
Lee MY, Chu CS, Lee KT, Wu CM, Su HM, Lin SJ, Sheu SH, Lai WT.
Division of Cardiology, Department of Internal Medicine, Kaohsiung Municipal
United Hospital, Taiwan.
BACKGROUND: Pulse wave velocity (PWV), a relevant indicator of arterial
stiffness, can be measured noninvasively with a variety of automatic devices, but
most are complexly equipped. We developed a novel index for estimating arterial
stiffness as "QPV interval," which was determined by means of surface
electrocardiogram and Doppler ultrasound of the brachial artery simultaneously.
HYPOTHESIS: This study aimed to validate the QPV interval as an exact and
convenient index for estimation of arterial stiffness. METHODS: Forty-seven
patients with untreated essential hypertension and 19 normotensive subjects were
enrolled. Brachial-ankle PWV (baPWV) was measured using an automatic
volume-plethysmographic apparatus, and Doppler ultrasound was implemented
sequentially to measure the QPV interval in each subject. Clinical biochemistry
and echocardiography were performed on the same day. RESULTS: Mean
baPWV was significantly higher in hypertensive patients than in normotensive
subjects (p = 0.002), whereas mean QPV interval was significantly shorter in
hypertensive patients than in the normotensive group (p = 0.019). A simple
regression analysis demonstrated an inverse correlation between the QPV interval
and baPWV (r = -0.671, p < 0.001) in all enrolled subjects. In a stepwise
regression model that adjusted for age, systolic blood pressure, and other
determinants of baPWV, the negative association remained between the QPV
interval and baPWV (p < 0.001). CONCLUSION: The QPV interval correlates
inversely with baPWV, independent of age and other determinants of baPWV;
hence, the QPV interval can serve as a simple and convenient index for assessing
arterial stiffness in clinical practice.
Publication Types:


Research Support, Non-U.S. Gov't
Validation Studies
PMID: 16933575 [PubMed - indexed for MEDLINE]
23: Eur Heart J. 2007 Jan;28(1):140-1. Epub 2006 Dec 12.
Related Articles, Links
N-terminal brain natriuretic peptide in scleroderma-associated
pulmonary arterial hypertension.
Mathai SC, Hassoun PM.
Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 East
Monument Street, Baltimore, Maryland 21205, USA. smathai4@jhmi.edu.
PMID: 17164254 [PubMed - in process]
24: Hypertension. 2007 Feb;49(2):311-6. Epub 2006 Dec 18.
Related Articles, Links
Left atrial size and risk of major cardiovascular events during
antihypertensive treatment: losartan intervention for endpoint
reduction in hypertension trial.
Gerdts E, Wachtell K, Omvik P, Otterstad JE, Oikarinen L, Boman K,
Dahlof B, Devereux RB.
Institute of Medicine, University of Bergen, Haukeland University Hospital, N5021 Bergen, Norway. gerdtsev@online.no
The influence of left atrial size on cardiovascular events during antihypertensive
treatment has not been reported previously from a long-term, prospective,
randomized hypertension treatment trial. We recorded left atrial diameter by
annual echocardiography and cardiovascular events in 881 hypertensive patients
(41% women) with electrocardiographic left ventricular hypertrophy aged 55 to 80
(mean: 66) years during a mean of 4.8 years of randomized losartan- or atenololbased treatment in the Losartan Intervention for Endpoint Reduction in
Hypertension Study. During follow-up, a total of 88 primary end points (combined
cardiovascular death, myocardial infarction, or stroke) occurred. In Cox
regression, baseline left atrial diameter/height predicted incidence of
cardiovascular events (hazard ratio: 1.98 per cm/m [95% CI: 1.02 to 3.83 per
cm/m]; P=0.042) adjusted for significant effects of Framingham risk score and
history of atrial fibrillation. Greater left atrial diameter reduction during follow-up
was associated with greater reduction in left ventricular hypertrophy, absence of
new-onset atrial fibrillation or mitral regurgitation during follow-up, and losartanbased treatment (B=-0.13+/-0.03 cm/m; P<0.001) in multiple linear regression,
adjusting for baseline left atrial diameter/height. However, in time-varying Cox
regression analysis, left atrial diameter reduction was not independent of left
ventricular hypertrophy regression in predicting cardiovascular events during
follow-up. In conclusion, left atrial diameter/height predicts risk of cardiovascular
events independent of other clinical risk factors in hypertensive patients with left
ventricular hypertrophy and may be useful in pretreatment clinical assessment of
cardiovascular risk in these patients.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17178978 [PubMed - in process]
25: Hypertension. 2007 Feb;49(2):272-5. Epub 2006 Dec 18.
Related Articles, Links
Low-dose quadruple antihypertensive combination: more efficacious
than individual agents--a preliminary report.
Mahmud A, Feely J.
Department of Pharmacology and Therapeutics, Trinity College Dublin, Centre
for Health Sciences, Dublin, Ireland.
Increasingly combined antihypertensive agents are being used in practice to
enhance control and improve compliance. To determine whether a capsule
containing a quarter of the standard dose of 4 antihypertensive agents has greater
efficacy than the standard dose of each individually, we prospectively randomized
108 untreated white hypertensive patients (55% male) aged 50+/-1 years (mean+/SEM), with mean blood pressure 160+/-1/96+/-1 mm Hg. Patients received
amlodipine (5 mg; n=22), atenolol (50 mg; n=20), bendroflumethiazide (2.5 mg;
n=22), captopril (50 mg twice daily; n=22) or a capsule containing each of the 4
above at one-quarter dosage (n=22) in a parallel group design for 4 weeks. Blood
pressure was measured using a semiautomated device (Omron 705), and the
reduction in mean arterial pressure with the combined preparation was compared
with that of the individual components. Statistical analysis used ANOVA and
Tukey-Kramer honestly significant difference for multiple comparisons. The
reduction in mean arterial pressure with the combination (19+/-2 mm Hg) was
significantly greater than that with individual agents amlodipine (10+/-2 mm Hg;
P<0.005), atenolol (10+/-2 mm Hg; P<0.005), bendroflumethiazide (6+/-1 mm
Hg; P<0.005), and captopril (11+/-1 mm Hg; P<0.01). In addition, the percentage
reduction in systolic (18+/-1 mm Hg; P<0.005) and diastolic (17+/-2 mm Hg;
P=0.06) blood pressure was greater with the combination. More patients achieved
a blood pressure of <140/90 mm Hg with the combination (60%) than any
individual drug (15% to 45%; P<0.05). A low-dose combination of 4 agents
representing 4 classes of standard antihypertensive agents was more efficacious
than a standard single dose of each agent individually.
PMID: 17178976 [PubMed - in process]
26: Hypertension. 2007 Feb;49(2):285-90. Epub 2006 Dec 18.
Related Articles, Links
Chronic treatment with long-acting nifedipine reduces
vasoconstriction to endothelin-1 in essential hypertension.
Sudano I, Virdis A, Taddei S, Spieker L, Corti R, Noll G, Salvetti A, Luscher
TF.
Cardiovascular Center, Cardiology, University Hospital of Zurich, Zurich,
Switzerland. sudano@usz.ch
Essential hypertension is associated with enhanced biological activity of
endothelin-1 (ET-1) and impaired endothelium-dependent vasodilatation.
Dihydropyridine calcium antagonists have antioxidant activity in vitro, and they
improve endothelial function in vivo. We tested whether calcium antagonists also
influence the biological activity of ET-1 in essential hypertensive (EH) patients in
the presence and absence of hypercholesterolemia. In 9 healthy subjects
(normotensive [NT] subjects, age: 48.3+/-7.6 years; blood pressure: 118+/8.6/69+/-5.4 mm Hg) and 21 EH subjects (age: 50.0+/-7.8 years; blood pressure:
164.4+/-5.4/103.8+/-4.4 mm Hg), we studied forearm blood flow and its
modification induced by intrabrachial administration of ET-1, phenylephrine,
acetylcholine, and sodium nitroprusside at baseline and after 24 weeks of
treatment with a nifedipine gastrointestinal therapeutic system (30 to 60 mg per
day). At baseline, the first dose of ET-1 (0.5 microg/100 mL of forearm tissue per
minute) caused a slight vasodilatation in NT but not in EH subjects, whereas the
following higher doses caused a comparable dose-dependent vasoconstriction in
EH and NT subjects. The effect of acetylcholine was significantly reduced in EH
as compared with NT subjects. In contrast, sodium nitroprusside and
phenylephrine had similar effects in NT and EH subjects. After chronic treatment
with the nifedipine gastrointestinal therapeutic system, the vasoconstrictor effect
induced by both ET-1 and phenylephrine was significantly blunted, whereas the
response to acetylcholine was significantly increased and the vasodilation to
sodium nitroprusside unchanged. Hypercholesterolemic EH subjects showed a
further reduced response to acetylcholine compared with normocholesterolemic
EH subjects, and the nifedipine gastrointestinal therapeutic system restored the
vasodilation to acetylcholine in this subgroup. In conclusion, in EH subjects,
chronic treatment with a long-acting dihydropyridine calcium antagonist not only
exhibits a blood pressure-lowering effect but also reduces ET-1-induced
vasoconstriction and improves endothelium-dependent vasodilation. Those
vasculoprotective effects may importantly contribute to a reduction in major
clinical events seen during treatment with these compounds.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17178974 [PubMed - in process]
27: Hypertension. 2007 Jan;49(1):19-20. Epub 2006 Dec 11.
Related Articles, Links
Comment on:

Hypertension. 2007 Jan;49(1):69-75.
Hypertension control: trends, approaches, and goals.
Kotchen TA.
Publication Types:



Comment
Editorial
Research Support, N.I.H., Extramural
PMID: 17159090 [PubMed - indexed for MEDLINE]
28: Hypertension. 2007 Feb;49(2):304-10. Epub 2006 Dec 11.
Related Articles, Links
Comparison of interleukin-6 and C-reactive protein for the risk of
developing hypertension in women.
Sesso HD, Wang L, Buring JE, Ridker PM, Gaziano JM.
Division of Preventive Medicine, Brigham and Women's Hospital and Harvard
Medical School, Boston, MA 02215-1204, USA. hsesso@hsph.harvard.edu
Although markers of systemic inflammation may have a role in the development
of hypertension, supportive clinical data remain limited. We, therefore, examined
interleukin (IL)-6 and C-reactive protein (CRP) in a nested case-control study of
400 women developing hypertension and an equal number of age-matched
normotensive control subjects during 10 years of follow-up as part of the Women's
Health Study. All of the women initially had nonhypertensive blood pressure
values and no history of diagnosis or treatment. Subjects provided self-reported
risk factors, and IL-6 and CRP were measured from baseline bloods. Case subjects
reported elevated systolic (>or=140 mm Hg) or diastolic (>or=90 mm Hg) blood
pressure, newly diagnosed hypertension, or initiating antihypertensive treatment
during follow-up. In crude-matched models, IL-6 and CRP quartiles were each
strongly associated with hypertension risk (both Ps for trend <0.0001). In
multivariate models, the linear trends became nonsignificant, and the relative risks
(95% CIs) of hypertension for IL-6 reduced to 1.00 (ref), 1.29 (0.76 to 2.19), 2.14
(1.23 to 3.73), and 1.70 (0.92 to 3.13) and for CRP were 1.00 (ref), 2.09 (1.16 to
3.76), 2.51 (1.42 to 4.44), and 2.44 (1.29 to 4.64), primarily because of
confounding by body mass index. Simultaneous adjustment for IL-6 and CRP
modestly attenuated both sets of relative risks, although more for IL-6. Finally,
there was no effect modification by baseline blood pressure or other risk factors
(all Ps for interaction >0.05). Therefore, after multivariate adjustment and strong
confounding by body mass index, IL-6 was weakly associated and CRP strongly
associated with hypertension risk. In models simultaneously examining IL-6 and
CRP, only CRP remained strongly associated with an increased risk of
hypertension.
Publication Types:


Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
PMID: 17159088 [PubMed - in process]
29: Hypertension. 2007 Jan;49(1):69-75. Epub 2006 Dec 11.
Related Articles, Links
Comment in:

Hypertension. 2007 Jan;49(1):19-20.
Prevalence, awareness, treatment, and control of hypertension
among United States adults 1999-2004.
Ong KL, Cheung BM, Man YB, Lau CP, Lam KS.
Department of Medicine and the Research Centre of Heart, Brain, Hormone and
Healthy Aging, University of Hong Kong, Hong Kong.
Detection of hypertension and blood pressure control are critically important for
reducing the risk of heart attacks and strokes. We analyzed the trends in the
prevalence, awareness, treatment, and control of hypertension in the United States
in the period 1999-2004. We used the National Health and Nutrition Examination
Survey 1999-2004 database. Blood pressure information on 14 653 individuals
(4749 in 1999-2000, 5032 in 2001-2002, and 4872 in 2003-2004) aged >or=18
years was used. Hypertension was defined as blood pressure >or=140/90 mm Hg
or taking antihypertensive medications. The prevalence of hypertension in 20032004 was 7.3+/-0.9%, 32.6+/-2.0%, and 66.3+/-1.8% in the 18 to 39, 40 to 59, and
>or=60 age groups, respectively. The overall prevalence was 29.3%. When
compared with 1999-2000, there were nonsignificant increases in the overall
prevalence, awareness, and treatment rates of hypertension. The blood pressure
control rate was 29.2+/-2.3% in 1999-2000 and 36.8+/-2.3% in 2003-2004. The
age-adjusted increase in control rate was 8.1% (95% CI: 2.4 to 13.8%; P=0.006).
The control rates increased significantly in both sexes, non-Hispanic blacks, and
Mexican Americans. Among the >or=60 age group, the awareness, treatment, and
control rates of hypertension had all increased significantly (P<or=0.01). The
improvement in blood pressure control is encouraging, although the prevalence of
hypertension has not declined.
PMID: 17159087 [PubMed - indexed for MEDLINE]
30: Hypertension. 2007 Jan 15; [Epub ahead of print]
Related Articles, Links
Association of Adrenal Steroids With Hypertension and the
Metabolic Syndrome in Blacks.
Kidambi S, Kotchen JM, Grim CE, Raff H, Mao J, Singh RJ, Kotchen TA.
Medical College of Wisconsin, Milwaukee; Aurora St Luke's Medical Center,
Milwaukee, Wis; and Mayo Foundation and Clinic, Rochester, Minn.
Blacks have a high prevalence of hypertension and adrenal cortical
adenomas/hyperplasia. We evaluated the hypothesis that adrenal steroids are
associated with hypertension and the metabolic syndrome in blacks. Ambulatory
blood pressures, anthropometric measurements, and measurements of plasma
renin activity (PRA), aldosterone, fasting lipids, glucose, and insulin were
obtained in 397 subjects (46% hypertensive and 50% female) after discontinuing
antihypertensive and lipid-lowering medications. Hypertension was defined as
average ambulatory blood pressure >130/85 mm Hg. Late-night and early morning
salivary cortisol, 24-hour urine-free cortisol, and cortisone excretion were
measured in a consecutive subsample of 97 subjects (40% hypertensive and 52%
female). Compared with normotensive subjects, hypertensive subjects had greater
waist circumference and unfavorable lipid profiles, were more insulin resistant,
and had lower PRA and higher plasma aldosterone and both late-night and early
morning salivary cortisol concentrations. Twenty-four-hour urine-free cortisol and
cortisone did not differ. Overall, ambulatory blood pressure was positively
correlated with plasma aldosterone (r=0.22; P<0.0001) and late-night salivary
cortisol (r=0.23; P=0.03) and inversely correlated with PRA (r=-0.21; P<0.001).
Plasma aldosterone correlated significantly with waist circumference, total
cholesterol, triglycerides, insulin, and the insulin-resistance index. Based on Adult
Treatment Panel III criteria, 17% of all of the subjects were classified as having
the metabolic syndrome. Plasma aldosterone levels, but not PRA, were elevated in
subjects with the metabolic syndrome (P=0.0002). The association of aldosterone
with blood pressure, waist circumference, and insulin resistance suggests that
aldosterone may contribute to obesity-related hypertension in blacks. In addition,
we speculate that relatively high aldosterone and low PRA in these hypertensive
individuals may reflect a mild variant of primary aldosteronism.
PMID: 17159085 [PubMed - as supplied by publisher]
31: Hypertension. 2007 Feb;49(2):341-6. Epub 2006 Dec 11.
Related Articles, Links
Angiotensin type 2 receptor in resistance arteries of type 2 diabetic
hypertensive patients.
Savoia C, Touyz RM, Volpe M, Schiffrin EL.
Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General
Hospital, McGill University, Montreal, Quebec, Canada.
The role of angiotensin type 2 receptor (AT(2)R) on vascular responses to
angiotensin II in humans remains unclear. In this study we explored whether
AT(2)R is expressed and functionally active on peripheral resistance arteries of
hypertensive diabetic patients treated for 1 year with either the angiotensin
receptor blocker valsartan or the beta-blocker atenolol. Twenty-six hypertensive
type 2 diabetic patients treated with oral hypoglycemic and antihypertensive
agents (not receiving angiotensin receptor blockers or beta-blockers) were
randomly assigned to double-blind treatment for 1 year with valsartan or atenolol
once daily added to their previous therapy in a clinical trial that we reported
recently and compared with 10 normal subjects. Resistance arteries dissected from
gluteal subcutaneous tissues were assessed on a pressurized myograph. Vasomotor
response curves to angiotensin II (1 nmol/L to 1 micromol/L) were performed on
norepinephrine precontracted vessels in the presence of valsartan (10 micromol/L)
with or without the AT(2)R inhibitor PD123319 (1 micromol/L). AT(2)R
expression was evaluated by confocal microscopy. After 1 year of treatment,
systolic and diastolic blood pressure was controlled and comparable in the
valsartan and atenolol groups. Angiotensin II evoked a significant vasodilatory
response only on resistance arteries from patients treated with valsartan, effect
blocked by PD123319. AT(2)R expression was 4-fold higher in small arteries of
valsartan-treated patients. In conclusion, AT(2)Rs are upregulated and contribute
to angiotensin II-induced vasodilation in resistance arteries of hypertensive
diabetic patients treated with angiotensin type 1 receptor blockers and may
mediate, in part, vascular actions of these drugs in high cardiovascular risk
patients.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17159079 [PubMed - in process]
32: Hypertension. 2006 Dec;48(6):1066-71. Epub 2006 Oct 23.
Related Articles, Links
NO synthase uncoupling in the kidney of Dahl S rats: role of
dihydrobiopterin.
Taylor NE, Maier KG, Roman RJ, Cowley AW Jr.
Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226,
USA. ntaylor@mcw.edu
NO synthase (NOS) can paradoxically contribute to the production of reactive
oxygen species when l-arginine or the cofactor R-tetrahydrobiopterin (BH(4))
becomes limited. The present study examined whether NOS contributes to
superoxide production in kidneys of hypertensive Dahl salt-sensitive (SS) rats
compared with an inbred consomic control strain (SS-13(BN)) and tested the
hypothesis that elevated dihydrobiopterin (BH(2)) levels are importantly involved
in this process. This was assessed by determining the effects of l-nitroarginine
methyl ester (l-NAME) inhibition of NOS on superoxide production and by
comparing tissue concentrations of BH(4) and BH(2). A reverse-phase highperformance liquid chromatography method was applied for direct measurements
of BH(4) and BH(2) using (S)-tetrahydrobiopterin as an internal standard.
Superoxide concentrations were measured in vivo from medullary microdialysis
fluid using dihydroethidine and in vitro using lucigenin. The results indicate the
following: (1) that superoxide levels were elevated in the outer medulla of SS rats
fed a 4% salt diet and could be inhibited by l-NAME. In contrast, l-NAME
resulted in elevated superoxide production in consomic SS-13(BN) rats because of
higher NOS activity; (2) SS rats showed a reduced ratio of BH(4)/BH(2) in the
outer medulla that was driven by increased concentrations of BH(2); and (3) lower
superoxide dismutase and catalase activities contributed to elevated reactive
oxygen species in SS samples. Based on the shift of BH(4) to BH(2) and the
observation of l-NAME inhibitable superoxide production, we conclude that NOS
uncoupling occurs in the renal medulla of hypertensive SS rats fed a high-salt diet.
Publication Types:


Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
PMID: 17060509 [PubMed - indexed for MEDLINE]
33: Hypertension. 2006 Dec;48(6):e108; author reply e109. Epub
2006 Oct 16.
Related Articles,
Links
Comment on:


Hypertension. 2006 Mar;47(3):359-64.
Hypertension. 2006 Mar;47(3):365-70.
Correlating ambulatory blood pressure measurements with arterial
stiffness: a conceptual inconsistency?
Gavish B.
Publication Types:


Comment
Letter
PMID: 17043160 [PubMed - indexed for MEDLINE]
34: Hypertension. 2006 Dec;48(6):1029-30. Epub 2006 Oct 16.
Related Articles, Links
Comment on:

Hypertension. 2006 Dec;48(6):1160-8.
Atrial peptides modify the effect of marinobufagenin on sodium
pumps: implications for blood pressure control.
Buckalew VM.
Publication Types:


Comment
Editorial
PMID: 17043156 [PubMed - indexed for MEDLINE]
35: Hypertension. 2006 Dec;48(6):e115-6; author reply e117. Epub
2006 Oct 9.
Comment on:

Hypertension. 2006 Jul;48(1):134-40.
Related Articles,
Links
Blood pressure in mutant rats lacking the 5-hydroxytryptamine
transporter.
Homberg J, Mudde J, Braam B, Ellenbroek B, Cuppen E, Joles JA.
Publication Types:


Comment
Letter
PMID: 17030677 [PubMed - indexed for MEDLINE]
36: Hypertension. 2006 Nov;48(5):e104; author reply e105. Epub
2006 Oct 2.
Related Articles,
Links
Comment on:

Hypertension. 2006 Apr;47(4):771-7.
Reduction of blood pressure levels study group.
Mann SJ.
Publication Types:


Comment
Letter
PMID: 17015771 [PubMed - indexed for MEDLINE]
37: Hypertension. 2006 Nov;48(5):832-3. Epub 2006 Oct 2.
Comment on:

Hypertension. 2006 Nov;48(5):870-6.
Predictors of the evolution of microalbuminuria.
Ruilope LM, Segura J.
Publication Types:
Related Articles, Links


Comment
Editorial
PMID: 17015769 [PubMed - indexed for MEDLINE]
38: Hypertension. 2006 Nov;48(5):914-20. Epub 2006 Sep 25.
Related Articles, Links
Circulating activities of angiotensin-converting enzyme, its homolog,
angiotensin-converting enzyme 2, and neprilysin in a family study.
Rice GI, Jones AL, Grant PJ, Carter AM, Turner AJ, Hooper NM.
Proteolysis Research Group, Institute of Molecular and Cellular Biology, Faculty
of Biological Sciences, University of Leeds, Leeds, LS2 9JT United Kingdom.
bmbgir@bmb.leeds.ac.uk
The renin-angiotensin system is a key regulator of blood pressure (BP), with
inhibitors of angiotensin-converting enzyme (ACE) used clinically to treat
hypertension and other cardiovascular conditions. ACE2 is a newly identified
member of this system, which converts angiotensin II to angiotensin, and of which
the occurrence in plasma has not been investigated. The aim of this study was to
determine the heritability of circulating ACE, ACE2, and neprilysin (NEP), which
may also be a regulator of BP, in a family study, and to determine covariates that
contribute to the variation in plasma activity. ACE, ACE2, and NEP activities
were measured in plasma from 534 subjects in the Leeds Family Study using
selective fluorogenic substrates. Genetic factors accounted for 24.5%, 67%, and
22.7% of the phenotypic variation in circulating ACE, ACE2, and NEP,
respectively. ACE insertion/deletion polymorphism and other measured covariates
accounted for 23.8% of variance in circulating ACE. High-density lipoprotein
cholesterol was a significant determinant of circulating ACE2. Measured
covariates accounted for 17.3% of variation in circulating NEP. ACE and NEP
were associated with systolic and diastolic BP in univariate analyses; however,
only ACE was independently associated with systolic and diastolic BP after
accounting for covariates and shared childhood household.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17000927 [PubMed - indexed for MEDLINE]
39: Hypertension. 2006 Nov;48(5):861-9. Epub 2006 Sep 25.
Comment in:
Related Articles, Links

Hypertension. 2006 Nov;48(5):818-9.
Importance of salt in determining blood pressure in children: metaanalysis of controlled trials.
He FJ, MacGregor GA.
Blood Pressure Unit, Cardiac and Vascular Sciences, St George's University of
London, Cranmer Terrace, London, SW17 0RE, United Kingdom. fhe@sgul.ac.uk
To assess the effect of reducing salt intake on blood pressure in children, we
carried out a meta-analysis of controlled trials. Trials were included if participants
were children (< or = 18 years), and duration of salt reduction must have been for
> or = 2 weeks. Mean effect size was calculated using a fixed-effect model,
because there was no significant heterogeneity. Ten trials of children and
adolescents with 966 participants were included (median age: 13 years; range: 8 to
16 years; median duration: 4 weeks; range: 2 weeks to 3 years). Salt intake was
reduced by 42% (interquartile range [IQR]: 7% to 58%). There were significant
reductions in blood pressure: systolic: -1.17 mm Hg (95% CI: -1.78 to -0.56 mm
Hg; P<0.001); diastolic: -1.29 mm Hg (95% CI: -1.94 to -0.65 mm Hg; P<0.0001).
Three trials of infants with 551 participants were included (median duration: 20
weeks; range: 8 weeks to 6 months). Salt intake was reduced by 54% (IQR: 51%
to 79%). There was a significant reduction in systolic blood pressure: -2.47 mm
Hg (95% CI: -4.00 to -0.94 mm Hg; P<0.01). This is the first meta-analysis of salt
reduction in children, and it demonstrates that a modest reduction in salt intake
causes immediate falls in blood pressure and, if continued, may well lessen the
subsequent rise in blood pressure with age. This would result in major reductions
in cardiovascular disease. These results in conjunction with other evidence
provide strong support for a reduction in salt intake in children.
Publication Types:


Meta-Analysis
Review
PMID: 17000923 [PubMed - indexed for MEDLINE]
40: Hypertension. 2006 Nov;48(5):812-4. Epub 2006 Sep 18.
Prehypertension revisited.
Chobanian AV.
Publication Types:
Related Articles, Links


Editorial
Review
PMID: 16982962 [PubMed - indexed for MEDLINE]
41: Hypertension. 2006 Nov;48(5):877-82. Epub 2006 Sep 18.
Related Articles, Links
Predicting stroke using 4 ambulatory blood pressure monitoringderived blood pressure indices: the Ohasama Study.
Inoue R, Ohkubo T, Kikuya M, Metoki H, Asayama K, Obara T, Hoshi H,
Hashimoto J, Totsune K, Satoh H, Kondo Y, Imai Y.
Comprehensive Research and Education Center for Planning of Drug
Development and Clinical Evaluation, Tohoku University Graduate School of
Pharmaceutical Science, 1-1 Seiryo-cho, Aoba-ku, Sendai, 980-8574, Japan.
We investigated the association between stroke and blood pressure (BP) indices
(systolic BP [SBP], diastolic BP [DBP], mean BP [MBP], and pulse pressure
[PP]) determined by ambulatory BP monitoring. The predictive power for stroke
of these indices was compared in the general Japanese population. We obtained
ambulatory BP data in 1271 subjects (40% men) aged > or = 40 (mean: 61) years.
During a mean follow-up of 11 years, 113 strokes were observed. The multivariate
adjusted relative hazard and likelihood ratio for a 1-SD increase for each BP index
was determined by Cox proportional hazard regression. Comparison of the
likelihood ratio between Cox models including 2 indices and those including 1
index indicated that PP was significantly less informative than other indices
(P<0.01 when adding MBP, SBP, or DBP to the PP model; P>0.09 when adding
PP to the model including another index). However, after removing age from
covariates, PP became more informative than DBP and MBP (P<0.0001 when
adding PP to the MBP or DBP model, whereas SBP was more informative than PP
even after removing age; P<0.05 when adding SBP to the PP model). In
conclusion, PP was the weakest predictor of stroke. Exclusion of age from
covariates increased the predictive power of PP, suggesting that the stroke risk
associated with PP reflected the risk of aging per se.
Publication Types:



Comparative Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
PMID: 16982961 [PubMed - indexed for MEDLINE]
42: Hypertension. 2006 Nov;48(5):988-93. Epub 2006 Sep 18.
Related Articles, Links
Insulin resistance and obesity in a mouse model of systemic lupus
erythematosus.
Ryan MJ, McLemore GR Jr, Hendrix ST.
Department of Physiology and Biophysics, University of Mississippi Medical
Center, 2500 North State St, Jackson, MS 39216, USA.
mjryan@physiology.umsmed.edu
Accumulating data indicate that metabolic syndrome is an inflammatory
condition. Systemic lupus erythematosus (SLE) is an autoimmune disorder
associated with nephritis and cardiovascular disease. Evidence suggests that
individuals with SLE are at risk for developing insulin resistance; however, this
has not been directly examined. Using an established mouse strain with SLE
(NZBWF1), we examined whether SLE is associated with increased body weight
and fat deposition. Mean arterial pressure was significantly increased (140+/-4
versus 114+/-2 mm Hg; n > or = 5) in SLE mice by 36 weeks of age compared
with control mice (NZW/LacJ). Body weight in SLE mice was higher at each age
compared with controls by 12%, 22%, and 34% (n > 30). Visceral adipose tissue
weight was increased in SLE by 44%, 74%, and 117% at 8, 20, and 36 weeks,
respectively (n > or = 12). Plasma leptin was increased in SLE mice (8.6+/-1.0
versus 24.7+/-2.2 ng/mL; n = 5), and renal and adipose tissue exhibited
macrophage infiltration. Fasted insulin was higher in SLE mice (0.6+/-0.1 versus
1.4+/-0.3 ng/mL; n > or = 10), but fasted glucose was not different (94+/-5 versus
80+/-9; n > or = 9). A glucose tolerance test caused a significantly greater and
longer increase in blood glucose from mice with SLE compared with control mice.
Food intake was not different between control and SLE mice. However, mice with
SLE demonstrated lower levels of nighttime activity than controls. These data
show that the NZBWF1 strain may be an important model to study the effects of
obesity and insulin resistance on SLE-associated hypertension.
Publication Types:


Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
PMID: 16982954 [PubMed - indexed for MEDLINE]
43: J Am Coll Cardiol. 2006 Dec 19;48(12):2546-52. Epub 2006
Nov 28.
Related Articles,
Links
Complications of right heart catheterization procedures in patients
with pulmonary hypertension in experienced centers.
Hoeper MM, Lee SH, Voswinckel R, Palazzini M, Jais X, Marinelli A, Barst
RJ, Ghofrani HA, Jing ZC, Opitz C, Seyfarth HJ, Halank M, McLaughlin V,
Oudiz RJ, Ewert R, Wilkens H, Kluge S, Bremer HC, Baroke E, Rubin LJ.
Department of Respiratory Medicine, Hannover Medical School, Hannover,
Germany. hoeper.marius@mh-hannover.de
OBJECTIVES: This study sought to assess the risks associated with right heart
catheter procedures in patients with pulmonary hypertension. BACKGROUND:
Right heart catheterization, pulmonary vasoreactivity testing, and pulmonary
angiography are established diagnostic tools in patients with pulmonary
hypertension, but the risks associated with these procedures have not been
systematically evaluated in a multicenter study. METHODS: We performed a
multicenter 5-year retrospective and 6-month prospective evaluation of serious
adverse events related to right heart catheter procedures in patients with
pulmonary hypertension, as defined by a mean pulmonary artery pressure >25 mm
Hg at rest, undergoing right heart catheterization with or without pulmonary
vasoreactivity testing or pulmonary angiography. RESULTS: During the
retrospective period, 5,727 right heart catheter procedures were reported, and
1,491 were reported from the prospective period, for a total of 7,218 right heart
catheter procedures performed. The results from the retrospective and the
prospective analyses were almost identical. The overall number of serious adverse
events was 76 (1.1%, 95% confidence interval 0.8% to 1.3%). The most frequent
complications were related to venous access (e.g., hematoma, pneumothorax),
followed by arrhythmias and hypotensive episodes related to vagal reactions or
pulmonary vasoreactivity testing. The vast majority of these complications were
mild to moderate in intensity and resolved either spontaneously or after
appropriate intervention. Four fatal events were recorded in association with any
of the catheter procedures, resulting in an overall procedure-related mortality of
0.055% (95% confidence interval 0.01% to 0.099%). CONCLUSIONS: When
performed in experienced centers, right heart catheter procedures in patients with
pulmonary hypertension are associated with low morbidity and mortality rates.
Publication Types:

Multicenter Study
PMID: 17174196 [PubMed - indexed for MEDLINE]
44: J Am Coll Cardiol. 2006 Dec 5;48(11):2293-300. Epub 2006
Nov 13.
Related Articles,
Links
A prospective study of the prevalence of primary aldosteronism in
1,125 hypertensive patients.
Rossi GP, Bernini G, Caliumi C, Desideri G, Fabris B, Ferri C, Ganzaroli C,
Giacchetti G, Letizia C, Maccario M, Mallamaci F, Mannelli M, Mattarello
MJ, Moretti A, Palumbo G, Parenti G, Porteri E, Semplicini A, Rizzoni D,
Rossi E, Boscaro M, Pessina AC, Mantero F; PAPY Study Investigators.
For a list of author affiliations, please see the.
OBJECTIVES: We prospectively investigated the prevalence of curable forms of
primary aldosteronism (PA) in newly diagnosed hypertensive patients.
BACKGROUND: The prevalence of curable forms of PA is currently unknown,
although retrospective data suggest that it is not as low as commonly perceived.
METHODS: Consecutive hypertensive patients referred to 14 hypertension
centers underwent a diagnostic protocol composed of measurement of Na+ and
K+ in serum and 24-h urine, sitting plasma renin activity, and aldosterone at
baseline and after 50 mg captopril. The patients with an aldosterone/renin ratio
>40 at baseline, and/or >30 after captopril, and/or a probability of PA (by a
logistic discriminant function) > or =50% underwent imaging tests and adrenal
vein sampling (AVS) or adrenocortical scintigraphy to identify the underlying
adrenal pathology. An aldosterone-producing adenoma (APA) was diagnosed in
patients who in addition to excess autonomous aldosterone secretion showed: 1)
lateralized aldosterone secretion at AVS or adrenocortical scintigraphy, 2)
adenoma at surgery and pathology, and 3) a blood pressure decrease after
adrenalectomy. Evidence of excess autonomous aldosterone secretion without
such criteria led to a diagnosis of idiopathic hyperaldosteronism (IHA).
RESULTS: A total of 1,180 patients (age 46 +/- 12 years) were enrolled; a
conclusive diagnosis was attained in 1,125 (95.3%). Of these, 54 (4.8%) had an
APA and 72 (6.4%) had an IHA. There were more APA (62.5%) and fewer IHA
cases (37.5%) at centers where AVS was available (p = 0.002); the opposite
occurred where AVS was unavailable. CONCLUSIONS: In newly diagnosed
hypertensive patients referred to hypertension centers, the prevalence of APA is
high (4.8%). The availability of AVS is essential for an accurate identification of
the adrenocortical pathologies underlying PA.
PMID: 17161262 [PubMed - indexed for MEDLINE]
45: J Am Coll Cardiol. 2006 Nov 7;48(9):1856-8. Epub 2006 Oct
17.
Related Articles,
Links
Comment on:

J Am Coll Cardiol. 2006 Nov 7;48(9):1851-5.
Physiologic assessment of renal artery stenosis: will history repeat
itself?
Fearon WF.
Publication Types:



Comment
Editorial
Research Support, N.I.H., Extramural
PMID: 17084262 [PubMed - indexed for MEDLINE]
46: J Am Coll Cardiol. 2006 Nov 7;48(9):1851-5. Epub 2006 Oct
17.
Related Articles,
Links
Comment in:

J Am Coll Cardiol. 2006 Nov 7;48(9):1856-8.
Assessment of renal artery stenosis severity by pressure gradient
measurements.
De Bruyne B, Manoharan G, Pijls NH, Verhamme K, Madaric J, Bartunek J,
Vanderheyden M, Heyndrickx GR.
Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.
bernard.de.bruyne@olvz-aalst.be
OBJECTIVES: The purpose of this study was to define "significant" renal artery
stenosis (i.e., a stenosis able to induce arterial hypertension). BACKGROUND:
The degree of renal artery stenosis that justifies an attempt at revascularization is
unknown. METHODS: In 15 patients, transstenotic pressure measurements were
obtained before and after unilateral stenting. After stenting, graded stenoses were
created in the stented segment by progressive inflation of a balloon catheter.
Stenosis severity was expressed as the ratio of distal pressure (P(d)) corrected for
aortic pressure (P(a)). Balloon inflation pressure was adjusted to create 6 degrees
of stenosis (P(d)/P(a) from 1.0 to 0.5, each step during 10 min). Plasma renin
concentration was measured at the end of each step in the aorta and in both renal
veins. RESULTS: For a P(d)/P(a) ratio >0.90, no significant change in plasma
renin concentration was observed. However, when P(d)/P(a) became <0.90, a
significant increase in renin was observed in the renal vein of the stenotic kidney,
finally reaching a maximal increase of 346 +/- 145% for P(d)/P(a) of 0.50 (p =
0.006). These values returned to baseline when the stenosis was relieved. In
addition, plasma renin concentration increased significantly in the vein from the
non-stenotic kidney (p = 0.02). CONCLUSIONS: In renal artery stenoses, a
P(d)/P(a) ratio of 0.90 can be considered a threshold value below which the
stenosis is likely responsible for an up-regulation of renin production and, thus, for
renovascular hypertension. These findings might contribute to better patient
selection for renal angioplasty.
Publication Types:

Comparative Study
PMID: 17084261 [PubMed - indexed for MEDLINE]
47: J Hum Hypertens. 2006 Dec 14; [Epub ahead of print]
Related Articles, Links
Reverse white-coat effect as an independent risk for left ventricular
concentric hypertrophy in patients with treated essential
hypertension.
Tomiyama M, Horio T, Kamide K, Nakamura S, Yoshihara F, Nakata H,
Nakahama H, Kawano Y.
1Division of Hypertension and Nephrology, Department of Medicine, National
Cardiovascular Center, Suita, Japan.
Recent studies have shown that the converse phenomenon of white-coat
hypertension called 'reverse white-coat hypertension' or 'masked hypertension' is
associated with poor cardiovascular prognosis. We assessed the hypothesis that
this phenomenon may specifically influence left ventricular (LV) structure in
treated hypertensive patients. A total of 272 outpatients (mean age, 65 years) with
chronically treated essential hypertension and without remarkable white-coat
effect were enrolled. Patients were classified into two groups according to office
and daytime ambulatory systolic blood pressure (SBP); that is subjects without
(Group 1: office SBP >/=daytime SBP, n=149) and with reverse white-coat effect
(Group 2: office SBP<daytime SBP, n=123). LV mass index and relative wall
thickness were echocardiographically determined. In all subjects, LV mass index
and relative wall thickness were positively correlated with daytime and 24-h SBP,
but not with office SBP. In addition, these two indices were inversely correlated
with office - daytime SBP difference. LV mass index (136+/-31 and 115+/-28
g/m(2), mean+/-s.d.) and relative wall thickness (0.49+/-0.09 and 0.46+/-0.07)
were significantly greater in Group 2 than in Group 1. As for LV geometric
patterns, Group 2 had a significantly higher rate of concentric hypertrophy
compared with Group 1 (48 and 28%). Multivariate analyses revealed that the
presence of reverse white-coat effect was a predictor for LV concentric
hypertrophy, independent of age, sex, hypertension duration, antihypertensive
treatment and ambulatory blood pressure levels. Our findings demonstrate that
reverse white-coat effect is an independent risk factor for LV hypertrophy,
especially concentric hypertrophy, in treated hypertensive patients.Journal of
Human Hypertension advance online publication, 14 December 2006;
doi:10.1038/sj.jhh.1002127.
PMID: 17167525 [PubMed - as supplied by publisher]
48: J Hum Hypertens. 2006 Dec 14; [Epub ahead of print]
Related Articles, Links
Plasma levels of complement C3 is associated with development of
hypertension: a longitudinal cohort study.
Engstrom G, Hedblad B, Berglund G, Janzon L, Lindgarde F.
1Department of Clinical Science, Malmo University Hospital, Lund University,
Malmo, Sweden.
Hypertension has been associated with raised plasma levels of complement factor
3 and 4 (C3 and C4). The nature of this association is unclear. This populationbased longitudinal study explored whether C3 or C4 is associated with
development of hypertension. Blood pressure and plasma levels of C3 and C4
were determined in 2178 healthy men, aged 35-50 years, initially without
treatment for hypertension. Incidence of hypertension and blood pressure increase
over 15.7 (+/-2.2) years follow-up was studied in relation to C3 and C4 at
baseline. Among men with initially normal blood pressure (<160/95 mm Hg),
incidence of hypertension (>/=160/95 mm Hg or treatment) was 32, 42, 37 and
47%, respectively, for men with C3 in the first, second, third and fourth quartile
(trend: P=0.001). This relationship remained significant after adjustment for
confounding factors. Among men without blood pressure treatment, systolic BP
increase (mean+standard error, adjusted for age, initial blood pressure and followup time) was 17.5+0.8, 19.6+0.9, 19.8+0.8 and 20.8+0.8 mm Hg, respectively, in
the C3 quartiles (trend: P=0.004). C3 was not associated diastolic blood pressure
at follow-up. Although C4 was associated with blood pressure at the baseline
examination, there was no relationship between C4 and development of
hypertension or future blood pressure increase. It is concluded that C3 in plasma is
associated with future blood pressure increase and development of
hypertension.Journal of Human Hypertension advance online publication, 14
December 2006; doi:10.1038/sj.jhh.1002129.
PMID: 17167524 [PubMed - as supplied by publisher]
49: J Hum Hypertens. 2006 Dec 14; [Epub ahead of print]
Related Articles, Links
Impacts of diabetes and hypertension on the risk of hospitalization
among less educated people.
Lin M, Chen Y, Sigal RJ.
1Department of Epidemiology and Community Medicine, Faculty of Medicine,
University of Ottawa, Ontario, Canada.
Coexisting hypertension increases the morbidity and mortality associated with
diabetes, and may be more so in less educated people. We analysed data from 49
904 Canadians 40-64 years of age who participated in the Canadian Community
Health Survey, 2000-2001. Multiple classification analysis was used to adjust for
covariates. Population weight and design effect of the survey were taken into
account in the analysis. The association between hypertension and hospitalization
varied according to diabetes and education. The adjusted difference in
hospitalization incidence attributable to hypertension was significantly higher for
the lower education group than the higher education group, and such a pattern
tended to be more pronounced among diabetic people. The adjusted incidence
difference attributable to hypertension was higher in the diabetic group (8.8, 95%
confidence interval (CI): 4.6, 13.0%) than in the non-diabetic group (4.6, 95% CI:
3.6, 5.6%) for people with low education, but was similar for those with welleducated people. Possible reasons for the modifying effect of education on the
relationship among hypertension, diabetes and hospitalization were
discussed.Journal of Human Hypertension advance online publication, 14
December 2006; doi:10.1038/sj.jhh.1002131.
PMID: 17167523 [PubMed - as supplied by publisher]
50: J Hum Hypertens. 2006 Dec 14; [Epub ahead of print]
Related Articles, Links
The effect of gender on the sympathetic nerve hyperactivity of
essential hypertension.
Hogarth AJ, Mackintosh AF, Mary DA.
1The Department of Cardiology, St James's University Hospital, Leeds, UK.
We planned to determine whether or not there is a difference in the level of
muscle sympathetic nerve activity (MSNA) between hypertensive women and
hypertensive men. Sympathetic activation of essential hypertension (EHT) has
been associated with increased cardiovascular events, which are known to be less
likely to occur in women than in men. Normal women have been reported to have
less sympathetic nerve activity than men, but no reported data are available
regarding gender differences in sympathetic activity in hypertensive subjects. We
examined 36 patients with untreated and uncomplicated EHT comprising 18
women and 18 men, and 36 normal controls comprising 18 women and 18 men.
MSNA was quantified as the mean frequency of single units and as multiunit
bursts using the technique of microneurography. The hypertensive groups had
greater sympathetic nerve activity than the control groups. Female hypertensives
had lower (P<0.001) single unit hyperactivity (56+/-1.7 impulses/100 cardiac
beats) than male hypertensives (72+/-1.7 impulses/100 cardiac beats).
Normotensive females had lower (P<0.01) single unit activity (42+/-3.6
impulses/100 cardiac beats) than normotensive males (56+/-4.6 impulses/100
cardiac beats). Similar results were obtained for the frequency of multiunit burst
activity. Hypertension in women is associated with a lower level of central
sympathetic hyperactivity than in men. It is suggested that this may at least partly
explain the observed lower hypertension-related cardiovascular events in women
than in men. In addition, the findings may have implications for gender-specific
management of hypertension.Journal of Human Hypertension advance online
publication, 14 December 2006; doi:10.1038/sj.jhh.1002132.
PMID: 17167522 [PubMed - as supplied by publisher]
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Jan 16 2007 05:58:20
Lee MY, Chu CS, Lee KT, Wu CM, Su HM, Lin SJ, Sheu SH, Lai WT.
Division of Cardiology, Department of Internal Medicine, Kaohsiung
Municipal United Hospital, Taiwan.
BACKGROUND: Pulse wave velocity (PWV), a relevant indicator of arterial
stiffness, can be measured noninvasively with a variety of automatic devices,
but most are complexly equipped. We developed a novel index for estimating
arterial stiffness as "QPV interval," which was determined by means of
surface electrocardiogram and Doppler ultrasound of the brachial artery
simultaneously. HYPOTHESIS: This study aimed to validate the QPV interval
as an exact and convenient index for estimation of arterial stiffness.
METHODS: Forty-seven patients with untreated essential hypertension and 19
normotensive subjects were enrolled. Brachial-ankle PWV (baPWV) was
measured using an automatic volume-plethysmographic apparatus, and
Doppler ultrasound was implemented sequentially to measure the QPV
interval in each subject. Clinical biochemistry and echocardiography were
performed on the same day. RESULTS: Mean baPWV was significantly
higher in hypertensive patients than in normotensive subjects (p = 0.002),
whereas mean QPV interval was significantly shorter in hypertensive patients
than in the normotensive group (p = 0.019). A simple regression analysis
demonstrated an inverse correlation between the QPV interval and baPWV (r
= -0.671, p < 0.001) in all enrolled subjects. In a stepwise regression model
that adjusted for age, systolic blood pressure, and other determinants of
baPWV, the negative association remained between the QPV interval and
baPWV (p < 0.001). CONCLUSION: The QPV interval correlates inversely
with baPWV, independent of age and other determinants of baPWV; hence,
the QPV interval can serve as a simple and convenient index for assessing
arterial stiffness in clinical practice.
Publication Types:


Research Support, Non-U.S. Gov't
Validation Studies
PMID: 16933575 [PubMed - indexed for MEDLINE]
23: Eur Heart J. 2007 Jan;28(1):140-1. Epub 2006 Dec 12.
Related Articles, Links
N-terminal brain natriuretic peptide in scleroderma-associated
pulmonary arterial hypertension.
Mathai SC, Hassoun PM.
Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 East
Monument Street, Baltimore, Maryland 21205, USA. smathai4@jhmi.edu.
PMID: 17164254 [PubMed - in process]
24: Hypertension. 2007 Feb;49(2):311-6. Epub 2006 Dec 18.
Related Articles, Links
Left atrial size and risk of major cardiovascular events during
antihypertensive treatment: losartan intervention for endpoint
reduction in hypertension trial.
Gerdts E, Wachtell K, Omvik P, Otterstad JE, Oikarinen L, Boman K,
Dahlof B, Devereux RB.
Institute of Medicine, University of Bergen, Haukeland University Hospital,
N-5021 Bergen, Norway. gerdtsev@online.no
The influence of left atrial size on cardiovascular events during
antihypertensive treatment has not been reported previously from a long-term,
prospective, randomized hypertension treatment trial. We recorded left atrial
diameter by annual echocardiography and cardiovascular events in 881
hypertensive patients (41% women) with electrocardiographic left ventricular
hypertrophy aged 55 to 80 (mean: 66) years during a mean of 4.8 years of
randomized losartan- or atenolol-based treatment in the Losartan Intervention
for Endpoint Reduction in Hypertension Study. During follow-up, a total of 88
primary end points (combined cardiovascular death, myocardial infarction, or
stroke) occurred. In Cox regression, baseline left atrial diameter/height
predicted incidence of cardiovascular events (hazard ratio: 1.98 per cm/m
[95% CI: 1.02 to 3.83 per cm/m]; P=0.042) adjusted for significant effects of
Framingham risk score and history of atrial fibrillation. Greater left atrial
diameter reduction during follow-up was associated with greater reduction in
left ventricular hypertrophy, absence of new-onset atrial fibrillation or mitral
regurgitation during follow-up, and losartan-based treatment (B=-0.13+/-0.03
cm/m; P<0.001) in multiple linear regression, adjusting for baseline left atrial
diameter/height. However, in time-varying Cox regression analysis, left atrial
diameter reduction was not independent of left ventricular hypertrophy
regression in predicting cardiovascular events during follow-up. In conclusion,
left atrial diameter/height predicts risk of cardiovascular events independent of
other clinical risk factors in hypertensive patients with left ventricular
hypertrophy and may be useful in pretreatment clinical assessment of
cardiovascular risk in these patients.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17178978 [PubMed - in process]
25: Hypertension. 2007 Feb;49(2):272-5. Epub 2006 Dec 18.
Related Articles, Links
Low-dose quadruple antihypertensive combination: more
efficacious than individual agents--a preliminary report.
Mahmud A, Feely J.
Department of Pharmacology and Therapeutics, Trinity College Dublin,
Centre for Health Sciences, Dublin, Ireland.
Increasingly combined antihypertensive agents are being used in practice to
enhance control and improve compliance. To determine whether a capsule
containing a quarter of the standard dose of 4 antihypertensive agents has
greater efficacy than the standard dose of each individually, we prospectively
randomized 108 untreated white hypertensive patients (55% male) aged 50+/1 years (mean+/-SEM), with mean blood pressure 160+/-1/96+/-1 mm Hg.
Patients received amlodipine (5 mg; n=22), atenolol (50 mg; n=20),
bendroflumethiazide (2.5 mg; n=22), captopril (50 mg twice daily; n=22) or a
capsule containing each of the 4 above at one-quarter dosage (n=22) in a
parallel group design for 4 weeks. Blood pressure was measured using a
semiautomated device (Omron 705), and the reduction in mean arterial
pressure with the combined preparation was compared with that of the
individual components. Statistical analysis used ANOVA and Tukey-Kramer
honestly significant difference for multiple comparisons. The reduction in
mean arterial pressure with the combination (19+/-2 mm Hg) was significantly
greater than that with individual agents amlodipine (10+/-2 mm Hg; P<0.005),
atenolol (10+/-2 mm Hg; P<0.005), bendroflumethiazide (6+/-1 mm Hg;
P<0.005), and captopril (11+/-1 mm Hg; P<0.01). In addition, the percentage
reduction in systolic (18+/-1 mm Hg; P<0.005) and diastolic (17+/-2 mm Hg;
P=0.06) blood pressure was greater with the combination. More patients
achieved a blood pressure of <140/90 mm Hg with the combination (60%)
than any individual drug (15% to 45%; P<0.05). A low-dose combination of 4
agents representing 4 classes of standard antihypertensive agents was more
efficacious than a standard single dose of each agent individually.
PMID: 17178976 [PubMed - in process]
26: Hypertension. 2007 Feb;49(2):285-90. Epub 2006 Dec 18.
Related Articles, Links
Chronic treatment with long-acting nifedipine reduces
vasoconstriction to endothelin-1 in essential hypertension.
Sudano I, Virdis A, Taddei S, Spieker L, Corti R, Noll G, Salvetti A,
Luscher TF.
Cardiovascular Center, Cardiology, University Hospital of Zurich, Zurich,
Switzerland. sudano@usz.ch
Essential hypertension is associated with enhanced biological activity of
endothelin-1 (ET-1) and impaired endothelium-dependent vasodilatation.
Dihydropyridine calcium antagonists have antioxidant activity in vitro, and
they improve endothelial function in vivo. We tested whether calcium
antagonists also influence the biological activity of ET-1 in essential
hypertensive (EH) patients in the presence and absence of
hypercholesterolemia. In 9 healthy subjects (normotensive [NT] subjects, age:
48.3+/-7.6 years; blood pressure: 118+/-8.6/69+/-5.4 mm Hg) and 21 EH
subjects (age: 50.0+/-7.8 years; blood pressure: 164.4+/-5.4/103.8+/-4.4 mm
Hg), we studied forearm blood flow and its modification induced by
intrabrachial administration of ET-1, phenylephrine, acetylcholine, and
sodium nitroprusside at baseline and after 24 weeks of treatment with a
nifedipine gastrointestinal therapeutic system (30 to 60 mg per day). At
baseline, the first dose of ET-1 (0.5 microg/100 mL of forearm tissue per
minute) caused a slight vasodilatation in NT but not in EH subjects, whereas
the following higher doses caused a comparable dose-dependent
vasoconstriction in EH and NT subjects. The effect of acetylcholine was
significantly reduced in EH as compared with NT subjects. In contrast, sodium
nitroprusside and phenylephrine had similar effects in NT and EH subjects.
After chronic treatment with the nifedipine gastrointestinal therapeutic system,
the vasoconstrictor effect induced by both ET-1 and phenylephrine was
significantly blunted, whereas the response to acetylcholine was significantly
increased and the vasodilation to sodium nitroprusside unchanged.
Hypercholesterolemic EH subjects showed a further reduced response to
acetylcholine compared with normocholesterolemic EH subjects, and the
nifedipine gastrointestinal therapeutic system restored the vasodilation to
acetylcholine in this subgroup. In conclusion, in EH subjects, chronic
treatment with a long-acting dihydropyridine calcium antagonist not only
exhibits a blood pressure-lowering effect but also reduces ET-1-induced
vasoconstriction and improves endothelium-dependent vasodilation. Those
vasculoprotective effects may importantly contribute to a reduction in major
clinical events seen during treatment with these compounds.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17178974 [PubMed - in process]
27: Hypertension. 2007 Jan;49(1):19-20. Epub 2006 Dec 11.
Comment on:

Hypertension. 2007 Jan;49(1):69-75.
Related Articles, Links
Hypertension control: trends, approaches, and goals.
Kotchen TA.
Publication Types:



Comment
Editorial
Research Support, N.I.H., Extramural
PMID: 17159090 [PubMed - indexed for MEDLINE]
28: Hypertension. 2007 Feb;49(2):304-10. Epub 2006 Dec 11.
Related Articles, Links
Comparison of interleukin-6 and C-reactive protein for the risk
of developing hypertension in women.
Sesso HD, Wang L, Buring JE, Ridker PM, Gaziano JM.
Division of Preventive Medicine, Brigham and Women's Hospital and
Harvard Medical School, Boston, MA 02215-1204, USA.
hsesso@hsph.harvard.edu
Although markers of systemic inflammation may have a role in the
development of hypertension, supportive clinical data remain limited. We,
therefore, examined interleukin (IL)-6 and C-reactive protein (CRP) in a
nested case-control study of 400 women developing hypertension and an equal
number of age-matched normotensive control subjects during 10 years of
follow-up as part of the Women's Health Study. All of the women initially had
nonhypertensive blood pressure values and no history of diagnosis or
treatment. Subjects provided self-reported risk factors, and IL-6 and CRP were
measured from baseline bloods. Case subjects reported elevated systolic
(>or=140 mm Hg) or diastolic (>or=90 mm Hg) blood pressure, newly
diagnosed hypertension, or initiating antihypertensive treatment during followup. In crude-matched models, IL-6 and CRP quartiles were each strongly
associated with hypertension risk (both Ps for trend <0.0001). In multivariate
models, the linear trends became nonsignificant, and the relative risks (95%
CIs) of hypertension for IL-6 reduced to 1.00 (ref), 1.29 (0.76 to 2.19), 2.14
(1.23 to 3.73), and 1.70 (0.92 to 3.13) and for CRP were 1.00 (ref), 2.09 (1.16
to 3.76), 2.51 (1.42 to 4.44), and 2.44 (1.29 to 4.64), primarily because of
confounding by body mass index. Simultaneous adjustment for IL-6 and CRP
modestly attenuated both sets of relative risks, although more for IL-6. Finally,
there was no effect modification by baseline blood pressure or other risk
factors (all Ps for interaction >0.05). Therefore, after multivariate adjustment
and strong confounding by body mass index, IL-6 was weakly associated and
CRP strongly associated with hypertension risk. In models simultaneously
examining IL-6 and CRP, only CRP remained strongly associated with an
increased risk of hypertension.
Publication Types:


Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
PMID: 17159088 [PubMed - in process]
29: Hypertension. 2007 Jan;49(1):69-75. Epub 2006 Dec 11.
Related Articles, Links
Comment in:

Hypertension. 2007 Jan;49(1):19-20.
Prevalence, awareness, treatment, and control of hypertension
among United States adults 1999-2004.
Ong KL, Cheung BM, Man YB, Lau CP, Lam KS.
Department of Medicine and the Research Centre of Heart, Brain, Hormone
and Healthy Aging, University of Hong Kong, Hong Kong.
Detection of hypertension and blood pressure control are critically important
for reducing the risk of heart attacks and strokes. We analyzed the trends in
the prevalence, awareness, treatment, and control of hypertension in the
United States in the period 1999-2004. We used the National Health and
Nutrition Examination Survey 1999-2004 database. Blood pressure
information on 14 653 individuals (4749 in 1999-2000, 5032 in 2001-2002,
and 4872 in 2003-2004) aged >or=18 years was used. Hypertension was
defined as blood pressure >or=140/90 mm Hg or taking antihypertensive
medications. The prevalence of hypertension in 2003-2004 was 7.3+/-0.9%,
32.6+/-2.0%, and 66.3+/-1.8% in the 18 to 39, 40 to 59, and >or=60 age
groups, respectively. The overall prevalence was 29.3%. When compared with
1999-2000, there were nonsignificant increases in the overall prevalence,
awareness, and treatment rates of hypertension. The blood pressure control
rate was 29.2+/-2.3% in 1999-2000 and 36.8+/-2.3% in 2003-2004. The ageadjusted increase in control rate was 8.1% (95% CI: 2.4 to 13.8%; P=0.006).
The control rates increased significantly in both sexes, non-Hispanic blacks,
and Mexican Americans. Among the >or=60 age group, the awareness,
treatment, and control rates of hypertension had all increased significantly
(P<or=0.01). The improvement in blood pressure control is encouraging,
although the prevalence of hypertension has not declined.
PMID: 17159087 [PubMed - indexed for MEDLINE]
30: Hypertension. 2007 Jan 15; [Epub ahead of print]
Related Articles, Links
Association of Adrenal Steroids With Hypertension and the
Metabolic Syndrome in Blacks.
Kidambi S, Kotchen JM, Grim CE, Raff H, Mao J, Singh RJ, Kotchen
TA.
Medical College of Wisconsin, Milwaukee; Aurora St Luke's Medical Center,
Milwaukee, Wis; and Mayo Foundation and Clinic, Rochester, Minn.
Blacks have a high prevalence of hypertension and adrenal cortical
adenomas/hyperplasia. We evaluated the hypothesis that adrenal steroids are
associated with hypertension and the metabolic syndrome in blacks.
Ambulatory blood pressures, anthropometric measurements, and
measurements of plasma renin activity (PRA), aldosterone, fasting lipids,
glucose, and insulin were obtained in 397 subjects (46% hypertensive and
50% female) after discontinuing antihypertensive and lipid-lowering
medications. Hypertension was defined as average ambulatory blood pressure
>130/85 mm Hg. Late-night and early morning salivary cortisol, 24-hour
urine-free cortisol, and cortisone excretion were measured in a consecutive
subsample of 97 subjects (40% hypertensive and 52% female). Compared with
normotensive subjects, hypertensive subjects had greater waist circumference
and unfavorable lipid profiles, were more insulin resistant, and had lower PRA
and higher plasma aldosterone and both late-night and early morning salivary
cortisol concentrations. Twenty-four-hour urine-free cortisol and cortisone did
not differ. Overall, ambulatory blood pressure was positively correlated with
plasma aldosterone (r=0.22; P<0.0001) and late-night salivary cortisol (r=0.23;
P=0.03) and inversely correlated with PRA (r=-0.21; P<0.001). Plasma
aldosterone correlated significantly with waist circumference, total
cholesterol, triglycerides, insulin, and the insulin-resistance index. Based on
Adult Treatment Panel III criteria, 17% of all of the subjects were classified as
having the metabolic syndrome. Plasma aldosterone levels, but not PRA, were
elevated in subjects with the metabolic syndrome (P=0.0002). The association
of aldosterone with blood pressure, waist circumference, and insulin resistance
suggests that aldosterone may contribute to obesity-related hypertension in
blacks. In addition, we speculate that relatively high aldosterone and low PRA
in these hypertensive individuals may reflect a mild variant of primary
aldosteronism.
PMID: 17159085 [PubMed - as supplied by publisher]
31: Hypertension. 2007 Feb;49(2):341-6. Epub 2006 Dec 11.
Related Articles, Links
Angiotensin type 2 receptor in resistance arteries of type 2
diabetic hypertensive patients.
Savoia C, Touyz RM, Volpe M, Schiffrin EL.
Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish
General Hospital, McGill University, Montreal, Quebec, Canada.
The role of angiotensin type 2 receptor (AT(2)R) on vascular responses to
angiotensin II in humans remains unclear. In this study we explored whether
AT(2)R is expressed and functionally active on peripheral resistance arteries
of hypertensive diabetic patients treated for 1 year with either the angiotensin
receptor blocker valsartan or the beta-blocker atenolol. Twenty-six
hypertensive type 2 diabetic patients treated with oral hypoglycemic and
antihypertensive agents (not receiving angiotensin receptor blockers or betablockers) were randomly assigned to double-blind treatment for 1 year with
valsartan or atenolol once daily added to their previous therapy in a clinical
trial that we reported recently and compared with 10 normal subjects.
Resistance arteries dissected from gluteal subcutaneous tissues were assessed
on a pressurized myograph. Vasomotor response curves to angiotensin II (1
nmol/L to 1 micromol/L) were performed on norepinephrine precontracted
vessels in the presence of valsartan (10 micromol/L) with or without the
AT(2)R inhibitor PD123319 (1 micromol/L). AT(2)R expression was
evaluated by confocal microscopy. After 1 year of treatment, systolic and
diastolic blood pressure was controlled and comparable in the valsartan and
atenolol groups. Angiotensin II evoked a significant vasodilatory response
only on resistance arteries from patients treated with valsartan, effect blocked
by PD123319. AT(2)R expression was 4-fold higher in small arteries of
valsartan-treated patients. In conclusion, AT(2)Rs are upregulated and
contribute to angiotensin II-induced vasodilation in resistance arteries of
hypertensive diabetic patients treated with angiotensin type 1 receptor
blockers and may mediate, in part, vascular actions of these drugs in high
cardiovascular risk patients.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17159079 [PubMed - in process]
32: Hypertension. 2006 Dec;48(6):1066-71. Epub 2006 Oct 23.Related Articles, Links
NO synthase uncoupling in the kidney of Dahl S rats: role of
dihydrobiopterin.
Taylor NE, Maier KG, Roman RJ, Cowley AW Jr.
Department of Physiology, Medical College of Wisconsin, Milwaukee, WI
53226, USA. ntaylor@mcw.edu
NO synthase (NOS) can paradoxically contribute to the production of reactive
oxygen species when l-arginine or the cofactor R-tetrahydrobiopterin (BH(4))
becomes limited. The present study examined whether NOS contributes to
superoxide production in kidneys of hypertensive Dahl salt-sensitive (SS) rats
compared with an inbred consomic control strain (SS-13(BN)) and tested the
hypothesis that elevated dihydrobiopterin (BH(2)) levels are importantly
involved in this process. This was assessed by determining the effects of lnitroarginine methyl ester (l-NAME) inhibition of NOS on superoxide
production and by comparing tissue concentrations of BH(4) and BH(2). A
reverse-phase high-performance liquid chromatography method was applied
for direct measurements of BH(4) and BH(2) using (S)-tetrahydrobiopterin as
an internal standard. Superoxide concentrations were measured in vivo from
medullary microdialysis fluid using dihydroethidine and in vitro using
lucigenin. The results indicate the following: (1) that superoxide levels were
elevated in the outer medulla of SS rats fed a 4% salt diet and could be
inhibited by l-NAME. In contrast, l-NAME resulted in elevated superoxide
production in consomic SS-13(BN) rats because of higher NOS activity; (2)
SS rats showed a reduced ratio of BH(4)/BH(2) in the outer medulla that was
driven by increased concentrations of BH(2); and (3) lower superoxide
dismutase and catalase activities contributed to elevated reactive oxygen
species in SS samples. Based on the shift of BH(4) to BH(2) and the
observation of l-NAME inhibitable superoxide production, we conclude that
NOS uncoupling occurs in the renal medulla of hypertensive SS rats fed a
high-salt diet.
Publication Types:


Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
PMID: 17060509 [PubMed - indexed for MEDLINE]
33: Hypertension. 2006 Dec;48(6):e108; author reply e109. Epub
2006 Oct 16.
Related Articles,
Links
Comment on:


Hypertension. 2006 Mar;47(3):359-64.
Hypertension. 2006 Mar;47(3):365-70.
Correlating ambulatory blood pressure measurements with
arterial stiffness: a conceptual inconsistency?
Gavish B.
Publication Types:


Comment
Letter
PMID: 17043160 [PubMed - indexed for MEDLINE]
34: Hypertension. 2006 Dec;48(6):1029-30. Epub 2006 Oct 16.Related Articles, Links
Comment on:

Hypertension. 2006 Dec;48(6):1160-8.
Atrial peptides modify the effect of marinobufagenin on sodium
pumps: implications for blood pressure control.
Buckalew VM.
Publication Types:


Comment
Editorial
PMID: 17043156 [PubMed - indexed for MEDLINE]
35: Hypertension. 2006 Dec;48(6):e115-6; author reply e117.
Epub 2006 Oct 9.
Related Articles,
Links
Comment on:

Hypertension. 2006 Jul;48(1):134-40.
Blood pressure in mutant rats lacking the 5-hydroxytryptamine
transporter.
Homberg J, Mudde J, Braam B, Ellenbroek B, Cuppen E, Joles JA.
Publication Types:


Comment
Letter
PMID: 17030677 [PubMed - indexed for MEDLINE]
36: Hypertension. 2006 Nov;48(5):e104; author reply e105. Epub
2006 Oct 2.
Related Articles,
Links
Comment on:

Hypertension. 2006 Apr;47(4):771-7.
Reduction of blood pressure levels study group.
Mann SJ.
Publication Types:


Comment
Letter
PMID: 17015771 [PubMed - indexed for MEDLINE]
37: Hypertension. 2006 Nov;48(5):832-3. Epub 2006 Oct 2.
Related Articles, Links
Comment on:

Hypertension. 2006 Nov;48(5):870-6.
Predictors of the evolution of microalbuminuria.
Ruilope LM, Segura J.
Publication Types:


Comment
Editorial
PMID: 17015769 [PubMed - indexed for MEDLINE]
38: Hypertension. 2006 Nov;48(5):914-20. Epub 2006 Sep 25.
Related Articles, Links
Circulating activities of angiotensin-converting enzyme, its
homolog, angiotensin-converting enzyme 2, and neprilysin in a
family study.
Rice GI, Jones AL, Grant PJ, Carter AM, Turner AJ, Hooper NM.
Proteolysis Research Group, Institute of Molecular and Cellular Biology,
Faculty of Biological Sciences, University of Leeds, Leeds, LS2 9JT United
Kingdom. bmbgir@bmb.leeds.ac.uk
The renin-angiotensin system is a key regulator of blood pressure (BP), with
inhibitors of angiotensin-converting enzyme (ACE) used clinically to treat
hypertension and other cardiovascular conditions. ACE2 is a newly identified
member of this system, which converts angiotensin II to angiotensin, and of
which the occurrence in plasma has not been investigated. The aim of this
study was to determine the heritability of circulating ACE, ACE2, and
neprilysin (NEP), which may also be a regulator of BP, in a family study, and
to determine covariates that contribute to the variation in plasma activity.
ACE, ACE2, and NEP activities were measured in plasma from 534 subjects
in the Leeds Family Study using selective fluorogenic substrates. Genetic
factors accounted for 24.5%, 67%, and 22.7% of the phenotypic variation in
circulating ACE, ACE2, and NEP, respectively. ACE insertion/deletion
polymorphism and other measured covariates accounted for 23.8% of variance
in circulating ACE. High-density lipoprotein cholesterol was a significant
determinant of circulating ACE2. Measured covariates accounted for 17.3% of
variation in circulating NEP. ACE and NEP were associated with systolic and
diastolic BP in univariate analyses; however, only ACE was independently
associated with systolic and diastolic BP after accounting for covariates and
shared childhood household.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17000927 [PubMed - indexed for MEDLINE]
39: Hypertension. 2006 Nov;48(5):861-9. Epub 2006 Sep 25.
Related Articles, Links
Comment in:

Hypertension. 2006 Nov;48(5):818-9.
Importance of salt in determining blood pressure in children:
meta-analysis of controlled trials.
He FJ, MacGregor GA.
Blood Pressure Unit, Cardiac and Vascular Sciences, St George's University
of London, Cranmer Terrace, London, SW17 0RE, United Kingdom.
fhe@sgul.ac.uk
To assess the effect of reducing salt intake on blood pressure in children, we
carried out a meta-analysis of controlled trials. Trials were included if
participants were children (< or = 18 years), and duration of salt reduction
must have been for > or = 2 weeks. Mean effect size was calculated using a
fixed-effect model, because there was no significant heterogeneity. Ten trials
of children and adolescents with 966 participants were included (median age:
13 years; range: 8 to 16 years; median duration: 4 weeks; range: 2 weeks to 3
years). Salt intake was reduced by 42% (interquartile range [IQR]: 7% to
58%). There were significant reductions in blood pressure: systolic: -1.17 mm
Hg (95% CI: -1.78 to -0.56 mm Hg; P<0.001); diastolic: -1.29 mm Hg (95%
CI: -1.94 to -0.65 mm Hg; P<0.0001). Three trials of infants with 551
participants were included (median duration: 20 weeks; range: 8 weeks to 6
months). Salt intake was reduced by 54% (IQR: 51% to 79%). There was a
significant reduction in systolic blood pressure: -2.47 mm Hg (95% CI: -4.00
to -0.94 mm Hg; P<0.01). This is the first meta-analysis of salt reduction in
children, and it demonstrates that a modest reduction in salt intake causes
immediate falls in blood pressure and, if continued, may well lessen the
subsequent rise in blood pressure with age. This would result in major
reductions in cardiovascular disease. These results in conjunction with other
evidence provide strong support for a reduction in salt intake in children.
Publication Types:


Meta-Analysis
Review
PMID: 17000923 [PubMed - indexed for MEDLINE]
40: Hypertension. 2006 Nov;48(5):812-4. Epub 2006 Sep 18.
Related Articles, Links
Prehypertension revisited.
Chobanian AV.
Publication Types:


Editorial
Review
PMID: 16982962 [PubMed - indexed for MEDLINE]
41: Hypertension. 2006 Nov;48(5):877-82. Epub 2006 Sep 18.
Related Articles, Links
Predicting stroke using 4 ambulatory blood pressure monitoringderived blood pressure indices: the Ohasama Study.
Inoue R, Ohkubo T, Kikuya M, Metoki H, Asayama K, Obara T, Hoshi
H, Hashimoto J, Totsune K, Satoh H, Kondo Y, Imai Y.
Comprehensive Research and Education Center for Planning of Drug
Development and Clinical Evaluation, Tohoku University Graduate School of
Pharmaceutical Science, 1-1 Seiryo-cho, Aoba-ku, Sendai, 980-8574, Japan.
We investigated the association between stroke and blood pressure (BP)
indices (systolic BP [SBP], diastolic BP [DBP], mean BP [MBP], and pulse
pressure [PP]) determined by ambulatory BP monitoring. The predictive
power for stroke of these indices was compared in the general Japanese
population. We obtained ambulatory BP data in 1271 subjects (40% men)
aged > or = 40 (mean: 61) years. During a mean follow-up of 11 years, 113
strokes were observed. The multivariate adjusted relative hazard and
likelihood ratio for a 1-SD increase for each BP index was determined by Cox
proportional hazard regression. Comparison of the likelihood ratio between
Cox models including 2 indices and those including 1 index indicated that PP
was significantly less informative than other indices (P<0.01 when adding
MBP, SBP, or DBP to the PP model; P>0.09 when adding PP to the model
including another index). However, after removing age from covariates, PP
became more informative than DBP and MBP (P<0.0001 when adding PP to
the MBP or DBP model, whereas SBP was more informative than PP even
after removing age; P<0.05 when adding SBP to the PP model). In conclusion,
PP was the weakest predictor of stroke. Exclusion of age from covariates
increased the predictive power of PP, suggesting that the stroke risk associated
with PP reflected the risk of aging per se.
Publication Types:



Comparative Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
PMID: 16982961 [PubMed - indexed for MEDLINE]
42: Hypertension. 2006 Nov;48(5):988-93. Epub 2006 Sep 18.
Related Articles, Links
Insulin resistance and obesity in a mouse model of systemic lupus
erythematosus.
Ryan MJ, McLemore GR Jr, Hendrix ST.
Department of Physiology and Biophysics, University of Mississippi Medical
Center, 2500 North State St, Jackson, MS 39216, USA.
mjryan@physiology.umsmed.edu
Accumulating data indicate that metabolic syndrome is an inflammatory
condition. Systemic lupus erythematosus (SLE) is an autoimmune disorder
associated with nephritis and cardiovascular disease. Evidence suggests that
individuals with SLE are at risk for developing insulin resistance; however,
this has not been directly examined. Using an established mouse strain with
SLE (NZBWF1), we examined whether SLE is associated with increased body
weight and fat deposition. Mean arterial pressure was significantly increased
(140+/-4 versus 114+/-2 mm Hg; n > or = 5) in SLE mice by 36 weeks of age
compared with control mice (NZW/LacJ). Body weight in SLE mice was
higher at each age compared with controls by 12%, 22%, and 34% (n > 30).
Visceral adipose tissue weight was increased in SLE by 44%, 74%, and 117%
at 8, 20, and 36 weeks, respectively (n > or = 12). Plasma leptin was increased
in SLE mice (8.6+/-1.0 versus 24.7+/-2.2 ng/mL; n = 5), and renal and adipose
tissue exhibited macrophage infiltration. Fasted insulin was higher in SLE
mice (0.6+/-0.1 versus 1.4+/-0.3 ng/mL; n > or = 10), but fasted glucose was
not different (94+/-5 versus 80+/-9; n > or = 9). A glucose tolerance test
caused a significantly greater and longer increase in blood glucose from mice
with SLE compared with control mice. Food intake was not different between
control and SLE mice. However, mice with SLE demonstrated lower levels of
nighttime activity than controls. These data show that the NZBWF1 strain may
be an important model to study the effects of obesity and insulin resistance on
SLE-associated hypertension.
Publication Types:


Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
PMID: 16982954 [PubMed - indexed for MEDLINE]
43: J Am Coll Cardiol. 2006 Dec 19;48(12):2546-52. Epub 2006
Nov 28.
Related Articles,
Links
Complications of right heart catheterization procedures in
patients with pulmonary hypertension in experienced centers.
Hoeper MM, Lee SH, Voswinckel R, Palazzini M, Jais X, Marinelli A,
Barst RJ, Ghofrani HA, Jing ZC, Opitz C, Seyfarth HJ, Halank M,
McLaughlin V, Oudiz RJ, Ewert R, Wilkens H, Kluge S, Bremer HC,
Baroke E, Rubin LJ.
Department of Respiratory Medicine, Hannover Medical School, Hannover,
Germany. hoeper.marius@mh-hannover.de
OBJECTIVES: This study sought to assess the risks associated with right
heart catheter procedures in patients with pulmonary hypertension.
BACKGROUND: Right heart catheterization, pulmonary vasoreactivity
testing, and pulmonary angiography are established diagnostic tools in patients
with pulmonary hypertension, but the risks associated with these procedures
have not been systematically evaluated in a multicenter study. METHODS:
We performed a multicenter 5-year retrospective and 6-month prospective
evaluation of serious adverse events related to right heart catheter procedures
in patients with pulmonary hypertension, as defined by a mean pulmonary
artery pressure >25 mm Hg at rest, undergoing right heart catheterization with
or without pulmonary vasoreactivity testing or pulmonary angiography.
RESULTS: During the retrospective period, 5,727 right heart catheter
procedures were reported, and 1,491 were reported from the prospective
period, for a total of 7,218 right heart catheter procedures performed. The
results from the retrospective and the prospective analyses were almost
identical. The overall number of serious adverse events was 76 (1.1%, 95%
confidence interval 0.8% to 1.3%). The most frequent complications were
related to venous access (e.g., hematoma, pneumothorax), followed by
arrhythmias and hypotensive episodes related to vagal reactions or pulmonary
vasoreactivity testing. The vast majority of these complications were mild to
moderate in intensity and resolved either spontaneously or after appropriate
intervention. Four fatal events were recorded in association with any of the
catheter procedures, resulting in an overall procedure-related mortality of
0.055% (95% confidence interval 0.01% to 0.099%). CONCLUSIONS: When
performed in experienced centers, right heart catheter procedures in patients
with pulmonary hypertension are associated with low morbidity and mortality
rates.
Publication Types:

Multicenter Study
PMID: 17174196 [PubMed - indexed for MEDLINE]
44: J Am Coll Cardiol. 2006 Dec 5;48(11):2293-300. Epub 2006
Nov 13.
Related Articles,
Links
A prospective study of the prevalence of primary aldosteronism
in 1,125 hypertensive patients.
Rossi GP, Bernini G, Caliumi C, Desideri G, Fabris B, Ferri C, Ganzaroli
C, Giacchetti G, Letizia C, Maccario M, Mallamaci F, Mannelli M,
Mattarello MJ, Moretti A, Palumbo G, Parenti G, Porteri E, Semplicini
A, Rizzoni D, Rossi E, Boscaro M, Pessina AC, Mantero F; PAPY Study
Investigators.
For a list of author affiliations, please see the.
OBJECTIVES: We prospectively investigated the prevalence of curable forms
of primary aldosteronism (PA) in newly diagnosed hypertensive patients.
BACKGROUND: The prevalence of curable forms of PA is currently
unknown, although retrospective data suggest that it is not as low as
commonly perceived. METHODS: Consecutive hypertensive patients referred
to 14 hypertension centers underwent a diagnostic protocol composed of
measurement of Na+ and K+ in serum and 24-h urine, sitting plasma renin
activity, and aldosterone at baseline and after 50 mg captopril. The patients
with an aldosterone/renin ratio >40 at baseline, and/or >30 after captopril,
and/or a probability of PA (by a logistic discriminant function) > or =50%
underwent imaging tests and adrenal vein sampling (AVS) or adrenocortical
scintigraphy to identify the underlying adrenal pathology. An aldosteroneproducing adenoma (APA) was diagnosed in patients who in addition to
excess autonomous aldosterone secretion showed: 1) lateralized aldosterone
secretion at AVS or adrenocortical scintigraphy, 2) adenoma at surgery and
pathology, and 3) a blood pressure decrease after adrenalectomy. Evidence of
excess autonomous aldosterone secretion without such criteria led to a
diagnosis of idiopathic hyperaldosteronism (IHA). RESULTS: A total of
1,180 patients (age 46 +/- 12 years) were enrolled; a conclusive diagnosis was
attained in 1,125 (95.3%). Of these, 54 (4.8%) had an APA and 72 (6.4%) had
an IHA. There were more APA (62.5%) and fewer IHA cases (37.5%) at
centers where AVS was available (p = 0.002); the opposite occurred where
AVS was unavailable. CONCLUSIONS: In newly diagnosed hypertensive
patients referred to hypertension centers, the prevalence of APA is high
(4.8%). The availability of AVS is essential for an accurate identification of
the adrenocortical pathologies underlying PA.
PMID: 17161262 [PubMed - indexed for MEDLINE]
45: J Am Coll Cardiol. 2006 Nov 7;48(9):1856-8. Epub 2006
Oct 17.
Related Articles,
Links
Comment on:

J Am Coll Cardiol. 2006 Nov 7;48(9):1851-5.
Physiologic assessment of renal artery stenosis: will history
repeat itself?
Fearon WF.
Publication Types:



Comment
Editorial
Research Support, N.I.H., Extramural
PMID: 17084262 [PubMed - indexed for MEDLINE]
46: J Am Coll Cardiol. 2006 Nov 7;48(9):1851-5. Epub 2006
Oct 17.
Related Articles,
Links
Comment in:

J Am Coll Cardiol. 2006 Nov 7;48(9):1856-8.
Assessment of renal artery stenosis severity by pressure gradient
measurements.
De Bruyne B, Manoharan G, Pijls NH, Verhamme K, Madaric J,
Bartunek J, Vanderheyden M, Heyndrickx GR.
Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.
bernard.de.bruyne@olvz-aalst.be
OBJECTIVES: The purpose of this study was to define "significant" renal
artery stenosis (i.e., a stenosis able to induce arterial hypertension).
BACKGROUND: The degree of renal artery stenosis that justifies an attempt
at revascularization is unknown. METHODS: In 15 patients, transstenotic
pressure measurements were obtained before and after unilateral stenting.
After stenting, graded stenoses were created in the stented segment by
progressive inflation of a balloon catheter. Stenosis severity was expressed as
the ratio of distal pressure (P(d)) corrected for aortic pressure (P(a)). Balloon
inflation pressure was adjusted to create 6 degrees of stenosis (P(d)/P(a) from
1.0 to 0.5, each step during 10 min). Plasma renin concentration was measured
at the end of each step in the aorta and in both renal veins. RESULTS: For a
P(d)/P(a) ratio >0.90, no significant change in plasma renin concentration was
observed. However, when P(d)/P(a) became <0.90, a significant increase in
renin was observed in the renal vein of the stenotic kidney, finally reaching a
maximal increase of 346 +/- 145% for P(d)/P(a) of 0.50 (p = 0.006). These
values returned to baseline when the stenosis was relieved. In addition, plasma
renin concentration increased significantly in the vein from the non-stenotic
kidney (p = 0.02). CONCLUSIONS: In renal artery stenoses, a P(d)/P(a) ratio
of 0.90 can be considered a threshold value below which the stenosis is likely
responsible for an up-regulation of renin production and, thus, for
renovascular hypertension. These findings might contribute to better patient
selection for renal angioplasty.
Publication Types:

Comparative Study
PMID: 17084261 [PubMed - indexed for MEDLINE]
47: J Hum Hypertens. 2006 Dec 14; [Epub ahead of print]
Related Articles, Links
Reverse white-coat effect as an independent risk for left
ventricular concentric hypertrophy in patients with treated
essential hypertension.
Tomiyama M, Horio T, Kamide K, Nakamura S, Yoshihara F, Nakata H,
Nakahama H, Kawano Y.
1Division of Hypertension and Nephrology, Department of Medicine,
National Cardiovascular Center, Suita, Japan.
Recent studies have shown that the converse phenomenon of white-coat
hypertension called 'reverse white-coat hypertension' or 'masked hypertension'
is associated with poor cardiovascular prognosis. We assessed the hypothesis
that this phenomenon may specifically influence left ventricular (LV) structure
in treated hypertensive patients. A total of 272 outpatients (mean age, 65
years) with chronically treated essential hypertension and without remarkable
white-coat effect were enrolled. Patients were classified into two groups
according to office and daytime ambulatory systolic blood pressure (SBP);
that is subjects without (Group 1: office SBP >/=daytime SBP, n=149) and
with reverse white-coat effect (Group 2: office SBP<daytime SBP, n=123).
LV mass index and relative wall thickness were echocardiographically
determined. In all subjects, LV mass index and relative wall thickness were
positively correlated with daytime and 24-h SBP, but not with office SBP. In
addition, these two indices were inversely correlated with office - daytime
SBP difference. LV mass index (136+/-31 and 115+/-28 g/m(2), mean+/-s.d.)
and relative wall thickness (0.49+/-0.09 and 0.46+/-0.07) were significantly
greater in Group 2 than in Group 1. As for LV geometric patterns, Group 2
had a significantly higher rate of concentric hypertrophy compared with Group
1 (48 and 28%). Multivariate analyses revealed that the presence of reverse
white-coat effect was a predictor for LV concentric hypertrophy, independent
of age, sex, hypertension duration, antihypertensive treatment and ambulatory
blood pressure levels. Our findings demonstrate that reverse white-coat effect
is an independent risk factor for LV hypertrophy, especially concentric
hypertrophy, in treated hypertensive patients.Journal of Human Hypertension
advance online publication, 14 December 2006; doi:10.1038/sj.jhh.1002127.
PMID: 17167525 [PubMed - as supplied by publisher]
48: J Hum Hypertens. 2006 Dec 14; [Epub ahead of print]
Related Articles, Links
Plasma levels of complement C3 is associated with development
of hypertension: a longitudinal cohort study.
Engstrom G, Hedblad B, Berglund G, Janzon L, Lindgarde F.
1Department of Clinical Science, Malmo University Hospital, Lund
University, Malmo, Sweden.
Hypertension has been associated with raised plasma levels of complement
factor 3 and 4 (C3 and C4). The nature of this association is unclear. This
population-based longitudinal study explored whether C3 or C4 is associated
with development of hypertension. Blood pressure and plasma levels of C3
and C4 were determined in 2178 healthy men, aged 35-50 years, initially
without treatment for hypertension. Incidence of hypertension and blood
pressure increase over 15.7 (+/-2.2) years follow-up was studied in relation to
C3 and C4 at baseline. Among men with initially normal blood pressure
(<160/95 mm Hg), incidence of hypertension (>/=160/95 mm Hg or treatment)
was 32, 42, 37 and 47%, respectively, for men with C3 in the first, second,
third and fourth quartile (trend: P=0.001). This relationship remained
significant after adjustment for confounding factors. Among men without
blood pressure treatment, systolic BP increase (mean+standard error, adjusted
for age, initial blood pressure and follow-up time) was 17.5+0.8, 19.6+0.9,
19.8+0.8 and 20.8+0.8 mm Hg, respectively, in the C3 quartiles (trend:
P=0.004). C3 was not associated diastolic blood pressure at follow-up.
Although C4 was associated with blood pressure at the baseline examination,
there was no relationship between C4 and development of hypertension or
future blood pressure increase. It is concluded that C3 in plasma is associated
with future blood pressure increase and development of hypertension.Journal
of Human Hypertension advance online publication, 14 December 2006;
doi:10.1038/sj.jhh.1002129.
PMID: 17167524 [PubMed - as supplied by publisher]
49: J Hum Hypertens. 2006 Dec 14; [Epub ahead of print]
Related Articles, Links
Impacts of diabetes and hypertension on the risk of
hospitalization among less educated people.
Lin M, Chen Y, Sigal RJ.
1Department of Epidemiology and Community Medicine, Faculty of
Medicine, University of Ottawa, Ontario, Canada.
Coexisting hypertension increases the morbidity and mortality associated with
diabetes, and may be more so in less educated people. We analysed data from
49 904 Canadians 40-64 years of age who participated in the Canadian
Community Health Survey, 2000-2001. Multiple classification analysis was
used to adjust for covariates. Population weight and design effect of the survey
were taken into account in the analysis. The association between hypertension
and hospitalization varied according to diabetes and education. The adjusted
difference in hospitalization incidence attributable to hypertension was
significantly higher for the lower education group than the higher education
group, and such a pattern tended to be more pronounced among diabetic
people. The adjusted incidence difference attributable to hypertension was
higher in the diabetic group (8.8, 95% confidence interval (CI): 4.6, 13.0%)
than in the non-diabetic group (4.6, 95% CI: 3.6, 5.6%) for people with low
education, but was similar for those with well-educated people. Possible
reasons for the modifying effect of education on the relationship among
hypertension, diabetes and hospitalization were discussed.Journal of Human
Hypertension advance online publication, 14 December 2006;
doi:10.1038/sj.jhh.1002131.
PMID: 17167523 [PubMed - as supplied by publisher]
50: J Hum Hypertens. 2006 Dec 14; [Epub ahead of print]
Related Articles, Links
The effect of gender on the sympathetic nerve hyperactivity of
essential hypertension.
Hogarth AJ, Mackintosh AF, Mary DA.
1The Department of Cardiology, St James's University Hospital, Leeds, UK.
We planned to determine whether or not there is a difference in the level of
muscle sympathetic nerve activity (MSNA) between hypertensive women and
hypertensive men. Sympathetic activation of essential hypertension (EHT) has
been associated with increased cardiovascular events, which are known to be
less likely to occur in women than in men. Normal women have been reported
to have less sympathetic nerve activity than men, but no reported data are
available regarding gender differences in sympathetic activity in hypertensive
subjects. We examined 36 patients with untreated and uncomplicated EHT
comprising 18 women and 18 men, and 36 normal controls comprising 18
women and 18 men. MSNA was quantified as the mean frequency of single
units and as multiunit bursts using the technique of microneurography. The
hypertensive groups had greater sympathetic nerve activity than the control
groups. Female hypertensives had lower (P<0.001) single unit hyperactivity
(56+/-1.7 impulses/100 cardiac beats) than male hypertensives (72+/-1.7
impulses/100 cardiac beats). Normotensive females had lower (P<0.01) single
unit activity (42+/-3.6 impulses/100 cardiac beats) than normotensive males
(56+/-4.6 impulses/100 cardiac beats). Similar results were obtained for the
frequency of multiunit burst activity. Hypertension in women is associated
with a lower level of central sympathetic hyperactivity than in men. It is
suggested that this may at least partly explain the observed lower
hypertension-related cardiovascular events in women than in men. In addition,
the findings may have implications for gender-specific management of
hypertension.Journal of Human Hypertension advance online publication, 14
December 2006; doi:10.1038/sj.jhh.1002132.
PMID: 17167522 [PubMed - as supplied by publisher]
51: J Hum Hypertens. 2006 Sep;20(9):693-700. Epub 2006 May
18.
Related Articles,
Links
Rationale and design of a study to evaluate management of
proteinuria in patients at high risk for vascular events: the
IMPROVE trial.
Bakris GL, Ruilope L, Locatelli F, Ptaszynska A, Pieske B, Raz I, Voors
AA, Dechamplain J, Weber MA.
Department of Preventive Medicine, Rush University Medical Center,
Chicago, IL 60612, USA. gbarkis@earthlink.net
Declining kidney function predicts increasing cardiovascular risk in people
with hypertension. Microalbuminuria is a marker for cardiovascular risk and
declining kidney function. Agents that block the renin-angiotensin-aldosterone
system (RAAS), notably angiotensin-converting enzyme (ACE) inhibitors and
angiotensin receptor blockers (ARBs), reduce proteinuria and
microalbuminuria, lower blood pressure and slow the progression of
proteinuric kidney disease. Evidence is accumulating that the combination of
an ACE inhibitor and an ARB is the optimal means of RAAS blockade in this
setting, slowing the progression of nephropathy independently of blood
pressure lowering to a greater degree than can be achieved using maximum
approved doses of either agent alone. However, the emerging therapeutic
potential of ACE inhibitor/ARB combination therapy in hypertensive kidney
disease requires further characterization. The Irbesartan in the Management of
PROteinuric patients at high risk for Vascular Events trial aims to determine
definitively whether the combination therapy of an ARB, irbesartan and an
ACE inhibitor, ramipril, is more effective than ramipril alone in reducing the
urinary albumin excretion rate in patients at high cardiovascular risk with
hypertension and proteinuria or microalbuminuria.
Publication Types:


Multicenter Study
Randomized Controlled Trial
PMID: 16710287 [PubMed - indexed for MEDLINE]
52: J Hum Hypertens. 2006 Sep;20(9):684-92. Epub 2006 Apr
20.
Related Articles,
Links
Association between the Pro12Ala variant of the peroxisome
proliferator-activated receptor-gamma2 gene and increased 24-h
diastolic blood pressure in obese patients with type II diabetes.
Stefanski A, Majkowska L, Ciechanowicz A, Frankow M, Safranow K,
Parczewski M, Moleda P, Pilarska K.
Department of Endocrinology, Hypertension and Metabolic Diseases,
Pomeranian Medical University, Szczecin, Poland.
stefend@sci.pam.szczecin.pl
The aim of the study was to examine an association between the Pro12Ala
polymorphism of the peroxisome proliferator-activated receptor (PPAR)gamma2 gene and blood pressure values assessed by 24-h ambulatory blood
pressure monitoring (ABPM) in obese patients with long-lasting type II
diabetes. Two hundred and fourteen obese patients (95 men and 119 women)
with above 10-year history of type II diabetes were recruited for the study. In
all the patients, ABPM was performed and other parameters, including age,
body mass index (BMI), waist/hip ratio (WHR), haemoglobin A1c (HbA(1c)),
serum lipids and creatinine were also evaluated. The Pro12Ala polymorphism
was analysed by polymerase chain reaction-restriction fragment length
polymorphism. Two subgroups of patients were compared: (a) Pro/Pro:
homozygotic Pro/Pro (n=154) and (b) Ala: Ala allele carriers
(Ala/Ala+Ala/Pro) (n=60). The studied groups were not different when age,
BMI, WHR, HbA(1c), lipids, creatinine and frequency of hypertension were
compared. A similar ratio of patients from both groups were treated with
angiotensin-converting enzyme inhibitors, calcium channel blockers, diuretics,
beta-blockers and alpha-blockers. A difference was observed in a mean 24-h
(Ala: 71.9+/-8.1 vs Pro/Pro: 69.4+/-7.8 mm Hg, P=0.034) and a mean night
time (Ala: 67.1+/-7.8 vs Pro/Pro: 64.5+/-8.4 mm Hg, P=0.025) diastolic blood
pressure, which was significantly higher in patients with Ala variant. There
was also a trend towards a higher mean daytime diastolic blood pressure in
this group. It seems that the Pro12Ala variant is associated with an increased
mean 24-h diastolic blood pressure in obese diabetic patients. Different
reaction for antihypertensive medication depending on a variant of the PPARgamma2 gene should also be considered as a possible cause of the presented
results.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 16625233 [PubMed - indexed for MEDLINE]
53: J Hum Hypertens. 2006 Sep;20(9):635-7. Epub 2006 Apr
13.
Related Articles,
Links
Blood pressure control in the setting of diabetes mellitus: new
targets, new hope for improvement?
Varughese GI, Patel JV, Lip GY.
University Department of Medicine, City Hospital, Birmingham, UK.
PMID: 16617307 [PubMed - indexed for MEDLINE]
54: J Hypertens. 2006 Nov;24(11):2239-46.
Related Articles, Links
Central receptors mediating the cardiovascular actions of
melanocyte stimulating hormones.
Ni XP, Butler AA, Cone RD, Humphreys MH.
Division of Nephrology, San Francisco General Hospital and University of
California San Francisco, San Francisco, California 94143-1341, USA.
OBJECTIVE: Alpha and gamma-melanocyte stimulating hormones (MSH)
are peptides that possess potent hypertensinogenic actions when injected
intravenously or intracerebroventricularly. We sought to define the central
receptor(s) mediating these cardiovascular actions. METHODS: We gave
bolus injections of synthetic alpha or gamma-MSH intravenously or
intracerebroventricularly to anesthetized wild-type (Mc3r+/+, Mc4r+/+) mice
and mice with targeted disruption of the gamma-MSH receptor (Mc3r-/-) or
the melanocortin 4 receptor (Mc4r-/-). RESULTS: Gamma-MSH injected
intravenously increased mean arterial pressure (MAP) and heart rate (HR)
dose-dependently, with the effect being evident at 10 mol/kg; the maximum
increase, at 10 mol/kg, was 38 mmHg in both strains from similar control
MAP. Parallel increases in HR also occurred. Injection of the sodium channel
blocker, benzamil, 4 microg/kg intracerebroventricularly, before intravenous
gamma-MSH completely prevented the increases in MAP and HR in both
strains. Injection of 2 x 10 mol/g body weight alpha-MSH intravenously had
no effect on MAP or HR in Mc4r wild-type or -/- mice. However, the same
dose given intracerebroventricularly to wild-type mice increased MAP from
76 +/- 4 to 95 +/- 5 mmHg at 10 min (P < 0.01) and HR from 416 +/- 15 to
480 +/- 15 beats/min (P < 0.01). In Mc4r-/- mice, the intracerebroventricular
administration of the peptide did not alter these variables, in contrast to the
results in wild-type mice. CONCLUSION: Both MSH peptides exert their
hypertensinogenic effects through central sites of action, which probably
reflect the activation of sympathetic outflow. The actions of
intracerebroventricular alpha-MSH appear to be mediated via Mc4r, whereas
those of gamma-MSH are independent of its receptor Mc3r, but reflect the
activation of a sodium channel in the central nervous system. These results
help to reconcile the hypertensive action of gamma-MSH injections with the
hypertension observed in states of gamma-MSH deficiency.
Publication Types:

Research Support, N.I.H., Extramural
PMID: 17053546 [PubMed - indexed for MEDLINE]
55: J Hypertens. 2006 Nov;24(11):2199-205.
Related Articles, Links
Interaction between CYP1A1 T3801C and AHR G1661A
polymorphisms according to smoking status on blood pressure in
the Stanislas cohort.
Gambier N, Marteau JB, Batt AM, Marie B, Thompson A, Siest G,
Foernzler D, Visvikis-Siest S.
INSERM U525, Faculte de Pharmacie, Universite Henri Poincare Nancy 1,
Nancy, France.
BACKGROUND: CYP1A1, one of the key enzymes in detoxifying toxic
components produced during cigarette smoking, is regulated by aromatic
hydrocarbon receptor (AHR). A CYP1A1 T3801C polymorphism, associated
with a higher CYP1A1 inducibility and enhanced catalytic activity, has been
linked to stroke, triple vessel disease and may, therefore, be associated with
blood pressure (BP). The relation of the widely studied G1661A
polymorphism of the human AHR gene with BP is unknown. OBJECTIVES:
To investigate the genetic influence of CYP1A1 T3801C and AHR G1661A
polymorphisms on BP in relation to tobacco consumption. DESIGN AND
PARTICIPANTS: Study participants were selected from a French longitudinal
cohort of volunteers for a free health check-up. These individuals (302 men
and 311 women) were not taking medication that can affect blood pressure.
Information about active smoking status was obtained by a self-administered
questionnaire. RESULTS: After multiple regression analysis, systolic blood
pressure (SBP) and diastolic blood pressure (DBP) did not differ significantly
according to their tobacco status excepted for DBP in men. In addition, neither
CYP1A1 T3801C nor AHR G1661A polymorphism was linked to blood
pressure. However, systolic and diastolic blood pressures differed significantly
according to CYP1A1 T3801C genotype between ex-smokers and smokers.
Finally, the interaction between CYP1A1 T3801C and AHR G1661A
polymorphisms explained a significant difference of SBP and DBP between
carriers of both CYP1A1-C3801 and AHR-A1661 alleles. CONCLUSION:
This study is the first to show an interaction between the CYP1A1 T3801C
and AHR G1661A polymorphisms. This interaction could explain the
difference in blood pressure level between smokers and non-smokers/exsmokers but needs to be confirmed in a large sample.
Publication Types:

Research Support, Non-U.S. Gov't
PMID: 17053541 [PubMed - indexed for MEDLINE]
56: J Hypertens. 2006 Nov;24(11):2183-9.
Related Articles, Links
Introversion associated with large differences between screening
blood pressure and home blood pressure measurement: The
Ohasama study.
Hozawa A, Ohkubo T, Obara T, Metoki H, Kikuya M, Asayama K,
Totsune K, Hashimoto J, Hoshi H, Arai Y, Satoh H, Hosokawa T, Imai Y.
Department of Health Science, Shiga University of Medical Science, Shiga,
Japan. hozawa-thk@umin.ac.jp
OBJECTIVE: To explore the effect of personality on screening blood
pressures measured in clinical settings and home blood pressure
measurements. METHODS: From 1997 to 1999, 699 participants underwent
screening and home blood pressure measurements and completed the Japanese
version of the short-form Eysenck personality questionnaire. An increased
screening blood pressure was defined as screening blood pressure > or =
140/90 mmHg and an increased home blood pressure was defined as home
blood pressure > or = 135/85 mmHg. RESULTS: Participants with lower
extroversion scores (i.e., introversion) showed a greater difference between
screening and home systolic blood pressure. The association between
introversion and differences was statistically significant, even after adjustment
for other possible factors (younger age, female, wide screening pulse pressure,
never smoked, and no antihypertensive medication). The adjusted means of
SBP differences were 7.3 and 4.4 mmHg among the lowest and highest
extroversion quartiles, respectively (P for trend = 0.02). Other personality
scores (psychoticism or neuroticism) were not associated with screening and
home blood pressure differences. The incorporation of an extroversion score
in the basic model consisting of the above factors that affected the difference
between screening and home blood pressure slightly improved the prediction
of a high home blood pressure. The area under the receiver operating
characteristic curve increased by 0.037 among participants with high screening
blood pressure and 0.006 for those with normal screening blood pressure
compared with the basic model. CONCLUSION: Physicians may need to be
aware of 'introverted' patients who have high blood pressure in clinic settings,
because they have the potential for 'white-coat' hypertension.
Publication Types:


Evaluation Studies
Research Support, Non-U.S. Gov't
PMID: 17053539 [PubMed - indexed for MEDLINE]
57: JAMA. 2006 Dec 20;296(23):2787-8.
Drug therapy for prehypertension questioned.
Related Articles, Links
Mitka M.
Publication Types:

News
1. SICA DA.
Interaction of grapefruit juice and calcium channel blockers.
Am J Hypertens. 2006;19:768-73.
http://amedeo.com/p2.php?id=16814135&s=hyp
ABSTRACT available
2. VOICULESCU A, Schmitz M, Plum J, Hollenbeck M, et al.
Duplex ultrasound and renin ratio predict treatment failure after
revascularization for renal artery stenosis.
Am J Hypertens. 2006;19:756-63.
http://amedeo.com/p2.php?id=16814133&s=hyp
ABSTRACT available
3. FIGAR S, Galarza C, Petrlik E, Hornstein L, et al.
Effect of education on blood pressure control in elderly persons: a
randomized controlled trial.
Am J Hypertens. 2006;19:737-43.
http://amedeo.com/p2.php?id=16814130&s=hyp
ABSTRACT available
4. KITAYAMA H, Maeshima Y, Takazawa Y, Yamamoto Y, et al.
Regulation of angiogenic factors in angiotensin II infusion model in
association with tubulointerstitial injuries.
Am J Hypertens. 2006;19:718-27.
http://amedeo.com/p2.php?id=16814127&s=hyp
ABSTRACT available
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*** FREE FULL TEXT ***
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