ISRN Hypertension The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Low Concordance with the DASH Plan Is Associated with Higher Cardiovascular Risk in Treated Hypertensive Patients Sun, 30 Mar 2014 09:01:28 +0000 This study aimed at analyzing the alimentary habits of treated hypertensive patients identifying the degree of concordance with Dietary Approaches to Stop Hypertension (DASH) plan. Anthropometry and blood pressure (BP) were evaluated, and the 10-year risk for general cardiovascular disease was estimated and used to calculate vascular age. A DASH concordance score was obtained using food frequency questionnaire and the cut-off points were established for eight food groups. Subjects were divided into two groups according to the median of DASH concordance score: lower concordance (LC group < 4.5 points, ) and higher concordance (HC group ≥ 4.5 points, ). LC group was associated with higher BP, vascular age, and cardiovascular risk. DASH concordance score was positively correlated with intake of fiber, calcium, potassium, and magnesium () and negatively correlated with BP, cardiovascular risk, and vascular age (). After logistic regression adjusted for age and gender, only cardiovascular risk (, ) was independently associated with DASH concordance score. Hypertensive patients with dietary patterns less concordant with the DASH plan had higher BP levels and increased cardiovascular risk, indicating the relevance of management in the treatment of these patients. M. A. Casanova, F. Medeiros, W. Oigman, and M. F. Neves Copyright © 2014 M. A. Casanova et al. All rights reserved. Racial Disparity in the Associations of Microalbuminuria and Macroalbuminuria with Odds of Hypertension: Results from the NHANES Study in the United States Thu, 12 Dec 2013 15:42:22 +0000 Background. Limited information is available on whether the associations of microalbuminuria and macroalbuminuria with the odds of hypertension differ among non-Hispanic Whites, non-Hispanic Blacks, and Hispanics. Methods. Cross-sectional data of 24,949 participants aged ≥18 years were collected from the National Health and Nutrition Examination Survey (NHANES) 1999–2008. Odds ratios of hypertension for microalbuminuria and macroalbuminuria were estimated by conducting weighted multiple logistic regression models. Results. After adjustment for extensive confounding factors, microalbuminuria is 1.45 (95% confidence interval (CI) [1.17, 1.80]), 2.07 (95% CI [1.52, 2.83]) and 2.81 (95% CI [2.06, 3.84]) times more likely to be associated with hypertension, and macroalbuminuria is 4.08 (95% CI [1.98, 8.38]), 8.62 (95% CI [3.84, 19.35]), and 4.43 (95% CI [2.13, 9.21]) times in non-Hispanic Whites, non-Hispanic Blacks, and Hispanics, respectively. The odds of hypertension for microalbuminuria (versus normalbuminuria) were 52% higher in non-Hispanic Blacks and 98% higher in Hispanics than in non-Hispanic Whites; the odds of hypertension for macroalbuminuria (versus normalbuminuria) did not differ among racial groups. Conclusion. Racial differences in the relation between microalbuminuria and hypertension are prevalent among non-Hispanic Whites, non-Hispanic Blacks, and Hispanics. More screening efforts should be encouraged in normotensive non-Hispanic Blacks and Hispanics with microalbuminuria. Xuefeng Liu, Yali Liu, Dennis Tsilimingras, and Kendall M. Campbell Copyright © 2013 Xuefeng Liu et al. All rights reserved. Hypertensive Patients and Their Management in Dentistry Mon, 09 Dec 2013 10:25:03 +0000 Hypertension is a common disease encountered in dental setting. Its wide spreading, terrible consequences, and life-long treatment require an attentive approach by dentists. Hypertension management in dental office includes disease recognition and correct measurement, knowledge of its treatment and oral adverse effects, and risk assessment for dental treatment. Dentist role in screening undiagnosed and undertreated hypertension is very important since this may lead to improved monitoring and treatment. Sanda Mihaela Popescu, Monica Scrieciu, Veronica Mercuţ, Mihaela Ţuculina, and Ionela Dascălu Copyright © 2013 Sanda Mihaela Popescu et al. All rights reserved. Blood Pressure Variability: Prognostic Value and Therapeutic Implications Sun, 23 Jun 2013 12:11:11 +0000 Blood pressure variability (BPV) is considered nowadays a novel risk factor for cardiovascular disease. Early findings in sinoaortic denervated rats have clearly shown that enhanced fluctuation of blood pressure induced left ventricular hypertrophy, vascular stiffness, and renal lesion. A large number of clinical trials confirm that short-term and long-term blood pressure variability independently contributes to target organ damage, cardiovascular events, and mortality not only in hypertensive patients but also in subjects with diabetes mellitus and chronic kidney disease. Therefore, amelioration of BPV has been suggested as an additional target of the treatment of cardiovascular diseases. Preliminary evidence obtained from meta-analysis and controlled clinical trials has shown that antihypertensive classes differ in their ability to control excessive BP fluctuations with an impact in the prevention of cardiovascular events. Calcium channel blockers seem to be more effective than other blood pressure lowering drugs for the reduction of short-term and long-term BPV. In order to increase actual knowledge regarding the prognostic value and therapeutic significance of BPV in cardiovascular disease, there is a need for additional clinical studies specifically designed for the study of the relevance of short-term and long-term BPV control by antihypertensive drugs. Christian Höcht Copyright © 2013 Christian Höcht. All rights reserved. Comparison among Different Screening Tests for Diagnosis of Adolescent Hypertension Thu, 20 Jun 2013 11:28:47 +0000 The diagnosis of childhood hypertension based upon percentile tables proposed by the international guidelines is complex and often a cause of underdiagnosis, particularly among physicians who have not had specific training in the field of adolescent hypertension. The use of a simple and accurate screening test may improve hypertension diagnosis in adolescents. The aim of our study is to compare the different screening methods currently used in the literature to improve the diagnosis of childhood hypertension. We have conducted a cross-sectional population-based study of 1412 Caucasian adolescents among students of public junior high schools of Turin, Italy. In this population we have defined the hypertensive status with four different screening tests: BPHR, Somu's equations, Ardissino, and Kaelber methods. Finally, we compared the diagnostic accuracy of the 4 screening tests with the gold standard. Our analysis identifies in BPHR the test which combines ease of use and diagnostic accuracy. Silvia Totaro, Franco Rabbia, Ivana Rabbone, Michele Covella, Elena Berra, Chiara Fulcheri, Silvia Di Monaco, Elisa Testa, and Franco Veglio Copyright © 2013 Silvia Totaro et al. All rights reserved. Hypertension: The Neglected Complication of Transplantation Sun, 12 May 2013 14:57:10 +0000 Arterial hypertension and transplantation are closely linked, and its association may promote impaired graft and overall survival. Since the introduction of calcineurin inhibitors, it is observed in 50–80% of transplanted patients. However, many pathophysiological mechanisms are involved in its genesis. In this review, we intend to provide an updated overview of these mechanisms, dealing with the causes common to all kinds of transplantation and emphasizing special cases with distinct features, and to give a perspective on the pharmacological approach, in order to help clinicians in the management of this frequent complication. Lucas S. Aparicio, José Alfie, Jessica Barochiner, Paula E. Cuffaro, Marcelo Rada, Margarita Morales, Carlos Galarza, and Gabriel D. Waisman Copyright © 2013 Lucas S. Aparicio et al. All rights reserved. Supplements and Foods with Potential Reduction of Blood Pressure in Prehypertensive and Hypertensive Subjects: A Systematic Review Tue, 26 Mar 2013 14:55:43 +0000 Although the dietary approaches for stop hypertension (DASH) is well established and effective in reduction of blood pressure, in recent years, new scientific studies have indicated that specific food, nutrients isolated from foods, and even commercial food supplements are not covered by DASH. In this research, these nutrients were evaluated through a review using the databases of PubMed with the terms “dietary supplements and blood pressure” without a limit of date. Vitamins (C, D, and E) and minerals (potassium and copper) promote the greatest reductions in BP, around 7 to 14 mmHg for systolic blood pressure (SBP) and 4 to 5 mmHg for diastolic blood pressure (PAD). Antioxidants reduce SBP and DBP in 3 to 27 mmHg and 3 to 4 mmHg, respectively. Among the amino acids, only L-arginine was effective in promoting reduction of 20 and 15 mmHg for SBP and DBP, respectively. In food, the grape juice promoted the highest reductions in SBP and DBP, around 8 mmHg and 6 mmHg, respectively. Finally, for commercial supplements, the fermented milk product GAIOR, the grain salba, and fish oil promoted reductions of about 4,4; 6; and 5 mmHg and 3,4; 3; and 1 mmHg for SBP and DBP, respectively. Therefore, new nutrients, foods, and supplements can enrich the recommendations of the DASH. Aline de Freitas Brito, Caio Victor Coutinho de Oliveira, Lydiane Tavares Toscano, and Alexandre Sérgio Silva Copyright © 2013 Aline de Freitas Brito et al. All rights reserved. A Qualitative Study of Patient Perspectives about Hypertension Tue, 05 Mar 2013 13:11:53 +0000 To understand hypertensive patients' perspectives regarding blood pressure and hypertension treatment, this qualitative study applied semistructured interviews of hypertensive patients. Participants were recruited from two hypertension clinics at the University of Alberta in Edmonton, Canada. To be eligible for inclusion, patients had to be aged 18 years or older, diagnosed with hypertension by a healthcare provider, and currently taking an antihypertensive medication. Participants were stratified in the analysis according to blood pressure control. Twenty-six patients (mean age 57; 62% female) were interviewed, of which 42% were on target and 58% were not. Three underlying themes emerged from the interviews: (a) knowledge of blood pressure relating to diagnosis and management and control of hypertension, (b) integration of hypertension management into daily routine, and (c) feelings and beliefs of wellness. None of the above themes were associated with better control. Knowledge gaps were found, which emphasize the need for further patient education and physician training. Feelings and beliefs of wellness, and not knowledge, were important factors in home assessment of blood pressure. The absence of connections between control of hypertension and the identified domains indicates that current approaches could benefit from the development of a more personalized approach for education and communication. Emily P. Jolles, Raj S. Padwal, Alexander M. Clark, and Branko Braam Copyright © 2013 Emily P. Jolles et al. All rights reserved. Therapeutic Education's Role in the Management of Hypertension in Chronic Hemodialysis Patients Wed, 16 Jan 2013 15:07:32 +0000 The prevalence of hypertension remains high in hemodialysis (HD) patients, leading to a considerable morbimortality. The “dry weight method (DW),” established by Scribner, presents an undeniable interest in the management of hypertension in HD patients. Aim. The aim of our work was to determine the prevalence and risk factors (RFs) of hypertension in our chronic HD patients and try to reduce it by using a therapeutic education (TE) strategy based on Scribner’s recommendations. Patients and Methods. We led an interventional prospective study in three phases. In phase 1, we determined the prevalence of hypertension. In phase 2, hypertensive patients benefited of a TE strategy. In phase 3, we evaluated the effects of our TE. Results. Hypertension was noted in 57 patients. RFs for hypertension included age, important interdialytic weight gain (IDWG), noncompliance to the dietary rules, and a rhythm of 2 sessions of dialysis per week. The use of a TE strategy enabled us to correct hypertension in some of our HD patients. Conclusion. A TE strategy improved the hypertension rate in our HD unit. This success could not be conceived without an educational effort supported by the whole medical team. Intissar Haddiya, Ryme El Harraqui, Ilham Karimi, Nawal Benabdallah, and Yassamine Bentata Copyright © 2013 Intissar Haddiya et al. All rights reserved. Cardiac Effects of Exercise Training in Hypertension Mon, 14 Jan 2013 09:07:36 +0000 Hypertension is a significant health concern. Hypertension leads to compensatory pathologic hypertrophy and impaired cardiac function. Lifestyle modifications such as exercise are encouraged for hypertensive patients. Some studies have shown that exercise training can reverse pathological hypertrophy. Conversely, studies on animal models of hypertension have shown increased cardiac growth with exercise training. Despite the further induction of hypertrophy, exercise training seems protective against cell death and may increase cardiomyocyte proliferation, leading to a putative phenotype. One of the hallmark beneficial effects of exercise in hypertension is an improvement in myocardial β adrenergic responsiveness. The focus of this paper is to discuss how exercise training impacts cardiac remodeling and function in the hypertensive heart with specific reference to β adrenergic signaling. Joseph R. Libonati Copyright © 2013 Joseph R. Libonati. All rights reserved. Serum Asymmetric Dimethylarginine Concentrations in Two Models of Experimentally Induced Hypertension Tue, 18 Dec 2012 14:25:54 +0000 The aim of this study was to evaluate the effect of two models of hypertension on serum ADMA concentrations and whether the changes of serum ADMA concentrations are reversible by removing the cause of hypertension. Materials and Methods. 48 male wistar rats were randomly assigned into four groups: control, deoxycorticosterone acetate salt (DOCA-Salt), sham, and two kidneys one clip (2K1C). After 12 weeks, in half of the animals ( each group), serums were taken and direct blood pressure was measured. Then, DOCA injection was withdrawn and the animals received tap water and, in 2K1C group, renal clips were removed. After 12 weeks, direct blood pressure was measured and blood samples were taken. Results. Serum ADMA concentration in DOCA-Salt group was slightly higher than control, although it was not statistically significant. In 2K1C hypertensive group, serum ADMA concentration was significantly elevated compared to sham group (). Unclipping and reversal of hypertension returned serum ADMA level to sham group. There was a weak positive correlation between systolic blood pressure and serum ADMA concentration. Conclusion. increased serum ADMA concentration during hypertension is dependent on the model of hypertension, and removing the cause of hypertension could reduce it M. Khazaei, M. Zarei, and N. Esmaeil Copyright © 2013 M. Khazaei et al. All rights reserved. The Influence of Arsenic, Lead, and Mercury on the Development of Cardiovascular Diseases Tue, 18 Dec 2012 08:52:41 +0000 As a group, cardiovascular disease (CVD) is the leading cause of death worldwide. It killed twice as many people as infectious and parasitic disease and three times as many people as all forms of cancer. There are other crucial risk factors next to the major risk factors identified by the Framingham Heart Study. In the last few years, detailed studies showed the correlation between environmental pollution and the development of CVD. The question, which environmental toxin is particularly harmful, is answered by CERCLA Priority List of Hazardous Substances with the following toxins: arsenic, lead, and mercury. The effect of these potential toxic metals on the development of cardiovascular diseases includes pathomechanisms as the accumulation of free radicals, damage of endothelial nitric oxide synthase, lipid peroxidation, and endocrine influences. This leads to the damage of vascular endothelium, atherosclerosis, high blood pressure, and an increased mortality from cardiovascular diseases. The cardiovascular effects of arsenic, lead, and mercury exposure and its impact on cardiovascular mortality need to be included in the diagnosis and the treatment of CVD. Peter Jennrich Copyright © 2013 Peter Jennrich. All rights reserved. The Effect of Metabolic Syndrome and Diabetes Mellitus Type 2 on the Arterial Reactivity of Hypertensive Patients during Cold Pressor Test Sun, 02 Dec 2012 15:04:27 +0000 Background: Arterial hypertension (AH), metabolic syndrome (MS) and diabetes mellitus type 2 (DM2) are interrelated metabolic disorders. The aim of our study was to evaluate how the coexistence of MS or DM2 with AH influences arterial reactivity during cold pressor test (CPT). Methods: We studied 102 patients, 32 with AH (Group A), 38 with AH and MS (Group B) and 32 with AH and DM2 (Group C). All patients underwent full laboratory evaluation and measurement of systolic and diastolic blood pressure (SBP and DBP), heart rate (HR) and carotid-femoral pulse wave velocity (PWVc-f) before and during CPT. Results: During CPT PWVc-f, SBP, DBP and HR were increased significantly in all studied groups, but the change of PWVc-f and HR during CPT was significantly greater in group A compared to group C. On the contrary, the coexistence of MS or DM2 with AH does not alter the response of BP to CPT. Conclusion: The increase of CV risk resulting from the coexistence of MS or DM2 with AH, is best expressed by PWVc-f, while the change of the former and HR during CPT possibly reflects dysfunction of the autonomic nervous system. K. Keramida, E. Karpanou, G. Vyssoulis, C. D. Olympios, C. Stefanadis, and D. V. Cokkinos Copyright © 2013 K. Keramida et al. All rights reserved. Meta-Analysis of the Hemodynamic Properties of Antihypertensive Medications Wed, 24 Oct 2012 11:07:47 +0000 Background. While all antihypertensive medications lower blood pressure, hemodynamic properties of various classes of antihypertensive medications may differ. Objective. To perform a meta-analysis to compare the hemodynamic properties of different classes of antihypertensive medications. Methods. Studies involving the treatment of hypertension using the effect of ACEIs, β-blockers, CCBs and thiazide diuretics on plasma volume (PV), cardiac output (CO) or stroke volume (SV) were searched using online databases prior to May 2011. Studies had to be written in the English language, studying human subjects with a single pharmacological agent (monotherapy), and with a minimum duration of 4 weeks. Results. Seventy-five (75) studies that enrolled a total of 1522 subjects were included. All four antihypertensive classes lowered blood pressure. β-blockers decreased heart rate; the other classes had no effect upon heart rate. ACEIs increased PV; the other classes had no effect upon PV. β-blockers and thiazide diuretics decreased CO while ACEIs and CCBs had no effect upon CO. β-blockers and CCBs increased SV, thiazide diuretics decreased SV, and ACEIs did not change SV. Conclusion. In the treatment of uncomplicated hypertension, the various classes of antihypertensive medications differ from each other in terms of their non-blood pressure lowering hemodynamic properties. Imran Hasan Iftikhar, Robert P. Blankfield, Nauman Hassan, and Daniel Tisch Copyright © 2013 Imran Hasan Iftikhar et al. All rights reserved. Perceptions of Community Resources and Insights for Program Development from Southern, Rural Hypertensive Women Sun, 21 Oct 2012 08:40:37 +0000 Background. Hypertension affects millions of Americans each year and is a significant contributor to the development of cardiovascular disease. African Americans, especially those living in rural locations, experience greater disparities in the incidence and prevalence rates of hypertension and cardiovascular disease. Methods. This study utilizes qualitative descriptive methodology. Focus groups involving African American women reporting hypertension were conducted in a rural community in Alabama. Results. The mean age was 60.3 years of age (SD = 10.3). Most were married and half were college educated. The majority reported an overweight or obese status. Most were aware that they had hypertension for more than five years, all were nonsmokers, and the majority had a family history of heart disease, hypertension, and/or heart attack or stroke. Key themes emerging from the focus groups included strengths of the community, support for the community, support for a healthy lifestyle, and intervention development. Conclusion. Hypertension is a treatable and preventable disease that not only causes disability, but also significantly decreases the quality of life in affected individuals. Findings from this study provide insight into the unique needs and perceptions of African American women residing in rural Alabama as they relate to community resources. Cassandra D. Ford and Alice L. March Copyright © 2013 Cassandra D. Ford and Alice L. March. All rights reserved. Racial/Ethnic Variability in Hypertension Prevalence and Risk Factors in National Health Interview Survey Wed, 12 Sep 2012 10:17:28 +0000 Objective. Hypertension is one of the leading causes of death attributed to cardiovascular diseases, and the prevalence varies across racial/ethnic groups, with African Americans being disproportionately affected. The underlying causes of these disparities are not fully understood despite volume of literature in this perspective. We aimed in this current study to examine ethnic/racial disparities in hypertension utilizing Hispanics as the base racial/ethnic group for comparison. Research Design and Methods. We utilized the National Health Interview Survey (NHIS), which is a large cross-sectional survey of the United States non-institutionalized residents to investigate the racial/ethnic disparities in hypertension after the adjustment of other socio-economic, demographic, and prognostic risk factors. The study participants were adults (n = 30,852). Data were analyzed using Chi square statistic, and logistic regression model. Results. There were statistically significant differences by race/ethnicity with respect to income, education, marital status, smoking, alcohol, physical activities, body mass index, and age, P < 0.01, but not insurance coverage, P > 0.01. Hispanic ethnicity (18.9%) compared to either non-Hispanic white (27.7%) or non-Hispanic black (35.5%) was associated with the lowest prevalence of hypertension. Race/ethnicity was a single independent predictor of hypertension, with non-Hispanic black more likely to be hypertensive compare with Hispanic, prevalence odds ratio (POR), 2.38, 99% Confidence Interval (CI), 2.17–2.61 and non-Hispanic white, POR, 1.64, 99% CI, 1.52–1.77. After controlling for the confounding variables, the racial/ethnic differences in hypertension persisted. Conclusions. Racial/ethnic disparities in hypertension persisted after controlling for potential predictors of hypertension in NHIS, implying the inability of known hypertension risk factors to account for racial/ethnic variability in hypertension in US. L. Holmes Jr., J. Hossain, D. Ward, and F. Opara Copyright © 2013 L. Holmes et al. All rights reserved. Pulmonary Hypertension Is a Probable NO/ONOO− Cycle Disease: A Review Tue, 04 Sep 2012 08:27:52 +0000 The NO/ONOO− cycle is a primarily local biochemical/physiological vicious cycle that appears to cause a series of chronic inflammatory diseases. This paper focuses on whether the cycle causes pulmonary arterial hypertension (PAH) when located in the pulmonary arteries. The cycle involves 12 elements, including superoxide, peroxynitrite (ONOO−), nitric oxide (NO), oxidative stress, NF-κB, inflammatory cytokines, iNOS, mitochondrial dysfunction, intracellular calcium, tetrahydrobiopterin depletion, NMDA activity, and TRP receptor activity. 10 of the 12 are elevated in PAH (NMDA?, NO?) and 11 have documented causal roles in PAH. Each stressor that initiates cases of PAH acts to raise cycle elements, and may, therefore, initiate the cycle in this way. PAH involves a primarily local mechanism as required by the cycle and the symptoms and signs of PAH are generated by elements of the cycle. Endothelin-1, which acts as a causal factor in PAH, acts as part of the cycle; its synthesis is stimulated by cycle elements, and it, in turn, increases each element of the cycle. This extraordinary fit to the principles of the NO/ONOO− cycle allows one to conclude that PAH is a NO/ONOO− cycle disease, and this fit supports the cycle as a major paradigm of chronic inflammatory disease. Martin L. Pall Copyright © 2013 Martin L. Pall. All rights reserved.