Essential hypertension. Part I: definition and etiology

Exposure to perchlorate, nitrate and thiocyanate was associated with the prevalence of hypertension

BACKGROUND

Our study aims to examinate the relationships between exposure to perchlorate, nitrate, and thiocyanate and the risk of hypertension.

METHODS

A total of 21,321 participants were selected from the National Health and Nutritional Examination Survey (NHANES). We used logistic regressions models to explore the odds ratio of urinary perchlorate, nitrate, and thiocyanate on the risk of hypertension and restricted cubic splines to check the nonlinearity.

RESULTS

2851 (13.4%) individuals were diagnosed with hypertension. Multivariable logistic regression analysis suggested that urinary perchlorate and nitrate were inversely associated with hypertension, and thiocyanate has a positive correlation. Compared with the lowest quartile, the highest quartile of odds ratios was 0.86 (0.74-1.00; P = 0.048) for perchlorate, 0.79 (0.67-0.94; P = 0.007) for nitrate, and 1.47 (1.25-1.73; P < 0.001) for thiocyanate. Restricted cubic splines showed that urinary perchlorate was nonlinearly associated with hypertension (P = 0.0014).

CONCLUSIONS

Higher exposure to perchlorate and nitrate were associated with a lower risk of hypertension, while a positive association was observed for urinary thiocyanate.

Eight months of marathon school training reduced blood pressure, systemic vascular resistance and extracellular water volume

The effects of an eight-month marathon school training program on blood pressure (BP) and underlying hemodynamics were examined in 45 participants and 43 controls. Hemodynamics were recorded using whole-body impedance cardiography, radial tonometric pulse wave analysis, and third-finger BP measurements during passive head-up tilt. The mean ages were 40.9 and 42.2 years, and body mass indexes (BMI) 25.1 and 25.8 kg/m2, respectively. Marathon training decreased mean weight (-1.6 kg), fat percentage (-2.7%), and BMI (-0.5 kg/m2) and increased maximal oxygen uptake (+3.2 ml/kg/min) and insulin sensitivity (+0.013 units) (p < 0.03 for all). During head-up tilt, systolic BP and cardiac output decreased, while diastolic BP, heart rate, and systemic vascular resistance (SVR) increased, but training did not affect these posture-induced changes. Initial aortic and third finger systolic/diastolic BP were numerically but not significantly lower in the marathon vs. control group (by 3.4/2.3 and 5.5/4.5 mmHg, respectively, p > 0.075). Final BP values were significantly lower in the marathon group (by 7.2/4.5 and 10.9/10.2 mmHg, respectively, p < 0.01). Marathon training reduced SVR by 167 dyn×s/cm5×m2(p = 0.041), and extracellular water volume by 0.34 L (p = 0.045). To conclude, aerobic exercise training appears to lower BP, a significant cardiovascular risk factor, by reducing SVR and decreasing extracellular water volume.

Chinese herb pairs for cardiovascular and cerebrovascular diseases: Compatibility effects, pharmacological potential, clinical efficacy, and molecular mechanisms

ETHNOPHARMACOLOGICAL RELEVANCE

Cerebrovascular and cardiovascular diseases are pathophysiologically interconnected. In the past, researchers have mainly focused on developing one herbal medicine treatment. Single herb often fails to address the multifactorial pathology of these diseases. The pathogenesis and progression of the disease are complex, making the therapeutic effect of a single herb potentially limiting. Traditional Chinese medicine emphasizes herb pairs, which enhance therapeutic efficacy through synergistic interactions.

AIM OF THE REVIEW

This review focused on the mechanisms and potential clinical applications of Chinese herb pairs such as Astragali Radix-Carthami Flos, Salviae Miltiorrhizae Radix-Puerariae Lobatae Radix, Salviae Miltiorrhizae Radix-Chuanxiong Rhizoma, Salviae Miltiorrhizae Radix-Notoginseng Radix, Salviae Miltiorrhizae Radix-Carthami Flos, Astragali Radix-Angelicae Sinensis Radix, Notoginseng Radix-Carthami Flos, and Astragali Radix-Salviae Miltiorrhizae Radix, as well as provided a scientific basis for clinical applications of Chinese herb pairs.

MATERIALS AND METHODS

A systematic search and collection of studies on Chinese herb pairs in cardiovascular and cerebrovascular diseases was carried out using electronic databases such as PubMed, CNKI, Wan Fang Database, Baidu Scholar, and Web of Science. The keywords searched included Chinese herb pairs, cardiovascular disease, cerebrovascular disease, Astragali Radix, Salviae Miltiorrhizae Radix, Angelicae Sinensis Radix, Carthami Flos, Notoginseng Radix, and so on.

RESULTS

Studies revealed that the Chinese herb pairs had more beneficial effects than single herb and demonstrated a variety of roles in cardiovascular and cerebrovascular diseases. Preclinical studies indicated that Chinese herb pairs are more effective than single herb in treating cardiovascular and cerebrovascular diseases by modulating disease-related pathways and molecular targets. Further research is needed to fully explore their potential. The review also outlined the potential clinical applications of these Chinese herb pairs, highlighting their safety and efficacy.

CONCLUSIONS

Chinese herb pairs showed good promise as an alternative therapy for cardiovascular and cerebrovascular diseases due to their multi-component and multi-target characteristics. Consequently, further research was necessary to fully explore the potential of Chinese herb pairs in treating cardiovascular and cerebrovascular diseases, based on the current data.

Rethinking arterial hypertension: the need for a paradigm shift

PURPOSE OF REVIEW

Essential (primary or idiopathic) hypertension is presented as the most prevalent 'cause' of arterial hypertension, which is a paradoxical statement for a condition whose causes are unknown. The consequence of this description is that secondary hypertension is held to be exceptional and, therefore, very rarely sought for in current clinical practice. Labelling a hypertensive patient as 'essential' means that no further investigations will be undertaken to discover the cause of hypertension, therefore neglecting the possibility of long-term cure of hypertension and sentencing the patient to a life-long drug treatment.

RECENT FINDINGS

We will describe how the notion of essential hypertension has developed and whether scientific evidence from the most recent studies still support the conclusion that it is highly prevalent. The concept of secondary hypertension along with the criteria to be used to define it as such are also being examined.

SUMMARY

The evidence that secondary hypertension is highly prevalent, when systematically sought for, should increase the awareness of this condition and lead to a broader search for it, which are fundamental steps to achieve cure or a better control of high blood pressure, thus improving patients' outcome and quality of life.

Impact of Renin-Angiotensin-Aldosterone System (RAAS) Gene Polymorphism in Essential Hypertension and Antihypertensive Drug Therapy: A Review

Genetic, demographic and environmental factors all play a role in the frequency of an intricate multifactorial condition known as hypertension. Approximately 30% and 50% of BP fluctuation are influenced by genetic variability. Many genetic studies have confirmed the link between genetic variability and susceptibility to essential hypertension; hence, identifying genes associated with essential hypertension susceptibility will aid in understanding the pathophysiology and their influence on how an individual responds towards the antihypertensive therapy. There are also controversial results highlighted in some reports. This review summarises genetic variants of the renin-angiotensin-aldosterone system (RAAS), angiotensinogen (AGT) (M235T), angiotensin converting enzyme (ACE) (insertion/deletion), angiotensin II type 1 receptor (AT1R) (A1166C) and aldosterone synthase (C344T) that are known and might contribute towards the pathophysiology of essential hypertension. Furthermore, the review highlights the response of certain RAAS gene polymorphisms (renin, ACE and AT1R genes) to antihypertensive drugs.

Moringa oleifera and Blood Pressure: Evidence and Potential Mechanisms

The prevalence of hypertension is increasing worldwide, in particular in developing countries. Anti-hypertensive drugs are commonly used to treat hypertension. However, in developing countries, where access to health care is scarce and the supply system is poor, anti-hypertensive drugs may not always be available. Moringa oleifera is a plant widely found in developing countries, with its leaves, seeds, flowers, roots, and pods used both for nutritional purposes and in traditional medicine to treat various diseases, including hypertension. This review summarizes the evidence, both in animal and human models, about the antihypertensive effects of different parts of M. oleifera, discusses possible mechanisms of action, explores its bioactive compounds with potential antihypertensive properties, and highlights the limitations of its use as a hypotensive agent. Many preclinical studies attribute antihypertensive properties to M. oleifera, particularly the leaves. However, it is premature to draw firm conclusions, as there is a great lack of randomized controlled trials demonstrating its real efficacy. The mechanisms of action and the compounds responsible for the hypotensive effect have not yet been fully elucidated. Therefore, further clinical trials showing its efficacy are strongly required before promoting Moringa for therapeutic purposes. At present, Moringa remains a plant with nutritional and pharmacological potential.

Hypotension after induction of anesthesia with remimazolam or etomidate: a non-inferiority randomized controlled trial in patients undergoing coronary artery bypass grafting

BACKGROUND

Remimazolam is a novel ultra-short-acting benzodiazepine known for its hemodynamic stability over propofol. However, its hemodynamic effects compared to those of etomidate are not well established. This study aimed to determine whether the use of remimazolam is non-inferior to etomidate with regard to the occurrence of post-induction hypotension in patients undergoing coronary artery bypass grafting.

METHODS

Patients were randomly assigned to either the remimazolam group (6 mg/kg/h) or the etomidate group (0.3 mg/kg) for induction of anesthesia. Anesthetic depth was adjusted based on the bispectral index. Primary outcome was the incidence of post-induction hypotension, defined as a mean arterial pressure less than 65 mmHg within 15 min after endotracheal intubation, with a non-inferiority margin of 12%.

RESULTS

A total of 144 patients were finally analyzed. Incidence of post-induction hypotension was 36/71 (50.7%) in the remimazolam group and 25/73 (34.2%) in the etomidate group, with a rate difference of 16.5% (95% CI [3.0-32.6]) between the two groups that was beyond the prespecified non-inferiority margin of 12.0%. The number of patients who needed vasopressors was similar in the two groups.

CONCLUSIONS

In this non-inferiority trial, remimazolam failed to show non-inferiority to etomidate in terms of post-induction hypotension when used as an induction drug for general anesthesia in patients undergoing coronary artery bypass grafting. However, different doses or infusion techniques of remimazolam should be compared with etomidate in various patient groups to fully assess its hemodynamic non-inferiority during induction of anesthesia.

A Two-Way Communication Between Apical Periodontitis and Various Systemic Disorders: A Narrative Review

One prevalent inflammatory disorder that affects the mouth is apical periodontitis. It starts with an infection in the tooth's pulp chamber. The periapical bone may eventually deteriorate as a result of this infection spreading there. Systemic immune responses are triggered when inflammatory cytokines generated in periapical lesions and pathogens and their metabolites in the periapical tissues enter the bloodstream. Numerous systemic disorders may emerge as a result of this procedure. Although endodontic infections can be influenced by systemic disorders, there is ample evidence that these infections can also result in bodily changes that impair general health. Therefore, rather than being a limited oral problem, apical periodontitis may be associated with systemic illnesses. Furthermore, individuals with chronic inflammation-related diseases may experience hyperinflammatory states, which could influence the progression or outcome of apical periodontitis. The underlying mechanisms and the relationship between apical periodontitis and systemic diseases are still unknown. Even though this topic has been explored previously, new information has just come to light. This review's objective is to evaluate the body of knowledge regarding the evolving relationships between endodontic therapy, apical periodontitis, and systemic health. Gaining a better understanding of this relationship will help medical professionals identify risk factors and enhance the recovery of apical periodontitis and systemic illnesses.

Re-thinking the link between exposure to mercury and blood pressure

Hypertension or high blood pressure (BP) is a prevalent and manageable chronic condition which is a significant contributor to the total global disease burden. Environmental chemicals, including mercury (Hg), may contribute to hypertension onset and development. Hg is a global health concern, listed by the World Health Organization (WHO) as a top ten chemical of public health concern. Most people are exposed to some level of Hg, with vulnerable groups, including Indigenous peoples and small-scale gold miners, at a higher risk for exposure. We published a systematic review and meta-analysis in 2018 showing a dose-response relationship between Hg exposure and hypertension. This critical review summarizes the biological effects of Hg (both organic and inorganic form) on the underlying mechanisms that may facilitate the onset and development of hypertension and related health outcomes and updates the association between Hg exposure (total Hg concentrations in hair) and BP outcomes. We also evaluated the weight of evidence using the Bradford Hill criteria. There is a strong dose-response relationship between Hg (both organic and inorganic) exposure and BP in animal studies and convincing evidence that Hg contributes to hypertension by causing structural and functional changes, vascular reactivity, vasoconstriction, atherosclerosis, dyslipidemia, and thrombosis. The underlying mechanisms are vast and include impairments in antioxidant defense mechanisms, increased ROS production, endothelial dysfunction, and alteration of the renin-angiotensin system. We found additional 16 recent epidemiological studies that have reported the relationship between Hg exposure and hypertension in the last 5 years. Strong evidence from epidemiological studies shows a positive association between Hg exposure and the risk of hypertension and elevated BP. The association is mixed at lower exposure levels but suggests that Hg can affect BP even at low doses when co-exposed with other metals. Further research is needed to develop robust conversion factors among different biomarkers and standardized measures of Hg exposure. Regulatory agencies should consider adopting a 2 µg/g hair Hg level as a cut-off for public health regulation, especially for adults older than child-bearing age.

The effect of Shirodhara on essential hypertension: Systematic review and meta-analysis

Essential hypertension, a common multifactorial condition, is a significant public health concern. In India, the prevalence of hypertension is high, with estimates indicating a rising trend. Shirodhara, an Ayurvedic therapy, has exhibited the potential for stress reduction and relaxation. Thus, the review investigates the effect of Shirodhara on systolic and diastolic blood pressure and its impact on clinical symptoms like palpitation, insomnia, giddiness, fatigue, and headache in essential hypertensive patients. We searched PubMed, Embase, Scopus, Google Scholar, and Shodhganga, Web of Science search for this systematic review and meta-analysis from inception to June 2023. Evidence from RCTs was synthesized as a standardized mean difference (SMDs) for systolic and diastolic blood pressure, comparing participants who received Shirodhara intervention along with Ayurveda medication and those who received only Ayurveda medication. The Revised Cochrane Risk of Bias tool for randomized control trials (RoB-2) was used for the quality assessment of randomized control trials. Analysis was done using Medcalc software. The comparison table is provided for the percentage of relief in clinical symptoms in both groups. Out of four RCTs, only three were included for quantitative analysis, which mentioned the mean and standard deviation of systolic and diastolic blood pressure. Meta-analyses revealed the effects of Shirodhara on systolic blood pressure (n = 100), the mean difference (MD) was - 1.257 mmHg, (2.660-0.145), I 2 = 89.3%, and diastolic blood pressure (n = 100) MD was - 0.40 mmHg, (-0.79-0.01) I 2 = 0. The percentage of relief in clinical symptoms was notably higher in the Shirodhara and Ayurveda groups than in the Ayurvedic drug group. Shirodhara lowered diastolic blood pressure significantly, but it has low clinical value. Shirodhara's effect on systolic blood pressure remained unclear. Relief in clinical symptom score was notable. Larger, well-designed research is needed to prove Shirodhara's effectiveness in hypertension management and optimize therapy methods.

Non-Contact Optical Blood Pressure Biometry Using AI-Based Analysis of Non-Mydriatic Fundus Imaging

Background

This study was developed to determine whether a machine learning model could be developed to assess blood pressure with accuracy comparable to arm cuff measurements.

Methods

A deep learning model was developed based on the UK Biobank dataset and was trained to detect both systolic and diastolic pressure. The hypothesis was formulated after data collection and before the development of the model. Comparison was conducted between arm cuff measurements, as ground truth, and results from the model, using Mean Absolute Error, Mean Squared Error, and Coefficient of Determination (R^2).

Results

Systolic pressure was measured with 9.81 Mean Absolute Error, 165.13 Mean Squared Error and 0.36 R^2. Diastolic pressure was measured with 6.00 Mean Absolute Error, 58.21 and 0.30 R^2.

Conclusions

This model improves on existing research and shows errors comparable to the variability of hand cuff measurements. The use of fundus images to assess blood pressure may be more indicative of long-term hypertension. Additional trials in clinical settings may be necessary, as well as additional prospective studies to validate results.

Determinant factors of the longitudinal pulse pressure among hypertensive patients treated at Assosa general hospital, Western Ethiopia

BACKGROUND

Hypertension is a common, long-term condition that tends to be associated with age and can lead to significant cardiovascular complications. This study aimed to identify factors influencing the longitudinal Pulse Pressure of hypertensive patients treated at Assosa General Hospital (AGH), Western Ethiopia.

METHODS

A retrospective study design was conducted from 325 randomly selected HTN patients in the outpatient department (OPD) clinic at AGH during the follow-up period from January 2022 to January 2024. The analysis included exploratory data analysis and the application of a linear mixed model. This model was used to analyze the longitudinally measured pulse pressure in patients with hypertension. The appropriate variance-covariance structure chosen for this analysis was the unstructured (UN) format.

RESULT

Among the 325 patients included in the study, 51.5% were female, and 54.2% were from urban areas. The variables: Age (p-value < 0.0001), Urban (p-value = 0.012), FHHTN (p-value < 0.0238), Stage-I HTN (p-value = 0.0403), Stage-II HTN (p-value = 0.0022), DM (p-value < 0.0001), CKD (p-value < 0.0001), Smoking (p-value < 0.0001), Enalapril + Nifedipine (p-value = 0.0249), and follow-up time (p-value < 0.0001) were significant factors for the progression of pulse pressure.

CONCLUSION

The profile plot showed that the patient's pulse pressure decreases slowly as follow-up time increases. Age, Residence, FHHTN, DM, CKD, Smoking status, and Stages of HTN were positively associated with pulse pressure, whereas Treatment type and follow-up time were negatively associated with pulse pressure. So, Healthcare providers should prioritize addressing the modifiable risk factors mentioned above to help mitigate the progression of blood pressure specifically pulse pressure in hypertensive patients.

A study of impulsivity and adverse childhood experiences in a population health setting

As complex mental health traits and life histories are often poorly captured in hospital systems, the utility of using the Barratt Impulsivity Scale (BIS) and Adverse Childhood Experiences (ACEs) for assessing adult disease risks is unknown. Here, we use participants from the Healthy Nevada Project (HNP) to determine if two standard self-assessments could predict the incidence and onset of disease. We conducted a retrospective cohort study involving adult participants who completed the Behavioral and Mental Health Self-Assessment (HDSA) between September 2018 and March 2024. Impulsivity levels were measured using the BIS-15, and retrospective self-reports of ACEs were collected through a standardized questionnaire. In total, 17,482 HNP participants completed the HDSA. Our findings indicate that ACEs were significantly associated with impulsivity. Disease associations with impulsivity and ACEs were evaluated using a phenome-wide association study, identifying 230 significant associations with impulsivity. Among these, 44 were related to mental health diagnoses, including major depressive disorder (MDD). Kaplan-Meier survival estimates characterized the differences in the lifetime predicted probability between high and low impulsivity for major depressive disorder and essential hypertension. This analysis showed that having both high ACEs and high impulsivity confer substantial risk of MDD diagnosis (hazard ratios 2.81, 2.17, respectively). Additionally, lifetime predicted probability of MDD was approximately 40% higher for high ACEs and high impulsivity compared to no ACEs and low impulsivity. Essential hypertension demonstrated similar trends, with an approximate 20% increase in predicted lifetime probability of diagnosis. These results demonstrate that high ACES and elevated impulsivity scores are associated with a range of negative health outcomes and a simple self-assessment of complex traits and life history may significantly impact clinical risk assessments.

Omentin roles in physiology and pathophysiology: an up-to-date comprehensive review

Omentin (intelectin) was first detected in the visceral omental adipose tissue. It has mainly two isoforms, omentin-1 and -2, with isoform-1 being the main form in human blood. It possesses insulin-sensitizing, anti-inflammatory, anti-atherogenic, cardio-protective, and oxidative stress-decreasing effects. Omentin's cardiovascular protective actions are caused by the improved endothelial cell survival and function, increased endothelial nitric oxide synthase (eNOS) and nitric oxide (NO) bioavailability, enhanced vascular smooth muscle cells (VSMCs) relaxation with reduced proliferation, decreased inflammation, and suppressed oxidative stress. Omentin may also have a potential role in different cancer types and rheumatic diseases. Thus, omentin is an excellent therapeutic target in many diseases, including diabetes mellitus (DM), metabolic syndrome (MetS), cardiovascular diseases (CVDs), inflammatory diseases, and cancer. This review demonstrates the physiological functions of omentin in ameliorating insulin resistance (IR), vascular function, and inflammation and its possible share in managing obesity-linked diseases, such as metabolic disorders, DM, and cardiovascular conditions.

Smoking and Health Profiles of Hypertensive Patients with COVID-19: An Exploratory Study of Key Physiological Markers

Background/Objectives: Smoking and hypertension are major contributors to cardiovascular diseases, with smoker hypertensives typically presenting with exacerbated health risks. These factors are associated with COVID-19 aggravation, but their cumulative impact in the context of this disease remains understudied. Our hypothesis was that hypertensive smokers display a more vulnerable health profile (versus non-smokers) upon hospital admission for COVID-19. Methods: This exploratory observational study compared the clinical profiles of hypertensive COVID-19 patients depending on their smoking status. Focusing on key cardiometabolic, blood, renal, hepatic, and inflammatory markers, this investigation included 100 hypertensive COVID-19 patients (50 smokers and 50 non-smokers) aged 50 and above. Logistic regression and Spearman's correlations were used to identify significant predictors and relationships among variables. Results: Hypertensive smokers with COVID-19 were significantly more likely to exhibit higher heart rate (p = 0.047), left atrial size (p = 0.013) and diameter (p = 0.040), left ventricular end-systolic volume (p = 0.036), and interventricular septal thickness (p ≤ 0.001). These patients were also much more prone to display elevated CRP (p = 0.035) and hemoglobin (p = 0.011). The renal profiles of the smokers and non-smokers differed, with the smokers showing a significantly greater likelihood to have high serum urea (p = 0.036), but normal-to-low serum potassium (p = 0.011) and sodium (p ≤ 0.001). Their lipid profile was less favorable, with higher triglycerides (p ≤ 0.001), but lower HDL (p = 0.008). The strongest predictors of smoking status were interventricular septal thickness, triglycerides, and serum sodium. Conclusions: Hypertensive smokers admitted to the hospital with COVID-19 tend to exhibit a more adverse clinical profile, particularly in terms of cardiovascular remodeling, lipid imbalances, renal profile, and inflammation. These findings suggest that smoking exacerbates the effects of hypertension in the context of COVID-19, highlighting the need for more aggressive monitoring and management in this patient group.

Prescriber Adherence to Antihypertensive Prescription Guidelines and the Impact of Patient Socioeconomic Factors: A Cross-Sectional Study Using Data From the Irish Longitudinal Study on Ageing

PURPOSE

Uncontrolled hypertension causes significant morbidity and mortality worldwide. Several prescribing guidelines have been created to address this, however, prescriber adherence to guidelines is influenced by various sociodemographic patient factors. This study aims to determine the effects of these patient factors on prescriber adherence to antihypertensive prescription guidelines.

METHODS

A secondary analysis of data from the first wave of The Irish Longitudinal Study on Ageing (TILDA), was conducted. Participants were included if they reported previous hypertension diagnoses. Antihypertensive medication regimes were compared with the prescribing guidance in the 2011 NICE hypertension guidelines. The effects of patient sociodemographic factors on prescriber adherence to guidelines, and the effect of prescriber adherence on blood pressure control (≥ 140/90 mmHg), were determined using binomial logistic regression models.

RESULTS

A total of 2992 participants were included in this analysis; 54.9% female with mean age 65.7 years (±9.23). Male sex and older age, and lower socioeconomic status were associated with increased prescriber guideline adherence. Prescribers were less likely to adhere to guidelines in female patients ≥ 55 years (Relative Risk [RR] 0.75 [0.62, 0.91]), and female patients across all age groups (RR 0.80 [0.67, 0.95]). Better blood pressure control was seen with medication regimes adherent to prescription guidelines (140.38 (±18.98)/83.09 (±11.02) mmHg adherent vs. 141.66 (±19.86)/84.77 (±11.71) mmHg non-adherent).

CONCLUSIONS

This study highlights the effect of patient sex on prescriber adherence to antihypertensive prescription guidelines, emphasizing a larger issue of systemic undertreatment of females observed within healthcare. Further research is needed to determine the reasons for such differences in hypertensive care.

Renal Inflammation, Oxidative Stress, and Metabolic Abnormalities During the Initial Stages of Hypertension in Spontaneously Hypertensive Rats

Background: Hypertension is a major cause of mortality worldwide. The kidneys play a crucial role in regulating blood pressure and fluid volume. The relationship between the kidneys and hypertension is complex, involving factors such as the renin-angiotensin system, oxidative stress, and inflammation. This study aims to assess the levels of inflammatory markers, oxidative stress, and metabolic factors in the kidneys, focusing on their potential role in early renal damage and their association with the development of hypertension. Methods: This study was designed to compare the levels of selected inflammatory markers, e.g., interleukins, tumor necrosis factor-α (TNF-α), transforming growth factor, and serine/threonine-protein (mTOR); oxidative stress markers such as malondialdehyde, sulfhydryl group, and glucose (GLC); and metabolic markers among other enzymes, such as alanine transaminase (ALT), aspartate transaminase (AST), hexokinase II (HK-II), and hypoxia-inducible factor-1α (HIF-1α), as well as creatinine in the kidneys of spontaneously hypertensive rats (SHR/NCrl, n = 12) and Wistar Kyoto rats (WKY/NCrl, n = 12). Both juvenile (5 weeks old) and maturing (10 weeks old) specimens were examined using spectrophotometric methods, e.g., ELISA. Results: Juvenile SHRs exhibited reduced renal levels of all studied cytokines and chemokines, with lower oxidative stress and deficits in the mTOR and HK-II levels compared to the age-matched WKYs. Maturing SHRs showed increased renal levels of interleukin-1β (IL-1β), IL-6, IL-18, and TNF-α, alongside elevated carbonyl stress and increased HIF-1α as opposed to their control peers. The levels of all other studied markers were normalized in these animals, except for ALT (increased), ALP, and GLC (both reduced). Conclusions: This study underscores the significant impact of inflammatory, oxidative stress, and metabolic marker changes on renal function. Juvenile SHRs display lower marker levels, indicating an immature immune response and potential subclinical kidney damage that may contribute to hypertension development. In contrast, mature SHRs exhibit chronic inflammation, oxidative dysregulation, and metabolic disturbances, suggesting cellular damage. These changes create a feedback loop that worsens kidney function and accelerates hypertension progression, highlighting the kidneys' crucial role in both initiating and exacerbating this condition.

Exaggerated postnatal surge of orexin neurons and the effects of elimination of excess orexin on blood pressure and exaggerated chemoreflex in spontaneously hypertensive rats

An overactive orexin (OX) system is associated with neurogenic hypertension and an exaggerated chemoreflex in spontaneously hypertensive rats (SHRs). However, the chronology and mechanism of this association is unclear. We hypothesized that increased postnatal neurogenesis of OX neurons in SHRs precedes and contributes to the aberrant increase in mean arterial blood pressure (MAP) and the exaggerated response to hypercapnia during postnatal development. Using immunohistochemical methods and bromodeoxyuridine, we mapped the timeline of orexin neuron neurogenesis and maturation during early postnatal development. We then used whole-body plethysmography with EEG and EMG to map the development of mean arterial pressure (MAP) and state regulation. Finally, we used OX-targeted saporin toxin to determine the effects of eliminating excess OX neurons on the elevated MAP and exaggerated chemoreflex in adult SHRs. We found that both SHRs and Wistar-Kyoto (WKY) rats experienced postnatal increases in OX neurons. However, SHRs experienced a greater increase than WKY rats before P15, which led to significantly more OX neurons in SHRs than age-matched WKY controls by P15-16 (3,720 ± 780 vs. 2,406 ± 363, p = 0.005). We found that neurogenesis, as evidenced by BrdU staining in OX-positive neurons, was the primary contributor to the excess OX neurons in SHRs during early postnatal development. While SHRs develop more OX neurons by P15-16, SHRs and normotensive WKY control rats have similar MAP during postnatal development until P25 in wakefulness (81.6 ± 6.6 vs. 67.5 ± 6.8 mmHg, p = 0.006) and sleep (79.3 ± 6.1 vs. 66.6 ± 6.5, p = 0.009), about 10 days after the surge of OX neurons. By selectively eliminating excess (∼30%) OX neurons in SHRs, we saw a significantly lowered MAP and hypercapnic ventilatory chemoreflex compared to non-lesioned SHRs at P40. Additionally, we found unique signatures in state indicative of the attention defecit phenotype commonly associated with this model. We suggest that the postnatal increase of OX neurons, primarily attributed to exaggerated postnatal OX neurogenesis, may be necessary for the development of higher MAP and exaggerated chemoreflex in SHRs, and modulation of the overactive OX system may have a potential therapeutic effect during the pre-hypertensive period.

The role of eprosartan in the management of essential hypertension: literature review and expert opinion

INTRODUCTION

Eprosartan is an angiotensin receptor blocker (ARB) used for management of essential hypertension. With unique pharmacological characteristics, dual action mechanism, and clinical effectiveness, eprosartan offers additional advantages over other ARBs in specific patient populations.

AREAS COVERED

A comprehensive review of the literature was performed across publicly available databases, with no time limitations, to ensure the inclusion of all relevant studies. The review focuses on presenting the efficacy and safety profile of eprosartan, alone or in combination with other agents. Additionally, it explores the etiology of hypertension concerning the structure and function of angiotensin II type 1 receptors. Further, the efficacy of eprosartan in special populations and its additional benefits are also discussed.

EXPERT OPINION

Eprosartan effectively reduces blood pressure (BP), with a 24-hour BP-lowering effect at 600 mg/day. Eprosartan demonstrates similar or better efficacy than other ARBs, such as telmisartan and losartan, particularly in managing coagulation-related abnormalities and peripheral resistance. In combination therapy, eprosartan with hydrochlorothiazide significantly enhances BP reduction. Eprosartan is well-tolerated, with a low incidence of adverse events, making it a reliable choice for long-term hypertension management across various patient populations, such as those with comorbid diabetes and renal disease and older adults.

Inflammation-based markers, especially the uric acid/albumin ratio, are associated with non-dipper pattern in newly diagnosed treatment-naive hypertensive patients

OBJECTIVE

Physiologically, at night, blood pressure (BP) is expected to decrease by at least 10% in hypertensive individuals. The absence of this decrease, called non-dipper hypertension, is associated with increased end-organ damage and cardiovascular mortality and morbidity in hypertensive individuals. It is known that increased inflammatory process plays an important role in the etiopathogenesis of non-dipper hypertension pattern. In recent years, it has been shown that inflammation-based markers (IBMs) obtained by combining various inflammation-related hematological and biochemical parameters in a single fraction have stronger predictive value than single inflammatory parameters. However, until now, there has not been a study investigating the relationship of these markers with dipper/non-dipper status in newly diagnosed hypertensive patients.

METHODS

Based on ambulatory BP monitoring, 217 dipper and 301 non-dipper naive hypertensive subjects were included in this study. All subjects' IBM values were compared between dipper and non-dipper hypertensive individuals.

RESULTS

IBMs [C-reactive protein/albumin ratio (CAR), monocyte/high-density lipoprotein cholesterol ratio (MHR), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio, systemic immune-inflammation index (SII), uric acid/albumin ratio (UAR)] were significantly higher in the non-dipper group. CAR, MHR, NLR, SII, and UAR were determined as independent predictors for non-dipper pattern ( P  < 0.05, for all). Also, UAR's diagnostic performance for non-dipper pattern was found to be superior to other IBMs (area under the curve: 0.783, 95% confidence interval: 0.743-0.822; P  < 0.001).

CONCLUSION

These findings suggest an association between elevated IBMs, particularly UAR, and the non-dipper hypertension pattern observed in our study.

Immediate-Release versus Extended-Release Tacrolimus: Comparing Blood Pressure Control in Kidney Transplant Recipients - A Retrospective Cohort Study

BACKGROUND

Hypertension (HTN) is a common side effect of tacrolimus (Tac), the first-line antirejection medication for kidney transplant recipients. The impact of immediate-release tacrolimus (Tac IR) dosed twice daily versus extended-release tacrolimus (Tac ER) dosed once daily on long-term blood pressure control in kidney transplant recipients remains understudied. This study aims to compare the use of Tac IR versus Tac ER in kidney transplant recipients and evaluate the effects of the different formulations on systolic blood pressure (SBP), diastolic blood pressure (DBP), and HTN crisis.

METHODS

This retrospective cohort study at a single institution collected baseline characteristics, time-varying exposure to Tac IR versus Tac ER, SBP, DBP, HTN crisis, and confounders at each posttransplant visit. A marginal structural linear mixed-effects model was employed to analyze the longitudinal blood pressure control in kidney transplant recipients receiving Tac IR and Tac ER.

RESULTS

The final analysis included 654 patients, with mean ages of 52.0 years for Tac IR and 50.3 years for Tac ER. Males constituted 56.7% in Tac IR and 55.0% in Tac ER. Notably, the black population had 2.44 times higher odds of receiving Tac ER after adjusting for the rest of the baseline characteristics. No difference was found between longitudinal SBP (p = 0.386, 95% CI: -1.00, 2.57) or DBP (p = 0.797, 95% CI: -1.38, 1.06).

CONCLUSION

Our study indicates that posttransplant patients taking Tac ER exhibit no difference in chronic SBP and DBP controls compared to Tac IR.

Microglia in the hypothalamic paraventricular nucleus sense hemodynamic disturbance and promote sympathetic excitation in hypertension

Hypertension is usually accompanied by elevated sympathetic tonicity, but how sympathetic hyperactivity is triggered is not clear. Recent advances revealed that microglia-centered neuroinflammation contributes to sympathetic excitation in hypertension. In this study, we performed a temporospatial analysis of microglia at both morphological and transcriptomic levels and found that microglia in the hypothalamic paraventricular nucleus (PVN), a sympathetic center, were early responders to hypertensive challenges. Vasculature analyses revealed that the PVN was characterized by high capillary density, thin vessel diameter, and complex vascular topology relative to other brain regions. As such, the PVN was susceptible to the penetration of ATP released from the vasculature in response to hemodynamic disturbance after blood pressure increase. Mechanistically, ATP ligation to microglial P2Y12 receptor was responsible for microglial inflammatory activation and the eventual sympathetic overflow. Together, these findings identified a distinct vasculature pattern rendering vulnerability of PVN pre-sympathetic neurons to hypertension-associated microglia-mediated inflammatory insults.

'Essential' arterial hypertension: time for a paradigm change

The exclusion of causes of hypertension is not systematically exploited in clinical practice. Therefore, essential hypertension is consistently presented as the most prevalent 'cause'. The paradox of a condition with unknown causes being described as a common cause of hypertension translates into a diagnosis of essential hypertension in most patients, which precludes the detection of a curable cause of hypertension. The aim of this review is to investigate how the notion of essential hypertension has developed and whether scientific evidence still support the notion of its high prevalence by examining the most recent studies. These studies provided solid scientific evidence that, when systematically sought for, secondary hypertension is quite common and that secondary hypertension is highly prevalent. The increased awareness should lead to a systematic search for, with the goal of curing or achieving a better control of high blood pressure, and ultimately improving patients' quality of life.

Assessing radiation-induced carotid artery injury using ultrasound in patients with head and neck cancer

BACKGROUND AND PURPOSE

Radiotherapy (RT) can damage neck vessels in patients with head and neck cancer (HNC). This study investigated the early effects of RT on carotid artery, including the internal media thickness (IMT) and carotid plaques of the common carotid artery (CCA).

MATERIALS AND METHODS

This study included 69 patients with HNC who underwent RT at the First Hospital of Jilin University from March 2017 to September 2022, and 69 healthy participants as controls. Color Doppler ultrasound (CDUS) of the carotid artery was used to measure the CCA IMT and plaques.

RESULTS

Left CCA IMT increased from 0.60 mm (0.60, 0.70) before RT to 0.70 mm (0.60, 1.20) after RT (P < 0.0001). Right CCA IMT changed from 0.60 mm (0.60, 0.71) before RT to 0.60 mm (0.60, 1.10) after RT (P = 0.0002). CCA IMT was 0.60 mm (0.60, 0.70) and 0.80 mm (0.60, 1.20) in the ≤40 Gy and >40 Gy groups (P = 0.0004). The CCA plaques number increased significantly after RT on both the left and right sides (Pleft < 0.0001; Pright <0.0001). The CCA plaques volume increased from 0 mm3 (0, 11.35) and 0 mm3 (0, 8.55) before RT to 8.8 mm3 (0, 21.5) and 5.8 mm3 (0, 16.1) on the left and right sides. Correlation analysis revealed a correlation between CCA IMT and age (r = 0.283, P = 0.001), smoking status (r = 0.179, P = 0.020), and radiation dose (r = 0.188, P = 0.028).

CONCLUSION

RT significantly increased CCA IMT, and the growth was related to the radiation dose. The number and volume of the CCA plaques also increased after RT.

AGT, CYP11B2 & ADRB2 gene polymorphism & essential hypertension (HT): A meta-analysis

Background & objectives The results of the genetic association studies between the selected candidate genes and hypertension (HT) contradicted across different populations. Majority of the meta-analyses carried out did not consider population genetic ancestry as a confounding factor. Therefore, this meta-analysis attempted to consolidate and re-evaluate the findings of the association between the selected candidate variants (AGT-rs699, CYP11B2-rs1799998, ADRB2-rs1042713 and rs1042714) and HT, by categorizing the genotyping data based on known genetic ancestry, and/or major geographical populations. Methods Publications were retrieved from PubMed, Cochrane and World of Science. The included articles were further divided into different populations based on their known genetic and/or geographical ancestry. Results AGTrs699-G was significantly associated with HT among Indians for (i) allele [P=0.03, Odds ratio (OR): 1.37, 95% Confidence Interval (CI): 1.03-1.82], and (ii) dominant mode of inheritance (P=0.009, OR:1.45, 95% CI: 1.09-1.91). CYP11B2rs1799998-G was significantly associated with HT in Europeans for (i) allele (P=6.9 × 10-5, OR: 0.82, 95% CI: 0.74-0.9), (ii) recessive (P=6.38 × 10-5, OR: 0.7, 95% CI: 0.59-0.83) and (iii) dominant mode of inheritance (P=0.008, OR: 0.81, 95% CI: 0.7-0.94). ADRB2-rs1042713-G was significantly associated with HT in east Asians for (i) allele (P=0.01, OR: 1.26, 95% CI: 1.05-1.51), and (ii) recessive mode of inheritance (P=0.04, OR: 1.36, 95% CI: 1.01-1.83). Interpretation & conclusions Different genotype and allele frequencies in diverse populations result in different genetic associations with HT across populations. This meta-analysis finding provides an update and summary of the genetic association between the selected simple nucleotide polymorphism (SNPs) and HT across different populations and essential insights into selecting appropriate pharmacogenetic marker(s) for effective HT management in populations of different ancestries.

Proteomic Analysis of Prehypertensive and Hypertensive Patients: Exploring the Role of the Actin Cytoskeleton

Hypertension is a pervasive and widespread health condition that poses a significant risk factor for cardiovascular disease, which includes conditions such as heart attack, stroke, and heart failure. Despite its widespread occurrence, the exact cause of hypertension remains unknown, and the mechanisms underlying the progression from prehypertension to hypertension require further investigation. Recent proteomic studies have shown promising results in uncovering potential biomarkers related to disease development. In this study, serum proteomic data collected from Qatar Biobank were analyzed to identify altered protein expression between individuals with normal blood pressure, prehypertension, and hypertension and to elucidate the biological pathways contributing to this disease. The results revealed a cluster of proteins, including the SRC family, CAMK2B, CAMK2D, TEC, GSK3, VAV, and RAC, which were markedly upregulated in patients with hypertension compared to those with prehypertension (fold change ≥ 1.6 or ≤-1.6, area under the curve ≥ 0.8, and q-value < 0.05). Pathway analysis showed that the majority of these proteins play a role in actin cytoskeleton remodeling. Actin cytoskeleton reorganization affects various biological processes that contribute to the maintenance of blood pressure, including vascular tone, endothelial function, cellular signaling, inflammation, fibrosis, and mechanosensing. Therefore, the findings of this study suggest a potential novel role of actin cytoskeleton-related proteins in the progression from prehypertension to hypertension. The present study sheds light on the underlying pathological mechanisms involved in hypertension and could pave the way for new diagnostic and therapeutic approaches for the treatment of this disease.

THE RISKS OF FIRST ONSET PRIMARY HYPERTENSION DIAGNOSIS IN THERMAL-INJURED PATIENTS

ABSTRACT

Introduction: Hypertension is a prevalent condition in the United States and leads to an increased risk of developing various comorbidities. However, the impact of new-onset hypertension after severe burns on patient outcomes is not known. We posit that hypertension onset after severe burn is associated with increased risk of developing comorbidities and mortality. Methods: Using the TriNetX database, burned patients diagnosed with essential hypertension after injury were compared with those who did not develop hypertension; neither had prior hypertension. Each cohort was grouped by sex, percent total body surface area (TBSA) burned, and age, then propensity matched for sex, race, ethnicity, and laboratory values. Outcomes assessed were acute kidney injury (AKI), hyperglycemia, heart failure, myocardial infarction (MI), and death. Results: Those diagnosed with hypertension after severe burn were 4.9 times more likely to develop AKI, 3.6 times for hyperglycemia, 5.3 times for heart failure, 4.7 times for acute MI, and 1.5 times for mortality. Sex analysis shows that men were at greater risk for AKI (1.5 times), heart failure (1.1 times), and death (1.4 times). Women were 1.3 times more likely to develop hyperglycemia. Percent TBSA burned grouping showed increased risk for all outcomes with increasing severity. Age grouping indicated an elevated risk of developing AKI, heart failure, acute MI, and death. Conclusion: New-onset hypertension diagnosis in severely burned patients is associated with acute kidney injury, heart failure, acute MI, and death. Overall, males, older patients, and those with a higher % TBSA burned are at a higher risk of developing these comorbidities.

Review Article on Molecular Mechanism of Regulation of Hypertension by Macro-elements (Na, K, Ca and Mg), Micro-elements/Trace Metals (Zn and Cu) and Toxic Elements (Pb and As)

Hypertension (HT) is a medical condition arising due to increase in blood pressure (BP) prevalent worldwide. The balanced dietary intakes of macro-elements and micro-elements including Na, K, Ca, Mg, Zn, and Cu have been described to maintain BP in humans by regulating the osmolarity of blood, cells/tissues, prevention of generation of oxidative and nitrosative stress (OANS), and endothelial damage through their functioning as important components of renin-angiotensin-aldosterone system (RAAS), antioxidant enzyme defense system, and maintenance of blood vascular-endothelial and vascular smooth muscle cell (VSMC) functions. However, inadequate/excess dietary intakes of Na/K, Ca/Mg, and Zn/Cu along with higher Pb and As exposures recognized to induce HT through common mechanisms including the followings: endothelial dysfunctions due to impairment of vasodilatation, increased vasoconstriction and arterial stiffness, blood clotting, inflammation, modification of sympathetic activity and higher catecholamine release, increased peripheral vascular resistance, and cardiac output; increased OANS due to reduced and elevated activities of extracellular superoxide dismutase and NAD(P)H oxidase, less nitric oxide bioavailability, decrease in cGMP and guanylate cyclase activity, increase in intracellular Ca2+ ions in VSMCs, and higher pro-inflammatory cytokines; higher parathyroid and calcitriol hormones; activation/suppression of RAAS resulting imbalance in blood Na+, K+, and water regulated by renin, angiotensin II, and aldosterone through affecting natriuresis/kaliuresis/diuresis; elevation in serum cholesterol and LDL cholesterol, decrease in HDL cholesterol due to defect in lipoprotein metabolism. The present study recommends the need to review simple dietary mineral intervention studies/supplementation trials before keeping their individual dietary excess intakes/exposures in consideration because their interactions lead to elevation and fall of their concentrations in body affecting onset of HT.

Role of the CCL5 and Its Receptor, CCR5, in the Genesis of Aldosterone-Induced Hypertension, Vascular Dysfunction, and End-Organ Damage

BACKGROUND

Aldosterone has been described to initiate cardiovascular diseases by triggering exacerbated sterile vascular inflammation. The functions of CCL5 (C-C motif chemokine ligand 5) and its receptor CCR5 (C-C motif chemokine receptor 5) are well known in infectious diseases, their contributions to aldosterone-induced vascular injury and hypertension remain unknown.

METHODS

We analyzed the vascular profile, blood pressure, and renal damage in wild-type (CCR5+/+) and CCR5 knockout (CCR5-/-) mice treated with aldosterone (600 µg/kg per day for 14 days) while receiving 1% saline to drink. Vascular function was analyzed in aorta and mesenteric arteries, blood pressure was measured by telemetry and renal injury and inflammation were analyzed via histology and flow cytometry. Endothelial cells were used to study the molecular signaling whereby CCL5 induces endothelial dysfunction.

RESULTS

Aldosterone treatment resulted in exaggerated CCL5 circulating levels and vascular CCR5 expression in CCR5+/+ mice accompanied by endothelial dysfunction, hypertension, and renal inflammation and damage. CCR5-/- mice were protected from these aldosterone-induced effects. Mechanistically, we demonstrated that CCL5 increased NOX1 (NADPH oxidase 1) expression, reactive oxygen species formation, NFκB (nuclear factor kappa B) activation, and inflammation and reduced NO production in isolated endothelial cells. These effects were abolished by antagonizing CCR5 with Maraviroc. Finally, aorta incubated with CCL5 displayed severe endothelial dysfunction, which is prevented by blocking NOX1, NFκB, or CCR5.

CONCLUSIONS

Our data demonstrate that CCL5/CCR5, through activation of NFκB and NOX1, is critically involved in aldosterone-induced vascular and renal damage and hypertension placing CCL5 and CCR5 as potential therapeutic targets for conditions characterized by aldosterone excess.

Left ventricle hypertrophy and re-modeling in children with essential hypertension: does the race matter?

BACKGROUND

This is the first study to report on the impact of race on differences in the prevalence of echocardiographic left ventricular hypertrophy and left ventricular adaptation at the time of diagnosis of essential hypertension in children.

METHODS

This cross-sectional, single-centre study included patients aged 3-18 years who had newly diagnosed essential hypertension. Echocardiography was used to assess left ventricular mass index and left ventricular relative wall thickness. An left ventricular mass index > the 95th percentile for age and gender, and an left ventricular relative wall thickness > 0.42, were used to diagnose left ventricular hypertrophy and concentric adaptation. Various echocardiographic parameters were compared between African Americans and Caucasians.

RESULTS

The study included 422 patients (289 African Americans and 133 Caucasians) diagnosed with essential hypertension at a median age of 14.6 (interquartile range; 12.1-16.3) years. Eighty-eight patients (20.9%) had left ventricular hypertrophy. There was no statistically significant difference in the prevalence of left ventricular hypertrophy between African Americans and Caucasians (22.5% versus 17.3%, p=0.22). The median left ventricular relative wall thickness was 0.35 (0.29-0.43), and 114 patients (27.0%) had an left ventricular relative wall thickness > 0.42. The presence of an left ventricular relative wall thickness > 0.42 was significantly higher among African Americans compared to Caucasians (30.1% versus 20.3%, p = 0.04). The African American race was a strong predictor for an left ventricular relative wall thickness > 0.42 (odds ratio 1.7, p = 0.04), but not for left ventricular mass index > the 95th percentile (p = 0.22). Overweight/obesity was a strong predictor for an left ventricular mass index > the 95th percentile.

CONCLUSIONS

There was no difference in the prevalence of left ventricular hypertrophy in children with essential hypertension of different races. Obesity, rather than being African American, is associated with left ventricular hypertrophy.

Exploring primary care physicians' challenges in using home blood pressure monitoring to manage hypertension in Singapore: a qualitative study

Objective

Hypertension guidelines recommend using home blood pressure (HBP) to diagnose, treat and monitor hypertension. This study aimed to explore the challenges primary care physicians (PCPs) face in using HBP to manage patients with hypertension.

Method

A qualitative study was conducted in 2022 at five primary care clinics in Singapore. An experienced qualitative researcher conducted individual in-depth interviews with 17 PCPs using a semi-structured interview guide. PCPs were purposively recruited based on their clinical roles and seniority until data saturation. The interviews were audio-recorded, transcribed verbatim and managed using NVivo qualitative data management software. Analysis was performed using thematic analysis.

Results

PCPs identified variations in patients' HBP monitoring practices and inconsistencies in recording them. Access to HBP records relied on patients bringing their records to the clinic visit. A lack of seamless transfer of HBP records to the EMR resulted in an inconsistency in documentation and additional workload for PCPs. PCPs struggled to interpret the HBP readings, especially when there were BP fluctuations; this made treatment decisions difficult.

Conclusion

Despite strong recommendations to use HBP to inform hypertension management, PCPs still faced challenges accessing and interpreting HBP readings; this makes clinical decision-making difficult. Future research should explore effective ways to enhance patient self-efficacy in HBP monitoring and support healthcare providers in documenting and interpreting HBP.

Computational investigation of the impact of potential AT2R polymorphism on small molecule binding

For more than a century, the renin-angiotensin system (RAS) has been acknowledged for playing a crucial part in the physiological control of arterial pressure, as well as sodium and fluid balance. It is now generally acknowledged that one of the receptor of RAS system i.e. angiotensin type 2 receptor (AT2R) functions as a repair system during pathophysiologic circumstances and performs a significant protective role. Efforts have been made previously to design suitable agonist and antagonist molecules to potentially modulate AT2R. One of the agonists and antagonists, named C21 and EMA401, has been studied in a number of pathological conditions. Additionally, a wide panel of single nucleotide polymorphisms (SNPs) has been reported for AT2R, which might potentially affect the efficacy of these molecules. Therefore, computational investigations have been carried out to analyze all the SNPs (1151) reported in NCBI to find potential SNPs affecting the active site of AT2R, as this domain is still unexplored. Structures of these polymorphic forms were modeled, and in silico drug interaction studies with C21 and EMA401 were carried out. The two mutants (rs868939201 and rs1042852794) that significantly affect the binding affinity as that of the wild type were subjected to molecular dynamics simulations. Our analysis of native and mutant AT2R and their complexes with C21 and EMA401 indicated that the occurrence of these mutations affects the conformation of the protein and has affected the binding of these ligand molecules. The study's findings will aid in the development of better, more versatile medications in the near future, and also in vitro and in vivo studies might be planned in accordance with recent findings.Communicated by Ramaswamy H. Sarma.

Prevalence of apical periodontitis and non-retention of root-filled teeth in hypertensive patients: Systematic review and meta-analysis

BACKGROUND

Several studies have suggested a relationship between AP, as well as the loss of root-filled teeth (RFT), and hypertension (HTN).

OBJECTIVES

The aims of this systematic review and meta-analysis were to investigate the prevalence of AP, and non-retention of RFT, in hypertensive patients.

METHODS

A search was performed in PubMed/MEDLINE, Web of Science, Scopus and EMBASE. The inclusion criteria established were studies published until February 2023, comparing hypertensive subjects with controls, assessing the prevalence of AP and/or providing data on the prevalence of non-retained RFT. Meta-analysis was performed using the RevMan (analyst) tool to determine the pooled prevalence of AP and loss of RFT. Risk of bias was assessed using the Cochrane Risk-of-Bias tool. The quality of evidence was assessed by GRADE.

RESULTS

The search strategy identified 454 articles, and only eight met the inclusion criteria. Six studies had analysed the association between AP and HTN and two studies had analysed the association between non-retention of RFT and HTN. Meta-analysis showed and overall OR = 1.71 (95% CI = 0.92-3.16; p = .09) for the prevalence of AP among patients with HTN. The prevalence of non-retention of RFT among patients with HTN has an overall OR = 1.78 (95% CI = 1.60-1.98; p = .000001). The risk of bias in the individual studies was low or moderate, and the quality of the overall evidence has shown a level of certainty very low.

DISCUSSION

There is no association between the prevalence of AP and HTN. In addition, hypertensive patients have significantly increased odds of losing RFT. Given the high prevalence of hypertension, it is very common to perform root canal treatments on hypertensive patients. It is imperative to communicate this heightened risk to patients and recommend periodic monitoring of oral health and hypertension, paying special attention to this subset of patients.

REGISTRATION

PROSPERO CRD42022302385.

Chronic Hypertension in Pregnancy and Placenta-Mediated Complications Regardless of Preeclampsia

BACKGROUND

The prevalence of chronic hypertension in women of reproductive age is on the rise mainly due to delayed childbearing. Maternal chronic hypertension, prevailing prior to conception or manifesting within the early gestational period, poses a substantial risk for the development of preeclampsia with adverse maternal and fetal outcomes, specifically as a result of placental dysfunction. We aimed to investigate whether chronic hypertension is associated with placenta-mediated complications regardless of the development of preeclampsia in pregnancy.

METHODS

This was a population-based, retrospective cohort study from 'Soroka' university medical center (SUMC) in Israel, of women who gave birth between 1991 and 2021, comparing placenta-mediated complications (including fetal growth restriction (FGR), placental abruption, preterm delivery, and perinatal mortality) in women with and without chronic hypertension. Generalized estimating equation (GEE) models were used for each outcome to control for possible confounding factors.

RESULTS

A total of 356,356 deliveries met the study's inclusion criteria. Of them, 3949 (1.1%) deliveries were of mothers with chronic hypertension. Women with chronic hypertension had significantly higher rates of all placenta-mediated complications investigated in this study. The GEE models adjusting for preeclampsia and other confounding factors affirmed that chronic hypertension is independently associated with all the studied placental complications except placental abruption.

CONCLUSIONS

Chronic hypertension in pregnancy is associated with placenta-mediated complications, regardless of preeclampsia. Therefore, early diagnosis of chronic hypertension is warranted in order to provide adequate pregnancy follow-up and close monitoring for placental complications, especially in an era of advanced maternal age.

Trends in prevalence of major etiologies leading to heart failure in young patients: An integrative review

The prevalence of Heart failure (HF) is increasing with the aging of the population but it is estimated that 10% of HF patients are younger than 50 years-old. HF development in this population is characterized with a fast-growing prevalence, and important disparities according to underlying etiologies or gender. These observations highlight the need to identify specific and preventable factors in these patients, a topic that is under-studied. Here we provide an overview of trends in prevalence of major etiologies leading to HF in young subjects, including genetic factors associated with cardiomyopathies, premature vascular dysfunction and related ischemia, metabolic stress, cardio-toxic responses to different agents, and myocarditis. We also highlight the increasing influence of major risk factors that are driving HF in younger patients, such as obesity, diabetes or arterial hypertension.

Primary Role of the Kidney in Pathogenesis of Hypertension

Previous transplantation studies and the concept of 'nephron underdosing' support the idea that the kidney plays a crucial role in the development of essential hypertension. This suggests that there are genetic factors in the kidney that can either elevate or decrease blood pressure. The kidney normally maintains arterial pressure within a narrow range by employing the mechanism of pressure-natriuresis. Hypertension is induced when the pressure-natriuresis mechanism fails due to both subtle and overt kidney abnormalities. The inheritance of hypertension is believed to be polygenic, and essential hypertension may result from a combination of genetic variants that code for renal tubular sodium transporters or proteins involved in regulatory pathways. The renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system (SNS) are the major regulators of renal sodium reabsorption. Hyperactivity of either the RAAS or SNS leads to a rightward shift in the pressure-natriuresis curve. In other words, hypertension is induced when the activity of RAAS and SNS is not suppressed despite increased salt intake. Sodium overload, caused by increased intake and/or reduced renal excretion, not only leads to an expansion of plasma volume but also to an increase in systemic vascular resistance. Endothelial dysfunction is caused by an increased intracellular Na+ concentration, which inhibits endothelial nitric oxide (NO) synthase and reduces NO production. The stiffness of vascular smooth muscle cells is increased by the accumulation of intracellular Na+ and subsequent elevation of cytoplasmic Ca++ concentration. In contrast to the hemodynamic effects of osmotically active Na+, osmotically inactive Na+ stimulates immune cells and produces proinflammatory cytokines, which contribute to hypertension. When this occurs in the gut, the microbiota may become imbalanced, leading to intestinal inflammation and systemic hypertension. In conclusion, the primary cause of hypertension is sodium overload resulting from kidney dysregulation.

Treating Primary Aldosteronism-Induced Hypertension: Novel Approaches and Future Outlooks

Primary aldosteronism (PA) is the most common cause of secondary hypertension and is associated with increased morbidity and mortality when compared with blood pressure-matched cases of primary hypertension. Current limitations in patient care stem from delayed recognition of the condition, limited access to key diagnostic procedures, and lack of a definitive therapy option for nonsurgical candidates. However, several recent advances have the potential to address these barriers to optimal care. From a diagnostic perspective, machine-learning algorithms have shown promise in the prediction of PA subtypes, while the development of noninvasive alternatives to adrenal vein sampling (including molecular positron emission tomography imaging) has made accurate localization of functioning adrenal nodules possible. In parallel, more selective approaches to targeting the causative aldosterone-producing adrenal adenoma/nodule (APA/APN) have emerged with the advent of partial adrenalectomy or precision ablation. Additionally, the development of novel pharmacological agents may help to mitigate off-target effects of aldosterone and improve clinical efficacy and outcomes. Here, we consider how each of these innovations might change our approach to the patient with PA, to allow more tailored investigation and treatment plans, with corresponding improvement in clinical outcomes and resource utilization, for this highly prevalent disorder.

A Pharmacological Update of Triazole Derivative: A Review

Recently, a large number of novel heterocyclic compounds and their derivatives have been synthesized, and studies on their biological functions have been conducted. Even though the triazole moiety of this scaffold appears to be fairly small, many researchers are interested in it because of its biological profile and variety of potential uses. Triazole derivatives have been synthesized and published by various researchers as their important characteristic against various diseases. Several researchers are interested in this scaffold because of its biological profile and wide variety of potential uses, even if its triazole moiety seems to be somewhat less. The derivative of this heterocyclic ring produced various biological activities such as anti-inflammatory, anticonvulsant, hypoglycemic, antitubercular, anxiolytic, antimicrobial, antitumor, and anticancer. The current review article focuses on pharmacological profile associated with triazoles and mainly focuses on structural modification done for various targets, along with a brief description of targets.

Exercise-induced neuroplasticity in autonomic nuclei restores the cardiac vagal tone and baroreflex dysfunction in aged hypertensive rats

Aging is accompanied by considerable deterioration of homeostatic systems, such as autonomic imbalance characterized by heightened sympathetic activity, lower parasympathetic tone, and depressed heart rate (HR) variability, which are aggravated by hypertension. Here, we hypothesized that these age-related deficits in aged hypertensive rats can be ameliorated by exercise training, with benefits to the cardiovascular system. Therefore, male 22-mo-old spontaneously hypertensive rats (SHRs) and age-matched Wistar Kyoto (WKY) submitted to moderate-intensity exercise training (T) or kept sedentary (S) for 8 wk were evaluated for hemodynamic/autonomic parameters, baroreflex sensitivity, cardiac sympathetic/parasympathetic tone and analysis of dopamine β-hydroxylase (DBH+) and oxytocin (OT+) pathways of autonomic brain nuclei. Aged SHR-S versus WKY-S exhibited elevated mean arterial pressure (MAP: +51%) and HR (+20%), augmented pressure/HR variability, no cardiac vagal tone, and depressed reflex control of the heart (HR range, -28%; gain, -49%). SHR-T exhibited a lower resting HR, a partial reduction in the MAP (-14%), in the pressure/HR variabilities, and restored parasympathetic modulation, with improvement of baroreceptor reflex control when compared with SHR-S. Exercise training increased the ascending DBH+ projections conveying peripheral information to the paraventricular nucleus of hypothalamus (PVN), augmented the expression of OT+ neurons, and reduced the density of DBH+ neurons in the rostral ventrolateral medulla (RVLM) of SHR-T. Data indicate that exercise training induces beneficial neuroplasticity in brain autonomic circuitry, and it is highly effective to restore the parasympathetic tone, and attenuation of age-related autonomic imbalance and baroreflex dysfunction, thus conferring long-term benefits for cardiovascular control in aged hypertensive individuals.NEW & NOTEWORTHY Exercise training reduces high blood pressure and cardiovascular autonomic modulation in aged hypertensive rats. The dysfunction in the baroreflex sensitivity and impaired parasympathetic tone to the heart of aged hypertensive rats are restored by exercise training. Exercise induces beneficial neuroplasticity in the brain nuclei involved with autonomic control of cardiovascular function of aged hypertensive rats.

Targeting Hypertension: A Review on Pathophysiological Factors and Treatment Strategies

Hypertension is one of the primary causes of cardiovascular diseases and death, with a higher prevalence in low- and middle-income countries. The pathophysiology of hypertension remains complex, with 2% to 5% of patients having underlying renal or adrenal disorders. The rest are referred to as essential hypertension, with derangements in various physiological mechanisms potentially contributing to the development of essential hypertension. Hypertension elevates the risk of cardiovascular disease (CVD) events (coronary heart disease, heart failure, and stroke) and mortality. First-line therapy for hypertension is lifestyle change, which includes weight loss, a balanced diet that includes low salt and high potassium intake, physical exercise, and limitation or elimination of alcohol use. Blood pressure-lowering effects of individual lifestyle components are partially additive, enhancing the efficacy of pharmaceutical treatment. The choice to begin antihypertensive medication should be based on the level of blood pressure and the existence of a high atherosclerotic CVD risk. First-line hypertension treatment includes a thiazide or thiazide-like diuretic, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and a calcium channel blocker. Addressing hypertension will require continued efforts to improve access to diagnosis, treatment, and lifestyle interventions.

Interactions between AT1R and GRKs: the determinants for activation of signaling pathways involved in blood pressure regulation

The success of Angiotensin II receptor blockers, specifically Angiotensin II type 1 receptor (AT1R) antagonists as antihypertensive drug emphasizes the involvement of AT1R in Essential hypertension. The structural insights and mutational studies of Ang II-AT1R have brought about the vision to design Ang II analogs that selectively activate the pathways with beneficial and cardioprotective effects such as cell survival and hinder the deleterious effects such as hypertrophy and cell death. AT1R belongs to G-protein coupled receptors and is regulated by G-protein coupled receptor kinases (GRKs) that either uncouples Gq protein for receptor desensitization or phosphorylate C-terminus to recruit β-arrestin for internalization of the receptor. The interaction of GRKs with ligand activated AT1R induces conformational changes and signal either Gq dependent or Gq independent pathways. These interactions might explain the complex regulatory mechanisms and offer promising ideas for hypertension therapeutics. This article reviews the functional role of AT1R, organization of GRK genes and regulation of AT1R by GRKs that play significant role in desensitization and internalization of the receptors.

Taoist way of a balanced exercise training cocktail for the management of primary hypertension in older persons

High blood pressure is the world's leading risk factor for mortality, affecting nearly half of the global population aged 50-79 years. Physical inactivity is one factor contributing to the prevalence of hypertension. This paper discusses a new concept for the management of hypertension in older persons. We are inclined to fade the current guidelines used in China, the United States, and Europe. Although demonstrating irrefutable benefits for blood pressure regulation, the guidelines fail to address the need to incorporate balance exercises, which are crucial for mitigating the risk of falling. We address three pressing questions regarding the efficacy of various combinations of exercise modes for blood pressure regulation, alongside providing an overview of balance exercises. At the core of our concept, we explicate the challenges inherent in addressing the global pandemic of physical inactivity and hypertension in regular socioeconomic people. No guidelines could change the state of inactivity by jumping between zero and all things, where "zero" symbolizes conditions such as physical inactivity and hypertension, and the concept of "all things" encompasses the ideals of an active lifestyle and healthy aging. We advocate a Taoist way, "zero-one-all things," where "one" in this context refers to an inclusive and culturally diverse exercise training cocktail. The Tao guides us to illuminate an ancient way of overcoming physical inactivity-associated diseases in the present day.

Conceptual foundations of physiological regulation incorporating the free energy principle and self-organized criticality

Bettinger, J. S., K. J. Friston. Conceptual Foundations of Physiological Regulation incorporating the Free Energy Principle & Self-Organized Criticality. NEUROSCI BIOBEHAV REV 23(x) 144-XXX, 2022. Since the late nineteen-nineties, the concept of homeostasis has been contextualized within a broader class of "allostatic" dynamics characterized by a wider-berth of causal factors including social, psychological and environmental entailments; the fundamental nature of integrated brain-body dynamics; plus the role of anticipatory, top-down constraints supplied by intrinsic regulatory models. Many of these evidentiary factors are integral in original descriptions of homeostasis; subsequently integrated; and/or cite more-general operating principles of self-organization. As a result, the concept of allostasis may be generalized to a larger category of variational systems in biology, engineering and physics in terms of advances in complex systems, statistical mechanics and dynamics involving heterogenous (hierarchical/heterarchical, modular) systems like brain-networks and the internal milieu. This paper offers a three-part treatment. 1) interpret "allostasis" to emphasize a variational and relational foundation of physiological stability; 2) adapt the role of allostasis as "stability through change" to include a "return to stability" and 3) reframe the model of homeostasis with a conceptual model of criticality that licenses the upgrade to variational dynamics.

Circulating Biomarkers and Risk of Hypertension: A Two-Sample Mendelian Randomisation Study

OBJECTIVE

This study systematically assessed circulating proteins to identify new serum biomarkers and risk of hypertension using Mendelian randomisation.

METHODS

The associations between 4,782 human circulating proteins and the risk of hypertension were evaluated using two-sample Mendelian randomisation. The FinnGen study demonstrated a link between genetic predisposition and hypertension in 85,438 cases and 223,663 controls.

RESULTS

Inverse variance weighted and sensitivity analysis revealed nine proteins in circulation that have a causative effect on hypertension. SMOC1 and TIE1 were determined to be causative factors in the decreased likelihood of developing hypertension, with odds ratios of 0.86 (95% CI 0.81-0.91; p=1.06e-06) and 0.96 (95% CI 0.94-0.98; p=9.39e-05), respectively. NDUFB4, ETHE1, POFUT2, TRIL, ADAM23, GXYLT1, OXT, TPST2, and TMCC3 showed a possible connection to hypertension.

CONCLUSIONS

This two-sample Mendelian randomisation study found that SMOC1 and TIE1 are causally linked to hypertension, making them a promising target for therapy.

Association between insulin resistance and uncontrolled hypertension and arterial stiffness among US adults: a population-based study

BACKGROUND

Prior research has established the correlation between insulin resistance (IR) and hypertension. While the association between triglyceride-glucose (TyG) index, a reliable surrogate marker of IR, and uncontrolled hypertension as well as arterial stiffness among individuals with hypertension remains undisclosed.

METHODS

In this study, a total of 8513 adults diagnosed with hypertension from the National Health and Nutrition Examination Survey 1999-2018 were included. The primary outcome of the study are arterial stiffness (represented with estimated pulse wave velocity, ePWV) and uncontrolled hypertension. Logistic regression model, subgroup analysis, restricted cubic spine, and smooth curve fitting curve were conducted to evaluate the association between the IR indicators and uncontrolled hypertension and arterial stiffness in individuals with hypertension.

RESULTS

Among included participants, the overall prevalence of uncontrolled hypertension was 54.3%. After adjusting for all potential covariates, compared with the first quartile of TyG index, the risk of uncontrolled hypertension increased about 28% and 49% for participants in the third quartile (OR, 1.28; 95% CI 1.06-1.52) and the fourth quartile (OR, 1.49; 95% CI 1.21-1.89) of TyG index, respectively. The higher OR of TyG index was observed in participants taking antihypertensive medication [fourth quartile versus first quartile (OR, 2.03; 95% CI 1.37-3.11)]. Meanwhile, we explored the potential association between TyG index and arterial stiffness and found that TyG index was significantly associated with increased arterial stiffness (β for ePWV, 0.04; 95% CI 0.00-0.08; P = 0.039). However, traditional IR indicator HOMA-IR showed no significant positive correlation to uncontrolled hypertension as well as arterial stiffness in US adults with hypertension.

CONCLUSION

Elevated levels of the TyG index were positive associated with prevalence of uncontrolled hypertension and arterial stiffness among US adults with hypertension.

Interstitial-fluid shear stresses induced by vertically oscillating head motion lower blood pressure in hypertensive rats and humans

The mechanisms by which physical exercise benefits brain functions are not fully understood. Here, we show that vertically oscillating head motions mimicking mechanical accelerations experienced during fast walking, light jogging or treadmill running at a moderate velocity reduce the blood pressure of rats and human adults with hypertension. In hypertensive rats, shear stresses of less than 1 Pa resulting from interstitial-fluid flow induced by such passive head motions reduced the expression of the angiotensin II type-1 receptor in astrocytes in the rostral ventrolateral medulla, and the resulting antihypertensive effects were abrogated by hydrogel introduction that inhibited interstitial-fluid movement in the medulla. Our findings suggest that oscillatory mechanical interventions could be used to elicit antihypertensive effects.

Left ventricular hypertrophy: an ECG-based study of prevalence and risk factors in a multiethnic population

BACKGROUND

Left ventricular hypertrophy (LVH) is frequently seen in association with arterial hypertension and indicates poor prognosis. This study aimed to determine the prevalence of LVH and associated factors in a multiethnic population from Mauritius.

METHODS

Population-based health surveys were performed in 2009 and 2015 and included in total 8961 individuals aged 35-75 years with recorded 12-lead ECG. LVH was defined according to three criteria: Sokolow-Lyon, Cornell voltage and Cornell product. Data were collected about health and lifestyle behaviour. Anthropometry and blood pressure were measured. Fasting levels of blood lipids and glucose were determined, oral glucose tolerance test was performed in people without glucose-lowering medications.

RESULTS

The age-standardised prevalence of LVH was 9% (n=875) according to any of the three ECG criteria. Individuals with LVH were older, more likely to have hypertension, diabetes, known cardiovascular disease (CVD) and elevated levels of cholesterol and creatinine. Further, they were more likely to be of African descent (Creole) and have lower educational level. In a multivariable model, Creole (OR (95% CI)) (1.56 (1.33 to 1.83)), low educational level (1.49 (1.28 to 1.75)), hypertension (3.01 (2.55 to 3.56)), known CVD (1.42 (1.11 to 1.83)) and elevated creatinine (1.08 (1.03 to 1.14)) remained associated with LVH. Individuals with non-treated or uncontrolled hypertension had a higher risk for LVH (3.09 (95% CI 2.57 to 3.71) and 4.07 (95% CI 3.29 to 5.05), respectively), than individuals with well controlled hypertension or normotension.

CONCLUSION

LVH occurs more frequently in individuals with hypertension, as well as in individuals with African ancestry and/or low education level.

Bioactive molecules from terrestrial and seafood resources in hypertension treatment: focus on molecular mechanisms and targeted therapies

Hypertension (HTN), a complex cardiovascular disease (CVD), significantly impacts global health, prompting a growing interest in complementary and alternative therapeutic approaches. This review article seeks to provide an up-to-date and thorough summary of modern therapeutic techniques for treating HTN, with an emphasis on the molecular mechanisms of action found in substances found in plants, herbs, and seafood. Bioactive molecules have been a significant source of novel therapeutics and are crucial in developing and testing new HTN remedies. Recent advances in science have made it possible to understand the complex molecular mechanisms underlying blood pressure (BP)-regulating effects of these natural substances better. Polyphenols, flavonoids, alkaloids, and peptides are examples of bioactive compounds that have demonstrated promise in influencing several pathways involved in regulating vascular tone, reducing oxidative stress (OS), reducing inflammation, and improving endothelial function. The article explains the vasodilatory, diuretic, and renin-angiotensin-aldosterone system (RAAS) modifying properties of vital plants such as garlic and olive leaf. Phytochemicals from plants are the primary in traditional drug development as models for novel antihypertensive drugs, providing diverse strategies to combat HTN due to their biological actions. The review also discusses the functions of calcium channel blockers originating from natural sources, angiotensin-converting enzyme (ACE) inhibitors, and nitric oxide (NO) donors. Including seafood components in this study demonstrates the increased interest in using bioactive chemicals originating from marine sources to treat HTN. Omega-3 fatty acids, peptides, and minerals obtained from seafood sources have anti-inflammatory, vasodilatory, and antioxidant properties that improve vascular health and control BP. Overall, we discussed the multiple functions of bioactive molecules and seafood components in the treatment of HTN.

Effects of S-Allylcysteine-Rich Garlic Extract and Dietary Inorganic Nitrate Formula on Blood Pressure and Salivary Nitric Oxide: An Open-Label Clinical Trial Among Hypertensive Subjects

INTRODUCTION

 The conversion of dietary inorganic nitrate (NO3-) to nitric oxide (NO) is a non-canonical pathway that plays an important role in NO biology, especially under pathological conditions. Inorganic NO3- supplementation is a proven method for controlling mild hypertension. Recent reports have suggested that another gaseous transmitter, hydrogen sulfide (H2S), influences NO biosynthesis and metabolism. Here, data are presented from an open-label clinical trial examining the effect of an encapsulated formulation (Vascanox® HP) that combines dietary sources of inorganic NO3- and S-allylcysteine (SAC), a source of H2S from garlic, on NO bioavailability and blood pressure in subjects experiencing elevated blood pressure or mild hypertension.

METHODS

 An open-label clinical trial was conducted among patients with hypertension. Participants took Vascanox® for four weeks. Blood pressure was measured at baseline, two weeks, and four weeks. Salivary nitrite (NO2-), a surrogate of NO bioavailability, and NO3- were assessed prior to and two, six, and 24 hours after dosing on the first day of the study and prior to and two hours after dosing at subsequent study visits using saliva NO test strips. Changes in study outcomes over time were evaluated via analysis of variance (ANOVA) and paired t-tests.

RESULTS

 Twelve participants completed the clinical trial. Vascanox® HP decreased systolic blood pressure by ~11 mmHg (p < 0.001) at two weeks and persisted beyond four weeks with daily supplementation. It also decreased the diastolic blood pressure of hypertensive subjects but not normotensive ones. The magnitude of the decrease was 11 mmHg (p < 0.01) at four weeks of study. Measurements of salivary concentrations of NO2- revealed high peak levels (743 uM) at two hours post-administration and a slow decay to elevated levels (348 uM) at 24 hours. NO2- salivary concentrations, a surrogate biomarker of NO bioavailability, remained above baseline for the duration of the study.

CONCLUSIONS

 Vascanox® HP was shown to be a safe, effective, quick-acting, and long-lasting dietary supplement for controlling mild hypertension.