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Lteif C, Ataya A, Duarte JD. Therapeutic Challenges and Emerging Treatment Targets for Pulmonary Hypertension in Left Heart Disease. J Am Heart Assoc 2021; 10:e020633. [PMID: 34032129 PMCID: PMC8483544 DOI: 10.1161/jaha.120.020633] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pulmonary hypertension (PH) attributable to left heart disease (LHD) is believed to be the most common form of PH and is strongly associated with increased mortality and morbidity in this patient population. Specific therapies for PH‐LHD have not yet been identified and the use of pulmonary artery hypertension‐targeted therapies in PH‐LHD are not recommended. Endothelin receptor antagonists, phosphodiesterase‐5 inhibitors, guanylate cyclase stimulators, and prostacyclins have all been studied in PH‐LHD with conflicting results. Understanding the mechanisms underlying PH‐LHD could potentially provide novel therapeutic targets. Fibrosis, oxidative stress, and metabolic syndrome have been proposed as pathophysiological components of PH‐LHD. Genetic associations have also been identified, offering additional mechanisms with biological plausibility. This review summarizes the evidence and challenges for treatment of PH‐LHD and focuses on underlying mechanisms on the horizon that could develop into potential therapeutic targets for this disease.
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Affiliation(s)
- Christelle Lteif
- Department of Pharmacotherapy and Translational Research Center for Pharmacogenomics and Precision Medicine University of Florida College of Pharmacy Gainesville FL
| | - Ali Ataya
- Division of Pulmonary, Critical Care & Sleep Medicine University of Florida College of Medicine Gainesville FL
| | - Julio D Duarte
- Department of Pharmacotherapy and Translational Research Center for Pharmacogenomics and Precision Medicine University of Florida College of Pharmacy Gainesville FL
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Polymorphisms in the serum- and glucocorticoid-inducible kinase 1 gene are associated with blood pressure and renin response to dietary salt intake. J Hum Hypertens 2012; 27:176-80. [PMID: 22648267 PMCID: PMC3463709 DOI: 10.1038/jhh.2012.22] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Serum- and glucocorticoid-inducible kinase 1 (SGK1) plays a central role in epithelial sodium channel (ENaC)-dependent Na+ transport in the distal nephron. We hypothesized that SGK1 gene variants may contribute to the effect of dietary salt intake on BP in humans with hypertension, and consequentially influence renin-angiotensin-aldosterone (RAA) system activity. Our study population included 421 hypertensive Caucasian participants of the HyperPath group who had completed a dietary salt protocol with measurement of BP and RAA system activity. Three SGK1 tagging single nucleotide polymorphisms (SNPs) from the HapMap CEU population captured the genetic variation in the SGK1 region. Assuming an additive genetic model, two SNPs (rs2758151 and rs9402571) were associated with BP and plasma renin activity (PRA) effects of dietary salt intake. Major alleles were associated with higher systolic BP on high salt and decreased PRA on low salt. In contrast, low salt neutralized genotype differences. Similar, non-significant trends were observed in a normotensive population (N=152). Genotype was also associated with two salt-sensitive subtypes of hypertension. SGK1 genetic variants are associated with salt sensitivity of BP and PRA in human hypertension. Genotype status at these SGK1 variants may identify individuals prone to salt-sensitive hypertension.
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Nakamura Y, Satoh F, Morimoto R, Kudo M, Takase K, Gomez-Sanchez CE, Honma S, Okuyama M, Yamashita K, Rainey WE, Sasano H, Ito S. 18-oxocortisol measurement in adrenal vein sampling as a biomarker for subclassifying primary aldosteronism. J Clin Endocrinol Metab 2011; 96:E1272-8. [PMID: 21593107 PMCID: PMC5393430 DOI: 10.1210/jc.2010-2785] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
CONTEXT 18-Oxocortisol (18-oxoF) is a derivative of cortisol (F) that is produced by aldosterone synthase (CYP11B2). The potential for this steroid as a biomarker for differentiating patients with aldosterone-producing adenoma (APA) from those with idiopathic hyperaldosteronism (IHA) has not been examined. OBJECTIVES We measured 18-oxoF, aldosterone, and F in plasma from adrenal vein sampling (AVS) of patients with primary aldosteronism. We compared 18-oxoF levels and 18-oxoF/F ratios for their potential to differentiate APA from IHA. DESIGN, SETTING, AND SUBJECTS This study measured 18-oxoF, F, and aldosterone in AVS obtained from patients with unilateral APA (14 cases) or bilateral IHA (seven cases, 14 samples total) using liquid chromatography-tandem mass spectrometry and RIA analyses. RESULTS The levels of 18-oxoF and the ratios of 18-oxoF/F, before and after ACTH stimulation, were significantly higher in blood-draining APA than in those from the contralateral adrenal glands and from adrenal glands with IHA. CONCLUSIONS The 18-oxoF levels and ratios of 18-oxoF/F in AVS samples can be a clinically useful biomarker for differentiating APA from IHA and for determining the localization or lateralization of APA in patients with primary aldosteronism.
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Abstract
PURPOSE To explore the role of genetic association studies in risk assessment for common complex diseases. ORGANIZING FRAMEWORK An introduction to the types of genetic association studies is followed by a discussion of their potential use in risk assessment for age-related macular degeneration and type 2 diabetes mellitus. The benefits and limitations of this burgeoning technology are explored and related to nursing practice and scholarship. CONCLUSIONS Nurses in practice must be prepared to assist clients with decisions about seeking and interpreting results from genetic association studies and nurse researchers must apply current guidelines for conducting robust studies and applying the results of such studies in clinical practice. CLINICAL RELEVANCE Data collected from genetic association studies will increasingly be used to identify novel prevention and treatment strategies for many complex diseases. An understanding of the principles that underlie this new science is essential for nurses in all areas of clinical practice as they design, test, and implement appropriate intervention and prevention strategies based on genetic association studies.
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Khaleghi M, Kullo IJ. Genetic markers of vascular aging. Biomark Med 2007; 1:453-65. [PMID: 20477386 DOI: 10.2217/17520363.1.3.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Age is a powerful determinant of cardiovascular risk, being associated with a number of deleterious changes in the cardiovascular system. Increased arterial stiffness is an almost ubiquitous accompaniment of aging. However, there is significant variability in age-related arterial changes between individuals likely due, in part, to genetic factors. Measures of arterial stiffness such as pulse pressure and aortic pulse wave velocity have been shown to be heritable, indicating that genetic factors play a role in the interindividual variation of these phenotypes. Linkage analyses in related individuals have identified several genomic regions that may influence measures of arterial stiffness, and numerous association studies have investigated whether polymorphisms in candidate genes are related to this phenotype. Genome-wide association studies using 500,000 single nucleotide polymorphisms or more are now feasible and will accelerate the discovery of specific genetic polymorphisms that influence vascular aging/stiffness. Such findings will facilitate the development of novel therapies to retard vascular aging.
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Affiliation(s)
- Mahyar Khaleghi
- Mayo Clinic, Division of Cardiovascular Diseases, 200 First Street Southwest, Rochester, MN 55905, USA.
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Pojoga L, Kolatkar NS, Williams JS, Perlstein TS, Jeunemaitre X, Brown NJ, Hopkins PN, Raby BA, Williams GH. β-2 Adrenergic Receptor Diplotype Defines a Subset of Salt-Sensitive Hypertension. Hypertension 2006; 48:892-900. [PMID: 17015767 DOI: 10.1161/01.hyp.0000244688.45472.95] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Two genetic variants of the beta-2 adrenergic receptor, 46G>A and 79C>G, affect agonist-mediated receptor downregulation and vascular reactivity. We determined whether these variants were associated with hypertension, per se, blood pressure response to dietary sodium, 2 forms of salt-sensitive hypertension (low renin and nonmodulation), and the activity of the renin-angiotensin-aldosterone system. Included are 280 hypertensive and 65 normotensive white subjects who had the 2 beta-2 adrenergic receptor genotypes available. Of all subjects, 171 hypertensive and 48 normotensive subjects had complete data for intermediate phenotyping and blood pressure evaluation on high- and low-sodium balance. The beta-2 adrenergic receptor variants were not associated with hypertension per se. However, among hypertensive subjects, the change (from low to high sodium balance) in mean arterial pressure differed significantly by genotype and by diplotype. Compared with all of the other diplotypes combined, 46AA/79CC was associated with a greater change in blood pressure. Furthermore, this diplotype was associated with low-renin (LR) hypertension (identifying 32% of the LR hypertensives), higher plasma aldosterone, and lower plasma renin and serum potassium levels. In conclusion, the 46AA/79CC diplotype is associated with greater blood pressure response to dietary sodium and higher odds of LR hypertension. We propose that the mechanism for the observed association is inadequate suppression of aldosterone with salt intake, implicating the beta-2 adrenergic receptor in the regulation of aldosterone secretion. This hypothesis was confirmed in isolated glomerulosa cells, where beta-2 adrenergic receptor stimulation increased aldosterone secretion, whereas blockade reduced the stimulated aldosterone response. Importantly, this association could only be detected with an intermediate and not a distant phenotype.
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Affiliation(s)
- Luminita Pojoga
- Brigham and Women's Hospital, Division of Endocrinology, Diabetes, and Hypertension, 221 Longwood Ave, Boston, MA 02115, USA
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Hajek D, Kolar P, Maini PK, Starha P. Extracellular volume regulation and growth. Med Hypotheses 2004; 64:303-6. [PMID: 15607560 DOI: 10.1016/j.mehy.2004.06.026] [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: 05/25/2004] [Accepted: 06/02/2004] [Indexed: 10/26/2022]
Abstract
We have formalized extracellular and intracellular volume interaction with each other and the influence of these processes on the type of cell growth. The linearized model was verified by stereo metric solution and the results were compared with experimental data. Two theoretical solutions were found: Solution 1, extracellular volume (ECV) was calculated to be about 23% of total body volume (TV). Stereo metric solution suggested the cubic cell cluster formed by 8-cells. This hypothesis (Solution l) explains the ECV to be compatible with the widely accepted value (about 23% of TV). In addition, the 8-cell cluster hypothesis explains the existence of ECV oscillation with the period of about seven days. This hypothesis probably describes the dominant type of growth in humans. Solution 2, in this type of growth, ECV fills about 77% per cent of TV. Instead of the 8-cell cube, in this type of proliferation 4-cells could form a tetrahedron. This type of growth could be beneficial in processes where free space in tissue or organ must be filled for example in peptic ulcer healing and namely in repopulating of free space in a bone after high dose chemotherapy.
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Affiliation(s)
- Dobroslav Hajek
- Medical Faculty, Institute of Pathophysiology, Masaryk University, Komenskeho namesti 2, CZ 664 43, Brno, Czech Republic.
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Odunsi K, Kidd KK. A paradigm for finding genes for a complex human trait: polycystic ovary syndrome and follistatin. Proc Natl Acad Sci U S A 1999; 96:8315-7. [PMID: 10411866 PMCID: PMC33617 DOI: 10.1073/pnas.96.15.8315] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Szombathy T, Szalai C, Katalin B, Palicz T, Romics L, Császár A. Association of angiotensin II type 1 receptor polymorphism with resistant essential hypertension. Clin Chim Acta 1998; 269:91-100. [PMID: 9498106 DOI: 10.1016/s0009-8981(97)00184-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Angiotensin II type 1 receptor (AT1) mediates the vasoconstrictive and growth-promoting effect of angiotensin II in humans. It has been reported that a polymorphism of the AT1 gene (an A/C transversion at position 1166: A-C1166) occurs more frequently in resistant hypertensives taking two or more antihypertensive drugs. On the contrary, a recent study of the influence of the A-C1166 polymorphism on aortic stiffness demonstrated that the distribution of the genotypes did not differ between normotensive and hypertensive subjects. In addition, a recent population-based survey of Caucasian hypertensives reported lower blood pressure values in CC homozygotes than in heterozygotes and AA homozygotes. Because of these controversial results and the lack of a sufficient amount of data the present study was designed to assess the contribution of the AT, gene A-C1166 polymorphism to resistant essential hypertension. Forty-eight subjects with resistant essential hypertension (HT) and 48 normotensive (NT), age and sex-adjusted controls (from a population of 300 healthy blood donors) were selected. All subjects were genotyped for the A-C1166 polymorphism in the 3'-UTR of the AT1 gene using PCR-based techniques. The influence of genotype on blood pressure (BP) was investigated using ANOVA Randomized Complete Block (ANOVA RCB) design according to sex, age and BMI. There were no significant differences in allele or genotype frequencies between HT and NT subjects (X2 = 0.61; P = NS). In HT subjects higher values of systolic blood pressure were associated with the C allele of the AT1 gene only in older and overweight patients (P < 0.001 and P < 0.001, respectively). Also in HT patients an association between the presence of the C allele of the AT1 gene and higher values of diastolic blood pressure was present in overweight patients (P = 0.001). These results suggest that in resistant hypertensive subjects the AT1 A-C1166 polymorphism is potentially involved in the regulation of blood pressure. As the effects of genotypes on blood pressure are pronounced in older and overweight subjects this polymorphism may amplify the effects of age and BMI on resistant essential hypertension.
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Affiliation(s)
- T Szombathy
- Third Department of Medicine, Semmelweis University of Medicine, Budapest, Hungary
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Re RN. The application of molecular genetic techniques to the study of hypertensive diseases. Med Clin North Am 1997; 81:1099-112. [PMID: 9308600 DOI: 10.1016/s0025-7125(05)70569-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The techniques of modern molecular genetics are shedding new light on hypertension and its sequelae. This article discusses techniques which have identified genes associated with hypertension and have pointed the way toward identifying the full cohort of genes operative in all forms of human hypertension. These techniques have expanded understanding of the pathophysiology of hypertension as well as its prevention.
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Affiliation(s)
- R N Re
- Division of Research, Alton Ochsner Medical Foundation, New Orleans, Louisiana, USA
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Turner ST, Kardia SL. Relationship between renal plasma flow response to angiotensin II and blood pressure in a population-based sample. J Hypertens 1997; 15:495-502. [PMID: 9170001 DOI: 10.1097/00004872-199715050-00004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To assess whether interindividual variation in renal plasma flow or in its response to angiotensin II infusion is associated with interindividual differences in blood pressure in a population-based sample of 287 non-Hispanic whites (143 women and 144 men), aged 20-49.9 years. METHODS After seven days of eating a high-sodium diet (260 mmol/day), the renal plasma flow was determined by measuring the clearance of p-aminohippurate before and after infusion of 3 ng/kg per min angiotensin II. Multiple linear regression methods were used to assess whether measures of the renal plasma flow and of its response to angiotensin II infusion were predictive of systolic or diastolic blood pressures measured prior to administration of the high-sodium diet, on day 6 of the high-sodium diet, or during the renal clearance procedure on day 7 prior to angiotensin II infusion. RESULTS There was some evidence that measures of the renal plasma flow and of its response to angiotensin II infusion during the high-sodium diet were statistically significant predictors of measures of blood pressure in women; there was less evidence for this for blood pressures in men. Interindividual variation in measures of the renal plasma flow and of its response to angiotensin II infusion explained less than 10% of the interindividual variation in any measure of the blood pressure in both sexes. CONCLUSION These results suggest that interindividual variation in renal plasma flow ad in its response to angiotensin II infusion during a high-sodium diet will be of limited utility in elucidating the basis for interindividual differences in blood pressure.
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Affiliation(s)
- S T Turner
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
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Williams GH, Hollenberg NK, Hopkins PM, Jeunemaitre X. The role of intermediate phenotypes in essential hypertension: non-modulation as a model. Endocr Res 1996; 22:675-80. [PMID: 8969927 DOI: 10.1080/07435809609043762] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- G H Williams
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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Bromberg JE, Rinkel GJ, Algra A, van den Berg UA, Tjin-A-Ton ML, van Gijn J. Hypertension, stroke, and coronary heart disease in relatives of patients with subarachnoid hemorrhage. Stroke 1996; 27:7-9. [PMID: 8553407 DOI: 10.1161/01.str.27.1.7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND PURPOSE First-degree relatives of patients with subarachnoid hemorrhage (SAH) have a three to seven times greater risk of SAH than second-degree relatives and than the general population. If hypertension, which is in part genetically determined, contributes to this increased risk, the frequency of hypertension and its sequelae would be expected to be higher in first- than in second-degree relatives of patients with SAH. METHODS We compared the reported frequency of hypertension, stroke, and coronary heart disease between 1290 first- and 3588 second-degree relatives of a prospective series of patients with SAH. RESULTS The relative risk adjusted for age and survival status in first-degree relatives was 2.3 (95% confidence interval [CI], 1.9 to 2.9) for hypertension, 1.8 (95% CI, 1.3 to 2.4) for stroke, and 1.9 (95% CI, 1.5 to 2.3) for coronary heart disease. CONCLUSIONS Hypertension is a familial factor contributing to the risk of SAH. Hypertension should be sought and treated in first-degree relatives of patients with SAH to reduce the increased risk of cerebrovascular and cardiovascular diseases.
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Affiliation(s)
- J E Bromberg
- University Department of Neurology, Utrecht, Netherlands
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