New statistical projections suggest that slashing salt in the US diet by 3 g per day would have huge benefits, reducing the annual number of new cases of coronary heart disease, strokes, and MIs and potentially saving up to 90 000 lives a year1. And even a more modest reduction of 1 g of salt per day would still have significant benefits, Dr Kirsten Bibbins-Domingo (University of California, San Francisco) and colleagues estimate in their paper published online January 20, 2010 in the New England Journal of Medicine. They call for urgent action in terms of a populationwide effort to reduce dietary salt in the US. In an accompanying editorial [2], Drs Lawrence J Appel and Cheryl AM ...
Hypertensive patients receiving long-term monotherapy with ACE inhibitors, angiotensin-receptor blockers (ARBs), or beta blockers were less likely to develop atrial fibrillation (AF) than those who received only calcium-channel blockers (CCBs), a new study has found1. Dr Beat A Schaer (University Hospital, Basel, Switzerland) and colleagues report their study in the January 18, 2010 issue of the Annals of Internal Medicine. But senior author of the paper, Dr Christoph R Meier (University Hospital, Basel, Switzerland), told that the "practical implications" of these findings are few, because "we studied a sample, a subset of patients on monotherapy, and therefore one cannot generalize to a ...
Background Patients with aortic valve sclerosis (AVS) have an increased risk of cardiovascular events. Patients with atherosclerotic renal artery stenosis (RAS) develop resistant hypertension and heart failure. We hypothesized AVS may be copresent with RAS in hypertensive patients.Methods Hypertensive patients with AVS (n = 167) underwent magnetic resonance (MR) angiography using nonenhanced steady-state free precession (SSFP) technique. More than 75% luminal narrowing in the proximal region of main renal artery was regarded as significant RAS. Peak aortic jet velocity was obtained by Doppler echocardiography. We measured brain natriuretic peptide (BNP), and estimated ...
Background Oxidative DNA damage is involved in the pathophysiology of essential hypertension (EH), which is a multifactorial disorder. Apurinic/apyrimidinic endonuclease 1/redox effector factor-1 (APE1/REF-1) is an essential endonuclease in the base excision repair pathway of oxidatively damaged DNA, in addition to having reducing properties that promote the binding of redox-sensitive transcription factors. Blood pressure in APE1/REF-1-knockout mice is reported to be significantly higher than in wild-type mice. The aim of this study was to investigate the relationship between EH and the human APE1/REF-1 gene through a haplotype-based case–control study using single-nucleotide ...
jueves, 14 ene 2010 Por A. Torres a, B. Fité a, P. Gascón a, M. Barau a, R. Guayta-Escolies a, M. Estrada-Campmany a, C. Rodríguez a a Col·legi de Farmacèutics de Barcelona, Barcelona, España Introducción Las actividades de atención farmacéutica son un recurso para aumentar el grado de control de pacientes con enfermedades crónicas. El objetivo de este estudio es evaluar la eficacia de una intervención del farmacéutico comunitario a hipertensos tratados con mal control de su presión arterial (PA). Material y métodos Estudio experimental, longitudinal, prospectivo, randomizado y sin enmascaramiento, realizado en 102 farmacias comunitarias. Cuatrocientos sesenta y un pacientes ...
Background Hypertension and dyslipidemia are highly prevalent in the elderly. We studied the combined impact of both conditions on cardiovascular disease (CVD) events.Methods We studied 4,311 participants aged 65–98 (61.2% female) from the Cardiovascular Health Study (CHS), a longitudinal epidemiologic study, with no prior CVD. We evaluated the relation of low-density lipoprotein (LDL), high-density lipoprotein (HDL), or non-HDL-cholesterol combined with blood pressure (BP) categories to incident CVD—including coronary heart disease (CHD) (angina, myocardial infarction (MI), angioplasty, coronary bypass surgery, or CHD death), stroke, claudication, and CVD death over 15 ...
Background Despite the efficacy of antihypertensive treatment in preventing cardiovascular complications, there are often problems with medication adherence in hypertensive patients. The objective of this study was to examine the medication adherence and its association with blood pressure (BP) control, cardiovascular disease (CVD) hospitalization, and all-cause hospitalization.Methods We conducted a retrospective cohort observation of patients who were treated for hypertension from January 2005 to December 2006. Medical and pharmacy claims were obtained from Taiwan's National Health Insurance (NHI) database, whereas electronic records, including demographic characteristics ...
Background Poor adherence to antihypertensive medication is one of the major problems in the treatment of hypertension. Electronic monitoring is currently considered to be the gold standard for assessing adherence, but it may trigger patients to open the pill bottle without taking medication or to take out more than prescribed. In adjunct to electronic monitoring, pill count could be a valuable tool for exploring adherence patterns, and their effects on blood pressure reduction.Methods Among a total of 228 patients with mild-to-moderate hypertension, adherence to treatment was measured by means of both the Medication Event Monitoring System (MEMS) and pill count. Patients ...
Background The Take Control of Your Blood Pressure trial evaluated the effect of a multicomponent telephonic behavioral lifestyle intervention, patient self-monitoring, and both interventions combined compared with usual care on reducing systolic blood pressure during 24 months. The combined intervention led to a significant reduction in systolic blood pressure compared with usual care alone. We examined direct and patient time costs associated with each intervention.Methods We conducted a prospective economic evaluation alongside a randomized controlled trial of 636 patients with hypertension participating in the study interventions. Medical costs were estimated using ...
Background Several new bioactive compounds of the N-acylhydrazone class were developed from the safrole, a Brazilian natural product obtained from sassafras oil (Ocotea pretiosa). This work investigated the effects on cardiovascular system of LASSBio-897, a new analogue of the lead compound 3,4-methylenedioxybenzoyl-2-thienylhydrazone named LASSBio-294.Methods Thoracic aorta from Wistar–Kyoto (WKY) rats was prepared for isometric tension recording and for cGMP content determination. Blood pressure (BP) was measured in WKY rats and spontaneously hypertensive rats (SHR) after treatment with 1 mg/kg intravenously of LASSBio-897 and during 14 days' treatment of SHR with ...
Background Ambulatory arterial stiffness index (AASI) has been proposed as a marker of arterial stiffness, which predicts cardiovascular mortality. This study compared the reproducibility of 24-h, daytime, night time, and symmetrical AASI.Methods A total of 126 untreated hypertensives (mean age 48.2 ± 10.7 (s.d.) years, 70 men) underwent 24-h ambulatory blood pressure (ABP) monitoring twice 2–4 weeks apart. The reproducibility of AASI was assessed using the following criteria: (i) repeatability coefficient (RC = 2 × s.d. of differences); (ii) RC expressed as a percentage of close to maximal variation (pMV = RC/(4 × s.d. of the mean of paired recordings)); (iii) ...
Background Dietary ω-3 fatty acid deficiency can lead to hypertension in later life; however, hypertension is affected by numerous other dietary factors. We examined the effect of altering the dietary protein level on blood pressure in animals deficient or sufficient in ω-3 fatty acids.Methods Female rats were placed on one of four experimental diets 1 week prior to mating. Diets were either deficient (10% safflower oil; DEF) or sufficient (7% safflower oil, 3% flaxseed oil; SUF) in ω-3 fatty acids and contained 20 or 30% casein (DEF20, SUF20, DEF30, SUF30). Offspring were maintained on the maternal diet for the duration of the experiment. At 12, 18, 24, and ...
Although hypertension is well known as a cause of vascular dementia (VaD), recent findings highlight the role of hypertension in the pathogenesis of Alzheimer's disease (AD) as well as mild cognitive impairment (MCI). Recent studies have shown that disruption of diurnal blood pressure (BP) variation is closely associated with cognitive impairment via injury of the small cerebral arteries indicating that long-standing hypertension constitutes a risk of brain matter atrophy or white matter lesions (WMLs). In several clinical trials, BP-lowering with antihypertensive agents was suggested to reduce the risk of dementia or cognitive decline. This review paper focuses on the role of ...
The accuracy of risk estimates depends on knowing the incidence of morbidity or mortality in a population. Because cardiovascular disease (CVD) swamps all other causes of disability and death among the elderly, it is particularly important to understand its distribution and determinants in the community to identify targets for interventions to estimate the potential benefits of possible treatments and to construct health services that match need. Lifelong observation is the ideal way to quantify risk and identify the factors that account for variation in event occurrence (probabilities) in chronic diseases. As a practical matter, however, the elegantly designed and carefully ...
Background Experimentally induced sleep deprivation can raise blood pressure (BP) and worsen hypertension. We recently reported a significantly higher prevalence of obstructive sleep apnea (OSA) and reduced rapid eye movement (REM) sleep time in drug-resistant hypertensives compared to controlled hypertensives. The objective of this study was to test the hypothesis that short sleep duration is associated with resistant hypertension (RH) independently of OSA, which can itself disrupt and shorten sleep.Methods In a case–control study, overnight polysomnographic results of subjects with OSA and RH (n = 62) were compared to those with OSA of equal severity and either controlled ...
Hay un interés creciente en el papel de la aldosterona en la fisiopatología de la hipertensión arterial, la enfermedad cardiovascular y el deterioro de la función renal. El objetivo de nuestro trabajo es analizar la relación entre la aldosterona y el filtrado glomerular (FG) en pacientes hipertensos con función renal conservada. Hemos estudiado a 186 pacientes hipertensos consecutivos con filtrado renal > 60 ml/min, a quienes se determinaron las concentraciones plasmáticas de aldosterona y el FG mediante la fórmula MDRD (Modification of Diet in Renal Disease). Los pacientes con FG de 60-89 ml/min presentaban concentraciones plasmáticas de aldosterona significativamente más elevadas ...
Lead is a ubiquitous environmental toxin that is capable of causing numerous acute and chronic illnesses. Population studies have demonstrated a link between lead exposure and subsequent development of hypertension (HTN) and cardiovascular disease. In vivo and in vitro studies have shown that chronic lead exposure causes HTN and cardiovascular disease by promoting oxidative stress, limiting nitric oxide availability, impairing nitric oxide signaling, augmenting adrenergic activity, increasing endothelin production, altering the renin-angiotensin system, raising vasoconstrictor prostaglandins, lowering vasodilator prostaglandins, promoting inflammation, disturbing vascular smooth muscle ...
Young African-American men have altered macrovascular and microvascular function. In this cross-sectional study, we tested the hypothesis that vascular dysfunction in young African-American men would contribute to greater central blood pressure (BP) compared with young white men. Fifty-five young (23 yr), healthy men (25 African-American and 30 white) underwent measures of vascular structure and function, including carotid artery intima-media thickness (IMT) and carotid artery β-stiffness via ultrasonography, aortic pulse wave velocity, aortic augmentation index (AIx), and wave reflection travel time (Tr) via radial artery tonometery and a generalized transfer function, and ...
Sr. Director: La hipertensión arterial (HTA) constituye uno de los factores de riesgo cardiovascular más importantes en la enfermedad coronaria y el más relevante en los accidentes cerebrovasculares1. A pesar de ello, el control de la presión arterial es insuficiente, consiguiéndose el objetivo en sólo el 40% de los pacientes, tanto en la población general como en pacientes seguidos en unidades de HTA2,3,4,5,6,7,8. Un grupo especialmente preocupante por su riesgo cardiovascular lo constituye los pacientes con HTA resistente. Sin embargo, son pocos los datos que disponemos de las características clínicas de estos pacientes y su riesgo cardiovascular8,9,10,11,12. Recientemente hemos ...
Resumen La rigidez de la arteria central con el envejecimiento es la fuerza principal que causa un aumento de la presión del pulso (PP) y finalmente el desarrollo de la hipertensión sistólica aislada (HSA). Ya que la presión sanguínea diastólica (PSD) aumenta con un aumento de la resistencia arteriola y de las pequeñas arterias y cae con un aumento de la rigidez de la arteria grande, la PSD demuestra un patrón de curva-J con riesgo cardiovascular. Por lo tanto, la presión del pulso (PP) es un factor con mayor riesgo que la PSD en pacientes con HSA cuando la PSD es de<70mmHg. HSA puede desarrollarse de una hipertensión diastólica de “burned-out” ó de novo, secundaria a una rigidez ...
