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1.
J Med Virol ; 93(2): 726-732, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-32692406

RESUMEN

Since its first appearance in Wuhan, China, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread throughout the world and has become a global pandemic. Several medical comorbidities have been identified as risk factors for coronavirus disease 2019 (COVID-19). However, it remains unclear whether people living with human immunodefeciency virus (PLWH) are at an increased risk of COVID-19 and severe disease manifestation, with controversial suggestion that HIV-infected individuals could be protected from severe COVID-19 by means of antiretroviral therapy or HIV-related immunosuppression. Several cases of coinfection with HIV and SARS-CoV-2 have been reported from different parts of the globe. This review seeks to provide a holistic overview of SARS-CoV-2 infection in PLWH.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/epidemiología , Huésped Inmunocomprometido , Pandemias , /patogenicidad , Adulto , Terapia Antirretroviral Altamente Activa/estadística & datos numéricos , Linfocitos T CD4-Positivos/efectos de los fármacos , Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD4-Positivos/virología , /mortalidad , Coinfección , Comorbilidad , Diabetes Mellitus/epidemiología , Diabetes Mellitus/fisiopatología , Femenino , VIH/efectos de los fármacos , VIH/crecimiento & desarrollo , VIH/patogenicidad , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/mortalidad , Infecciones por VIH/virología , Humanos , Hipertensión/epidemiología , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Análisis de Supervivencia , Resultado del Tratamiento
2.
J Stroke Cerebrovasc Dis ; 30(1): 105456, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33171422

RESUMEN

BACKGROUND: Recent clinical trials suggest that it is safe to acutely lower systolic blood pressure (BP) to 140 mm Hg after ICH, but uncertainty remains regarding optimal management. We sought to better define the link between BP and outcome in ICH patients using data from the Virtual International Stroke Trials Archive (VISTA). METHODS: We performed a retrospective analysis of patients of the VISTA-ICH trials. We measured the strength of association between systolic and diastolic BP various components at different timepoints with unfavorable 3 month-outcome, defined as death or moderate-to-severe disability at 3 months (mRS of 4-6), after adjustment for known confounders. We also dichotomized BP values obtained at 24 h at different thresholds to better define an optimal treatment target. The association of BP with hematoma expansion (HE) was also analyzed. RESULTS: A total of 384 patients were included. Higher BP at 24 hours was associated with unfavorable outcome for systolic BP (OR 1.16, 95% C.I. 1.07-1.25), pulse pressure (OR 1.13, 95% C.I. 1.03-1.24), and diastolic BP (OR 1.11, 95% C.I. 1.01-1.23) per 10 mm Hg increment. The association between higher BP at 24 h and unfavorable outcome remained significant down to >140 mm Hg. Elevated systolic BP at 24 h was also associated with HE (OR 1.11, 95% C.I. 1.02-1.21 per 10 mm Hg increment). CONCLUSION: Elevated BP after ICH at 24 h is associated with poor outcome. Our results support the practice of targeting a systolic BP of 140 mm Hg.


Asunto(s)
Presión Sanguínea , Hemorragia Cerebral/fisiopatología , Hipertensión/fisiopatología , Anciano , Hemorragia Cerebral/diagnóstico por imagen , Hemorragia Cerebral/mortalidad , Hemorragia Cerebral/terapia , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/mortalidad , Hipertensión/terapia , Masculino , Persona de Mediana Edad , Pronóstico , Ensayos Clínicos Controlados Aleatorios como Asunto , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo
3.
J Stroke Cerebrovasc Dis ; 30(1): 105467, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33207300

RESUMEN

OBJECTIVES: India faces a high and growing burden of hypertension, which is an important cerebrovascular risk factor, especially in elderly persons. Poor awareness contributes to delays in seeking health care, which is undesirable given the emergent nature of stroke. Literature regarding awareness in this subgroup of the population is scarce. Our objective was to assess awareness regarding cerebrovascular disease among elderly persons with hypertension residing in a rural area of Bangalore district, and estimate their individual risk of stroke. MATERIAL & METHODS: We randomly selected 144 elderly hypertensives residing in a rural area in Bangalore district from a list of known hypertensives maintained as part of a population-based senior citizen health service. We developed an open-ended, face-validated questionnaire, which was administered following informed consent, to assess stroke awareness. We defined good awareness as knowing at least one risk factor, one warning sign, and having the knowledge that stroke requires immediate treatment. Univariate and multivariate analyses were performed to assess factors associated with good or poor awareness. RESULTS: 40% of the study population had not heard of the term 'stroke'. Only 22% could identify the brain as the organ affected. 51% could name at least one symptom. 45% of males and 24% of females believed that their hypertension predisposed them to stroke. 56% could not name a single risk factor. Only 37% of the males and 18% of the females had good overall awareness. Female gender and low literacy were associated with poor overall awareness, while being gainfully employed, a history of alcohol use and doing higher levels of exercise were associated with greater awareness on univariate analysis. None of these factors were statistically significantly related to stroke awareness on multivariate analysis. CONCLUSIONS: Awareness of different aspects of stroke was very poor, highlighting the need for stroke education at all levels of care.


Asunto(s)
Presión Sanguínea , Conocimientos, Actitudes y Práctica en Salud , Hipertensión/complicaciones , Salud Rural , Accidente Cerebrovascular/etiología , Factores de Edad , Anciano , Estudios Transversales , Femenino , Alfabetización en Salud , Humanos , Hipertensión/diagnóstico , Hipertensión/fisiopatología , India , Masculino , Persona de Mediana Edad , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología
4.
Front Public Health ; 8: 593256, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33330336

RESUMEN

Objectives: We aimed to describe the epidemiological and clinical characteristics of patients with COVID-19 in Saudi Arabia in various severity groups. Methods: Data for 485 patients were extracted from the medical records from the infectious disease center of Prince Mohammed bin Abdul Aziz Hospital in Riyadh. Patients' basic information, laboratory test results, signs and symptoms, medication prescribed, other comorbidities, and outcome data were collected and analyzed. Descriptive data were reported to examine the distribution of study variables between the severe and not severe groups. Results: Of 458 included patients, 411 (89.7%) were classified as not severe, 47 (10.3%) as severe. Most (59.1%) patients were aged between 20 and 39 years. Patients with severe conditions were non-Saudi, with a chronic condition history, and tended to have more chronic conditions compared with those without severe disease. Diabetes, hypertension, and thyroid disease were significantly higher in patients with severe disease. Death was reported in only 4.26% of severe patients. Only 16 (34.04%) patients remained in the hospital in the severe group. Conclusions: Severe cases were more likely to have more comorbidities, diabetes, hypertension, and thyroid disorders were most common compared with non-severe cases.


Asunto(s)
/epidemiología , Comorbilidad , Diabetes Mellitus/fisiopatología , Hipertensión/fisiopatología , Índice de Severidad de la Enfermedad , Enfermedades de la Tiroides/fisiopatología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios Transversales , Diabetes Mellitus/epidemiología , Femenino , Humanos , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Arabia Saudita/epidemiología , Enfermedades de la Tiroides/epidemiología , Adulto Joven
5.
PLoS One ; 15(11): e0242679, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33237923

RESUMEN

PURPOSE: Ectopic Cushing Syndrome (EAS) is a rare condition responsible for about 5-20% of all Cushing syndrome cases. It increases the mortality of affected patients thus finding and removal of the ACTH-producing source allows for curing or reduction of symptoms and serum cortisol levels. The aim of this study is to present a 20-year experience in the diagnosis and clinical course of patients with EAS in a single Clinical Centre in Southern Poland as well as a comparison of clinical course and outcomes depending on the source of ectopic ACTH production-especially neuroendocrine tumors with other neoplasms. METHODS: Twenty-four patients were involved in the clinical study with EAS diagnosed at the Department of Endocrinology between years 2000 and 2018. The diagnosis of EAS was based on the clinical presentation, hypercortisolemia with high ACTH levels, high dose dexamethasone suppression test and/or corticotropin-releasing hormone tests. To find the source of ACTH various imaging studies were performed. RESULTS: Half of the patients were diagnosed with neuroendocrine tumors, whereby muscle weakness was the leading symptom. Typical cushingoid appearance was seen in merely a few patients, and weight loss was more common than weight gain. Patients with neuroendocrine tumors had significantly higher midnight cortisol levels than the rest of the group. Among patients with infections, we observed a significantly higher concentrations of cortisol 2400 levels in gastroenteropancreatic neuroendocrine tumors. Chromogranin A correlated significantly with potassium in patients with neuroendocrine tumors and there was a significant correlation between ACTH level and severity of hypokalemia. CONCLUSION: EAS is not common, but if it occurs it increases the mortality of patients; therefore, it should be taken into consideration in the case of coexistence of severe hypokalemia with hypertension and muscle weakness, especially when weight loss occurs. Because the diagnosis of gastroenteropancreatic neuroendocrine tumor worsens the prognosis-special attention should be paid to these patients.


Asunto(s)
Síndrome de ACTH Ectópico , Síndrome de ACTH Ectópico/sangre , Síndrome de ACTH Ectópico/diagnóstico , Síndrome de ACTH Ectópico/fisiopatología , Adolescente , Hormona Adrenocorticotrópica/sangre , Adulto , Anciano , Síndrome de Cushing/sangre , Síndrome de Cushing/diagnóstico , Síndrome de Cushing/fisiopatología , Femenino , Humanos , Hidrocortisona/sangre , Hipertensión/sangre , Hipertensión/diagnóstico , Hipertensión/fisiopatología , Hipopotasemia/sangre , Hipopotasemia/diagnóstico , Hipopotasemia/fisiopatología , Masculino , Persona de Mediana Edad , Debilidad Muscular/sangre , Debilidad Muscular/diagnóstico , Debilidad Muscular/fisiopatología , Polonia , Estudios Retrospectivos
6.
PLoS One ; 15(11): e0242774, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33237935

RESUMEN

BACKGROUND: There are conflicting reports on the association of undercarboxylated osteocalcin (ucOC) in cardiovascular disease development, including endothelial function and hypertension. We tested whether ucOC is related to blood pressure and endothelial function in older adults, and if ucOC directly affects endothelial-mediated vasodilation in the carotid artery of rabbits. METHODS: In older adults, ucOC, blood pressure, pulse wave velocity (PWV) and brachial artery flow-mediated dilation (BAFMD) were measured (n = 38, 26 post-menopausal women and 12 men, mean age 73 ± 0.96). The vasoactivity of the carotid artery was assessed in male New Zealand White rabbits following a four-week normal or atherogenic diet using perfusion myography. An ucOC dose response curve (0.3-45 ng/ml) was generated following incubation of the arteries for 2-hours in either normal or high glucose conditions. RESULTS: ucOC levels were higher in normotensive older adults compared to those with stage 2 hypertension (p < 0.05), particularly in women (p < 0.01). In all participants, higher ucOC was associated with lower PWV (p < 0.05), but not BAFMD (p > 0.05). In rabbits, ucOC at any dose did not alter vasoactivity of the carotid artery, either following a normal or an atherogenic diet (p > 0.05). CONCLUSION: Increased ucOC is associated with lower blood pressure and increased arterial stiffness, particularly in post-menopausal women. However, ucOC administration has no direct short-term effect on endothelial function in rabbit arteries. Future studies should explore whether treatment with ucOC, in vivo, has direct or indirect effects on blood vessel function.


Asunto(s)
Presión Sanguínea , Arterias Carótidas , Endotelio Vascular , Hipertensión , Osteocalcina/metabolismo , Vasodilatación , Anciano , Animales , Arterias Carótidas/metabolismo , Arterias Carótidas/patología , Arterias Carótidas/fisiopatología , Endotelio Vascular/metabolismo , Endotelio Vascular/patología , Endotelio Vascular/fisiopatología , Femenino , Humanos , Hipertensión/metabolismo , Hipertensión/patología , Hipertensión/fisiopatología , Masculino , Conejos
7.
PLoS One ; 15(11): e0242865, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33253251

RESUMEN

OBJECTIVES: The study examined the prevalence, sociodemographic, and clinical correlates of chronic pain among primary care patients in the state of Kerala, India. It also examined the patterns and relationships of chronic physical and mental health conditions with chronic pain. METHODS: This study is a cross-sectional survey conducted among 7165 adult patients selected randomly by a multi-stage stratified design from 71 primary health centers. The questionnaires administered included Chronic pain screening questionnaire, self-reported Chronic physical health condition checklist, Patient Health Questionnaire-SADS, The Alcohol Use Disorders Identification Test, Fagerström Test for Nicotine Dependence, WHO Disability Assessment Schedule and WHOQOL- BREF for Quality/Satisfaction with Life. The prevalence and comorbid patterns of chronic pain were determined. Logistic regression analysis and generalized linear mixed-effects model was employed to examine the relationship of chronic pain to socio-demographic variables and examined physical and mental health conditions. RESULTS: A total of 1831 (27%) patients reported chronic pain. Among those with chronic pain, 28.3% reported no co-occurring chronic mental or physical illness, 35.3% reported one, and 36.3% reported multi-morbidity. In the multivariate analysis, patients with chronic pain when compared to those without had higher odds of being older, female, having lower education, not living with their family, greater disability, and poor satisfaction with life. Chronic pain was independently associated with both medical (hypertension, diabetes mellitus, tuberculosis, arthritis, and other medical illnesses) and mental health conditions (depressive disorders, anxiety disorders, and tobacco dependence). It showed a varying strength of association and additive effect with increasing number of co-occurring physical and mental illnesses. CONCLUSIONS: Chronic pain is a common condition among primary care attendees associated with significant burden of medical and mental health comorbidity. The findings highlight the need to incorporate treatment models that will ensure appropriate management to improve outcomes within the resource constraints.


Asunto(s)
Trastornos de Ansiedad/fisiopatología , Dolor Crónico/fisiopatología , Comorbilidad , Diabetes Mellitus/fisiopatología , Adulto , Trastornos de Ansiedad/epidemiología , Enfermedad Crónica/epidemiología , Dolor Crónico/epidemiología , Diabetes Mellitus/epidemiología , Femenino , Humanos , Hipertensión/epidemiología , Hipertensión/fisiopatología , India/epidemiología , Masculino , Salud Mental , Persona de Mediana Edad , Cuestionario de Salud del Paciente , Atención Primaria de Salud , Autoinforme , Encuestas y Cuestionarios
8.
Artículo en Inglés | MEDLINE | ID: mdl-33142996

RESUMEN

Recreational hiking in the mountains is a common activity, whether for a single day or for several days in a row. We sought to measure blood pressure (BP) response during a 10-day trek at moderate-altitude elevation (6500-13,000 feet) and observe for uncontrolled hypertension and/or adverse cardiovascular outcomes. A total of 1279 adult participants completed an observational study of resting BP during a 10-day trek in the Sangre de Cristo mountains. Following initial recruitment, participants were issued a trail data card to record BP measurements at day 0 (basecamp), day 3, day 6 and day 9. BP was measured using a sphygmomanometer and auscultation. Demographic data, height, weight, home altitude, daily water and sports drink intake, existence of pre-arrival hypertension and BP medication class were also recorded. We observed a rise in mean blood pressure for the cohort during all exposures to moderate altitudes. The increases were greatest for individuals with pre-existing hypertension and/or obesity. There were no observed life-threatening cardiovascular events for participants. We conclude that for individuals with a modestly controlled blood pressure of 160/95 mmHg, hiking at a moderate altitude is a safe activity.


Asunto(s)
Aclimatación/fisiología , Altitud , Presión Sanguínea/fisiología , Hipertensión/fisiopatología , Montañismo/fisiología , Adulto , Anciano , Estudios de Cohortes , Femenino , Humanos , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos
9.
PLoS Biol ; 18(11): e3000885, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33170835

RESUMEN

Hypertension is the most important cause of death and disability in the elderly. In 9 out of 10 cases, the molecular cause, however, is unknown. One mechanistic hypothesis involves impaired endothelium-dependent vasodilation through reactive oxygen species (ROS) formation. Indeed, ROS forming NADPH oxidase (Nox) genes associate with hypertension, yet target validation has been negative. We re-investigate this association by molecular network analysis and identify NOX5, not present in rodents, as a sole neighbor to human vasodilatory endothelial nitric oxide (NO) signaling. In hypertensive patients, endothelial microparticles indeed contained higher levels of NOX5-but not NOX1, NOX2, or NOX4-with a bimodal distribution correlating with disease severity. Mechanistically, mice expressing human Nox5 in endothelial cells developed-upon aging-severe systolic hypertension and impaired endothelium-dependent vasodilation due to uncoupled NO synthase (NOS). We conclude that NOX5-induced uncoupling of endothelial NOS is a causal mechanism and theragnostic target of an age-related hypertension endotype. Nox5 knock-in (KI) mice represent the first mechanism-based animal model of hypertension.


Asunto(s)
Hipertensión/fisiopatología , NADPH Oxidasa 5/genética , Óxido Nítrico/metabolismo , Adulto , Factores de Edad , Anciano , Animales , Células Endoteliales , Endotelio Vascular , Femenino , Técnicas de Sustitución del Gen/métodos , Humanos , Hipertensión/genética , Hipertensión/metabolismo , Masculino , Proteínas de la Membrana/genética , Ratones , Persona de Mediana Edad , NADPH Oxidasa 5/metabolismo , NADPH Oxidasas/genética , NADPH Oxidasas/metabolismo , Óxido Nítrico/genética , Óxido Nítrico Sintasa/genética , Óxido Nítrico Sintasa/metabolismo , Óxido Nítrico Sintasa de Tipo III/genética , Óxido Nítrico Sintasa de Tipo III/metabolismo , Especies Reactivas de Oxígeno
11.
PLoS One ; 15(11): e0242666, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33227012

RESUMEN

INTRODUCTION: Cardiovascular disease (CVD) being the leading cause of the morbidity and mortality in Vietnam, the objective of this study was to estimate the total 10-year CVD risk among adults aged 40-69 years by utilizing World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction charts in Central Vietnam. MATERIALS AND METHODS: In this cross-sectional study, multi-staged sampling was used to select 938 participants from a general population aged from 40 to 69. The CVD risk factors were then collected throughout the interviews with a standardized questionnaire, anthropometric measurements and a blood test. The cardiovascular risk was calculated using the WHO/ISH risk prediction charts. RESULTS: According to the WHO/ISH charts, the proportion of moderate risk (10-20%) and high risk (>20%) among the surveyed participants were equal (5.1%). When "blood pressure of more than 160/100 mmHg" was applied, the proportion of moderate risk reduced to 2.3% while the high risk increased markedly to 12.8%. Those proportions were higher in men than in women (at 18.3% and 8.5% respectively, p-value <0.001, among the high-risk group), increasing with age. Male gender, smoking, ethnic minorities, hypertension and diabetes were associated with increased CVD risk. CONCLUSIONS: There was a high burden of CVD risk in Central Vietnam as assessed with the WHO/ISH risk prediction charts, especially in men and among the ethnic minorities. The use of WHO/ISH charts provided a feasible and affordable screening tool in estimating the cardiovascular risk in primary care settings.


Asunto(s)
Hipertensión , Adulto , Anciano , Determinación de la Presión Sanguínea , Estudios Transversales , Femenino , Humanos , Hipertensión/epidemiología , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Prevalencia , Medición de Riesgo , Vietnam/epidemiología , Organización Mundial de la Salud
12.
High Blood Press Cardiovasc Prev ; 27(6): 547-560, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33159664

RESUMEN

The vast majority of hypertensive patients are never sought for a cause of their high blood pressure, i.e. for a 'secondary' form of arterial hypertension. This under detection explains why only a tiny percentage of hypertensive patients are ultimately diagnosed with a secondary form of arterial hypertension. The prevalence of these forms is, therefore, markedly underestimated, although, they can involve as many as one-third of the cases among referred patients and up to half of those with difficult to treat hypertension. The early detection of a secondary form is crucial, because if diagnosed in a timely manner, these forms can be cured at long-term, and even when cure cannot be achieved, their diagnosis provides a better control of high blood pressure, and allows prevention of hypertension-mediated organ damage, and related cardiovascular complications. Enormous progress has been made in the understanding, diagnostic work-up, and management of secondary hypertension in the last decades. The aim of this minireview is, therefore, to provide updated concise information on the screening, diagnosis, and management of the most common forms, including primary aldosteronism, renovascular hypertension, pheochromocytoma and paraganglioma, Cushing's syndrome, and obstructive sleep apnea.


Asunto(s)
Presión Sanguínea , Hipertensión/diagnóstico , Hipertensión/terapia , Humanos , Hipertensión/etiología , Hipertensión/fisiopatología , Valor Predictivo de las Pruebas , Factores de Riesgo , Resultado del Tratamiento
13.
High Blood Press Cardiovasc Prev ; 27(6): 587-596, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33165768

RESUMEN

INTRODUCTION: Despite hypertension guidelines suggest that the most effective treatment strategy to improve blood pressure (BP) target achievement is to implement the use of combination treatment, monotherapy is still widely used in the clinical practice of hypertension. AIM: To investigate BP control under monotherapy in the setting of real-life. METHODS: We extracted data from a medical database of adult outpatients who were referred to the Hypertension Unit, Sant'Andrea Hospital, Rome (IT), including anthropometric data, CV risk factors and comorbidities, presence or absence of antihypertensive therapy and concomitant medications. Among treated hypertensive patients, we identified only those under single antihypertensive agent (monotherapy). Office BP treatment targets were defined according to 2018 ESC/ESH guidelines as: (a) < 130/80 mmHg in individuals aged 18-65 years; (b) < 140/80 mmHg in those aged > 65 years. RESULTS: From an overall sample of 7797 records we selected 1578 (20.2%) hypertensive outpatients (47.3% female, age 59.5 ± 13.6 years, BMI 26.6 ± 4.4 kg/m2) treated with monotherapies, among whom 30.5% received ACE inhibitors, 37.7% ARBs, 15.8% beta-blockers, 10.6% CCBs, 3.0% diuretics, and 2.0% alpha-blockers. 36.6% of these patients reached the conventional clinic BP goal of < 140/90 mmHg, whilst the 2018 European guidelines BP treatment targets were fulfilled only in 14.0%. In particular, 10.2% patients aged 18-65 years and 20.4% of those aged > 65 years achieved the recommended BP goals. All these proportions results significantly lower than those achieved with dual (18.2%) or triple (22.2%) combination therapy, though higher than those obtained with life-style changes (10.8%). Proportions of patients on monotherapies with normal home and 24-h BP levels were 22.0% and 30.2%, respectively, though only 5.2% and 7.3% of these patients achieved sustained BP control, respectively. Ageing and dyslipidaemia showed significant and independent positive predictive value for the achievement of the recommended BP treatment targets, whereas European SCORE resulted a negative and independent predictor in outpatients treated with monotherapies. CONCLUSIONS: Our data showed a persistent use of monotherapy in the clinical practice, though with unsatisfactory BP control, especially in light of the BP treatment targets suggested by the last hypertension guidelines.


Asunto(s)
Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Hipertensión/tratamiento farmacológico , Adolescente , Adulto , Anciano , Antihipertensivos/efectos adversos , Estudios Transversales , Bases de Datos Factuales , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Roma , Resultado del Tratamiento , Adulto Joven
15.
Med Sci (Paris) ; 36(11): 1004-1011, 2020 Nov.
Artículo en Francés | MEDLINE | ID: mdl-33151864

RESUMEN

In the first part of this review [22], "How and why circulatory phylogenesis fits into the evolution of species", we explained that the acquisition of a high-pressure arterial sector, as originally described by William Harvey in 1619, was the consequence, during evolution, of the appearance of vasomotor tone, inducing systemic friction forces (peripheral resistances), which, regulated locally (by vasodilatation), allows to adapt metabolic needs to the demand of functionally active territories. In this second part, we will try to understand how this phylogenesis directly influences the physiology, then the pathologies of the circulatory system in humans which are largely predominant, but not exclusively.


Asunto(s)
Evolución Biológica , Circulación Sanguínea/fisiología , Enfermedades Cardiovasculares/etiología , Animales , Enfermedades Cardiovasculares/patología , Enfermedades Cardiovasculares/fisiopatología , Enfermedades Hematológicas/etiología , Enfermedades Hematológicas/patología , Enfermedades Hematológicas/fisiopatología , Historia del Siglo XV , Historia del Siglo XVI , Historia del Siglo XVII , Historia del Siglo XVIII , Historia del Siglo XIX , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Hipertensión/etiología , Hipertensión/fisiopatología , Modelos Biológicos , Filogenia
16.
Clin Sci (Lond) ; 134(21): 2791-2805, 2020 11 13.
Artículo en Inglés | MEDLINE | ID: mdl-33135725

RESUMEN

Angiotensin-converting enzyme II (ACE2) is a homologue of angiotensin-converting enzyme discovered in 2000. From the initial discovery, it was recognized that the kidneys were organs very rich on ACE2. Subsequent studies demonstrated the precise localization of ACE2 within the kidney and the importance of this enzyme in the metabolism of Angiotensin II and the formation of Angiotensin 1-7. With the recognition early in 2020 of ACE2 being the main receptor of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2), the interest in this protein has dramatically increased. In this review, we will focus on kidney ACE2; its localization, its alterations in hypertension, diabetes, the effect of ACE inhibitors and angiotensin type 1 receptor blockers (ARBs) on ACE2 and the potential use of ACE2 recombinant proteins therapeutically for kidney disease. We also describe the emerging kidney manifestations of COVID-19, namely the frequent development of acute kidney injury. The possibility that binding of SARS-CoV-2 to kidney ACE2 plays a role in the kidney manifestations is also briefly discussed.


Asunto(s)
Betacoronavirus/patogenicidad , Infecciones por Coronavirus/enzimología , Enfermedades Renales/enzimología , Riñón/enzimología , Peptidil-Dipeptidasa A/metabolismo , Neumonía Viral/enzimología , Receptores Virales/metabolismo , Lesión Renal Aguda/enzimología , Lesión Renal Aguda/virología , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Animales , Antivirales/uso terapéutico , Betacoronavirus/efectos de los fármacos , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/virología , Diabetes Mellitus/enzimología , Diabetes Mellitus/fisiopatología , Historia del Siglo XXI , Interacciones Huésped-Patógeno , Humanos , Hipertensión/enzimología , Hipertensión/fisiopatología , Riñón/fisiopatología , Enfermedades Renales/tratamiento farmacológico , Enfermedades Renales/fisiopatología , Pandemias , Peptidil-Dipeptidasa A/historia , Peptidil-Dipeptidasa A/uso terapéutico , Neumonía Viral/virología , Receptores Virales/historia
17.
Elife ; 92020 11 09.
Artículo en Inglés | MEDLINE | ID: mdl-33164751

RESUMEN

Pandemic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus 19 disease (COVID-19) which presents a large spectrum of manifestations with fatal outcomes in vulnerable people over 70-years-old and with hypertension, diabetes, obesity, cardiovascular disease, COPD, and smoking status. Knowledge of the entry receptor is key to understand SARS-CoV-2 tropism, transmission and pathogenesis. Early evidence pointed to angiotensin-converting enzyme 2 (ACE2) as SARS-CoV-2 entry receptor. Here, we provide a critical summary of the current knowledge highlighting the limitations and remaining gaps that need to be addressed to fully characterize ACE2 function in SARS-CoV-2 infection and associated pathogenesis. We also discuss ACE2 expression and potential role in the context of comorbidities associated with poor COVID-19 outcomes. Finally, we discuss the potential co-receptors/attachment factors such as neuropilins, heparan sulfate and sialic acids and the putative alternative receptors, such as CD147 and GRP78.


Asunto(s)
Betacoronavirus/fisiología , Infecciones por Coronavirus/virología , Peptidil-Dipeptidasa A/fisiología , Neumonía Viral/virología , Acoplamiento Viral , Basigina/fisiología , Comorbilidad , Infecciones por Coronavirus/epidemiología , Regulación Enzimológica de la Expresión Génica , Heparitina Sulfato/fisiología , Humanos , Hipertensión/epidemiología , Hipertensión/fisiopatología , Neuropilina-1/fisiología , Oligopéptidos/fisiología , Especificidad de Órganos , Pandemias , Neumonía Viral/epidemiología , Unión Proteica , ARN Mensajero/biosíntesis , ARN Mensajero/genética , Receptores Virales , Sistema Renina-Angiotensina/fisiología , Sistema Respiratorio/enzimología , Ácidos Siálicos/fisiología , Glicoproteína de la Espiga del Coronavirus/química , Glicoproteína de la Espiga del Coronavirus/fisiología , Internalización del Virus
19.
Am J Physiol Heart Circ Physiol ; 319(6): H1387-H1397, 2020 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-33035443

RESUMEN

Perivascular adipose tissue (PVAT) depots are metabolically active and play a major vasodilator role in healthy lean individuals. In obesity, they become inflamed and eosinophil-depleted and the anticontractile function is lost with the development of diabetes and hypertension. Moreover, eosinophil-deficient ΔdblGATA-1 mice lack PVAT anticontractile function and exhibit hypertension. Here, we have investigated the effects of inducing eosinophilia on PVAT function in health and obesity. Control, obese, and ΔdblGATA-1 mice were administered intraperitoneal injections of interleukin-33 (IL-33) for 5 days. Conscious restrained blood pressure was measured, and blood was collected for glucose and plasma measurements. Wire myography was used to assess the contractility of mesenteric resistance arteries. IL-33 injections induced a hypereosinophilic phenotype. Obese animals had significant elevations in blood pressure, blood glucose, and plasma insulin, which were normalized with IL-33. Blood glucose and insulin levels were also lowered in lean treated mice. In arteries from control mice, PVAT exerted an anticontractile effect on the vessels, which was enhanced with IL-33 treatment. In obese mice, loss of PVAT anticontractile function was rescued by IL-33. Exogenous application of IL-33 to isolated arteries induced a rapidly decaying endothelium-dependent vasodilation. The therapeutic effects were not seen in IL-33-treated ΔdblGATA-1 mice, thereby confirming that the eosinophil is crucial. In conclusion, IL-33 treatment restored PVAT anticontractile function in obesity and reversed development of hypertension, hyperglycemia, and hyperinsulinemia. These data suggest that targeting eosinophil numbers in PVAT offers a novel approach to the treatment of hypertension and type 2 diabetes in obesity.NEW & NOTEWORTHY In this study, we have shown that administering IL-33 to obese mice will restore PVAT anticontractile function, and this is accompanied by normalized blood pressure, blood glucose, and plasma insulin. Moreover, the PVAT effect is enhanced in control mice given IL-33. IL-33 induced a hypereosinophilic phenotype in our mice, and the effects of IL-33 on PVAT function, blood pressure, and blood glucose are absent in eosinophil-deficient mice, suggesting that the effects of IL-33 are mediated via eosinophils.


Asunto(s)
Tejido Adiposo/efectos de los fármacos , Hipertensión/prevención & control , Interleucina-33/farmacología , Arterias Mesentéricas/efectos de los fármacos , Obesidad/tratamiento farmacológico , Vasodilatación/efectos de los fármacos , Vasodilatadores/farmacología , Tejido Adiposo/metabolismo , Tejido Adiposo/fisiopatología , Animales , Presión Arterial/efectos de los fármacos , Glucemia/efectos de los fármacos , Glucemia/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/fisiopatología , Diabetes Mellitus Tipo 2/prevención & control , Modelos Animales de Enfermedad , Eosinófilos/efectos de los fármacos , Eosinófilos/metabolismo , Factor de Transcripción GATA1/genética , Factor de Transcripción GATA1/metabolismo , Hipertensión/metabolismo , Hipertensión/fisiopatología , Hipoglucemiantes/farmacología , Masculino , Arterias Mesentéricas/metabolismo , Arterias Mesentéricas/fisiopatología , Ratones Endogámicos C57BL , Ratones Noqueados , Óxido Nítrico Sintasa de Tipo III/genética , Óxido Nítrico Sintasa de Tipo III/metabolismo , Obesidad/metabolismo , Obesidad/fisiopatología
20.
Sci Rep ; 10(1): 16116, 2020 09 30.
Artículo en Inglés | MEDLINE | ID: mdl-32999400

RESUMEN

Repeated blood pressure (BP) measurements allow better control of hypertension. Current measurements rely on cuff-based devices. The aim of the present study was to compare BP measurements using a novel cuff-less photoplethysmography-based device to a standard sphygmomanometer device. Males and females were recruited from within the general population who arrived at a public BP screening station. One to two measurements were taken from each using a sphygmomanometer-based and the photoplethysmography-based devices. Devices were considered equal if the mean difference between paired measurements was below 5 mmHg and the Standard Deviation (SD) was no greater than 8 mmHg. Agreement and reliability analyses were also performed. 1057 subjects were included in the study analysis. There were no adverse events during the study. The mean (± SD) difference between paired measurements for all subjects was -0.1 ± 3.6 mmHg for the systolic and 0.0 ± 3.5 mmHg for the diastolic readings. We found 96.31% agreement in identifying hypertension and an Interclass Correlation Coefficient of 0.99 and 0.97 for systolic and diastolic measurements, respectively. The photoplethysmography-based device was found similar to the gold-standard sphygmomanometer-based device with high agreement and reliability levels. The device might enable a reliable, more convenient method for repeated BP monitoring.


Asunto(s)
Determinación de la Presión Sanguínea/métodos , Presión Sanguínea/fisiología , Fotopletismografía/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Monitores de Presión Sanguínea , Niño , Femenino , Humanos , Hipertensión/fisiopatología , Masculino , Manometría/métodos , Persona de Mediana Edad , Oscilometría/métodos , Estudios Prospectivos , Estándares de Referencia , Reproducibilidad de los Resultados , Esfigmomanometros , Adulto Joven
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