Hypertension: The role of biochemistry in the diagnosis and management

The low bone mass density in adults with hypertension: A meta-analysis

Objectives

Osteoporosis and hypertension are frequently co-occurring disorders which cause significant challenges to the public health. According to some researches, adult persons with hypertension often have low bone mass density (BMD). However, there are discrepancies in the reported results. Thus, the primary objective of our meta-analysis is to explore the potential link between low BMD and hypertension in adults.

Methods

Two authors systematically carried out a comprehensive review of the available literature on the connection of BMD and hypertension by retrieving PubMed, Web of Science, Cochrane and Embase up to March 2024. The confidence intervals (CIs) and odds ratios (ORs) and were estimated utilising the random effect model. Heterogeneity, subgroup analysis, sensibility analyses and publication bias were performed.

Results

13 studies from the 6080 unique records were analyzed. Pooled analysis revealed that the danger of low BMD was significantly elevated in hypertensive patients than in non-hypertension (OR 1.33, 95 % CI 1.17-1.53, I 2 = 79.9 %, p < 0.01). Subgroup analysis revealed a more pronounced link between low BMD and hypertension in the untreated hypertension group (OR 1.64, 95 % CI 0.45-6.02) as opposed to the cohort receiving antihypertensive medication (OR 1.32, 95 % CI 1.16-1.51). The studies carried out in Europe were consistent with those of studies conducted in Asia and North America.

Conclusions

Low BMD is associated with hypertension in adults. Nevertheless, it remains uncertain whether this finding is influenced by shared risk factors, given the considerable heterogeneity between study types and methodologies. Further extensive epidemiological documents are necessary.

Effect of Metacognitive Strategy-guided Health Management Model in Patients with Hypertension and Hyperlipidemia

The present study assessed the effects of a metacognitive strategy-guided health management model on vascular endothelial function and quality of life in patients with hypertension and hyperlipidemia. Patient self-management ability, such as medication adherence, rational diet, and moderate exercise, before and after management was assessed by questionnaire (36-Item Short Form Health Survey, SF-36). Total cholesterol (TC), triacylglycerol (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and blood pressure (BP) were compared. Vascular endothelial function was evaluated: Serum levels of endothelin-1 (ET-1) were measured by radioimmunoassay, and serum levels of nitric oxide (NO) were measured by a nitrate reduction method. Quality of life after management was assessed by the SF-36. The observation group (implementation of metacognitive strategy-guided health management) had higher self-management ability scores, lower lipid indicators, lower systolic and diastolic BP, decreased ET-1 and higher NO levels, and greater quality of life scores than the control group (no health management; all P < .05). Metacognitive strategy-guided health management model can improve vascular endothelial function and enhances quality of life in patients with hypertension and hyperlipidemia.

Correlations of serum uric acid, fibrinogen and homocysteine levels with carotid atherosclerosis in hypertensive patients

Objective

Uric acid (UA), fibrinogen (FIB), and homocysteine (Hcy) are the main contributors to cardiovascular and cerebrovascular diseases, and are related to hypertension. Hypertension plays a role in atherosclerosis (CAS). We hence explored the correlations of UA, FIB, and Hcy levels with CAS in hypertensive patients.

Methods

Totally 170 hypertensive patients were retrospectively included and assigned into the Non-sclerosis, Thickened, and Plaque groups based on carotid intima-media thickness (cIMT), with serum UA, FIB, and Hcy compared. Correlations of UA, FIB, and Hcy with cIMT and carotid atherosclerotic plaque (CAP) were assessed using Spearman's correlation analysis. The risk factors of CAS were evaluated by logistic multivariate regression analysis. The predictive value of UA, FIB, and Hcy for CAS was estimated by the receiver operating characteristic (ROC) curve.

Results

UA, FIB, and Hcy were up-regulated in the Plaque group vs. other two groups. Serum UA, FIB, and Hcy were positively linked to cIMT and CAP, and were independent risk factors for CAS. The area under ROC curve of UA, FIB, Hcy levels and their combination for predicting CAS were 0.889, 0.855, 0.902, and 0.958, respectively. Hypertensive patients with high levels of UA, FIB, or Hcy were more likely to develop CAS.

Conclusion

Serum UA, FIB, and Hcy are positively correlated with cIMT and CAP, and are independent risk factors for CAS in hypertensive patients. High UA, FIB and Hcy expression could assist in predicting CAS in patients with hypertension, and the combination of the three was more valuable than all three alone.

Drug-Related Hypertension: A Disproportionality Analysis Leveraging the FDA Adverse Event Reporting System

Hypertension exerts a significant global disease burden, adversely affecting the well-being of billions. Alarmingly, drug-related hypertension remains an area that has not been comprehensively investigated. Therefore, this study is designed to utilize the adverse event reports (AERs) from the US Food and Drug Administration's Adverse Event Reporting System (FAERS) to more comprehensively identify drugs that may potentially lead to hypertension. Specifically, a total of 207 233 AERs were extracted from FAERS, spanning the time period from 2004 to 2024. Based on these reports, this study presented the top 40 drugs most frequently reported to be associated with post-administration hypertension in different genders. Furthermore, we employed four disproportionality analysis methods, including Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and Empirical Bayes Geometric Mean (EBGM), to pinpoint the top three drugs with strongest signals in relation to hypertension across different age and gender subgroups. Some drugs, such as rofecoxib, lenvatinib, and celecoxib, were found to appear on both the frequency and signal strength lists. These results contribute to a more comprehensive understanding of the cardiovascular safety profiles of pharmacological agents, suggesting the necessity of blood pressure monitoring following administration.

The Association between Magnesium Depletion Score and Hypertension in US Adults: Evidence from the National Health and Nutrition Examination Survey (2007-2018)

The magnesium depletion score (MDS) emerges as a new valuable predictor of the body's magnesium status index. This study aims to explore the link between MDS and hypertension (HTN) using the National Health and Nutrition Examination Survey (NHANES) data. A total of 9708 participants from NHANES (2007-2018) were enrolled to investigate MDS's connection with HTN. HTN was defined based on clinical guidelines. MDS classification (low, 0-1; middle, 2; high, 3-5) relied on alcohol consumption, diuretic use, proton-pump inhibitor (PPI) usage, and kidney disease. Multivariable logistic regression assessed MDS-HTN association. Subsequent analyses included interaction tests, subgroups, and sensitivity analysis. Each unit increase in MDS correlated with an 87% higher HTN risk (OR, 1.87; 95% CI, 1.64-2.13) after adjusting for confounders. High MDS participants exhibited significantly elevated HTN risk compared to low MDS counterparts (OR, 8.31; 95% CI, 4.81-14.36), with a significant trend across MDS groups (p < 0.001). Subgroup analyses supported a consistent positive correlation. Sensitivity analysis confirmed a robust association. The results indicated a positive correlation between MDS and the risk of developing HTN in US adults.

Identification of potential diagnostic biomarkers for hypertension via integrated analysis of gene expression and DNA methylation

OBJECTIVE

Hypertension refers to the elevated blood pressure (BP) in arteries, with a BP reading of 140/90 mm Hg or higher in adults. Over 40% of >25-year-old population have suffered from hypertension. Thus, this study aimed to find novel diagnostic biomarkers for hypertension.

METHODS

All hypertension-related mRNA and methylation datasets were downloaded from the GEO database. Liner model method was used to identify differentially expressed genes (DEGs) between hypertension and control groups. Gene Ontology and Kyoto Encyclopaedia of Genes and Genomes enrichment analysis was employed to obtain functional information. CpG sites and the corresponding genes associated with hypertension were screened using epigenome-wide association study (EWAS) analysis.

RESULTS

There were 37 DEGs between the hypertension group and control group, which were significantly enriched in 84 Biological Process terms, 31 Cellular Component terms, 18 Molecular Function terms and 9 signalling pathways. EWAS results indicated that 1072 CpG sites were associated with hypertension occurrence, corresponding to 1029 genes. After cross-analysis, complement factor D (CFD) and OTU deubiquitinase, ubiquitin aldehyde binding 2 (OTUB2) with methylation modification were identified as diagnostic markers for hypertension.

CONCLUSION

In conclusion, CFD and OTUB2 were potential biomarkers of hypertension occurrence. Our results will provide more information for hypertension diagnosis and would be more reliable combined with multiple biomarkers.

No Association Between AGT Gene Polymorphisms with Hypertension in a South African Population

Purpose

Hypertension is a leading cause of cardiovascular-related morbidity and mortality worldwide, with a prevalence increasing at an alarming rate in both middle- and low-income countries. Various environmental and genetic factors have been attributed to play a significant role in the increasing prevalence of hypertension. Single nucleotide polymorphisms (SNPs) in the angiotensinogen (AGT) gene are reported to have a significant association with hypertension; however, there are limited studies done on South African populations. Therefore, this case-control study aimed to investigate the association between AGT SNPs (rs2004776, rs3789678, rs5051 and rs7079) with hypertension in a study population of isiXhosa-speaking participants from the Eastern Cape Province in South Africa.

Materials and Methods

The SNPs were genotyped in 250 hypertensive cases and 237 normotensive controls, using TaqMan genotyping assays.

Results

For the SNP rs2004776, the frequency of CC genotype (18.4%) and C allele (44%) in hypertensive cases showed no significant differences (p = 0.52, χ2 = 1.32), when compared to the normotensive control group (CC: 19.8% and C allele: 43%). Similar results were obtained for the genotypic and allelic frequencies between hypertensive cases and normotensive controls for rs3789678 (p = 0.88, χ2=0.26) and rs5051 (p = 0.57, χ2=1.12), and rs7079 (p = 0.33, χ2=2.23). These findings demonstrate that there were no significant associations between the SNPs rs2004776, rs3789678, rs7079, rs5051 with hypertension in our study population.

Conclusion

These findings suggest that AGT gene polymorphisms are not associated with the development of hypertension in the studied population. The present study represents the first genetic report to investigate the AGT gene polymorphisms with hypertension in an isiXhosa-speaking South African population.

A biomarker panel of secondary hypertension is simultaneously quantified by coupling of magnetic solid-phase extraction and liquid chromatography-tandem mass spectrometry

RATIONALE

Secondary hypertension is often caused by activation of complex multi-organ endocrine systems, while renin activity indicated by angiotensins (Angs), aldosterone (ALD) and cortisol (COR) in such systems are generally accepted as its diagnostic markers. As antibody-based methods cannot offer comparable quantification for these biomarkers, a liquid chromatography (LC)-tandem mass spectrometry (MS/MS)-based approach was developed to quantify them simultaneously and accurately.

METHODS

Five different beads for magnetic solid-phase extraction (MSPE) were evaluated towards their enrichment efficiency for these biomarkers. An LC system with optimized elution gradient and a triple-quadrupole MS with tuned parameters were coupled to quantitatively monitor the extracted analytes. The method performance was further examined such as linearity, precision, stability, recovery rate and matrix effect. Based on the developed method, the abundance of Ang II, ALD and COR in plasma was measured and the quantification was compared with that derived from commercial ELISA kits.

RESULTS

As compared with other MSPEs, Angs, ALD and COR were highly enriched by the HLB magnetic beads with satisfactory recoveries. These analytes were simultaneously quantified by LC/MS/MS and all the method parameters for quantification were well matched with the requirements of clinical testing. Comparison of the quantitative results derived from ELISA and LC/MS/MS exhibited that the two methods offered basically comparable values with Pearson r values at 0.896, 0.895 and 0.835, respectively. The stability test for plasma Angs at room temperature indicated that the abundance of Ang II was relatively stable within 3 h, whereas that of Ang I and Ang 1-7 was time-dependently changed.

CONCLUSIONS

Coupling of HLB beads and LC/MS/MS thus enables simultaneous quantification of a set of biomarkers related to secondary hypertension.

The Rise and Fall of Well-Controlled Blood Pressure: Labile Hypertension Following Repair of a Ruptured Abdominal Aortic Aneurysm

Hypertension is a common pathology with several etiologies. If left uncontrolled, severe and even fatal complications can develop, including heart disease, vascular damage, and stroke. Primary hypertension is most commonly seen without an underlying etiology; however, several contributing factors can lead to the development of hypertension. There have been limited cases reporting the effects of an abdominal aortic dissection treated with endovascular aortic repair (EVAR) on the development of labile hypertension. We report a case of uncontrolled, labile hypertension following an EVAR of an abdominal aortic aneurysm in a patient without prior medical history of hypertension.

Surface-enhanced Raman Spectroscopy in urinalysis of hypertension patients with kidney disease

Arterial hypertension (AH) is a multifactorial and asymptomatic disease that affects vital organs such as the kidneys and heart. Considering its prevalence and the associated severe health repercussions, hypertension has become a disease of great relevance for public health across the globe. Conventionally, the classification of an individual as hypertensive or non-hypertensive is conducted through ambulatory blood pressure monitoring over a 24-h period. Although this method provides a reliable diagnosis, it has notable limitations, such as additional costs, intolerance experienced by some patients, and interferences derived from physical activities. Moreover, some patients with significant renal impairment may not present proteinuria. Accordingly, alternative methodologies are applied for the classification of individuals as hypertensive or non-hypertensive, such as the detection of metabolites in urine samples through liquid chromatography or mass spectrometry. However, the high cost of these techniques limits their applicability for clinical use. Consequently, an alternative methodology was developed for the detection of molecular patterns in urine collected from hypertension patients. This study generated a direct discrimination model for hypertensive and non-hypertensive individuals through the amplification of Raman signals in urine samples based on gold nanoparticles and supported by chemometric techniques such as partial least squares-discriminant analysis (PLS-DA). Specifically, 162 patient urine samples were used to create a PLS-DA model. These samples included 87 urine samples from patients diagnosed with hypertension and 75 samples from non-hypertensive volunteers. In the AH group, 35 patients were diagnosed with kidney damage and were further classified into a subgroup termed (RAH). The PLS-DA model with 4 latent variables (LV) was used to classify the hypertensive patients with external validation prediction (P) sensitivity of 86.4%, P specificity of 77.8%, and P accuracy of 82.5%. This study demonstrates the ability of surface-enhanced Raman spectroscopy to differentiate between hypertensive and non-hypertensive patients through urine samples, representing a significant advance in the detection and management of AH. Additionally, the same model was then used to discriminate only patients diagnosed with renal damage and controls with a P sensitivity of 100%, P specificity of 77.8%, and P accuracy of 82.5%.

Cardiometabolic Risk Factors Associated With Type 2 Diabetes Mellitus: A Mechanistic Insight

A complex metabolic condition referred to as Type 2 diabetes mellitus (T2DM) is characterized by insulin resistance (IR) and decreased insulin production. Obesity, dyslipidemia, hypertension, and chronic inflammation are just a few of the cardiometabolic illnesses that people with T2DM are more likely to acquire and results in cardiovascular issues. It is essential to comprehend the mechanistic insights into these risk variables in order to prevent and manage cardiovascular problems in T2DM effectively. Impaired glycemic control leads to upregulation of De novo lipogenesis (DNL), promote hepatic triglyceride (TG) synthesis, worsening dyslipidemia that is accompanied by low levels of high density lipoprotein cholesterol (HDL-C) and high amounts of small, dense low-density lipoprotein cholesterol (LDL-C) further developing atherosclerosis. By causing endothelial dysfunction, oxidative stress, and chronic inflammation, chronic hyperglycemia worsens already existing cardiometabolic risk factors. Vasoconstriction, inflammation, and platelet aggregation are caused by endothelial dysfunction, which is characterized by decreased nitric oxide production, increased release of vasoconstrictors, proinflammatory cytokines, and adhesion molecules. The loop of IR and endothelial dysfunction is sustained by chronic inflammation fueled by inflammatory mediators produced in adipose tissue. Infiltrating inflammatory cells exacerbate inflammation and the development of plaque in the artery wall. In addition, the combination of chronic inflammation, dyslipidemia, and IR contributes to the emergence of hypertension, a prevalent comorbidity in T2DM. The ability to target therapies and management techniques is made possible by improvements in our knowledge of these mechanistic insights. Aim of present review is to enhance our current understanding of the mechanistic insights into the cardiometabolic risk factors related to T2DM provides important details into the interaction of pathophysiological processes resulting in cardiovascular problems. Understanding these pathways will enable us to create efficient plans for the prevention, detection, and treatment of cardiovascular problems in T2DM patients, ultimately leading to better overall health outcomes.

Computed tomographic manifestations of celiac ganglia between hypertensive and non-hypertensive population

The celiac ganglion (CG) is associated with the sympathetic nervous system (SNS) and plays an important role in the pathogenesis of hypertension. The characteristics of the CG in patients with hypertension remain unknown. The aim of our study was to explore the differences in celiac ganglia (CGs) characteristics between hypertensive and non-hypertensive populations using computed tomography (CT). CGs manifestations on multidetector row CT in 1003 patients with and without hypertension were retrospectively analyzed. The morphological characteristics and CT values of the left CGs were recorded. The CT values of the ipsilateral adrenal gland (AG) and crus of the diaphragm (CD) were also measured. The left CG was located between the left AG and CD, and most CGs were long strips. The frequency of visualization of the left CGs was higher in the hypertension group than in the non-hypertension group (p < .05). There were no significant differences in the maximum diameter, size, and shape ratio of the left CGs between the two groups (p > .05). Except for the left CG in the arterial phase, the CT values of the left CG and AG in the non-hypertensive group were higher than those in the hypertension group (p < .05). The venous phase enhancement of the left CG in the non-hypertension group was significantly higher than that in the hypertension group (p < .05). Our findings reveal that CGs have characteristic manifestations in the hypertensive population. As important targets of the SNS, CGs have the potential to regulate blood pressure.

Investigating the effect of history of fractures and hypertension on the risk of all-cause death from osteoporosis: A retrospective cohort study

To assess the coexistence effect between history of fractures and hypertension on the all-cause death risk of osteoporosis. In this retrospective cohort study, some characteristics of osteoporosis patients aged ≥ 20 years were extracted from the National Health and Nutrition Examination Survey (NHANES) database (2005-2010, 2013-2014), such as age, gender, smoking, drinking, the history of diabetes, cardiovascular and cerebrovascular diseases, fractures and hypertension. The outcome of this study was defined as all-cause death of osteoporosis. These patients were followed up until 2015 with an average follow-up time of 62.00 ± 34.79 months. Univariate and multivariate logistic regression was utilized to evaluate the association of history of fractures and hypertension on all-cause death risk of osteoporosis, respectively. The death risk factors were presented by using relative risk (RR) and 95% confidence interval (CI). The attributable proportion (AP) to explore the interaction between history of fractures and hypertension on the all-cause death risk of osteoporosis. Of the total 801 osteoporosis patients, 227 died. After adjusting age, gender, marital status, education background, annual household income, diabetes, the prior use of prednisone or cortisone medication, cardiovascular and cerebrovascular diseases, the history of fractures (RR = 1.502, 95% CI: 1.035-2.180), spine fracture (RR = 2.944, 95% CI: 1.244-6.967), hip fracture (RR = 2.033, 95% CI: 1.066-3.875) was significantly associated with the increased death risk of osteoporosis. However, there was no significant difference between hypertension and the all-cause death risk of osteoporosis (P > .05). Additionally, there was a significant interaction between the history of fractures and hypertension on the all-cause death risk of osteoporosis, and the interaction was an enhancement effect (AP = 0.456, 95% CI: 0.005-0.906). The co-existence of the history of fractures and hypertension could increase the all-cause death risk of osteoporosis, which indicated that osteoporosis patients with the history of fractures should actively monitor blood pressure levels and prevent the occurrence of hypertension.

Latest Knowledge on the Role of Vitamin D in Hypertension

Hypertension is the third leading cause of the global disease burden, and while populations live longer, adopt more sedentary lifestyles, and become less economically concerned, the prevalence of hypertension is expected to increase. Pathologically elevated blood pressure (BP) is the strongest risk factor for cardiovascular disease (CVD) and related disability, thus making it imperative to treat this disease. Effective standard pharmacological treatments, i.e., diuretics, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blocker (ARBs), beta-adrenergic receptor blockers (BARBs), and calcium channel blockers (CCBs), are available. Vitamin D (vitD) is known best for its role in bone and mineral homeostasis. Studies with vitamin D receptor (VDR) knockout mice show an increased renin-angiotensin-aldosterone system (RAAS) activity and increased hypertension, suggesting a key role for vitD as a potential antihypertensive agent. Similar studies in humans displayed ambiguous and mixed results. No direct antihypertensive effect was shown, nor a significant impact on the human RAAS. Interestingly, human studies supplementing vitD with other antihypertensive agents reported more promising results. VitD is considered a safe supplement, proposing its great potential as antihypertensive supplement. The aim of this review is to examine the current knowledge about vitD and its role in the treatment of hypertension.

Preparation and evaluation of a lipid-based drug delivery system to ımprove valsartan oral bioavailability: pharmacokinetic and pharmacodynamic analysis

Antihypertensive treatment reduces the risk of cardiovascular complications in patients with high mortality with hypertension. Valsartan is highly selective antihypertensive that is rapidly absorbed after oral administration, but its oral bioavailability is only 25%. It is absorbed from the upper part of the gastrointestinal tract but is less soluble in this acidic environment. We aimed to develop a lipid-based formulation to produce a self-emulsifying drug delivery system (SEDDS) for valsartan. Solubility studies were performed to identify the components of the SEDDS that provided the best dissolution of valsartan. Ternary phase diagrams were drawn using the titration method with oil, surfactants and co-surfactants in which valsartan was highly soluble, and microemulsion formulations with the highest area were determined. Characterization and in vitro release studies were performed to optimize the formulation. In vitro release profiles of commercial and SEDDS formulations showed the F2 formulation release rate increased at pH 1.2 fasted state simulated gastric fluid. After oral administration, plasma drug concentrations in rats indicate that the F2 formulation provided a 4.2-fold greater AUC for valsartan than the commercial formulaiton, resulting in an 8.5-fold greater Cmax. These findings suggest the F2 formulation increases valsartan solubility, resulting in an improved oral pharmacokinetic profile. According to the pharmacodynamic study, the F2 formulation is more effective than the commercial formulation in restoring systolic and diastolic blood pressure within a few hours.

Association of dietary intake of saturated fatty acids with hypertension: 1999-2018 National Health and Nutrition Examination Survey

Objective

This study aimed to assess the relationship between the dietary intake of saturated fatty acids (SFAs) and its subtypes (C4:0, C6:0, C8:0, C10:0, C12:0, C14:0, C16:0, and C18:0) and hypertension.

Design participants and methods

Adults aged 20 years and older based used the U.S. Health and Nutrition Survey (1999-2018) were used as participants. Two averages of 24 h dietary recall data were obtained for weight-adjusted continuous cross-sectional analysis. Two 24-h recall interview data means were obtained for weight-adjusted continuous cross-sectional analysis. A logistic regression model was used to estimate the weighted odds ratio (OR) and its 95% confidence interval (CI) for hypertension.

Results

The study included 7,222 respondents over 20 years of age with a hypertension prevalence of 23.2% and a significant difference in the dietary intake of carbohydrates among patients with hypertension. Dietary intake of nutrients was more in men than in women with hypertension. After adjusting for confounders, adjusting for nutrients, and reducing covariance among nutrients, the OR (95% CI) for women's dietary intake of SFAs, C14:0, C16:0, C18:0 fourth quartile, and C14:0 third quartile were 0.57 (0.34, 0.95), 0.57 (0.34, 0.95), 0.57 (0.34, 0.95), 0.57 (0.34, 0.95), and 0.57 (0.34, 0.95), respectively, which may be a risk factor for hypertension. In older (≥65, years) respondents, the OR (95% CI) for dietary intake of SFAs, C4:0, C14:0, C16:0 fourth quartile, and C12:0 third quartile were 0.42 (0.21, 0.86), 0.46 (0.22, 0.95), 0.39 (0.18, 0.85), 0.38 (0.17, 0.84), and 0.45 (0.20, 0.99), respectively, which may be a protective factor for hypertension.

Conclusion

The study was based on the American Health and Nutrition Examination Survey, and a strong correlation was found between dietary intake of SFAs, C14:0, C16:0, and C18:0 and hypertension in women (dietary intake of SFAs, C4:0, C12:0, C14:0, and C16:0) and middle-aged and older adults (dietary intake of SFAs, C4:0, C12:0, C14:0, and C16:0). In addition, dietary nutrient intake should be carefully selected for the rational prevention of hypertension.

Approach of Acromegaly during Pregnancy

Acromegaly-related sub/infertility, tidily related to suboptimal disease control (1/2 of cases), correlates with hyperprolactinemia (1/3 of patients), hypogonadotropic hypogonadism—mostly affecting the pituitary axis in hypopituitarism (10−80%), and negative effects of glucose profile (GP) anomalies (10−70%); thus, pregnancy is an exceptional event. Placental GH (Growth Hormone) increases from weeks 5−15 with a peak at week 37, stimulating liver IGF1 and inhibiting pituitary GH secreted by normal hypophysis, not by somatotropinoma. However, estrogens induce a GH resistance status, protecting the fetus form GH excess; thus a full-term, healthy pregnancy may be possible. This is a narrative review of acromegaly that approaches cardio-metabolic features (CMFs), somatotropinoma expansion (STE), management adjustment (MNA) and maternal-fetal outcomes (MFOs) during pregnancy. Based on our method (original, in extenso, English—published articles on PubMed, between January 2012 and September 2022), we identified 24 original papers—13 studies (3 to 141 acromegalic pregnancies per study), and 11 single cases reports (a total of 344 pregnancies and an additional prior unpublished report). With respect to maternal acromegaly, pregnancies are spontaneous or due to therapy for infertility (clomiphene, gonadotropins or GnRH) and, lately, assisted reproduction techniques (ARTs); there are no consistent data on pregnancies with paternal acromegaly. CMFs are the most important complications (7.7−50%), especially concerning worsening of HBP (including pre/eclampsia) and GP anomalies, including gestational diabetes mellitus (DM); the best predictor is the level of disease control at conception (IGF1), and, probably, family history of 2DM, and body mass index. STE occurs rarely (a rate of 0 to 9%); some of it symptoms are headache and visual field anomalies; it is treated with somatostatin analogues (SSAs) or alternatively dopamine agonists (DAs); lately, second trimester selective hypophysectomy has been used less, since pharmaco-therapy (PT) has proven safe. MNA: PT that, theoretically, needs to be stopped before conception—continued if there was STE or an inoperable tumor (no clear period of exposure, preferably, only first trimester). Most data are on octreotide > lanreotide, followed by DAs and pegvisomant, and there are none on pasireotide. Further follow-up is required: a prompt postpartum re-assessment of the mother’s disease; we only have a few data confirming the safety of SSAs during lactation and long-term normal growth and developmental of the newborn (a maximum of 15 years). MFO seem similar between PT + ve and PT − ve, regardless of PT duration; the additional risk is actually due to CMF. One study showed a 2-year median between hypophysectomy and pregnancy. Conclusion: Close surveillance of disease burden is required, particularly, concerning CMF; a personalized approach is useful; the level of statistical evidence is expected to expand due to recent progress in MNA and ART.

Arterial Stiffness and the Canonical WNT/β-catenin Pathway

PURPOSE OF REVIEW

Arterial stiffness (AS) was mainly associated with cardiovascular morbidity and mortality in a hypertensive patient. Some risk factors contribute to the development of AS, such as aging, high blood pressure, vascular calcification, inflammation, and diabetes mellitus. The WNT/β-catenin pathway is implicated in numerous signaling and regulating pathways, including embryogenesis, cell proliferation, migration and polarity, apoptosis, and organogenesis. The activation of the WNT/β-catenin pathway is associated with the development of these risk factors.

RECENT FINDINGS

Aortic pulse wave velocity (PWV) is measured to determine AS, and in peripheral artery disease patients, PWV is higher than controls. An augmentation in PWV by 1 m/s has been shown to increase the risk of cardiovascular events by 14%. AS measured by PWV is characterized by the deregulation of the WNT/β-catenin pathway by the inactivation of its two inhibitors, i.e., DKK1 and sclerostin. Thus, this review focuses on the role of the WNT/β-catenin pathway which contributes to the development of arterial stiffness.

Relationship between circadian syndrome and stroke: A cross-sectional study of the national health and nutrition examination survey

Aim

The aim of this study was to assess the relationship of circadian syndrome and stroke.

Methods

We performed a cross-sectional analysis of 11,855 participants from the National Health and Nutrition Examination Survey (NHANES) database between 2005 and 2018, and collected the baseline characteristics. Multivariate logistic regression models were developed to explore the association between circadian syndrome and stroke. Simultaneously, subgroup analyses based on the difference of gender, race, and components associated with circadian syndrome also were performed. The odds ratio (OR) and 95% CI were calculated in this study.

Results

All the participants were divided into the non-stroke group and the stroke group. There were approximately 3.48% patients exclusively with stroke and 19.03% patients exclusively with circadian syndrome in our study. The results suggested that the risk of stroke in patients with circadian syndrome was higher than that in patients without circadian syndrome (OR = 1.322, 95 CI%: 1.020–1.713). Similar associations were found in women with circadian syndrome (OR = 1.515, 95 CI%: 1.086–2.114), non-Hispanic whites with circadian syndrome (OR = 1.544, 95 CI%: 1.124–2.122), participants with circadian syndrome who had elevated waist circumference (OR = 1.395, 95 CI%: 1.070–1.819) or short sleep (OR = 1.763, 95 CI%: 1.033–3.009).

Conclusion

Circadian syndrome was associated with the risk of stroke. Particularly, we should pay more close attention to the risk of stroke in those populations who were female, non-Hispanic whites, had the symptoms of elevated waist circumference or short sleep.

Machine Learning and Electrocardiography Signal-Based Minimum Calculation Time Detection for Blood Pressure Detection

Objective

Measurement and monitoring of blood pressure are of great importance for preventing diseases such as cardiovascular and stroke caused by hypertension. Therefore, there is a need for advanced artificial intelligence-based systolic and diastolic blood pressure systems with a new technological infrastructure with a noninvasive process. The study is aimed at determining the minimum ECG time required for calculating systolic and diastolic blood pressure based on the Electrocardiography (ECG) signal. Methodology. The study includes ECG recordings of five individuals taken from the IEEE database, measured during daily activity. For the study, each signal was divided into epochs of 2-4-6-8-10-12-14-16-18-20 seconds. Twenty-five features were extracted from each epoched signal. The dimension of the dataset was reduced by using Spearman's feature selection algorithm. Analysis based on metrics was carried out by applying machine learning algorithms to the obtained dataset. Gaussian process regression exponential (GPR) machine learning algorithm was preferred because it is easy to integrate into embedded systems.

Results

The MAPE estimation performance values for diastolic and systolic blood pressure values for 16-second epochs were 2.44 mmHg and 1.92 mmHg, respectively.

Conclusion

According to the study results, it is evaluated that systolic and diastolic blood pressure values can be calculated with a high-performance ratio with 16-second ECG signals.

Is waist-to-height ratio the best predictive indicator of cardiovascular disease incidence in hypertensive adults? A cohort study

Background

Cardiovascular disease (CVD) brings high mortality and economic burden to patients, especially in rural areas. Simple, low-cost abdominal adiposity measures may help identify individuals with increased CVD risk. It is unclear that which obesity indices is the best to predict CVD in hypertensive people.

Methods

Northeast China Rural Cardiovascular Health Study (NCRCHS) is a prospective cohort study in a general population in Northeast China. The study examined the cardiovascular health from 2013 to 2015, and follow-up captured the CVD incidence in 2018. Baseline waist-to-height ratio (WHtR), waist circumference (WC), waist-to-hip (WHR)and body mass index (BMI) were calculated and analyzed in relation to the CVD incidence.

Results

A total of 4244 hypertensive adults without pre-existing CVD at baseline were included in this analysis (age 35–92 years; 2108 men). Over a median follow-up of 4.66 years, a total of 290 CVD cases (6.83%) were documented during the follow-up. Baseline WHtR showed a significant positive association with CVD incidence, even after adjusting for age, sex, diabetes, drinking, smoking, SBP, DBP, Triglyceride, HDL-C, LDL-C, and TC (Hazard Ratios per SD of WHtR ranging from 1.03 to 1.31, p = 0.017). Reclassification and discrimination analyses indicated WHtR addition could improve the conventional model for predicting adverse outcomes within 4 years. Moreover, WHtR predicted the CVD incidence better than other obesity indices (BMI, WC, WHR).

Conclusion

These findings support a positive association between WHtR and CVD incidence in CVD-free hypertensive adults. WHtR can be used to predict CVD incidence in hypertensive adults.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12872-022-02646-1.

Nephroprotective Plants: A Review on the Use in Pre-Renal and Post-Renal Diseases

Kidney diseases are expected to become the fifth leading cause of death by 2040. Several physiological failures classified as pre-, intra-, and post-renal factors induce kidney damage. Diabetes, liver pathologies, rhabdomyolysis, and intestinal microbiota have been identified as pre-renal factors, and lithiasis or blood clots in the ureters, prostate cancer, urethral obstructions, prostate elongation, and urinary tract infections are post-renal factors. Additionally, the nephrotoxicity of drugs has been highlighted as a crucial factor inducing kidney injuries. Due to the adverse effects of drugs, it is necessary to point to other alternatives to complement the treatment of these diseases, such as nephroprotective agents. Plants are a wide source of nephroprotective substances and can have beneficial effects in different levels of the physiological pathways which lead to kidney damage. In traditional medicines, plants are used as antioxidants, anti-inflammatories, diuretics, and anticancer agents, among other benefits. However, the mechanism of action of some plants empirically used remains unknown and scientific data are required to support their nephroprotective effects. The present work reviewed the plants with a beneficial effect on kidney diseases. The classification of nephroprotective plants according to the clinical definition of pre-renal, intrinsic, and post-renal factors is proposed to orient their use as complementary treatments.

LncRNA FENDRR Servers as a Possible Marker of Essential Hypertension and Regulates Human Umbilical Vein Endothelial Cells Dysfunction via miR-423-5p/Nox4 Axis

Purpose

Essential hypertension (EH) is an intricate non-communicable infirmity and lncRNAs are validated as essential mediators in EH. The study aimed to propose the expression pattern of FENDRR and miR-423-5p, substantiate the potential mechanism of FENDRR/miR-423-5p/Nox4 axis in EH.

Patients and Methods

The expression of FENDRR and miR-423-5p was evaluated by qRT-PCR and the clinical significance was explored by the ROC curve. Pearson correlation indicated the relationship between FENDRR and miR-423-5p. The function of FENDRR and miR-423-5p on HUVECs was clarified by CCK-8 assay, Transwell assay, and flow cytometry. Western blot was used to assess the relative protein expression of Nox4.

Results

FENDRR was highly expressed and miR-423-5p was lowly expressed in EH patients and a negative correlation between them was determined. FENDRR might serve as a predictive diagnosis in differentiating EH patients. Knockdown of FENDRR or overexpression of miR-423-5p showed expansionary effects in cell proliferation, cell migration, and inhibiting cell apoptosis. Meanwhile, miR-423-5p was determined as a target of FENDRR and mediated the function of FENDRR on HUVECs. Moreover, Nox4 is a down-streaming target gene of miR-423-5p. The protein expression of Nox4 was regulated by the alternation of miR-423-5p expression.

Conclusion

FENDRR played an energetic role in EH and contributed to HUVECs dysfunction by restricting cell proliferation, suppressing cell migration, and accelerating cell apoptosis by manipulating the miR-423-5p/Nox4 axis.

Primary Aldosteronism, Aldosterone, and Extracellular Vesicles

Primary aldosteronism (PA) is an endocrine related condition leading to arterial hypertension due to inappropriately high and unregulated aldosterone concentration. Recently, a broad spectrum of PA has been recognized, which brings new challenges associated with early identification of this condition that affect renal epithelial and extrarenal tissues. Reports have shown the potential role of extracellular vesicles (EVs) and EV cargo as novel and complementary biomarkers in diagnosis and prognosis of PA. In vivo and in vitro studies have identified specific EV surface antigens, EV-proteins, and EV microRNAs that can be useful to develop novel diagnostic algorithms to detect, confirm, or follow up the PA. Moreover, the study of EVs in the field of PA provides further insight in the pathophysiological mechanism of the PA disease.

The Functions of LncRNA H19 in the Heart

Cardiovascular diseases (CVDs) are major causes of morbidity and mortality worldwide. Great effort has been put into exploring early diagnostic biomarkers and innovative therapeutic strategies for preventing CVD progression over the last two decades. Long non-coding RNAs (lncRNAs) have been identified as novel regulators in cardiac development and cardiac pathogenesis. For example, lncRNA H19 (H19), also known as a fetal gene abundant in adult heart and skeletal muscles and evolutionarily conserved in humans and mice, has a regulatory role in aortic aneurysm, myocardial hypertrophy, extracellular matrix reconstitution, and coronary artery diseases. Yet, the exact function of H19 in the heart remains unknown. This review summarises the functions of H19 in the heart and discusses the challenges and possible strategies of H19 research for cardiovascular disease.

Association of plasma lead, cadmium and selenium levels with hearing loss in adults: National Health and Nutrition Examination Survey (NHANES) 2011-2012

To determine the association between hearing loss and environmental Pb, Cd and Se exposure, a total of 1503 American adults from National Health and Nutrition Examination Survey (NHANES) (2011-2012) were assessed. The average of four audiometric frequencies (0·5, 1, 2 and 4 kHz) was used to identify speech-frequency hearing loss (SFHL), while the average of 3 audiometric frequencies (3, 4 and 6 kHz) was used to identify high-frequency hearing loss (HFHL). HFHL adjusted OR determined by comparing the highest and lowest blood Pb and Cd quartiles were 1·98 (95 % CI: 1·27, 3·10) and 1·81 (95 % CI: 1·13, 2·90), respectively. SFHL was significantly associated with blood Cd with the OR = 2·42 for the highest quartile. When further stratified by age, this association appeared to be limited to adults aged 35-52 years. After stratified by gender, except for Pb and Cd, we observed that blood Se showed a dose-dependent association with SFHL in men. In women, only Cd showed a dose-dependent association with speech and high-frequency hearing loss. Hearing loss was positively associated with blood levels of Pb and Cd. Additionally, our study provided novel evidence suggesting that excessive Se supplement would increase SFHL risk in men.

Twenty-Four-Hour Ambulatory Blood Pressure Monitoring

The diagnosis, management, and estimated mortality risk in patients with hypertension have been historically based on clinic or office blood pressure readings. Current evidence indicates that 24-hour ambulatory blood pressure monitoring should be an integral part of hypertension care. The 24-hour ambulatory monitors currently available on the market are small devices connected to the arm cuff with tubing that measure blood pressure every 15 to 30 minutes. After 24 hours, the patient returns, and the data are downloaded, including any information requested by the physician in a diary. The most useful information includes the 24-hour average blood pressure, the average daytime blood pressure, the average nighttime blood pressure, and the calculated percentage drop in blood pressure at night. The most widely used criteria for 24-hour measurements are from the American Heart Association 2017 guidelines and the European Society of Hypertension 2018 guidelines. Two important scenarios described in this document are white coat hypertension, in which patients have normal blood pressures at home but high blood pressures during office visits, and masked hypertension, in which patients are normotensive in the clinic but have high blood pressures outside of the office. The Centers for Medicare and Medicaid Services has made changes in its policy to allow reimbursement for a broader use of 24-hour ambulatory blood pressure monitoring within some specific guidelines. Primary care physicians should make more use of ambulatory blood pressure monitoring, especially in patients with difficult to manage hypertension.

Case report: An unusual presentation of renal hypertension after damage control surgery

INTRODUCTION AND IMPORTANCE

Hypertensive crisis may be a life-threatening condition to any patient and represents an even more serious condition in trauma patients following severe hemorrhage.

CASE PRESENTATION

We present a case were surgical drape packing induced hypertensive crisis in a trauma patient, recently resuscitated from abdominal hemorrhage.

CLINICAL DISCUSSION

We argue that direct compression of the kidney by the surgical drapes induced hypersecretion of renin with a mechanism equal to Page kidney. The hypertensive crisis as well as the hyperreninemia was resolved after removing the surgical drapes, and the patient's condition returned to normal without any sequelae.

CONCLUSION

We encourage considering this unusual but important complication when packing of the abdomen has been carried out, and strongly recommend ruling out renin-mediated hypertension as a cause of post-operative hypertension in such cases.

Proteomic Profile of Urinary Extracellular Vesicles Identifies AGP1 as a Potential Biomarker of Primary Aldosteronism

CONTEXT

Primary aldosteronism (PA) represents 6% to 10% of all essential hypertension patients and is diagnosed using the aldosterone-to-renin ratio (ARR) and confirmatory studies. The complexity of PA diagnosis encourages the identification of novel PA biomarkers. Urinary extracellular vesicles (uEVs) are a potential source of biomarkers, considering that their cargo reflects the content of the parent cell.

OBJECTIVE

We aimed to evaluate the proteome of uEVs from PA patients and identify potential biomarker candidates for PA.

METHODS

Second morning spot urine was collected from healthy controls (n = 8) and PA patients (n = 7). The uEVs were isolated by ultracentrifugation and characterized. Proteomic analysis on uEVs was performed using LC-MS Orbitrap.

RESULTS

Isolated uEVs carried extracellular vesicle markers, showed a round shape and sizes between 50 and 150 nm. The concentration of uEVs showed a direct correlation with urinary creatinine (r = 0.6357; P = 0.0128). The uEV size mean (167 ± 6 vs 183 ± 4nm) and mode (137 ± 7 vs 171 ± 11nm) was significantly smaller in PA patients than in control subjects, but similar in concentration. Proteomic analysis of uEVs from PA patients identified an upregulation of alpha-1-acid glycoprotein 1 (AGP1) in PA uEVs, which was confirmed using immunoblot. A receiver operating characteristic curve analysis showed an area under the curve of 0.92 (0.82 to 1; P = 0.0055).

CONCLUSION

Proteomic and further immunoblot analyses of uEVs highlights AGP1 as potential biomarker for PA.

Effectiveness of a pathway-driven eHealth-based integrated care model (PEICM) for community-based hypertension management in China: study protocol for a randomized controlled trial

Background

The prevalence of hypertension is high and increasing in China in recent years. The treatment and control of hypertension calls for long-term management beyond hospital, which is hard to implement in traditional care settings. Integrated care combined with information technology can promote high-quality healthcare services across the life-course. However, few studies have applied a customized integrated care model in community-based hypertension management in China, catering to the emerging “three-manager” mode. This study aims to identify the effectiveness of a pathway-driven eHealth-based integrated model that implemented as a full-featured telehealth system to facilitate standardized management of hypertension in China.

Methods

The trial has been designed as a 1-year, non-blinded superiority trial with two parallel groups. A total of 402 hypertensive patients who meet the eligibility criteria will be recruited and randomized with a 1:1 allocation. All the participants will receive a mobile device for self-management, which is a part of our telehealth system. Participants in the control group will only use the device for BP measurement and receive regular follow-ups from care providers according to the guidelines. Participants in the intervention group will gain full access to the system and receive intervention based on the proposed model (a well-designed coordinated care pathway consisting of 9 tasks). Outcomes will be measured mainly on three occasions (at inclusion, at 6 months, and at 12 months). The primary outcome is mean change in systolic blood pressure over a 12-month period. Secondary outcomes include changes in diastolic blood pressure, biochemical indexes related to hypertension, lifestyles, self-management adherence, and hypertension awareness, as well as work efficiency of care providers.

Discussion

This study aims to investigate whether a pathway-driven eHealth-based integrated care model based on the “three-manager” mode will improve hypertension control in China. Success of the model would help improve the quality of present community-based management procedures and benefit more patients with uncontrolled hypertension.

Trial registration

Chinese Clinical Trial Registry ChiCTR1900027645. Registered on November 22, 2019.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05020-2.

Association of Hypertension and Hyperthyroidism in a Subspecialty Clinic and a National Database

OBJECTIVE

Hypertension can cause significant morbidity and reduced life expectancy. Most patients with hypertension have primary hypertension; however, 10% to 15% have secondary hypertension. Endocrine disorders as a secondary cause occur in approximately 10% of patients with secondary hypertension, and thyroid disorders account for approximately 1% of all patients with hypertension. The identification of patients with hyperthyroidism has important benefits for these particular patients. The objective of this study was to examine the occurrence of high blood pressure in patients with hyperthyroidism.

METHODS

We reviewed the clinical information available from 414 new patients referred to an endocrinology clinic in west Texas for evaluation of hyperthyroidism. The final cohort included 96 patients who had both thyroid laboratory tests and blood pressure measurements at the time of their clinic visit. We also examined this relationship in a nationally representative sample of US adults (National Health and Nutrition Examination Survey 2007-2012), which included thyroid test results and at least one blood pressure measurement (N = 8837).

RESULTS

Sixty-five of these clinic patients had elevated blood pressure based on criteria suggested by the American College of Cardiology/American Heart Association. These patients had similar thyroid hormone levels as patients who did not have hypertension but tended to be older. Ordinary least squares regression analysis of the National Health and Nutrition Examination Survey 2007-2012 data demonstrated a significant positive association between free T3 levels and systolic blood pressure, adjusting for age, sex, and the use of levothyroxine.

CONCLUSIONS

These findings from a specialty clinic and a national sample suggest that clinicians should consider the possibility of hyperthyroidism in patients with hypertension, even in older patients.

Hypertension and Hyperthyroidism: Association and Pathogenesis

Hypertension can cause significant morbidity and reduced life expectancy. Most patients with hypertension have primary hypertension; however, 10 to 15% of patients have secondary hypertension. Endocrine disorders explain approximately 10% of hypertension in all patients, and thyroid disorders account for approximately 1% of cases with hypertension. Hyperthyroidism can cause increased cardiac output, increased systolic blood pressures, and increased levels of renin, angiotensin, and aldosterone. Treatment of hyperthyroidism can cure hypertension in some patients. Consequently, identification of patients with secondary hypertension potentially has important benefits, and understanding secondary hypertension provides a framework for investigating the pathophysiology of hypertension. Clinicians should consider the possibility of hyperthyroidism in patients with hypertension, even in those of more advanced age.

Relieving the tension in hypertension: Food-drug interactions and anti-hypertensive mechanisms of food bioactive compounds

Hypertension is a global health problem. Statistics report from the World Health Organization reveals its prevalence in about a quarter of the world global population. Due to the complications associated with hypertension, it is required to be well managed or prevented pharmacologically or non-pharmacologically. Pharmacologically, the major antihypertensive drugs used are centrally acting sympatholytic drugs, diuretics, vasodilators, angiotensin converting enzyme inhibitors, and angiotensin II receptor blockers while non-pharmacological means of management include lifestyle changes, intake of diet or supplements with antihypertensive effects. Interestingly, the use of diet as a complement with drug intake has become very popular due to occurring side effects over time. Recent research efforts have revealed that foods such as fruits and vegetables contain bioactive substances that modulate the activities of macromolecules involved in the development, complications, and management of hypertension. PRACTICAL APPLICATIONS: Recent research efforts have suggested the efficacy of diets rich in fruits and vegetables in the management of hypertension. This review examines some of the mechanisms involved in the dietary management or prevention of hypertension by bioactive compounds found in foods. This review promotes the use of diet in the management of the condition and also suggests that precautions to be taken in the combined use of food and drugs.

Down-regulation of lncRNA MALAT1 alleviates vascular lesion and vascular remodeling of rats with hypertension

Objective: Recently, the effect of long non-coding RNAs (lncRNAs) in hypertension (HTN) has been identified. This study aims to explore the expression of lncRNA metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) in HTN and its role in vascular lesion and remodeling of HTN rats.

Results: LncRNA MALAT1 expression was up-regulated in HTN patients, and lncRNA MALAT1 could be an effective index of HTN diagnosis. Down-regulated MALAT1 and inhibited Notch-1 could reduce relative factor expression, including inflammation-related factors, endothelial function-related factors and oxidative stress-related factors, and inhibit apoptosis of aortic endothelial cells of HTN rats.

Methods: LncRNA MALAT1 expression in HTN patients and healthy controls was detected by reverse transcription quantitative polymerase chain reaction (RT-qPCR). Angiotensin II (Ang II)-induced HTN rat models were injected with MALAT1-siRNA, empty lentivirus vector, Notch pathway inhibitor (DAPT) and dimethyl sulphoxide (DMSO) via caudal vein. After three-week treatment, changes of blood pressure, inflammatory factor levels, endothelial function-related factors, oxidative stress indices and apoptosis of vascular endothelial cells were determined by a series of assays.

Conclusion: This study revealed that down-regulated lncRNA MALAT1 could alleviate the vascular lesion and remodeling of HTN rats, the mechanism may be related to the inhibited activation of Notch signaling pathway.

A Guide to the Short, Long and Circular RNAs in Hypertension and Cardiovascular Disease

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in adults in developed countries. CVD encompasses many diseased states, including hypertension, coronary artery disease and atherosclerosis. Studies in animal models and human studies have elucidated the contribution of many genetic factors, including non-coding RNAs. Non-coding RNAs are RNAs not translated into protein, involved in gene expression regulation post-transcriptionally and implicated in CVD. Of these, circular RNAs (circRNAs) and microRNAs are relevant. CircRNAs are created by the back-splicing of pre-messenger RNA and have been underexplored as contributors to CVD. These circRNAs may also act as biomarkers of human disease, as they can be extracted from whole blood, plasma, saliva and seminal fluid. CircRNAs have recently been implicated in various disease processes, including hypertension and other cardiovascular disease. This review article will explore the promising and emerging roles of circRNAs as potential biomarkers and therapeutic targets in CVD, in particular hypertension.

Establishment of the circadian metabolic phenotype strategy in spontaneously hypertensive rats: a dynamic metabolomics study

BACKGROUND

Circadian rhythms play a fundamental role in the progression of cardiovascular events. Almost all cardiovascular diseases have a circadian misalignment usually characterized by changes in metabolites. This study aimed to dynamically monitor rhythmic biomarkers, to elucidate the metabolic pathways that are potentially under circadian control in spontaneously hypertensive rats (SHRs), and to eventually establish a circadian metabolic phenotype strategy based on metabolomics.

METHODS

In this study, an untargeted metabolomics technology was used to dynamically monitor changes in serum metabolites between SHR model group and WKY control group. Liquid chromatography-mass spectrometry (LC-MS) combined with multivariate statistical analysis was applied to identify markers of hypertension rhythm imbalance. The concentrations of amino acids and their metabolites identified as markers were quantified by a subsequent targeted metabolomics analysis. Overall, these approaches comprehensively explored the rhythm mechanism and established a circadian metabolic phenotype strategy.

RESULTS

The metabolic profile revealed a disorder in the diurnal metabolism pattern in SHRs. Moreover, multivariate statistical analysis revealed metabolic markers of rhythm homeostasis, such as arginine, proline, phenylalanine, citric acid, L-malic acid, succinic acid, etc., accompanied by an imbalance in hypertension. The key metabolic pathways related to rhythm imbalance in hypertension were found by enrichment analysis, including amino acid metabolism, and the tricarboxylic acid cycle (TCA). In addition, the quantitative analysis of amino acids and their metabolites showed that the changes in leucine, isoleucine, valine, taurine, serine, and glycine were the most obvious.

CONCLUSIONS

In summary, this study illustrated the relationship between metabolites and the pathways across time on hypertension. These results may provide a theoretical basis for personalized treatment programmes and timing for hypertension.

[The Main Provisions of the International Recommendations on Detection of Endocrine Hypertension]

In 2017 the Endocrine Society issued the Scientific Statement "Screening for Endocrine Hypertension" This document was developed by experts from different medical institutions of USA, Europe and Australia. Herein we present the main provisions of this Statement in the form of brief algorithm for the clinicians' actions for timely detection of secondary endocrine hypertension and rational referral of the patient for confirmational testing.The full text of the Scientific Statement in English is contained in the article. Young WF Jr., Calhoun DA, Lenders JW, Stowasser M, Textor SC. Screening for Endocrine Hypertension: An Endocrine Society Scientific Statement. Endocrine Reviews. 2017; 38 (2):103-122.URL: https://academic.oup.com/edrv/article/38/2/103/3104343.

The aldosterone to renin ratio in the diagnosis of primary aldosteronism: Promises and challenges

The complexity of evaluating patients for secondary treatable causes of hypertension is underappreciated. Primary aldosteronism (PA) is the most prevalent cause of secondary hypertension (3%-32% of hypertensive patients). The recent endocrine society clinical practice guideline (ESCPG), "The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment", differs from the previous version in the explicit recognition of PA as a major public health issue. Despite this, PA is underdiagnosed. The guidelines call on physicians to substantially ramp up the screening of hypertensive patients at risk of PA. Further, it recommends the plasma aldosterone to renin ratio (ARR), as the test of choice for screening for PA. However, the ARR is a highly variable test with reported diagnostic sensitivities and specificities ranging from 66% to 100% and 61% to 100%, respectively. Variability of the ARR can be attributed to the high degree of within-subject variation, differences in sampling protocols, laboratory assays, reporting units, the effect of medications and the population characteristics used to establish the decision thresholds. These factors render the possibility of false positive and false negative results-which have the potential to adversely impact patients. The limitations and caveats to the use of the ARR necessitate an effective clinic-laboratory interface, with specialist physician and clinical scientist collaboration for ARR result interpretation. Improvement in the diagnostic sensitivity and specificity of the ARR is predicated on harmonisation of pretesting patient preparation criteria, knowledge of the analytical methods used to derive the ratio and the method-specific threshold for PA.

Metabolic Syndrome and Male Fertility

Metabolic syndrome (MetS) represents a cluster of conditions that have a negative impact on human health overall. Its prevalence has been rapidly increasing worldwide and has coincided with a global decrease in birth rates and fertility potential. This review aims to address this observation through studying the relationship between MetS and male reproductive health. The effects of obesity, dyslipidemia, hypertension, and insulin resistance on male fertility were examined and supporting evidence explaining the pathophysiology of sperm dysfunction with each MetS component were described. Adopting a healthy lifestyle appears to be the single most important intervention to prevent the unwanted effects of MetS on men's health and fertility. Further studies addressing the components of MetS and their impact on male reproduction are required to enhance our understanding of the underlying pathophysiology and to propose new methods for therapeutic intervention.

Inherited risk plus prenatal insult caused malignant dysfunction in mesenteric arteries in adolescent SHR offspring

Prenatal hypoxia can induce cardiovascular diseases in the offspring. This study determined whether and how prenatal hypoxia may cause malignant hypertension and impaired vascular functions in spontaneous hypertension rat (SHR) offspring at adolescent stage. Pregnant SHR were placed in a hypoxic chamber (11% O2) or normal environment (21% O2) from gestational day 6 until birth. Body weight and blood pressure (BP) of SHR offspring were measured every week from 5 weeks old. Mesenteric arteries were tested. Gestational hypoxia resulted in growth restriction during 6-12 weeks and a significant elevation in systolic pressure in adolescent offspring at 12 weeks old. Notably, endothelial vasodilatation of mesenteric arteries was impaired in SHR adolescent offspring exposed to prenatal hypoxia, vascular responses to acetylcholine (ACh) and sodium nitroprusside (SNP) were reduced, as well as plasma nitric oxide levels and expression of endothelial nitric oxide synthase (eNOS) in vessels were decreased. Moreover, mesenteric arteries in SHR offspring following prenatal hypoxia showed enhanced constriction responses to phenylephrine (PE), associated with up-regulated activities of L-type calcium channel (Ca2+-dependent), RhoA/Rock pathway signaling (Ca2+-sensitization), and intracellular Ca2+ flow. Pressurized myograph demonstrated altered mechanical properties with aggravated stiffness in vessels, while histological analysis revealed vascular structural disorganization in prenatal hypoxia offspring. The results demonstrated that blood pressure and vascular function in young SHR offspring were affected by prenatal hypoxia, providing new information on development of hypertension in adolescent offspring with inherited hypertensive backgrounds.

Minimally Invasive Surgery-Based Multidisciplinary Clinical Management of Reninoma: A Single-Center Study

Background

This article presents our experience in managing a rare kidney tumor – reninoma – by analyzing a relatively large series of cases from a single center.

Material/Methods

Nine cases of reninoma were reviewed. Clinical manifestations, imaging examinations, laboratory examinations, perioperative data, and pathological findings were summarized. A 58.8-month follow-up was performed to evaluate patient survival and recrudescence.

Results

The main clinical manifestations were hypertension, hypokalemia, headache, dizziness, nausea, vomiting, palpation, and sweating. Three patients had hypertensive end-organ damage, including brain hemorrhage, gestation termination, and grade III ocular fundus changes. All patients underwent retroperitoneal laparoscopic partial nephrectomy successfully. The mean warm ischemic time was 23.4 min. The median operation time was 95.1 min, with a median estimated blood loss of 60 ml. The median hospital stay was 6 days. No serious intraoperative or postoperative complications occurred. The histology and electron microscopy findings confirmed the diagnosis of reninoma in all cases. After 58.8 months of follow-up, symptoms involving hypertension were relieved in all patients, and no tumor recurrence or metastasis was detected.

Conclusions

Reninoma may have severe consequences despite being a benign tumor. Retroperitoneal laparoscopic partial nephrectomy is a feasible and effective method for the surgical removal of reninoma. Multidisciplinary cooperation plays an important role in improving the diagnosis and enabling the early surgical treatment of reninoma. Especially in cases of reninoma with moderate and high RENAL scores, an accurate diagnosis of reninoma based on multidisciplinary cooperation facilitates the selection of less invasive surgical approaches.

Serum levels of sclerostin as a potential biomarker in central arterial stiffness among hypertensive patients

BACKGROUND

Sclerostin is known to be a canonical Wnt/β-catenin signaling pathway inhibitor, while the Wnt/β-catenin signaling pathway is proposed to be involved in the development of arterial stiffness. This study aims to investigate the relationship between serum sclerostin levels and carotid-femoral pulse wave velocity (cfPWV) among hypertensive patients.

METHODS

Fasting blood samples were obtained from 105 hypertensive patients. Patients with cfPWV values of > 10 m/s were classified in the high arterial stiffness group, whereas those with cfPWV values of ≤10 m/s were assigned to the low arterial stiffness group. Serum sclerostin and Dickkopf-1 (DKK1) levels were quantified using commercially available enzyme-linked immunosorbent assays.

RESULTS

Thirty-six hypertensive patients (34.3%) who belonged to the high arterial stiffness group were generally older (p < 0.001), presented with lower estimated glomerular filtration rates (eGFR, p = 0.014), higher incidence of diabetes mellitus (p = 0.030), average systolic blood pressures (SBP, p = 0.013), pulse pressure (p = 0.026), serum creatinine levels (p = 0.013), intact parathyroid hormone levels (iPTH, p = 0.003), and sclerostin levels (p < 0.001) than their counterparts in the low arterial stiffness group. A multivariable logistic regression analysis identified sclerostin as an independent predictor of arterial stiffness in hypertensive patients (odds ratio, 1.042; 95% confidence interval (CI), 1.017-1.068; p = 0.001). Multivariable forward stepwise linear regression analysis also showed that serum sclerostin level (β = 0.255, adjusted R2 change: 0.146, p = 0.003) was positively associated with cfPWV values in patients with hypertension.

CONCLUSIONS

In this study, serum sclerostin level, but not DKK1, is found to be positively correlated with cfPWV values and is identified as an independent predictor of arterial stiffness in hypertensive patients after adjusting for significant confounders.

Renal complications during pregnancy: In the hypertension spectrum

In pregnancy, there are numerous changes which occur to accommodate the needs of both the fetus and placenta. These changes present us with a unique set of clinical challenges particularly in the setting of any disease processes occurring during pregnancy. It is essential to understand that the systems profoundly affected are the cardiovascular and renal systems. The most predominant disease process occurring in pregnancy affecting both the cardiovascular and renal system is the spectrum of hypertensive disorders specifically pre-eclampsia. Due to its high incidence worldwide, it is considered as the most common cause of infant and maternal morbidity and mortality. While the international definition, classification scheme and diagnostic criteria for Hypertensive Disorders of Pregnancy still must be agreed upon, hypertension has been the mandatory feature for all established guidelines. Pre-eclampsia particularly the severe form which is recognized as HELLP (Hemolysis, Elevated Liver enzymes and Low Platelet count) syndrome is the primary cause of acute kidney injury in pregnancy. In this review, we would primarily discuss the hemodynamic and vascular changes, anatomical and physiologic renal adaptations occurring during normal pregnancy and the complications which arise in the setting of hypertensive diseases. Mainly focusing on the pre-eclampsia spectrum, since knowledge of these is of clinical importance not only in understanding its role in the disease process but more so its implications for prevention, screening, diagnosis, and management.

Mechanistic Pathways Underlying the Antihypertensive Effect of Fermented Milk with Lactococcus lactis NRRL B-50571 in Spontaneously Hypertensive Rats

It has been reported that fermented milk (FM) with Lactococcus lactis NRRL B-50571 had an antihypertensive effect in spontaneously hypertensive rats (SHR) and prehypertensive subjects. Therefore, the objective of the present study was to evaluate the possible mechanisms involved (angiotensin converting enzyme inhibition (ACEI), enhancement of nitric oxide production, antioxidant activity and opioid effect), in the antihypertensive effect of FM with SHR. First, twenty one SHR were randomized into three groups to either receive in a single-oral dose of purified water (negative control), FM, or naloxone (opioid receptor antagonist) + FM. In a parallel study, twenty seven SHR were randomized into three groups to either receive ad libitum purified water (negative control), Captopril or FM. After six weeks of treatment ACEI activity, enhancement of nitric oxide production, and antioxidant activity were evaluated in plasma. Results indicated that opioid receptors were not involved in the hypotensive effect of FM. However, ACEI activity (94 U/L), the oxidative stress index (malondialdehyde/catalase + glutathione peroxidase) 0.9, and nitric oxide in plasma (4.4 ± 1.3 U/L), were significantly different from the negative control, and not significantly different from the Captopril group. Thus, these results suggested that these mechanisms are involved in the hypotensive effect of FM.

Associations between glycaemic control and activation of the renin-angiotensin-aldosterone system in participants with type 2 diabetes mellitus and hypertension

Introduction

Hyperglycaemia increases succinate concentrations and succinate receptor activation in the kidney resulting in renin release. The aim of our study was to determine if there is an association between glycaemic control as evidenced by glycated haemoglobin values and activation of the renin-angiotensin-aldosterone system in patients with type 2 diabetes mellitus and hypertension.

Methods

A cross-sectional study was conducted at Galway University Hospitals between December 2014 and March 2015. Participants ( n = 66) were identified following interrogation of the electronic database for patients with type 2 diabetes mellitus. Baseline clinical demographics, aldosterone, plasma renin activity, direct renin concentration, urea and electrolytes, glycated haemoglobin, cholesterol, urine sodium and albumin creatinine ratio were recorded.

Results

There was a significant positive linear correlation between glycated haemoglobin and renin (both plasma renin activity [ P = 0.002] and direct renin concentration [ P = 0.008]) and between serum creatinine and aldosterone measured using both radioimmunoassay ( P = 0.008) and immunochemiluminometric assay ( P = 0.008). A significant negative linear correlation was demonstrated between serum sodium and plasma renin activity ( P = 0.005) and direct renin concentration ( P = 0.015) and between estimated glomerular filtration rate and aldosterone measured using radioimmunoassay ( P = 0.02) and immunochemiluminometric assay ( P = 0.016). A significant negative linear correlation existed between urine sodium and plasma renin activity ( P = 0.04) and aldosterone measured using radioimmunoassay ( P = 0.045).

Conclusions

There is a direct positive association between glycaemic control and renin. We advocate for renin measurement to be part of the diabetologist's armamentarium to assess, guide and optimize therapeutic strategies in patients with diabetes.

Prenatal Exposure to LPS Alters The Intrarenal RAS in Offspring, Which Is Ameliorated by Adipose Tissue-Derived Mesenchymal Stem Cells

BACKGROUND

Prenatal lipopolysaccharide (LPS) exposure causes hypertension in rat offspring through an unknown mechanism. Here, we investigated the role of the intrarenal renin-angiotensin system (RAS) in hypertension induced by prenatal LPS exposure and also explored whether adipose tissue-derived mesenchymal stem cells (ADSCs) can ameliorate the effects of prenatal LPS exposure in rat offspring.

METHODS

Sixty-four pregnant rats were randomly divided into 4 groups (n = 16 in each), namely, a control group and an LPS group, which were intraperitoneally injected with vehicle and 0.79 mg/kg LPS, respectively, on the 8th, 10th, and 12th days of gestation; an ADSCs group, which was intravenously injected with 1.8 × 107 ADSCs on the 8th, 10th, and 12th days of gestation; and an LPS + ADSCs group, which received a combination of the treatments administered to the LPS and ADSCs groups.

RESULTS

Prenatal LPS exposure increased blood pressure, Ang II expression, Ang II-positive, monocyte and lymphocyte, apoptotic cells in the kidney, and induced renal histological changes in offspring; however, the LPS and control groups did not differ significantly with respect to plasma renin activity levels, Ang II levels, or renal function. ADSCs treatment attenuated the blood pressure and also ameliorated the other effects of LPS-treated adult offspring.

CONCLUSIONS

Prenatal exposure to LPS activates the intrarenal RAS but not the circulating RAS and thus induces increases in blood pressure in adult offspring; however, ADSCs treatment attenuates the blood pressure increases resulting from LPS exposure and also ameliorates the other phenotypic changes induced by LPS treatment by inhibiting intrarenal RAS activation.