Influence of periodontitis on abdominal aortic aneurysms

Periodontitis is known to be a risk factor for abdominal aortic aneurysm (AAA). However, the influence of periodontitis on AAA development is to be elucidated. This article is to review the relationship between periodontitis and AAA. We focused on the roles of specific periodontopathic bacteria in AAA, matrix metalloproteinases and toll-like receptors in the pathophysiology in the section of experimental analysis. Furthermore, we showed clinical data of periodontitis in patients with AAA. We concluded that periodontal pathogens play a critical role in the AAA development.

Blood pressure variability and cerebrovascular disease

Variability is an aspect of blood pressure (BP) relatively unknown and poorly evaluated systematically in clinical practice. Although the introduction of intensive BP measurement methods, such as ambulatory blood pressure monitoring provided evidence of the importance of BP variability in the short-term, more recently, however, emphasis has been placed on the relevance of variability of BP in the medium- and long-term. The adverse cardiovascular consequences of high BP not only depend on absolute BP values, but also on BP variability. Independently of mean BP levels, BP variations in the short- and long-term are associated an increased risk of cardiovascular events and mortality. Also, it has been suggested that modulation of such variability may explain the different level protection exerted by different antihypertensive-drug classes.

Dashing away hypertension: Evaluating the efficacy of the dietary approaches to stop hypertension diet in controlling high blood pressure

The dietary approaches to stop hypertension (DASH) diet has been developed and popularized as a non-pharmaceutical intervention for high blood pressure reduction since 1995. However, to date, a comprehensive description of the biochemical rationale behind the diet’s principal guidelines has yet to be compiled. With rising interest for healthy and reliable life-style modifications to combat cardiovascular disease, this review aims to compile the most recent and relevant studies on this topic and make an informed assessment as to the efficacy of and underlying mechanisms operant in the DASH diet. Specifically, the merits of lowering dietary intake of sodium and saturated fat, as well as increasing the intake of fruits, vegetables, fiber, and dairy, have been shown to attenuate hypertension individually. Upon review of this evidence, we conclude that the combination of dietary patterns proposed in the DASH diet is effective in attenuating high blood pressure. We also suggest that efforts to more widely implement adoption of the DASH diet would be beneficial to public health.

Contribution of miRNAs to ion-channel remodelling in atrial fibrillation

Atrial fibrillation (AF) is the most commonly encountered clinical arrhythmia associated with pronounced mortality and morbidity, which are related to palpitations, fainting, congestive heart failure, and stroke. Prolonged episodes of AF promote AF persistence mainly due to electrical remodelling that alters ion-channel expression and/or function. MicroRNAs (miRNAs), a new class of non-coding mRNAs of around 22 nucleotides in length, have recently emerged as one of the key players in the gene-expression regulatory networks. The potential roles of miRNAs in controlling AF have recently been investigated. Several recent studies have provided promising results for a better understanding of the molecular mechanisms of AF. In this review, we summarize the mechanism of miRNAs as regulators of ion-channel gene expression and their role in causing AF through electrical remodelling.

Nice new hypertension guidelines

The National Institute for Clinical Excellence in the United Kingdom published a new set of guidelines on the management of primary hypertension in August 2011, reflecting some important changes in the diagnosis and treatment of hypertension. Ambulatory blood pressure measurement is now the new gold standard for diagnosis. Home blood pressure monitoring is a useful alternative for the diagnosis and monitoring of hypertension. Calcium channel blockers (CCB) and blockers of the renin-angiotensin system have surpassed diuretics and β-blockers as first line options. Patients younger than 55 should receive an angiotensin-converting enzyme inhibitor, or an angiotensin receptor blocker if the former is not tolerated. Older patients should be started on a CCB. A thiazide diuretic can be added to these two groups for better blood pressure control, but. chorthalidone and indapamide are the preferred diuretics as they showed favorable outcomes in large clinical trials. Treatment with these three drug classes should be sufficient in the majority of patients, but if triple therapy is still insufficient, referral to a hypertension specialist is recommended. Additional diuretic therapy, spironolactone, or an α or β blocker can be used as the fourth line treatment.

A survey of recent reports on ambulatory blood pressure monitoring

This article is a review of 25 publications on ambulatory blood pressure monitoring (ABPM) and the importance of its results in everyday clinical practice. These studies, published in 2008-2011, were selected from the Scopus database, but are also available in Pubmed. They were prepared by researchers from around the world, concerned with the problems of proper control of blood pressure (BP), and of abnormalities in the circadian pattern of BP in patients with arterial hypertension, diabetes mellitus or renal failure. In the first part of this article, I analyse publications focused on some nuances in the methodology of ABPM and recommend ways to avoid some traps, related not only to the individual patient but also to the device used and the technical staff. The next section is devoted to the advantages of ABPM as a diagnostic tool which enables clinicians to learn about patients’ BP during sleep, and emphasizes the practical implications of this information for so-called chronotherapy. This section also presents some new studies on the prognostic value of ABPM in patients with cardiovascular (CV) risk. Some recent articles on the results of various methods of pharmacological treatment of arterial hypertension in different age groups are then described. The observations presented in this article may be helpful not only for researchers interested in the chronobiology of the CV system, but also for general practitioners using ABPM.

Epidemiology of elevated blood pressure in youth and its utility for predicting adulthood outcomes: A review

Elevated blood pressure has been demonstrated to track from youth to adulthood and some have demonstrated an association between early-life blood pressure and subsequent atherosclerosis and cardiovascular disease. In addition, reports regarding the strength of tracking are inconsistent and the modifiable risk factors that affect the trajectory of blood pressure from youth to adulthood remain unclear. This paper comprehensively evaluated the existing classifications of youth hypertension and the current trends of youth hypertension. Further, evidence for the consequences of hypertension in youth has been comprehensively evaluated. Importantly, a review of the studies examining tracking from youth to adulthood has been performed and a number of studies investigating the factors affecting tracking has also been investigated. The overall consideration of this body of literature highlights the vital importance of identifying hypertension in youth to prevent complications in adulthood. Adiposity is regarded to be a factor affecting the progression of hypertension from youth to adulthood yet there is little evidence available for other modifiable factors. It is apparent that further research is necessary within this field in order to create effective preventative strategies to target youth hypertension.

Kidney in primary aldosteronism: A key determinant of treatment outcome

Recently, it has been suggested that primary aldosteronism (PA) is associated with a variety of cardiac, vascular, metabolic, and renal sequelae that reflect the capability of elevated aldosterone to induce organ damage beyond that induced by hypertension itself. The evidence supporting of these views has been obtained from experiments conducted in rodents and clinical studies conducted in patients with this endocrine disorder. It has been suggested that untoward effects of high-salt intake are dependent on activation of mineralocorticoid receptors that might result from increased oxidative stress and changes in the intracellular redox potential. Unilateral adrenalectomy or treatment with mineralocorticoid receptor antagonists are the current options for treating an aldosterone-producing adrenal adenoma or idiopathic adrenal hyperplasia. Treatments are largely effective in correcting hypertension and hypokalemia, and currently available information on their capability to prevent deterioration of renal function indicates that surgery and medical treatment are equally beneficial in the long term. This editorial review will focus on the renal aspects of PA and highlights the role of the kidney as a key determinant of both adaptation to aldosterone-induced volume retention and response of blood pressure to treatment.

Blood pressure goals: A moving target

Clinical guidelines on hypertension have evolved over the past several decades. Each recommends varying blood pressure (BP) cut-offs which define hypertension, determine the thresholds to initiate pharmacotherapy, and guide treatment targets. In addition, different techniques of measuring BP in clinical trials may further contribute to the discrepancies in the achieved BP targets. Physicians find it difficult to navigate through different recommendations for hypertension management based on studies among different age groups and patients with a variety of co-morbidities and target organ involvement. In 2003, JNC 7 recommended a BP goal of < 140/90 mmHg in the general population and < 130/80 mmHg in those with diabetes mellitus or renal disease. JNC 8 re-set the BP target at < 140/90 mmHg for all adults under the age of 60 regardless of co-morbidities, and an even higher target of < 150/90 mmHg for those 60 years or older without diabetes or chronic kidney disease. The more recent results of the Systolic BP Intervention Trial (SPRINT) have a significant influence on the 2017 American College of Cardiology (ACC) and American Heart Association (AHA) guideline which redefines hypertension as BP ≥ 130/80 mmHg. It emphasizes individualized cardiovascular risk assessment and recommends a more aggressive BP target of < 130/80 mmHg and a treatment threshold based on the age, co-morbidities, and cardiovascular risk. The 2017 ACC/AHA guideline also advocates proper BP measurement and provides the estimates of corresponding BP values for clinic, home, and ambulatory BP monitoring measurements. A higher prevalence of hypertension is expected based on the ACC/AHA 2017 guideline. Its implementation may potentially lead to better BP control through enhanced awareness, improved adherence, and more timely initiation and intensification of pharmacologic therapy. Although there is no one-size-fits-all BP target, the ACC/AHA 2017 guideline is simple, inclusive and practical. Nonetheless, more studies are warranted to help further individualize BP goals for elderly patients and those with certain co-morbidities or multiple cardiovascular risk factors.

Regression of cardiovascular remodeling in hypertension: Novel relevant mechanisms

Asymptomatic organ damage due to progressive kidney damage, cardiac hypertrophy and remodeling put hypertensive patients at high risk for developing heart and renal failure, myocardial infarction and stroke. Current antihypertensive treatment normalizes high blood pressure, partially reverses organ damage, and reduces the incidence of heart and renal failure. Activation of the renin-angiotensin system (RAS) is a primary mechanism of progressive organ damage and, specifically, a major cause of both renal and cardiovascular fibrosis. Currently, inhibition of the RAS system [mainly with angiotensin I converting enzyme inhibitors or angiotensin II (Ang II) receptor antagonists] is the most effective antihypertensive strategy for normalizing blood pressure and preventing target organ damage. However, residual organ damage and consequently high risk for cardiovascular events and renal failure still persist. Accordingly, in hypertension, it is relevant to develop new therapeutic perspectives, beyond reducing blood pressure to further prevent/reduce target organ damage by acting on pathways that trigger and maintain cardiovascular and renal remodeling. We review here relevant novel mechanisms of target organ damage in hypertension, their role and evidence in prevention/regression of cardiovascular remodeling and their possible clinical impact as well. Specifically, we focus on the signaling pathway RhoA/Rho kinase, on the impact of the vasodilatory peptides from the RAS and some insights on the role of estrogens and myocardial chymase in cardiovascular hypertensive remodeling.

Association between G-protein β3 subunit gene and isolated systolic blood pressure elevation of greater than 130 mmHg: A large-scale cross-sectional study in the Japanese population

AIM

To investigate whether GNB3 C825T single nucleotide polymorphism (SNP) contributes to systolic blood pressure (SBP) ≥ 130 mmHg in a large-scale cross-sectional study among the Japanese population with diastolic blood pressure (DBP) < 85 mmHg.

METHODS

We analyzed 11008 Japanese subjects, including 2797 cases (SBP ≥ 130 and DBP < 85 mmHg) who were not taking anti-hypertensive medication and 8211 controls (SBP < 130 and DBP < 85 mmHg), all of whom enrolled in the genome banking project of the 21^st Century COE (Center of Excellence) Program at Jichi Medical University. Subjects were divided into four groups according to gender (male and female) and age (≤ 49 years and ≥ 50 years). GNB3 gene polymorphism was determined using the TaqMan probe method. We compared the frequencies of alleles and genotypes between cases and controls by chi-squared test. The strength of the associations was estimated by odds ratios (ORs) and 95%CI by using logistic regression analysis. The ORs were adjusted for age and body mass index.

RESULTS

Allele and genotype distributions significantly differed between cases and controls only in males aged ≤ 49 years. Compared to the CC genotype, a significant OR was obtained in the TT genotype among males aged ≤ 49 years.

CONCLUSION

This study indicates that the TT genotype of the GNB3 C825T SNP may contribute to SBP elevation of greater than 130 mmHg compared to the CC genotype in Japanese males aged ≤ 49 years.

Multi-slice computerized tomography critical role in transcatheter aortic valve implantation plan: Review of current literature

Transcatheter aortic valve implantation (TAVI) has been shown in improve outcome of severe aortic stenosis (AS) patients, deemed surgical high-risk or inoperable, and has grown popular in the past decade. The procedure requires accurate prior planning, and demands an integration of a “Heart Team” consisted from cardiac surgeons, interventional cardiologists, and imaging experts. The role of cardiac imaging and especially multi-slice computerized tomography (MSCT) has been a mainstay of pre-evaluation of severe AS patients that allows to accurately depict and size the cardiac and vascular structures, and has become the primary tool for procedural planning. This article is aimed to evaluate current uses of MSCT in severe AS patients undergoing TAVI, delineate the various measurements derived from this modality and review current literature regarding it’s advantages over other techniques.

Hypertension, type IV cardiorenal syndrome and chronic kidney disease: Pathophysiological and therapeutical approach

Hypertension represent one of the most important comorbid factors in chronic kidney disease (CKD) patients and its prevalence increases from 65% to 95% according to glomerular filtration rate decline. CKD patients need to maintain their blood pressure levels into 130/80 mmHg according to most recent guidelines. Despite of many therapeutic agents, achievement of ideal blood pressure levels remains so far from the ideal ones. Hypertensive disease represent most important risk factor to develop a type IV cardiorenal syndrome, while prevalence of end stage renal disease is still raising and it represents worldwide epidemiological challenge. Correct management of hypertensive disease can obtain better control on CKD progression.

Novel contributions of multimodality imaging in hypertension: A narrative review

Hypertension is currently one of the most prevalent illnesses worldwide, and is the second most common cause of heart failure, only behind ischemic cardiomyopathy. The development of novel multimodality imaging techniques in recent years has broadened the diagnostic methods, risk stratification and monitoring of treatment of cardiovascular diseases available for clinicians. Cardiovascular magnetic resonance (CMR) has a great capacity to evaluate cardiac dimensions and ventricular function, is extremely useful in ruling-out ischemic cardiomyopathy, the evaluation of the vascular system, in making the differential diagnosis for resistant hypertension and risk stratification for hypertensive cardiomyopathy and constitutes today, the method of choice to evaluate left ventricular systolic function. Computed tomography (CT) is the method of choice for the evaluation of vascular anatomy, including coronary arteries, and is also able to provide both functional and structural information. Finally, nuclear cardiology studies have been traditionally used to evaluate myocardial ischemia, along with offering the capacity to evaluate ventricular, endothelial and cardiac innervation function; information that is key in directing the treatment of the patient. In this narrative review, the most recent contributions of multimodality imaging to the patient with hypertension (CMR, CT and nuclear cardiology) will be reviewed.

Symplicity-3 hypertension trial: Basic and clinical insights

Symplicity-3 hypertension (HTN) was a recently completed clinical trial that was assumed to be the basis for the approved use of renal artery denervation for the treatment of resistant hypertension in the United States. Dramatic reductions in blood pressure had been reported in two clinical trials (Symplicity-1HTN, -2HTN) carried out in Europe, however Symplicity-3HTN did not show a significant reduction of systolic blood pressure in patients with resistant hypertension 6 mo after renal artery denervation as compared with a sham control. (Denervation group, blood pressure reduction: -14 ± 24, Sham control: -12 ± 26 mmHg). In this review we discuss several potential explanations for the failure of efficacy of Symplicity-3HTN taking into account basic and clinical factors which could have played a role in the discrepancy between the European and American experience.

A hypothesis on the relationship between tea drinking and sexual activity

As a major beverage in the world, the health benefits of drinking tea have been reported in numerous studies. The effects of green tea are mainly attributed to its polyphenol content, although caffeine, accounting for 2%-4%, appears to be related to the adaptation of mental energy by increasing alertness, attention and cognitive function, as well as elevating mood. L-Theanine, a unique amino acid in tea, has neuroprotective and mood effects. In addition, some studies on functional neuroanatomy and cerebral control of sexual function have demonstrated that the thalamus and hypothalamus play a role in emotional changes, memory and sexual behavior patterns. Our recent epidemiology research has unexpectedly found that tea drinking was positively related with sexual orgasm and sexual satisfaction in female hypertensive patients. We therefore hypothesize that long-term regular consumption of tea may play a role in sexual activity.

Diagnosis and management of thoracic aortic dissection: An update

Acute thoracic aortic dissection is part of the acute aortic syndrome triad. Caused by an intimal tear in the lumen of the aorta, it leads to the creation and propagation of a false lumen. In the acute setting this can lead to malignant hypertension, pain and end organ malperfusion. In the chronic setting it can lead to aneurysm formation and rupture. It remains the most common aortic emergency, affecting up to 4 per 100000 people per year in the United Kingdom and United States. Despite advances in treatment and centralisation of vascular services, it continues to be associated with a high pre-admission and in-hospital mortality. Dissection is classified in several ways according to anatomical extent, timing and underlying pathology, all of which guides clinical management. Traditionally, medical management has been the mainstay of treatment in patients with uncomplicated disease. Surgery has been used in symptomatic patients. With published information now available from several prospective international registries, we are beginning to see the advantages of newer surgical treatment options such as endovascular repair, in the acute setting. This review provides an update on diagnosis and management of aortic dissection, including new information that has become available in recent years.

Catheter ablation for atrial fibrillation in a subset of patients with concomitant hypertension

AIM: To study patients with atrial fibrillation and hypertension who had successful catheter ablation for changes in blood pressure 1 year later.

METHODS: A retrospective study was performed on patients who had catheter ablation for atrial fibrillation (AF) and hypertension (HTN) which included local autonomic ganglionated plexi denervation and pulmonary veins isolation. Of the records of 119 patients, follow-up data was found in order to determine the presence of sinus rhythm and data on systolic (SBP) and diastolic blood pressure at 2 wk, 3 mo, 6 mo and 1 year after the ablation procedure. Transthoracic echocardiograms were taken at the time of the catheter procedure to determine left atrial dimensions (LADs) and left ventricular size.

RESULTS: There was no significant difference in the pre-ablation mean blood pressures between the two groups (P = 0.08). After 1 year 33 of the 60 with AF and HTN were in sinus rhythm, of whom 12 had normal LADs, ≤ 4 cm Group 1, and 21 had enlarged left atria (LADs > 4 cm, Group 2). For Group 1, at 1 year of follow up, there was a significant difference in the SBP (119.2 ± 13 mmHg) compared to pre-ablation (142.6 ± 13.7 mmHg, P = 0.001). For Group 2, there was no significant difference in the SBP, pre-ablation (130.3 ± 17.5 mmHg) and at 1 year of follow up (130.4 ± 13.4 mmHg, P = 0.75). All patients were on similar anti-hypertensive medications. There was a trend for a greater left ventricular size in Group 2 compared to Group 1.

CONCLUSION: We suggest that Group 1 had HTN due to sympathetic hyperactivity, neurogenic HTN; whereas HTN in Group 2 was based on arterial vasoconstriction.

Roles of catecholamine related polymorphisms in hypertension

The objective of this review is to summarize current data obtained so far in catecholamine-essential hypertension (EH) relationships on a genetic basis. As the major elements driving the sympathetic system’s actions, catecholamines modulate a variety of physiological processes and mutations related to the system. This could generate serious disorders, such as severe mental illnesses, stress-induced disorders, or impaired control of blood pressure or motor pathways. EH is idiopathic, and the genetic basis of its causes and substantial interindividual discrepancies in response to different types of treatments are the focus of interest. Susceptibility to disease or efficacy of treatments are thought to reflect genomic variabilities among individuals. Therefore, outlining the available knowledge in functional genetic polymorphisms linked to EH will make the picture clearer and will help to establish future prospects in the field.

Achieving control of resistant hypertension: Not just the number of blood pressure medications

Resistant hypertension (RH) has a prevalence of around 12% and is associated with an increased risk of cardiovascular disease, progression to end-stage renal disease, and even mortality. In 2017, the American College of Cardiology and American Heart Association released updated guidelines that detail steps to ensure proper diagnosis of RH, including the exclusion of pseudoresistance. Lifestyle modifications, such as low salt diet and physical exercise, remain at the forefront of optimizing blood pressure control. Secondary causes of RH also need to be investigated, including screening for obstructive sleep apnea. Notably, the guidelines demonstrate a major change in medication management recommendations to include mineralocorticoid receptor antagonists. In addition to advances in medication optimization, there are several device-based therapies that have been showing efficacy in the treatment of RH. Renal denervation therapy has struggled to show efficacy for blood pressure control, but with a re-designed catheter device, it is once again being tested in clinical trials. Carotid baroreceptor activation therapy (BAT) via an implantable pulse generator has been shown to be effective in lowering blood pressure both acutely and in long-term follow up data, but there is some concern about the safety profile. Both a second-generation pulse generator and an endovascular implant are being tested in new clinical trials with hopes for improved safety profiles while maintaining therapeutic efficacy. Both renal denervation and carotid BAT need continued study before widespread clinical implementation. Central arteriovenous anastomosis has emerged as another possible therapy and is being actively explored. The ongoing pursuit of blood pressure control is a vital part of minimizing adverse patient outcomes. The future landscape appears hopeful for helping patients achieve blood pressure goals not only through the optimization of antihypertensive medications but also through device-based therapies in select individuals.

Role of adipocytes in hypertension

Although it has known for some time that obesity is associated with salt sensitivity and hypertension, recent data suggests that the adipocyte may actually be the proximate cause of this physiological changes. In the following review, the data demonstrating this association as well as the potentially operative pathophysiological mechanisms are reviewed and discussed.

Kidney and cardiovascular risk in primary hypertension

In patients with primary hypertension, therapeutic strategies should be based on global cardiovascular risk profile rather than on the severity of blood pressure alone. Accurate assessment of concomitant risk factors and especially of the presence and extent of subclinical organ damage is of paramount importance in defining individual risk. Given the high prevalence of hypertension in the population at large, however, extensive diagnostic evaluation is often impractical or unfeasible in clinical practice. Low cost, easy to use markers of risk are needed to improve the clinical management of patients with hypertension. Early renal abnormalities such as a slight reduction in glomerular filtration rate and/or the presence of microalbuminuria are well known and powerful predictors of cardio-renal morbidity and mortality and provide a useful, low cost tools to optimize cardiovascular risk assessment. A greater use of these tests should therefore be implemented in clinical practice in order to optimize the management of hypertensive patients.

Renal venous hypertension

Renal venous hypertension usually seen in young, otherwise healthy individuals and can lead to significant overall morbidity. Aside from clinical findings and physical examination, diagnosis can be made with ultrasound, computed tomography, or magnetic resonance conventional venography. Symptoms and haemodynamic significance of the compression determine the ideal treatment method. This review of the literature discusses normal and pathological developmental aspects of renocaval venous segment and related circulatory disorders, summarizes congenital and acquired changes in left renal vein and their impact on development of renal venous hypertension. Also will be discussed surgical tactics of portosystemic shunting and their potential effects on renal hemodynamics.