Aspects of campus climate and mental health threats: The role of hypervigilance

Objective: This study sought to examine if hypervigilance is one mechanism through which aspects of less supportive campus climates are associated with mental health symptoms for college students. Participants: Data from 386 undergraduate college students attending a small college in the northeastern United States were collected. Methods: Participants completed online surveys which employed established measures of study variables. Results: Hypervigilance mediated the association between subjective social status and symptoms of anxiety and depression; lower subjective social status was associated with greater hypervigilance and greater hypervigilance was associated with more symptoms of anxiety and depression. Less sense of community was also directly associated with more anxiety, depression, and somatic symptoms. Conclusions: Hypervigilance may be an adaptive strategy to protect against psychosocial harm for low status members of the campus community, but may damage longer-term mental health. Implications for higher education administrators are discussed.

Intraradical colonization by arbuscular mycorrhizal fungi triggers induction of a lipochitooligosaccharide receptor

Functional divergence of paralogs following gene duplication is one of the mechanisms leading to evolution of novel pathways and traits. Here we show that divergence of Lys11 and Nfr5 LysM receptor kinase paralogs of Lotus japonicus has affected their specificity for lipochitooligosaccharides (LCOs) decorations, while the innate capacity to recognize and induce a downstream signalling after perception of rhizobial LCOs (Nod factors) was maintained. Regardless of this conserved ability, Lys11 was found neither expressed, nor essential during nitrogen-fixing symbiosis, providing an explanation for the determinant role of Nfr5 gene during Lotus-rhizobia interaction. Lys11 was expressed in root cortex cells associated with intraradical colonizing arbuscular mycorrhizal fungi. Detailed analyses of lys11 single and nfr1nfr5lys11 triple mutants revealed a functional arbuscular mycorrhizal symbiosis, indicating that Lys11 alone, or its possible shared function with the Nod factor receptors is not essential for the presymbiotic phases of AM symbiosis. Hence, both subfunctionalization and specialization appear to have shaped the function of these paralogs where Lys11 acts as an AM-inducible gene, possibly to fine-tune later stages of this interaction.

Influence of metabolic syndrome on hypertension-related target organ damage

OBJECTIVES

The aim of our study was to analyse, in a wide group of essential hypertensive patients without diabetes mellitus, the influence of metabolic syndrome (MS) (defined according to the criteria laid down in the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults) on markers of preclinical cardiac, renal and retinal damage.

DESIGN

Cross-sectional study.

SETTING

Outpatient hypertension clinic.

SUBJECTS AND METHODS

A total of 353 young and middle-aged hypertensives, free from cardiovascular and renal diseases (and 37% of whom had MS), underwent echocardiographic examination, microalbuminuria determination and non-mydriatic retinography.

RESULTS

When compared with subjects without MS, hypertensive patients with MS exhibited more elevated left ventricular (LV) mass (either normalized by body surface area or by height elevated by a power of 2.7), higher myocardial relative wall thickness, albumin excretion rate (AER) and a greater prevalence of LV hypertrophy (57.7% vs. 25.1%; P < 0.00001), of microalbuminuria (36.2% vs. 19.3%; P = 0.002) and of hypertensive retinopathy (87.7% vs. 48.4%; P < 0.00001). These results held even after correction for age, 24-h blood pressures, duration of hypertension, previous antihypertensive therapy, and gender distribution. The independent relationships between LV mass and MS, and between AER and MS, were confirmed in multivariate regression models including MS together with its individual components.

CONCLUSIONS

MS may amplify hypertension-related cardiac and renal changes, over and above the potential contribution of each single component of this syndrome. As these markers of target organ damage are well-known predictors of cardiovascular events, our results may partly explain the enhanced cardiovascular risk associated with MS.

Relationship between albumin excretion rate and aortic stiffness in untreated essential hypertensive patients

OBJECTIVES

To evaluate, in a group of nondiabetic essential hypertensive patients with normal renal function, the relationship between albumin excretion rate (AER) and carotid-femoral pulse wave velocity (PWV), as an index of aortic stiffness.

DESIGN

Cross-sectional study.

SETTING

Outpatient hypertension clinic.

SUBJECTS

Seventy patients with mild-to-moderate essential hypertension, aged 42 +/- 8 years, never pharmacologically treated. All subjects underwent routine laboratory tests, 24-h ambulatory blood pressure (BP) monitoring, measurement of carotid-femoral PWV, by means of a computerized method, and AER.

RESULTS

Microalbuminuric patients (AER > or = 20 microg min(-1); n = 19), when compared with normoalbuminuric subjects, showed more elevated 24-h BP (136/88 +/- 10/10 vs. 128/83 +/- 7/6 mmHg; P < 0.001 and P = 0.013, for systolic and diastolic BP respectively) and higher values of carotid-femoral PWV (10.4 +/- 2 m s(-1) vs. 9.2 +/- 1.3; P = 0.006). This latter difference remained statistically significant, even after correction by ancova for 24-h systolic and diastolic BP, and body mass index (BMI, P = 0.016). Univariate regression analysis disclosed a tight correlation between AER and carotid-femoral PWV (r = 0.42; P = 0.0003). This association was confirmed in a multiple regression model (beta = 0.35; P = 0.009) in which, as independent variables, besides PWV, 24-h BP, age, serum glucose values, smoking status, gender and BMI, were added.

CONCLUSIONS

Our results seem to confirm that microalbuminuria may represent the early renal manifestation of a widespread vascular dysfunction, and therefore it is an integrated marker of cardiovascular risk.

Pulsatile and steady 24-h blood pressure components as determinants of left ventricular mass in young and middle-aged essential hypertensives

In order to explore the relations between left ventricular mass (LVM) and the pulsatile (pulse pressure) and steady (mean pressure) components of the blood pressure (BP) curve, 304 young and middle-aged essential hypertensive patients were studied by means of 24-h ambulatory BP monitoring and echocardiography. In the overall study population, both the BP components showed significant correlations with LVM. These correlations were unevenly distributed in the subgroups of subjects younger and in those older than 50 years. While in this latter subgroup, in multivariate analysis, both 24-h mean BP (24-MBP) (beta = 0.27; P = 0.008) and 24-h pulse pressure (24-h PP) (beta = 0.23; P = 0.02) were associated with LVM, in the subset of younger hypertensives only 24-h MBP (beta = 0.21; P = 0.009) was related to LVM, independent of other covariates. The relations observed between 24-h PP and LVM in the entire study population and in the patients older than 50 years lost statistical significance when the effect of 24-h systolic blood pressure (24-h SBP) was taken into account, in a multiple regression model in which 24-h MBP was replaced by 24-h SBP. Our findings seem to suggest that the association of PP with LVM in middle-aged hypertensives may partially explain the increased cardiovascular risk, documented in subjects with high PP. However, this relation is not independent, but is mediated by SBP.

Using artificial neural networks to model the urinary excretion of total and purine derivative nitrogen fractions in cows

A dataset of 177 individual nitrogen balances from dry and lactating cows was split in two independent groups: training dataset (n = 130) and challenge dataset (n = 47). The training dataset was used to develop multiple linear regressions (MLR) and artificial neural networks (ANN) aimed at predicting the urinary excretion of total (NURI) and that of purine derivative nitrogen (PDN). Input variables for the prediction of NURI were crude protein (CP) intake, effective degradability of non-protein dry matter (DM), neutral detergent fiber (NDF) content of the diet, live weight and milk yield. Live weight, total carbohydrate intake, the ratio of non-protein DM degraded to CP degraded and milk yield corrected for DM intake were entered to predict PDN. The regression between predicted and observed values for the training dataset showed a better statistical accuracy of ANN than did MLR models, especially for PDN. The evaluation of the two models on the challenge dataset showed similar determination coefficients, either when predicting total nitrogen excretion (0.623 and 0.614 for ANN and MLR, respectively) or PDN (0.688 and 0.666, for ANN and MLR, respectively). Moreover, both approaches were affected by a tendency to under-predict both targets at high levels of NURI and PDN. However, with the ANN approach, it is possible to study the response of the model to modifications of individual inputs by the so-called response analysis. This unique feature could be used to study the effect of different physiological situations as well as providing hypotheses for additional research.

Relationships between 24 h blood pressure load and target organ damage in patients with mild-to-moderate essential hypertension

OBJECTIVE

To analyse the relationships between 24 h blood pressure load (the percentage of systolic/diastolic blood pressures exceeding 140/90 mmHg while awake and 120/80 mmHg during sleep) and some indices of hypertensive target organ involvement, independently of the mean level of 24 h blood pressure.

METHODS

One hundred and thirty patients with mild-to-moderate hypertension underwent 24 h ambulatory blood pressure monitoring, ocular fundus examination, microalbuminuria assay and two-dimensional guided M-mode echocardiography. The study population was divided into subsets according to the systolic and diastolic 24 h blood pressure load values predicted from the regression equation relating 24 h blood pressure load to 24 h mean blood pressure. The subjects with an observed load above this predicted value were included in the higher blood pressure load groups, the remaining ones being included in the lower groups.

RESULTS

Relative myocardial wall thickness and total peripheral resistance were greater, and mid-wall fractional shortening, end-systolic stress-corrected mid-wall fractional shortening and cardiac index lower, in the subjects with a higher systolic blood pressure load. Moreover, the stroke index:pulse pressure ratio was reduced, and a greater prevalence of hypertensive retinopathy was observed in the higher systolic load group. On the contrary, no statistically significant difference was found for any of the cardiac, renal and funduscopic parameters examined when the two groups with a higher and lower 24 h diastolic blood pressure load were compared.

CONCLUSIONS

Our results seem to suggest that, in mild-to-moderate arterial hypertension, a high 24 h systolic blood pressure load may be associated, independently of the average level of 24 h systolic ambulatory blood pressure, with an adverse cardiovascular risk profile.

Microalbuminuria, renal dysfunction and cardiovascular complication in essential hypertension

OBJECTIVE

To evaluate the prevalence of microalbuminuria (albumin excretion rate, AER) in a wide hypertensive population, and to evaluate any relationship with cardiovascular damage and renal dysfunction.

DESIGN

A transversal study.

SUBJECTS AND METHODS

In 383 hospitalized Caucasian essential hypertensives (198 men, 185 women) of mean age 44 +/- 0.5 years and mean clinic blood pressure 170.3 +/- 0.95/ 103.4 +/- 0.47 mmHg, metabolic parameters, serum creatinine level (Cs), creatinine clearance rate (Ccs), 24 AER and plasma renin activity (PRA) were measured. Furthermore, each patient underwent 24 h ambulatory blood pressure monitoring (ABPM) and echocardiography to measure left ventricular mass, which was indexed both by body surface area to obtain left ventricular mass index (LVMI) and by height to obtain the left ventricular mass indexed for height (LVMH). By Doppler echocardiography, the diastolic compliance by early:late peak filling velocity ratio was analysed. The fundus oculi was also observed. Three subsets of hypertensives were obtained by dividing the 383 essential hypertensives on the basis of their AER: < or = 11 (group A), 11 < or = 20 (group B) and > 20 micrograms/min (group C).

MAIN OUTCOME MEASURES

Microalbuminuria, creatinine clearance, PRA, ABPM, LVMI, LVMH, early:late peak filling velocity ratio, hypertensive retinopathy.

RESULTS

Among the 383 essential hypertensives, AER was < 11 micrograms/min in 55% of the patients (group A), 18% had AER in the range 11-20 micrograms/min (group B) and 27% had AER > 20 micrograms/min (group C). In the entire essential hypertensive population the prevalence of left ventricular hypertrophy was 44.39% and hypertensive retinopathy was observed in 54.83%. Moreover, AER significantly correlated with clinic systolic blood pressure (SBP) and diastolic blood pressure (DBP), with 24 SBP and DBP and with 24 h daytime and night-time mean blood pressure (MBP). AER was correlated also with LVMH and creatinine clearance. The analysis of the three subsets revealed no differences in age, body mass index, serum creatinine level and PRA. Group C in comparison with group A showed higher values of clinic SBP, 24 h SBP, DBP and MBP, and of daytime and night-time MBP. Furthermore, in group C, LVMI and LVMH were significantly greater than in group A, with a prevalence of left ventricular hypertrophy of 55% in the former group. Group C showed a prevalence of hypertensive retinopathy of 69% whereas in group A the prevalence was 48%. In group C, AER was significantly correlated with serum creatinine level.

CONCLUSIONS

The transversal phase of our research, performed in a homogeneous population of Caucasian essential hypertensives with no metabolic disturbances, confirms the relationship between blood pressure pattern and early glomerular changes in essential hypertensives without overt proteinuria. Furthermore, these results emphasize the role of microalbuminuria as a marker of early cardiac, renal and retinal structural and functional changes in essential hypertension. The longitudinal study, which is in progress, will confirm the prognostic value of microalbuminuria in essential hypertension.

White-coat hypertension and cardiovascular risk

OBJECTIVE

To compare cardiovascular risk in white-coat hypertensives, normotensives and established hypertensives.

METHODS

We studied 61 hypertensive individuals, 27 of whom were white-coat hypertensives, and 35 normotensives. All subjects underwent 24 h noninvasive blood pressure monitoring and Doppler echocardiographic examination of the heart; urine was tested for microalbuminuria and the fundi of the eyes examined for retinopathy.

RESULTS

The 24 h as well as the day- and night-time mean systolic blood pressure (SBP) was slightly but significantly higher in white-coat hypertensives than in normotensives; no significant difference was observed in diastolic blood pressure (DBP) between these groups. In white-coat hypertensives, 24 h SBP and DBP were lower than in established hypertensives (P < 0.001). The echocardiographic study showed higher values of posterior wall thickness, left ventricular mass index (LVMI), and ventricular septum thickness (P < 0.05) in white-coat hypertensives than in normotensives; fractional shortening and ejection fraction were similar. The E:A ratio, obtained from the Doppler study, was lower in white-coat hypertensives than in normotensives (1.14 +/- 0.3 versus 1.24 +/- 0.25; P < 0.05). LVMI values were smaller in white-coat hypertensives than in established hypertensives (P < 0.05), and both ejection fraction and fractional shortening were similar in the two groups. Among white-coat hypertensives, eight out of 27 showed hypertensive retinal damage; microalbuminuria values were similar to those obtained in normotensives.

CONCLUSIONS

The results of this cross-sectional and therefore limited study lead us to hypothesize that white-coat hypertensives are at higher risk than normotensives and lower risk than established hypertensives for developing cardiovascular damage.

Sympathetic overactivity and 24-hour blood pressure pattern in hypertensives with chronic renal failure

In order to assess the activity of the sympathetic system and to evaluate the 24-h blood pressure pattern in hypertensives with chronic renal failure (CRF), 12 CRF patients and 16 essential hypertensives (EHs) were studied. In all subjects, plasma samples for catecholamines and renin activity were obtained both in the basal condition and after standing, and 24-h blood pressure monitoring (ABPM) was performed. The 24-h mean blood pressure results were quite similar between CRFs and EHs. In 50% of the CRFs, ABPM showed a nighttime decrease in diastolic BP (DBP) greater than 10%, while in the remaining 50% the ABPM indicated a nondipper blood pressure pattern. Of the 16 EHs, 4 had a nighttime decrease in DBP < 10%, that is, nondippers. The study of circulating catecholamines showed no significant differences in plasma epinephrine between CRFs and EHs, while plasma norepinephrine (NE) was significantly higher in hypertensives with CRF than in EHs, both at rest and after standing (p < 0.05 and 0.02, respectively). Among dipper hypertensives, subjects with CRF showed greater values of basal plasma NE than EHs (535 +/- 67 vs. 412 +/- 24.5 pg/mL, p < 0.05); the comparison between dipper and nondipper CRFs showed no differences in circulating NE levels (535 vs. 516 pg/mL). The present study shows that CRFs are characterized by higher values of plasma NE than EHs, and that there are no differences in sympathetic activity between dipper and nondipper hypertensives with CRF.

Blood pressure pattern importance in the development of left ventricular hypertrophy in hypertension

Heterogeneous results regarding correlations between blood pressure, (measured by various methods and in different conditions), and left ventricular mass in arterial hypertension have been reported. Fifty-three essential hypertensives, I-II WHO stage, have been studied in order to verify the relationship between office and average 24-hour blood pressure, and its day- and night-time pattern with left ventricular hypertrophy. All patients had newly diagnosed essential hypertension, and no subject had received any antihypertensive therapy before entry. The subjects underwent 24-hour blood pressure monitoring, evaluating the average of 24 hours, day- and night-time blood pressures, and M-mode echocardiography. Neither subjects with nor without left ventricular hypertrophy showed correlations between office blood pressure and left ventricular mass. On the contrary, average 24-hour systolic and diastolic blood pressure resulted related to left ventricular mass (r = 0.36 and 0.40, p less than 0.01 respectively). Furthermore, in the subgroup with left ventricular hypertrophy, left ventricular mass was correlated directly with nocturnal systolic blood pressure (r = 0.46) and inversely with the rate of nocturnal decrease in systolic pressure (r = -0.60, p less than 0.01). These results appear to confirm the usefulness of 24-hour blood pressure monitoring in evaluating cardiac afterload in essential hypertension, and the important role that the 24-hour systolic pressure has in the development of left ventricular hypertrophy in these subjects.