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Mathew A, Mesa RA, Nahodyl L, Tremblay J, Rundek T, Zeki Al Hazzouri A, Elfassy T. Diastolic Blood Pressure and Cognitive Functioning: Differences by Systolic Blood Pressure Among US Adults. Am J Alzheimers Dis Other Demen 2023; 38:15333175231172283. [PMID: 37177903 PMCID: PMC10398835 DOI: 10.1177/15333175231172283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND The role of diastolic blood pressure (DBP) with cognitive functioning is under-explored in relation to levels of systolic blood pressure (SBP). METHODS We studied 5466 participants from the National Health and Nutrition Examination Survey. Blood pressure was measured 3 times manually with a standardized sphygmomanometer and averaged. Cognitive functioning was measured using the digit symbol substitution test (DSST). RESULTS Participants were 60 years or older, 55% female, and 81% non-Hispanic White. Most participants had a DBP between 70 to <80 mmHg (33.7%), between 60 to <70 mmHg (29.3%), or <60 mmHg (18.8%). From multivariable linear regression analyses, each 5 mmHg increment of DBP was associated with significantly higher DSST scores among individuals with SBP <120 only (ß: 0.56, 95% CI: 0.09, 1.03). CONCLUSIONS Among older US adults, at non-elevated levels of SBP, higher DBP is associated with better cognitive performance.
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Affiliation(s)
- A Mathew
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - RA Mesa
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - L Nahodyl
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - J Tremblay
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - T Rundek
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - A Zeki Al Hazzouri
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - T Elfassy
- Department of Medicine, Katz Family Division of Nephrology and Hypertension, University of Miami, Miami, FL, USA
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Wang Z, Mithieux SM, Vindin H, Wang Y, Zhang M, Liu L, Zbinden J, Blum KM, Yi T, Matsuzaki Y, Oveissi F, Akdemir R, Lockley KM, Zhang L, Ma K, Guan J, Waterhouse A, Pham NTH, Hawkett BS, Shinoka T, Breuer CK, Weiss AS. Rapid Regeneration of a Neoartery with Elastic Lamellae. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2022; 34:e2205614. [PMID: 36120809 DOI: 10.1002/adma.202205614] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/24/2022] [Indexed: 06/15/2023]
Abstract
Native arteries contain a distinctive intima-media composed of organized elastin and an adventitia containing mature collagen fibrils. In contrast, implanted biodegradable small-diameter vascular grafts do not present spatially regenerated, organized elastin. The elastin-containing structures within the intima-media region encompass the elastic lamellae (EL) and internal elastic lamina (IEL) and are crucial for normal arterial function. Here, the development of a novel electrospun small-diameter vascular graft that facilitates de novo formation of a structurally appropriate elastin-containing intima-media region following implantation is described. The graft comprises a non-porous microstructure characterized by tropoelastin fibers that are embedded in a PGS matrix. After implantation in mouse abdominal aorta, the graft develops distinct cell and extracellular matrix profiles that approximate the native adventitia and intima-media by 8 weeks. Within the newly formed intima-media region there are circumferentially aligned smooth muscle cell layers that alternate with multiple EL similar to that found in the arterial wall. By 8 months, the developed adventitia region contains mature collagen fibrils and the neoartery presents a distinct IEL with thickness comparable to that in mouse abdominal aorta. It is proposed that this new class of material can generate the critically required, organized elastin needed for arterial regeneration.
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Affiliation(s)
- Ziyu Wang
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, 2006, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, 2006, Australia
| | - Suzanne M Mithieux
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, 2006, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, 2006, Australia
| | - Howard Vindin
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, 2006, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, 2006, Australia
| | - Yiwei Wang
- Burns Research and Reconstructive Surgery, Anzac Research Institute, Sydney, NSW, 2139, Australia
- Jiangsu Provincial Engineering Research Centre of TCM External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210023, China
| | - Miao Zhang
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, 2006, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, 2006, Australia
| | - Linyang Liu
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, 2006, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, 2006, Australia
| | - Jacob Zbinden
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, 43215, USA
| | - Kevin M Blum
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, 43215, USA
| | - Tai Yi
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, 43215, USA
| | - Yuichi Matsuzaki
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, 43215, USA
| | - Farshad Oveissi
- School of Chemical and Biomolecular Engineering, University of Sydney, Sydney, NSW, 2006, Australia
| | - Reyda Akdemir
- Department of Chemical Engineering, University Rovira i Virgili, Tarragona, E-43007, Spain
| | - Karen M Lockley
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, 2006, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, 2006, Australia
| | - Lingyue Zhang
- International Research Center for Advanced Structural and Biomaterials, School of Materials Science and Engineering, Beihang University, Beijing, 100191, China
| | - Ke Ma
- International Research Center for Advanced Structural and Biomaterials, School of Materials Science and Engineering, Beihang University, Beijing, 100191, China
| | - Juan Guan
- International Research Center for Advanced Structural and Biomaterials, School of Materials Science and Engineering, Beihang University, Beijing, 100191, China
| | - Anna Waterhouse
- Charles Perkins Centre, University of Sydney, Sydney, NSW, 2006, Australia
- School of Medical Science, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
- The Heart Research Institute, University of Sydney, Sydney, NSW, 204206, Australia
- The University of Sydney Nano Institute, University of Sydney, Sydney, NSW, 2006, Australia
| | - Nguyen T H Pham
- Key Centre for Polymers and Colloids, School of Chemistry, University of Sydney, Sydney, NSW, 2006, Australia
| | - Brian S Hawkett
- The University of Sydney Nano Institute, University of Sydney, Sydney, NSW, 2006, Australia
- Key Centre for Polymers and Colloids, School of Chemistry, University of Sydney, Sydney, NSW, 2006, Australia
| | - Toshiharu Shinoka
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, 43215, USA
| | - Christopher K Breuer
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, 43215, USA
| | - Anthony S Weiss
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, 2006, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, 2006, Australia
- The University of Sydney Nano Institute, University of Sydney, Sydney, NSW, 2006, Australia
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Speed S, Schneider N, Stutzman SE, Olson DM, Higbea A. Feasibility and efficacy of a nurse practitioner-and pharmacist-led hypertension clinic. J Am Assoc Nurse Pract 2022; 34:1045-1049. [PMID: 36044343 DOI: 10.1097/jxx.0000000000000765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/06/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT Hypertension (HTN) affects over one third of adults in the United States. Blood pressure (BP) management and patient education are provided by physicians, advanced practice clinicians, pharmacists, and nurses. In the traditional medical/clinic model, physicians have provided and directed HTN care. However, advanced practice nurses and pharmacists are also well trained and positioned to manage HTN. The purpose of this study was to explore the feasibility of an HTN clinic, led by a nurse practitioner (NP) and PharmD, specifically analyzing if targeted HTN can be achieved in this setting. Registry data were used to analyze the initial and the most recent visit BP levels in patients who were seen in an NP/PharmD-led HTN clinic. Measures of central tendency and differences between initial and most recent visit were also compared. A total of 46 patients were included in this analysis. Data showed that there was no statistically significant difference in the first visit (144/86) and the most recent visit (138/84) BP ( p = .26), but that there was a clinical trend in decreasing BP as well as narrowing of BP ranges and interquartile ranges between visit. The NP/PharmD-led clinic is feasible and can help lower BP and narrow ranges toward targeted BP.
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Affiliation(s)
- Shelley Speed
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Nathan Schneider
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sonja E Stutzman
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - DaiWai M Olson
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ashley Higbea
- Department of Pharmacy Practice, Texas Tech University Health Science Center, Jerry H. Hodge School of Pharmacy, Dallas, Texas
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Almahmoud OH, Arabiat DH, Saleh MY. Systematic review and meta-analysis: Prevalence of hypertension among adolescents in the Arab countries. J Pediatr Nurs 2022; 65:e72-e79. [PMID: 35305878 DOI: 10.1016/j.pedn.2022.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/25/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
PROBLEM Hypertension (HTN) is one of the non-communicable diseases which prevalence is rising in both developed and developing countries. There is a scarcity of data on the prevalence of HTN in Arab countries. This review outlines what is currently known about prevalence and risk factors of HTN in adolescence in Arab world. ELIGIBILITY CRITERIA A systematic review and meta-analysis were conducted using PubMed, Cochrane Library, Scopus, CINAHL, Science Direct, and Google Scholar databases from 2011 to 2021. SAMPLE Fourteen studies from 9 Arab countries met inclusion criteria. Studies included a total of 777 adolescents with HTN and 2147 adolescents with pre-HTN. RESULTS The overall prevalence of HTN among adolescents in the Arab World was estimated at 12.6% (95CI 0.083-0.176), while pre-HTN was 13.9% (95CI 0.084-0205). Overweight and obesity resemble the higher risk of developing hypertension. Family history, high consumption of salt, smoking and low physical activity also increase the risk of HTN. The development of adolescent HTN can be predicted through anthropometric measurements such as Body Mass Index (BMI), wrist circumferences, and high waist circumference. CONCLUSION The prevalence of HTN among adolescents in the Arab world was significant, ranging from 4 to 26%. The heterogeneity between studies was high. IMPLICATION Local governments and policymakers must consider strengthening regulations to address environmental risk factors and improve public awareness about risk factors to HTN. A combined use of nurse- and patient targeted educational interventions could also help in reducing the burden of HTN in this population.
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Affiliation(s)
- Omar H Almahmoud
- Nursing Department, Pharmacy, Nursing and Health Professions College, Birzeit University, Palestine.
| | - Diana H Arabiat
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia; The Centre for Evidence Informed Nursing, Midwifery and Healthcare Practice, Joondalup, WA, Australia; Maternal and Child Nursing Department, Faculty of Nursing, The University of Jordan, Amman, Jordan
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Efat A, Wahb R, Shoeib SAA, Dawod AAE, Abd ElHafez MA, Abd ElMohsen EA, Elkholy A. GDF-15 is associated with atherosclerosis in adults with transfusion-dependent beta-thalassemia. EJHAEM 2022; 3:353-361. [PMID: 35846052 PMCID: PMC9175794 DOI: 10.1002/jha2.415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To study serum growth differentiation factor-15 (GDF-15) serum level in β-thalassemia patients and its relation to carotid intima-media thickness. BACKGROUND Thalassemia is a common genetic disease resulting in decreased beta-chains, leading to manifested anemia. It may be subsequently complicated by iron overload, which induces numerous morbidities and even death. Growth differentiation factor-15 (GDF-15) is a strong and independent predictor of mortality and disease progression in patients with atherosclerosis alongside with carotid-intimal media thickness (CIMT). PATIENTS AND METHODS This monocentric case-control study was done on 90 subjects in the period from January 2020 to March 2021. Sixty transfusion-dependent beta-thalassemia (TDβT) cases (≥18 years) were selected from the thalassemia clinic of Hematology division at Menoufia University hospitals. We included also 30 sex and age matched healthy as the controls. Routine investigations were done beside. Serum GDF-15 was measured by ELISA. CIMT was measured by Doppler Ultrasonography. RESULTS CIMT on both sides was statistically significant higher in cases (median of 0.08 cm) than in the controls (median of 0.04). GDF-15 was also significantly higher in cases (median of 1839.89 pg/dl) than in controls (median of 256.14 pg/dl). So, we found that GDF-15 is a predictor of and associated with atherosclerosis in thalassemic adults (OR = 39.198, p value 0.008, 95% CI: 2.576-596.5). CONCLUSION GDF- 15 is increased in TDβT. CIMT (as a marker of subclinical atherosclerosis) is increased in these patients alongside with GDF-15, is a predictor, and associated with atherosclerosis in thalassemic adults.
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Affiliation(s)
- Alaa Efat
- Faculty of MedicineDepartment of Internal Medicine and HematologyMenoufia UniversityShebin Al‐KomMenoufiaEgypt
| | - Rana Wahb
- Faculty of MedicineDepartment of Internal Medicine and HematologyMenoufia UniversityShebin Al‐KomMenoufiaEgypt
| | - Sabry Abd Allah Shoeib
- Faculty of MedicineDepartment of Internal Medicine and HematologyMenoufia UniversityShebin Al‐KomMenoufiaEgypt
| | - Ashraf Abd ElRaof Dawod
- Faculty of MedicineDepartment of Medical BiochemistryMenoufia UniversityShebin Al‐KomMenoufiaEgypt
| | - Mohamad Ahmed Abd ElHafez
- Faculty of MedicineDepartment of Internal Medicine and HematologyMenoufia UniversityShebin Al‐KomMenoufiaEgypt
| | - Essam Ali Abd ElMohsen
- Department of Hematology and Bone Marrow Transplantation, Maadi Military Forces Medical ComplexMaadi, Cairo GovernorateEgypt
| | - Aly Elkholy
- Faculty of MedicineDepartment of Internal Medicine and HematologyMenoufia UniversityShebin Al‐KomMenoufiaEgypt
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6
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Leite APDO, Li XC, Nwia SM, Hassan R, Zhuo JL. Angiotensin II and AT 1a Receptors in the Proximal Tubules of the Kidney: New Roles in Blood Pressure Control and Hypertension. Int J Mol Sci 2022; 23:2402. [PMID: 35269547 PMCID: PMC8910592 DOI: 10.3390/ijms23052402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 02/01/2023] Open
Abstract
Contrary to public perception, hypertension remains one of the most important public health problems in the United States, affecting 46% of adults with increased risk for heart attack, stroke, and kidney diseases. The mechanisms underlying poorly controlled hypertension remain incompletely understood. Recent development in the Cre/LoxP approach to study gain or loss of function of a particular gene has significantly helped advance our new insights into the role of proximal tubule angiotensin II (Ang II) and its AT1 (AT1a) receptors in basal blood pressure control and the development of Ang II-induced hypertension. This novel approach has provided us and others with an important tool to generate novel mouse models with proximal tubule-specific loss (deletion) or gain of the function (overexpression). The objective of this invited review article is to review and discuss recent findings using novel genetically modifying proximal tubule-specific mouse models. These new studies have consistently demonstrated that deletion of AT1 (AT1a) receptors or its direct downstream target Na+/H+ exchanger 3 (NHE3) selectively in the proximal tubules of the kidney lowers basal blood pressure, increases the pressure-natriuresis response, and induces natriuretic responses, whereas overexpression of an intracellular Ang II fusion protein or AT1 (AT1a) receptors selectively in the proximal tubules increases proximal tubule Na+ reabsorption, impairs the pressure-natriuresis response, and elevates blood pressure. Furthermore, the development of Ang II-induced hypertension by systemic Ang II infusion or by proximal tubule-specific overexpression of an intracellular Ang II fusion protein was attenuated in mutant mice with proximal tubule-specific deletion of AT1 (AT1a) receptors or NHE3. Thus, these recent studies provide evidence for and new insights into the important roles of intratubular Ang II via AT1 (AT1a) receptors and NHE3 in the proximal tubules in maintaining basal blood pressure homeostasis and the development of Ang II-induced hypertension.
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Affiliation(s)
- Ana Paula de Oliveira Leite
- Tulane Hypertension and Renal Center of Excellence, 1430 Tulane Avenue, New Orleans, LA 70112, USA; (A.P.d.O.L.); (X.C.L.); (S.M.N.); (R.H.)
- Department of Physiology, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Xiao C. Li
- Tulane Hypertension and Renal Center of Excellence, 1430 Tulane Avenue, New Orleans, LA 70112, USA; (A.P.d.O.L.); (X.C.L.); (S.M.N.); (R.H.)
- Department of Physiology, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Sarah M. Nwia
- Tulane Hypertension and Renal Center of Excellence, 1430 Tulane Avenue, New Orleans, LA 70112, USA; (A.P.d.O.L.); (X.C.L.); (S.M.N.); (R.H.)
- Department of Physiology, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Rumana Hassan
- Tulane Hypertension and Renal Center of Excellence, 1430 Tulane Avenue, New Orleans, LA 70112, USA; (A.P.d.O.L.); (X.C.L.); (S.M.N.); (R.H.)
- Department of Physiology, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Jia L. Zhuo
- Tulane Hypertension and Renal Center of Excellence, 1430 Tulane Avenue, New Orleans, LA 70112, USA; (A.P.d.O.L.); (X.C.L.); (S.M.N.); (R.H.)
- Department of Physiology, Tulane University School of Medicine, New Orleans, LA 70112, USA
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Kaur H, Crawford DC, Liang J, Benchek P, Zhu X, Kallianpur AR, Bush WS. Replication of European hypertension associations in a case-control study of 9,534 African Americans. PLoS One 2021; 16:e0259962. [PMID: 34793544 PMCID: PMC8601554 DOI: 10.1371/journal.pone.0259962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 10/29/2021] [Indexed: 12/01/2022] Open
Abstract
Objective Hypertension is more prevalent in African Americans (AA) than other ethnic groups. Genome-wide association studies (GWAS) have identified loci associated with hypertension and other cardio-metabolic traits like type 2 diabetes, coronary artery disease, and body mass index (BMI), however the AA population is underrepresented in these studies. In this study, we examined a large AA cohort for the generalizability of 14 Metabochip array SNPs with previously reported European hypertension associations. Methods To evaluate associations, we analyzed genotype data of 14 SNPs for their associations with a diagnosis of hypertension, systolic blood pressure (SBP), and diastolic blood pressure (DBP) in a case-control study of an AA population (N = 9,534). We also performed an age-stratified analysis (>30, 30≥59 and ≥60 years) following the hypertension definition described by the 8th Joint National Committee (JNC). Associations were adjusted for BMI, age, age2, sex, clinical confounders, and genetic ancestry using multivariable regression models to estimate odds ratios (ORs) and beta-coefficients. Analyses stratified by sex were also conducted. Meta-analyses (including both BioVU and COGENT-BP cohorts) were performed using a random-effects model. Results We found rs880315 to be associated with systolic hypertension (SBP≥140 mmHg) in the entire cohort (OR = 1.14, p = 0.003) and within women only (OR = 1.16, p = 0.012). Variant rs17080093 associated with lower SBP and DBP (β = -2.99, p = 0.0352 and - β = 1.69, p = 0.0184) among younger individuals, particularly in younger women (β = -3.92, p = 0.0025 and β = -1.87, p = 0.0241 for SBP and DBP respectively). SNP rs1530440 associated with higher SBP and DBP measurements (younger individuals β = 4.1, p = 0.039 and β = 2.5, p = 0.043 for SBP and DBP; (younger women β = 4.5, p = 0.025 and β = 2.9, p = 0.028 for SBP and DBP), and hypertension risk in older women (OR = 1.4, p = 0.050). rs16948048 increases hypertension risk in younger individuals (OR = 1.31, p = 0.011). Among mid-age women rs880315 associated with higher risk of hypertension (OR = 1.20, p = 0.027). rs1361831 associated with DBP (β = -1.96, p = 0.02) among individuals older than 60 years. rs3096277 increases hypertension risk among older individuals (OR = 1.26 p = 0.0015), however, this variant also reduces SBP among younger women (β = -2.63, p = 0.0102). Conclusion These findings suggest that European-descent and AA populations share genetic loci that contribute to blood pressure traits and hypertension. However, the OR and beta-coefficient estimates differ, and some are age-dependent. Additional genetic studies of hypertension in AA are warranted to identify new loci associated with hypertension and blood pressure traits in this population.
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Affiliation(s)
- Harpreet Kaur
- Genomic Medicine Institute, Cleveland Clinic/Lerner Research Institute, Cleveland, OH, United States of America
- Department of Population and Quantitative Health Sciences, Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, OH, United States of America
| | - Dana C. Crawford
- Department of Population and Quantitative Health Sciences, Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, OH, United States of America
| | - Jingjing Liang
- Department of Population and Quantitative Health Sciences, Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, OH, United States of America
| | - Penelope Benchek
- Department of Population and Quantitative Health Sciences, Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, OH, United States of America
| | | | - Xiaofeng Zhu
- Department of Population and Quantitative Health Sciences, Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, OH, United States of America
| | - Asha R. Kallianpur
- Genomic Medicine Institute, Cleveland Clinic/Lerner Research Institute, Cleveland, OH, United States of America
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States of America
| | - William S. Bush
- Genomic Medicine Institute, Cleveland Clinic/Lerner Research Institute, Cleveland, OH, United States of America
- Department of Population and Quantitative Health Sciences, Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, OH, United States of America
- * E-mail:
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Shoenbill K, Song Y, Gress L, Johnson H, Smith M, Mendonca EA. Natural language processing of lifestyle modification documentation. Health Informatics J 2020; 26:388-405. [PMID: 30791802 PMCID: PMC6722039 DOI: 10.1177/1460458218824742] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Lifestyle modification, including diet, exercise, and tobacco cessation, is the first-line treatment of many disorders including hypertension, obesity, and diabetes. Lifestyle modification data are not easily retrieved or used in research due to their textual nature. This study addresses this knowledge gap using natural language processing to automatically identify lifestyle modification documentation from electronic health records. Electronic health record notes from hypertension patients were analyzed using an open-source natural language processing tool to retrieve assessment and advice regarding lifestyle modification. These data were classified as lifestyle modification assessment or advice and mapped to a coded standard ontology. Combined lifestyle modification (advice and assessment) recall was 99.27 percent, precision 94.44 percent, and correct classification 88.15 percent. Through extraction and transformation of narrative lifestyle modification data to coded data, this critical information can be used in research, metric development, and quality improvement efforts regarding care delivery for multiple medical conditions that benefit from lifestyle modification.
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Chiu WC, Chiang JY, Juang JM, Wu CK, Tsai CT, Tseng YZ, Su MJ, Chiang FT. Reduction of blood pressure elevation by losartan in spontaneously hypertensive rats through suppression of LARG expression in vascular smooth muscle cells. J Formos Med Assoc 2020; 119:164-172. [DOI: 10.1016/j.jfma.2019.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/22/2018] [Accepted: 03/21/2019] [Indexed: 10/27/2022] Open
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Brașoveanu AM, Șerbănescu MS, Mălăescu DN, Predescu OI, Cotoi BV. High Blood Pressure-A High Risk Problem for Public Healthcare. CURRENT HEALTH SCIENCES JOURNAL 2019; 45:251-257. [PMID: 32042451 PMCID: PMC6993761 DOI: 10.12865/chsj.45.03.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 08/28/2019] [Indexed: 11/27/2022]
Abstract
High blood pressure is the most common cardiovascular disease and the first one due to mortality risk. Prospective studies showed that, until 2025, the number of individuals with HBP will increase up to 1.56 billion in adults, of which more than two thirds will be found in poor countries or developing ones. In the present study, we evaluated the clinical and epidemiological aspects of HBP in a group of 3050 patients admitted in the Department of Cardiology of the Public Hospital of Caracal, Olt county. The study on the distribution of patients according to sex allowed us to observe that most patients suffering from HBP were women, while the distribution according to the social environment showed that more than 2/3 of high blood pressure patients came from the rural area. By studying the distribution of patients according to age, we observed that most HBP patients were aged over 60 years old (86.49%).
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Affiliation(s)
- A M Brașoveanu
- Department of Cardiology, Public Hospital of Caracal, Olt County, Romania
| | - M S Șerbănescu
- Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy of Craiova, Romania
| | - D N Mălăescu
- Department of Anatomy, Faculty of Nursing, Târgu Jiu Subsidiary, "Titu Maiorescu" University, Bucharest, Romania
| | - O I Predescu
- Department of Nursing, Faculty of Nursing, Târgu Jiu Subsidiary, "Titu Maiorescu" University, Bucharest, Romania
| | - B V Cotoi
- Department of Nursing, University of Medicine and Pharmacy of Craiova, Romania
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Kianbakht S, Hashem-Dabaghian F. Antihypertensive efficacy and safety of Vaccinium arctostaphylos berry extract in overweight/obese hypertensive patients: A randomized, double-blind and placebo-controlled clinical trial. Complement Ther Med 2019; 44:296-300. [PMID: 31126570 DOI: 10.1016/j.ctim.2019.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 04/13/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES To evaluate the antihypertensive efficacy and safety of a standardized Vaccinium arctostaphylos (V. arctostaphylos) berry hydro-alcoholic extract in the overweight/obese hypertensive patients. DESIGN Randomized placebo-controlled trial. SETTING Baqiyatallah hospital (Tehran, Iran). INTERVENTIONS The antihypertensive efficacy and safety of 3-month intake of 400 mg extract capsule three times daily alongside standardized anti-hypertensive regimen in the treatment of 50 patients was compared with the placebo (n = 50). MAIN OUTCOME MEASURES SBP (systolic blood pressure), DBP (diastolic blood pressure), body mass index, waist circumference, CBC (complete blood count), blood levels of AST (aspartate aminotransferase), ALT (alanine aminotransferase), ALP (alkaline phosphatase), BUN (blood urea nitrogen) and creatinine. RESULTS SBP decreased from 152.1 ± 7.7 to 140.5 ± 10.7 in the V. arctostaphylos group and from 152.9 ± 8.1 to 150.8 ± 9.3 in the placebo group (P < 0.001). DBP decreased from 90.3±8 to 82.1±8.8 in the V. arctostaphylos group and from 89.6 ± 7.8 to 87.6 ± 7.9 in the placebo group (P < 0.001). The extract capsule had no significant effect on the other parameters (P > 0.05). Moreover, no drug side effect and adverse interaction with other antihypertensive drugs was observed in the patients. CONCLUSIONS V. arctostaphylosberry extract improves blood pressure control and has safety and tolerability in the overweight/obese hypertensive patients taking standard antihypertensive drugs.
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Affiliation(s)
- Saeed Kianbakht
- Research Institute for Islamic and Complementary Medicine, Iran University of Medical Sciences, Tehran, Iran; Medicinal Plants Research Center, Institute of Medicinal Plants, ACECR, Karaj, Iran.
| | - Fataneh Hashem-Dabaghian
- Research Institute for Islamic and Complementary Medicine, Iran University of Medical Sciences, Tehran, Iran; School of Persian Medicine, Iran University of Medical Sciences, Tehran, Iran
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Álvarez C, Ramírez-Campillo R, Cristi-Montero C, Ramírez-Vélez R, Izquierdo M. Prevalence of Non-responders for Blood Pressure and Cardiometabolic Risk Factors Among Prehypertensive Women After Long-Term High-Intensity Interval Training. Front Physiol 2018; 9:1443. [PMID: 30405426 PMCID: PMC6206174 DOI: 10.3389/fphys.2018.01443] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 09/21/2018] [Indexed: 12/14/2022] Open
Abstract
Background: Exercise is known to improve cardiometabolic outcomes; however, results are typically reported as mean values, and there is wide interindividual variability in terms of response that has not been explored in populations at risk for hypertension. Our aim was to investigate both the effects on and the prevalence of non-responders (NRs) for decreasing blood pressure (BP) and other risk factors among prehypertensive women after long-term high-intensity interval training (HIIT). A secondary aim was to report potential variables that can predict decreases in BP after HIIT. Methods: Sedentary overweight/obese women (age 35.9 ± 5.4 year; body mass index [BMI] 30.9 ± 6.2 kg/m2) were assigned to a prehypertensive (PreHTN; N = 44) or normotensive (NT; N = 40) group according to their ambulatory BP at baseline. Subjects underwent a thrice-weekly 16-week HIIT program (7-10 × 1 min exercise with 2 min of rest). Training-induced changes in body composition and cardiovascular, metabolic, strength, and endurance performance markers were measured, and the prevalence of NRs was reported as a percentage. All outcomes were analyzed by multivariable regression. Results: Statistically significant (P < 0.05) decreases in systolic BP (SBP) were detected in the PreHTN group (Δ -8 mmHg) compared with baseline, whereas the NT group (Δ + 3 mmHg) showed a non-significant increase in SBP. Diastolic BP (DBP) was significantly decreased in the PreHTN group (Δ -5.8 mmHg) and non-significantly decreased (Δ -2 mmHg) in the NT group. Also, there were significant differences (P < 0.0001) in the prevalence of NRs based on SBP between the PreHTN and NT groups (11.4 vs. 68.8%), but similar prevalence of NRs based on DBP. SBP alone was a powerful predictive factor for a beneficial SBP reduction, explaining 51.2% of the results, which was similar to other more complex models tested. Conclusion: The prevalence of NRs based on SBP and DBP was different between prehypertensive and normotensive subjects after 16 weeks of HIIT. Other comorbidities such as body composition and metabolic outcomes showed almost similar modifications between prehypertensive and normotensive subjects, being the most basic predictive factor for BP reduction baseline SBP, which we refer to as 'BP health status' (51.2%). This improvement in BP was accompanied by other known improvements of HIIT on body composition, metabolic and endurance performance in both study cohorts. Trial Registration: ClinicalTrials.gov ID: NCT03000140 (Register 20 December, 2016).
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Affiliation(s)
- Cristian Álvarez
- Laboratory of Human Performance, Quality of Life and Wellness Research Group, Department of Physical Activity Sciences, Universidad de Los Lagos, Osorno, Chile
| | - Rodrigo Ramírez-Campillo
- Laboratory of Human Performance, Quality of Life and Wellness Research Group, Department of Physical Activity Sciences, Universidad de Los Lagos, Osorno, Chile
| | | | - Robinson Ramírez-Vélez
- Centro de Estudios en Medición de la Actividad Física (CEMA), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Mikel Izquierdo
- Department of Health Sciences, Public University of Navarra, Navarrabiomed, CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Pamplona, Spain
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13
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Zhang S, Chen C, Lu W, Wei L. Phytochemistry, pharmacology, and clinical use of Panax notoginseng flowers buds. Phytother Res 2018; 32:2155-2163. [PMID: 30088301 DOI: 10.1002/ptr.6167] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/28/2018] [Accepted: 07/03/2018] [Indexed: 12/15/2022]
Abstract
Panax notoginseng is a well-known traditional Chinese medicine, and dried flower buds of P. notoginseng (FBP) have also been used as a medicine or tea for a long time. The pharmacological effects of FBP include antihypertensive, anticancer, hepatoprotective, and cardiovascular protective effects. The compounds in FBP include saponins, flavonoids, volatile oils, and polysaccharides. The total saponins are the principal bioactive components. In modern applications, FBP is used to treat hypertension and tinnitus. There have been many studies on FBP and its effects in recent years, and it has attracted much attention in the medical field. This review summarizes the chemical components, pharmacological action, and clinical uses of FBP comprehensively to provide the references of deeper studies.
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Affiliation(s)
- Siqi Zhang
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chong Chen
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wenxi Lu
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Li Wei
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Şen S, Demir M, Yiğit Z, Üresin AY. Efficacy and Safety of S-Amlodipine 2.5 and 5 mg/d in Hypertensive Patients Who Were Treatment-Naive or Previously Received Antihypertensive Monotherapy. J Cardiovasc Pharmacol Ther 2018; 23:318-328. [PMID: 29649885 PMCID: PMC5974697 DOI: 10.1177/1074248418769054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The aim of the present study was to evaluate the efficacy and safety of S-amlodipine 2.5 and 5 mg/d in patients with hypertension who were treatment-naive or previously received antihypertensive monotherapy. During the 8-week treatment period, all patients received S-amlodipine 2.5 mg/d for the first 4 weeks, followed by S-amlodipine 5 mg/d for the second 4 weeks. For efficacy assessments, ambulatory and office blood pressure (BP) measurements were performed during the baseline, fourth-week, and eighth-week visits. For safety assessments, all adverse events and abnormal laboratory findings were recorded. This study is registered with ClinicalTrials.gov (NCT03038451). Of 43 patients evaluated at the screening visit, 33 were enrolled. In the treatment-naive arm, significant reductions in both office and ambulatory systolic BP (SBP) and diastolic BP (DBP) were observed with S-amlodipine 2.5 mg/d and additional significant reductions were achieved with dose titration (S-amlodipine 5 mg/d). At the end of the study, the rate of the treatment-naive patients with BP under control (SBP/DBP <140/90 mm Hg) was 53% with S-amlodipine 2.5 mg and increased to 78% with S-amlodipine 5 mg. For the noninferiority evaluation, S-amlodipine 2.5 and 5 mg/d treatments were generally noninferior to both office and ambulatory BP levels achieved with the medications that the patients received before participating in the study. Five nonserious adverse events likely to be associated with the study drug were observed. No serious adverse event was encountered. Consequently, S-amlodipine can be suggested as an effective and safe treatment option for patients with hypertension.
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Affiliation(s)
- Selçuk Şen
- 1 Department of Medical Pharmacology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Meral Demir
- 1 Department of Medical Pharmacology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zerrin Yiğit
- 2 Department of Cardiology, Institute of Cardiology, Istanbul University, Istanbul, Turkey
| | - Ali Yağız Üresin
- 1 Department of Medical Pharmacology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Russo A, Di Gaetano C, Cugliari G, Matullo G. Advances in the Genetics of Hypertension: The Effect of Rare Variants. Int J Mol Sci 2018; 19:E688. [PMID: 29495593 PMCID: PMC5877549 DOI: 10.3390/ijms19030688] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 02/19/2018] [Accepted: 02/26/2018] [Indexed: 12/22/2022] Open
Abstract
Worldwide, hypertension still represents a serious health burden with nine million people dying as a consequence of hypertension-related complications. Essential hypertension is a complex trait supported by multifactorial genetic inheritance together with environmental factors. The heritability of blood pressure (BP) is estimated to be 30-50%. A great effort was made to find genetic variants affecting BP levels through Genome-Wide Association Studies (GWAS). This approach relies on the "common disease-common variant" hypothesis and led to the identification of multiple genetic variants which explain, in aggregate, only 2-3% of the genetic variance of hypertension. Part of the missing genetic information could be caused by variants too rare to be detected by GWAS. The use of exome chips and Next-Generation Sequencing facilitated the discovery of causative variants. Here, we report the advances in the detection of novel rare variants, genes, and/or pathways through the most promising approaches, and the recent statistical tests that have emerged to handle rare variants. We also discuss the need to further support rare novel variants with replication studies within larger consortia and with deeper functional studies to better understand how new genes might improve patient care and the stratification of the response to antihypertensive treatments.
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Affiliation(s)
- Alessia Russo
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy.
- Italian Institute for Genomic Medicine (IIGM, Formerly HuGeF), 10126 Turin, Italy.
| | - Cornelia Di Gaetano
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy.
- Italian Institute for Genomic Medicine (IIGM, Formerly HuGeF), 10126 Turin, Italy.
| | - Giovanni Cugliari
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy.
- Italian Institute for Genomic Medicine (IIGM, Formerly HuGeF), 10126 Turin, Italy.
| | - Giuseppe Matullo
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy.
- Italian Institute for Genomic Medicine (IIGM, Formerly HuGeF), 10126 Turin, Italy.
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Ma L, Han R, Li L, Li Z, Sun F, Diao L, Tang Z. Trends in the prevalence of antihypertensive drug treatment in the Beijing Longitudinal Study of Aging. Arch Gerontol Geriatr 2017; 74:44-48. [PMID: 28957687 DOI: 10.1016/j.archger.2017.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 09/06/2017] [Accepted: 09/15/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study aimed to explore the epidemiological characteristics of antihypertensive drug use by community residents in Beijing, China. METHODS Based on well-established statistical sampling techniques such as cluster, stratification, and random selection, 2832, 1828, and 2277 elderly residents aged ≥60 years in Beijing in 2000, 2004, and 2007, respectively, were included. The trend in antihypertensive drug use by elderly patients with hypertension was analyzed. RESULTS The proportion of patients using angiotensin converting enzyme inhibitors (ACEIs) or β-blockers increased, while the proportions of both male and female patients using Chinese single-pill combination decreased. The proportion of relatively young patients using ACEIs or β-blockers increased, as did the proportion of relatively old patients using calcium channel blockers (CCB), ACEIs, or β-blockers. The proportions of both relatively young and relatively old patients using Chinese single-pill combination decreased. The proportion of urban patients using ACEIs, or β-blockers and the proportion of rural patients using CCBs or diuretics increased, while the proportion of both urban and rural patients using Chinese single-pill combination decreased. CONCLUSION During the 7-year study period in Beijing, the proportion of patients using CCBs, ACEIs, diuretics, or β-blockers increased, while the proportion of patients using Chinese single-pill combination decreased. Our results provide important data for the limited evidence on the trend of prevalence of antihypertensive drug used in China.
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Affiliation(s)
- Lina Ma
- Beijing Geriatric Healthcare Center, Xuanwu Hospital, Capital Medical University, Key Laboratory for Neurodegenerative Disease of Ministry of Education, Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing, China; Department of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Rui Han
- Beijing Geriatric Healthcare Center, Xuanwu Hospital, Capital Medical University, Key Laboratory for Neurodegenerative Disease of Ministry of Education, Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing, China; Department of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Li Li
- Beijing Geriatric Healthcare Center, Xuanwu Hospital, Capital Medical University, Key Laboratory for Neurodegenerative Disease of Ministry of Education, Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing, China; Department of Geriatrics, Beijing Geriatric Hospital, Beijing, China
| | - Zhenzhen Li
- Beijing Geriatric Healthcare Center, Xuanwu Hospital, Capital Medical University, Key Laboratory for Neurodegenerative Disease of Ministry of Education, Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing, China; Department of Respiratory, Cangzhou People's Hospital, Cangzhou, China
| | - Fei Sun
- Beijing Geriatric Healthcare Center, Xuanwu Hospital, Capital Medical University, Key Laboratory for Neurodegenerative Disease of Ministry of Education, Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing, China
| | - Lijun Diao
- Beijing Geriatric Healthcare Center, Xuanwu Hospital, Capital Medical University, Key Laboratory for Neurodegenerative Disease of Ministry of Education, Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing, China
| | - Zhe Tang
- Beijing Geriatric Healthcare Center, Xuanwu Hospital, Capital Medical University, Key Laboratory for Neurodegenerative Disease of Ministry of Education, Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing, China.
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Seidel E, Scholl UI. Genetic mechanisms of human hypertension and their implications for blood pressure physiology. Physiol Genomics 2017; 49:630-652. [PMID: 28887369 DOI: 10.1152/physiolgenomics.00032.2017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Hypertension, or elevated blood pressure, constitutes a major public health burden that affects more than 1 billion people worldwide and contributes to ~9 million deaths annually. Hereditary factors are thought to contribute to up to 50% of interindividual blood pressure variability. Blood pressure in the general population approximately shows a normal distribution and is thought to be a polygenic trait. In rare cases, early-onset hypertension or hypotension are inherited as Mendelian traits. The identification of the underlying Mendelian genes and variants has contributed to our understanding of the physiology of blood pressure regulation, emphasizing renal salt handling and the renin angiotensin aldosterone system as players in the determination of blood pressure. Genome-wide association studies (GWAS) have revealed more than 100 variants that are associated with blood pressure, typically with small effect sizes, which cumulatively explain ~3.5% of blood pressure trait variability. Several GWAS associations point to a role of the vasculature in the pathogenesis of hypertension. Despite these advances, the majority of the genetic contributors to blood pressure regulation are currently unknown; whether large-scale exome or genome sequencing studies will unravel these factors remains to be determined.
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Affiliation(s)
- Eric Seidel
- Department of Nephrology, Medical School, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Ute I Scholl
- Department of Nephrology, Medical School, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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