Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 36.693
Filtrar
2.
Afr Health Sci ; 16(3): 766-771, 2016 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-27917210

RESUMEN

OBJECTIVE: The study was performed to investigate the association of interleukin 17 (IL 17) or angiotensin II (Ang II) with refractory hypertension risk in hemodialysis patients. METHODS: Ninety hemodialysis patients were enrolled into this study, and those with hypertension were divided into two groups. The Easy-to-Control Hypertension group (ECHG) had fifty patients, while the refractory hypertension group (RHG) had forty patients. Twenty healthy individuals were recruited as the control group. IL17 and Ang II were determined using a human IL 17 / Ang II enzyme-linked immunosorbent assay kit. Serum IL 17 and Ang II concentrations in RHG patients were higher than those in ECHG patients. RESULTS: Serum IL 17 and Ang II concentrations in both patient groups were higher than those in the control group. Linear regression analysis showed a positive correlation between IL 17 and Ang II. In multivariate regression analysis, we found that IL17 and Ang II were associated with refractory hypertension risk in hemodialysis patients. CONCLUSION: IL17 and Ang II were associated with refractory hypertension risk in hemodialysis patients. There was also a positive correlation between IL 17and Ang II.


Asunto(s)
Angiotensina II/sangre , Hipertensión , Interleucina-17/sangre , Fallo Renal Crónico , Diálisis Renal , Femenino , Humanos , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Medición de Riesgo
3.
S Afr Med J ; 106(12): 1188-1189, 2016 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-27917763

RESUMEN

A hypertensive patient presented with complaints of headache and fluctuating double vision and deterioration in vision from 2010. She displayed symptoms associated with convergence spasms, which could be confused with sixth cranial nerve palsies. A few pointers are given to prevent clinicians from being caught off-guard when encountering this clinical condition.


Asunto(s)
Enfermedades del Nervio Abducens/diagnóstico , Convergencia Ocular , Trastornos de la Motilidad Ocular/diagnóstico , Adulto , Diagnóstico Diferencial , Diplopía/etiología , Diplopía/fisiopatología , Femenino , Humanos , Hipertensión/complicaciones , Trastornos de la Motilidad Ocular/complicaciones , Trastornos de la Motilidad Ocular/fisiopatología , Estrés Psicológico/complicaciones
4.
Sci Rep ; 6: 38447, 2016 12 05.
Artículo en Inglés | MEDLINE | ID: mdl-27917928

RESUMEN

Hypertensive rats with chronic kidney disease (CKD) exhibit enhanced gamma-aminobutyric acid (GABA)B receptor function and regulation within the nucleus tractus solitarii (NTS). For CKD with hypertension, renal denervation (RD) interrupts the afferent renal sympathetic nerves, which are connecting to the NTS. The objective of the present study was to investigate how RD improves CKD-induced hypertension. Rats underwent 5/6 nephrectomy for 8 weeks, which induced CKD and hypertension. RD was induced by applying phenol to surround the renal artery in CKD. RD improved blood pressure (BP) by lowering sympathetic nerve activity and markedly restored the baroreflex response in CKD. The GABAB receptor expression was increased in the NTS of CKD; moreover, the central GABA levels were reduced in the cerebrospinal fluid, and the peripheral GABA levels were increased in the serum. RD restored the glutamic acid decarboxylase activity in the NTS in CKD, similar to the effect observed for central treatment with baclofen, and the systemic administration of gabapentin reduced BP. RD slightly improved renal function and cardiac load in CKD. RD may improve CKD-induced hypertension by modulating the baroreflex response, improving GABA system dysfunction and preventing the development and reducing the severity of cardiorenal syndrome type 4 in CKD rats.


Asunto(s)
Barorreflejo/fisiología , Hipertensión Renal/terapia , Hipertensión/terapia , Riñón/inervación , Nefritis/terapia , Insuficiencia Renal Crónica/terapia , Animales , Barorreflejo/efectos de los fármacos , Presión Sanguínea/efectos de los fármacos , Desnervación/métodos , Humanos , Hipertensión/complicaciones , Hipertensión/metabolismo , Hipertensión/fisiopatología , Hipertensión Renal/metabolismo , Hipertensión Renal/fisiopatología , Riñón/efectos de los fármacos , Riñón/fisiopatología , Nefrectomía/efectos adversos , Nefritis/metabolismo , Nefritis/fisiopatología , Neuronas Aferentes/efectos de los fármacos , Fenol/efectos adversos , Ratas , Receptores de GABA-B/metabolismo , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/metabolismo , Insuficiencia Renal Crónica/fisiopatología , Núcleo Solitario/metabolismo , Núcleo Solitario/fisiopatología
5.
Int J Mol Sci ; 17(12)2016 Dec 02.
Artículo en Inglés | MEDLINE | ID: mdl-27918455

RESUMEN

Adult-onset diseases, including hypertension, can originate from early life, known as the developmental origins of health and disease (DOHaD). Because the developing kidney is vulnerable to early-life insults, renal programming is considered key in the developmental programming of hypertension. Asymmetric dimethylarginine (ADMA), an endogenous nitric oxide (NO) synthase inhibitor, can regulate the NO-reactive oxygen species (ROS) balance, and is involved in the development of hypertension. Reprogramming interventions aimed at NO-ROS balance can be protective in both genetic and developmentally programmed hypertension. Here we review several emergent themes of the DOHaD approach regarding the impact of ADMA-related NO-ROS imbalance on programmed hypertension. We focus on the kidney in the following areas: mechanistic insights to interpret programmed hypertension; the impact of ADMA-related NO-ROS imbalance in both genetic and acquired animal models of hypertension; alterations of the renal transcriptome in response to ADMA in the developing kidney; and reprogramming strategies targeting ADMA-related NO-ROS balance to prevent programmed hypertension.


Asunto(s)
Arginina/análogos & derivados , Hipertensión/metabolismo , Óxido Nítrico/metabolismo , Especies Reactivas de Oxígeno/metabolismo , Animales , Arginina/metabolismo , Humanos , Riñón/metabolismo
6.
Artículo en Inglés | MEDLINE | ID: mdl-27918461

RESUMEN

In China, the prevalence of hypertension is increasing and is showing an epidemic accelerating trend. However, there is a lack of studies reporting the hypertension status of rural residents with minimum living allowances. We performed a cross-sectional study including 11,435 (5285 men and 6150 women) from the general population aged ≥35 years in the Liaoning Province of China from 2012 to 2013, of which 1258 (11.0%) participants came from minimal assurance families. Anthropometric measurements, laboratory examinations and self-reported lifestyle factor information were collected by trained personnel. Multivariate logistic regression was used to detect the association between socioeconomic status (SES) and the risk of hypertension. We found that the prevalence of hypertension was as high as 61.9% in participants from minimal assurance families and the odd ratio for hypertension was 1.32 (95% CI: 1.15-1.52). The awareness, treatment, and control rates among treated hypertensive participants did not increase with higher level of income and education. In the total sample, the lower income levels increased the risk for hypertension, but education didn't show a significant association with hypertension. Thus, there is a severe hypertension situation in the Liaoning rural population of minimal assurance families, which need more attention and prevention and control measures for hypertension.


Asunto(s)
Hipertensión/epidemiología , Salud Rural/estadística & datos numéricos , Clase Social , Adulto , Anciano , Anciano de 80 o más Años , China/epidemiología , Estudios Transversales , Femenino , Humanos , Hipertensión/etiología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Prevalencia , Factores de Riesgo , Autoinforme
7.
J Clin Lipidol ; 10(6): 1338-1343, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27919350

RESUMEN

BACKGROUND: Patients with severe familial hypercholesterolemia (FH) are often unrecognized despite typical presentation. The introduction of PCSK9 inhibitors opens new therapeutic options and emphasizes the need for identification of severe FH patients. OBJECTIVES: The objective was identification, characterization, and management of severe FH patients by screening of cardiac catheterization (CC) database. METHODS: Retrospective analysis of CC database from 2002 to mid-2015 was performed for low-density lipoprotein cholesterol (LDL-C) ≥130 mg/dL (n = 2383). Severe FH was diagnosed if any prior LDL-C was ≥280 mg/dL, excluding secondary causes. Peak/current LDL-C levels and lipid-lowering therapies were evaluated. Initial attempt was made to detect relatives with FH according to identifying data and age-dependent LDL-C cutoffs. RESULTS: Severe FH was identified in 54 of initial 2382 patients with CC LDL-C ≥130 mg/dL. Mean age at cardiovascular disease diagnosis was 45 years. Peak LDL-C was 280 to 464 mg/dL (median, 322). Coronary artery bypass graft surgery was performed in 26 patients (48%) and redo coronary artery bypass graft surgery in 5 patients (9%). Risk factors included obesity (33%), hypertension (59%), smoking (33%), and diabetes (24%). LDL-C reduction ≥50% of peak value was achieved in 56%, LDL-C <130 mg/dL in 32%, and LDL-C <100 mg/dL in 17% of patients. High-intensity statin plus ezetimibe was prescribed for 67%, high-intensity statin alone for 24%, and other lipid-lowering therapies for 9% of patients. Treatment intensity was directly associated with attainment of LDL-C goals. Matching probands' surnames and place of residency with district health maintenance organization database has identified 161 additional individuals with possible FH; 58% were not treated with lipid-lowering drugs. CONCLUSIONS: A simple algorithm for identification of patients with severe FH was implemented based on large catheterization and health maintenance organization databases and revealed patients with severe FH and coronary disease at a young age, with low attainment of cholesterol treatment goals. Screening existing cardiovascular databases of populations at risk will promote identification and management of severe FH patients and their affected family members.


Asunto(s)
Cateterismo Cardíaco , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/diagnóstico , Hiperlipoproteinemia Tipo II/complicaciones , Hiperlipoproteinemia Tipo II/patología , Adulto , Anciano , Anticolesterolemiantes/uso terapéutico , LDL-Colesterol/sangre , Puente de Arteria Coronaria , Enfermedad Coronaria/cirugía , Quimioterapia Combinada , Ezetimiba/uso terapéutico , Femenino , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Hiperlipoproteinemia Tipo II/tratamiento farmacológico , Hipertensión/complicaciones , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad
8.
Medicina (Kaunas) ; 52(6): 378-388, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27932197

RESUMEN

Aortic dissection is a life-threatening rare condition that may virtually present by any organ system dysfunction, the nervous system included. Acute cerebral infarction among multiple other neurological and non-neurological presentations is part of this acute aortic syndrome. Rapid and correct diagnosis is of extreme importance keeping in mind the possibility of thrombolytic treatment if a patient with a suspected ischemic stroke arrives to the Emergency Department within a 4.5-h window after symptom onset. Systemic intravenous thrombolysis in the case of an acute brain infarction due to aortic dissection may lead to fatal outcomes. In this neurological emergency it is important to rule out underlying aortic dissection by choosing appropriately quick and accurate diagnostic tool. We aimed to present a prospective follow-up case, where carotid ultrasound examination was the primary key method that led to a correct diagnosis in hyperacute (<24h) Stanford type A aortic dissection presenting as an acute ischemic stroke, and thereafter with a repeated contrast-enhanced computed tomography and transthoracic echocardiography, helped to monitor topography of intravascular processes and hemodynamic properties during the clinical course of a disease, which influenced treatment decisions. Thus, we reviewed the literature mainly focusing on the various neurological aspects associated with aortic dissection.


Asunto(s)
Aneurisma Disecante/complicaciones , Aneurisma Disecante/diagnóstico , Arterias Carótidas/diagnóstico por imagen , Infarto Cerebral/diagnóstico , Infarto Cerebral/etiología , Aneurisma Disecante/tratamiento farmacológico , Infarto Cerebral/tratamiento farmacológico , Progresión de la Enfermedad , Ecocardiografía , Hemiplejía/diagnóstico , Hemiplejía/etiología , Hemodinámica/fisiología , Humanos , Hipertensión/etiología , Imagenología Tridimensional , Masculino , Trombolisis Mecánica , Persona de Mediana Edad , Estudios Prospectivos , Factores de Tiempo , Tomografía Computarizada por Rayos X , Ultrasonografía Doppler
9.
Indian J Med Res ; 144(2): 281-287, 2016 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-27934810

RESUMEN

BACKGROUND & OBJECTIVES: Dilated cardiomyopathy (DCM) is a progressive disease of heart with systolic and diastolic dysfunction carrying a poor long-term prognosis. The prognostic index and predictors of mortality are considered to be useful in guiding the treatment. This study was undertaken to evaluate the effects of hypertension at presentation on prognosis in patients with DCM presenting with normal renal and coronary angiogram. METHODS: An observational, analytical, non-interventional and a combination of retrospective and prospective study was conducted in patients between 15 and 75 yr of age with DCM having on and off symptoms while receiving treatment in a cardiology outpatient department for more than a year. Sixty patients who fulfilled the inclusion criteria were enrolled in the study. Left ventricular systolic and diastolic functions were assessed by echocardiography along with New York Heart Association (NYHA) functional class prospectively and at baseline retrospectively. Patients were grouped into two categories: DCM with hypertension at presentation (HTNAP, Category 1) and DCM without hypertension at presentation (NHTNAP, Category 2). The primary end-points were the number and dose of parenteral drugs at hospitalization, duration of hospital stay and change in the left ventricular (LV) systolic function expressed as LV ejection fraction, and the secondary end-points included overall mortality, change in LV and right ventricular systolic and diastolic functions and change in the NYHA functional class between baseline and three month follow up in patients. RESULTS: Thirty five and 25 patients presented with HTNAP and NHTNAP, respectively (total 60). The overall mortality was 10 per cent (6/60). The number of hospitalizations was less in HTNAP category and of days of hospital stay was 6.3 in HTNAP and 9.8 in NHTNAP, the difference being significant (P < 0.001). The HTNAP category required less parenteral diuretics and inotropes compared with the NHTNAP category. The echocardiographic parameters showed better improvements in the HTNAP group as compared to the NHTNAP group. Overall, the patients in the <35 yr of age showed the best prognosis (P < 0.001). INTERPRETATION & CONCLUSIONS: Normal or high blood pressure response at acute presentation of DCM leads to better prognosis which may be due to an intact renovascular and an active sympathetic system and can depict the stage of DCM.


Asunto(s)
Cardiomiopatía Dilatada/fisiopatología , Hipertensión/fisiopatología , Riñón/fisiopatología , Pronóstico , Adolescente , Adulto , Anciano , Angiografía , Cardiomiopatía Dilatada/complicaciones , Cardiomiopatía Dilatada/diagnóstico por imagen , Cardiomiopatía Dilatada/tratamiento farmacológico , Cardiotónicos/administración & dosificación , Angiografía Coronaria , Diuréticos/administración & dosificación , Ecoencefalografía , Femenino , Humanos , Hipertensión/complicaciones , Hipertensión/diagnóstico por imagen , Hipertensión/tratamiento farmacológico , Riñón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Función Ventricular Izquierda/efectos de los fármacos , Función Ventricular Izquierda/fisiología
10.
Clin Exp Hypertens ; 38(8): 659-665, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27935319

RESUMEN

BACKGROUND: Aldosterone synthase (CYP11B2) is a key enzyme involved in the terminal steps of aldosterone biosynthesis. Genetic variability in CYP11B2 gene has been associated with heterogeneous aldosterone production, which can affect sodium homeostasis and thereby regulation of blood pressure. Hence, the present study was aimed to explore the single-locus variations, haplotype and epistasis patterns of CYP11B2 (C-344T, intron-2 gene conversion and Lys173Arg) gene polymorphisms, and the risk contributed by them to the development of essential hypertension (EHT). METHODS: A total of 279 hypertensive patients and 200 normotensive controls were enrolled in this study. C-344T and Lys173Arg polymorphisms of CYP11B2 gene were genotyped by PCR-RFLP method and intron-2 gene conversion (IC) polymorphism by allele-specific PCR analysis. RESULTS: Single-locus analysis revealed significant association of CYP11B2 C-344T and Lys173Arg polymorphisms with EHT (p < 0.05). Considering the sexes, Lys173 allele was found to be at risk for hypertension in males (OR 1.40; 95% CI = 1.01-1.96). Unphased haplotype analysis revealed H1 (T-Conv-Lys; p = 0.0017) to have significant risk for EHT, while haplotype H4 (T-Wt-Arg) had a significant protective effect. Multifactor dimensionality reduction (MDR) interaction analysis found the overall best model with C-344T and IC polymorphisms exhibiting strong synergistic effect. CONCLUSION: The present study revealed a strong synergistic effect of CYP11B2 C-344T and IC polymorphisms causing susceptibility to EHT and haplotype H1 (-344T-Conv-Lys173) as the risk-conferring factor for hypertension predisposition.


Asunto(s)
Aldosterona/sangre , Presión Sanguínea/fisiología , Citocromo P-450 CYP11B2/genética , ADN/genética , Predisposición Genética a la Enfermedad/genética , Hipertensión/genética , Polimorfismo Genético , Alelos , Citocromo P-450 CYP11B2/metabolismo , Hipertensión Esencial , Femenino , Genotipo , Haplotipos , Humanos , Hipertensión/epidemiología , Hipertensión/metabolismo , Incidencia , India/epidemiología , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Factores de Riesgo
12.
Am J Clin Nutr ; 104(6): 1703-1711, 2016 12.
Artículo en Inglés | MEDLINE | ID: mdl-27935524

RESUMEN

BACKGROUND: Renal transplant recipients (RTRs) have commonly been urged to limit their potassium intake during renal insufficiency and may adhere to this principle after transplantation. Importantly, in experimental animal models, low dietary potassium intake induces kidney injury through stimulation of ammoniagenesis. In humans, low potassium intake is an established risk factor for high blood pressure. OBJECTIVE: We hypothesized that low 24-h urinary potassium excretion [UKV; urinary potassium concentration × volume], the gold standard for assessment of dietary potassium intake, represents a risk factor for graft failure and mortality in RTRs. In secondary analyses, we aimed to investigate whether these associations could be explained by ammoniagenesis, plasma potassium, or blood pressure. DESIGN: In a prospective cohort of 705 RTRs, we assessed dietary potassium intake by a single 24-h UKV and food-frequency questionnaires. Cox regression analyses were used to investigate prospective associations with outcome. RESULTS: We included 705 stable RTRs (mean ± SD age: 53 ± 13 y; 57% men) at 5.4 y (IQR: 1.9-12.0 y) after transplantation and 253 kidney donors. Mean ± SD UKV was 73 ± 24 mmol/24 h in RTRs compared with 85 ± 25 mmol/24 h in kidney donors. During follow-up for 3.1 y (IQR: 2.7-3.9 y), 45 RTRs developed graft failure and 83 died. RTRs in the lowest sex-specific tertile of UKV (women, <55 mmol/24 h; men, <65 mmol/24 h) had an increased risk of graft failure (HR: 3.70; 95% CI: 1.64, 8.34) and risk of mortality (HR; 2.66; 95% CI: 1.53, 4.61), independent of potential confounders. In causal path analyses, 24-h urinary ammonia excretion, plasma potassium, and blood pressure did not affect these associations. CONCLUSIONS: Our results indicate that low UKV is associated with a higher risk of graft failure and mortality in RTRs. Specific attention for adequate potassium intake after transplantation seems warranted. This trial was registered at clinicaltrials.gov as NCT02811835.


Asunto(s)
Rechazo de Injerto/mortalidad , Trasplante de Riñón/mortalidad , Potasio en la Dieta/orina , Adulto , Anciano , Amoníaco/orina , Femenino , Estudios de Seguimiento , Supervivencia de Injerto , Humanos , Hipertensión/sangre , Hipertensión/etiología , Riñón , Fallo Renal Crónico/cirugía , Masculino , Persona de Mediana Edad , Potasio en la Dieta/administración & dosificación , Potasio en la Dieta/efectos adversos , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Factores de Riesgo , Encuestas y Cuestionarios
13.
Chin Med J (Engl) ; 129(24): 2907-2912, 2016 12 20.
Artículo en Inglés | MEDLINE | ID: mdl-27958221

RESUMEN

BACKGROUND: Antihypertensive drugs have been linked to new-onset osteoporotic fracture (NOF), and different classes of antihypertensive drugs may alter the risk for the development of NOF; however, the classic effect of different antihypertensive drugs on the development of NOF in the elderly has not been well studied during long-term follow-up. METHODS: In this study, we investigated the association between different classic antihypertensives and the development of NOF in the elderly. This was a longitudinal cohort study performed using data from claim forms submitted to the Taiwan Bureau of National Health Insurance in Central Taiwan, China including case patients with NOF aged 65-80 years from January 2002 to December 2012 and non-NOF controls. Prescriptions for antihypertensives before the index date were retrieved from a prescription database. We estimated the hazard ratios (HR s) of NOF associated with antihypertensive use. Non-NOF controls served as the reference group. RESULTS: A total of 128 patients with NOF were identified from among 1144 patients with hypertension during the study period. The risk of NOF after adjusting age, sex, comorbidities, and concurrent medications was higher among the users of angiotensin-converting enzyme (ACE) inhibitors (HR, 1.64; 95% confidence interval [CI], 1.01-2.66) than among nonusers. Patients who took calcium channel blockers (CCBs) (HR, 0.70; 95% CI, 0.49-0.99) were at a lower risk of developing NOF than nonusers. Loop diuretics, thiazide diuretics, angiotensin receptor blocker, beta-blocker, and alpha-blocker were not associated with the risk of NOF. CONCLUSIONS: Elderly with hypertension who take CCBs are at a lower risk of NOF and that the use of ACE inhibitors was associated with a significantly increased risk of developing NOF during the 11-year follow-up.


Asunto(s)
Antihipertensivos/efectos adversos , Fracturas Osteoporóticas/inducido químicamente , Anciano , Anciano de 80 o más Años , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Bloqueadores de los Canales de Calcio/efectos adversos , Bloqueadores de los Canales de Calcio/uso terapéutico , Estudios de Cohortes , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Estudios Longitudinales , Masculino , Fracturas Osteoporóticas/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Taiwán/epidemiología
14.
Physiol Res ; 65(6): 1039-1044, 2016 12 13.
Artículo en Inglés | MEDLINE | ID: mdl-27959576

RESUMEN

The spontaneously hypertensive rat (SHR) is the most widely used animal model of essential hypertension and left ventricular hypertrophy. Catecholamines play an important role in the pathogenesis of both essential hypertension in humans and in the SHR. Recently, we obtained evidence that the SHR harbors a variant in the gene for dopamine beta hydroxylase (Dbh) that is associated with reduced adrenal expression of Dbh mRNA and reduced DBH enzymatic activity which correlated negatively with blood pressure. In the current study, we used a transgenic experiment to test the hypothesis that reduced Dbh expression predisposes the SHR to hypertension and that augmentation of Dbh expression would reduce blood pressure. We derived 2 new transgenic SHR-Dbh lines expressing Dbh cDNA under control of the Brown Norway (BN) wild type promoter. We found modestly increased adrenal expression of Dbh in transgenic rats versus SHR non-transgenic controls that was associated with reduced adrenal levels of dopamine and increased plasma levels of norepinephrine and epinephrine. The observed changes in catecholamine metabolism were associated with increased blood pressure and left ventricular mass in both transgenic lines. We did not observe any consistent changes in brainstem levels of catecholamines or of mRNA levels of Dbh in the transgenic strains. Contrary to our initial expections, these findings are consistent with the possibility that genetically determined decreases in adrenal expression and activity of DBH do not represent primary determinants of increased blood pressure in the SHR model.


Asunto(s)
Presión Sanguínea/genética , Dopamina beta-Hidroxilasa/biosíntesis , Dopamina beta-Hidroxilasa/genética , Hipertensión/genética , Hipertensión/fisiopatología , Glándulas Suprarrenales/enzimología , Animales , Animales Modificados Genéticamente , Tronco Encefálico/metabolismo , ADN Complementario/biosíntesis , ADN Complementario/genética , Dopamina/metabolismo , Epinefrina/metabolismo , Regulación Enzimológica de la Expresión Génica/genética , Norepinefrina/metabolismo , Ratas , Ratas Endogámicas BN , Ratas Endogámicas SHR , Transgenes
17.
Curr Hypertens Rev ; 12(3): 196-202, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27964699

RESUMEN

Atrial fibrillation (AF) is one of the commonest arrhythmias in clinical practice and has major healthcare and economic implications. It is a growing epidemic with prevalence all set to double to 12 million by 2050. After adjusting for other associated conditions, hypertension confers a 1.5- and 1.4-fold risk of developing AF, for men and women respectively. Furthermore, in patients with AF, the presence of hypertension has a cumulative effect on the risk of stroke. Growing evidence suggests reversal or attenuation of various structural and functional changes predisposing to AF with the use of antihypertensive medications. Randomized trials have shown major reduction in the risk of stroke and heart failure with blood pressure reduction. However, such trials are lacking in AF patients specifically. The Joint National Committee-8 guidelines have not addressed the threshold or goal BP for patients with known AF. Furthermore, "J-shaped" or "U-shaped" curves have been noted during hypertension management in patients with AF with published data demonstrating worse outcomes in patients with strict BP control to <110/60 mmhg similar to coronary artery disease. In this review, we outline the available literature on management of hypertension in patients with AF as well as the role of individual anti-hypertensive medications in reducing the incidence of AF Fig. 1.


Asunto(s)
Antihipertensivos/uso terapéutico , Fibrilación Atrial/prevención & control , Hipertensión/tratamiento farmacológico , Fibrilación Atrial/etiología , Femenino , Humanos , Hipertensión/complicaciones , Masculino , Riesgo , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control , Resultado del Tratamiento
18.
Br J Nutr ; 116(11): 1889-1900, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-27964766

RESUMEN

The lower threshold plasma 25-hydroxy vitamin D (25(OH)D) level for optimal cardiovascular health is unclear, whereas the toxicity threshold is less clear. The aim of this study was to examine the cardiovascular-vitamin D dose-response curve in a normal rat model. Doses of cholecalciferol ranged from deficiency to toxic levels (equivalent to human doses of 0, 0·015, 0·25 and 3·75mg/d) for 4 weeks, and then cardiovascular health was examined using blood pressure telemetry and high-resolution ultrasound in normal male rats (n 16/group, 64 rats total). After 1 month, only the 0·25mg/d group had plasma 25(OH)D that was within current recommended range (100-125 nmol/l), and all groups failed to change plasma Ca or phosphate. Systolic blood pressure increased significantly (10-15 mmHg) in the rat groups with plasma 25(OH)D levels at both 30 and 561 nmol/l (groups fed 0 and 3·75mg/d) compared with the group fed the equivalent to 0·015mg/d (43 nmol/l 25(OH)D). Although not significant, the group fed the equivalent to 0·25mg/d (108 nmol/l 25(OH)D) also showed a 10 mmHg increase in systolic blood pressure. Carotid artery diameter was significantly smaller and wall thickness was larger, leading to higher peak carotid systolic blood velocity in these two groups. Despite these vascular changes, cardiac function did not differ among treatment groups. The key finding in this study is that arterial stiffness and systolic blood pressure both showed a U-shaped dose-response for vitamin D, with lowest values (best cardiovascular health) observed when plasma 25(OH)D levels were 43 nmol/l in normal male rats.


Asunto(s)
Calcifediol/sangre , Colecalciferol/envenenamiento , Modelos Animales de Enfermedad , Hipertensión/etiología , Deficiencia de Vitamina D/fisiopatología , Animales , Presión Sanguínea , Calcio/sangre , Gasto Cardíaco , Arterias Carótidas/diagnóstico por imagen , Arterias Carótidas/fisiopatología , Colecalciferol/administración & dosificación , Colecalciferol/uso terapéutico , Dieta Vegetariana/efectos adversos , Ecocardiografía , Corazón/diagnóstico por imagen , Corazón/fisiopatología , Hipertensión/sangre , Hipertensión/diagnóstico por imagen , Hipertensión/fisiopatología , Masculino , Fosfatos/sangre , Ratas Wistar , Volumen Sistólico , Factores de Tiempo , Ultrasonografía Doppler , Rigidez Vascular , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/prevención & control
19.
J Am Heart Assoc ; 5(12)2016 12 13.
Artículo en Inglés | MEDLINE | ID: mdl-27965209

RESUMEN

BACKGROUND: Prehypertension is associated with higher cardiovascular risk, target organ damage, and incidence of hypertension. The Prevention of Hypertension in Patients with PreHypertension (PREVER-Prevention) trial aimed to evaluate the efficacy and safety of a low-dose diuretic for the prevention of hypertension and end-organ damage. METHODS AND RESULTS: This randomized, parallel, double-blind, placebo-controlled trial was conducted in 21 Brazilian academic medical centers. Participants with prehypertension who were aged 30 to 70 years and who did not reach optimal blood pressure after 3 months of lifestyle intervention were randomized to a chlorthalidone/amiloride combination pill or placebo and were evaluated every 3 months during 18 months of treatment. The primary outcome was incidence of hypertension. Development or worsening of microalbuminuria, new-onset diabetes mellitus, and reduction of left ventricular mass were secondary outcomes. Participant characteristics were evenly distributed by trial arms. The incidence of hypertension was significantly lower in 372 study participants allocated to diuretics compared with 358 allocated to placebo (hazard ratio 0.56, 95% CI 0.38-0.82), resulting in a cumulative incidence of 11.7% in the diuretic arm versus 19.5% in the placebo arm (P=0.004). Adverse events; levels of blood glucose, glycosylated hemoglobin, creatinine, and microalbuminuria; and incidence of diabetes mellitus were no different between the 2 arms. Left ventricular mass assessed through Sokolow-Lyon voltage and voltage-duration product decreased to a greater extent in participants allocated to diuretic therapy compared with placebo (P=0.02). CONCLUSIONS: A combination of low-dose chlorthalidone and amiloride effectively reduces the risk of incident hypertension and beneficially affects left ventricular mass in patients with prehypertension. CLINICAL TRIAL REGISTRATION: URL: http://www.ClinicalTrials.gov, www.ensaiosclinicos.gov. Unique identifiers: NCT00970931, RBR-74rr6s.


Asunto(s)
Amilorida/administración & dosificación , Antihipertensivos/administración & dosificación , Clortalidona/administración & dosificación , Diuréticos/administración & dosificación , Hipertensión/prevención & control , Adulto , Anciano , Presión Sanguínea/efectos de los fármacos , Método Doble Ciego , Combinación de Medicamentos , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/fisiopatología , Hipertrofia Ventricular Izquierda/fisiopatología , Hipertrofia Ventricular Izquierda/prevención & control , Masculino , Persona de Mediana Edad , Resultado del Tratamiento
20.
Am J Crit Care ; 26(1): 62-69, 2016 12.
Artículo en Inglés | MEDLINE | ID: mdl-27965231

RESUMEN

BACKGROUND: Factors that precipitate hospitalization for exacerbation of heart failure provide targets for intervention to prevent hospitalizations. OBJECTIVES: To describe demographic, clinical, behavioral, and psychosocial factors that precipitate admission for exacerbation of heart failure and assess the relationships between precipitating factors and delay before hospitalization, and between delay time and length of hospital stay. METHODS: All admissions in 12 full months to a tertiary medical center were reviewed if the patient had a discharge code related to heart failure. Data on confirmed admissions for exacerbation of heart failure were included in the study. Electronic and paper medical records were reviewed to identify how long it took patients to seek care after they became aware of signs and symptoms, factors that precipitated exacerbation, and discharge details. RESULTS: Exacerbation of heart failure was confirmed in 482 patients. Dyspnea was the most common symptom (92.5% of patients), and 20.3% of patients waited until they were severely dyspneic before seeking treatment. The most common precipitating factor was poor medication adherence. Delay times from symptom awareness to seeking treatment were shorter in patients who had a recent change in medicine for heart failure, renal failure, or poor medication adherence and longer in patients with depressive symptoms and hypertension. CONCLUSIONS: Depressive symptoms, recent change in heart failure medicine, renal failure, poor medication adherence, and hypertension are risk factors for hospitalizations for exacerbation of heart failure.


Asunto(s)
Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/fisiopatología , Hospitalización/estadística & datos numéricos , Tiempo de Tratamiento/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Depresión/epidemiología , Disnea/epidemiología , Femenino , Conductas Relacionadas con la Salud , Humanos , Hipertensión/epidemiología , Tiempo de Internación/estadística & datos numéricos , Masculino , Cumplimiento de la Medicación , Persona de Mediana Edad , Insuficiencia Renal/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Factores Socioeconómicos
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...