International Journal of Hypertension The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. A Concept Mapping Study of Physicians’ Perceptions of Factors Influencing Management and Control of Hypertension in Sub-Saharan Africa Tue, 13 Oct 2015 11:53:10 +0000 Hypertension, once a rare problem in Sub-Saharan Africa (SSA), is predicted to be a major cause of death by 2020 with mortality rates as high as 75%. However, comprehensive knowledge of provider-level factors that influence optimal management is limited. The objective of the current study was to discover physicians’ perceptions of factors influencing optimal management and control of hypertension in SSA. Twelve physicians attending the Cardiovascular Research Training (CaRT) Institute at the University of Ghana, College of Health Sciences, were invited to complete a concept mapping process that included brainstorming the factors influencing optimal management and control of hypertension in patients, sorting and organizing the factors into similar domains, and rating the importance and feasibility of efforts to address these factors. The highest ranked important and feasible factors include helping patients accept their condition and availability of adequate equipment to enable the provision of needed care. The findings suggest that patient self-efficacy and support, physician-related factors, policy factors, and economic factors are important aspects that must be addressed to achieve optimal hypertension management. Given the work demands identified by physicians, future research should investigate cost-effective strategies of shifting physician responsibilities to well-trained no-physician clinicians in order to improve hypertension management. Juliet Iwelunmor, Sarah Blackstone, Joyce Gyamfi, Collins Airhihenbuwa, Jacob Plange-Rhule, Bamidele Tayo, Richard Adanu, and Gbenga Ogedegbe Copyright © 2015 Juliet Iwelunmor et al. All rights reserved. Provider Adherence to National Guidelines for Managing Hypertension in African Americans Tue, 13 Oct 2015 08:49:36 +0000 Purpose. To evaluate provider adherence to national guidelines for the treatment of hypertension in African Americans. Design. A descriptive, preexperimental, quantitative method. Methods. Electronic medical records were reviewed and data were obtained from 62 charts. Clinical data collected included blood pressure readings, medications prescribed, laboratory studies, lifestyle modification, referral to hypertension specialist, and follow-up care. Findings. Overall provider adherence was 75%. Weight loss, sodium restriction, and physical activity recommendations were documented on 82.3% of patients. DASH diet and alcohol consumption were documented in 6.5% of participants. Follow-up was documented in 96.6% of the patients with controlled blood pressure and 9.1% in patients with uncontrolled blood pressure. Adherence in prescribing ACEIs in patients with a comorbidity of DM was documented in 70% of participants. Microalbumin levels were ordered in 15.2% of participants. Laboratory adherence prior to prescribing medications was documented in 0% of the patients and biannual routine labs were documented in 65% of participants. Conclusion. Provider adherence overall was moderate. Despite moderate provider adherence, BP outcomes and provider adherence were not related. Contributing factors that may explain this lack of correlation include patient barriers such as nonadherence to medication and lifestyle modification recommendations and lack of adequate follow-up. Further research is warranted. Jeanette Sessoms, Kathryn Reid, Ishan Williams, and Ivora Hinton Copyright © 2015 Jeanette Sessoms et al. All rights reserved. Correlation of Prehypertension with Left Ventricular Mass Assessed by Cardiac Magnetic Resonance Imaging Mon, 12 Oct 2015 11:53:39 +0000 Introduction. The purpose of this observational cross-sectional study was to assess left ventricular mass (LVM) in prehypertensive individuals in comparison to normotensives and to determine if central blood pressure (BP) correlates better with LVM index (LVMI) than brachial BP. Methods and Result. Brachial and central BP measurements were completed at first visit and at 4 weeks in 65 healthy volunteers who were at least 40 years old and not on medication. Subjects were divided into two groups of normotensives and prehypertensives based on JNC-7 criteria and LVM was obtained using cardiac magnetic resonance imaging. Prehypertensives had significantly higher LVMI compared to normotensives (). Brachial and central BP also both positively correlate with LVMI (, ; , , resp.) in both groups and neither method was superior to the other. After multivariate regression analysis and adjusting for cardiovascular risk factors, prehypertension remained an independent determinant of LVM. Conclusion. Prehypertension is associated with cardiovascular target organ damage, and central BP was not superior to brachial BP or vice versa for association with LVMI. Tarek M. Mousa, Oluwaseun A. Akinseye, Ketevan Berekashvili, and Olakunle O. Akinboboye Copyright © 2015 Tarek M. Mousa et al. All rights reserved. Factors Associated with Medication Nonadherence among Hypertensives in Ghana and Nigeria Mon, 05 Oct 2015 12:59:44 +0000 Background. Blood pressure (BP) control is poor among hypertensives in many parts of sub-Saharan Africa. A potentially modifiable factor for control of BP is medication nonadherence (MNA); our study therefore aimed to determine factors associated with MNA among hypertensives in Ghana and Nigeria. Methodology. We conducted a multicenter cross-sectional study. Patients were recruited from Korle-Bu Hospital (), Ghana; and University of Port Harcourt Teaching Hospital, () Apapa General Hospital Lagos () and University College Hospital Ibadan (), Nigeria. Results. 357 hypertensive patients (42.6% males) participated. MNA was found in 66.7%. Adherence showed correlation with depression (, ), concern about medications (, ), and knowledge of hypertension (, ). MNA was associated with formal education () and use of herbal preparation (). MNA was found in 61.7% of uninsured participants versus 73.1% of insured participants (). Poor BP control was observed in 69.7% and there was significant association between MNA and poor BP control (). Conclusion. MNA is high among hypertensives in Ghana and Nigeria and is associated with depression, concern about hypertensive medications, formal education, and use of herbal preparations. The negative association between health insurance and MNA suggests interplay of other factors and needs further investigation. Vincent Boima, Adebowale Dele Ademola, Aina Olufemi Odusola, Francis Agyekum, Chibuike Eze Nwafor, Helen Cole, Babatunde L. Salako, Gbenga Ogedegbe, and Bamidele O. Tayo Copyright © 2015 Vincent Boima et al. All rights reserved. Low-Glycemic-Index Foods Can Decrease Systolic and Diastolic Blood Pressure in the Short Term Mon, 05 Oct 2015 06:53:00 +0000 Background. We aimed to compare the effects of low- and high-GI foods on 24-hour ambulatory blood pressure. Methods. This longitudinal study was performed on 30 women, aged 18 to 40 years, during 24 hours. In the first leg of study all recruited subjects were assigned to LGI period for 24 hours and, after a 2-week washout period, all subjects were assigned to HGI period. BP was measured every hour during the 24-hour monitoring. Results. After the intervention, there were significant decreases in SBP and DBP in the LGI period ( mmHg versus  mmHg for SBP and  mmHg versus  mmHg for DBP) ( and , resp.). However, in the HGI period, there was no significant change in SBP or DBP ( versus for SBP and versus for DBP) ( and , resp.). Conclusion. The results suggest that LGI foods may be beneficial in reducing 24-hour BP. Mina Hosseininasab, Abdolreza Norouzy, Mohsen Nematy, and Shokoufeh Bonakdaran Copyright © 2015 Mina Hosseininasab et al. All rights reserved. Micro and Macro Element Composition of Kalanchoe integra Leaves: An Adjuvant Treatment for Hypertension in Ghana Thu, 01 Oct 2015 16:06:25 +0000 Two samples, water extract and blended whole leaves, of fresh Kalanchoe integra leaves (Crassulaceae), a traditional antihypertensive medicine used in Ghana, were analyzed with Energy Dispersive X-Ray Fluorescence spectroscopy (EDXRF). Analysis revealed 12 macro and 26 micro elements in both extracts. Further quantitative assessment of the results for amounts of elements that are pharmacologically significant revealed that the amounts of calcium, potassium, and magnesium present in the extracts could be correlated to its traditional usage in managing hypertension and arrhythmias. However, heavy metals (lead and inorganic arsenic) detected in the extracts may pose a threat at doses normally used traditionally for the treatment of hypertension. S. Frimpong-Manso, I. J. Asiedu-Gyekye, J. P. Naadu, G. T. Magnus-Aryitey, A. K. Nyarko, D. Boamah, and M. Awan Copyright © 2015 S. Frimpong-Manso et al. All rights reserved. Associations of Short Sleep and Shift Work Status with Hypertension among Black and White Americans Thu, 01 Oct 2015 12:20:12 +0000 Objective. The purpose of this study was to investigate whether short sleepers (<6 hrs) who worked the non-day-shift were at greater likelihood of reporting hypertension and if these associations varied by individuals’ ethnicity. Methods. Analysis was based on the 2010 National Health Interview Survey (NHIS). A total of 59,199 American adults provided valid data for the present analyses (mean age = years; 51.5% were female). Respondents provided work schedule and estimated habitual sleep durations as well as self-report of chronic conditions. Results. Of the sample, 30.8% reported a diagnosis of hypertension, 79.1% reported daytime shift work, 11.0% reported rotating shift work, and 4.0% reported night shift work. Logistic regression analysis showed that shift work was significantly associated with hypertension among Blacks [OR = 1.35, CI: 1.06–1.72. ], but not among Whites [OR = 1.01, CI: 0.85–1.20, NS]. Black shift workers sleeping less than 6 hours had significantly increased odds of reporting hypertension [OR = 1.81, CI: 1.29–2.54, ], while their White counterparts did not [OR = 1.17, CI: 0.90–1.52, NS]. Conclusions. Findings suggest that Black Americans working the non-day-shift especially with short sleep duration have increased odds of reporting hypertension. Mirnova E. Ceïde, Abhishek Pandey, Joe Ravenell, Margaret Donat, Gbenga Ogedegbe, and Girardin Jean-Louis Copyright © 2015 Mirnova E. Ceïde et al. All rights reserved. Genetic Variants of C-5312T REN Increased Renin Levels and Diastolic Blood Pressure Response to Angiotensin Receptor Blockers Thu, 01 Oct 2015 11:47:13 +0000 Renin catalyzes the cleavage of angiotensinogen into angiotensin I. Genetic variant C-5312T of renin enhancer has been reported to increase in vitro renin gene transcription. However, no obvious in vivo study was performed to see the renin level in C-5312T when treated with angiotensin receptor blockers (ARB). Therefore, this study aimed to investigate the serum renin level and blood pressure response in ARB treated hypertensive patients. Single nucleotide polymorphism (SNP) of C-5312T was identified in 55 hypertensive patients by using multiplex PCR and renin serum level was assayed by ELISA. The data showed that the increase of serum renin levels after 5 months of ARB treatment was significantly higher in patients with CT/TT genotype (10 pg/mL) than those with CC genotype (4.08 pg/mL) (P = 0.025). Hypertensive patients with CT/TT genotypes also showed less diastolic pressure reduction than CC genotypes in hypertensive patients with valsartan treatment (P = 0.04) or telmisartan treatment (P = 0.03). Finally, these findings suggested that SNP of C-5312T REN enhancer might contribute to higher increased renin serum levels and less diastolic blood pressure response to ARB treatment. Mohammad Saifur Rohman, Ika Arum Dewi Satiti, Nashi Widodo, Mifetika Lukitasari, and Hidayat Sujuti Copyright © 2015 Mohammad Saifur Rohman et al. All rights reserved. Sleep Deficiency and Deprivation Leading to Cardiovascular Disease Thu, 01 Oct 2015 10:07:44 +0000 Sleep plays a vital role in an individual’s mental, emotional, and physiological well-being. Not only does sleep deficiency lead to neurological and psychological disorders, but also the literature has explored the adverse effects of sleep deficiency on the cardiovascular system. Decreased quantity and quality of sleep have been linked to cardiovascular disease (CVD) risk factors, such as hypertension, obesity, diabetes, and dyslipidemia. We explore the literature correlating primary sleep deficiency and deprivation as a cause for cardiovascular disease and cite endothelial dysfunction as a common underlying mechanism. Michelle Kohansieh and Amgad N. Makaryus Copyright © 2015 Michelle Kohansieh and Amgad N. Makaryus. All rights reserved. Epidemiology of Hypertension Stages in Two Countries in Sub-Sahara Africa: Factors Associated with Hypertension Stages Thu, 01 Oct 2015 07:32:24 +0000 Studies using the revised hypertension classification are needed to better understand epidemiology of hypertension across full distribution. The sociodemographic, biological, and health behavior characteristics associated with different stages of hypertension in Ghana and South Africa (SA) were studied using global ageing and adult health (SAGE), WAVE 1 dataset. Blood pressure was assessed for a total of 7545 respondents, 2980 from SA and 4565 from Ghana. Hypertension was defined using JNC7 blood pressure classification considering previous diagnosis and treatment. Multivariate multinomial logistic regression analysis using Stata version 12 statistical software was done to identify independent predictors. The weighted prevalence of prehypertension and hypertension in Ghana was 30.7% and 42.4%, respectively, and that of SA was 29.4% and 46%, respectively, showing high burden. After adjusting for the independent variables, only age (OR = 1.32, 95% CI: 1.14–1.53), income (OR = 1.9, 95% CI: 1.04–3.47), and BMI (OR = 1.16, 95% CI: 1.1–1.22) remained independent predictors for stage 1 hypertension in Ghana, while, for SA, age (OR = 2.27, 95% CI: 1.53–3.36), sex (OR = 0.28, 95% CI: 0.08–1), and BMI (OR = 1.15, 95% CI: 1.07–1.25) were found to be independent predictors of stage 1 hypertension. Healthy lifestyle changes and policy measures are needed to promptly address these predictors. Kirubel Zemedkun Gebreselassie and Mojgan Padyab Copyright © 2015 Kirubel Zemedkun Gebreselassie and Mojgan Padyab. All rights reserved. Implications of Renal Denervation Therapy in Patients with Sleep Apnea Wed, 30 Sep 2015 13:59:03 +0000 Obstructive sleep apnea (OSA) syndrome is a prevalent condition characterized by repeated episodes of obstruction of the upper airway, leading to intermittent hypoxemia and important endothelial and anatomical dysfunctions that cause cardiovascular and cerebrovascular disease. The finding of the relationship between OSA and hypertension, especially resistant hypertension (RHT), has increased the interest in therapeutic strategies that affect renal sympathetic activity in these patients. The observational studies published until now demonstrated that renal denervation therapy can reduce the severity of OSA syndrome. Renal sympathetic denervation (RDN) could be a future therapeutic possibility for conditions other than RHT, such as atrial fibrillation, heart failure, obesity, and OSA syndrome, where renal sympathetic system plays an important physiological role. The aim of this review was to elucidate the implications of renal sympathetic activity in OSA syndrome. Fernando Jaén-Águila, José Antonio Vargas-Hitos, and Juan Diego Mediavilla-García Copyright © 2015 Fernando Jaén-Águila et al. All rights reserved. Renin-Angiotensin System Genes Polymorphisms and Essential Hypertension in Burkina Faso, West Africa Mon, 17 Aug 2015 09:49:59 +0000 Objective. This study aimed to investigate the association between three polymorphisms of renin-angiotensin system and the essential hypertension in the population of Burkina Faso. Methodology. This was a case-control study including 202 cases and 204 matched controls subjects. The polymorphisms were identified by a classical and a real-time PCR. Results. The AGT 235M/T and AT1R 1166A/C polymorphisms were not associated with the hypertension while the genotype frequencies of the ACE I/D polymorphism between patients and controls (DD: 66.83% and 35.78%, ID: 28.22% and 50.98%, II: 4.95% and 13.24%, resp.) were significantly different (p < 10−4). The genotype DD of ACE gene (OR = 3.40, p < 0.0001), the increasing age (OR = 3.83, p < 0.0001), obesity (OR = 4.84, p < 0.0001), dyslipidemia (OR = 3.43, p = 0.021), and alcohol intake (OR = 2.76, p < 0.0001) were identified as the independent risk factors for hypertension by multinomial logistic regression. Conclusion. The DD genotype of the ACE gene is involved in susceptibility to hypertension. Further investigations are needed to better monitor and provide individualized care for hypertensive patients. Daméhan Tchelougou, Jonas K. Kologo, Simplice D. Karou, Valentin N. Yaméogo, Cyrille Bisseye, Florencia W. Djigma, Djeneba Ouermi, Tegwindé R. Compaoré, Maléki Assih, Virginio Pietra, Patrice Zabsonré, and Jacques Simpore Copyright © 2015 Daméhan Tchelougou et al. All rights reserved. Preeclampsia Is Associated with Increased Central Aortic Pressure, Elastic Arteries Stiffness and Wave Reflections, and Resting and Recruitable Endothelial Dysfunction Thu, 13 Aug 2015 12:11:25 +0000 Introduction. An altered endothelial function (EF) could be associated with preeclampsia (PE). However, more specific and complementary analyses are required to confirm this topic. Flow-mediated dilation (FMD), low-flow-mediated constriction (L-FMC), and hyperemic-related changes in carotid-radial pulse wave velocity (PWVcr) offer complementary information about “recruitability” of EF. Objectives. To evaluate, in healthy and hypertensive pregnant women (with and without PE), central arterial parameters in conjunction with “basal and recruitable” EF. Methods. Nonhypertensive (HP) and hypertensive pregnant women (gestational hypertension, GH; preeclampsia, PE) were included. Aortic blood pressure (BP), wave reflection parameters (AIx@75), aortic pulse wave velocity (PWVcf) and PWVcr, and brachial and common carotid stiffness and intima-media thickness were measured. Brachial FMD and L-FMC and hyperemic-related change in PWVcr were measured. Results. Aortic BP and AIx@75 were elevated in PE. PE showed stiffer elastic but not muscular arteries. After cuff deflation, PWVcr decreased in HP, while GH showed a blunted PWVcr response and PE showed a tendency to increase. Maximal FMD and L-FMC were observed in HP followed by GH; PE did not reach significant arterial constriction. Conclusion. Aortic BP and wave reflections as well as elastic arteries stiffness are increased in PE. PE showed both “resting and recruitable” endothelial dysfunctions. Juan Torrado, Ignacio Farro, Yanina Zócalo, Federico Farro, Claudio Sosa, Santiago Scasso, Justo Alonso, and Daniel Bia Copyright © 2015 Juan Torrado et al. All rights reserved. Blood Pressure Response to Zofenopril or Irbesartan Each Combined with Hydrochlorothiazide in High-Risk Hypertensives Uncontrolled by Monotherapy: A Randomized, Double-Blind, Controlled, Parallel Group, Noninferiority Trial Wed, 05 Aug 2015 15:21:08 +0000 In this randomized, double-blind, controlled, parallel group study (ZENITH), 434 essential hypertensives with additional cardiovascular risk factors, uncontrolled by a previous monotherapy, were treated for 18 weeks with zofenopril 30 or 60 mg plus hydrochlorothiazide (HCTZ) 12.5 mg or irbesartan 150 or 300 mg plus HCTZ. Rate of office blood pressure (BP) response (zofenopril: 68% versus irbesartan: 70%; ) and 24-hour BP response (zofenopril: 85% versus irbesartan: 84%; ) was similar between the two treatment groups. Cardiac and renal damage was equally reduced by both treatments, whereas the rate of carotid plaque regression was significantly larger with zofenopril. In conclusion, uncontrolled monotherapy treated hypertensives effectively respond to a combination of zofenopril or irbesartan plus a thiazide diuretic, in terms of either BP response or target organ damage progression. Ettore Malacco, Stefano Omboni, and Gianfranco Parati Copyright © 2015 Ettore Malacco et al. All rights reserved. A Comparison of Casual In-Clinic Blood Pressure Measurements to Standardized Guideline-Concordant Measurements in Severely Obese Individuals Wed, 29 Jul 2015 13:29:51 +0000 Background/Objectives. The objective of this study was to compare casual BP taken in a bariatric clinic to standardized guideline-concordant BP. Subjects/Methods. A cross sectional analysis was performed using baseline data from a weight management trial. Patients were recruited from a Canadian bariatric care program. Standardized BP was performed using a Watch BP oscillometric device. Casual in-clinic BP single readings, taken using a Welch Allyn oscillometric device, were chart-abstracted. Paired -tests, Bland-Altman plots, and Pearson’s correlations were used for analysis. Results. Data from 134 patients were analyzed. Mean age was 41.5 ± 8.9 y, mean BMI was 46.8 ± 6.5 kg/m2, and 40 (30%) had prior hypertension. Mean casual in-clinic BP was 128.8 ± 14.1/81.6 ± 9.9 mmHg and mean standardized BP was 133.2 ± 15.0/82.0 ± 10.3 mmHg (difference of −4.3 ± 12.0 for systolic () and −0.4 ± 10.0 mmHg for diastolic BP ()). Pearson’s coefficients were 0.66 () for SBP and 0.50 () for DBP. 28.4% of casual versus 26.9% of standardized measurements were ≥140/90 mmHg (). Conclusion. In this bariatric clinic, casual BP was unexpectedly lower than standardized BP. This could potentially lead to the underdiagnosis of hypertension. Sana Vahidy, Sumit R. Majumdar, and Raj S. Padwal Copyright © 2015 Sana Vahidy et al. All rights reserved. Prevalence of Hypertension in Akwa Ibom State, South-South Nigeria: Rural versus Urban Communities Study Wed, 10 Jun 2015 12:39:21 +0000 Recent studies have shown an increasing trend in the prevalence of hypertension in rural communities compared to that of the urban communities. This study was therefore carried out to determine the prevalence of hypertension and its predictors (if any) in both urban and rural communities of Akwa Ibom State of Nigeria. Subjects and Method. This was a cross-sectional study of urban and rural communities of Akwa Ibom State for the prevalence of hypertension and its predictors. Two urban cities and two rural communities were randomly selected from the three senatorial districts of the state. Hypertension was defined based on the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of Hypertension. Results. Nine hundred and seventy-eight (978) participants were recruited from rural areas and five hundred and ninety (590) from urban centers. The rural populace had higher systolic, diastolic, and mean arterial blood pressure than the urban populace (, < 0.002, < 0.001, resp.). The prevalence of hypertension was significantly higher in the rural populace than in the urban populace [44.3% (95% CI 41.1–47.4%) versus 28.6% (95% CI 24.9–32.3%)]. Age, BMI, and proteinuria were independent predictors of hypertension occurrence. Conclusion. There is an epidemiologic change in the prevalence of hypertension in the rural communities of Nigeria. Effiong Ekong Akpan, Udeme E. Ekrikpo, Aniema I. A. Udo, and Bassey Edet Bassey Copyright © 2015 Effiong Ekong Akpan et al. All rights reserved. Genetic Variant of C-5434T REN Enhancer on Serum Renin Levels and Binding Pattern of Signal Transducers and Activators Transcription 3 Thu, 21 May 2015 11:42:01 +0000 The human renin gene has been widely known to be involved in essential hypertension (EH) pathogenesis. Genetic variant C-5434T of REN enhancer contributed to renin gene transcription and serum renin regulation. However, the mechanism associated with the transcription level changes remains unknown, and only a few reports exist that discussed serum renin levels on C-5434T of REN. Thus, this study aims to investigate the relationship between genetic variant C-5434T of REN enhancer and serum renin levels in Indonesian hypertensive patients. SNP of C-5434T was genotyped in 56 hypertensive patients by using RFLP. The data showed that serum renin is slightly higher in hypertensive patients with the TT genotype (39 ± 10.3) than patients with the CC genotype (33 ± 10.6) but the difference was not statistically significant (). Here, we also present a docking approach for predicting interaction between genetic variant -5434C/T and STAT3 (Signal Transducers and Activators Transcription 3), the predicted transcription factor that regulates renin gene enhancer. The results showed that STAT3-DNA allele T more favorably binds to DNA than STAT3-DNA allele C. These data suggest that the presence of genetic variant C-5434T has changed the binding pattern of STAT3 to REN enhancer. This is likely to influence STAT3 activity to stimulate the expression of renin gene in producing renin. Imama Maslahah, Mohammad Saifur Rohman, Nashi Widodo, Agustina Tri Endharti, and Didik Utomo Copyright © 2015 Imama Maslahah et al. All rights reserved. Brain Angiotensin II Type 1 Receptor Blockade Improves Dairy Blood Pressure Variability via Sympathoinhibition in Hypertensive Rats Mon, 30 Mar 2015 06:48:21 +0000 Abnormal blood pressure (BP) elevation in early morning is known to cause cardiovascular events. Previous studies have suggested that one of the reasons in abnormal dairy BP variability is sympathoexcitation. We have demonstrated that brain angiotensin II type 1 receptor (AT1R) causes sympathoexcitation. The aim of the present study was to investigate whether central AT1R blockade attenuates the excess BP elevation in rest-to-active phase in hypertensive rats or not. Stroke-prone spontaneously hypertensive rats (SHRSP) were treated with intracerebroventricular infusion (ICV) of AT1R receptor blocker (ARB), oral administration of hydralazine (HYD), or ICV of vehicle (VEH). Telemetric averaged mean BP (MBP) was measured at early morning (EM), after morning (AM), and night (NT). At EM, MBP was significantly lower in ARB to a greater extent than in HYD compared to VEH, though MBP at AM was the same in ARB and HYD. At NT, MBP was also significantly lower in ARB than in HYD. These results in MBP were compatible to those in sympathoexcitation and suggest that central AT1R blockade attenuates excess BP elevation in early active phase and continuous BP elevation during rest phase independent of depressor response in hypertensive rats. Takuya Kishi, Yoshitaka Hirooka, and Kenji Sunagawa Copyright © 2015 Takuya Kishi et al. All rights reserved. Corrigendum to “Reference Values of Pulse Wave Velocity in Healthy People from an Urban and Rural Argentinean Population” Sun, 29 Mar 2015 09:42:35 +0000 Alejandro Díaz, Cintia Galli, Matías Tringler, Agustín Ramírez, and Edmundo Ignacio Cabrera Fischer Copyright © 2015 Alejandro Díaz et al. All rights reserved. Modulation of miRNAs in Pulmonary Hypertension Wed, 11 Mar 2015 09:34:58 +0000 MicroRNAs (miRNAs) have emerged as a new class of posttranscriptional regulators of many cardiac and vascular diseases. They are a class of small, noncoding RNAs that contributes crucial roles typically through binding of the 3′-untranslated region of mRNA. A single miRNA may influence several signaling pathways associated with cardiac remodeling by targeting multiple genes. Pulmonary hypertension (PH) is a rare disorder characterized by progressive obliteration of pulmonary (micro) vasculature that results in elevated vascular resistance, leading to right ventricular hypertrophy (RVH) and RV failure. The pathology of PH involves vascular cell remodeling including pulmonary arterial endothelial cell (PAEC) dysfunction and pulmonary arterial smooth muscle cell (PASMC) proliferation. There is no cure for this disease. Thus, novel intervention pathways that govern PH induced RVH may result in new treatment modalities. Current therapies are limited to reverse the vascular remodeling. Recent studies have demonstrated the roles of various miRNAs in the pathogenesis of PH and pulmonary disorders. This review provides an overview of recent discoveries on the role of miRNAs in the pathogenesis of PH and discusses the potential for miRNAs as therapeutic targets and biomarkers of PH at clinical setting. Sudhiranjan Gupta and Li Li Copyright © 2015 Sudhiranjan Gupta and Li Li. All rights reserved. Sleep as a Mediator in the Pathway Linking Environmental Factors to Hypertension: A Review of the Literature Mon, 02 Mar 2015 09:41:44 +0000 Environmental factors, such as noise exposure and air pollution, are associated with hypertension. These environmental factors also affect sleep quality. Given the growing evidence linking sleep quality with hypertension, the purpose of this review is to investigate the role of sleep as a key mediator in the association between hypertension and environmental factors. Through this narrative review of the extant literature, we highlight that poor sleep quality mediates the relationship between environmental factors and hypertension. The conceptual model proposed in this review offers opportunities to address healthcare disparities in hypertension among African Americans by highlighting the disparate impact that the predictors (environmental factors) and mediator (sleep) have on the African-American community. Understanding the impact of these factors is crucial since the main outcome variable (hypertension) severely burdens the African-American community. Oluwaseun A. Akinseye, Stephen K. Williams, Azizi Seixas, Seithikurippu R. Pandi-Perumal, Julian Vallon, Ferdinand Zizi, and Girardin Jean-Louis Copyright © 2015 Oluwaseun A. Akinseye et al. All rights reserved. The ACE2/Apelin Signaling, MicroRNAs, and Hypertension Sun, 01 Mar 2015 12:27:22 +0000 The renin-angiotensin aldosterone system (RAAS) plays a pivotal role in the development of hypertension. Angiotensin converting enzyme 2 (ACE2), which primarily metabolises angiotensin (Ang) II to generate the beneficial heptapeptide Ang-(1-7), serves as a negative regulator of the RAAS. Apelin is a second catalytic substrate for ACE2 and functions as an inotropic and cardiovascular protective peptide. The physiological effects of Apelin are exerted through binding to its receptor APJ, a seven-transmembrane G protein-coupled receptor that shares significant homology with the Ang II type 1 receptor (AT1R). The deregulation of microRNAs, a class of short and small noncoding RNAs, has been shown to involve cardiovascular remodeling and pathogenesis of hypertension via the activation of the Ang II/AT1R pathway. MicroRNAs are linked with modulation of the ACE2/Apelin signaling, which exhibits beneficial effects in the cardiovascular system and hypertension. The ACE2-coupled crosstalk among the RAAS, the Apelin system, and microRNAs provides an important mechanistic insight into hypertension. This paper focuses on what is known about the ACE2/Apelin signaling and its biological roles, paying particular attention to interactions and crosstalk among the ACE2/Apelin signaling, microRNAs, and hypertension, aiming to facilitate the exploitation of new therapeutic medicine to control hypertension. Lai-Jiang Chen, Ran Xu, Hui-Min Yu, Qing Chang, and Jiu-Chang Zhong Copyright © 2015 Lai-Jiang Chen et al. All rights reserved. Association of Serum Bisphenol A with Hypertension in Thai Population Mon, 16 Feb 2015 11:33:19 +0000 Objective. The present study aimed to examine the association between serum BPA and hypertension and evaluated whether it was influenced by estradiol level. Methods. A subsample of 2588 sera randomly selected from the Thai National Health Examination Survey IV, 2009, was measured for serum BPA and estradiol. Logistic regression was used to examine the association controlling for age, sex, diabetes, body mass index, and estradiol level. Results. Compared with the lowest quartile, the adjusted odds ratio (AOR) of hypertension for the fourth quartile of serum BPA was 2.16 (95% CI 1.31, 3.56) in women and 1.44 (0.99, 2.09) in men. There was no interaction between serum BPA and estradiol level. For analysis using log(BPA) as a continuous variable, the AOR per unit change in log(BPA) was 1.09 (95% CI 1.02, 1.16). Among postmenopausal women, the AOR for the fourth quartile of BPA was 2.33 (95% CI 1.31, 4.15) and, for premenopausal women, it was 2.12 (95% CI 0.87, 5.19). Conclusion. Serum BPA was independently associated with hypertension in women and was not likely to be affected by estrogen; however, its mechanism related to blood pressure needs further investigation. Wichai Aekplakorn, La-or Chailurkit, and Boonsong Ongphiphadhanakul Copyright © 2015 Wichai Aekplakorn et al. All rights reserved. Evaluation of 24-Hour Arterial Stiffness Indices and Central Hemodynamics in Healthy Normotensive Subjects versus Treated or Untreated Hypertensive Patients: A Feasibility Study Mon, 26 Jan 2015 12:52:17 +0000 Objective. Central blood pressure (BP) and vascular indices estimated noninvasively over the 24 hours were compared between normotensive volunteers and hypertensive patients by a pulse wave analysis of ambulatory blood pressure recordings. Methods. Digitalized waveforms obtained during each brachial oscillometric BP measurement were stored in the device memory and analyzed by the validated Vasotens technology. Averages for the 24 hours and for the awake and asleep subperiods were computed. Results. 142 normotensives and 661 hypertensives were evaluated. 24-hour central BP, pulse wave velocity (PWV), and augmentation index (AI) were significantly higher in the hypertensive group than in the normotensive group (119.3 versus 105.6 mmHg for systolic BP, 75.6 versus 72.3 mmHg for diastolic BP, 10.3 versus 10.0 m/sec for aortic PWV, −9.7 versus −40.7% for peripheral AI, and 24.7 versus 11.0% for aortic AI), whereas reflected wave transit time (RWTT) was significantly lower in hypertensive patients (126.6 versus 139.0 ms). After adjusting for confounding factors a statistically significant between-group difference was still observed for central BP, RWTT, and peripheral AI. All estimates displayed a typical circadian rhythm. Conclusions. Noninvasive assessment of 24-hour arterial stiffness and central hemodynamics in daily life dynamic conditions may help in assessing the arterial function impairment in hypertensive patients. Stefano Omboni, Igor N. Posokhov, and Anatoly N. Rogoza Copyright © 2015 Stefano Omboni et al. All rights reserved. CYP17A1 and Blood Pressure Reactivity to Stress in Adolescence Mon, 26 Jan 2015 09:00:10 +0000 Adolescents who exhibit exaggerated blood pressure (BP) reactivity to physical and mental challenges are at increased risk of developing hypertension in adulthood. BP at rest and in response to challenges is higher in males than females, beginning in early adolescence. CYP17A1 is one of the well-established gene loci of adult hypertension. Here, we investigated whether this gene locus is associated with elevated BP at rest and in response to physical (active standing) and mental (math stress) challenges in adolescence. We studied 496 male and 532 female adolescents (age 12–18 years) who were recruited from a genetic founder population. Our results showed that the variant of CYP17A1 rs10786718 was associated with enhanced BP reactivity to the mental but not physical challenge and in males but not females. In males, BP increase in response to math stress was higher in major versus minor allele homozygotes by 7.6 mm Hg (). Resting BP was not associated with the CYP17A1 variant in either sex. These results suggest that, in adolescent males but not females, CYP17A1 enhances BP reactivity to mental stress. Whether this effect contributes to the higher prevalence of hypertension in males than females later in life remains to be determined. Mariel Van Woudenberg, Jean Shin, Manon Bernard, Catriona Syme, Michal Abrahamowicz, Gabriel Leonard, Michel Perron, Louis Richer, Suzanna Veillette, Daniel Gaudet, Tomas Paus, and Zdenka Pausova Copyright © 2015 Mariel Van Woudenberg et al. All rights reserved. Sociodemographic Correlates of Modifiable Risk Factors for Hypertension in a Rural Local Government Area of Oyo State South West Nigeria Sun, 21 Dec 2014 00:10:09 +0000 Modifiable risk factors of hypertension contribute significantly to all-cause morbidity and mortality worldwide. The study aimed to determine the prevalence of and the association of modifiable risk factors with hypertension in rural community. A cross-sectional study was conducted among 166 male and 201 female adults of 18 years and above using cluster sampling technique. Data were collected using modified WHO STEPS instrument and hypertensive subjects were defined as those with systolic greater than or equal to 140 and diastolic of 90 mmHg. Data were analyzed with SPSS version 17 with level of significance at . The mean age of the subjects was 36.36 (±16.88) years and mean systolic and diastolic pressures were 124 (±16.93) and 76.32 (±11.85) mmHg, respectively. The prevalence of hypertension was high (22.9%) in this rural communities but awareness was low, 10.71%. The prevalence of alcohol consumption, sedentary lifestyle, abnormal weight, inadequate sleep, smoking, significant stress, and female use of hormonal contraceptives was 149 (40.6%), 91 (24.8%), 88 (24.0%), 122 (33.2%), 14 (3.8%), 65 (17.7%), and 53 (26.5%), respectively. Overweight, sex, inadequate sleep, and stress were established as positive predictors of hypertension. The rising prevalence of hypertension and its modifiable risk factors in rural communities require prompt interventions directed at reversing these trends. Saliu Abdulsalam, Adenike Olugbenga-Bello, Olakunle Olarewaju, and Ismail Abdus-salam Copyright © 2014 Saliu Abdulsalam et al. All rights reserved. Determinants of the Morning-Evening Home Blood Pressure Difference in Treated Hypertensives: The HIBA-Home Study Sun, 14 Dec 2014 13:46:27 +0000 Background. The morning home blood pressure (BP) rise is a significant asymptomatic target organ damage predictor in hypertensives. Our aim was to evaluate determinants of home-based morning-evening difference (MEdiff) in Argentine patients. Methods. Treated hypertensive patients aged 18 years participated in a cross-sectional study, after performing home morning and evening BP measurement. MEdiff was morning minus evening home average results. Variables identified as relevant predictors were entered into a multivariable linear regression analysis model. Results. Three hundred sixty-seven medicated hypertensives were included. Mean age was 66.2 (14.5), BMI 28.1 (4.5), total cholesterol 4.89 (1.0) mmol/L, 65.9% women, 11.7% smokers, and 10.6% diabetics. Mean MEdiff was 1.1 (12.5) mmHg systolic and 2.3 (6.1) mmHg diastolic, respectively. Mean self-recorded BP was 131.5 (14.1) mmHg systolic and 73.8 (7.6) mmHg diastolic, respectively. Mean morning and evening home BPs were 133.1 (16.5) versus 132 (15.7) systolic and 75.8 (8.4) versus 73.5 (8.2) diastolic, respectively. Significant beta-coefficient values were found in systolic MEdiff for age and smoking and in diastolic MEdiff for age, smoking, total cholesterol, and calcium-channel blockers. Conclusions. In a cohort of Argentine medicated patients, older age, smoking, total cholesterol, and use of calcium channel blockers were independent determinants of home-based MEdiff. Lucas S. Aparicio, Jessica Barochiner, Paula E. Cuffaro, José Alfie, Marcelo A. Rada, Margarita S. Morales, Carlos R. Galarza, Marcos J. Marín, and Gabriel D. Waisman Copyright © 2014 Lucas S. Aparicio et al. All rights reserved. Variations in Aging, Gender, Menopause, and Obesity and Their Effects on Hypertension in Taiwan Mon, 10 Nov 2014 12:57:03 +0000 Aim. We assessed obesity, sex, menopause, and gender differences on hypertension in a Hakka-majority Taiwanese sample. Methods. 9621 subjects aged 20 and over participated in this community-based study. Trained nurses collected blood pressure (BP) measurements and anthropometric indices, including weight, height, hip circumference (HC), waist circumference (WC), body mass index (BMI), waist to height ratio (WHtR), and waist to hip ratio (WHR). Results. Levels of systolic and diastolic BP significantly increased at a dose-dependent relationship based on four anthropometric indices (BMI, WC, WHR, and WHtR); the slopes for SBP and DBP differed. After controlling for other covariates using multivariate logistic regression, we found the adjusted odds ratios (OR) of hypertension to be significantly related to the four anthropometric indices. Notably, the effect of obesity on the ORs for hypertension was considerably higher in premenopausal women, but we found no such phenomenon among men. BMI, WC, WHR, and WHtR had significant linear associations with BP. Conclusion. Obesity indices are significantly correlated with the risk of hypertension across gender and age, with BMI having the highest relative potency. The effect of obesity on the risk of hypertension is especially high in premenopausal women, implying a relationship between hormones and hypertension. Shu C. Chen, Tsai C. Lo, Jui H. Chang, and Hsien W. Kuo Copyright © 2014 Shu C. Chen et al. All rights reserved. High Salt Intake Increases Copeptin but Salt Sensitivity Is Associated with Fluid Induced Reduction of Copeptin in Women Thu, 23 Oct 2014 00:00:00 +0000 This study investigated if copeptin is affected by high salt intake and whether any salt-induced changes in copeptin are related to the degree of salt sensitivity. The study was performed on 20 men and 19 women. In addition to meals containing 50 mmol NaCl daily, capsules containing 100 mmol NaCl and corresponding placebo capsules were administered during 4 weeks each, in random order. Measurements of 24 h blood pressure, body weight, 24 h urinary volume, and fasting plasma copeptin were performed at high and low salt consumption. Copeptin increased after a high compared to low dietary salt consumption in all subjects 3,59 ± 2,28 versus 3,12 ± 1,95 ( = 0,02). Copeptin correlated inversely with urinary volume, at both low ( = −0,42; = 0,001) and high ( = −0,60; < 0,001) salt consumption, as well as with the change in body weight ( = −0,53; < 0,001). Systolic salt sensitivity was inversely correlated with salt-induced changes of copeptin, only in females ( = −0,58; = 0,017). As suppression of copeptin on high versus low salt intake was associated with systolic salt sensitivity in women, our data suggest that high fluid intake and fluid retention may contribute to salt sensitivity. Irina Tasevska, Sofia Enhörning, Philippe Burri, and Olle Melander Copyright © 2014 Irina Tasevska et al. All rights reserved. Hypertension Subtypes among Hypertensive Patients in Ibadan Sun, 19 Oct 2014 13:48:43 +0000 Background. Certain hypertension subtypes have been shown to increase the risk for cardiovascular morbidity and mortality and may be related to specific underlying genetic determinants. Inappropriate characterization of subtypes of hypertension makes efforts at elucidating the genetic contributions to the etiology of hypertension largely vapid. We report the hypertension subtypes among patients with hypertension from South-Western Nigeria. Methods. A total of 1858 subjects comprising 76% female, hypertensive, aged 18 and above were recruited into the study from two centers in Ibadan, Nigeria. Hypertension was identified using JNCVII definition and was further grouped into four subtypes: controlled hypertension (CH), isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic-diastolic hypertension (SDH). Results. Systolic-diastolic hypertension was the most prevalent. Whereas SDH (77.6% versus 73.5%) and IDH (4.9% versus 4.7%) were more prevalent among females, ISH (10.1% versus 6.2%) was higher among males . Female subjects were more obese and SDH was prevalent among the obese group. Conclusion. Gender and obesity significantly influenced the distribution of the hypertension subtypes. Characterization of hypertension by subtypes in genetic association studies could lead to identification of previously unknown genetic variants involved in the etiology of hypertension. Large-scale studies among various ethnic groups may be needed to confirm these observations. Abiodun M. Adeoye, Adewole Adebiyi, Bamidele O. Tayo, Babatunde L. Salako, Adesola Ogunniyi, and Richard S. Cooper Copyright © 2014 Abiodun M. Adeoye et al. All rights reserved.