Hypertension: a review for clinicians

In vivo quantification of aortic stiffness using MR elastography in hypertensive porcine model

PURPOSE

Aortic stiffness plays an important role in evaluating and predicting the progression of systemic arterial hypertension (SAH). The aim of this study is to determine the stiffness of aortic wall using MR elastography (MRE) in a hypertensive porcine model and compare it against invasive aortic pressure measurements.

METHODS

Renal wrapping surgery was performed on eight pigs to induce SAH. Aortic MRE was performed at baseline and 2 months postsurgery using a retrospectively pulse-gated gradient-echo MRE sequence on a 1.5 tesla scanner. Mechanical waves of 70 Hz were introduced into the aorta. Invasive central aortic pressure measurements were obtained prior to each scan to calculate mean arterial pressure (MAP). MRE data were analyzed to obtain effective aortic stiffness. Spearman's rank correlation analysis was performed to assess the relationship between MAP and MRE-derived aortic stiffness.

RESULTS

Significant increase in effective aortic stiffness was observed between baseline and 2 months postsurgery measurements (paired t test; P = 0.004). The average MAP, determined by pooling all animals, was 65.24 ± 9.42 mm Hg at baseline and 92.57 ± 11.80 mm Hg 2 months postsurgery with P < 0.0001. Moderate linear correlation was observed between MAP and effective aortic stiffness (ρ = 0.52; P = 0.046).

CONCLUSION

This study demonstrated that, in a SAH porcine model, MRE-derived aortic stiffness increased with increase in MAP. Magn Reson Med 78:2315-2321, 2017. © 2017 International Society for Magnetic Resonance in Medicine.

Shear-Sensitive Genes in Aortic Valve Endothelium

SIGNIFICANCE

Currently, calcific aortic valve disease (CAVD) is only treatable through surgical intervention because the specific mechanisms leading to the disease remain unclear. In this review, we explore the forces and structure of the valve, as well as the mechanosensors and downstream signaling in the valve endothelium known to contribute to inflammation and valve dysfunction.

RECENT ADVANCES

While the valvular structure enables adaptation to dynamic hemodynamic forces, these are impaired during CAVD, resulting in pathological systemic changes. Mechanosensing mechanisms-proteins, sugars, and membrane structures-at the surface of the valve endothelial cell relay mechanical signals to the nucleus. As a result, a large number of mechanosensitive genes are transcribed to alter cellular phenotype and, ultimately, induce inflammation and CAVD. Transforming growth factor-β signaling and Wnt/β-catenin have been widely studied in this context. Importantly, NADPH oxidase and reactive oxygen species/reactive nitrogen species signaling has increasingly been recognized to play a key role in the cellular response to mechanical stimuli. In addition, a number of valvular microRNAs are mechanosensitive and may regulate the progression of CAVD.

CRITICAL ISSUES

While numerous pathways have been described in the pathology of CAVD, no treatment options are available to avoid surgery for advanced stenosis and calcification of the aortic valve. More work must be focused on this issue to lead to successful therapies for the disease.

FUTURE DIRECTIONS

Ultimately, a more complete understanding of the mechanisms within the aortic valve endothelium will lead us to future therapies important for treatment of CAVD without the risks involved with valve replacement or repair. Antioxid. Redox Signal. 25, 401-414.

Access to health care and heavy drinking in patients with diabetes or hypertension: implications for alcohol interventions

Supported by a National Institute of Alcoholism and Alcohol Abuse grant, this study examined associations between health care access and heavy drinking in patients with hypertension and diabetes. Using a sample of 7,428 US adults from the 2007 National Health Interview Survey data, multivariate logistic regressions were performed. Better access to health care, as indicated by regular source of care and frequent use of primary care, was associated with reduced odds of heavy drinking. Alcohol interventions may be more effective if targeted at patients with chronic conditions adversely affected by drinking. Future research needs to investigate factors facilitating such interventions.

The effect of selective antihypertensive drugs on the vascular remodeling-associated hypertension: insights from a profilin1 transgenic mouse model

Hypertension represents a major risk factor for cardiovascular diseases. We have developed a novel transgenic mouse model by overexpressing the cDNA of human profilin1 in the blood vessels of transgenic mice, which led to vascular hypertrophy and hypertension. We assessed the effects of losartan, amlodipine, or atenolol on vascular hypertrophy-associated hypertension, by treating the profilin1 transgenic mice for 4 weeks. Our myograph results showed improvement in the contraction response toward phenylephrine and in the relaxation response toward acetylcholine and sodium nitrite in losartan- and amlodipine-treated profilin1 mice. Western blot analyses using mesenteric arteries of losartan- and amlodipine-treated profilin1 mice showed significant decreases in their signaling, respectively, as follows: the expression of α1 integrin (104% and 93%) and β1 integrin (116% and 109%); p-ERK1/2 (149% and 130%) and p-JNK (171% and 137%); the phospho-myosin light chain 20 (117% and 150%); and the ROCKII expression (125% and 180%). Conversely, there were significant increases in the endothelial nitric oxide synthase expression (82% and 80%) and activation (p-endothelial nitric oxide synthase) (78% and 76%). On the other hand, atenolol-treated profilin1 mice showed no significant change in all measured parameters. In conclusion, the profilin1 gene may represent a new therapeutic target in the treatment of vascular hypertrophy-associated hypertension.