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D’Elia L, Strazzullo P. Dietary Salt Restriction and Adherence to the Mediterranean Diet: A Single Way to Reduce Cardiovascular Risk? J Clin Med 2024; 13:486. [PMID: 38256620 PMCID: PMC10816989 DOI: 10.3390/jcm13020486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/08/2024] [Accepted: 01/13/2024] [Indexed: 01/24/2024] Open
Abstract
The dietary restriction of salt intake and the adhesion to Mediterranean dietary patterns are among the most recommended lifestyle modifications for the prevention of cardiovascular diseases. A large amount of evidence supports these recommendations; indeed, several studies show that a higher adherence to Mediterranean dietary patterns is associated with a reduced risk of cardiovascular disease. Likewise, findings from observational and clinical studies suggest a causal role of excess salt intake in blood pressure increase, cardiovascular organ damage, and the incidence of cardiovascular diseases. In this context, it is also conceivable that the beneficial effects of these two dietary patterns overlap because Mediterranean dietary patterns are typically characterized by a large consumption of plant-based foods with low sodium content. However, there is little data on this issue, and heterogeneous results are available on the relationship between adherence to salt restriction and to Mediterranean dietary patterns. Thus, this short review focuses on the epidemiological and clinical evidence of the relationship between the adherence to Mediterranean dietary patterns and dietary salt restriction in the context of cardiovascular risk.
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Affiliation(s)
| | - Pasquale Strazzullo
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples Medical School, 80131 Naples, Italy;
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Chen Z, Qi L, Wang J, Nie K, Peng X, Chen L, Xia L. Research trends and hotpots on the relationship between high salt and hypertension: A bibliometric and visualized analysis. Medicine (Baltimore) 2023; 102:e35492. [PMID: 37832093 PMCID: PMC10578769 DOI: 10.1097/md.0000000000035492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/13/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION A high salt diet is a significant risk factor for hypertension, and scholarly investigations into this relationship have garnered considerable attention worldwide. However, bibliometric analyses in this field remain underdeveloped. This study aimed to conduct a bibliometric and visual analysis of research progress on the link between high salt and hypertension from 2011 to 2022 with the goal of identifying future research trends and providing valuable insights for this field. METHODS High salt and hypertension data were obtained from the Web of Science Core Collection database. Microsoft Excel, Scimago Graphica, CiteSpace, and VOSviewer software were employed to analyze publication output trends, the most productive countries or regions, journals, authors, co-cited references, and keywords. RESULTS After screening, 1470 papers met the inclusion criteria. Relevant publications increased annually by 3.66% from 2011 to 2022. The United States led in research productivity, with The Journal of Hypertension publishing the most papers, and David L. Mattson as the most prolific author. Oxidative stress has emerged as a prominent research topic, and extensive investigations have been conducted on related mechanisms. "Oxidative stress," "gut microbiota," and "kidney injury" are recent hotspots that are expected to remain so, and this study carefully characterizes the mechanism of high salt-induced hypertension based on these hotspots. CONCLUSION This study utilized bibliometric and visualization analysis to identify the development trends and hotspots of publications related to high salt and hypertension. The findings of this study offer valuable insights into the forefront of emerging trends and future directions in this field.
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Affiliation(s)
- Zhixuan Chen
- State Administration of Traditional Chinese Medicine, Key Laboratory of Traditional Chinese Medicine Regimen and Health, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Key Laboratory of Traditional Chinese Medicine Regimen and Health of Sichuan Province, Chengdu, Sichuan, China
| | - Luming Qi
- State Administration of Traditional Chinese Medicine, Key Laboratory of Traditional Chinese Medicine Regimen and Health, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Key Laboratory of Traditional Chinese Medicine Regimen and Health of Sichuan Province, Chengdu, Sichuan, China
| | - Jie Wang
- State Administration of Traditional Chinese Medicine, Key Laboratory of Traditional Chinese Medicine Regimen and Health, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Key Laboratory of Traditional Chinese Medicine Regimen and Health of Sichuan Province, Chengdu, Sichuan, China
| | - Kaidi Nie
- State Administration of Traditional Chinese Medicine, Key Laboratory of Traditional Chinese Medicine Regimen and Health, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Key Laboratory of Traditional Chinese Medicine Regimen and Health of Sichuan Province, Chengdu, Sichuan, China
| | - Xile Peng
- State Administration of Traditional Chinese Medicine, Key Laboratory of Traditional Chinese Medicine Regimen and Health, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Key Laboratory of Traditional Chinese Medicine Regimen and Health of Sichuan Province, Chengdu, Sichuan, China
| | - Li Chen
- State Administration of Traditional Chinese Medicine, Key Laboratory of Traditional Chinese Medicine Regimen and Health, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Key Laboratory of Traditional Chinese Medicine Regimen and Health of Sichuan Province, Chengdu, Sichuan, China
| | - Lina Xia
- State Administration of Traditional Chinese Medicine, Key Laboratory of Traditional Chinese Medicine Regimen and Health, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Key Laboratory of Traditional Chinese Medicine Regimen and Health of Sichuan Province, Chengdu, Sichuan, China
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Cardiovascular Disease in Obstructive Sleep Apnea: Putative Contributions of Mineralocorticoid Receptors. Int J Mol Sci 2023; 24:ijms24032245. [PMID: 36768567 PMCID: PMC9916750 DOI: 10.3390/ijms24032245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/12/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a chronic and highly prevalent condition that is associated with oxidative stress, inflammation, and fibrosis, leading to endothelial dysfunction, arterial stiffness, and vascular insulin resistance, resulting in increased cardiovascular disease and overall mortality rates. To date, OSA remains vastly underdiagnosed and undertreated, with conventional treatments yielding relatively discouraging results for improving cardiovascular outcomes in OSA patients. As such, a better mechanistic understanding of OSA-associated cardiovascular disease (CVD) and the development of novel adjuvant therapeutic targets are critically needed. It is well-established that inappropriate mineralocorticoid receptor (MR) activation in cardiovascular tissues plays a causal role in a multitude of CVD states. Clinical studies and experimental models of OSA lead to increased secretion of the MR ligand aldosterone and excessive MR activation. Furthermore, MR activation has been associated with worsened OSA prognosis. Despite these documented relationships, there have been no studies exploring the causal involvement of MR signaling in OSA-associated CVD. Further, scarce clinical studies have exclusively assessed the beneficial role of MR antagonists for the treatment of systemic hypertension commonly associated with OSA. Here, we provide a comprehensive overview of overlapping mechanistic pathways recruited in the context of MR activation- and OSA-induced CVD and propose MR-targeted therapy as a potential avenue to abrogate the deleterious cardiovascular consequences of OSA.
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Ertuglu LA, Laffer CL, Kirabo A. In Memoriam: Fernando Elijovich. Hypertension 2023; 80:e1-e3. [PMID: 36475860 DOI: 10.1161/hypertensionaha.122.20541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Lale A Ertuglu
- Division of Nephrology, Department of Medicine (L.A.E.), Vanderbilt University Medical Center, Nashville, TN
| | - Cheryl L Laffer
- Division of Clinical Pharmacology, Department of Medicine (C.L.L., A.K.), Vanderbilt University Medical Center, Nashville, TN
| | - Annet Kirabo
- Division of Clinical Pharmacology, Department of Medicine (C.L.L., A.K.), Vanderbilt University Medical Center, Nashville, TN
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Abstract
Isolated systolic hypertension is associated with higher risk of cardiovascular disease and all-cause mortality. Despite being the most common form of hypertension in the elderly, it is also detectable among young and middle-aged subjects. Dietary salt (sodium chloride) intake is an important determinant of blood pressure, and high salt intake is associated with greater risk of hypertension and cardiovascular events. In most countries, habitual salt intake at all age categories largely exceeds the international recommendations. Excess salt intake, often interacting with overweight and insulin resistance, may contribute to the development and maintenance of isolated systolic hypertension in young individuals by causing endothelial dysfunction and promoting arterial stiffness through a number of mechanisms, namely increase in the renin-angiotensin-aldosterone system activity, sympathetic tone and salt-sensitivity. This short review focused on the epidemiological and clinical evidence, the mechanistic pathways and the cluster of pathophysiological factors whereby excess salt intake may favor the development and maintenance of isolated systolic hypertension in young people.
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Affiliation(s)
- Lanfranco D'Elia
- Medical School, Department of Clinical Medicine and Surgery, ESH Excellence Center of Hypertension, University of Naples Federico II, Naples, Italy
| | - Pasquale Strazzullo
- Medical School, Department of Clinical Medicine and Surgery, ESH Excellence Center of Hypertension, University of Naples Federico II, Naples, Italy -
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Pathare G, Raju S, Mashru M, Shah V, Shalia K. Gene expression of klotho & antioxidative enzymes in peripheral blood mononuclear cells of essential hypertension patients in Indian population. Indian J Med Res 2021; 152:607-613. [PMID: 34145100 PMCID: PMC8224152 DOI: 10.4103/ijmr.ijmr_2112_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background & objectives: Oxidative stress is known to have a causal role in hypertension. Klotho has emerged as a novel anti-aging molecule to inhibit oxidative stress at cellular level. This study aimed at evaluating the gene expression of klotho and antioxidative enzymes, manganese superoxide dismutase (Mn-SOD) and catalase, in peripheral blood mononuclear cells of essential hypertensive patients as compared to normotensive healthy controls. Methods: Ninety-nine newly diagnosed hypertensives and 103 age- and BMI-matched controls were recruited. The participants were non-diabetic and not on any medication. Soluble α-klotho levels were detected using enzyme-linked immunosorbent assay. Gene expression was evaluated by quantitative real-time polymerase chain reaction. Results: Soluble α-klotho levels were significantly lower (27%, P=0.001) in patients as compared to controls. The trend remained same when compared against 44 out of 103 controls considered for gene expression analysis. Relative gene expression of klotho and catalase were 3-fold and 1.25-fold lower in patients as compared to controls, respectively. ΔCt value-based gene expression were also significantly lower for both genes (P=0.001). A decreasing but non-significant trend was observed for Mn-SOD gene expression. ΔCt value-based gene expression of catalase positively correlated with that of Mn-SOD in patient (rs=0.448) and control (rs=0.547) groups (P<0.001). In patients, the gene expression of Klotho positively correlated with that of catalase (rs=0.498, P=0.001), but not Mn-SOD (rs=0.155, P=0.126). Interpretation & conclusions: In the present study on newly diagnosed hypertensives, klotho and catalase gene expression were found to be significantly lower as compared to controls, indicating the role of oxidative stress in this patient group. In addition, a significant correlation between Klotho and catalase gene expression suggests a role for klotho in essential hypertension with respect to antioxidant defence.
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Affiliation(s)
- Gauri Pathare
- Department of Biochemistry, Sir H.N. Medical Research Society, Mumbai, Maharashtra, India
| | - Sunila Raju
- Department of Biochemistry, Sir H.N. Medical Research Society, Mumbai, Maharashtra, India
| | - Manoj Mashru
- Department of Cardiology, Sir H.N. Reliance Foundation Hospital & Research Center, Mumbai, Maharashtra, India
| | - Vinod Shah
- Department of Cardiology, Sir H.N. Reliance Foundation Hospital & Research Center, Mumbai, Maharashtra, India
| | - Kavita Shalia
- Department of Biochemistry, Sir H.N. Medical Research Society, Mumbai, Maharashtra, India
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Reina-Couto M, Afonso J, Carvalho J, Morgado L, Ronchi FA, de Oliveira Leite AP, Dias CC, Casarini DE, Bettencourt P, Albino-Teixeira A, Morato M, Sousa T. Interrelationship between renin-angiotensin-aldosterone system and oxidative stress in chronic heart failure patients with or without renal impairment. Biomed Pharmacother 2021; 133:110938. [DOI: 10.1016/j.biopha.2020.110938] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 10/18/2020] [Accepted: 10/24/2020] [Indexed: 12/22/2022] Open
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Pirouzeh R, Heidarzadeh-Esfahani N, Morvaridzadeh M, Izadi A, Yosaee S, Potter E, Heshmati J, Pizarro AB, Omidi A, Heshmati S. Effect of DASH diet on oxidative stress parameters: A systematic review and meta-analysis of randomized clinical trials. Diabetes Metab Syndr 2020; 14:2131-2138. [PMID: 33395773 DOI: 10.1016/j.dsx.2020.10.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/27/2020] [Accepted: 10/31/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIMS Oxidative stress (OS) is one of the main risk factors for several chronic diseases. The Dietary Approaches to Stop Hypertension (DASH) contain many antioxidants and may contribute to managing OS. OBJECTIVE To perform a systematic review and meta-analysis to examine the impacts of the DASH diet on OS parameters. METHODS A comprehensive electronic search in MEDLINE, Scopus, EMBASE, and the Cochrane Central Register of Controlled Trials was performed through September 2020 to find related studies evaluating the impact of the DASH diet on OS parameters. Standardized mean differences were pooled using random-effects meta-analysis. RESULTS Eight studies with a total of 317 subjects met our inclusion criteria. Four studies included in meta-analysis model with 200 participants (100 in treatment and 100 in control group). The DASH diet was associated with a statistically significant decrease in malondialdehyde (MDA) (SMD: -0.53; 95% CI: -0.89, -0.16; I2 = 42.1%), and a significant increase in glutathione (GSH) (SMD: 0.83; 95% CI: 0.36, 1.03; I2 = 42.1%). Meta-analysis found no statistically significant effect of DASH diet on nitric oxide (NO) (SMD: -1.40; 95% CI: -0.12, 1.93; I2 = 92.6%) or total antioxidant capacity (TAC) levels (SMD: 0.95; 95% CI: -0.10, 1.99; I2 = 87.6%). CONCLUSION Our results demonstrated that a DASH diet could significantly increase GSH and decrease MDA levels. Furthermore, there is a trend to improve TAC, NO, and f2-isoprostanes by the adherence to the DASH diet. However, long-term, large sample size and well-designed randomized clinical trials are still needed to draw concrete conclusions about DASH diet's effects on OS parameters.
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Affiliation(s)
- Razieh Pirouzeh
- Department of Education and Health Promotion, School of Health, Iran University of Medical Sciences, Tehran, Iran.
| | - Neda Heidarzadeh-Esfahani
- Department of Nutritional Science, School of Nutritional Science and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Mojgan Morvaridzadeh
- Department of Nutritional Science, School of Nutritional Science and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Azimeh Izadi
- Department of Biochemistry and Diet therapy, Faculty of Nutrition and Food sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Somaye Yosaee
- Department of Nutrition, School of Health, Larestan University of Medical Sciences, Larestan, Iran.
| | - Eric Potter
- Baylor Scott & White Research Institute, Dallas, TX, USA.
| | - Javad Heshmati
- Department of Nutritional Science, School of Nutritional Science and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | | | - Amirhosein Omidi
- Department of Nutritional Science, School of Nutritional Science and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shilan Heshmati
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology, Research Institute Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Kazmi I, Al-Maliki WH, Ali H, Al-Abbasi FA. Biochemical interaction of salt sensitivity: a key player for the development of essential hypertension. Mol Cell Biochem 2020; 476:767-773. [PMID: 33070283 DOI: 10.1007/s11010-020-03942-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/09/2020] [Indexed: 12/15/2022]
Abstract
Worldwide, more than 1 billion people have elevated blood pressure, with up to 45% of adults affected by the disease. In 2016 the global health study report on patients from 67 countries was released in Lancet, which identified hypertension as the world's leading cause for death and disability-adjusted years since 1990. This paper aims to analyze the pathophysiological connection between hemodynamic inflammatory reactions through sodium balance, salt sensitivity, and potential pathophysiological reactions. Besides, we explore how sodium consumption enhances the expression of transient receptor potential channel 3 (TrpC3) mRNA and facilitates the release of calcium inside immune cell groups, together with elevated blood pressure in essential hypertensive patients.
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Affiliation(s)
- Imran Kazmi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Waleed Hassan Al-Maliki
- Department of Pharmacology, College of Pharmacy, Umm Al Qura University, Mecca, Saudi Arabia
| | - Haider Ali
- Faculty of Medicine, Ala-Too International University, 720048, Bishkek, Kyrgyzstan
| | - Fahad A Al-Abbasi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
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Verma MK, Jaiswal A, Sharma P, Kumar P, Singh AN. Oxidative stress and biomarker of TNF-α, MDA and FRAP in hypertension. J Med Life 2019; 12:253-259. [PMID: 31666827 PMCID: PMC6814874 DOI: 10.25122/jml-2019-0031] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Concurrent with the misbalance of oxidizing agents and antioxidants, high blood pressure is a major physical burden condition in the current scenario. Tumor necrosis factor-α (TNF-α) plays a vital role in the pathogenesis of hypertension. Tumor necrosis factor-α, inhibitor improves clinical symptoms however their outcome on high blood pressure has not been investigated. We investigated the inflammatory marker TNF-α, malondialdehyde (MDA) and ferric reducing antioxidant power (FRAP) in hypertensive patients. We measured randomly blood pressure using an ambulatory observe in hypertensive patients, measured systolic BP X 140 mmHg and/or diastolic BP X 90 mmHg were considered hypertensive. Total 60 cases were considered in the study that involves 30 hypertensive patients and 30 normal control. Measurements of serum concentrations of TNF-α, MDA, FRAP in hypertension patients was done in both the groups. Serum TNF-α was found to be remarkably increased in study subjects as compared to normal group (r=0.32, p<0.0001*). Serum MDA was also raised in hypertensive as compared to control (r=0.99**, p<0.0001*). While Serum FRAP was found to be decreased in hypertensive group in comparison to healthy control (r=0.23, p<0.0001*). It is concluded that high blood pressure leads to generation of oxidative stress with remarkable elevation of TNF-α and malondialdehyde levels. While reduced FRAP indicates its probable role in lipid peroxidation and in the pathogenesis of hypertension.
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Affiliation(s)
| | - Anoop Jaiswal
- Department of Biochemistry, Moti Lal Nehru Medical College, Allahabad, India
| | - Preeti Sharma
- Department of Biochemistry, Santosh Medical College and Hospital (Santosh University), Ghaziabad, India
| | - Pradeep Kumar
- Department of Biochemistry, Santosh Medical College and Hospital (Santosh University), Ghaziabad, India
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Singh A, Verma M, Jaiswal A, Sharma P, Kumar P. Oxidative stress and biomarker of tumor necrosis factor-alpha, malondialdehyde, and ferric reducing antioxidant power in hypertension. ACTA MEDICA INTERNATIONAL 2019. [DOI: 10.4103/ami.ami_34_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kurtz TW, DiCarlo SE, Pravenec M, Morris RC. An Appraisal of Methods Recently Recommended for Testing Salt Sensitivity of Blood Pressure. J Am Heart Assoc 2017; 6:JAHA.117.005653. [PMID: 28365569 PMCID: PMC5533040 DOI: 10.1161/jaha.117.005653] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Theodore W Kurtz
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA
| | | | - Michal Pravenec
- Institute of Physiology, Academy of Sciences of the Czech Republic, Prague, Czech Republic
| | - R Curtis Morris
- Department of Medicine, University of California, San Francisco, San Francisco, CA
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Elijovich F, Weinberger MH, Anderson CAM, Appel LJ, Bursztyn M, Cook NR, Dart RA, Newton-Cheh CH, Sacks FM, Laffer CL. Salt Sensitivity of Blood Pressure: A Scientific Statement From the American Heart Association. Hypertension 2016; 68:e7-e46. [PMID: 27443572 DOI: 10.1161/hyp.0000000000000047] [Citation(s) in RCA: 337] [Impact Index Per Article: 42.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Tangvarasittichai S. Oxidative stress, insulin resistance, dyslipidemia and type 2 diabetes mellitus. World J Diabetes 2015; 6:456-480. [PMID: 25897356 PMCID: PMC4398902 DOI: 10.4239/wjd.v6.i3.456] [Citation(s) in RCA: 701] [Impact Index Per Article: 77.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 11/21/2014] [Accepted: 01/12/2015] [Indexed: 02/05/2023] Open
Abstract
Oxidative stress is increased in metabolic syndrome and type 2 diabetes mellitus (T2DM) and this appears to underlie the development of cardiovascular disease, T2DM and diabetic complications. Increased oxidative stress appears to be a deleterious factor leading to insulin resistance, dyslipidemia, β-cell dysfunction, impaired glucose tolerance and ultimately leading to T2DM. Chronic oxidative stress, hyperglycemia and dyslipidemia are particularly dangerous for β-cells from lowest levels of antioxidant, have high oxidative energy requirements, decrease the gene expression of key β-cell genes and induce cell death. If β-cell functioning is impaired, it results in an under production of insulin, impairs glucose stimulated insulin secretion, fasting hyperglycemia and eventually the development of T2DM.
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Abstract
The role of sympathetic nerve activity in hypertension is currently receiving increased attention, because catheter-based renal denervation was recently shown to reduce blood pressure safely in patients with treatment-resistant hypertension. The central nervous system, which regulates sympathetic nerve activity and blood pressure, is pivotal. Central sympathoexcitation has been shown to be deeply involved in the pathogenesis of salt-sensitive hypertension, although its precise mechanisms have not yet been fully elucidated due to their complexity. Recently, a role for brain oxidative stress in sympathoexcitation has been suggested in some hypertensive animal models. We have demonstrated that increased brain oxidative stress may elevate arterial pressure through central sympathoexcitation in salt-sensitive hypertension. Several factors other than oxidative stress have also been shown to play important roles in central sympathetic activation. In the future, strategies may be developed to elicit a sympathetic inhibition by modulating these factors to prevent and manage salt-sensitive hypertension.
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Affiliation(s)
- Megumi Fujita
- Department of Nephrology and Endocrinology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
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Konerman MC, Hummel SL. Sodium restriction in heart failure: benefit or harm? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:286. [PMID: 24398803 DOI: 10.1007/s11936-013-0286-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OPINION STATEMENT Current guidelines vary in the recommended amount of dietary sodium intake for heart failure (HF) patients. Observational studies and the hypertension literature support the concept that sodium restriction improves HF outcomes. In contrast, several randomized controlled trials imply that dietary sodium restriction can cause harm through hypovolemia and increased neurohormonal activation. Data from hypertensive animal models and humans suggest that dietary sodium intake may need to be individually tailored based on HF severity and the physiologic response to sodium loading. Future studies must assess interactions between sodium intake, fluid intake, and diuretics to match clinical practice and improve safety. More information is needed in multiple areas, including accurate measurement of sodium intake, implementation of dietary changes in HF patients, and establishment of biomarkers that predict response to changes in sodium intake. Additional research is urgently needed to determine the true impact of the most commonly recommended self-care strategy in HF.
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Affiliation(s)
- Matthew C Konerman
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
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Impact of ramadan intermittent fasting on oxidative stress measured by urinary 15-f(2t)-isoprostane. J Nutr Metab 2012; 2012:802924. [PMID: 23150812 PMCID: PMC3485525 DOI: 10.1155/2012/802924] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Revised: 09/05/2012] [Accepted: 09/23/2012] [Indexed: 11/28/2022] Open
Abstract
Fasting and caloric restriction have been associated with reduced incidence of chronic diseases and cancers. These effects have been attributed to reduced oxidative stress. Since Ramadan intermittent fasting (RIF) has been associated with reduced caloric intake, it was hypothesized that RIF would alleviate oxidative stress in healthy volunteers. The study was designed to elucidate the impact of RIF on oxidative stress measured by 15-F2t-Isoprostane (15FIP). Fifty healthy subjects (23 men and 27 women) who intended to
fast Ramadan were recruited. Urine and serum sampling and anthropometric and dietary assessments were conducted one week before Ramadan (T0), at the end of the third week of Ramadan (T1), and one month after Ramadan (T2). Biochemical measurements included urinary 15FIP, creatinine, and hematological indices. Results revealed that the urinary level of 15FIP measured at T0 was normal, while they showed a significantly (P < 0.05) higher level when measured at T1 concomitant with a significant (P < 0.05) increase in the body weight and total body fat percent. In conclusion, results suggest that increased body weight is associated with increased lipid peroxidation and oxidative stress, and the impact of RIF on oxidative stress is mediated by the changes in body weight at the end of the month.
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Hummel SL, Seymour EM, Brook RD, Kolias TJ, Sheth SS, Rosenblum HR, Wells JM, Weder AB. Low-sodium dietary approaches to stop hypertension diet reduces blood pressure, arterial stiffness, and oxidative stress in hypertensive heart failure with preserved ejection fraction. Hypertension 2012; 60:1200-6. [PMID: 23033371 DOI: 10.1161/hypertensionaha.112.202705] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Recent studies suggest that oxidative stress and vascular dysfunction contribute to heart failure with preserved ejection fraction (HFPEF). In salt-sensitive HFPEF animal models, diets low in sodium and high in potassium, calcium, magnesium, and antioxidants attenuate oxidative stress and cardiovascular damage. We hypothesized that the sodium-restricted Dietary Approaches to Stop Hypertension diet (DASH/SRD) would have similar effects in human hypertensive HFPEF. Thirteen patients with treated hypertension and compensated HFPEF consumed the DASH/SRD for 21 days (all food/most beverages provided). The DASH/SRD reduced clinic systolic (155-138 mm Hg; P=0.02) and diastolic blood pressure (79-72 mm Hg; P=0.04), 24-hour ambulatory systolic (130-123 mm Hg; P=0.02) and diastolic blood pressure (67-62 mm Hg; P=0.02), and carotid-femoral pulse wave velocity (12.4-11.0 m/s; P=0.03). Urinary F2-isoprostanes decreased by 31% (209-144 pmol/mmol Cr; P=0.02) despite increased urinary aldosterone excretion. The reduction in urinary F2-isoprostanes closely correlated with the reduction in urinary sodium excretion on the DASH/SRD. In this cohort of HFPEF patients with treated hypertension, the DASH/SRD reduced systemic blood pressure, arterial stiffness, and oxidative stress. These findings are characteristic of salt-sensitive hypertension, a phenotype present in many HFPEF animal models and suggest shared pathophysiological mechanisms linking these 2 conditions. Further dietary modification studies could provide insights into the development and progression of hypertensive HFPEF.
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Affiliation(s)
- Scott L Hummel
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, 1500 East Medical Center Dr, CVC Room 2383, SPC 5853, Ann Arbor, MI 48109, USA.
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Queisser N, Schupp N. Aldosterone, oxidative stress, and NF-κB activation in hypertension-related cardiovascular and renal diseases. Free Radic Biol Med 2012; 53:314-27. [PMID: 22609249 DOI: 10.1016/j.freeradbiomed.2012.05.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 05/07/2012] [Accepted: 05/07/2012] [Indexed: 02/07/2023]
Abstract
The mineralocorticoid aldosterone regulates electrolyte and fluid balance and is involved in blood pressure homoeostasis. Classically, it binds to its intracellular mineralocorticoid receptor to induce expression of proteins influencing the reabsorption of sodium and water in the distal nephron. Aldosterone gained special attention when large clinical studies showed that blocking its receptor in patients with cardiovascular diseases reduced their mortality. These patients present increased plasma aldosterone levels. The exact mechanisms of the potential toxic effects of aldosterone leading to cardiovascular damage are not known yet. The observation of reduced nitric oxide bioavailability in hyperaldosteronism implied the generation of oxidative stress by aldosterone. Subsequent studies confirmed the increase of oxidative stress markers in patients with chronic heart failure and in animal models of hyperaldosteronism. The effects of reactive oxygen species have been related to the activation of transcription factors, such as NF-κB. This review summarizes the present-day knowledge of aldosterone-induced oxidative stress and NF-κB activation in humans and different experimental models.
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Affiliation(s)
- Nina Queisser
- Institute of Pharmacology and Toxicology, University of Würzburg, Versbacher Str. 9, 97078 Würzburg, Germany
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21
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Piecha G, Koleganova N, Ritz E, Müller A, Fedorova OV, Bagrov AY, Lutz D, Schirmacher P, Gross-Weissmann ML. High salt intake causes adverse fetal programming--vascular effects beyond blood pressure. Nephrol Dial Transplant 2012; 27:3464-76. [PMID: 22431707 DOI: 10.1093/ndt/gfs027] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND High salt intake causes hypertension, adverse cardiovascular outcomes and potentially also blood pressure (BP)-independent target organ damage. Excess salt intake in pregnancy is known to affect BP in the offspring. The present study was designed to assess whether high salt intake in pregnancy affects BP and vascular morphology in the offspring. METHODS Sprague-Dawley rats were fed a standard rodent diet with low-normal (0.15%) or high (8.0%) salt content during pregnancy and lactation. After weaning at 4 weeks of age, offspring were maintained on the same diet or switched to a high- or low-salt diet, respectively. Vascular geometry was assessed in male offspring at 7 and 12 weeks postnatally. RESULTS Up to 12 weeks of age, there was no significant difference in telemetrically measured BP between the groups of offspring. At 12 weeks of age, wall thickness of central (aorta, carotid), muscular (mesenteric) and intrapulmonary arteries was significantly higher in offspring of mothers on a high-salt diet irrespective of the post-weaning diet. This correlated with increased fibrosis of the aortic wall, more intense nitrotyrosine staining as well as elevated levels of marinobufagenin (MBG) and asymmetric dimethyl arginine (ADMA). CONCLUSIONS High salt intake in pregnant rats has long-lasting effects on the modeling of central and muscular arteries in the offspring independent of postnatal salt intake and BP. Circulating MBG and ADMA and local oxidative stress correlate with the adverse vascular modeling.
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Affiliation(s)
- Grzegorz Piecha
- Department of Internal Medicine, University of Heidelberg, Heidelberg, Germany.
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22
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Nichols J, Elijovich F, Laffer CL. Lack of validation of a same-day outpatient protocol for determination of salt sensitivity of blood pressure. Hypertension 2011; 59:390-4. [PMID: 22184320 DOI: 10.1161/hypertensionaha.111.185835] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Salt sensitivity of blood pressure has been studied in humans with a 48-hour inpatient protocol of salt loading and depletion or with longer outpatient protocols using high- and low-salt diets. Results have been reproducible, but both methods are laborious and costly. A 6-hour protocol of intravenous salt loading and furosemide has been reported but never validated. We studied 14 normal volunteers (39±2 years old; 86% women and 21% black) with the inpatient and 6-hour protocols, separated by 30 days. Four subjects (29%) were salt sensitive in the inpatient protocol. They had higher systolic blood pressure, higher body mass index, and somewhat lower plasma renin activity than salt-resistant subjects. Baseline systolic blood pressure before both protocols was highly reproducible (r=0.90; P<0.0001; limits of agreement: +6.2 to -8.0 mm Hg), whereas the response to salt depletion was not (r=0.09). Three salt-sensitive and 4 salt-resistant subjects were misclassified by the short protocol. Three-hour natriuresis by furosemide in the short protocol (344±15 mmol) was not different from the 12-hour natriuresis in the inpatient protocol (357±19). However, stimulation of plasma renin activity and aldosterone was significantly less in the short (+0.10±0.07 ngA(I)/L/sec and -61±44 pmol/L) than in the inpatient protocol (+1.80±0.60 ngA(I)/L/sec and +256±88 pmol/L; P<0.03 for both). Activation of hormonal changes that regulate depressor responses to salt depletion may not have occurred with the 3-hour natriuresis of the short protocol. This methodology cannot be used to study salt sensitivity of blood pressure, because the phenotype, mechanisms, and prognosis of the latter have been defined with the inpatient protocol.
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Affiliation(s)
- JoAnn Nichols
- Texas A&M Health Science Center College of Medicine, 2401 South 31st St, Temple, TX 76508, USA
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Fujita M, Ando K, Kawarazaki H, Kawarasaki C, Muraoka K, Ohtsu H, Shimizu H, Fujita T. Sympathoexcitation by brain oxidative stress mediates arterial pressure elevation in salt-induced chronic kidney disease. Hypertension 2011; 59:105-12. [PMID: 22083162 DOI: 10.1161/hypertensionaha.111.182923] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hypertension is very prevalent in chronic kidney disease and critical for its prognosis. Sympathoexcitation and oxidative stress have been demonstrated to be involved in chronic kidney disease. We have shown previously that sympathoexcitation by brain oxidative stress mediates arterial pressure elevation in the salt-sensitive hypertension model, Dahl salt-sensitive rats. Thus, we investigated whether sympathoexcitation by excessive brain oxidative stress could contribute to arterial pressure elevation in salt-induced chronic kidney disease model rats. Young (3-week-old) male Sprague-Dawley rats were randomly assigned to a uninephrectomy or sham operation and then subjected to either a normal salt (0.5%) or high-salt (8.0%) diet for 4 weeks. The young salt-loaded uninephrectomized rats exhibited sympathoexcitation, hypertension, and renal injury, proteinuria and global glomerulosclerosis together with tubulointerstitial damage. Under urethane anesthesia and artificial ventilation, renal sympathetic nerve activity, arterial pressure, and heart rate decreased to a greater degree in the salt-loaded uninephrectomized rats than in the nonsalt-loaded uninephrectomized rats and the salt-loaded or nonsalt-loaded sham-operated rats, when Tempol, a membrane-permeable superoxide dismutase mimetic, was infused acutely into the lateral cerebral ventricle. Oxidative stress in the hypothalamus, measured by lucigenin chemiluminescence, was also significantly greater. Furthermore, in the salt-loaded uninephrectomized rats, antioxidant treatment with chronic intracerebroventricular Tempol decreased sympathetic nerve activity and arterial pressure, which, in turn, led to a decrease in renal damage. Similar effects were elicited by treatment with oral moxonidine, the central sympatholytic agent. In conclusion, sympathoexcitation by brain oxidative stress may mediate arterial pressure elevation in salt-induced chronic kidney disease.
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Affiliation(s)
- Megumi Fujita
- Department of Nephrology and Endocrinology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
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24
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Abstract
It is currently accepted that hypertension, atherosclerosis, and diabetes are disorders with subtle or overt activation of inflammatory mediators. Therefore, it has become increasingly important to ascertain whether current antihypertensive drug families have proinflammatory or anti-inflammatory actions that modify the outcomes of their hemodynamic effects on blood pressure. We review the current state of knowledge about the effects of the major classes of available antihypertensive agents on inflammation and speculate on the possible contribution of these effects to observations in clinical trials. We suggest that a strategy of drug development specifically addressing inflammation in hypertension may provide increased benefit in terms of target organ damage, and we describe some examples of these promising developments.
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Abstract
The epithelial sodium channel (ENaC) is a heteromeric channel composed of three similar but distinct subunits, α, β and γ. This channel is an end-effector in the rennin-angiotensin-aldosterone system and resides in the apical plasma membrane of the renal cortical collecting ducts, where reabsorption of Na(+) through ENaC is the final renal adjustment step for Na(+) balance. Because of its regulation and function, the ENaC plays a critical role in modulating the homeostasis of Na(+) and thus chronic blood pressure. The development of most forms of hypertension requires an increase in Na(+) and water retention. The role of ENaC in developing high blood pressure is exemplified in the gain-of-function mutations in ENaC that cause Liddle's syndrome, a severe but rare form of inheritable hypertension. The evidence obtained from studies using animal models and in human patients indicates that improper Na(+) retention by the kidney elevates blood pressure and induces salt-sensitive hypertension.
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Ilhan S, Oktar S, Sahna E, Aksulu HE. Salt and Nitric Oxide Inhibition Induced Hypertension: The Role of Prostacycline and 8-Isoprostane. Clin Exp Hypertens 2011; 33:84-8. [DOI: 10.3109/10641963.2010.503305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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de Cavanagh EMV, Ferder LF, Ferder MD, Stella IY, Toblli JE, Inserra F. Vascular structure and oxidative stress in salt-loaded spontaneously hypertensive rats: effects of losartan and atenolol. Am J Hypertens 2010; 23:1318-25. [PMID: 20706197 DOI: 10.1038/ajh.2010.167] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Renin-angiotensin system (RAS) modulation by high dietary sodium may contribute to salt-induced hypertension, oxidative stress, and target organ damage. We investigated whether angiotensin II (Ang-II) type 1 (AT1)-receptor blockade (losartan) could protect the aorta and renal arteries from combined hypertension- and high dietary salt-related oxidative stress. METHODS Spontaneously hypertensive rats (3-month-old, n = 10/group) received tap water (SHR), water containing 1.5% NaCl (SHR+S), 1.5% NaCl and 30 mg losartan/kg/day (SHR+S+L), or 50 mg atenolol/kg/day (SHR+S+A). Atenolol was used for comparison. Ten Wistar-Kyoto rats (WKY) were controls. Systolic blood pressure (SBP) was determined by tail plethysmography. After 5 months of treatment, vascular remodeling and oxidative stress (superoxide production and NAD(P)H-oxidase activity (chemiluminescence), malondialdehyde (MDA) content (high-performance liquid chromatography), endothelial nitric oxide synthase (eNOS) activity [(14)C-arginine to (14)C citrulline], CuZn-SOD activity (spectrophotometry)) were studied. RESULTS In SHR, salt-loading significantly aggravated hypertension, urinary protein excretion, intraparenchymal renal artery (IPRArt) perivascular fibrosis, aortic and renal artery oxidative stress, and induced endothelial cell loss in IPRArts. In salt-loaded SHR, 5-month losartan and atenolol treatments similarly reduced SBP, but only losartan significantly prevented (i) urinary protein excretion increase, (ii) or attenuated hypertension-related vascular remodeling, (iii) aortic MDA accumulation, (iv) renal artery eNOS activity lowering, and (v) aortic and renal artery superoxide dismutase (SOD) activity reduction. In SHR+S, the contributions to aortic superoxide production were as follows: uncoupled eNOS > xanthine oxidase (XO) > NAD(P)H oxidase. CONCLUSIONS In this salt-sensitive genetic hypertension model, losartan protects from hypertension- and high dietary salt-related vascular oxidative stress, exceeding the benefits of BP reduction. Also, during salt overload, BP-independent factors contribute to vascular remodeling, at least part of which derive from AT1-receptor activation.
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Al-Solaiman Y, Jesri A, Zhao Y, Morrow JD, Egan BM. Low-Sodium DASH reduces oxidative stress and improves vascular function in salt-sensitive humans. J Hum Hypertens 2009; 23:826-35. [PMID: 19404315 PMCID: PMC2783838 DOI: 10.1038/jhh.2009.32] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Revised: 02/24/2009] [Accepted: 02/25/2009] [Indexed: 12/15/2022]
Abstract
Salt induces oxidative stress in salt-sensitive (SS) animals and man. It is not known whether in SS subjects the low-sodium dietary approaches to stop hypertension (LS-DASH) reduces oxidative stress more than DASH, which is high in antioxidants. To assess the effects of DASH and LS-DASH on oxidative stress, 19 volunteers were studied after 3 weeks of a standardized usual low fruits and vegetables diet (ULFV), followed by 3 weeks on DASH (both diets approximately 120 mmol Na(+) per day), then 3 weeks on LS-DASH (60 mmol Na(+) per day). SS was defined as systolic blood pressure >or=5 mm Hg lower on LS-DASH than DASH. In SS subjects (N=9), systolic blood pressure was lower on LS-DASH (111.0+/-2.0 mm Hg) than DASH (118.0+/-2.2, P<0.01) and ULFV (122.3+/-2.7, P=0.002). In salt-resistant (SR) volunteers (N=10), systolic blood pressure was lower on DASH (113.0+/-1.6) than ULFV (119.0+/-1.8, P<0.05) but not LS-DASH (115.7+/-1.8). Urine F2-isoprostanes, a marker of oxidative stress, were lower in SS subjects on LS-DASH (1.69+/-0.24) than ULFV (3.09+/-0.50, P<0.05) and marginally lower than DASH (2.46+/-0.44, P<0.20). F2-isoprostanes were not different among the three diets in SR volunteers (2.18+/-0.29, 2.06+/-0.29, 2.27+/-0.53, respectively). Aortic augmentation index, a measure of vascular stiffness, was lower in SS subjects on LS-DASH than either DASH or ULFV, and lower on DASH than ULFV in SR volunteers. In SS but not SR subjects, LS-DASH is associated with lower values for F2-isoprostanes and the aortic augmentation index. The results suggest that LS-DASH decreases oxidative stress, improves vascular function and lowers blood pressure in SS but not SR volunteers.
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Affiliation(s)
- Y Al-Solaiman
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
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Abstract
Impaired kidney function increases the risk of cardiovascular morbidity and mortality. Coexistence of hypertension and type 2 diabetes increases the risk of kidney damage, hypertension being an independent risk factor for kidney disease progression. Angiotensin II, through its inflammatory, proliferative, and thrombotic effects, adversely affects renal perfusion and increases oxidative stress, thus playing a pivotal role in kidney disease progression. Angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors improve markers of kidney disease and slow kidney disease progression in diabetic and nondiabetic patients; this kidney protection may be in addition to their antihypertensive activity in those with advanced proteinuric nephropathy. Key beneficial effects of ARBs and ACE inhibitors throughout the kidney disease continuum are primarily explained by blood pressure lowering effects and partially by their direct blockade of angiotensin II. Recent studies have shown that telmisartan, an ARB with high lipophilicity and the longest half-life compared with other ARBs, provides benefits on markers of cardiovascular risk, that is, microalbuminuria and slowing of early-stage nephropathy.
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Ando K, Fujita T. Metabolic syndrome and oxidative stress. Free Radic Biol Med 2009; 47:213-8. [PMID: 19409982 DOI: 10.1016/j.freeradbiomed.2009.04.030] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Revised: 04/24/2009] [Accepted: 04/24/2009] [Indexed: 01/23/2023]
Abstract
Metabolic syndrome is an obesity-associated collection of disorders, each of which contributes to cardiovascular risk. Metabolic syndrome is also associated with overproduction of reactive oxygen species (ROS). ROS contribute to the interrelationship between metabolic syndrome and salt-sensitive hypertension, which are both caused by obesity and excess salt consumption and are major threats to health in developed countries. ROS can induce insulin resistance, which is indispensable for the progression of metabolic syndrome, and salt-sensitive hypertension stimulates ROS production, thereby promoting the development of metabolic syndrome. Moreover, ROS activate mineralocorticoid receptors (MRs) and the sympathetic nervous system, which can contribute to the development of metabolic syndrome and salt-sensitive hypertension. Salt-induced progression of cardiovascular disease (CVD) is also accelerated in animal models with metabolic syndrome, probably owing to further stimulation of ROS overproduction and subsequent ROS-induced MR activation and sympathetic excitation. Therefore, ROS contribute to the progression of the metabolic syndrome itself and to the CVD accompanying it, particularly in conjunction with excessive salt consumption.
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Affiliation(s)
- Katsuyuki Ando
- Department of Nephrology and Endocrinology, University of Tokyo Graduate School of Medicine, Tokyo 113-8655, Japan
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Benndorf RA, Schwedhelm E, Gnann A, Taheri R, Kom G, Didié M, Steenpass A, Ergün S, Böger RH. Isoprostanes Inhibit Vascular Endothelial Growth Factor–Induced Endothelial Cell Migration, Tube Formation, and Cardiac Vessel Sprouting In Vitro, As Well As Angiogenesis In Vivo via Activation of the Thromboxane A
2
Receptor. Circ Res 2008; 103:1037-46. [DOI: 10.1161/circresaha.108.184036] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Isoprostanes are endogenously formed end products of lipid peroxidation. Furthermore, they are markers of oxidative stress and independent risk markers of coronary heart disease. In patients experiencing coronary heart disease, impaired angiogenesis may exacerbate insufficient blood supply of ischemic myocardium. We therefore hypothesized that isoprostanes may exert detrimental cardiovascular effects by inhibiting angiogenesis. We studied the effect of isoprostanes on vascular endothelial growth factor (VEGF)-induced migration and tube formation of human endothelial cells (ECs), and cardiac angiogenesis in vitro as well as on VEGF-induced angiogenesis in the chorioallantoic membrane assay in vivo. The isoprostanes 8-iso-PGF
2α
, 8-iso-PGE
2
, and 8-iso-PGA
2
inhibited VEGF-induced migration, tube formation of ECs, and cardiac angiogenesis in vitro, as well as VEGF-induced angiogenesis in vivo via activation of the thromboxane A
2
receptor (TBXA2R): the specific TBXA2R antagonists SQ-29548, BM 567, and ICI 192,605 but not the thromboxane A
2
synthase inhibitor ozagrel blocked the effect of isoprostanes. The isoprostane 8-iso-PGA
2
degraded into 2 biologically active derivatives in vitro, which also inhibited EC tube formation via the TBXA2R. Moreover, short hairpin RNA–mediated knockdown of the TBXA2R antagonized isoprostane-induced effects. In addition, Rho kinase inhibitor Y-27632 reversed the inhibitory effect of isoprostanes and the thromboxane A
2
mimetic U-46619 on EC migration and tube formation. Finally, the various isoprostanes exerted a synergistic inhibitory effect on EC tube formation. We demonstrate for the first time that isoprostanes inhibit angiogenesis via activation of the TBXA2R. By this mechanism, isoprostanes may contribute directly to exacerbation of coronary heart disease and to capillary rarefaction in disease states of increased oxidative stress.
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Affiliation(s)
- Ralf A. Benndorf
- From the Clinical Pharmacology Unit (R.A.B., E.S., A.G., R.T., G.K., M.D., A.S., R.H.B.), Institute of Experimental and Clinical Toxicology and Pharmacology, University Hospital Hamburg-Eppendorf; and Institute of Anatomy (S.E.), University Hospital Essen, Germany
| | - Edzard Schwedhelm
- From the Clinical Pharmacology Unit (R.A.B., E.S., A.G., R.T., G.K., M.D., A.S., R.H.B.), Institute of Experimental and Clinical Toxicology and Pharmacology, University Hospital Hamburg-Eppendorf; and Institute of Anatomy (S.E.), University Hospital Essen, Germany
| | - Anke Gnann
- From the Clinical Pharmacology Unit (R.A.B., E.S., A.G., R.T., G.K., M.D., A.S., R.H.B.), Institute of Experimental and Clinical Toxicology and Pharmacology, University Hospital Hamburg-Eppendorf; and Institute of Anatomy (S.E.), University Hospital Essen, Germany
| | - Raihana Taheri
- From the Clinical Pharmacology Unit (R.A.B., E.S., A.G., R.T., G.K., M.D., A.S., R.H.B.), Institute of Experimental and Clinical Toxicology and Pharmacology, University Hospital Hamburg-Eppendorf; and Institute of Anatomy (S.E.), University Hospital Essen, Germany
| | - Ghainsom Kom
- From the Clinical Pharmacology Unit (R.A.B., E.S., A.G., R.T., G.K., M.D., A.S., R.H.B.), Institute of Experimental and Clinical Toxicology and Pharmacology, University Hospital Hamburg-Eppendorf; and Institute of Anatomy (S.E.), University Hospital Essen, Germany
| | - Michael Didié
- From the Clinical Pharmacology Unit (R.A.B., E.S., A.G., R.T., G.K., M.D., A.S., R.H.B.), Institute of Experimental and Clinical Toxicology and Pharmacology, University Hospital Hamburg-Eppendorf; and Institute of Anatomy (S.E.), University Hospital Essen, Germany
| | - Anna Steenpass
- From the Clinical Pharmacology Unit (R.A.B., E.S., A.G., R.T., G.K., M.D., A.S., R.H.B.), Institute of Experimental and Clinical Toxicology and Pharmacology, University Hospital Hamburg-Eppendorf; and Institute of Anatomy (S.E.), University Hospital Essen, Germany
| | - Süleyman Ergün
- From the Clinical Pharmacology Unit (R.A.B., E.S., A.G., R.T., G.K., M.D., A.S., R.H.B.), Institute of Experimental and Clinical Toxicology and Pharmacology, University Hospital Hamburg-Eppendorf; and Institute of Anatomy (S.E.), University Hospital Essen, Germany
| | - Rainer H. Böger
- From the Clinical Pharmacology Unit (R.A.B., E.S., A.G., R.T., G.K., M.D., A.S., R.H.B.), Institute of Experimental and Clinical Toxicology and Pharmacology, University Hospital Hamburg-Eppendorf; and Institute of Anatomy (S.E.), University Hospital Essen, Germany
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Decrease in oxidative stress through supplementation of vitamins C and E is associated with a reduction in blood pressure in patients with essential hypertension. Clin Sci (Lond) 2008; 114:625-34. [PMID: 17999638 DOI: 10.1042/cs20070343] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Oxidative stress has been associated with mechanisms of EH (essential hypertension). The aim of the present study was to test the hypothesis that the antioxidant properties of vitamins C and E are associated with a decrease in BP (blood pressure) in patients with EH. A randomized double-blind placebo-controlled clinical trial was conducted in 110 men with grade 1 EH (35-60 years of age without obesity, dyslipidaemia and diabetes mellitus, non-smokers, not undergoing vigorous physical exercise, without the use of any medication and/or high consumption of fruit and vegetables). Participants were randomly assigned to receive either vitamins C+E [vitamin C (1 g/day) plus vitamin E (400 international units/day)] or placebo for 8 weeks. Measurements included 24 h ambulatory BP and blood analysis of oxidative-stress-related parameters in erythrocytes (GSH/GSSH ratio, antioxidant enzymes and malondialdehyde) and plasma [FRAP (ferric reducing ability of plasma)], and levels of 8-isoprostane, vitamins C and E were measured at baseline and after treatment. Following administration of vitamins C+E, patients with EH had significantly lower systolic BP, diastolic BP and mean arterial BP and higher erythrocyte and serum antioxidant capacity compared with either placebo-treated patients with EH or the patients with EH at baseline prior to treatment. BP correlated positively with plasma 8-isoprostane levels and negatively with plasma FRAP levels in the vitamins C+E- and placebo-treated groups. In conclusion, the present study supports the view that oxidative stress is involved in the pathogenesis of EH, and that enhancement of antioxidant status by supplementation with vitamins C and E in patients with EH is associated with lower BP. This suggests intervention with antioxidants as an adjunct therapy for hypertension.
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Mimran A, du Cailar G. Dietary sodium: the dark horse amongst cardiovascular and renal risk factors. Nephrol Dial Transplant 2008; 23:2138-41. [PMID: 18456679 DOI: 10.1093/ndt/gfn160] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Albert Mimran
- Department of Internal Medicine, Hôpital Lapeyronie, Montpellier Cedex, France.
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Rodrigo R, Prat H, Passalacqua W, Araya J, Guichard C, Bächler JP. Relationship between oxidative stress and essential hypertension. Hypertens Res 2008; 30:1159-67. [PMID: 18344620 DOI: 10.1291/hypres.30.1159] [Citation(s) in RCA: 156] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study investigated the association of blood pressure with blood oxidative stress-related parameters in normotensive and hypertensive subjects. A cross-sectional design was applied to 31 hypertensive patients and 35 healthy normotensive subjects. All subjects were men between the ages of 35 and 60 years. Exclusion criteria were obesity, dyslipidemia, diabetes mellitus, smoking and current use of any medication. All patients underwent 24-h ambulatory blood pressure monitoring and sampling of blood and urine. Antioxidant enzymes activity, reduced/oxidized glutathione ratio (GSH/GSSG), and lipid peroxidation (malondialdehyde) were determined in erythrocytes. Parameters measured in the plasma of test subjects were plasma antioxidant status, lipid peroxidation (8-isoprostane), plasma vitamin C and E, and the blood pressure modulators renin, aldosterone, endothelin-1 and homocysteine. Daytime systolic and diastolic blood pressures of hypertensives were negatively correlated with plasma antioxidant capacity (r=-0.46, p<0.009 and r=-0.48, p<0.007), plasma vitamin C levels (r=-0.53, p<0.003 and r=-0.44, p<0.02), erythrocyte activity of antioxidant enzymes, and erythrocyte GSH/GSSG ratio, with hypertensives showing higher levels of oxidative stress. Blood pressures showed a positive correlation with both plasma and urine 8-isoprostane. Neither plasma vitamin E nor the assessed blood pressure modulator levels showed significant differences between the groups or correlation with blood pressures. These findings demonstrate a strong association between blood pressure and some oxidative stress-related parameters and suggest a possible role of oxidative stress in the pathophysiology of essential hypertension.
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Affiliation(s)
- Ramón Rodrigo
- Laboratory of Renal Pathophysiology, Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile.
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Majid DSA, Kopkan L. Nitric oxide and superoxide interactions in the kidney and their implication in the development of salt-sensitive hypertension. Clin Exp Pharmacol Physiol 2007; 34:946-52. [PMID: 17645645 DOI: 10.1111/j.1440-1681.2007.04642.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
1. Enhanced superoxide (O2(-)) activity as a result of the inhibition of the superoxide dismutase (SOD) enzyme results in vasoconstrictor and antinatriuretic responses in the canine kidney; these responses were shown to be greatly enhanced during inhibition of nitric oxide synthase (NOS). Glomerular filtration rate remained mostly unchanged during SOD inhibition in the intact nitric oxide (NO) condition, but was markedly reduced during NOS inhibition. These findings indicate that endogenous NO has a major renoprotective effect against O2(-) by acting as an anti-oxidant. Nitric oxide synthase inhibition was also shown to enhance endogenous O2(-) activity. 2. Experiments in our laboratory using dogs, rats and gene knockout mice have shown that renal vasoconstrictor and antinatriuretic responses to acute or chronic angiotensin (Ang) II administration are mediated, in part, by O2(-) generation. In the absence of NO, enhanced O2(-) activity largely contributes to AngII-induced renal tubular sodium reabsorption. Acute or chronic treatment with the O2(-) scavenger tempol in experimental models of hypertension (induced by chronic low-dose treatment with AngII and NO inhibitors) causes an improvement in renal haemodynamics and in excretory function, abolishes salt sensitivity and reduces blood pressure. 3. The present mini review also discusses related studies from many other laboratories implicating a role for O2(-) and its interaction with NO in the development of salt-sensitive hypertension. 4. Overall, the collective data support the hypothesis that an imbalance between the production of NO and O2(-) in the kidney primarily determines the condition of oxidative stress that alters renal haemodynamics and excretory function leading to sodium retention and, thus, contributes to the development of salt-sensitive hypertension.
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Affiliation(s)
- Dewan S A Majid
- Department of Physiology, Tulane Hypertension and Renal Center of Excellence, Tulane University Health Sciences Center, New Orleans, Louisiana 70112, USA.
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Fujita M, Ando K, Nagae A, Fujita T. Sympathoexcitation by oxidative stress in the brain mediates arterial pressure elevation in salt-sensitive hypertension. Hypertension 2007; 50:360-7. [PMID: 17576857 DOI: 10.1161/hypertensionaha.107.091009] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Central sympathoexcitation is involved in the pathogenesis of salt-sensitive hypertension. We have suggested that oxidative stress in the brain modulates the sympathetic regulation of arterial pressure. Thus, we investigated whether oxidative stress could mediate central sympathoexcitation in salt-sensitive hypertension. Five- to 6-week-old male Dahl salt-sensitive rats and salt-resistant rats were fed with a normal (0.3%) or high- (8%) salt diet for 4 weeks. In urethane-anesthetized and artificially ventilated rats, arterial pressure, renal sympathetic nerve activity, and heart rate decreased in a dose-dependent fashion, when 20 or 40 micromol of tempol, a membrane-permeable superoxide dismutase mimetic, was infused into the lateral cerebral ventricle. The same degree of reduction was noted in salt-sensitive and salt-resistant rats without salt loading. Salt loading significantly increased central tempol-induced reductions in arterial pressure (-29.1+/-4.8% versus -10.6+/-3.3% at 40 micromol; P<0.01), sympathetic nerve activity (-18.7+/-2.0% versus -7.1+/-1.8%; P<0.01), and heart rate (-10.7+/-2.8% versus -2.0+/-0.7%; P<0.05) in salt-sensitive rats but not in salt-resistant rats. Intracerebroventricular diphenyleneiodonium, a reduced nicotinamide-adenine dinucleotide phosphate oxidase inhibitor, also elicited significantly greater reduction in each parameter in salt-loaded salt-sensitive rats. Moreover, salt loading increased reduced nicotinamide-adenine dinucleotide phosphate-dependent superoxide production in the hypothalamus in salt-sensitive rats but not in salt-resistant rats. In addition, reduced nicotinamide-adenine dinucleotide phosphate oxidase subunits p22(phox), p47(phox), and gp91(phox) mRNA expression significantly increased in the hypothalamus of salt-loaded salt-sensitive rats. In conclusion, in salt-sensitive hypertension, increased oxidative stress in the brain, possibly via activation of reduced nicotinamide-adenine dinucleotide phosphate oxidase, may elevate arterial pressure through central sympathoexcitation.
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Affiliation(s)
- Megumi Fujita
- Department of Nephrology and Endocrinology, Faculty of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Abstract
After the demonstration of a positive correlation between sodium intake and arterial pressure in large population studies, the effect of short-term reduction in sodium intake demonstrated the efficacy of this nonpharmacological therapy. In addition, a positive relation between urinary sodium (the most reliable estimate of salt intake) and left ventricular hypertrophy was found; and in recent years it was shown that cardiovascular morbidity clearly progressed with increasing sodium intake, despite one contradictory study. The role of non-pressure-related effects of dietary sodium is discussed in order to bring more arguments for a large-scale attempt to reduce sodium intake by 30% to 50%.
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Affiliation(s)
- Guilhem du Cailar
- Department of Internal Medicine, Hôpital Lapeyronie, Montpellier Cedex 5, France
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Sudano I, Hermann M, Ruschitzka FT. Endothelin-receptor antagonists in arterial hypertension: Further indications? Curr Hypertens Rep 2007; 9:59-65. [PMID: 17362673 DOI: 10.1007/s11906-007-0011-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Endothelin-1 exerts vasoactive, pro-inflammatory, hypertrophic, and profibrotic properties on the heart, kidney, and blood vessels. Hence, endothelin-receptor antagonists hold the potential to reduce blood pressure and to prevent complications of hypertension, atherosclerosis, and diabetes through blood pressure-independent effects on cardiovascular growth, inflammation, and fibrosis. These potentially important effects of endothelin antagonism may contribute to its therapeutic potential in hypertension and other cardiovascular disorders, including chronic renal failure and diabetes. First clinical trial evidence demonstrates a moderate reduction in blood pressure in studies of patients with mild-to-moderate essential hypertension and patients with resistant hypertension. Future large-scale randomized clinical trials will provide more insight into whether the blood-pressure reduction and promising pleiotropic effects observed with several members of this novel class of drugs, which are already established therapy in pulmonary hypertension, will translate into clinical benefit in patients with arterial hypertension.
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Affiliation(s)
- Isabella Sudano
- Department of Cardiology, University Hospital, Rämistrasse 100, 8091 Zurich, Switzerland
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Sarafidis PA, Grekas DM. Insulin Resistance and Oxidant Stress: An Interrelation With Deleterious Renal Consequences? ACTA ACUST UNITED AC 2007; 2:139-42. [PMID: 17684472 DOI: 10.1111/j.1559-4564.2007.06666.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Within the past years, several epidemiologic studies have shown that insulin resistance and hyperinsulinemia are associated with chronic kidney disease, and experimental data suggest that a number of background mechanisms could connect insulin resistance with renal injury. Moreover, the acute sodium-retaining action of insulin at the kidney level has been proposed to participate in the development of salt sensitivity in essential hypertension. Current knowledge suggests that oxidative stress can be involved in the development of renal injury and can also promote primary salt retention at the kidney level. Insulin resistance and hyperinsulinemia seem to be closely connected with oxidative stress in the form of a vicious circle. This article discusses the potential role of oxidative stress as a mediator of the renal effects of insulin resistance/hyperinsulinemia.
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Affiliation(s)
- Pantelis A Sarafidis
- 1st Department of Medicine, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece. psarafidis l l @yahoo.gr
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Sarafidis PA, Bakris GL. The antinatriuretic effect of insulin: an unappreciated mechanism for hypertension associated with insulin resistance? Am J Nephrol 2007; 27:44-54. [PMID: 17245074 DOI: 10.1159/000098955] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2006] [Accepted: 12/13/2006] [Indexed: 12/24/2022]
Abstract
Insulin resistance is proposed to be causally related to the metabolic syndrome disorders, but a direct cause-and-effect relationship between insulin resistance and hypertension was not originally obvious. Previous data suggested that insulin promotes sodium retention from the kidney, and thus research efforts focused on this action among several other possible pathways connecting insulin resistance and hyperinsulinemia with hypertension. A review of numerous studies provides evidence that this antinatriuretic effect of insulin is preserved in states of metabolic insulin resistance, representing a major mechanism for blood pressure elevation. More recent experimental and clinical studies have added data about the exact tubular sites of this insulin action, its relation with the respective insulin action on potassium handling, its possible role in the development of salt sensitivity in essential hypertension, as well as the involvement of oxidant stress in these associations. This review summarizes the current state of knowledge in this area and attempts to highlight an important but rather overlooked pathway for hypertension development in the metabolic syndrome, the influence of high insulin levels leading to volume expansion.
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Affiliation(s)
- Pantelis A Sarafidis
- First Department of Medicine, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece.
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Matavelli LC, Zhou X, Varagic J, Susic D, Frohlich ED. Salt loading produces severe renal hemodynamic dysfunction independent of arterial pressure in spontaneously hypertensive rats. Am J Physiol Heart Circ Physiol 2006; 292:H814-9. [PMID: 16997890 DOI: 10.1152/ajpheart.00671.2006] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We have previously shown that salt excess has adverse cardiac effects in spontaneously hypertensive rats (SHR), independent of its increased arterial pressure; however, the renal effects have not been reported. In the present study we evaluated the role of three levels of salt loading in SHR on renal function, systemic and renal hemodynamics, and glomerular dynamics. At 8 wk of age, rats were given a 4% (n = 11), 6% (n = 9), or 8% (n = 11) salt-load diet for the ensuing 8 wk; control rats (n = 11) received standard chow (0.6% NaCl). Rats had weekly 24-h proteinuria and albuminuria quantified. At the end of salt loading, all rats had systemic and renal hemodynamics measured; glomerular dynamics were specially studied by renal micropuncture in the control, 4% and 6% salt-loaded rats. Proteinuria and albuminuria progressively increased by the second week of salt loading in the 6% and 8% salt-loaded rats. Mean arterial pressure increased minimally, and glomerular filtration rate decreased in all salt-loaded rats. The 6% and 8% salt-loaded rats demonstrated decreased renal plasma flow and increased renal vascular resistance and serum creatinine concentration. Furthermore, 4% and 6% salt-loaded rats had diminished single-nephron plasma flow and increased afferent and efferent arteriolar resistances; glomerular hydrostatic pressure also increased in the 6% salt-loaded rats. In conclusion, dietary salt loading as low as 4% dramatically deteriorated renal function, renal hemodynamics, and glomerular dynamics in SHR independent of a minimal further increase in arterial pressure. These findings support the concept of a strong independent causal relationship between salt excess and cardiovascular and renal injury.
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Affiliation(s)
- Luis C Matavelli
- Hypertension Research Laboratory, Division of Research, Ochsner Clinic Foundation, New Orleans, Louisiana 70121, USA
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