http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2013 , Hindawi Publishing Corporation . All rights reserved. Mon, 17 Jun 2013 13:41:24 +0000 http://www.hindawi.com/journals/ijht/2013/627938/ Hypertensive patients unable to reach blood pressure (BP) targets with antihypertensive monotherapy may be switched to a combination of two medications with complementary modes of action for improved treatment response. This post hoc analysis pools data from 2812 patients, 1891 of whom were not at goal (diastolic BP [DBP] <90 mm Hg) with amlodipine 5 mg (A5) monotherapy who subsequently switched to telmisartan 40 or 80 mg (T80)/A5 single-pill combination (SPC) or amlodipine 10 mg (A10) monotherapy, and considers an additional 921 patients, 616 of whom were not at goal with A10 monotherapy who switched to telmisartan/amlodipine SPC. Patients switched to telmisartan/amlodipine SPC achieved significantly greater BP reductions compared with continued monotherapy () with reductions of −15.2/−10.9 mm Hg seen with T80/A5 after 8 weeks in patients switched from A5. BP goal (<140/90 mm Hg), systolic BP goal (<140 mm Hg), and DBP goal (<90 mm Hg) were reached by significantly more patients with telmisartan/amlodipine than with monotherapy ( for all comparisons; 56.1%, 69.7%, and 66.9%, resp., in patients who switched from A5 to T80/A5). Early use of such combination therapy should be considered to quickly reach BP targets, particularly in patients with added risk. Steen Neldam, Dingliang Zhu, and Helmut Schumacher Copyright © 2013 Steen Neldam et al. All rights reserved. Thu, 30 May 2013 11:39:06 +0000 http://www.hindawi.com/journals/ijht/2013/526949/ The objective of this study was to investigate the self-care behaviors among hypertensive patients in primary care. A cross-sectional survey, with 318 hypertensive patients, was conducted in a rural area in Beijing, China, in 2012. Participants were mainly recruited from a community health clinic and completed questionnaires assessing their self-care behaviors, including data on adherence to a prescribed medication regimen, low-salt diet intake, smoking habits, alcohol consumption, blood pressure monitoring, and physical exercise. The logistic regression model was used for the analysis of any association between self-care behaviors and age, gender, duration of hypertension, self-rated health, marital status, education level, diabetes status, or body mass index. Subjects that adhered to their medication schedule were more likely to have hypertension for a long duration (OR, 3.44; 95% CI 1.99–5.97). Older participants (OR, 1.80; 95% CI 1.08–2.99) were more likely to monitor their blood pressure. Subjects who did not partake in physical exercise were more likely to be men, although the difference between genders was not significant (OR, 0.60; 95% CI 0.36–1.01). Patients with shorter history of hypertension, younger and being males have lower self-care behaviors. Primary care providers and public health practitioner should pay more attention to patients recently diagnosed with hypertension as well as younger male patients. Huanhuan Hu, Gang Li, and Takashi Arao Copyright © 2013 Huanhuan Hu et al. All rights reserved. Tue, 28 May 2013 15:39:38 +0000 http://www.hindawi.com/journals/ijht/2013/193010/ Hypertension (HTN) is a modifiable, highly prevalent risk factor for cardiovascular morbidity and renal dysfunction worldwide. In the United States, HTN affects one in three adults, contributes to one out of every seven deaths and to nearly half of all cardiovascular disease-related deaths. HTN is considered resistant when the blood pressure remains above goal despite lifestyle modification and administration of three antihypertensive agents of different classes including a diuretic. Large population-based studies have suggested that obstructive sleep apnea (OSA) is a risk factor for resistant HTN. The mechanism proposed is a pattern of intermittent hypoxia associated with hyperaldosteronism, increased sympathetic tone, endothelial dysfunction, and inflammation. In this review we discuss the association between OSA and resistant HTN, the physiologic mechanisms linking OSA with resistant HTN, and the effect of continuous positive airway pressure therapy (CPAP) on blood pressure in patients with resistant HTN. While the reduction in blood pressure with CPAP is usually modest in patients with OSA, a decrease of only a few mmHg in blood pressure can significantly reduce cardiovascular risk. Patients presenting to a center specializing in management of hypertension should be screened and treated for OSA as a potentially modifiable risk factor. Akram Khan, Nimesh K. Patel, Daniel J. O’Hearn, and Supriya Khan Copyright © 2013 Akram Khan et al. All rights reserved. Tue, 30 Apr 2013 10:08:58 +0000 http://www.hindawi.com/journals/ijht/2013/276564/ Background. Cardiovascular disease (CVD) is the leading cause of death in adult Canadians. Cardiometabolic risk (CMR) derived from 10-year risk of cardiovascular diseases and metabolic syndrome (MetS) needs to be evaluated in Canadian adults. Objective. To determine CMR among Canadian adults by sociodemographic and lifestyle characteristics. Subjects and Methods. Data from the Canadian Health Measures Survey (CHMS), Cycle 1, 2007–2009, was used. Framingham Risk Score (FRS) was implemented to predict 10-year risk of CVD, and metabolic syndrome was identified using the most recent criteria. The 10-year risk of CVD was multiplied by 1.5 in individuals with MetS to obtain CMR. Data were weighted and bootstrapped to be able to generalize the results nationally. Results and Conclusion. CMR gave more accurate estimation of 10-year risk of CVD in Canadian adults from 30 to 74 years than using only FRS. The 10-year risk of CVD in Canadian adults significantly increased when CMR was taken into account from 8.10% to 9.86%. The CVD risk increased by increase in age, decrease in education, and decrease in physical activity and in smokers. Canadians with medium risk of CVD consumed significantly less fruit and vegetable juice compared to Canadians with low risk. No other dietary differences were found. Solmaz Setayeshgar, Susan J. Whiting, and Hassanali Vatanparast Copyright © 2013 Solmaz Setayeshgar et al. All rights reserved. Tue, 23 Apr 2013 15:18:46 +0000 http://www.hindawi.com/journals/ijht/2013/349782/ High blood pressure is common in acute stroke patients. Very high as well as very low blood pressure is associated with poor outcome. Spontaneous fall of blood pressure within the first few days after stroke was associated both with neurological improvement and impairment. Several randomized trials investigated the pharmacological reduction of blood pressure versus control. Most trials showed no significant difference in their primary outcome apart from the INWEST trial which found an increase of poor outcome when giving intravenous nimodipine. Nevertheless, useful information can be extracted from the published data to help guide the clinician's decision. Blood pressure should only be lowered when it is clearly elevated, and early after onset, reduction should be moderate but may be achieved rapidly. No clear recommendations can be given on the substances to use; however, care should be taken with intravenous calcium channel blockers and angiotensin receptor antagonists. Two ongoing randomized trials will help to solve the questions on blood pressure management in acute stroke. Gordian J. Hubert, Peter Müller-Barna, and Roman L. Haberl Copyright © 2013 Gordian J. Hubert et al. All rights reserved. Tue, 23 Apr 2013 08:26:20 +0000 http://www.hindawi.com/journals/ijht/2013/849750/ We investigated the involvement of potassium inward rectifier current (Kir) impairment in smooth muscle cells of cerebral arteries under the condition of increased susceptibility of stroke, in spontaneously hypertensive stroke-prone (SHRsp) rats compared to spontaneously hypertensive (SHR) ones as well as to controls (WKY). Kir current was studied with whole-cell patch-clamp techniques on freshly isolated single smooth muscle cells (SMC) of middle cerebral artery (MCA) from SHRsp, SHR, and WKY male rats (are range 12–32 weeks). A significant and progressive Kir current density reduction was observed on SMC of SHRsp rats from the 22nd week of age on, as opposed to the Kir current density stability observed over the same time in the SMC of WKY and SHR rats. The Kir density alteration was correlated to the age of the SHRsp animals. These results suggest that in the cerebral vascular smooth muscle cells of SHRsp rats, there is a progressive Kir channel impairment, leading to a reduction of Kir current density. This impairment may underpin a lack of vasodilation of the MCA and be implicated in the stroke-proneness observed on SHRsp animals. Michèle Bastide, Thavarak Ouk, Olivier Pétrault, and Régis Bordet Copyright © 2013 Michèle Bastide et al. All rights reserved. Mon, 22 Apr 2013 10:43:01 +0000 http://www.hindawi.com/journals/ijht/2013/929183/ Resistant hypertension (RH) is defined as blood pressure (BP) that remains above the target of less than 140/90 mmHg in the general population and 130/80 mmHg in people with diabetes mellitus or chronic kidney disease (CKD) in spite of the use of at least three full-dose antihypertensive drugs including a diuretic or as BP that reaches the target by means of four or more drugs. In CKD, RH is a common condition due to a combination of factors including sodium retention, increased activity of the renin-angiotensin system, and enhanced activity of the sympathetic nervous system. Before defining the hypertensive patient as resistant it is mandatory to exclude the so-called “pseudoresistance.” This condition, which refers to the apparent failure to reach BP target in spite of an appropriate antihypertensive treatment, is mainly caused by white coat hypertension that is prevalent (30%) in CKD patients. Recently we have demonstrated that “true” RH represents an independent risk factor for renal and cardiovascular outcomes in CKD patients. Silvio Borrelli, Luca De Nicola, Giovanna Stanzione, Giuseppe Conte, and Roberto Minutolo Copyright © 2013 Silvio Borrelli et al. All rights reserved. Mon, 22 Apr 2013 08:03:50 +0000 http://www.hindawi.com/journals/ijht/2013/597906/ Hypertension frequently complicates chronic kidney disease (CKD), with studies showing clinical benefit from blood pressure lowering. Subgroups of patients with severe hypertension exist. We aimed to identify patients with the greatest mortality risk from uncontrolled hypertension to define the prevalence and phenotype of patients who might benefit from adjunctive therapies. 1691 all-cause CKD patients from the CRISIS study were grouped by baseline blood pressure—target (<140/80 mmHg); elevated (140–190/80–100 mmHg); extreme (>190 and/or 100 mmHg). Groups were well matched for age, eGFR, and comorbidities. 77 patients had extreme hypertension at recruitment but no increased mortality risk (HR 0.9, ) over a median follow-up period of 4.5 years. The 1.2% of patients with extreme hypertension at recruitment and at 12-months had a significantly increased mortality risk (HR 4.3, ). This association was not seen in patients with baseline extreme hypertension and improved 12-month blood pressures (HR 0.86, ). Most CKD patients with extreme hypertension respond to pharmacological blood pressure control, reducing their risk for death. Patients with extreme hypertension in whom blood pressure control cannot be achieved have an approximate prevalence of 1%. These patients have an increased mortality risk and may be an appropriate group to consider for further therapies, including renal nerve ablation. James Ritchie, Francesco Rainone, Darren Green, Helen Alderson, Diana Chiu, Rachel Middleton, Donal O’Donoghue, and Philip A. Kalra Copyright © 2013 James Ritchie et al. All rights reserved. Sun, 21 Apr 2013 16:34:00 +0000 http://www.hindawi.com/journals/ijht/2013/436502/ Background. Evidence suggests that insufficient sleep duration is associated with an increased likelihood for hypertension. Both short (<6 hours) and long (>8 hour) sleep durations as well as hypertension are more prevalent among blacks than among whites. This study examined associations between sleep duration and hypertension, considering differential effects of race and ethnicity among black and white Americans. Methods. Data came from a cross-sectional household interview with 25,352 Americans (age range: 18–85 years). Results. Both white and black short sleepers had a greater likelihood of reporting hypertension than those who reported sleeping 6 to 8 hours. Unadjusted logistic regression analysis exploring the race/ethnicity interactions between insufficient sleep and hypertension indicated that black short (<6 hours) and long (>8 hours) sleepers were more likely to report hypertension than their white counterparts (OR = 1.34 and 1.37, resp.; ). Significant interactions of insufficient sleep with race/ethnicity were observed even after adjusting to effects of age, sex, income, education, body mass index, alcohol use, smoking, emotional distress, diabetes, coronary heart disease, and stroke. Conclusion. Results suggest that the race/ethnicity interaction is a significant mediator in the relationship between insufficient sleep and likelihood of having a diagnosis of hypertension. A. Pandey, N. Williams, M. Donat, M. Ceide, P. Brimah, G. Ogedegbe, S. I. McFarlane, and G. Jean-Louis Copyright © 2013 A. Pandey et al. All rights reserved. Thu, 18 Apr 2013 09:40:59 +0000 http://www.hindawi.com/journals/ijht/2013/538017/ African Americans have the highest prevalence of hypertension in the world which may emanate from their predisposition to heightened endothelial inflammation. The purpose of this study was to determine the effects of a 6-month aerobic exercise training (AEXT) intervention on the inflammatory biomarkers interleukin-10 (IL-10), interleukin-6 (IL-6), and endothelial microparticle (EMP) CD62E+ and endothelial function assessed by flow-mediated dilation (FMD) in African Americans. A secondary purpose was to evaluate whether changes in IL-10, IL-6, or CD62E+ EMPs predicted the change in FMD following the 6-month AEXT intervention. A pre-post design was employed with baseline evaluation including office blood pressure, FMD, fasting blood sampling, and graded exercise testing. Participants engaged in 6 months of AEXT. Following the AEXT intervention, all baseline tests were repeated. FMD significantly increased, CD62E+ EMPs and IL-6 significantly decreased, and IL-10 increased but not significantly following AEXT. Changes in inflammatory biomarkers did not significantly predict the change in FMD. The change in significantly predicted the change in IL-10. Based on these results, AEXT may be a viable, nonpharmacological method to improve inflammation status and endothelial function and thereby contribute to risk reduction for cardiovascular disease in African Americans. Dianne M. Babbitt, Keith M. Diaz, Deborah L. Feairheller, Kathleen M. Sturgeon, Amanda M. Perkins, Praveen Veerabhadrappa, Sheara T. Williamson, Jan Kretzschmar, Chenyi Ling, Hojun Lee, Heather Grimm, Sunny R. Thakkar, Deborah L. Crabbe, Mohammed A. Kashem, and Michael D. Brown Copyright © 2013 Dianne M. Babbitt et al. All rights reserved. Wed, 10 Apr 2013 11:52:43 +0000 http://www.hindawi.com/journals/ijht/2013/698940/ Hypertension is a major health problem worldwide. Its attendant morbidity and mortality complications have a great impact on patient’s quality of life and survival. Optimizing blood pressure control has been shown to improve overall health outcomes. In addition to pharmacological therapies, nonpharmacological approach such as dietary modification plays an important role in controlling blood pressure. Many dietary components such as sodium, potassium, calcium, and magnesium have been studied substantially in the past decades. While some of these nutrients have clear evidence for their recommendation, some remain controversial and are still of ongoing study. Dietary modification is often discussed with patients and can provide a great benefit in blood pressure regulation. As such, reviewing the current evidence will be very useful in guiding patients and their physician and/or dietician in decision making. In this review article of nutritional factors in hypertension management, we aim to examine the role of nutritional factors individually and as components of whole dietary patterns. Ha Nguyen, Olaide A. Odelola, Janani Rangaswami, and Aman Amanullah Copyright © 2013 Ha Nguyen et al. All rights reserved. Sun, 07 Apr 2013 14:31:39 +0000 http://www.hindawi.com/journals/ijht/2013/878460/ Shanthi Mendis, Eoin O'Brien, Yackoob Kassim Seedat, and Salim Yusuf Copyright © 2013 Shanthi Mendis et al. All rights reserved. Thu, 04 Apr 2013 17:34:54 +0000 http://www.hindawi.com/journals/ijht/2013/749830/ Objective. Report of prespecified and post hoc subgroup analyses of a randomized, controlled trial comparing telmisartan 80 mg/hydrochlorothiazide 25 mg (T80/H25) combination therapy with T80 monotherapy, according to the presence of cardiovascular disease (CVD) risk factors. Methods. Hypertensive patients were randomized (2 : 1) to receive T80/H25 or T80 for 6 weeks, following a 1-week, low-dose, and run-in period. Systolic blood pressure (SBP) and diastolic BP reductions and BP goal achievement were evaluated in patients with CVD risk factors: presence of diabetes mellitus (DM), renal impairment, increased body mass index (BMI), and 10-year estimated risk for coronary heart disease (CHD). Results. In total, 888 patients received treatment. Overall, T80/H25 therapy significantly reduced SBP more than T80 monotherapy, irrespective of patient subgroup. In patients with DM, renal impairment, high BMI, and high CHD risk, BP goal achievement rates (<140/90 mm Hg) at Week 7, among those treated with T80/H25, were 52.8%, 52.8%, 50.6%, and 38.5%, respectively. More patients with DM reached a guideline-based BP goal (<130/80 mm Hg) at 7 weeks with T80/H25 than with T80 monotherapy (16.7% versus 8.8%). Rates of treatment-related adverse events were low and comparable across patient subgroups. Conclusions. Antihypertensive treatment with T80/H25 single-pill combination is effective and generally well tolerated, irrespective of the presence of CVD risk factors. Harold Bays, Pingjin Gao, Birgit Völker, Michaela Mattheus, Luis M. Ruilope, and Dingliang Zhu Copyright © 2013 Harold Bays et al. All rights reserved. Sun, 31 Mar 2013 11:27:47 +0000 http://www.hindawi.com/journals/ijht/2013/842827/ Although NADPH oxidase 4 (Nox4) is the most abundant Nox isoform in systemic vascular endothelial and smooth muscle cells, its function in the vascular tissue is not entirely known. The literature describes a pathophysiological role for Nox4 in cardiovascular disease; however, some studies have reported that it has a protective role. To date, specific Nox4 inhibitors are not available; hence, the development of a pharmacologic tool to assess Nox4’s pathophysiological role garners intense interest. In this study, we selected peptides corresponding to regions in the Nox4 oxidase complex critical to holoenzyme activity and postulated their utility as specific competitive inhibitors. Previous studies in our laboratory yielded selective inhibition of Nox2 using this strategy. We postulated that peptides mimicking the Nox4 B-loop and C-terminus and regions on inhibit Nox4 activity. To test our hypothesis, the inhibitory activity of Nox4 B-loop and C-terminal peptides as well as N-terminal peptides was assessed in a reconstituted Nox4 system. Our findings demonstrate that Nox4 inhibition is not achieved by preincubation with this comprehensive array of peptides derived from previously identified active regions. These findings suggest that Nox4 exists in a tightly assembled and active conformation which, unlike other Noxes, cannot be disrupted by conventional means. Gábor Csányi and Patrick J. Pagano Copyright © 2013 Gábor Csányi and Patrick J. Pagano. All rights reserved. Wed, 27 Mar 2013 14:38:39 +0000 http://www.hindawi.com/journals/ijht/2013/178780/ Background. A paradoxical increase in cardiovascular events has been reported with intensively lowering diastolic blood pressure (DBP). This J-curve phenomenon has challenged the aggressive lowering of blood pressure, especially in patients with coronary artery disease. Objective. Our objective was to study the effects of low DBP on mortality and determine a threshold for which DBP should not be lowered beyond. Methods. We evaluated a two-year cross-section of primary care veteran patients, from 45 to 85 years of age. Receiver operating characteristics (ROC) were employed to establish an optimal cut-off point for DBP. Propensity-score matching and multivariate logistic regression were used to control for confounders. All-cause mortality was the primary outcome. Results. 14,270 patients were studied. An ROC curve found a threshold value of DBP 70 mmHg had the greatest association with mortality (). 49% of patients had a DBP of 70 mmHg or less. Using a propensity-matched multivariate logistic regression, odds ratio for all-cause mortality in subjects with a DBP less than 70 mmHg was 1.5 (95% CI 1.3–1.8). Conclusions. Reduction of DBP below 70 mmHg is associated with increased all-cause mortality. Hypertension guidelines should include a minimum blood pressure target. Steven Tringali, Charles William Oberer, and Jian Huang Copyright © 2013 Steven Tringali et al. All rights reserved. Mon, 25 Mar 2013 18:51:36 +0000 http://www.hindawi.com/journals/ijht/2013/157180/ Marc de Gasparo, Robert C. Speth, Ovidiu C. Baltatu, and Patrick Vanderheyden Copyright © 2013 Marc de Gasparo et al. All rights reserved. Thu, 21 Mar 2013 15:20:48 +0000 http://www.hindawi.com/journals/ijht/2013/492094/ Hypertension is a chronic disease with global prevalence and incidence rapidly increasing in low and medium income countries. The surveillance of cardiovascular risk factors, such as hypertension, is a global health priority in order to estimate the burden and trends, to appropriately direct resources, and to measure the effect of interventions. We propose here that the adoption of Western lifestyles in low and middle incomes countries has dramatically increased the prevalence of abdominal obesity, which is the main source of proinflammatory cytokines, and that the vascular systemic inflammation produced by adipose tissue contributes to the development of hypertension. The concentration of proinflammatory cytokines is higher in the Latin American population than that reported in developed countries, suggesting a higher susceptibility to develop systemic low-degree inflammation at a given level of abdominal obesity. These particularities are important to be considered when planning resources for health care programs. Moreover, studying these singularities may provide a better understanding of the causes of the burden of cardiovascular risk factors and the remarkable variability in the prevalence of these medical conditions within and between countries. Patricio López-Jaramillo, Carlos Velandia-Carrillo, Julie Álvarez-Camacho, Daniel Dylan Cohen, Tatiana Sánchez-Solano, and Gabriela Castillo-López Copyright © 2013 Patricio López-Jaramillo et al. All rights reserved. Wed, 20 Mar 2013 08:53:22 +0000 http://www.hindawi.com/journals/ijht/2013/230868/ Metabolic syndrome is a cluster of metabolic and cardiovascular symptoms: insulin resistance (IR), obesity, dyslipemia. Hypertension and vascular disorders are central to this syndrome. After a brief historical review, we discuss the role of sympathetic tone. Subsequently, we examine the link between endothelial dysfunction and IR. NO is involved in the insulin-elicited capillary vasodilatation. The insulin-signaling pathways causing NO release are different to the classical. There is a vasodilatory pathway with activation of NO synthase through Akt, and a vasoconstrictor pathway that involves the release of endothelin-1 via MAPK. IR is associated with an imbalance between both pathways in favour of the vasoconstrictor one. We also consider the link between hypertension and IR: the insulin hypothesis of hypertension. Next we discuss the importance of perivascular adipose tissue and the role of adipokines that possess vasoactive properties. Finally, animal models used in the study of vascular function of metabolic syndrome are reviewed. In particular, the Zucker fatty rat and the spontaneously hypertensive obese rat (SHROB). This one suffers macro- and microvascular malfunction due to a failure in the NO system and an abnormally high release of vasoconstrictor prostaglandins, all this alleviated with glitazones used for metabolic syndrome therapy. Yolanda Mendizábal, Silvia Llorens, and Eduardo Nava Copyright © 2013 Yolanda Mendizábal et al. All rights reserved. Tue, 19 Mar 2013 09:51:09 +0000 http://www.hindawi.com/journals/ijht/2013/175428/ Angiotensin II increases blood pressure and stimulates thirst and sodium appetite in the brain. It also stimulates secretion of aldosterone from the adrenal zona glomerulosa and epinephrine from the adrenal medulla. The rat has 3 subtypes of angiotensin II receptors: , , and AT2. mRNAs for all three subtypes occur in the adrenal and brain. To immunohistochemically differentiate these receptor subtypes, rabbits were immunized with C-terminal fragments of these subtypes to generate receptor subtype-specific antibodies. Immunofluorescence revealed and AT2 receptors in adrenal zona glomerulosa and medulla. immunofluorescence was present in the zona glomerulosa, but not the medulla. Ultrastructural immunogold labeling for the receptor in glomerulosa and medullary cells localized it to plasma membrane, endocytic vesicles, multivesicular bodies, and the nucleus. and AT2, but not , immunofluorescence was observed in the anterior pituitary. Stellate cells were positive while ovoid cells were AT2 positive. In the brain, neurons were , , and AT2 positive, but glia was only positive. Highest levels of , , and AT2 receptor immunofluorescence were in the subfornical organ, median eminence, area postrema, paraventricular nucleus, and solitary tract nucleus. These studies complement those employing different techniques to characterize Ang II receptors. Courtney Premer, Courtney Lamondin, Ann Mitzey, Robert C. Speth, and Mark S. Brownfield Copyright © 2013 Courtney Premer et al. All rights reserved. Thu, 14 Mar 2013 13:51:00 +0000 http://www.hindawi.com/journals/ijht/2013/409083/ Aim. To review the available literature on burden of diabetes mellitus (DM) and hypertension (HTN) and its coexistence in Southeast Asian (SEA) and the African (AFR) regions and to suggest strategies to improve DM and HTN prevention and control in primary health care (PHC) in the two regions. Methods. A systematic review of the papers published on DM, HTN, and prevention/control of chronic diseases in SEA and AFR regions between 1980 and December 2012 was included. Results. In the year 2011, SEA region had the second largest number of people with DM (71.4 million), while the AFR region had the smallest number (14.7 million). Screening studies identified high proportions (>50%) of individuals with previously undiagnosed HTN and DM in both of the SEA and AFR regions. Studies from both regions have shown that DM and HTN coexist in type 2 DM ranging from 20.6% in India to 78.4% in Thailand in the SEA region and ranging from 9.7% in Nigeria to 70.4% in Morocco in the AFR region. There is evidence that by lifestyle modification both DM and HTN can be prevented. Conclusion. To meet the twin challenge of DM and HTN in developing countries, PHCs will have to be strengthened with a concerted and multipronged effort to provide promotive, preventive, curative, and rehabilitative services. Viswanathan Mohan, Yackoob K. Seedat, and Rajendra Pradeepa Copyright © 2013 Viswanathan Mohan et al. All rights reserved. Thu, 14 Mar 2013 10:04:20 +0000 http://www.hindawi.com/journals/ijht/2013/390872/ Cirrhosis is a common disease in Western countries. Liver failure, hyperammonemia, and portal hypertension are the main factors that contribute to human cirrhosis that frequently leads to a neuropsychiatric disorder known as hepatic encephalopathy (HE). In this study, we examined the differential contribution of these leading factors to the oxidative metabolism of diverse brain limbic system regions frequently involved in memory process by histochemical labelling of cytochrome oxidase (COx). We have analyzed cortical structures such as the infralimbic and prelimbic cotices, subcortical structures such as hippocampus and ventral striatum, at thalamic level like the anterodorsal, anteroventral, and mediodorsal thalamus, and, finally, the hypothalamus, where the mammillary nuclei (medial and lateral) were measured. The severest alteration is found in the model that mimics intoxication by ammonia, followed by the thioacetamide-treated group and the portal hypertension group. No changes were found at the mammillary bodies for any of the experimental groups. Natalia Arias, Marta Méndez, Camino Fidalgo, María Ángeles Aller, Jaime Arias, and Jorge L. Arias Copyright © 2013 Natalia Arias et al. All rights reserved. Thu, 14 Mar 2013 09:43:34 +0000 http://www.hindawi.com/journals/ijht/2013/793630/ Oxidative stress is involved in many hypertension-related vascular diseases in the brain, including stroke and dementia. Thus, we examined the role of genetic deficiency of NADPH oxidase subunit Nox2 in the function and structure of cerebral arterioles during hypertension. Arterial pressure was increased in right-sided cerebral arterioles with transverse aortic banding for 4 weeks in 8-week-old wild-type (WT) and Nox2-deficient (-/y) mice. Mice were given -nitro-L-arginine methyl ester (L-NAME, 10 mg/kg) or vehicle to drink. We measured the reactivity in cerebral arterioles through open cranial window in anesthetized mice and wall cross-sectional area and superoxide levels ex vivo. Aortic constriction increased systolic and pulse pressures in right-sided carotid arteries in all groups of mice. Ethidium fluorescence showed increased superoxide in right-sided cerebral arterioles in WT, but not in Nox2-/y mice. Dilation to acetylcholine, but not sodium nitroprusside, was reduced, and cross-sectional areas were increased in the right-sided arterioles in WT, but were unchanged in Nox2-/y mice. L-NAME reduced dilation to acetylcholine but did not result in hypertrophy in right-sided arterioles of Nox2-/y  mice. In conclusion, hypertension-induced superoxide production derived from Nox2-containing NADPH oxidase promotes hypertrophy and causes endothelial dysfunction in cerebral arterioles, possibly involving interaction with nitric oxide. Siu-Lung Chan and Gary L. Baumbach Copyright © 2013 Siu-Lung Chan and Gary L. Baumbach. All rights reserved. Wed, 13 Mar 2013 16:01:10 +0000 http://www.hindawi.com/journals/ijht/2013/863067/ Nonischemic 5/6 nephrectomized rat (NefR) is a model of chronic kidney disease. However, little is known about vascular dysfunction and its relation with hypertension in NefR. Aims. To evaluate possible alterations of endothelial function, NO-bioavailability, and basal tone in aorta from NefR and the role of oxidative stress. Sprague Dawley rats were divided into sham rats (SR), NefR, and NefR treated with tempol (NefR-T). Mean arterial pressure (MAP) and renal function were determined. In isolated aortic rings the following was measured: 1-endothelial function, 2-basal tone, 3-NO levels, 4-membrane potential (MP), and 5-oxidative stress. NefR increased MAP (SR: 119 ± 4 mmHg; ; NefR: 169 ± 6; ; ). Tempol did not modify MAP (NefR-T: 168 ± 10; ; ). NefR showed endothelial dysfunction, increased basal tone and decreased NO levels (SR: 32 ± 2 nA; , NefR: 10 ± 2; ; ). In both in vitro and in vivo tempol improves basal tone, NO levels, and MP. Oxidative stress in NefR was reverted in NefR-T. We described, for the first time, that aorta from NefR presented increased basal tone related to endothelial dysfunction and decreased NO-bioavailability. The fact that tempol improves NO-contents and basal tone, without decrease MAP, indicates that oxidative stress could be implicated early and independently to hypertension, in the vascular alterations. Rodrigo O. Marañón, Claudio Joo Turoni, Maria Sofia Karbiner, Nicolas Salas, and Maria Peral de Bruno Copyright © 2013 Rodrigo O. Marañón et al. All rights reserved. Tue, 05 Mar 2013 08:09:11 +0000 http://www.hindawi.com/journals/ijht/2013/985087/ Recent findings indicate an inverse relationship between cardiovascular disease and consumption of flavonoids. We aimed to identify clinical and vascular parameters of treated hypertensive who present beneficial effects of dark chocolate for one-week period on vascular function. Twenty-one hypertensive subjects, aged 40–65 years, were included in a prospective study with measurement of blood pressure (BP), brachial flow-mediated dilatation (FMD), peripheral arterial tonometry, and central hemodynamic parameters. These tests were repeated after seven days of eating dark chocolate 75 g/day. Patients were divided according to the response in FMD: responders () and nonresponders (). The responder group presented lower age (54 ± 7 versus 61 ± 6 years, ), Framingham risk score (FRS) (2.5 ± 1.8 versus 8.1 ± 5.1%, ), values of peripheral (55 ± 9 versus 63 ± 5 mmHg, ), and central pulse pressure (PP) (44 ± 10 versus 54 ± 6 mmHg, ). FMD response showed negative correlation with FRS (, ), baseline FMD (, ), baseline reactive hyperemia index (RHI; , ), and central PP (, ). However, after linear regression analysis, only FRS and baseline RHI were associated with FMD response. In conclusion, one-week dark chocolate intake significantly improved endothelial function and reduced BP in younger hypertensive with impaired endothelial function in spite of lower cardiovascular risk. Jenifer d'El-Rei, Ana Rosa Cunha, Adriana Burlá, Marcelo Burlá, Wille Oigman, Mario Fritsch Neves, Agostino Virdis, and Fernanda Medeiros Copyright © 2013 Jenifer d'El-Rei et al. All rights reserved. Mon, 04 Mar 2013 13:57:51 +0000 http://www.hindawi.com/journals/ijht/2013/565263/ Objective. This study evaluated the prevalence, awareness, and type of treatment for hypertension in Brazil in patients with type 1 diabetes (T1D). Methods. This was a cross-sectional, multicenter study that was conducted from December 2008 to December 2010 in 28 public clinics located in 20 Brazilian cities. Results. A total of 3,591 patients were studied, 56% female, average age years, with a median duration of diabetes years. Blood pressure levels were available for a total of 3,323 patients and 689 (19.2%) patients were hypertensive. Hypertensive patients were older, exhibited longer duration of diabetes, and had higher body mass index (BMI), total cholesterol, triglycerides, and LDL-C values (, for all comparisons), but only 370 (53.7%) received treatment. Patient awareness of hypertension was documented in 453 (65.5%) patients. However, only 76 (22.9%) of the treated patients attained the target systolic (sBP) and diastolic blood pressures (dBP). Conclusions. Our results demonstrate that a large number of T1D patients with hypertension do not receive appropriate treatment; few of the treated T1D patients achieved the target sBP and dBP values. Greater attention should be paid to blood pressure evaluation, hypertension diagnosis, and treatment of T1D patients in Brazil. Marilia B. Gomes, Lucianne Righeti Monteiro Tannus, Alessandra Saldanha de Mattos Matheus, Roberta Arnoldi Cobas, Catia C. Sousa Palma, Aline Tiemi Kano Silva, Carlos Antonio Negrato, Sergio Atala Dib, Melanie Rodacki, João Soares Felício, and Luis Henrique Canani Copyright © 2013 Marilia B. Gomes et al. All rights reserved. Mon, 04 Mar 2013 11:54:46 +0000 http://www.hindawi.com/journals/ijht/2013/653789/ Cardiovascular diseases are the most prevalent cause of morbidity and mortality among patients with type 1 or type 2 diabetes. The proposed mechanisms that can link accelerated atherosclerosis and increased cardiovascular risk in this population are poorly understood. It has been suggested that an association between hyperglycemia and intracellular metabolic changes can result in oxidative stress, low-grade inflammation, and endothelial dysfunction. Recently, epigenetic factors by different types of reactions are known to be responsible for the interaction between genes and environment and for this reason can also account for the association between diabetes and cardiovascular disease. The impact of clinical factors that may coexist with diabetes such as obesity, dyslipidemia, and hypertension are also discussed. Furthermore, evidence that justify screening for subclinical atherosclerosis in asymptomatic patients is controversial and is also matter of this review. The purpose of this paper is to describe the association between poor glycemic control, oxidative stress, markers of insulin resistance, and of low-grade inflammation that have been suggested as putative factors linking diabetes and cardiovascular disease. Alessandra Saldanha de Mattos Matheus, Lucianne Righeti Monteiro Tannus, Roberta Arnoldi Cobas, Catia C. Sousa Palma, Carlos Antonio Negrato, and Marilia de Brito Gomes Copyright © 2013 Alessandra Saldanha de Mattos Matheus et al. All rights reserved. Mon, 25 Feb 2013 15:42:06 +0000 http://www.hindawi.com/journals/ijht/2013/541689/ This study was designed to assess the effects of moxonidine on blood pressure and aspects of the metabolic syndrome in racially diverse population of patients encountered in routine medical practice. Physicians collected data on a minimum of three consecutive patients with uncontrolled essential hypertension and criteria for metabolic syndrome, eligible to receive moxonidine (0.2–0.4 mg once daily) for 6 months, either as monotherapy or as adjunct therapy to current antihypertensive treatment. Systolic and diastolic blood pressure (BP) declined by an average of  mmHg and  mmHg, respectively. BP responder rates defined as attaining BP < 140/90 mmHg were significantly () and substantially higher among younger patients, nonpostmenopausal women, and patients receiving monotherapy. While potentially relevant improvements in the entire cohort were observed in regard to body weight ( kg), fasting plasma glucose (from 6.8 to 6.2 mmol/L), and triglycerides (2.4 to 2.0 mmol/L), statistically significant changes in metabolic parameters could only be detected in subgroup analyses. Moxonidine therapy reduced blood pressure and improved rates of blood pressure control in this group of patients. While the observed trend towards improvement in various metabolic parameters merits further investigation, the overall effect of moxonidine treatment is consistent with a reduction of total cardiovascular risk in this hypertensive metabolic syndrome cohort. Irina Chazova and Markus P. Schlaich Copyright © 2013 Irina Chazova and Markus P. Schlaich. All rights reserved. Wed, 20 Feb 2013 10:09:29 +0000 http://www.hindawi.com/journals/ijht/2013/696598/ Animal studies suggest that renal tissue hypoxia plays an important role in the development of renal damage in hypertension and renal diseases, yet human data were scarce due to the lack of noninvasive methods. Over the last decade, blood oxygenation level-dependent magnetic resonance imaging (BOLD-MRI), detecting deoxyhemoglobin in hypoxic renal tissue, has become a powerful tool to assess kidney oxygenation noninvasively in humans. This paper provides an overview of BOLD-MRI studies performed in patients suffering from essential hypertension or chronic kidney disease (CKD). In line with animal studies, acute changes in cortical and medullary oxygenation have been observed after the administration of medication (furosemide, blockers of the renin-angiotensin system) or alterations in sodium intake in these patient groups, underlining the important role of renal sodium handling in kidney oxygenation. In contrast, no BOLD-MRI studies have convincingly demonstrated that renal oxygenation is chronically reduced in essential hypertension or in CKD or chronically altered after long-term medication intake. More studies are required to clarify this discrepancy and to further unravel the role of renal oxygenation in the development and progression of essential hypertension and CKD in humans. Menno Pruijm, Lucie Hofmann, Bruno Vogt, Marie-Eve Muller, Maciej Piskunowicz, Matthias Stuber, and Michel Burnier Copyright © 2013 Menno Pruijm et al. All rights reserved. Sun, 17 Feb 2013 15:43:54 +0000 http://www.hindawi.com/journals/ijht/2013/284524/ Background. Few studies have shown that self-reported secondhand smoke exposure in never smokers is associated with high blood pressure. However, there are no studies investigating the relationship between secondhand smoke exposure, measured objectively by serum cotinine levels, and high blood pressure in never smokers. Methods. We examined never smokers () from the National Health and Nutrition Examination Survey 2005–2008. Our exposure of interest was the secondhand smoke exposure estimated by serum cotinine level and our outcome was prehypertension (), defined as a systolic blood pressure of 120–139 mmHg or diastolic blood pressure of 80–89 mmHg. Results. We found that, in never smokers, serum cotinine levels were positively associated with prehypertension. Compared to those with cotinine levels in the lowest quartile (≤0.024 ng/mL), the multivariable odds ratio (95% confidence interval) of prehypertension among those with cotinine levels in the highest quartile (≥0.224 ng/mL) was 1.45(1.00, 2.11); trend . In subsequent subgroup analyses, the positive association was found to be stronger among men, non-Whites, and non-obese subjects. Conclusion. Higher secondhand smoke exposure measured objectively by serum cotinine levels was found to be associated with prehypertension in certain subgroups of a representative sample of the US population. Omayma Alshaarawy, Jie Xiao, Michael E. Andrew, Cecil Burchfiel, and Anoop Shankar Copyright © 2013 Omayma Alshaarawy et al. All rights reserved. Thu, 14 Feb 2013 15:23:36 +0000 http://www.hindawi.com/journals/ijht/2013/782861/ It is postulated that central effects of angiotensin (Ang) II may be indirect due to rapid conversion to Ang III by aminopeptidase A (APA). Previously, we showed that Ang II and Ang III induced mitogen-activated protein (MAP) kinases ERK1/2 and stress-activated protein kinase/Jun-terminal kinases (SAPK/JNK) phosphorylation in cultured rat astrocytes. Most importantly, both peptides were equipotent in causing phosphorylation of these MAP kinases. In these studies, we used brainstem and cerebellum astrocytes to determine whether Ang II’s phosphorylation of these MAP kinases is due to the conversion of the peptide to Ang III. We pretreated astrocytes with 10 μM amastatin A or 100 μM glutamate phosphonate, selective APA inhibitors, prior to stimulating with either Ang II or Ang III. Both peptides were equipotent in stimulating ERK1/2 and SAPK/JNK phosphorylation. The APA inhibitors failed to prevent Ang II- and Ang III-mediated phosphorylation of the MAP kinases. Further, pretreatment of astrocytes with the APA inhibitors did not affect Ang II- or Ang III-induced astrocyte growth. These findings suggest that both peptides directly induce phosphorylation of these MAP kinases as well as induce astrocyte growth. These studies establish both peptides as biologically active with similar intracellular and physiological effects. Michelle A. Clark, Chinh Nguyen, and Hieu Tran Copyright © 2013 Michelle A. Clark et al. All rights reserved.