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Bolin LP, Crane PB, Gunn LH. Exploring Cytokine Networks in Resistant Hypertension. Nurs Res 2024; 73:16-25. [PMID: 37878533 PMCID: PMC10841083 DOI: 10.1097/nnr.0000000000000699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND Controlling high blood pressure (BP) continues to be a major concern because the associated complications can lead to an increased risk of heart, brain, and kidney disease. Those with hypertension, despite lifestyle and diet modifications and pharmacotherapy, defined as resistant hypertension, are at increased risk for further risk for morbidity and mortality. Understanding inflammation in this population may provide novel avenues for treatment. OBJECTIVES This study aimed to examine a broad range of cytokines in adults with cardiovascular disease and identify specific cytokines associated with resistant hypertension. METHODS A secondary data analysis was conducted. The parent study included 156 adults with a history of myocardial infarction within the past 3-7 years and with a multiplex plasma analysis yielding a cytokine panel. A network analysis with lasso penalization for sparsity was performed to explore associations between cytokines and BP. Associated network centrality measures by cytokine were produced, and a community graph was extracted. A sensitivity analysis BP was also performed. RESULTS Cytokines with larger node strength measures were sTNFR2 and CX3. The graphical network highlighted six cytokines strongly associated with resistant hypertension. Cytokines IL-29 and CCL3 were found to be negatively associated with resistant hypertension, whereas CXCL12, MMP3, sCD163, and sIL6Rb were positively associated with resistant hypertension. DISCUSSION Understanding the network of associations through exploring oxidative stress and vascular inflammation may provide insight into treatment approaches for resistant hypertension.
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Song W, Zhang C, Tang J, Li Y, Jiao T, Lin X, Wang Y, Fang J, Sha J, Ding T, Cheng J, Li J. Hypersensitive C-reactive protein as a potential indicator for predicting left ventricular hypertrophy in elderly community-dwelling patients with hypertension. BMC Cardiovasc Disord 2023; 23:480. [PMID: 37759159 PMCID: PMC10537845 DOI: 10.1186/s12872-023-03509-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the relationship between Hypersensitive C-reactive protein (hs-CRP) and left ventricular hypertrophy (LVH) in elderly community-dwelling patients with hypertension. METHODS A cross-sectional study was conducted, involving the recruitment of 365 elderly hypertensive residents ≥ 65 years of age from five communities. The participants were divided into two groups: an LVH group (n = 134) and a non-LVH group (n = 231), based on the left ventricular mass index (LVMI) determined by echocardiography. Spearman correlation analysis was used to assess the relationship between hs-CRP and LVH. Univariate and Multivariate analysis was performed to detect variables associated with LVH. The diagnostic value of hs-CRP for LVH was expressed as the area under the receiver operating characteristic (ROC) curve. RESULTS The incidence of LVH in elderly hypertension patients in the community was 36.7%. The hs-CRP levels were significantly higher in subjects with LVH compared to those without LVH (1.9 [0.8, 2.9] vs. 0.7 [0.4, 1.4], P = 0.002). Spearman correlation analysis demonstrated a positive correlation between hs-CRP and LVMI (r = 0.246, P < 0.001), as well as with IVST (r = 0.225, P < 0.001) and LVPWT (r = 0.172, P = 0.001). Among elderly hypertensive residents in the community, the cut-off value of hs-CRP for diagnosing LVH was 1.25 mg/L (sensitivity: 57.5%; specificity: 78.4%), and the area under the ROC curve for hs-CRP to predict LVH was 0.710 (95%CI: 0.654-0.766; P < 0.001). In the final model, hs-CRP ≥ 1.25 mg/L (OR = 3.569; 95%CI, 2.153-5.916; P<0.001) emerged as an independent risk factor for LVH. This association remained significant even after adjusting for various confounding factors (adjusted OR = 3.964; 95%CI, 2.323-6.765; P < 0.001). CONCLUSIONS This community-based cohort of elderly hypertensive individuals demonstrates a strong association between hs-CRP levels and the presence of LVH. The hs-CRP ≥ 1.25 mg/L may serve as an independent predictor for LVH in hypertensive subjects and exhibit good diagnostic efficacy for LVH.
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Affiliation(s)
- Wei Song
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
- Department of General Practice, Jinyang Community Health Service Center, Shanghai, 200136, China
| | - Chunsheng Zhang
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Jiamei Tang
- Department of Ultrasound, Shanghai Changhai Hospital, Navy Medical University, Shanghai, China
| | - Yan Li
- Department of General Practice, Jinyang Community Health Service Center, Shanghai, 200136, China
| | - Tiantian Jiao
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Xueqi Lin
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Yuanqi Wang
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Jialiang Fang
- Department of General Practice, Jinyang Community Health Service Center, Shanghai, 200136, China
| | - Jingjing Sha
- Department of General Practice, Jinyang Community Health Service Center, Shanghai, 200136, China
| | - Tongjiu Ding
- Department of General Practice, Jinyang Community Health Service Center, Shanghai, 200136, China
| | - Jiayue Cheng
- Department of General Practice, Jinyang Community Health Service Center, Shanghai, 200136, China
| | - Jiming Li
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Pudong New Area, Shanghai, 200120, China.
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Ribeiro Vitorino T, Ferraz do Prado A, Bruno de Assis Cau S, Rizzi E. MMP-2 and its implications on cardiac function and structure: Interplay with inflammation in hypertension. Biochem Pharmacol 2023; 215:115684. [PMID: 37459959 DOI: 10.1016/j.bcp.2023.115684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023]
Abstract
Hypertension is one of the leading risk factors for the development of heart failure. Despite being a multifactorial disease, in recent years, preclinical and clinical studies suggest strong evidence of the pivotal role of inflammatory cells and cytokines in the remodeling process and cardiac dysfunction. During the heart remodeling, activation of extracellular matrix metalloproteinases (MMPs) occurs, with MMP-2 being one of the main proteases secreted by cardiomyocytes, fibroblasts, endothelial and inflammatory cells in cardiac tissue. In this review, we will address the process of cardiac remodeling and injury induced by the increase in MMP-2 and the main signaling pathways involving cytokines and inflammatory cells in the process of transcriptional, secretion and activation of MMP-2. In addition, an interaction and coordinated action between MMP-2 and inflammation are explored and significant in maintaining the cardiac cycle. These observations suggest that new therapeutic opportunities targeting MMP-2 could be used to reduce inflammatory biomarkers and reduce cardiac damage in hypertension.
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Affiliation(s)
- Thaís Ribeiro Vitorino
- Unit of Biotechnology, University of Ribeirao Preto, UNAERP, Brazil; Department of Pharmacology, Faculty of Medical Sciences, University of Campinas, UNICAMP, Brazil
| | - Alejandro Ferraz do Prado
- Cardiovascular System Pharmacology and Toxicology, Institute of Biological Sciences, Federal University of Para, UFPA, Brazil
| | - Stefany Bruno de Assis Cau
- Department of Pharmacology, Institute of Biological Science, Federal University of Minas Gerais, UFMG, Brazil.
| | - Elen Rizzi
- Unit of Biotechnology, University of Ribeirao Preto, UNAERP, Brazil.
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Yap YS, Chi WC, Lin CH, Liu YC, Wu YW, Yang HY. Combined cardiomegaly and aortic arch calcification predict mortality in hemodialysis patients. Ther Apher Dial 2023; 27:31-38. [PMID: 35735215 DOI: 10.1111/1744-9987.13902] [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: 12/13/2021] [Revised: 03/22/2022] [Accepted: 06/20/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION This study aimed to investigate the relationship between cardiomegaly and aortic arch calcification (AAC) and overall/cardiovascular mortality in hemodialysis patients. METHODS We conducted a retrospective cohort study and enrolled patients who underwent initial hemodialysis. Cardiomegaly and AAC were determined by chest radiography and classified into four groups according to cross-classification of cardiothoracic ratio (CTR) of 0.5 and lower/higher grade AAC (LGAAC/HGAAC). The relationship between these groups and mortality was then analyzed by Cox proportional hazards model. RESULTS In multivariate Cox regression analysis, those in CTR ≤ 0.5 and HGAAC [hazard ratio (95% confidence interval): 2.07 (1.14-3.77)], CTR > 0.5 & LGAAC [3.60 (2.07-6.25)] and CTR > 0.5 & HGAAC [3.42 (2.03-5.77)] were significantly associated with overall mortality; while those in CTR > 0.5 & LGAAC [2.81 (1.28-6.19)] and CTR > 0.5 & HGAAC [2.32 (1.09-4.95)] were significantly related to cardiovascular mortality. CONCLUSION Combined cardiomegaly and AAC predicted overall and cardiovascular mortality in hemodialysis patients.
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Affiliation(s)
- Yit-Sheung Yap
- Division of Nephrology, Department of Internal Medicine, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Wen-Che Chi
- Division of Nephrology, Department of Internal Medicine, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Cheng-Hao Lin
- Division of Nephrology, Department of Internal Medicine, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Yi-Chun Liu
- Division of Nephrology, Department of Internal Medicine, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Yi-Wen Wu
- Chronic Kidney Disease Education Center, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Hui-Yueh Yang
- Hemodialysis Center, Yuan's General Hospital, Kaohsiung, Taiwan
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Yan YQ, Liu L, Sun S, Feng YQ, Li J, Huang YQ. The Relationship Between Famine Exposure During Early Life and Left Ventricular Hypertrophy in Adulthood. Front Nutr 2022; 9:898932. [PMID: 35711549 PMCID: PMC9193804 DOI: 10.3389/fnut.2022.898932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/27/2022] [Indexed: 11/25/2022] Open
Abstract
Background Although the evidence was still limited, some studies suggested that childhood malnutrition might affect cardiac function and structure in adulthood. To address the knowledge gap, this study investigated if the Great Chinese Famine exposure during early life had affected left ventricular hypertrophy (LVH). Methods This research was a cross-sectional study. It included participants who had cardiac ultrasound assessments and were born in Guangdong, China, from 1 October 1952 to 30 September 1964. They were classified according to their exposure period to famine, namely, no exposure, fetal-, early-, mid-, and late childhood. Multivariate logistic regression and subgroup analysis have been conducted to determine the odds ratio (OR) and confidence intervals (CIs) between famine exposure and LVH. Results This research included 2,543 participants, 1,612 women, their mean age was 59.07 ± 3.65 years, and 704 participants had LVH. LVH prevalence was 122 (23.6%), 87 (25.1%), 133 (27.3%), 184 (29.2%), and 178 (31.7%), in non-, fetal-, early-, mid-, and late-childhood exposed groups, respectively (p = 0.031), while in the non-exposed group, the ORs for developing carotid plaque as a result of fetal, early-, mid- to late-childhood exposure were 1.08 (95% CI: 0.76, 1.59, p = 0.619), 1.24 (95% CI: 1.03, 1.79, p = 0.031), 1.49 (95% CI: 1.10, 2.01, p = 0.009), and 1.64 (95% CI: 1.25, 2.18, p = 0.001), respectively (p for trend = 0.003). There was no interactive effect between gender, obesity, or hypertension history with how the famine influenced LVH, as the subgroups analyses demonstrated (all p for interaction > 0.05). Conclusion This research has demonstrated the potential relationship between Great Chinese Famine exposure during childhood and LVH in adults.
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Affiliation(s)
- Yu-qin Yan
- Department of Cardiology, People’s Hospital of Shenzhen Baoan District, Shenzhen, China
| | - Lin Liu
- Department of Cardiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shuo Sun
- Department of Cardiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ying-qing Feng
- Department of Cardiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jie Li
- Department of Cardiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Jie Li,
| | - Yu-qing Huang
- Department of Cardiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Yu-qing Huang,
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Adu-Amankwaah J, Adzika GK, Adekunle AO, Ndzie Noah ML, Mprah R, Bushi A, Akhter N, Huang F, Xu Y, Adzraku SY, Nadeem I, Sun H. ADAM17, A Key Player of Cardiac Inflammation and Fibrosis in Heart Failure Development During Chronic Catecholamine Stress. Front Cell Dev Biol 2021; 9:732952. [PMID: 34966735 PMCID: PMC8710811 DOI: 10.3389/fcell.2021.732952] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/16/2021] [Indexed: 12/24/2022] Open
Abstract
Heart failure development is characterized by persistent inflammation and progressive fibrosis owing to chronic catecholamine stress. In a chronic stress state, elevated catecholamines result in the overstimulation of beta-adrenergic receptors (βARs), specifically β2-AR coupling with Gαi protein. Gαi signaling increases the activation of receptor-stimulated p38 mitogen-activated-protein-kinases (p38 MAPKs) and extracellular signal-regulated kinases (ERKs). Phosphorylation by these kinases is a common way to positively regulate the catalytic activity of A Disintegrin and Metalloprotease 17 (ADAM17), a metalloprotease that has grown much attention in recent years and has emerged as a chief regulatory hub in inflammation, fibrosis, and immunity due to its vital proteolytic activity. ADAM17 cleaves and activates proinflammatory cytokines and fibrotic factors that enhance cardiac dysfunction via inflammation and fibrosis. However, there is limited information on the cardiovascular aspect of ADAM17, especially in heart failure. Hence, this concise review provides a comprehensive insight into the structure of ADAM17, how it is activated and regulated during chronic catecholamine stress in heart failure development. This review highlights the inflammatory and fibrotic roles of ADAM17’s substrates; Tumor Necrosis Factor α (TNFα), soluble interleukin-6 receptor (sIL-6R), and amphiregulin (AREG). Finally, how ADAM17-induced chronic inflammation and progressive fibrosis aggravate cardiac dysfunction is discussed.
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Affiliation(s)
| | | | | | | | - Richard Mprah
- Department of Physiology, Xuzhou Medical University, Xuzhou, China
| | | | - Nazma Akhter
- Department of Physiology, Xuzhou Medical University, Xuzhou, China
| | - Fei Huang
- Department of Physiology, Xuzhou Medical University, Xuzhou, China
| | - Yaxin Xu
- Department of Physiology, Xuzhou Medical University, Xuzhou, China
| | - Seyram Yao Adzraku
- Key Laboratory of Bone Marrow Stem Cell, Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Iqra Nadeem
- Department of Neurobiology and Anatomy, Xuzhou Medical University, Xuzhou, China
| | - Hong Sun
- Department of Physiology, Xuzhou Medical University, Xuzhou, China
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Frenzel S, Wittfeld K, Bülow R, Völzke H, Friedrich N, Habes M, Felix SB, Dörr M, Grabe HJ, Bahls M. Cardiac Hypertrophy Is Associated With Advanced Brain Aging in the General Population. J Am Heart Assoc 2021; 10:e020994. [PMID: 34465186 PMCID: PMC8649275 DOI: 10.1161/jaha.121.020994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Hypertrophy of the left ventricle (LV) has recently been associated with adverse changes of brain structure in older adults, notably increased burden of white matter hyperintensities (WMHs). Whether greater LV size or mass is also related to WMH burden in middle‐aged adults is currently unclear. In addition, its relation with alterations in cortical thickness (CT) has not been studied to date. Methods and Results Data from 1602 participants of the population‐based SHIP (Study of Health in Pomerania) with LV ejection fraction >40% and no history of myocardial infarction were included (aged 21–82 years; median age, 49 years; 53% women). Participants underwent both echocardiography and magnetic resonance imaging of the head. Imaging markers of brain aging (ie, CT and WMH volume) were determined from magnetic resonance imaging scans. LV mass and diameter were associated with lower global CT and greater WMH volume, while adjusting for age, sex, body height, fat‐free body mass, and intracranial volume. Moreover, thicknesses of the interventricular septum and posterior wall were also associated with lower global CT. These associations could not be explained by cardiovascular risk factors (including hypertension), inflammatory markers, or sociodemographic factors. Regional analyses showed distinct spatial patterns of lower CT in association with LV diameter and posterior wall thickness. Conclusions LV diameter and mass are associated with lower global and regional CT as well as greater WMH burden in the general population. These findings highlight the brain structural underpinnings of the associations of LV hypertrophy with cognitive decline and dementia.
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Affiliation(s)
- Stefan Frenzel
- Department of Psychiatry and PsychotherapyUniversity Medicine GreifswaldGreifswaldGermany
| | - Katharina Wittfeld
- Department of Psychiatry and PsychotherapyUniversity Medicine GreifswaldGreifswaldGermany
- German Center for Neurodegenerative Disease (DZNE), Partner Site Rostock/GreifswaldGreifswaldGermany
| | - Robin Bülow
- Institute of Diagnostic Radiology and NeuroradiologyUniversity Medicine GreifswaldGreifswaldGermany
| | - Henry Völzke
- Institute for Community MedicineUniversity Medicine GreifswaldGreifswaldGermany
- German Centre for Cardiovascular Research (DZHK), Partner Site GreifswaldGreifswaldGermany
| | - Nele Friedrich
- German Centre for Cardiovascular Research (DZHK), Partner Site GreifswaldGreifswaldGermany
- Institute of Clinical Chemistry and Laboratory MedicineUniversity Medicine GreifswaldGreifswaldGermany
| | - Mohamad Habes
- Neuroimage Analytics Laboratory (NAL) and the Biggs Institute Neuroimaging Core (BINC)Glenn Biggs Institute for Alzheimer's and Neurodegenerative DiseasesUniversity of Texas Health Science Center San Antonio (UTHSCSA)San AntonioTX
| | - Stephan B. Felix
- German Centre for Cardiovascular Research (DZHK), Partner Site GreifswaldGreifswaldGermany
- Department of Internal Medicine BUniversity Medicine GreifswaldGreifswaldGermany
| | - Marcus Dörr
- German Centre for Cardiovascular Research (DZHK), Partner Site GreifswaldGreifswaldGermany
- Department of Internal Medicine BUniversity Medicine GreifswaldGreifswaldGermany
| | - Hans J. Grabe
- Department of Psychiatry and PsychotherapyUniversity Medicine GreifswaldGreifswaldGermany
- German Center for Neurodegenerative Disease (DZNE), Partner Site Rostock/GreifswaldGreifswaldGermany
| | - Martin Bahls
- German Centre for Cardiovascular Research (DZHK), Partner Site GreifswaldGreifswaldGermany
- Department of Internal Medicine BUniversity Medicine GreifswaldGreifswaldGermany
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Plasma lipocalin-2/NGAL is stable over 12 weeks and is not modulated by exercise or dieting. Sci Rep 2021; 11:4056. [PMID: 33603000 PMCID: PMC7893047 DOI: 10.1038/s41598-021-83472-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 12/29/2020] [Indexed: 02/07/2023] Open
Abstract
Amongst other immune cells, neutrophils play a key role in systemic inflammation leading to cardiovascular disease and can release inflammatory factors, including lipocalin-2 (LCN2). LCN2 drives cardiac hypertrophy and plays a role in maladaptive remodelling of the heart and has been associated with renal injury. While lifestyle factors such as diet and exercise are known to attenuate low-grade inflammation, their ability to modulate plasma LCN2 levels is unknown. Forty-eight endurance athletes and 52 controls (18–55 years) underwent measurement for various cardiovascular health indicators, along with plasma LCN2 concentration. No significant difference in LCN2 concentration was seen between the two groups. LCN2 was a very weak predictor or absent from models describing blood pressures or predicting athlete status. In another cohort, 57 non-diabetic overweight or obese men and post-menopausal women who fulfilled Adult Treatment Panel III metabolic syndrome criteria were randomly allocated into either a control, modified Dietary Approaches to Stop Hypertension (DASH) diet, or DASH and exercise group. Pre- and post-intervention demographic, cardiovascular health indicators, and plasma LCN2 expression were measured in each individual. While BMI fell in intervention groups, LCN2 levels remained unchanged within and between all groups, as illustrated by strong correlations between LCN2 concentrations pre- and 12 weeks post-intervention (r = 0.743, P < 0.0001). This suggests that circulating LCN2 expression are stable over a period of at least 12 weeks and is not modifiable by diet and exercise.
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Firefighting Induces Acute Inflammatory Responses that are not Relieved by Aspirin in Older Firefighters. J Occup Environ Med 2020; 61:617-622. [PMID: 31090673 DOI: 10.1097/jom.0000000000001626] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Sudden cardiac events account for 40% to 50% of firefighter line-of-duty deaths. Inflammatory proteins are strong biomarkers of cardiovascular inflammation. The present study investigated the effects of aspirin supplementation on inflammatory biomarkers following firefighting. METHODS Using a randomized, placebo-controlled, double-blind crossover design, 24 male firefighters (48.2 ± 5.9 years) were allocated into four conditions: acute (81 mg; single-dose) aspirin and placebo supplementation, and chronic (81 mg; 14 days) aspirin and placebo supplementation. Inflammatory proteins [interleukin (IL)-6, C-reactive protein (CRP), intracellular adhesion molecule (ICAM)-1, P-selectin, matrix metalloproteinase-9 (MMP-9)] and antioxidant potential [total antioxidant capacity (TAC)] were measured pre- and post-structural firefighting drills. RESULTS Firefighting activities significantly increased IL-6, MMP-9, and P-Selectin; however, no changes in TAC and ICAM-1 were detected. Neither acute nor chronic aspirin supplementation attenuated this inflammatory response. CONCLUSION Firefighting significantly increases inflammatory biomarkers and neither acute nor chronic low-dose aspirin mitigates this response.
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Peterson MR, Getiye Y, Bosch L, Sanders AJ, Smith AR, Haller S, Wilson K, Paul Thomas D, He G. A potential role of caspase recruitment domain family member 9 (Card9) in transverse aortic constriction-induced cardiac dysfunction, fibrosis, and hypertrophy. Hypertens Res 2020; 43:1375-1384. [PMID: 32647279 DOI: 10.1038/s41440-020-0507-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/29/2020] [Accepted: 06/11/2020] [Indexed: 12/24/2022]
Abstract
Macrophage- and monocyte-derived cytokines are elevated in the myocardium of pressure-overloaded hearts, where they play critical roles in pathological remodeling. Caspase recruitment domain family member 9 (CARD9) regulates macrophage cytokine secretion, but its role in a transverse aortic constriction (TAC) model of pressure overload has not been evaluated. To investigate whether CARD9 may serve as a valuable therapeutic target, wild-type (WT) and CARD9-knockout mice were subjected to 3 months of TAC, and then cardiac function, hypertrophy, and fibrosis were analyzed. The expression of protein markers of myocardial autophagy and nuclear factor kappa B signaling was also investigated. At 1 month after TAC, cardiomyocyte contractile dynamics were measured in a separate cohort to further assess contractility and diastolic function. In WT but not CARD9-/- mice, TAC resulted in severe cardiomyocyte contractile dysfunction at 1 month and functional decrements in fractional shortening at 3 months in vivo. Furthermore, CARD9-/- mice did not develop cardiac fibrosis or hypertrophy. CARD9-/- mice also had decreased protein expression of inhibitor of κB kinase-α/β, decreased phosphorylation of p65, and increased expression of protein markers of autophagy. These findings suggest that CARD9 plays a role in pathological remodeling and cardiac dysfunction in mouse hearts subjected to TAC and should be investigated further.
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Affiliation(s)
- Matthew R Peterson
- School of Pharmacy, University of Wyoming College of Health Sciences, Laramie, WY, 82071, USA
| | - Yohannes Getiye
- School of Pharmacy, University of Wyoming College of Health Sciences, Laramie, WY, 82071, USA
| | - Luiza Bosch
- School of Pharmacy, University of Wyoming College of Health Sciences, Laramie, WY, 82071, USA
| | - Alyssa J Sanders
- School of Pharmacy, University of Wyoming College of Health Sciences, Laramie, WY, 82071, USA
| | - Aspen R Smith
- School of Pharmacy, University of Wyoming College of Health Sciences, Laramie, WY, 82071, USA
| | - Samantha Haller
- School of Pharmacy, University of Wyoming College of Health Sciences, Laramie, WY, 82071, USA
| | - Kayla Wilson
- School of Pharmacy, University of Wyoming College of Health Sciences, Laramie, WY, 82071, USA
| | - D Paul Thomas
- Division of Kinesiology & Health, University of Wyoming College of Health Sciences, Laramie, WY, 82071, USA
| | - Guanglong He
- School of Pharmacy, University of Wyoming College of Health Sciences, Laramie, WY, 82071, USA.
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11
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Yu X, Xue Y, Bian B, Wu X, Wang Z, Huang J, Huang L, Sun Y. NLR-A Simple Indicator of Inflammation for the Diagnosis of Left Ventricular Hypertrophy in Patients with Hypertension. Int Heart J 2020; 61:373-379. [PMID: 32173694 DOI: 10.1536/ihj.19-138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We aimed to investigate the relationship between neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), brain natriuretic peptide (BNP), and left ventricular hypertrophy (LVH) in hypertension. METHODS This study included 386 patients with hypertension. Mann-Whitney U test and multivariate binary logistic regression analysis were used to investigate the relationship between NLR, CRP, BNP, and LVH in patients with hypertension, as well as compare the levels of NLR, CRP, and BNP in the four configurations. Receiver operator characteristic (ROC) curve was used to compare the diagnostic efficacy of NLR, CRP, and BNP on LVH. RESULTS The NLR and CRP and BNP levels of the LVH group were significantly higher than those of the non-LVH group. In the multivariate logistic regression analysis, NLR as well as age, BMI, and SBP were associated with LVH. In addition, in patients with eccentric and concentric hypertrophy, the NLR and CRP and BNP levels were higher than those of the normal left ventricular geometry and concentric remodeling groups. The cutoff values of NLR, CRP, and BNP obtained by ROC curve were 2.185, 2.205, and 283.45, respectively, for the prediction of LVH. CONCLUSIONS NLR is independently associated with LVH in patients with hypertension, and this is consistent with the diagnostic efficacy of CRP and BNP, which may be a simple and convenient indicator for judging LVH.
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Affiliation(s)
- Xuefang Yu
- Department of Cardiology, Tianjin Medical University General Hospital
| | - Yuchen Xue
- Department of Cardiology, Tianjin Medical University General Hospital
| | - Bo Bian
- Department of Cardiology, Tianjin Medical University General Hospital
| | - Xianming Wu
- Department of Cardiology, Tianjin Medical University General Hospital
| | - Zhuoqun Wang
- Department of Cardiology, Tianjin Medical University General Hospital
| | - Jingjing Huang
- Department of Cardiology, Tianjin Medical University General Hospital
| | - Lei Huang
- Department of Cardiology, Tianjin Medical University General Hospital
| | - Yuemin Sun
- Department of Cardiology, Tianjin Medical University General Hospital
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Abstract
PURPOSE OF REVIEW To gather data from studies evaluating the pro-inflammatory profile of individuals with resistant hypertension (RH), and bring a clinical update of new and potential complementary therapies to treat inflammation in RH. RECENT FINDINGS Increases in pro-inflammatory cytokines are related to elevated blood pressure and target organ damage in RH patients. Clinical and experimental studies have shown that some biological therapies, especially TNF-α inhibitors, regulated pro- and anti-inflammatory cytokines associated with improvements in clinical outcomes, although they are not yet reported in RH. New emerging therapies to treat inflammation in RH, although promising, are still hypotheses that have not been scientifically confirmed in clinical trials. For this reason, inflammation-target treatments, such as the TNF-α and IL-6 inhibitors, should be encouraged for testing as complementary therapies in RH in order to elucidate their potential benefits.
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13
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The Role of Fibroblast Growth Factor 23 in Inflammation and Anemia. Int J Mol Sci 2019; 20:ijms20174195. [PMID: 31461904 PMCID: PMC6747522 DOI: 10.3390/ijms20174195] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/22/2019] [Accepted: 08/23/2019] [Indexed: 02/07/2023] Open
Abstract
In patients with chronic kidney disease (CKD), adverse outcomes such as systemic inflammation and anemia are contributing pathologies which increase the risks for cardiovascular mortality. Amongst these complications, abnormalities in mineral metabolism and the metabolic milieu are associated with chronic inflammation and iron dysregulation, and fibroblast growth factor 23 (FGF23) is a risk factor in this context. FGF23 is a bone-derived hormone that is essential for regulating vitamin D and phosphate homeostasis. In the early stages of CKD, serum FGF23 levels rise 1000-fold above normal values in an attempt to maintain normal phosphate levels. Despite this compensatory action, clinical CKD studies have demonstrated powerful and dose-dependent associations between FGF23 levels and higher risks for mortality. A prospective pathomechanism coupling elevated serum FGF23 levels with CKD-associated anemia and cardiovascular injury is its strong association with chronic inflammation. In this review, we will examine the current experimental and clinical evidence regarding the role of FGF23 in renal physiology as well as in the pathophysiology of CKD with an emphasis on chronic inflammation and anemia.
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14
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Budzyń M, Gryszczyńka B, Boruczkowski M, Kaczmarek M, Begier-Krasińska B, Osińska A, Bukowska A, Iskra M, Kasprzak MP. The Potential Role of Circulating Endothelial Cells and Endothelial Progenitor Cells in the Prediction of Left Ventricular Hypertrophy in Hypertensive Patients. Front Physiol 2019; 10:1005. [PMID: 31447695 PMCID: PMC6696897 DOI: 10.3389/fphys.2019.01005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 07/19/2019] [Indexed: 01/20/2023] Open
Abstract
Background The main aim of present study is to evaluate the potential role of circulating endothelial cells (CECs) and endothelial progenitor cells (CEPCs) – representing specific markers of endothelial damage, in the prediction of left ventricular hypertrophy (LVH) in hypertensive patients categorized into two groups; mild (MH) and resistant hypertension (RH). Materials and Methods Thirty patients with MH and 28 subjects with RH were involved in the study. In both groups, patients were divided into an LVH and non-LVH group. The control group included 33 age and sex-matched normotensive volunteers. Physical examination, laboratory tests and echocardiography were conducted. Results In both the MH and RH group, patients with as well as without LVH demonstrated a higher number of CECs and a lower ratio of CEPCs/CECs as compared to the healthy control. Multiple linear regression analysis showed a positive association of CEPCs with left ventricular mass (LVM) and left ventricular mass index (LVMI), independently of other confounders. Conclusion Our results suggest that endothelial injury observed as an elevated CECs number and its impaired regeneration, reflected by a lowered CEPCs/CECs ratio, precede LVH occurrence and may play a significant role in LVH development regardless of the clinical severity of hypertension. Moreover, independent correlation of CEPCs with echocardiographic (ECG) incidences of LVH suggests their potential use as a screening biomarker to stratify the risk of LVH development.
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Affiliation(s)
- Magdalena Budzyń
- Department of General Chemistry, Chair of Chemistry and Clinical Biochemistry, Poznań University of Medical Sciences, Poznań, Poland
| | - Bogna Gryszczyńka
- Department of General Chemistry, Chair of Chemistry and Clinical Biochemistry, Poznań University of Medical Sciences, Poznań, Poland
| | - Maciej Boruczkowski
- Department of Clinical Immunology, Poznań University of Medical Sciences, Poznań, Poland
| | - Mariusz Kaczmarek
- Department of Clinical Immunology, Poznań University of Medical Sciences, Poznań, Poland
| | - Beata Begier-Krasińska
- Department of Hypertensiology, Angiology, and Internal Diseases, Poznań University of Medical Sciences, Poznań, Poland
| | - Angelika Osińska
- Department of Hypertensiology, Angiology, and Internal Diseases, Poznań University of Medical Sciences, Poznań, Poland
| | - Alicja Bukowska
- Medical Analysis Laboratory, Regional Blood Center, Poznań, Poland
| | - Maria Iskra
- Department of General Chemistry, Chair of Chemistry and Clinical Biochemistry, Poznań University of Medical Sciences, Poznań, Poland
| | - Magdalena Paulina Kasprzak
- Department of General Chemistry, Chair of Chemistry and Clinical Biochemistry, Poznań University of Medical Sciences, Poznań, Poland
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15
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Protective effect of Xin-Ji-Er-Kang on cardiovascular remodeling in high-salt induced hypertensive mice: Role ofoxidative stress and endothelial dysfunction. Biomed Pharmacother 2019; 115:108937. [DOI: 10.1016/j.biopha.2019.108937] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 04/17/2019] [Accepted: 04/29/2019] [Indexed: 11/18/2022] Open
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16
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Faria APD, Ritter AMV, Gasparetti CS, Corrêa NB, Brunelli V, Almeida A, Pires NF, Modolo R, Moreno Junior H. A Proposed Inflammatory Score of Circulating Cytokines/Adipokines Associated with Resistant Hypertension, but Dependent on Obesity Parameters. Arq Bras Cardiol 2019; 112:383-389. [PMID: 30843931 PMCID: PMC6459424 DOI: 10.5935/abc.20190032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 09/05/2018] [Indexed: 01/06/2023] Open
Abstract
Background There is evidence that subclinical systemic inflammation is present in
resistant hypertension (RHTN). Objective The aim of the study was to develop an integrated measure of circulating
cytokines/adipokines involved in the pathophysiology of RHTN. Methods RHTN (n = 112) and mild to moderate hypertensive (HTN) subjects (n=112) were
studied in a cross-sectional design. Plasma cytokines/adipokines (TNF-alpha,
interleukins [IL]-6, -8, -10, leptin and adiponectin) values were divided
into tertiles, to which a score ranging from 1 (lowest tertile) to 3
(highest tertile) was assigned. The inflammatory score (IS) of each subject
was the sum of each pro-inflammatory cytokine scores from which
anti-inflammatory cytokines (adiponectin and IL-10) scores were subtracted.
The level of significance accepted was alpha = 0.05. Results IS was higher in RHTN subjects compared with HTN subjects [4 (2-6) vs. 3
(2-5); p = 0.02, respectively]. IS positively correlated with body fat
parameters, such as body mass index (r = 0.40; p < 0.001), waist
circumference (r = 0.30; p < 0.001) and fat mass assessed by
bioelectrical impedance analysis (r = 0.31; p < 0.001) in all
hypertensive subjects. Logistic regression analyses revealed that IS was an
independent predictor of RHTN (OR = 1.20; p = 0.02), independent of age,
gender and race, although it did not remain significant after adjustment for
body fat parameters. Conclusion A state of subclinical inflammation defined by an IS including TNF-alpha,
IL-6, IL-8, IL-10, leptin and adiponectin is associated with obese RHTN. In
addition, this score correlates with obesity parameters, independently of
hypertensive status. The IS may be used for the evaluation of conditions
involving low-grade inflammation, such as obesity-related RHTN. Indeed, it
also highlights the strong relationship between obesity and inflammatory
process.
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Affiliation(s)
- Ana Paula de Faria
- Departamento de Farmacologia da Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, SP - Brazil
| | | | - Carolina Souza Gasparetti
- Departamento de Farmacologia da Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, SP - Brazil.,Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP - Brazil
| | - Nathália Batista Corrêa
- Departamento de Farmacologia da Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, SP - Brazil
| | - Veridiana Brunelli
- Departamento de Farmacologia da Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, SP - Brazil
| | - Aurélio Almeida
- Departamento de Farmacologia da Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, SP - Brazil
| | - Nayara Fraccari Pires
- Departamento de Farmacologia da Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, SP - Brazil
| | - Rodrigo Modolo
- Departamento de Medicina Interna - Disciplina de Cardiologia da Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, SP - Brazil
| | - Heitor Moreno Junior
- Departamento de Medicina Interna da Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, SP - Brazil
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17
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Verdecchia P, Reboldi G, Angeli F, Mazzotta G, Lip GYH, Brueckmann M, Kleine E, Wallentin L, Ezekowitz MD, Yusuf S, Connolly SJ, Di Pasquale G. Dabigatran vs. warfarin in relation to the presence of left ventricular hypertrophy in patients with atrial fibrillation- the Randomized Evaluation of Long-term anticoagulation therapY (RE-LY) study. Europace 2018; 20:253-262. [PMID: 28520924 PMCID: PMC5834147 DOI: 10.1093/europace/eux022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/01/2017] [Indexed: 11/12/2022] Open
Abstract
Aim We tested the hypothesis that left ventricular hypertrophy (LVH) interferes with the antithrombotic effects of dabigatran and warfarin in patients with atrial fibrillation (AF). Methods and results This is a post-hoc analysis of the Randomized Evaluation of Long-term anticoagulation therapY (RE-LY) Study. We defined LVH by electrocardiography (ECG) and included patients with AF on the ECG tracing at entry. Hazard ratios (HR) for each dabigatran dose vs. warfarin were calculated in relation to LVH. LVH was present in 2353 (22.7%) out of 10 372 patients. In patients without LVH, the rates of primary outcome were 1.59%/year with warfarin, 1.60% with dabigatran 110 mg (HR vs. warfarin 1.01, 95% confidence interval (CI) 0.75-1.36) and 1.08% with dabigatran 150 mg (HR vs. warfarin 0.68, 95% CI 0.49-0.95). In patients with LVH, the rates of primary outcome were 3.21%/year with warfarin, 1.69% with dabigatran 110 mg (HR vs. warfarin 0.52, 95% CI 0.32-0.84) and 1.55% with 150 mg (HR vs. warfarin 0.48, 95% CI 0.29-0.78). The interaction between LVH status and dabigatran 110 mg vs. warfarin was significant for the primary outcome (P = 0.021) and stroke (P = 0.016). LVH was associated with a higher event rate with warfarin, not with dabigatran. In the warfarin group, the time in therapeutic range was significantly lower in the presence than in the absence of LVH. Conclusions LVH was associated with a lower antithrombotic efficacy of warfarin, but not of dabigatran, in patients with AF. Consequently, the relative benefit of the lower dose of dabigatran compared to warfarin was enhanced in patients with LVH. The higher dose of dabigatran was superior to warfarin regardless of LVH status. Clinical trial registration http:www.clinicaltrials.gov. Unique identifier: NCT00262600.
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Affiliation(s)
| | | | - Fabio Angeli
- Department of Cardiology and Cardiovascular Pathophysiology, Hospital S.M. della Misericordia, Perugia, Italy
| | | | - Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Martina Brueckmann
- Boehringer Ingelheim GmbH & Co, Ingelheim am Rhein, Germany.,Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Eva Kleine
- Boehringer Ingelheim GmbH & Co, Ingelheim am Rhein, Germany
| | - Lars Wallentin
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Michael D Ezekowitz
- Sidney Kimmel Medical College at Jefferson University, Philadelphia, PA, USA.,Medical College and Lankenau Medical Center, Wynnewood, PA, USA
| | - Salim Yusuf
- McMaster University, Hamilton, Ontario, Canada
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18
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Çetin Güvenç R, Ceran N, Güvenç TS, Tokgöz HC, Velibey Y. Right Ventricular Hypertrophy and Dilation in Patients With Human Immunodeficiency Virus in the Absence of Clinical or Echocardiographic Pulmonary Hypertension. J Card Fail 2018; 24:583-593. [PMID: 30195828 DOI: 10.1016/j.cardfail.2018.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 07/09/2018] [Accepted: 08/14/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Involvement of right-sided heart chambers (RSHCs) in patients infected with human immunodeficiency virus (HIV) is common and is usually attributed to pulmonary arterial or venous hypertension (PH). However, myocardial involvement in patients with HIV is also common and might affect RSHCs even in the absence of overt PH. Our aim was to define morphologic and functional alterations in RSHC in patients with HIV and without PH. METHODS AND RESULTS A total of 50 asymptomatic patients with HIV and 25 control subjects without clinical or echocardiographic signs for PH were included in the study. Transthoracic echocardiography was used to obtain measurements. Patients with HIV had significantly increased right ventricular end-diastolic diameter (RVEDD) and right ventricular free wall thickness (RVFWT), as well as increased right atrial area and pulmonary arterial diameter, compared with control subjects. After adjustment for age, sex, and body surface area, RVFWT (average 1.81 mm, 95% confidence interval [CI] 0.35-3.26 mm) and RVEDD (average 6.82 mm, 95% CI 2.40-11.24 mm) were significantly higher in subjects infected with HIV. More patients with right ventricular hypertrophy were on antiretroviral treatment, and RVFWT was on average 1.3 mm higher (95% CI 0.24-2.37 mm) in patients on antiretroviral treatment after adjustment for confounders. CONCLUSIONS These findings suggest that alterations in RSHCs were present in patients with HIV without PH.
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Affiliation(s)
- Rengin Çetin Güvenç
- Division of Cardiology, Haydarpaşa Numune Research and Training Hospital, Istanbul, Turkey
| | - Nurgül Ceran
- Division of Infectious Disorders, Haydarpaşa Numune Research and Training Hospital, Istanbul, Turkey
| | - Tolga Sinan Güvenç
- Division of Cardiology, Dr Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey.
| | - Hacer Ceren Tokgöz
- Division of Cardiology, Haydarpaşa Numune Research and Training Hospital, Istanbul, Turkey
| | - Yalçin Velibey
- Division of Cardiology, Dr Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey
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19
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Brandani L. Resistant hypertension: a therapeutic challenge. J Clin Hypertens (Greenwich) 2018; 20:76-78. [DOI: 10.1111/jch.13144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Laura Brandani
- Prevention Department; Arterial Hypertension and Metabolic Unit; University Hospital of Favaloro Foundation; Favaloro University; Buenos Aires Argentina
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20
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Prognostic impact of baseline urinary albumin excretion rate in patients with resistant hypertension: a prospective cohort study. J Hum Hypertens 2017; 32:139-149. [DOI: 10.1038/s41371-017-0013-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/01/2017] [Accepted: 10/03/2017] [Indexed: 11/09/2022]
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21
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Machalińska A, Pius-Sadowska E, Babiak K, Sałacka A, Safranow K, Kawa MP, Machaliński B. Correlation between Flicker-Induced Retinal Vessel Vasodilatation and Plasma Biomarkers of Endothelial Dysfunction in Hypertensive Patients. Curr Eye Res 2017; 43:128-134. [PMID: 29135307 DOI: 10.1080/02713683.2017.1358372] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Hypertension (HT) strongly affects the vascular endothelium, resulting in chronic inflammatory disease. Dynamic vessel analysis (DVA) is a modern methodological approach to analyze vascular function in the retinal microcirculation. The aim of this study was to examine whether a defective retinal vessels response is associated with HT-induced endothelial dysfunction. MATERIALS AND METHODS Retinal vessel reactions to flicker stimulation were examined by DVA in both eyes of 37 hypertensive and 41 healthy control subjects. Plasma concentrations of C-reactive protein (CRP), interleukin-6, and tumor necrosis factor alpha (TNFɑ) were measured using the enzyme-linked immunosorbent assay. RESULTS Both arterial and vein responses to flicker stimulation were significantly decreased in patients with HT compared with the healthy controls (dilatation of the arteries was lower in the HT group by, on average, 1.31, p = 0.001 and dilatation of the veins was lower in the HT group by, on average, 1.32, p = 0.002) after independent adjustment for age, sex, body mass index, and pressure values. In the hypertensive group, there was a negative correlation between the arterial response to flicker stimulation and the plasma CRP concentration (Spearman's Rank-order Coefficient (Rs) = -0.29, p = 0.07). Similarly, the plasma TNFα concentrations negatively correlated with the arterial response to flicker stimulation (Rs = -0.39, p = 0.02). CONCLUSIONS Our results indicate that DVA directly reflects the actual metabolic status of the retinal endothelium. DVA might be used as an early noninvasive screening tool to detect vascular dysregulation and pan-endothelial dysfunction in patients with HT.
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Affiliation(s)
- Anna Machalińska
- a First Department of Ophthalmology , Pomeranian Medical University , Szczecin , Poland
| | - Ewa Pius-Sadowska
- b Department of General Pathology , Pomeranian Medical University , Szczecin , Poland
| | - Katarzyna Babiak
- b Department of General Pathology , Pomeranian Medical University , Szczecin , Poland
| | - Anna Sałacka
- c Department of Family Medicine , Pomeranian Medical University , Szczecin , Poland
| | - Krzysztof Safranow
- d Department of Biochemistry and Medical Chemistry , Pomeranian Medical University , Szczecin , Poland
| | - Miłosz Piotr Kawa
- b Department of General Pathology , Pomeranian Medical University , Szczecin , Poland
| | - Bogusław Machaliński
- b Department of General Pathology , Pomeranian Medical University , Szczecin , Poland
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22
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Marques FZ, Prestes PR, Byars SG, Ritchie SC, Würtz P, Patel SK, Booth SA, Rana I, Minoda Y, Berzins SP, Curl CL, Bell JR, Wai B, Srivastava PM, Kangas AJ, Soininen P, Ruohonen S, Kähönen M, Lehtimäki T, Raitoharju E, Havulinna A, Perola M, Raitakari O, Salomaa V, Ala-Korpela M, Kettunen J, McGlynn M, Kelly J, Wlodek ME, Lewandowski PA, Delbridge LM, Burrell LM, Inouye M, Harrap SB, Charchar FJ. Experimental and Human Evidence for Lipocalin-2 (Neutrophil Gelatinase-Associated Lipocalin [NGAL]) in the Development of Cardiac Hypertrophy and heart failure. J Am Heart Assoc 2017; 6:e005971. [PMID: 28615213 PMCID: PMC5669193 DOI: 10.1161/jaha.117.005971] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 05/02/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Cardiac hypertrophy increases the risk of developing heart failure and cardiovascular death. The neutrophil inflammatory protein, lipocalin-2 (LCN2/NGAL), is elevated in certain forms of cardiac hypertrophy and acute heart failure. However, a specific role for LCN2 in predisposition and etiology of hypertrophy and the relevant genetic determinants are unclear. Here, we defined the role of LCN2 in concentric cardiac hypertrophy in terms of pathophysiology, inflammatory expression networks, and genomic determinants. METHODS AND RESULTS We used 3 experimental models: a polygenic model of cardiac hypertrophy and heart failure, a model of intrauterine growth restriction and Lcn2-knockout mouse; cultured cardiomyocytes; and 2 human cohorts: 114 type 2 diabetes mellitus patients and 2064 healthy subjects of the YFS (Young Finns Study). In hypertrophic heart rats, cardiac and circulating Lcn2 was significantly overexpressed before, during, and after development of cardiac hypertrophy and heart failure. Lcn2 expression was increased in hypertrophic hearts in a model of intrauterine growth restriction, whereas Lcn2-knockout mice had smaller hearts. In cultured cardiomyocytes, Lcn2 activated molecular hypertrophic pathways and increased cell size, but reduced proliferation and cell numbers. Increased LCN2 was associated with cardiac hypertrophy and diastolic dysfunction in diabetes mellitus. In the YFS, LCN2 expression was associated with body mass index and cardiac mass and with levels of inflammatory markers. The single-nucleotide polymorphism, rs13297295, located near LCN2 defined a significant cis-eQTL for LCN2 expression. CONCLUSIONS Direct effects of LCN2 on cardiomyocyte size and number and the consistent associations in experimental and human analyses reveal a central role for LCN2 in the ontogeny of cardiac hypertrophy and heart failure.
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Affiliation(s)
- Francine Z Marques
- School of Applied and Biomedical Sciences, Faculty of Science and Technology, Federation University Australia, Ballarat, Victoria, Australia
- Heart Failure Research Group, Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia
| | - Priscilla R Prestes
- School of Applied and Biomedical Sciences, Faculty of Science and Technology, Federation University Australia, Ballarat, Victoria, Australia
| | - Sean G Byars
- Centre for Systems Genomics, The University of Melbourne, Victoria, Australia
- School of BioSciences, The University of Melbourne, Victoria, Australia
- Department of Pathology, The University of Melbourne, Victoria, Australia
| | - Scott C Ritchie
- Centre for Systems Genomics, The University of Melbourne, Victoria, Australia
- Department of Pathology, The University of Melbourne, Victoria, Australia
| | - Peter Würtz
- Computational Medicine, Faculty of Medicine, University of Oulu and Biocenter Oulu, Oulu, Finland
| | - Sheila K Patel
- Department of Medicine, The University of Melbourne Austin Health, Heidelberg, Victoria, Australia
| | - Scott A Booth
- School of Applied and Biomedical Sciences, Faculty of Science and Technology, Federation University Australia, Ballarat, Victoria, Australia
| | - Indrajeetsinh Rana
- School of Applied and Biomedical Sciences, Faculty of Science and Technology, Federation University Australia, Ballarat, Victoria, Australia
| | - Yosuke Minoda
- School of Applied and Biomedical Sciences, Faculty of Science and Technology, Federation University Australia, Ballarat, Victoria, Australia
| | - Stuart P Berzins
- School of Applied and Biomedical Sciences, Faculty of Science and Technology, Federation University Australia, Ballarat, Victoria, Australia
- Department of Microbiology and Immunology, Peter Doherty Institute, The University of Melbourne, Victoria, Australia
| | - Claire L Curl
- Department of Physiology, The University of Melbourne, Victoria, Australia
| | - James R Bell
- Department of Physiology, The University of Melbourne, Victoria, Australia
| | - Bryan Wai
- Department of Medicine, The University of Melbourne Austin Health, Heidelberg, Victoria, Australia
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
| | - Piyush M Srivastava
- Department of Medicine, The University of Melbourne Austin Health, Heidelberg, Victoria, Australia
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
| | - Antti J Kangas
- Computational Medicine, Faculty of Medicine, University of Oulu and Biocenter Oulu, Oulu, Finland
| | - Pasi Soininen
- Computational Medicine, Faculty of Medicine, University of Oulu and Biocenter Oulu, Oulu, Finland
- NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Saku Ruohonen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Terho Lehtimäki
- Fimlab Laboratories, Department of Clinical Chemistry, Pirkanmaa Hospital District, School of Medicine, University of Tampere, Finland
| | - Emma Raitoharju
- Fimlab Laboratories, Department of Clinical Chemistry, Pirkanmaa Hospital District, School of Medicine, University of Tampere, Finland
| | - Aki Havulinna
- National Institute for Health and Welfare, Helsinki, Finland
| | - Markus Perola
- National Institute for Health and Welfare, Helsinki, Finland
- Institute for Molecular Medicine Finland, University of Helsinki, Finland
| | - Olli Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Veikko Salomaa
- National Institute for Health and Welfare, Helsinki, Finland
| | - Mika Ala-Korpela
- Computational Medicine, Faculty of Medicine, University of Oulu and Biocenter Oulu, Oulu, Finland
- NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, United Kingdom
- School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Johannes Kettunen
- Computational Medicine, Faculty of Medicine, University of Oulu and Biocenter Oulu, Oulu, Finland
- NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- National Institute for Health and Welfare, Helsinki, Finland
| | - Maree McGlynn
- School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia
| | - Jason Kelly
- School of Applied and Biomedical Sciences, Faculty of Science and Technology, Federation University Australia, Ballarat, Victoria, Australia
| | - Mary E Wlodek
- Department of Medicine, The University of Melbourne Austin Health, Heidelberg, Victoria, Australia
| | | | - Lea M Delbridge
- Department of Physiology, The University of Melbourne, Victoria, Australia
| | - Louise M Burrell
- Department of Medicine, The University of Melbourne Austin Health, Heidelberg, Victoria, Australia
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
| | - Michael Inouye
- Heart Failure Research Group, Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia
- Centre for Systems Genomics, The University of Melbourne, Victoria, Australia
- School of BioSciences, The University of Melbourne, Victoria, Australia
- Department of Pathology, The University of Melbourne, Victoria, Australia
- Department of Physiology, The University of Melbourne, Victoria, Australia
| | - Stephen B Harrap
- Department of Physiology, The University of Melbourne, Victoria, Australia
| | - Fadi J Charchar
- School of Applied and Biomedical Sciences, Faculty of Science and Technology, Federation University Australia, Ballarat, Victoria, Australia
- Department of Physiology, The University of Melbourne, Victoria, Australia
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom
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23
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Shi H, Chu H, Lv Z, Qi G, Guo J, Fu W, Wang X, Guo X, Ge J, Yin C. Association of white blood cell counts with left ventricular mass index in hypertensive patients undergoing anti-hypertensive drug therapy. Exp Ther Med 2017; 13:1566-1571. [PMID: 28413510 DOI: 10.3892/etm.2017.4119] [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: 03/23/2015] [Accepted: 09/20/2016] [Indexed: 11/06/2022] Open
Abstract
Although studies using animal models have demonstrated that nonhemodynamic factors, including inflammatory cells and cytokines, contribute to left ventricular hypertrophy (LVH), there is little clinical data to confirm this association. Therefore in the present study, levels of circulating specific types of leukocyte were measured to determine the association between white blood cells and left ventricular mass index (LVMI) in hypertensive patients undergoing anti-hypertensive drug therapy. A total of 144 consecutive hypertensive patients taking anti-hypertensive drug therapy were enrolled in the current study. Subjects were divided into two groups: Those with normal geometry and those with left LVH. Total white blood cells and differentiated subtypes (neutrophils, lymphocytes, monocytes) were counted, and left ventricular end-diastolic diameter, left ventricular posterior wall thickness in diastole and inter-ventricular septal wall thickness in diastole were all measured. Analysis revealed a significant correlation between LVMI and total white blood cell levels (P=0.013). The percentage of LVH in the highest tertile of WBC was increased compared with the middle tertile (P=0.008). Furthermore, a significant correlation between the highest tertile of neutrophil counts and LVH was observed (P=0.039). However, no significant associations between LVMI and monocyte or lymphocyte counts were detected. Therefore, the current study determined that increased total white blood cell and neutrophil subtype counts were associated with LVMI in hypertensive patients undergoing anti-hypertensive drug therapy. They may provide convenient and useful markers for further risk appraisal of LVH caused by nonhemodynamic factors of hypertension.
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Affiliation(s)
- Hongtao Shi
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China.,Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Hongxia Chu
- Department of Cardiology, Yuhuangding Hospital, Qingdao Medical College, Qingdao University, Yantai, Shandong 264000, P.R. China
| | - Zhiyang Lv
- Department of Cardiology, Yichang Central People's Hospital, Institute of Cardiovascular Diseases, Three Gorges University, Yichang, Hubei 443003, P.R. China
| | - Guanming Qi
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Junjie Guo
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China.,Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266071, P.R. China
| | - Wei Fu
- Department of Cardiology, Gaoan People's Hospital, Gaoan, Jiangxi 330800, P.R. China
| | - Xiaojing Wang
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Xiangyu Guo
- Department of Pharmacy, Capital Medical University, Beijing 100054, P.R. China
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Chengqian Yin
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
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Tan X, Jiao PL, Wang YK, Wu ZT, Zeng XR, Li ML, Wang WZ. The phosphoinositide-3 kinase signaling is involved in neuroinflammation in hypertensive rats. CNS Neurosci Ther 2017; 23:350-359. [PMID: 28191736 DOI: 10.1111/cns.12679] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 01/20/2017] [Accepted: 01/22/2017] [Indexed: 12/20/2022] Open
Abstract
AIMS It has been demonstrated that neuroinflammation is associated with cardiovascular dysfunction. The phosphoinositide-3 kinase (PI3K) signaling in the rostral ventrolateral medulla (RVLM), a key region for sympathetic outflow, is upregulated and contributes to increased blood pressure (BP) and sympathetic outflow in hypertension. This study was designed to determine the role of the PI3K signaling in neuroinflammation in the RVLM of hypertension. METHODS The normotensive WKY rats were performed by intracisternal infusion of lipopolysaccharide (LPS) or angiotensin II (Ang II) for inducing neuroinflammation. Elisa was used to determine the level of proinflammatory cytokines. Western blot was employed to detect the protein expression of PI3K signaling pathway. Gene silencing of PI3K p110δ subunit and overexpression of angiotensin-converting enzyme 2 (ACE2) were realized by injecting related lentivirus into the RVLM. RESULTS In the spontaneously hypertensive rats (SHR), the PI3K signaling in the RVLM was upregulated compared with WKY, gene silencing of PI3K in the RVLM significantly reduced BP and renal sympathetic nerve activity (RSNA), but also decreased the levels of proinflammatory cytokines. In the WKY rats, central infusion of LPS and Ang II significantly elevated BP and RSNA, but also increased the levels of proinflammatory cytokines and PI3K signaling activation in the RVLM. These changes in the Ang II-induced hypertension were effectively prevented by gene silencing of PI3K in the RVLM. Furthermore, overexpression of ACE2 in the RVLM significantly attenuated high BP and neuroinflammation, as well as decreased the activation of PI3K signaling in hypertensive rats. CONCLUSION This study suggests that the PI3K signaling in the RVLM is involved in neuroinflammation in hypertension and plays an important role in the renin-angiotensin system-mediated changes in neuroinflammation in the RVLM.
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Affiliation(s)
- Xing Tan
- Department of Physiology and Center of Polar Medical Research, Second Military Medical University, Shanghai, China
| | - Pei-Lei Jiao
- Department of Physiology and Center of Polar Medical Research, Second Military Medical University, Shanghai, China
| | - Yang-Kai Wang
- Department of Physiology and Center of Polar Medical Research, Second Military Medical University, Shanghai, China
| | - Zhao-Tang Wu
- Department of Physiology and Center of Polar Medical Research, Second Military Medical University, Shanghai, China
| | - Xiao-Rong Zeng
- Institute of Cardiovascular Medical Research, West-South Medical University, Luzhou, China
| | - Miao-Ling Li
- Institute of Cardiovascular Medical Research, West-South Medical University, Luzhou, China
| | - Wei-Zhong Wang
- Department of Physiology and Center of Polar Medical Research, Second Military Medical University, Shanghai, China
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Gancheva R, Kundurdjiev A, Ivanova M, Kundurzhiev T, Kolarov Z. Evaluation of cardiovascular risk in stages of gout by a complex multimodal ultrasonography. Rheumatol Int 2016; 37:121-130. [PMID: 27577941 DOI: 10.1007/s00296-016-3556-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/22/2016] [Indexed: 12/22/2022]
Abstract
The aim of our work was to assess ultrasound features of cardiovascular (CV) risk in stages of gout. Cross-sectional complex multimodal ultrasound study of 169 age-matched patients, with similar distribution of arterial hypertension, diabetes mellitus, obesity and chronic renal failure, was divided into four groups: 41 with asymptomatic hyperuricemia, 52 gout without tophi, 42 gouty tophi and 34 controls with osteoarthritis. Parameters independently associated with CV risk were measured: renal resistive index (RRI), left ventricular mass index (LVMi), mitral annulus early diastolic velocity (e'), intima-media thickness (IMT) and common carotid artery resistive index (CCARI). Multivariate analyses were performed to evaluate the impact of gout stages and CV risk factors on ultrasound alterations. Gouty tophi increased the risk of having IMT >0.90 mm with an OR 11.51 (95 % CI 2.32-57.21, p = 0.003), gout without tophi raised the risk with an OR 6.25 (95 % CI 1.37-28.44, p = 0.018), while asymptomatic hyperuricemia had no effect on IMT. The category of CCARI >0.70 was influenced by tophi with an OR 11.18 (95 % CI 2.61-47.83, p = 0.001) and by arterial hypertension with an OR 3.22 (95 % CI 1.11-9.36, p = 0.032). Neither asymptomatic hyperuricemia nor gout without tophi modified the development of abnormally high CCARI. Gout stages had no impact on LVMi, e' and RRI. Tophi are related to worsened ultrasonographic parameters evaluating target organs in gout, relative to earlier stages of the disease. They create a strong risk of carotid arteries' changes even beyond arterial hypertension.
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Affiliation(s)
- Rada Gancheva
- Department of Internal Medicine, Medical Faculty, Clinic of Rheumatology, Medical University, University Hospital St. Iv. Rilski, 13, Urvich St., 1612, Sofia, Bulgaria.
| | - Atanas Kundurdjiev
- Department of Internal Medicine, Medical Faculty, Clinic of Nephrology, Medical University, University Hospital St. Iv. Rilski, 15, Iv. Geshov St., 1431, Sofia, Bulgaria
| | - Mariana Ivanova
- Department of Internal Medicine, Medical Faculty, Clinic of Rheumatology, Medical University, University Hospital St. Iv. Rilski, 13, Urvich St., 1612, Sofia, Bulgaria
| | - Todor Kundurzhiev
- Faculty of Public Health, Medical University, 8, Bialo more St., 1527, Sofia, Bulgaria
| | - Zlatimir Kolarov
- Department of Internal Medicine, Medical Faculty, Clinic of Rheumatology, Medical University, University Hospital St. Iv. Rilski, 13, Urvich St., 1612, Sofia, Bulgaria
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Cortez AF, Muxfeldt ES, Cardoso CRL, Salles GF. Prognostic Value of C-Reactive Protein in Resistant Hypertension. Am J Hypertens 2016; 29:992-1000. [PMID: 26884133 DOI: 10.1093/ajh/hpw011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 01/19/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND C-reactive protein (CRP) is a biomarker of systemic low-grade inflammation and a cardiovascular risk predictor in several clinical conditions. However, its prognostic value has never been examined in patients with resistant hypertension. METHODS In a prospective study, 476 patients with resistant hypertension had CRP levels measured at baseline, together with other clinical laboratory variables, including ambulatory blood pressures (BPs). Primary end points were a composite of major fatal or nonfatal cardiovascular events, all-cause mortality, and cardiovascular mortality. Multiple Cox regression assessed the associations between CRP levels and end points. RESULTS Median CRP was 3.8mg/l (interquartile range: 2.0-7.2mg/l). After a median follow-up of 9 years, 103 major cardiovascular events occurred, and 120 patients died, 62 from cardiovascular causes. Patients with CRP levels above the median value had a doubled excess risk of major cardiovascular events (95% confidence interval: 1.29-3.06; P = 0.002) and an 86% higher risk of cardiovascular death (95% confidence interval: 1.07-3.25; P = 0.029), after adjustments for potential confounders including traditional cardiovascular risk factors and ambulatory BP and dipping pattern. A high CRP equally predicted coronary (hazard ratio: 2.04; 95% confidence interval: 1.10-3.76; P = 0.023) and cerebrovascular events (hazard ratio: 2.72; 95% confidence interval: 1.30-5.67; P = 0.007). In interaction and sensitivity analyses, CRP levels were stronger predictors of worse cardiovascular outcomes in younger and obese patients, and in those with uncontrolled ambulatory BPs and with the nondipping pattern. CONCLUSIONS In patients with resistant hypertension, elevated serum CRP levels is predictive of worse cardiovascular prognosis above and beyond other cardiovascular risk factors, including ambulatory BP levels and dipping patterns.
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Affiliation(s)
- Arthur Fernandes Cortez
- Hypertension Program, University Hospital Clementino Fraga Filho, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Elizabeth Silaid Muxfeldt
- Hypertension Program, University Hospital Clementino Fraga Filho, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Claudia Regina Lopes Cardoso
- Hypertension Program, University Hospital Clementino Fraga Filho, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gil Fernando Salles
- Hypertension Program, University Hospital Clementino Fraga Filho, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Carotid flow velocity/diameter ratio is a predictor of cardiovascular events in hypertensive patients. J Hypertens 2016; 33:2054-60. [PMID: 26237558 DOI: 10.1097/hjh.0000000000000688] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the performance of common carotid artery diameter, flow velocity and flow velocity/artery diameter ratio as predictors of major adverse cardiovascular events (MACEs) in a sample of hypertensive patients. METHODS A cohort of 403 hypertensive patients was followed up for a median of 1260 (714) days, and 27 suffered MACEs. At baseline, participants were evaluated by clinical, laboratory, echocardiographic and carotid ultrasound analysis. RESULTS Patients with peak-systolic flow velocity (sFV) less than the median value and systolic artery diameter (sAD) greater than the median value presented the worst clinical outcome compared to those with isolated sFV less than the median value or sAD greater than the median value, suggesting an additive effect of these two variables. Further, Kaplan-Meier analysis demonstrated worse outcome for individuals with sFV/sAD ratio less than 85.7/s (optimal cut-off point obtained by receiver-operating characteristic analysis) compared to those with higher sFV/sAD values (log-rank test: P < 0.0001). In stepwise multivariable Cox-regression analyses, sFV/sAD was significantly associated with MACEs (P < 0.001), whereas carotid intima-media thickness and clinically defined high cardiovascular risk did not. Furthermore, area under the receiver-operating characteristic curve for sFV/sAD was higher than that for Framingham risk score (0.77 versus 0.64; P = 0.045), whereas adding sFV/sAD to the Framingham risk factors resulted in increased net reclassification improvement (P = 0.041) and integrated discrimination improvement (P < 0.001). CONCLUSIONS Lower carotid sFV/sAD was associated with MACEs in hypertensive patients independent of cardiovascular prediction models and carotid intima-media thickness. These findings suggest that this index may be a promising approach to identify hypertensive subjects at increased risk for future cardiovascular events.
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de Faria AP, Ritter AMV, Sabbatini AR, Corrêa NB, Brunelli V, Modolo R, Moreno H. Deregulation of Soluble Adhesion Molecules in Resistant Hypertension and Its Role in Cardiovascular Remodeling. Circ J 2016; 80:1196-201. [DOI: 10.1253/circj.cj-16-0058] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ana Paula de Faria
- Laboratory of Cardiovascular Pharmacology, Faculty of Medical Sciences, University of Campinas
| | | | | | - Nathália Batista Corrêa
- Laboratory of Cardiovascular Pharmacology, Faculty of Medical Sciences, University of Campinas
| | - Veridiana Brunelli
- Laboratory of Cardiovascular Pharmacology, Faculty of Medical Sciences, University of Campinas
| | - Rodrigo Modolo
- Laboratory of Cardiovascular Pharmacology, Faculty of Medical Sciences, University of Campinas
| | - Heitor Moreno
- Laboratory of Cardiovascular Pharmacology, Faculty of Medical Sciences, University of Campinas
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Seyfeli E, Sarli B, Saglam H, Karatas CY, Ozkan E, Ugurlu M. The Relationship Between High-Sensitivity C-Reactive Protein Levels and Left Ventricular Hypertrophy in Patients With Newly Diagnosed Hypertension. J Clin Hypertens (Greenwich) 2015; 18:679-84. [PMID: 26603359 DOI: 10.1111/jch.12734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 09/21/2015] [Accepted: 09/27/2015] [Indexed: 01/19/2023]
Abstract
The authors aimed to evaluate the relationship between high-sensitivity C-reactive protein (hs-CRP) and presence of left ventricular hypertrophy and diastolic dysfunction in patients with hypertension. A total of 95 newly diagnosed hypertensive patients (mean age, 54±10 years) and 20 controls were included in this study. Patients were divided into four groups according to relative wall thickness as normal, concentric remodeling, concentric, and eccentric hypertrophy. hs-CRP was measured in all patients and serum hs-CRP level was shown to be increased in patients with hypertension compared with controls (0.57 mg/dL vs 0.25 mg/dL, respectively; P<.001). The hs-CRP level was highest in patients with concentric hypertrophy. When compared with controls, serum hs-CRP level was significantly higher in patients with concentric remodeling (0.61±0.3 mg/dL vs 0.43±0.5 mg/dL, P<.030) and concentric hypertrophy (0.69±0.3 mg/dL vs 0.43±0.5 mg/dL, P<.032). The present study shows that serum hs-CRP is significantly associated with left ventricular diastolic function and concentric hypertrophy in patients with hypertension.
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Affiliation(s)
- Ergun Seyfeli
- Department of Cardiology, School of Medicine, Acibadem University, Istanbul, Turkey
| | - Bahadir Sarli
- Department of Cardiology, Research and Education Hospital, Kayseri, Turkey
| | - Hayrettin Saglam
- Department of Cardiology, Research and Education Hospital, Kayseri, Turkey
| | - Can Y Karatas
- Department of Cardiology, Research and Education Hospital, Darica, Kocaeli, Turkey
| | - Eyup Ozkan
- Department of Cardiology, Research and Education Hospital, Kayseri, Turkey
| | - Mehmet Ugurlu
- Department of Cardiology, Research and Education Hospital, Kayseri, Turkey
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Abstract
Resistant hypertension (RHTN), defined as an uncontrolled blood pressure despite the use of multiple antihypertensive medications, is an increasing clinical problem associated with increased cardiovascular (CV) risk, including stroke and target organ damage. Genetic variability in blood pressure (BP)-regulating genes and pathways may, in part, account for the variability in BP response to antihypertensive agents, when taken alone or in combination, and may contribute to the RHTN phenotype. Pharmacogenomics focuses on the identification of genetic factors responsible for inter-individual variability in drug response. Expanding pharmacogenomics research to include patients with RHTN taking multiple BP-lowering medications may identify genetic markers associated with RHTN. To date, the available evidence surrounding pharmacogenomics in RHTN is limited and primarily focused on candidate genes. In this review, we summarize the most current data in RHTN pharmacogenomics and offer some recommendations on how to advance the field.
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Affiliation(s)
- Nihal El Rouby
- Department of Pharmacotherapy and Translational Research, University of Florida, PO Box 100486, 1600 SW Archer Road, Gainesville, FL 32610-0486, USA
| | - Rhonda M. Cooper-DeHoff
- Department of Pharmacotherapy and Translational Research, University of Florida, PO Box 100486, 1600 SW Archer Road, Gainesville, FL 32610-0486, USA
- Division of Cardiovascular Medicine, Colleges of Pharmacy and Medicine, University of Florida, PO Box 100486, 1600 SW Archer Road, Gainesville, FL 32610-0486, USA
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Muxfeldt ES, de Souza F, Margallo VS, Salles GF. Cardiovascular and renal complications in patients with resistant hypertension. Curr Hypertens Rep 2015; 16:471. [PMID: 25079852 DOI: 10.1007/s11906-014-0471-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
With an increased prevalence, resistant hypertension is recognized as an entity with a high cardiovascular morbidity and mortality. In a large cohort of patients with resistant hypertension, the crude incidence rate of total cardiovascular events reached 4.32 per 100 patient-years of follow-up (19.6 %), with a cardiovascular mortality of 8.3 % (incidence rate of 1.72 per 100 patient-years). Cardiovascular event rates are significantly higher in resistant hypertensives compared with non-resistant (18.0 % versus 13.5 %). In the same way, the prevalence of established cardiovascular and renal disease, as the asymptomatic organ damage (represented by left ventricular hypertrophy, carotid wall thickening, arterial stiffness, and microalbuminuria) is higher in these patients. Many studies have demonstrated a strong association between damage to these organs with higher blood pressure levels, the diagnosis of true resistant hypertension, and refractory hypertension. All efforts should be employed in order to control blood pressure and also to regress and/or prevent subclinical cardiovascular and renal damage. The focus should be on prevention of cardiovascular and renal complications, improving the prognosis of resistant hypertension.
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Affiliation(s)
- Elizabeth S Muxfeldt
- Department of Internal Medicine, University Hospital Clementino Fraga Filho, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil,
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Gupta J, Dominic EA, Fink JC, Ojo AO, Barrows IR, Reilly MP, Townsend RR, Joffe MM, Rosas SE, Wolman M, Patel SS, Keane MG, Feldman HI, Kusek JW, Raj DS. Association between Inflammation and Cardiac Geometry in Chronic Kidney Disease: Findings from the CRIC Study. PLoS One 2015; 10:e0124772. [PMID: 25909952 PMCID: PMC4409366 DOI: 10.1371/journal.pone.0124772] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 03/08/2015] [Indexed: 01/27/2023] Open
Abstract
Background Left ventricular hypertrophy (LVH) and myocardial contractile dysfunction are independent predictors of mortality in patients with chronic kidney disease (CKD). The association between inflammatory biomarkers and cardiac geometry has not yet been studied in a large cohort of CKD patients with a wide range of kidney function. Methods Plasma levels of interleukin (IL)-1β, IL-1 receptor antagonist (IL-1RA), IL-6, tumor necrosis factor (TNF)-α, transforming growth factor (TGF)-β, high-sensitivity C-Reactive protein (hs-CRP), fibrinogen and serum albumin were measured in 3,939 Chronic Renal Insufficiency Cohort study participants. Echocardiography was performed according to the recommendations of the American Society of Echocardiography and interpreted at a centralized core laboratory. Results LVH, systolic dysfunction and diastolic dysfunction were present in 52.3%, 11.8% and 76.3% of the study subjects, respectively. In logistic regression analysis adjusted for age, sex, race/ethnicity, diabetic status, current smoking status, systolic blood pressure, urinary albumin- creatinine ratio and estimated glomerular filtration rate, hs-CRP (OR 1.26 [95% CI 1.16, 1.37], p<0.001), IL-1RA (1.23 [1.13, 1.34], p<0.0001), IL-6 (1.25 [1.14, 1.36], p<0.001) and TNF-α (1.14 [1.04, 1.25], p = 0.004) were associated with LVH. The odds for systolic dysfunction were greater for subjects with elevated levels of hs-CRP (1.32 [1.18, 1.48], p<0.001) and IL-6 (1.34 [1.21, 1.49], p<0.001). Only hs-CRP was associated with diastolic dysfunction (1.14 [1.04, 1.26], p = 0.005). Conclusion In patients with CKD, elevated plasma levels of hs-CRP and IL-6 are associated with LVH and systolic dysfunction.
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Affiliation(s)
- Jayanta Gupta
- Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, Texas, United States of America
| | - Elizabeth A. Dominic
- The George Washington University School of Medicine, Washington, DC, United States of America
| | - Jeffrey C. Fink
- Division of Nephrology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Akinlolu O. Ojo
- Division of Nephrology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Ian R. Barrows
- The George Washington University School of Medicine, Washington, DC, United States of America
| | - Muredach P. Reilly
- Cardiovascular Institute, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Raymond R. Townsend
- Renal and Electrolyte Division, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Marshall M. Joffe
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Sylvia E. Rosas
- Joslyn Diabetic Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Melanie Wolman
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Samir S. Patel
- Division of Renal Diseases and Hypertension, The George Washington University, Washington, DC, United States of America
| | - Martin G. Keane
- Department of Medicine, Temple University, Philadelphia, Pennsylvania, United States of America
| | - Harold I. Feldman
- Renal and Electrolyte Division, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - John W. Kusek
- Division of Kidney, Urologic, and Hematologic Diseases, The National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, United States of America
| | - Dominic S. Raj
- Division of Renal Diseases and Hypertension, The George Washington University, Washington, DC, United States of America
- * E-mail:
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Belen E, Sungur A, Sungur MA, Erdoğan G. Increased Neutrophil to Lymphocyte Ratio in Patients With Resistant Hypertension. J Clin Hypertens (Greenwich) 2015; 17:532-7. [DOI: 10.1111/jch.12533] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 12/30/2014] [Accepted: 01/02/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Erdal Belen
- Department of Cardiology; Okmeydanı Training and Research Hospital; Istanbul Turkey
| | - Aylin Sungur
- Department of Cardiology; Kahramanmaras Necip Fazıl City Hospital; Kahramanmaras Turkey
| | - Mustafa Azmi Sungur
- Department of Cardiology; Kahramanmaras Necip Fazıl City Hospital; Kahramanmaras Turkey
| | - Güney Erdoğan
- Department of Cardiology; Ordu Training and Research Hospital; Ordu Turkey
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Lazutkina AY, Gorbunov VV. Prognostic value of risk factors for cardiovascular diseases and target organ damages for the occurrence of resistant hypertension. TERAPEVT ARKH 2015; 87:19-23. [DOI: 10.17116/terarkh201587419-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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de Faria APC, Modolo R, Sabbatini AR, Barbaro NR, Corrêa NB, Brunelli V, Tanus-Santos JE, Fontana V, Moreno H. Adiponectin -11377C/G and +276G/T polymorphisms affect adiponectin levels but do not modify responsiveness to therapy in resistant hypertension. Basic Clin Pharmacol Toxicol 2014; 117:65-72. [PMID: 25546819 DOI: 10.1111/bcpt.12368] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 12/11/2014] [Indexed: 01/03/2023]
Abstract
Resistant hypertension (RHTN) is a multifactorial and polygenic disease, frequently associated with obesity. Low plasma adiponectin levels, a hormone produced by the adipose tissue, were associated with RHTN. Single nucleotide polymorphisms (SNPs) -11377C/G (rs266729) and +276G/T (rs1501299) in ADIPOQ (adiponectin gene) were associated with hypertension. This study evaluated the association between two SNPs (-11377C/G and +276G/T) and adiponectin levels in RHTN. This study comprised 109 patients with RHTN genotyped for both polymorphisms. A cross-sectional study was designed to compare features of CC homozygous versus G allele carriers for -11377C/G and GG homozygous versus T allele carriers for +276G/T. Office and ambulatory BP measurements were similar among genotypes subgroups in both SNPs as well as the markers of target organ damage (arterial stiffness, left ventricular mass index and microalbuminuria). Adiponectin concentrations were significantly higher in CC compared to G carrier for -11377C/G (CC:7.0 (4.0-10.2) versus G allele:5.5 (2.5-7.9), p = 0.04) and lower in GG compared to T carrier for +276G/T (GG:5.3 (2.3-7.7) versus T allele:7.1 (3.6-10.5), p = 0.04). Adjusting for systolic ambulatory BP, body mass index, age, gender, race and presence of type 2 diabetes, multiple linear regression analyses revealed that the minor alleles G (β-coefficient= -0.14, SE=0.07, p = 0.03) and T (β-coefficient=0.12, SE=0.06, p = 0.04) were independent predictors of adiponectin. The -11377C/G and +276G/T SNPs in ADIPOQ were associated with adiponectin levels in RHTN individuals.
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Affiliation(s)
- Ana Paula C de Faria
- Laboratory of Cardiovascular Pharmacology, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Rodrigo Modolo
- Laboratory of Cardiovascular Pharmacology, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Andréa R Sabbatini
- Laboratory of Cardiovascular Pharmacology, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Natália R Barbaro
- Laboratory of Cardiovascular Pharmacology, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Nathália B Corrêa
- Laboratory of Cardiovascular Pharmacology, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Veridiana Brunelli
- Laboratory of Cardiovascular Pharmacology, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - José E Tanus-Santos
- Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Vanessa Fontana
- Brazilian Biosciences National Laboratory, Brazilian Center for Research in Energy and Materials, Campinas, SP, Brazil
| | - Heitor Moreno
- Laboratory of Cardiovascular Pharmacology, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil
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de Faria AP, Modolo R, Fontana V, Moreno H. Adipokines: novel players in resistant hypertension. J Clin Hypertens (Greenwich) 2014; 16:754-9. [PMID: 25186286 DOI: 10.1111/jch.12399] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 05/08/2014] [Accepted: 05/12/2014] [Indexed: 12/27/2022]
Abstract
Resistant hypertension (RH) is a multifactorial disease, frequently associated with obesity and characterized by blood pressure above goal (140/90 mm Hg) despite the concurrent use of ≥3 antihypertensive drugs of different classes. The mechanisms of obesity-related hypertension include, among others, aldosterone excess and inflammatory adipokines, which have demonstrated a significant role in the pathogenesis of metabolic syndrome and RH. This review aims to summarize recent studies on the role of the adipokines leptin, resistin, and adiponectin in the pathophysiology of RH and target-organ damage associated with this condition. The deregulation of adipokine levels has been associated with clinical characteristics frequently recognized in RH such as diabetes, hyperactivity of sympathetic and renin-angiotensin-aldosterone systems, and vascular and renal damage. Strategies to regulate adipokines may be promising for the management of RH and some clinical implications must be considered when managing controlled and uncontrolled patients with RH.
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Affiliation(s)
- Ana Paula de Faria
- Department of Pharmacology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
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Mordi I, Tzemos N. Is reversal of endothelial dysfunction still an attractive target in modern cardiology? World J Cardiol 2014; 6:824-835. [PMID: 25228961 PMCID: PMC4163711 DOI: 10.4330/wjc.v6.i8.824] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 04/17/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Although the endothelium has a number of important functions, the term endothelial dysfunction is commonly used to describe impairment in its vasodilatory capacity. There have been numerous studies evaluating the relationship between endothelial dysfunction and cardiovascular disease, however assessment of endothelial function is perhaps still primarily thought of as a research tool and has not reached widespread clinical acceptance. In this review we explore the relationship between endothelial dysfunction and cardiovascular disease, its prognostic significance, methods of pharmacological reversal of endothelial dysfunction, and ask the question, is reversal of endothelial dysfunction still an attractive target in modern cardiology?
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Modolo R, de Faria AP, Almeida A, Moreno H. Resistant or Refractory Hypertension: Are They Different? Curr Hypertens Rep 2014; 16:485. [DOI: 10.1007/s11906-014-0485-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Markers of inflammation, endothelial activation, and arterial stiffness in hypertensive heart disease and the effects of treatment: results from the SILVHIA study. J Cardiovasc Pharmacol 2014; 62:559-66. [PMID: 24084214 DOI: 10.1097/fjc.0000000000000017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We assessed the contribution of blood pressure (BP), inflammation, and endothelial activation to the development of structural vascular and cardiac changes in hypertension. Furthermore, the effects of antihypertensive therapy were studied. We studied 114 patients with hypertension and left ventricular hypertrophy and 38 matched hypertensive subjects without cardiac hypertrophy and 38 normotensive subjects. The group with hypertension and cardiac hypertrophy were randomized to treatment with an angiotensin receptor blocker (irbesartan) or a beta-adrenergic receptor blocker (atenolol) for 48 weeks. Markers of inflammation (high-sensitive C-reactive protein, interleukin-6, leukocyte counts), vascular function (ambulatory aortic stiffness index, arterial compliance, and pulse pressure), and endothelial activation (E-selectin, intracellular adhesion molecule-1, vascular adhesion molecule-1) were assessed. Markers of inflammation and arterial stiffness were lowest in the normotensive group and highest in patients with hypertensive heart disease; endothelial markers were similar between groups. Inflammation was independently related to BP. Markers of arterial stiffness were independently related to BP and to a lesser extent to left ventricular mass. Antihypertensive treatment improved arterial compliance; inflammatory and endothelial markers remained unchanged. In conclusion, markers of inflammation and arterial stiffness are independently related to BP. Antihypertensive therapy seems to improve arterial stiffness, but effects on markers of inflammation and endothelial activation are small.
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Barbaro NR, Fontana V, Modolo R, De Faria AP, Sabbatini AR, Fonseca FH, Anhê GF, Moreno H. Increased arterial stiffness in resistant hypertension is associated with inflammatory biomarkers. Blood Press 2014; 24:7-13. [PMID: 25061978 DOI: 10.3109/08037051.2014.940710] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Increased levels of inflammatory biomarkers such as interleukin-6 (IL-6), 10 (IL-10), 1β (IL-1β), tumor necrosis factor-α (TNF-α) high-sensitivity C-reactive protein (hs-CRP) are associated with arterial stiffness in hypertension. Indeed, resistant hypertension (RHTN) leads to unfavorable prognosis attributed to poor blood pressure (BP) control and target organ damage. This study evaluated the potential impact of inflammatory biomarkers on arterial stiffness in RHTN. METHODS In this cross-sectional study, 32 RHTN, 20 mild hypertensive (HTN) and 20 normotensive (NT) patients were subjected to office BP and arterial stiffness measurements assessed by pulse wave velocity (PWV). Inflammatory biomarkers were measured in plasma samples. RESULTS PWV was increased in RHTN compared with HTN and NT (p < 0.05). TNF-α levels were significantly higher in RHTN and HTN than NT patients. No differences in IL-6 levels were observed. RHTN patients had a higher frequency of subjects with increased levels of IL-10 and IL-1β compared with HTN and NT patients. Finally, IL-1β was independently associated with PWV (p < 0.001; R(2) = 0.5; β = 0.077). CONCLUSION RHTN subjects have higher levels of inflammatory cytokines (TNF-α, IL-1β and IL-10) as well as increased arterial stiffness, and detectable IL-1β levels are associated arterial stiffness. These findings suggest that inflammation plays a possible role in the pathophysiology of RHTN.
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Affiliation(s)
- Natália Ruggeri Barbaro
- Laboratory of Cardiovascular Pharmacology, Faculty of Medical Sciences, University of Campinas (Unicamp) , Campinas , Brazil
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van der Walt C, Malan L, Uys AS, Malan NT. Low Grade Inflammation and ECG Left Ventricular Hypertrophy in Urban African Males: The SABPA Study. Heart Lung Circ 2013; 22:924-9. [DOI: 10.1016/j.hlc.2013.03.075] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 01/25/2013] [Accepted: 03/19/2013] [Indexed: 12/16/2022]
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Papageorgiou N, Tousoulis D, Androulakis E, Antoniades C, Tentolouris C, Stefanadis C. Inflammation and right ventricle: the hunting of the missing link. Int J Cardiol 2013; 168:3152-4. [PMID: 23910446 DOI: 10.1016/j.ijcard.2013.07.082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 07/03/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Nikolaos Papageorgiou
- 1st Cardiology Department, Athens University Medical School, Hippokration Hospital, Greece.
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Poulikakos D, Ross L, Recio-Mayoral A, Cole D, Andoh J, Chitalia N, Sharma R, Carlos Kaski J, Banerjee D. Left ventricular hypertrophy and endothelial dysfunction in chronic kidney disease. Eur Heart J Cardiovasc Imaging 2013; 15:56-61. [PMID: 23811493 DOI: 10.1093/ehjci/jet120] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
UNLABELLED Aim Mortality, predominantly due to cardiovascular events, is high in patients with chronic kidney disease (CKD) and left ventricular hypertrophy (LVH) is a strong risk factor. Vascular endothelial dysfunction (ED) is common in CKD, but its potential contribution to LVH in non-dialysis CKD is unknown. This study investigated the association of ED with LVH in non-dialysis CKD patients. METHODS AND RESULTS We studied 30 CKD patients (17 pre-dialysis and 13 renal transplant recipients) and 29 age-gender-matched controls. In both groups, high-sensitivity C-reactive protein (hsCRP) levels, systemic ED (brachial artery flow-mediated dilatation, FMD), and LVH using two-dimensional echocardiography were measured. LV mass index (LVMI) was calculated using Penn formula and indexed by height. CKD patients had higher CRP levels (3.9 ± 2.8 vs. 1.0 ± 0.7 mg/L; P < 0.001), reduced FMD (3.2 ± 2.1 vs. 6.1 ± 1.9%; P < 0.001), and increased LVMI (146.1 ± 40.2 vs. 105.3 ± 26.2 g/m; P < 0.001), compared with controls. In CKD patients, LVMI increased with decreasing FMD (r = -0.371; P = 0.043) and FMD decreased with increasing CRP (r = -0.741; P < 0.001). Patients with low FMD <2.3% had higher CRP and LVMI (161.9 ± 48.9 vs. 130.4 ± 20.7 g/m; P = 0.033), compared with CKD patients with FMD ≥2.3%. There was no significant difference in age, blood pressure, cholesterol, FMD, and LVMI between pre-dialysis and post-renal transplant CKD patients. In multivariate regression, the relationship between LVMI and FMD remained significant after adjusting for age, diabetes, and smoking (adjacent beta = -0.396; P = 0.004). CONCLUSION This pilot study demonstrates for the first time a relationship of ED with LVH in non-dialysis CKD patients; suggesting but not proving a cause-effect relationship.
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Affiliation(s)
- Dimitrios Poulikakos
- Renal and Transplantation Unit, St George's Healthcare NHS Trust, Blackshaw Road, Tooting, London SW19 8TN, UK
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Jiang W, Tan L, Guo Y, Li X, Tang X, Yang K. Effect of renal denervation procedure on left ventricular hypertrophy of hypertensive rats and its mechanisms. Acta Cir Bras 2013; 27:815-20. [PMID: 23117615 DOI: 10.1590/s0102-86502012001100012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 09/13/2012] [Indexed: 08/30/2023] Open
Abstract
PURPOSE To investigate the effect of renal denervation (RDN) on the blood pressure, left ventricular hypertrophy and myocardial expression of TLR4/NF-κB in spontaneously hypertensive rats (SHR). METHODS A total of 36 SHR were randomly assigned into control group (D0), RDN group (D) and sham group (S). 12 WKY rats of same age served as controls (WKY group). Rats in the D0 and WKY groups were sacrificed, but rats in the D and S group were sacrificed at one week and six weeks after surgery. The heart was collected and the left ventricle weighted followed by calculation of left ventricular mass index (LVMI). RESULTS In the D0 group, the blood pressure, LVMI and protein expression of TLR4, NF-κB, TNF-α and IL-6 in the myocardium were markedly higher than that in the WKY group (p<0.05). In the D1 and D2 group, the LVMI, NE and protein expression of TLR4, NF-κB, TNF-α and IL-6 in the myocardium were significantly reduced (p<0.05). CONCLUSION Renal denervation can significantly delay the progression of left ventricular hypertrophy in spontaneously hypertensive rats, which may be attributed to the not only the suppression of sympathetic activity and attenuation of pressure load but the improvement of myocardial immuno-inflammation.
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Affiliation(s)
- Weihong Jiang
- Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha, China
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de Souza F, Muxfeldt ES, Salles GF. Prognostic factors in resistant hypertension: implications for cardiovascular risk stratification and therapeutic management. Expert Rev Cardiovasc Ther 2013; 10:735-45. [PMID: 22894630 DOI: 10.1586/erc.12.58] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Resistant hypertension (RH) is defined as uncontrolled office blood pressure (BP) in spite of the use of at least three antihypertensive medications. Although its condition has a high prevalence, it is still understudied, and its prognosis is not well established. Some prospective studies evaluated the prognostic value of ambulatory BP monitoring, ECG and renal parameters. They pointed out that ambulatory BPs are important predictors of cardiovascular morbidity and mortality, whereas office BP has no prognostic value. The diagnosis of true RH and the nondipping pattern are also valuable predictors of cardiovascular outcomes. Moreover, several ECG (prolonged ventricular repolarization, serial changes in the strain pattern and left ventricular hypertrophy) and renal parameters (albuminuria and reduced glomerular filtration rate) are also powerful cardiovascular risk markers in RH. These markers and others yet unexplored, such as arterial stiffness and serum biomarkers, may improve cardiovascular risk stratification in these very high-risk patients.
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Affiliation(s)
- Fabio de Souza
- Internal Medicine Department, University Hospital Clementino Fraga Filho, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Bo S, Mandrile C, Milanesio N, Pagani A, Gentile L, Gambino R, Villois P, Ghinamo L, Canil S, Durazzo M, Cassader M, Cavallo-Perin P. Is left ventricular hypertrophy a low-level inflammatory state? A population-based cohort study. Nutr Metab Cardiovasc Dis 2012; 22:668-676. [PMID: 21429721 DOI: 10.1016/j.numecd.2010.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 10/24/2010] [Accepted: 11/04/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIMS Cross-sectional studies have shown that chronic sub-clinical inflammation is associated with left ventricular hypertrophy (LVH), but results are conflicting. We investigated the association between baseline LVH and high-sensitivity C-reactive protein (CRP) values, both cross-sectionally and after a six-year-follow-up, in a population-based cohort (n = 1564) and a subgroup from this cohort (n = 515), without obesity, diabetes, metabolic syndrome or any drugs. METHODS AND RESULTS ECG tracings at baseline were interpreted according to the Cornell voltage-duration product criteria: 166/1564 subjects (10.6%) showed LVH. Patients with baseline LVH showed increased BMI, waist circumference, blood pressure, and a worse metabolic pattern. Their CRP values both at baseline and at follow-up were almost two-fold higher than in patients without LVH. Similar results were found in the healthier sub-sample. In a multiple regression model, CRP at follow-up was directly associated with baseline LVH (expressed as Cornell voltage-duration product) in the whole cohort (β = 0.0003; 95%CI 0.0002-0.0006; p < 0.001) and in the sub-sample (β = 0.0003; 0.0002-0.0004; p < 0.001), after adjusting for age, sex, BMI, waist circumference, smoking, exercise levels, blood pressure and baseline CRP values. CONCLUSION Baseline LVH, which is associated with systemic inflammation, predicts increased CRP values at follow-up, independently of cardiovascular and metabolic risk factors, both in a population-based cohort and a healthier sub-sample. The inflammatory consequences of LVH might be an intriguing subject for further researches.
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Affiliation(s)
- S Bo
- Department of Internal Medicine, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy.
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MOUBARAK M, JABBOUR H, SMAYRA V, CHOUERY E, SALIBA Y, JEBARA V, FARÈS N. Cardiorenal Syndrome in Hypertensive Rats: Microalbuminuria, Inflammation and Ventricular Hypertrophy. Physiol Res 2012; 61:13-24. [DOI: 10.33549/physiolres.932146] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The aim of our study was to evaluate a possible association between microalbuminuria (MA), several low-grade inflammation factors and left ventricular hypertrophy (LVH) by using a pharmacological approach. This may provide new insights into the pathophysiologic mechanisms of the cardiorenal syndrome (CRS) linking early renal impairment with elevated cardiovascular risk. Two kidney-one clip (2K-1C) renovascular hypertension was induced in 24 male Wistar rats (220-250 g). After the development of hypertension, rats were divided into four groups: 2K-1C (untreated), calcium channel blocker (amlodipine-treated), angiotensin receptor blocker (losartan-treated) and peripheral vasodilator (hydralazine-treated), which were treated for 10 weeks. Rats in the 2K-1C group had all developed hypertension, a significant increase in plasma levels of tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), brain natriuretic peptide (BNP) and C-reactive protein (CRP). Moreover MA and creatininaemia underwent a significant increase. Under treatment decreases were observed in systolic blood pressure (SBP), TNF-α, CRP, IL-6, BNP concentrations and creatininaemia. These results were related to the absence of MA which was significantly associated with reductions in cardiac mass and hypertrophy markers (BNP and β-MHC gene expression) as well as renal interstitial inflammation. In conclusion, our results suggest that the reduction of MA is correlated with the decrease of the inflammatory components and seems to play an important role in protecting against cardiac hypertrophy and renal injury.
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Affiliation(s)
| | | | | | | | | | | | - N. FARÈS
- Laboratoire de Physiologie et Physiopathologie, Faculté de Médecine, Université Saint Joseph, Beyrouth, Liban
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Meenakshisundaram R, Babuvinish D, Grootveld M, Rajendiran C, Thirumalaikolundusubramanian P. Status of end organs in newly detected rural essential hypertensives: a study from southern India. Clin Exp Hypertens 2011; 34:201-8. [PMID: 22150025 DOI: 10.3109/10641963.2011.618201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Hypertension is associated with end-organ damage (EOD). Since EOD is a risk factor for cardio- and cerebrovascular complications, it is a major requirement for these to be detected, prevented, and treated. OBJECTIVE The objectives of our study were to determine out the prevalence of EOD in newly detected rural essential hypertensives, identify the pattern of EOD involved, and also assess the interrelationship among them. METHODS A total of 147 consecutive patients with newly diagnosed essential hypertension and, attending the outpatient clinic, were included in this study based on a set of inclusion and exclusion criteria. Patients with comorbid illnesses were excluded from the investigation. The significance of a range of variables involved was evaluated using statistical software. RESULTS Amongst the cases, there were 79 males (M) and 68 females (F). Their mean and median ages were 55 (standard deviation (SD) = 9.90) and 54 years, respectively. Of these 86% (70 M and 56 F) had one or more EODs; an observation which was very close to statistically significant (P = .054). In our patients, microalbuminuria (35%), diastolic dysfunction (59%), increased left ventricular (LV) mass (68%) and retinopathy (69%) were particularly notable. Increased LV mass had a strong association with retinopathy, microalbuminuria, and diastolic dysfunction. CONCLUSION The presence of one or more EODs in newly detected hypertension indicates widespread vascular damage that carries a high risk for cardio- and cerebrovascular morbidity and mortality. Hence, there is an urgent requirement not only for complete evaluation but also to stimulate an increased awareness amongst physicians and the general public, regarding the control of blood pressure.
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de La Sierra A, Larrousse M, Oliveras A, Armario P, Hernández-Del Rey R, Poch E, Roca-Cusachs A. Abnormalities of vascular function in resistant hypertension. Blood Press 2011; 21:104-9. [PMID: 22017418 DOI: 10.3109/08037051.2011.622983] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We aimed to evaluate markers of vascular dysfunction in patients with resistant hypertension (RH). A group of 144 patients (61 years, 42% women) with essential RH were divided in two groups based on ambulatory blood pressure monitoring (ABPM). True RH (72%) was considered when 24-h blood pressure (BP) was ≥ 130 and/or 80 mmHg. Otherwise, patients were classified as white coat RH (28%). Hyperemia-induced forearm vasodilation (HIFV), serum inflammatory biomarkers (hs-CRP, s-ICAM-1, s-VCAM-1, e-selectin, p-selectin and MCP-1) and large (C1) and small arterial (C2) compliance (HDI/Pulse Wave CR 2000) were determined in all individuals. In comparison with patients with white coat RH, and after adjustment for age, office systolic BP and diabetes status, those with true RH had a more impaired HIFV (201 ± 159 vs 436 ± 157%; p < 0.001), increased e-selectin (53.1 ± 29.8 vs 40.7 ± 23.5 ng/ml; p = 0.035), and MCP-1 (445 ± 120 vs 386 ± 126 ng/ml; p = 0.027). No significant differences were observed in arterial compliance. Maximal HIFV inversely correlated with urinary albumin excretion (Rho: - 0.278; p = 0.004) and with some inflammatory biomarkers (MCP-1: - 0.441; p < 0.001, e-selectin: - 0.468; p < 0.001 and p-selectin: - 0.329; p = 0.001). We conclude that true RH, diagnosed by ABPM, is associated with a more severe degree of vascular dysfunction, as measured by HIFV and serum biomarkers, whereas other types of vascular alterations, such as compliance, are not directly linked with the level of BP.
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Affiliation(s)
- Alejandro de La Sierra
- Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain.
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