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Keyal S, Vasant PK, Kulirankal KG. Association of Mean Platelet Volume with Grades of Hypertensive Retinopathy. Ann Afr Med 2024; 23:488-493. [PMID: 39034577 PMCID: PMC11364312 DOI: 10.4103/aam.aam_130_23] [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: 08/03/2023] [Accepted: 09/01/2023] [Indexed: 07/23/2024] Open
Abstract
OBJECTIVE Hypertension is the most prevalent non communicable disease causing deaths even before evidence of target organ damage. Platelet activation is associated with risk of vascular events. Identification of mean platelet volume (MPV) values in patients with hypertensive retinopathy (HR) can help in prognostication and risk stratification of possible complications. MATERIALS AND METHODS Patients presenting to the outpatient department over a period of 18 months underwent clinical examination, blood sampling, direct ophthalmoscopic examination, and two-dimensional echocardiography. RESULTS Out of 104 subjects, there were a total of 25 females and 79 males. Patients with grade 1HR had a mean MPV value of 9.4, those with grade 2 HR had a mean MPV of 9.8, among people with grade 3 HR the mean MPV was 10.1, and those with grade 4 HR had a mean MPV of 10.9. CONCLUSION In our study, we have seen that MPV increases with increasing severity of HR, thus implying that MPV probably plays a role in HR. Testing of MPV can be used to decide whether preventative treatments should be instituted to the prevent the severe complications of retinopathy and thus decrease the risk and occurrence of cardiovascular and cerebrovascular events.
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Affiliation(s)
- Shruti Keyal
- Department of Gastroenterology, Amrita Institute of Medical Science, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - P. K. Vasant
- Department of General Medicine, Amrita Institute of Medical Science, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Kiran G. Kulirankal
- Department of General Medicine, Amrita Institute of Medical Science, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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Association between central non-dipping pattern and platelet morphology in adults with type 1 diabetes without cardiovascular disease: a cross-sectional study. Sci Rep 2021; 11:15416. [PMID: 34326364 PMCID: PMC8322100 DOI: 10.1038/s41598-021-94414-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/14/2021] [Indexed: 11/15/2022] Open
Abstract
The non-dipping pattern is nighttime systolic blood pressure (SBP) fall of less than 10%. Several studies showed that the non-dipping pattern, increased mean platelet volume (MPV), and platelet distribution width (PDW) are associated with elevated cardiovascular risk. Hypertensives with the non-dipping pattern have higher MPV than the dippers but this relationship was never investigated among people with type 1 diabetes mellitus (T1DM). This study aimed to investigate the association between the central dipping pattern and platelet morphology in T1DM subjects. We measured the central and brachial blood pressure with a validated non-invasive brachial oscillometric device—Arteriograph 24—during twenty-four-hour analysis in T1DM subjects without diagnosed hypertension. The group was divided based on the central dipping pattern for the dippers and the non-dippers. From a total of 62 subjects (32 males) aged 30.1 (25.7–37) years with T1DM duration 15.0 (9.0–20) years, 36 were non-dippers. The non-dipper group had significantly higher MPV (MPV (10.8 [10.3–11.5] vs 10.4 [10.0–10.7] fl; p = 0.041) and PDW (13.2 [11.7–14.9] vs 12.3 [11.7–12.8] fl; p = 0.029) than dipper group. Multivariable logistic regression revealed that MPV (OR 3.74; 95% CI 1.48–9.45; p = 0.005) and PDW (OR 1.91; 95% CI 1.22–3.00; p = 0.005) were positively associated with central non-dipping pattern adjusting for age, sex, smoking status, daily insulin intake, and height. MPV and PDW are positively associated with the central non-dipping pattern among people with T1DM.
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Baş HA, Aksoy F, Bağcı A, Varol E, Altınbaş A. Incidence of aspirin resistance is higher in patients with acute coronary syndrome and atrial fibrillation than without atrial fibrillation. Rev Assoc Med Bras (1992) 2020; 66:800-805. [PMID: 32696878 DOI: 10.1590/1806-9282.66.6.800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 01/19/2020] [Indexed: 08/30/2023] Open
Abstract
In patients with atrial fibrillation, standard anticoagulation with a vitamin K antagonist plus dual antiplatelet therapy with a P2Y12 inhibitor and aspirin is the standard of care after percutaneous coronary intervention (PCI). While this therapy reduces the risk of thrombosis and stroke, it increases the risk of bleeding. It is unclear whether the antiplatelet effect of aspirin and clopidogrel may worsen atrial fibrillation (AF). OBJECTIVE Thus we aimed to analyze platelet aspirin resistance (AR) and clopidogrel resistance (CR) in acute coronary (ACS) patients based on sinus rhythm (SR) and AF. METHODS In this prospective trial, we included 543 patients (mean age: 62± 12 years; range: 26 - 89 years) who were on aspirin and clopidogrel therapy after the diagnosis of acute coronary syndrome. AR and CR were analyzed by a Multiplate® MP-0120 device by using the method of whole blood aggregometry. RESULTS AF patients had significantly higher age, mean platelet volume, and High-Sensitivity C-Reactive Protein (p< 0.01 for each parameter). Similarly, Arachidonic-acid induced (ASPI) aggregation was higher in AF patients compared to SR patients (666±218 vs. 187±179, p<0.001). Among the ACS patients, significantly more female patients had AF (p<0.001). The incidence of hypertension in the AF group was higher compared to the SR group (p<0.001). However, adenosine diphosphate levels were not at a significant level in the two groups. CONCLUSION Our findings indicate that the platelet inhibitory effect of Aspirin was worse for patients with AF, suggesting that the effectiveness of aspirin may be less in the prophylaxis of thromboembolism and more a bleeding risk.
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Affiliation(s)
- Hasan Aydin Baş
- Department of Cardiology, Isparta City Hospital, Isparta, Turkey
| | - Fatih Aksoy
- Department of Cardiology, Medical School, Suleyman Demirel University, Isparta, Turkey
| | - Ali Bağcı
- Department of Cardiology, Medical School, Suleyman Demirel University, Isparta, Turkey
| | - Ercan Varol
- Department of Cardiology, Medical School, Suleyman Demirel University, Isparta, Turkey
| | - Ahmet Altınbaş
- Department of Cardiology, Medical School, Suleyman Demirel University, Isparta, Turkey
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Batista TR, Figueiredo RCD, Rios DRA. Platelets volume indexes and cardiovascular risk factors. ACTA ACUST UNITED AC 2018; 64:554-559. [PMID: 30304315 DOI: 10.1590/1806-9282.64.06.554] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 09/25/2017] [Indexed: 11/21/2022]
Abstract
Obesity, diabetes and hypertension are risk factors for cardiovascular diseases (CVD) because they promote a state of hypercoagulability. It is known that platelets play an important role in the development of atherosclerosis. Recent studies have evaluated platelet volume indexes (PVIs) in individuals with risk factors for CVD to better understand the platelet mechanisms involved in their development. The IVPs indirectly estimate platelet function and are easily obtained from automated hematology analyzers, which provide platelet counts, mean platelet volume (MPV), platelet distribution width (PDW) and the platelet-large cell ratio (P-LCR). The present study aims to review literature studies that investigated the association between PVIs and obesity, diabetes, and arterial hypertension, in order to evaluate its use as a potential subclinical marker of CVD. Studies have shown promising results for MPV, an index that allows for early detection of platelet activation and may be useful in identifying patients before the onset of CVD development so that preventive strategies can be implemented. The PDW, although evaluated by a smaller number of studies, also showed promising results. However, there is still a long way to go in order for the MPV and PDW to be used in clinical practice, since there is still a need for more epidemiological evidence, establishing reference values, and standardizing the way results are presented.
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Affiliation(s)
- Thaís Resende Batista
- Dona Lindu Center West Campus, Federal University of São João del-Rei, São João del Rei MG, Brasil
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5
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Zeng X, Xu X, Boezen HM, Vonk JM, Wu W, Huo X. Decreased lung function with mediation of blood parameters linked to e-waste lead and cadmium exposure in preschool children. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2017; 230:838-848. [PMID: 28734265 DOI: 10.1016/j.envpol.2017.07.014] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/05/2017] [Accepted: 07/05/2017] [Indexed: 02/05/2023]
Abstract
Blood lead (Pb) and cadmium (Cd) levels have been associated with lower lung function in adults and smokers, but whether this also holds for children from electronic waste (e-waste) recycling areas is still unknown. To investigate the contribution of blood heavy metals and lung function levels, and the relationship among living area, the blood parameter levels, and the lung function levels, a total of 206 preschool children from Guiyu (exposed area), and Haojiang and Xiashan (reference areas) were recruited and required to undergo blood tests and lung function tests during the study period. Preschool children living in e-waste exposed areas were found to have a 1.37 μg/dL increase in blood Pb, 1.18 μg/L increase in blood Cd, and a 41.00 × 109/L increase in platelet counts, while having a 2.82 g/L decrease in hemoglobin, 92 mL decrease in FVC and 86 mL decrease in FEV1. Each unit of hemoglobin (1 g/L) decline was associated with 5 mL decrease in FVC and 4 mL decrease in FEV1. We conclude that children living in e-waste exposed area have higher levels of blood Pb, Cd and platelets, and lower levels of hemoglobin and lung function. Hemoglobin can be a good predictor for lung function levels.
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Affiliation(s)
- Xiang Zeng
- Laboratory of Environmental Medicine and Developmental Toxicology, Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, 22 Xinling Road, Shantou 515041, Guangdong, China; Department of Epidemiology, University Medical Center Groningen, University of Groningen, 1 Hanzeplein, Groningen 9700RB, Groningen, The Netherlands; School of Public Health, Xinxiang Medical University, 601 Jinsui Road, Xinxiang 453003, Henan, China
| | - Xijin Xu
- Laboratory of Environmental Medicine and Developmental Toxicology, Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, 22 Xinling Road, Shantou 515041, Guangdong, China.
| | - H Marike Boezen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 1 Hanzeplein, Groningen 9700RB, Groningen, The Netherlands
| | - Judith M Vonk
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 1 Hanzeplein, Groningen 9700RB, Groningen, The Netherlands
| | - Weidong Wu
- School of Public Health, Xinxiang Medical University, 601 Jinsui Road, Xinxiang 453003, Henan, China
| | - Xia Huo
- Guangzhou Key Laboratory of Environmental Exposure and Health, Guangdong Key Laboratory of Environmental Pollution and Health, School of Environment, Jinan University, Guangzhou 510632, Guangdong, China.
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Chen G, Bliden KP, Chaudhary R, Liu F, Kaza H, Navarese EP, Tantry US, Gurbel PA. Central aortic pulse pressure, thrombogenicity and cardiovascular risk. J Thromb Thrombolysis 2017; 44:223-233. [PMID: 28695310 DOI: 10.1007/s11239-017-1524-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
High central aortic pulse pressure (CPP) and thrombin-induced platelet-fibrin clot strength (TIP-FCS) have been associated with ischemic outcomes in patients with coronary artery disease in separate studies. But, the ischemic risk associated with these factors has never been analyzed in a single study and their interrelation is unknown. The primary aim of the study was to establish cut points for CPP and TIP-FCS measured at the time of catheterization associated with long term major adverse cardiovascular events. We enrolled 334 consecutive patients undergoing cardiac catheterization and assessed thrombogenicity by thrombelastography. Patients were followed up to 3 years. The primary endpoint was a composite of cardiovascular death, myocardial infarction, and ischemic stroke and the secondary endpoint was occurrence of the primary endpoint or recurrent ischemic events requiring hospitalization. Patients with primary and secondary endpoint occurrence had higher CPP (83 ± 20 vs. 60 ± 18 mmHg, p < 0.0001; 70 ± 21 vs. 59 ± 18 mmHg, p < 0.0001, respectively) and TIP-FCS (68.5 ± 5.8 vs. 65.5 ± 5.0 mm, p = 0.008; 67.4 ± 5.9 vs. 65.2 ± 4.8 mm, p = 0.001, respectively). CPP >60 mmHg and TIP-FCS >69 mm were both independent predictors of primary endpoint occurrence (p = 0.0001 and p = 0.02, respectively). ROC analysis for CPP and TIP-FCS showed a C-statistic of 0.81 (p < 0.0001) and 0.68 (p = 0.007) for the primary endpoint, respectively. Patients with CPP >60 mmHg had higher TIP-FCS (66.8 ± 5.1 vs. 64.8 ± 5.0 mm, p < 0.001) and primary and secondary endpoint occurrence (13 vs. 1.1%, p < 0.0001 and 31.8 vs. 14.4%, p = 0.0002, respectively). CPP >60 mmHg + TIP-FCS > 69 mm was associated with a markedly increased risk of primary endpoint occurrence [HR (95% CI) 5.4(2.3-12.5), p = 0.0001]. High CPP and thrombogenicity are interrelated; each are independently associated with increased cardiovascular risk; and simultaneous presence markedly enhances risk. The mechanistic link between CPP and thrombogenicity deserves further study.
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Affiliation(s)
- Gailing Chen
- Sinai Center for Thrombosis Research, Sinai Hospital, Baltimore, MD, USA.,Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Kevin P Bliden
- Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, 3300 Gallows Rd, Fairfax, VA, USA
| | - Rahul Chaudhary
- Division of Medicine, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Fang Liu
- Sinai Center for Thrombosis Research, Sinai Hospital, Baltimore, MD, USA.,Department of Neurology, Beijing Hospital, Beijing, China
| | - Himabindu Kaza
- Sinai Center for Thrombosis Research, Sinai Hospital, Baltimore, MD, USA
| | - Eliano P Navarese
- Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, 3300 Gallows Rd, Fairfax, VA, USA
| | - Udaya S Tantry
- Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, 3300 Gallows Rd, Fairfax, VA, USA
| | - Paul A Gurbel
- Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, 3300 Gallows Rd, Fairfax, VA, USA.
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Manner IW, Waldum-Grevbo B, Witczak BN, Bækken M, Øktedalen O, Os I, Schwartz T, Sjaastad I. Immune markers, diurnal blood pressure profile and cardiac function in virologically suppressed HIV-infected patients. Blood Press 2017; 26:332-340. [PMID: 28675304 DOI: 10.1080/08037051.2017.1346459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE Non-dipping nocturnal blood pressure (BP) pattern has been reported prevalent among HIV-infected patients and is associated with adverse cardiovascular outcomes. The aims of this observational study were to identify predictors of nocturnal BP decline, and to explore whether diurnal BP profile is associated with alterations in cardiac structure and function. MATERIALS AND METHODS A total of 108 treated HIV-infected patients with suppressed viremia underwent ambulatory BP measurement, 51 of these patients also underwent echocardiography. RESULTS Non-dipping nocturnal BP pattern was present in 51% of the patients. Decreased nocturnal decline in systolic BP (SBP) correlated with lower CD4 count (rsp = 0.21, p = 0.032) and lower CD4/CD8 ratio (rsp = 0.26, p = 0.008). In multivariate linear regression analyses, lower BMI (p = 0.015) and CD4/CD8 ratio <0.4 (p = 0.010) remained independent predictors of nocturnal decline in SBP. Nocturnal decline in SBP correlated with impaired diastolic function, e' (r = 0.28, p = 0.049) as did nadir CD4 count (rsp = 0.38, p = 0.006). In multivariate linear regression analyses, nadir CD4 count <100 cells/μL (p = 0.037) and age (p < 0.001) remained independent predictors of e'. CONCLUSIONS Compromised immune status may contribute to attenuated diurnal BP profile as well as impaired diastolic function in well-treated HIV infection.
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Affiliation(s)
- Ingjerd W Manner
- a Department of Nephrology , Oslo University Hospital , Oslo , Norway
| | | | - Birgit Nomeland Witczak
- b Institute for Experimental Medical Research , Oslo University Hospital and University of Oslo , Oslo , Norway
| | - Morten Bækken
- a Department of Nephrology , Oslo University Hospital , Oslo , Norway
| | - Olav Øktedalen
- c Department of Infectious Diseases , Oslo University Hospital , Oslo , Norway
| | - Ingrid Os
- a Department of Nephrology , Oslo University Hospital , Oslo , Norway.,d Institute of Clinical Medicine, Faculty of Medicine , University of Oslo , Oslo , Norway
| | - Thomas Schwartz
- b Institute for Experimental Medical Research , Oslo University Hospital and University of Oslo , Oslo , Norway.,c Department of Infectious Diseases , Oslo University Hospital , Oslo , Norway
| | - Ivar Sjaastad
- b Institute for Experimental Medical Research , Oslo University Hospital and University of Oslo , Oslo , Norway.,e Department of Cardiology , Oslo University Hospital , Oslo , Norway
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Lian H, Zhuo SQ, Tian XT, Liu FC. Increased plasma lactate level is associated with subclinical cardiovascular damage in patient with non-dipping hypertension. Clin Exp Hypertens 2016; 38:541-4. [PMID: 27399330 DOI: 10.3109/10641963.2016.1174247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the difference of plasma lactate level between dipping and non-dipping hypertension, and to investigate the effects of lactate on subclinical cardiovascular damages in dipping and non-dipping hypertension. METHODS According to 24 h ambulatory blood pressure monitoring, 236 patients with dipping and 152 with non-dipping hypertension were included. Clinical characteristics were collected and compared between dipping and non-dipping groups. Left ventricle hypertrophy (LVH) and N-terminal pro-B type natriuretic peptide (NT-proBNP) level were used to evaluate subclinical cardiovascular damage. Multivariate regression analysis was performed to evaluate the relationship between lactate and LVH and NT-proBNP elevation. RESULTS Compared to dipping hypertension, plasma levels of lactate and NT-proBNP in non-dipping hypertension group were significantly higher. Moreover, the value of left ventricle mass index to height (LVMI/height) was also significantly higher in non-dipping group, and the percentage of patient with LVH was also higher in non-dipping group (36.8% vs. 28.9%, P < 0.05). Multivariate regression analysis revealed that in non-dipping group, after fully adjustment, the associations between lactate with LVH and NT-proBNP remained significant, with odds ratio (OR) of 1.18 (95% confidence interval [CI] of 1.13-1.24) in LVH and OR of 1.16 in NT-proBNP (95% CI of 1.10-1.23), respectively. Nonetheless, the associations between lactate with LVH and NT-proBNP elevation in dipping group were diminished to statistical nonsignificance. CONCLUSION Plasma lactate level in non-dipping hypertension is significantly higher than dipping hypertension, and this difference may be the potential mechanism non-dipping hypertension contributes to greater targeted organ damage.
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Affiliation(s)
- Huan Lian
- a Department of Cardiology , Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences , Guangzhou , Guangdong , China
| | - Sheng-Qing Zhuo
- a Department of Cardiology , Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences , Guangzhou , Guangdong , China
| | - Xiang-Ting Tian
- a Department of Cardiology , Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences , Guangzhou , Guangdong , China
| | - Fu-Cheng Liu
- b Department of Cardiology, Huaqiao Hospital , Jinan University , Guangzhou , Guangdong , China
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Ahbap E, Sakaci T, Kara E, Sahutoglu T, Koc Y, Basturk T, Sevinc M, Akgol C, Hasbal B, Isleem M, Nazif P, Caglayan FB, Unsal A. Serum uric acid levels and inflammatory markers with respect to dipping status: A retrospective analysis of hypertensive patients with or without chronic kidney disease. Clin Exp Hypertens 2016; 38:555-63. [PMID: 27392197 DOI: 10.3109/10641963.2016.1174251] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The aim of this study was to evaluate serum uric acid levels, inflammatory markers [C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR)] and mean platelet volume (MPV) among hypertensive patients with or without chronic kidney disease (CKD) with respect to dipping status. METHODS A total of 432 hypertensive patients with (n = 340) or without (n = 92) CKD who had ambulatory blood pressure monitoring recordings were included. Correlation of serum uric acid levels with inflammatory markers (CRP, PLR, NLR) was evaluated as was the logistic regression analysis for determinants of nondipper pattern. RESULTS Nondipper pattern was noted in 65.2% and 79.7% of non-CKD and CKD patients, respectively. Multivariate logistic regression analysis revealed that only serum uric acid (OR, 2.69; 95% CI, 1.60 to 4.52; p = 0.000), MPV (OR, 1.81; 95% CI, 1.30 to 2.53; p = 0.000), PLR (OR, 0.98; 95% CI, 0.97 to 0.99; p = 0.000), and serum albumin (OR, 0.42; 95% CI, 0.19 to 0.93; p = 0.031) were significant determinants of nondipper pattern in the overall study population. CONCLUSION In conclusion, our findings revealed higher prevalence of nondipper pattern in hypertensive patients with than without CKD and significantly higher levels for uric acid, CRP, MPV, PLR, and NLR among nondipper than dipper hypertensive patients with CKD. High levels for uric acid and MPV and lower levels for PLR and serum albumin were noted as significant determinants of nondipper pattern among hypertensive patients.
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Affiliation(s)
- Elbis Ahbap
- a Department of Nephrology , Sisli Etfal Training and Research Hospital , Istanbul , Turkey
| | - Tamer Sakaci
- a Department of Nephrology , Sisli Etfal Training and Research Hospital , Istanbul , Turkey
| | - Ekrem Kara
- b Department of Internal Medicine, Division of Nephrology , RecepTayyip Erdogan University Faculty of Medicine , Rize , Turkey
| | - Tuncay Sahutoglu
- a Department of Nephrology , Sisli Etfal Training and Research Hospital , Istanbul , Turkey
| | - Yener Koc
- a Department of Nephrology , Sisli Etfal Training and Research Hospital , Istanbul , Turkey
| | - Taner Basturk
- a Department of Nephrology , Sisli Etfal Training and Research Hospital , Istanbul , Turkey
| | - Mustafa Sevinc
- a Department of Nephrology , Sisli Etfal Training and Research Hospital , Istanbul , Turkey
| | - Cuneyt Akgol
- a Department of Nephrology , Sisli Etfal Training and Research Hospital , Istanbul , Turkey
| | - Barıs Hasbal
- a Department of Nephrology , Sisli Etfal Training and Research Hospital , Istanbul , Turkey
| | - Mahmoud Isleem
- a Department of Nephrology , Sisli Etfal Training and Research Hospital , Istanbul , Turkey
| | - Perin Nazif
- a Department of Nephrology , Sisli Etfal Training and Research Hospital , Istanbul , Turkey
| | | | - Abdulkadir Unsal
- a Department of Nephrology , Sisli Etfal Training and Research Hospital , Istanbul , Turkey
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Li P, Zhang L, Zhang M, Zhou C, Lin N. Uric acid enhances PKC-dependent eNOS phosphorylation and mediates cellular ER stress: A mechanism for uric acid-induced endothelial dysfunction. Int J Mol Med 2016; 37:989-97. [PMID: 26935704 PMCID: PMC4790645 DOI: 10.3892/ijmm.2016.2491] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 02/03/2016] [Indexed: 12/18/2022] Open
Abstract
The mechanism by which hyperuricemia induced-endothelial dysfunction contributes to cardiovascular diseases (CVDs) is not yet fully understood. In the present study, we used uric acid (UA) to trigger endothelial dysfunction in cultured endothelial cells, and investigated the effects of induced reactive oxygen species (ROS) generation, endoplasmic reticulum (ER) stress induction, and the protein kinase C (PKC)-dependent endothelial nitric oxide synthase (eNOS) signaling pathway. Human umbilical vein endothelial cells (HUVECs) were incubated with 6, 9 or 12 mg/dl UA, ROS scavenger polyethylene glycol-superoxide dismutase (PEG‑SOD), ER stress inhibitor 4-phenylbutyric acid (4-PBA), and PKC inhibitor polymyxin B for 6-48 h. Nitric oxide (NO) production, eNOS activity, intracellular ROS, ER stress levels, and the interaction between eNOS and calmodulin (CaM) and cytosolic calcium levels were assessed using fluorescence microscopy and western blot analysis. Apoptosis was assessed by annexin V staining. UA increased HUVEC apoptosis and reduced eNOS activity and NO production in a dose- and time-dependent manner. Intracellular ROS was elevated after 3 h, while ER stress level increased after 6 h. UA did not alter intracellular Ca2+, CaM, or eNOS concentration, or eNOS Ser1177 phosphorylation. However, PKC-dependent eNOS phosphorylation at Thr495 was greatly enhanced, and consequently interaction between eNOS and CaM was reduced. Cellular ROS depletion, ER stress inhibition and PKC activity reduction inhibited the effect of UA on eNOS activity, NO release and apoptosis in HUVECs. Thus, we concluded that UA induced HUVEC apoptosis and endothelial dysfunction by triggering oxidative and ER stress through PKC/eNOS-mediated eNOS activity and NO production.
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Affiliation(s)
- Peng Li
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministy of Education and Chinese Ministy of Public Health, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China
| | - Lina Zhang
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, P.R. China
| | - Mei Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministy of Education and Chinese Ministy of Public Health, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China
| | - Changyong Zhou
- Department of Emergency Room, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, P.R. China
| | - Nan Lin
- Department of Emergency Room, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, P.R. China
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Kent ST, Bromfield SG, Burkholder GA, Falzon L, Oparil S, Overton ET, Mugavero MJ, Schwartz JE, Shimbo D, Muntner P. Ambulatory Blood Pressure Monitoring in Individuals with HIV: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0148920. [PMID: 26882469 PMCID: PMC4755611 DOI: 10.1371/journal.pone.0148920] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 01/23/2016] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Abnormal diurnal blood pressure (BP) rhythms may contribute to the high cardiovascular disease risk in HIV-positive (HIV+) individuals. To synthesize the current literature on ambulatory BP monitoring (ABPM) in HIV+ individuals, a systematic literature review and meta-analysis were performed. METHODS Medical databases were searched through November 11, 2015 for studies that reported ABPM results in HIV+ individuals. Data were extracted by 2 reviewers and pooled differences between HIV+ and HIV-negative (HIV-) individuals in clinic BP and ABPM measures were calculated using random-effects inverse variance weighted models. RESULTS Of 597 abstracts reviewed, 8 studies with HIV+ cohorts met the inclusion criteria. The 420 HIV+ and 714 HIV- individuals in 7 studies with HIV- comparison groups were pooled for analyses. The pooled absolute nocturnal systolic and diastolic BP declines were 3.16% (95% confidence interval [CI]: 1.13%, 5.20%) and 2.92% (95% CI: 1.64%, 4.19%) less, respectively, in HIV+ versus HIV- individuals. The pooled odds ratio for non-dipping systolic BP (nocturnal systolic BP decline <10%) in HIV+ versus HIV- individuals was 2.72 (95% CI: 1.92, 3.85). Differences in mean clinic, 24-hour, daytime, or nighttime BP were not statistically significant. I2 and heterogeneity chi-squared statistics indicated the presence of high heterogeneity for all outcomes except percent DBP dipping and non-dipping SBP pattern. CONCLUSIONS An abnormal diurnal BP pattern may be more common among HIV+ versus HIV- individuals. However, results were heterogeneous for most BP measures, suggesting more research in this area is needed.
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Affiliation(s)
- Shia T. Kent
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Samantha G. Bromfield
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Greer A. Burkholder
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Louise Falzon
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Suzanne Oparil
- Department of Medicine, Vascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Edgar T. Overton
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Michael J. Mugavero
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Joseph E. Schwartz
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
- Applied Behavioral Medicine Research Institute, Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, United States of America
| | - Daichi Shimbo
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
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Kent ST, Burkholder GA, Tajeu GS, Overton ET, Muntner P. Mechanisms Influencing Circadian Blood Pressure Patterns Among Individuals with HIV. Curr Hypertens Rep 2016; 17:88. [PMID: 26429228 DOI: 10.1007/s11906-015-0598-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
HIV+ individuals have an increased risk for cardiovascular disease (CVD), but the mechanisms behind this association are poorly understood. While hypertension is a well-established CVD risk factor, clinic-based blood pressure (BP) assessment by itself cannot identify several important BP patterns, including white coat hypertension, masked hypertension, nighttime hypertension, and nighttime BP dipping. These BP patterns can be identified over a 24-h period by ambulatory BP monitoring (ABPM). In this review, we provide an overview of the potential value of conducting ABPM in HIV+ individuals. ABPM phenotypes associated with increased CVD risk include masked hypertension (i.e., elevated out-of-clinic BP despite non-elevated clinic BP), nighttime hypertension, and a non-dipping BP pattern (i.e., a drop in BP of <10 % from daytime to nighttime). These adverse ABPM phenotypes may be highly relevant in the setting of HIV infection, given that increased levels of inflammatory biomarkers, high psychosocial burden, high prevalence of sleep disturbance, and autonomic dysfunction have been commonly reported in HIV+ persons. Additionally, although antiretroviral therapy (ART) is associated with lower AIDS-related morbidity and CVD risk, the mitochondrial toxicity, oxidative stress, lipodystrophy, and insulin resistance associated with long-term ART use potentially lead to adverse ABPM phenotypes. Existing data on ABPM phenotypes in the setting of HIV are limited, but suggest an increased prevalence of a non-dipping BP pattern. In conclusion, identifying ABPM phenotypes may provide crucial information regarding the mechanisms underlying the excess CVD risk in HIV+ individuals.
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Affiliation(s)
- Shia T Kent
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd RPBH 220, Birmingham, AL, 35294, USA.
| | - Greer A Burkholder
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gabriel S Tajeu
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd RPBH 220, Birmingham, AL, 35294, USA
| | - E Turner Overton
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd RPBH 220, Birmingham, AL, 35294, USA
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Karabacak M, Yiğit M, Turkdogan KA, Yiğit E, Selek S. Is signal peptide-CUB-EGF domain-containing protein1 a diagnostic biomarker in patients with hypertensive crises. Clin Hemorheol Microcirc 2016; 61:513-22. [PMID: 25536916 DOI: 10.3233/ch-141917] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Mehmet Yiğit
- Department of Emergency Medicine, Bezimialem Foundation University, Istanbul, Turkey
| | - Kenan Ahmet Turkdogan
- Department of Emergency Medicine, Bezimialem Foundation University, Istanbul, Turkey
| | - Eda Yiğit
- Department of Emergency Medicine, Bezimialem Foundation University, Istanbul, Turkey
| | - Sehabettin Selek
- Department of Biochemistry, Bezmialem Foundation University, Istanbul, Turkey
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14
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Karabulut A, Karadag A. Clinical implication of hematological indices in the essential hypertension. World J Hypertens 2015; 5:93-97. [DOI: 10.5494/wjh.v5.i2.93] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 03/10/2015] [Accepted: 04/20/2015] [Indexed: 02/06/2023] Open
Abstract
Prognostic value of haematological indices, especially red cell distribution width, neutrophil lymphocyte ratio and mean platelet volume, was reported with numerous investigations in miscellaneous cardiovascular settings. Their major prognostic value was linked to oxidative stress and inflammation since their level was correlated with major inflammatory markers such as high sensitive C-reactive protein and interleukins. Oxidative stress and chronic inflammation are also postulated as the main pathophysiologic mechanism of essential hypertension (HT) and its vascular complication. Recently, correlation between HT and haematological parameters was searched in numerous studies, which has made the topic more popular. Herein, we reveal the correlation between haematological indices and HT and we also demonstrate the clinical implication of this correlation. Impaired haematological parameters may strongly indicate hypertensive end-organ damage.
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15
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Bakirci EM, Degirmenci H, Hamur H, Gunay M, Gulhan B, Aydin M, Kucuksu Z, Ceyhun G, Topal E. New inflammatory markers for prediction of non-dipper blood pressure pattern in patients with essential hypertension: Serum YKL-40/Chitinase 3-like protein 1 levels and echocardiographic epicardial adipose tissue thickness. Clin Exp Hypertens 2015; 37:505-10. [PMID: 25919569 DOI: 10.3109/10641963.2015.1013122] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of the present study was to investigate whether YKL-40 levels and epicardial adipose tissue (EAT) thickness were associated with non-dipping pattern in essential hypertension (HT). Age- and sex-matched 40 dipper hypertensive patients and 40 non-dipper hypertensive patients were included in the study. Non-dippers had significantly increased EAT thickness and higher YKL-40 and high-sensitivity C-reactive protein levels than dippers. Multivariate logistic regression analysis showed that the EAT thickness and serum levels of YKL-40 and high-sensitivity C-reactive protein were independent predictors of non-dipping pattern in essential HT. In essential HT, presence of non-dipping pattern is associated with increased inflammatory response.
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Affiliation(s)
| | | | | | | | - Barıs Gulhan
- c Department of Microbiology, Faculty of Medicine , Erzincan University , Erzincan , Turkey
| | - Merve Aydin
- c Department of Microbiology, Faculty of Medicine , Erzincan University , Erzincan , Turkey
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Androulakis E, Papageorgiou N, Chatzistamatiou E, Kallikazaros I, Stefanadis C, Tousoulis D. Improving the detection of preclinical organ damage in newly diagnosed hypertension: nocturnal hypertension versus non-dipping pattern. J Hum Hypertens 2015; 29:689-95. [DOI: 10.1038/jhh.2015.5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 12/16/2014] [Accepted: 12/30/2014] [Indexed: 11/09/2022]
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17
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Liu W, Ye H, Tang B, Song Z, Sun Z, Wen P, Yang J. Profile of interdialytic ambulatory blood pressure in a cohort of Chinese patients. J Hum Hypertens 2014; 28:677-83. [PMID: 24919753 DOI: 10.1038/jhh.2014.41] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 04/19/2014] [Accepted: 05/01/2014] [Indexed: 01/20/2023]
Abstract
Management of hypertension is one of the fundamental interventions in dialysis patients. However, the profile of interdialytic blood pressure (BP) in Chinese dialysis patients remains elusive. We aim to investigate this issue as well as the effect of antihypertensive medication in this population. We performed 44-h ambulatory BP in 90 patients on maintenance hemodialysis. Patients were classified as 'dipping', 'non-dipping' or 'reverse-dipping' based on night/day ratio (N/D) of systolic BP on nondialysis day. The prevalence of blunted circadian BP pattern was strikingly high (92.2%), with more than half of the patients (55.6%) classified as reverse-dipping. There was a close association between high erythropoietin (EPO) dose used and deteriorated circadian rhythm. Patients in the dipping group also displayed a dipping state for heart rate (HR) compared with the other two groups (N/D of HR: 81.5 ± 6.6 vs 92.1 ± 6.0 and 91.3 ± 10.7, P=0.02). Only 26.7% patients had a controlled nocturnal BP. Patients with bedtime dosing had lower N/D of systolic BP compared with patients without (100.1 ± 7.0 vs 105.2 ± 7.1, P=0.01). Non-dipping and reverse-dipping are highly prevalent in Chinese patients. EPO use and autonomic dysfunction may contribute to the blunted circadian rhythm. More tightly control of nighttime BP is an urgent need and bedtime dosing may be beneficial.
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Affiliation(s)
- W Liu
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - H Ye
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - B Tang
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Z Song
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Z Sun
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - P Wen
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - J Yang
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
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