Blood pressure effects of CPAP in nonresistant and resistant hypertension associated with OSA: A systematic review of randomized clinical trials.

Obstructive sleep apnea (OSA) is a rather common chronic disorder, associated with increased prevalence of hypertension. The pathophysiological mechanisms for hypertension in OSA are at least in part linked to intermittent hypoxia developed during nightly hypopneas and apneas. Hypoxemia stimulates sympathetic overactivity, systemic inflammation, oxidative stress, and endothelial dysfunction. However, it appears that intermittent hypoxemia is not the only factor in the development of hypertension in OSA. Supplemental oxygen therapy that improved oxyhemoglobin saturation to similar levels to those achieved with CPAP treatment did not reduce BP. In this scenario, it could be proposed that hypoxemia acts as a trigger of sympathetic overdrive, which when set is the main factor in the development of hypertension in OSA. This review appraises evidence provided by randomized controlled trials on the BP-lowering effectiveness of continuous positive airway pressure (CPAP) treatment of OSA patients with nonresistant and resistant hypertension. It suggests that CPAP treatment is more effective in treating resistant hypertension than nonresistant hypertension. A possible explanation is that sympathetic overactivity and altered vascular reactivity in OSA could be more severe in resistant hypertension than in nonresistant hypertension. An intricate interaction among compliance, adherence, and their interaction with demographic characteristics, genetic factors, and comorbidities of the population included might explain the differences found between trials on their influence over the antihypertensive effectiveness of CPAP. Further long-term trials are needed in hypertensive OSA patients to assess whether CPAP treatment in OSA patients consistently restores physiological nocturnal BP fall and adjusts resting and circadian heart rate.

Lowering blood pressure to prevent stroke recurrence: a systematic review of long-term randomized trials.

Albeit hypertension is a leading risk factor for an initial stroke, the role of blood pressure (BP) lowering to prevent a subsequent stroke is controversial. The present systematic review searched randomized trials published from January 1990 to January 2014 with the aim to assess antihypertensive treatment effects on recurrent stroke prevention. Seven randomized placebo-controlled trials enrolling 49,518 patients, two randomized trials not placebo controlled comparing antihypertensive drugs, and one randomized trial that compared the effects of intensive systolic BP lowering with a more conservative systolic BP management, were identified. The placebo-controlled trials had substantial methodological differences, explaining the difficulties to compare their results. An important obstacle arises from the large dispersion in the window's time between the qualifying stroke and randomization. Another barrier is the variation among studies in the recruited patient's stroke subtypes. Differences between trials could not be attributed to disparity in lowering BP or to different degrees of no adherence. The American Heart Association/American Stroke Association stated that although an absolute target of BP level has not been clearly defined, a reduction in recurrent stroke has been associated with an average lowering of 10/5 mm Hg. It should be taken into account that it is not advisable to reduce BP levels to <120/80 mm Hg. It should carry out an individualized selection, based on demographic characteristics and comorbidities (cardiovascular disease, diabetes mellitus, and chronic disease) among diuretics, angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, or calcium channel blockers.

Early treatment of hypertension in acute ischemic and intracerebral hemorrhagic stroke: progress achieved, challenges, and perspectives.

Hypertension is the leading risk factor for ischemic and intracerebral hemorrhagic subtypes of stroke. Additionally, high blood pressure (BP) in the acute cerebrovascular event is associated with poor outcome, and a high percentage of stroke survivors have inadequate control of hypertension. The present is a systematic review of prospective, randomized, and controlled trials carried out on safety and efficacy of antihypertensive treatment of both subtypes of acute stroke. Six trials involving 7512 patients were included, which revealed controversies on the speed and the goals of treatment. These controversies could be due at least in part, from the fact that some studies analyzed the results of antihypertensive treatment in ischemic and intracerebral hemorrhagic subtypes of acute stroke together, and from a different prevalence of past-stroke in the randomized groups. Further research is necessary to establish whether standard antihypertensive treatment provides greater benefit than simple observation in patients with ischemic acute stroke and Stage 2 hypertension of JNC 7, albeit they were not candidates for acute reperfusion. In that case, the target reduction in BP could be 10% to 15% within 24 hours. The recently published INTERACT 2 has provided evidence that patients with hemorrhagic stroke may receive intensive antihypertensive treatment safely with the goal of reducing systolic BP to levels no lower than 130 mm Hg. It is important to take into account that marked BP lowering in acute stroke increases the risk of poor outcome by worsening cerebral ischemia from deterioration of cerebral blood flow autoregulation.

Nocturia in arterial hypertension: a prevalent, underreported, and sometimes underestimated association.

Nocturia is a risk factor for morbidity and mortality but is frequently overlooked and underreported by patients and unrecognized by physicians. Epidemiologic studies reported that nocturnal voiding is associated not only with aging and benign prostatic hyperplasia, but also with many other clinical conditions. The majority of epidemiologic studies reported a significant relationship between nocturia and hypertension. However, the cause-and-effect relationship between them has not been established. Some physiopathological changes in hypertension are conducive to result in nocturia. These include the effects of hypertension on glomerular filtration and tubular transport, resetting of the kidney pressure-natriuresis relationship, atrial stretch and release of atrial natriuretic peptide when congestive heart failure complicates hypertension, and peripheral edema. Another link between hypertension and nocturia is obstructive sleep apnea. Furthermore, some evidence supports the relationship between nondipping behavior of blood pressure and an increased prevalence of nocturia. The use of some classes of antihypertensive agents may result in nocturia. The present review aims to provide a comprehensive evaluation of the epidemiologic evidence and physiopathological links that correlate hypertension and nocturia. Emphasis is placed on the need to take a pro-active attitude to detect and treat this hazardous condition.

Association between chronic blood pressure changes and development of Alzheimer's disease.

Epidemiological studies suggest an association between chronic blood pressure (BP) changes and Alzheimer's disease (AD). In particular, there is growing evidence that hypertensive people that do not have their BP adequately treated and controlled in midlife are more likely to develop AD in late-life. It has been hypothesized that cerebrovascular disease is a common pathway which connects hypertension and AD in individuals with apolipoprotein E genotype through brain hypoperfusion and hypoxia. This could accelerate amyloid-ß aggregation that disrupts cell-to-cell connectivity and leads to eventual brain neuron loss. Also, high BP contributes to worsen AD by raising oxidative stress and inflammatory response. Aging-related structural and functional disturbances appear to exacerbate the deleterious effect of chronic hypertension on cerebral blood flow autoregulation. There is evidence suggesting that some antihypertensive drug classes reduce the risk and progression of AD more than others. Further prospective randomized studies comparing different classes of antihypertensive drugs are needed to provide more evidence regarding their effects on AD risk. Hypotension could be a consequence of the incident dementia and conversely deteriorate the outcome of AD by worsening brain hypoperfusion. Frequent home BP monitoring should be carried out in AD patients to detect harmful orthostatic hypotension.

Asociación entre el comportamiento non-dipper de la presión arterial y las fracciones del calcio sérico en pacientes hipertensos con disfunción renal crónica leve a moderada / Association between non-dipper blood pressure behavior and serum calcium fractions in hypertensive patients with mild to moderate chronic renal dysfunction

Objetivos: Determinar asociación entre calcio total sérico y calcio iónico, con las determinaciones del MAPA en pacientes hipertensos en estadios 1-3 de enfermedad renal crónica. Métodos: se incluyeron 231 pacientes hipertensos. Resultados: En non dippers la prevalencia de Clcr <60 mL/ min/1,73 m2 fue mayor que en dippers (p < 0,02). El análisis de covarianza mostró que en estadío 3 de K/DOQI el Cat fue menor en non-dippers que en dippers (9,03 ± 0,66 vs 9,41 ± 1 mg/dL, p<0,02). En non-dippers hubo correlaciones significativas entre Cai y PAS 24 hs (r = 0,21, p < 0,03), PAS diurna 24 hs.(r=0,21, p<0,03) y PP 24 hs (r = 0,23; P < 0,02). Los non dippers tuvieron una mayor prevalencia del tercilo mas elevado de PP 24 horas que dippers. Los pacientes con Clcr > 60 mL/min/1,73 m2 tienen menor riesgo de presentar comportamiento non dipper que pacientes con (Clcr<60 mL/min/1,73 m2 (OR 2,445, IC 95% 1,398-4,277, p < 0,002). Conclusiones: los hipertensos en estadio 3 de K/DOQI tienen una mayor alteración de ritmo circadiano de PA que aquéllos en estadías 1-2. La alta prevalencia de non dipper en estadio 3 K/ DOQI sugiere que aun en disfunción renal moderada este patrón circadiano es común. Se puede especular que el Cai tiene un rol en patogénesis de alteración en descenso fisiológico nocturno de PA. El aumento de rigidez arterial puede ser un mecanismo significativo por el que comportamiento non dipper ejerce su influencia deletérea sobre evolución cardiovascular y renal de pacientes con ERC.(AU)

Objectives: To determine the association between total serum calcium (tCa) and ionic calcium (tCa), with MAPA measurements in hypertensive patients with early renal failure. Methods: 231 hypertensive patients stages 1-3 of chronic kidney disease (CKD) were included. 24 Hr arterial pressure (AP) was determined by MAPA. Results: in non-dippers, the prevalence of Cr.Cl. <60 ml/mins/1.73 m2 was greater than in dippers (p<0.02). Covariance analysis showed that in stage 3 of K/DOQI, tCa was less in non-dippers than dippers (9.03 ± 0.66 vs. 9.41 ± 1 mg/dL, p<0.02). In non-dippers, there were significant correlations between iCa and 24 hr- systolic AP (SAP)(r = 0.21, p < 0.03), diurnal SAP (r=0.21, p<0.03) and 24hr-PP(r = 0.23; p < 0,02). Non- dippers showed a greater prevalence of the 24 Hr-PP in the highest tertile than dippers. Patients with Cr.Cl. 2::60 mL/min/1, 73 m2 have less propensity to present non-dipper patterns than patients with Clcr<60 mL/min/1, 73 m2 (OR 2.44, IC 95% 1.39-4.27, p < 0.002). Conclusions: Hypertensive patients in K/ DOQIs stage 3 present a greater alteration of APs circadian rhythm than those on stages 1-2. High prevalence of non-dippers in K/DOQIs stage 3 suggests that even in moderate renal dysfunction, this circadian pattern is common. We can speculate that iCa has a role in the pathogenesis of disturbances in the nocturnal physiological drop of AP. The Increase in arterial stiffness can be an irnportant mechanism by which the non-dipper pattern exerts its deleterious influence on cardiovascular and renal evolution of patients with CKD.(AU)

Asociación entre el comportamiento non-dipper de la presión arterial y las fracciones del calcio sérico en pacientes hipertensos con disfunción renal crónica leve a moderada / Association between non-dipper blood pressure behavior and serum calcium fractions in hypertensive patients with mild to moderate chronic renal dysfunction

Objetivos: Determinar asociación entre calcio total sérico y calcio iónico, con las determinaciones del MAPA en pacientes hipertensos en estadios 1-3 de enfermedad renal crónica. Métodos: se incluyeron 231 pacientes hipertensos. Resultados: En non dippers la prevalencia de Clcr <60 mL/ min/1,73 m2 fue mayor que en dippers (p < 0,02). El análisis de covarianza mostró que en estadío 3 de K/DOQI el Cat fue menor en non-dippers que en dippers (9,03 ± 0,66 vs 9,41 ± 1 mg/dL, p<0,02). En non-dippers hubo correlaciones significativas entre Cai y PAS 24 hs (r = 0,21, p < 0,03), PAS diurna 24 hs.(r=0,21, p<0,03) y PP 24 hs (r = 0,23; P < 0,02). Los non dippers tuvieron una mayor prevalencia del tercilo mas elevado de PP 24 horas que dippers. Los pacientes con Clcr > 60 mL/min/1,73 m2 tienen menor riesgo de presentar comportamiento non dipper que pacientes con (Clcr<60 mL/min/1,73 m2 (OR 2,445, IC 95% 1,398-4,277, p < 0,002). Conclusiones: los hipertensos en estadio 3 de K/DOQI tienen una mayor alteración de ritmo circadiano de PA que aquéllos en estadías 1-2. La alta prevalencia de non dipper en estadio 3 K/ DOQI sugiere que aun en disfunción renal moderada este patrón circadiano es común. Se puede especular que el Cai tiene un rol en patogénesis de alteración en descenso fisiológico nocturno de PA. El aumento de rigidez arterial puede ser un mecanismo significativo por el que comportamiento non dipper ejerce su influencia deletérea sobre evolución cardiovascular y renal de pacientes con ERC.

Objectives: To determine the association between total serum calcium (tCa) and ionic calcium (tCa), with MAPA measurements in hypertensive patients with early renal failure. Methods: 231 hypertensive patients stages 1-3 of chronic kidney disease (CKD) were included. 24 Hr arterial pressure (AP) was determined by MAPA. Results: in non-dippers, the prevalence of Cr.Cl. <60 ml/mins/1.73 m2 was greater than in dippers (p<0.02). Covariance analysis showed that in stage 3 of K/DOQI, tCa was less in non-dippers than dippers (9.03 ± 0.66 vs. 9.41 ± 1 mg/dL, p<0.02). In non-dippers, there were significant correlations between iCa and 24 hr- systolic AP (SAP)(r = 0.21, p < 0.03), diurnal SAP (r=0.21, p<0.03) and 24hr-PP(r = 0.23; p < 0,02). Non- dippers showed a greater prevalence of the 24 Hr-PP in the highest tertile than dippers. Patients with Cr.Cl. 2::60 mL/min/1, 73 m2 have less propensity to present non-dipper patterns than patients with Clcr<60 mL/min/1, 73 m2 (OR 2.44, IC 95% 1.39-4.27, p < 0.002). Conclusions: Hypertensive patients in K/ DOQI's stage 3 present a greater alteration of AP's circadian rhythm than those on stages 1-2. High prevalence of non-dippers in K/DOQI's stage 3 suggests that even in moderate renal dysfunction, this circadian pattern is common. We can speculate that iCa has a role in the pathogenesis of disturbances in the nocturnal physiological drop of AP. The Increase in arterial stiffness can be an irnportant mechanism by which the non-dipper pattern exerts its deleterious influence on cardiovascular and renal evolution of patients with CKD.

Effects of blood pressure changes on Alzheimer's disease.

Alzheimer's disease is the most frequent cause of dementia. Whereas other major causes of death have been decreasing, the number of deaths due to Alzheimer's disease is rising. As there is no cure for this type of dementia at present, preventive measures have assumed great importance. By analyzing data from available longitudinal studies, the current review presents evidence supporting a link between Alzheimer's disease and blood pressure changes.

Long-term effects of parathyroidectomy on hypertension prevalence and circadian blood pressure profile in primary hyperparathyroidism.

Our aims were to evaluate the prevalence and outcome of hypertension in patients with primary hyperparathyroidism (PHPT), previously and after follow-up of parathyroidectomy. A group of 46 consecutive patients with sporadic PHPT due to adenoma undergoing surgery were followed an average of 3.5 years (range 36 to 53 months). In 16 nonselected, consecutive parathyroidectomized patients, with normalized biochemical measurements, circadian rhythm of blood pressure was evaluated with ambulatory blood pressure monitoring (ABPM). Prevalence of hypertension in PHPT was 54.35%, and there was no significant association of PTH, total and ionic calcium levels with SBP and DBP. During follow-up, none of the patients with presurgical hypertension became normotensive and five of the normotensive patients developed clinical hypertension. In ABPM, 6/11 hypertensive and 3/5 normotensive subjects showed nondipper behavior. Serum total calcium was significantly related to night-time systolic blood pressure (SBP) (r = 0.620, P < 0.02), and night-time diastolic blood pressure (DBP) (r = 0.758, P < 0.002). In dippers, creatinine clearance was significantly higher (91.3 +/- 18.5 vs. 64.3 +/- 11.5 ml/min, P < 0.01), while serum total calcium was lower (2.42 +/- 0.13 vs. 2.23 +/- 0.17 mmol/L, P < 0.04) than in nondippers. In conclusion, our results suggest that parathyroidectomy has little effect on hypertension prevalence. Renal impairment, a condition that did not improve after parathyroidectomy, may be a causal factor of hypertension in PHPT. Also, the high prevalence of nondipper behavior in hypertensive and normotensive subjects after parathyroidectomy, suggests that target organ risk persists. We hypothesized that slight elevations of serum total calcium even in the normal range could be involved in the alteration of the circadian rhythm of blood pressure.

Statins in hypertension: are they a new class of antihypertensive agents?

High blood pressure is a very common disease in hypercholesterolemic and diabetic patients and contributes to the increase in cardiovascular risk. Inhibitors of 3OH-3methyl-glutaryl-coenzyme A reductase are the most effective and widely used cholesterol-lowering drugs. They significantly reduce the risk of cardiovascular events and death in both primary and secondary prevention of cardiovascular disease. Although the long-term benefit by statin treatment is largely attributed to their cholesterol-lowering action, increasing attention focuses on additional actions called "pleitropic effects" that might explain the cardiovascular protection seen shortly after the initiation of therapy. Very few and small studies have investigated the antihypertensive effect of statins in patients with hypertension associated with hypercholesterolemia, and the results of recently published large statin studies (albeit not designed to answer this question) have attracted the interest on this subject. Many other studies, also not specifically aimed at the evaluation of the statins' antihypertensive effect, have provided information concerning changes in blood pressure during treatment with statins, but severe limitations such as inadequate study design, small or very small sample size, too short of a treatment period, and modification of concomitant antihypertensive therapy have prevented finding a definitive effect on blood pressure. From the available results, it appears consistent that statins may be useful in hypertensives with high serum total cholesterol, in those whose hypertension is not well controlled with antihypertensive agents even without high serum total cholesterol, in hypertensive subjects well controlled with antihypertensives without high serum cholesterol when they have high polymerase chain reaction levels, in those who require preventive measures because of other concomitant cardiovascular risk factors, or when they require secondary prevention. Future research could further characterize the impact of statin use alone or in combination with antihypertensive agents to delay the development of Stage 1 hypertension in prehypertension.

Primary care survey of awareness and control of hypertension: a hospital-based study.

The objectives of this cross-sectional study were to determine awareness degree, treatment status, and control of hypertension and its predictors in a consecutive group of attendees at a Buenos Aires University School Hospital primary care setting from April 2003 to May 2006. Results for 1733 hypertensive subjects, all of them white (578 men and 1155 women), were available for analyses. Mean age of hypertensive subjects was 66.61 +/- 12.34 years. Eighty-seven percent of hypertensive patients knew their diagnosis. Prevalence of hypertension was consistently higher in overweight-obese than in normal weight subjects (P < 0.001). Overall prevalence of hypertension treatment was 62%, and blood pressure (BP) control rate was 30%. Among knowledgeable treated hypertensive patients, 80.4% used only one antihypertensive drug, 17.6% used two, and 2% used three (P < 0.001). Only 8% of hypertensive patients carried out consensus-recommended dietarian guidelines. A prevention index performed with periodic general prevention measures during the past 5 years was calculated. Logistic regression model showed that independent variables more likely to be associated with poor BP control were being overweight (odds ratio [OR] 1.53, 95% confidence interval [CI] 1.057-2.208), obesity (OR 2.1, 95% CI 1.307-3.286), and previous stroke (OR 2.9, 95% CI 1.099-7.652). Conversely, the higher the prevention index, the less odds of uncontrolled BP (OR 0.841, 95% CI 0.725-0.975). These results highlight the consistency of general primary care prevention measures with achieving BP control. The poor control rates of BP found in patients who already suffered from stroke suggest that, after hospital discharge for that event, antihypertensive therapy was inadequate and document the challenge that these situations impose on primary care physicians.

[Resistant hypertension]. / Hipertensión arterial resistente.

Resistant hypertension, defined as a persistent blood pressure over 140/90 mmHg despite the use of three antihypertensive drugs including a diuretic, is unusual. The diagnosis requires ruling out initially pseudoresistance and a lack of compliance with treatment. Ambulatory blood pressure recording allow the recognition of white coat hypertension. When there is a clinical or laboratory suspicion, secondary causes of hypertension should be discarded. Excessive salt intake, the presence of concomitant diseases such as diabetes mellitus, chronic renal disease, obesity, and psychiatric conditions such as panic attacks, anxiety and depression, should also be sought. The presence of target organ damage requires a more aggressive treatment of hypertension. Recent clinical studies indicate that the administration of aldosterone antagonists as a fourth therapeutic line provides significant additional blood pressure reduction, when added to previous antihypertensive regimens in subjects with resistant hypertension. The possible blood pressure lowering effects of prolonged electrical activation of carotid baroreceptors is under investigation.

Statins as antihypertensives.

The beneficial effects of statins in hypertension stem from their effects on endothelial function, their interactions with the renin-angiotensin system, and their influence on large artery compliance. Substantial evidence has recently accumulated showing that statins exert pleiotropic effects in vascular function. These include an increase in the synthesis of NO, inhibition of vascular smooth muscle cell proliferation and migration, anti-inflammatory actions, downregulation of angiotensin II type 1 receptor expression, and anti-oxidative effects. These effects occur before reduction of cholesterolemia. Available data support only a modest BP-lowering effect of statins which is most prominent in those patients with poorly controlled hypertension. Even though they only cause a minor reduction in BP, they may play a role in the prevention of cardiovascular disease. Statins may be useful therapeutic agents in hypertensives with high serum total cholesterol, in patients with poorly controlled hypertension even without hypercholesterolemia, in normocholesterolemic well-controlled hypertensive subjects with high C reactive protein levels, and in those subjects who need secondary prevention. Future research is needed to further characterize the impact of statins alone or in combination with antihypertensive agents to prevent or delay the development of stage 1 hypertension. This review article also includes relevant patents.

Hipertensión arterial resistente: [revisión] / Resistant hypertension: [review]

Resistant hypertension, defined as a persistent blood pressure over 140/90 mmHg despite the use of three antihypertensive drugs including a diuretic, is unusual. The diagnosis requires ruling out initially pseudoresistance and a lack of compliance with treatment. Ambulatory blood pressure recording allow the recognition of white coat hypertension. When there is a clinical or laboratory suspicion, secondary causes of hypertension should be discarded. Excessive salt intake, the presence of concomitant diseases such as diabetes mellitus, chronic renal disease, obesity, and psychiatric conditions such as panic attacks, anxiety and depression, should also be sought. The presence of target organ damage requires a more aggressive treatment of hypertension. Recent clinical studies indicate that the administration of aldosterone antagonists as a fourth therapeutic line provides significant additional blood pressure reduction, when added to previous antihypertensive regimens in subjects with resistant hypertension. The possible blood pressure lowering effects of prolonged electrical activation of carotid baroreceptors is under investigation.

Las respuestas lentas a la angiotensina II, la activación de la proteína Src y del factor de crecimiento epidérmico en la génesis de la hipertensión esencial / Factors contributing to essential hypertension genesis

La hipertensión esencial es inducida por disfunción renal. Receptores normotensos de riñones de hipertensos desarrollan hipertensión y viceversa. La alteración renal más importante es el desacople del SRA respecto del nivel de sodio. El estrés oxidativo (ST-OX) es estimulado cuando los niveles de angiotensina II (Ang II) son inapropiados respecto del sodio corporal total. El ST-OX potencia el efecto vasoconstrictor de la Ang II por disminución del óxido nítrico (NO) y/o por incremento de los vasoconstrictores, como isoprostanos, ET1 y otros. Estos efectos se ponen de manifiesto en la ôrespuesta lenta a la Ang IIõ en la que la infusión en dosis pequeñas (subpresoras) induce retención de sodio y consecuente estímulo del STOX, con vasoconstricción. Estos efectos están mediados por señales intracelulares como la activación de proteína Src y del receptor del factor de crecimiento epidérmico por la Ang II, que parecen ser un mecanismo de vasoconstricción importante. Las especies reactivas de oxígeno inducidas por estos factores sostendrían una reacción autocatalítica, responsable de la producción sostenida de vasoconstrictores, con lo que se perpetúa la hipertensión.

A comparison of body mass index and waist-to-hip ratio as indicators of hypertension risk in an urban Argentine population: a hospital-based study.

BACKGROUND AND AIM: To examine the relationship between 24-h ambulatory blood pressure monitoring (ABPM) and three commonest anthropometric measurements for obesity [body mass index (BMI), waist circumference (WC) and waist-hip ratio (WHR)] in patients with essential hypertension never treated or after a 3 week placebo period, living in Buenos Aires. METHODS AND RESULTS: Cross-sectional survey among outpatients at the Hypertension Program of Buenos Aires University Hospital de Clinicas. Three-hundred seventy-seven essential hypertensives, aged 18-86 years, of either sex, were consecutively recruited. All subjects underwent 24 h ABPM performed with a blood pressure (BP) device. The prevalence of overweight-obesity was 56.76% in women and 75.86% in men. High WHR prevalence in non-obese women was 4.5% and 4.1% in non-obese men while high values of WC were observed in 3.0% of non-obese women and in 0% of non-obese men. The two-way ANCOVA showed that in women with high values of WHR, 24 h DBP was higher in those with BMI<25 than in those with BMI> or =25. Those females with a BMI> or =25 had a higher prevalence of top tertile values of PP (> or =68 mmHg) (P<0.05) than non-obese females. Only in women was mean pulse pressure (PP) significantly correlated with age (r=0.38; P<0.0001), WC (r=0.22; P<0.005), WHR (r=0.21, P<0.008), and BMI (r=0.20; P<0.01) while in men there was no significant correlation between variables. Logistic regression showed that the odds of morning blood pressure surge (MBPS) increased with age, central obesity (represented by high WHR and dipper status), while the odds of higher mean PP increased with age and high WHR. CONCLUSION: These results indicated a high prevalence of overweight-obesity (more than 56% of women and 75% of men) in our hospital-based sample of essential hypertension and that the WHR offers additional information beyond BMI and WC to predict the hypertension risk according to the ABPM.

Role of endothelin in the pathogenesis of hypertension.

In 1985, investigators characterized a potent vasoconstrictor of endothelial origin called endothelin (ET). Subsequently, 3 peptides were recognized that had a comparable molecular structure but different receptors that mediate potent vasoconstrictive and mild vasodilative effects. The renal effects are characterized by natriuresis despite renal vasoconstriction. This effect, along with the stimulation of ET by high sodium intake, suggests that ET may be responsible for maintaining sodium balance when the renin-angiotensin system is depressed. Endothelin is activated in desoxycorticosterone acetate salt hypertension models and salt-sensitive hypertension. However, ET involvement with spontaneous hypertension models and renovascular hypertension in rats appears minimal. In humans, the role of ET appears similar to that in experimental animals; in both, ET regulates salt metabolism. Salt-sensitive patients exhibit a blunted renal ET-1 response during sodium load. The role of ET in humans has been investigated using nonspecific ET receptor blockers that inhibit the vasoconstrictive and vasodilative components of ET. However, the effects of ET blockade should be investigated with ET subtype A receptor blockers that mediate vasoconstriction alone. Effects of ET blockade also should be evaluated with respect to stimulation of oxidative stress and tissue damage, important mechanisms responsible for tissue fibrosis. This review offers the clinician a balanced view on the hypertensive mechanisms involved with activation of ET and associated clinical implications.

[Treatment of hypertension in type 2 diabetes: importance of therapeutic selection]. / Tratamiento de la hipertension arterial en la diabetes tipo 2: importancia de la selección terapeutica.

BACKGROUND: Type 2 diabetes and essential hypertension are the most common causes of end-stage renal disease in Argentina. Over 887 organ transplantations performed in the year 2004, 577 were kidney transplants. In urban and rural populations hypertension was more prevalent in type 2 diabetics, in particular systolic hypertension. Outcome studies are used to measure clinically meaningful primary end points, such as mortality and cardiovascular morbidity. Our current knowledge of the effects of antihypertensive agents on cardiovascular risk in hypertensive patients with type 2 diabetes has been achieved from subgroups included in large-scale studies. SCOPE: The present study, based on a search of MEDLINE literature in the period 1990-2005, revised major randomised studies with the purpose of finding out which are the most advisable therapeutic strategies against this morbid association. The majority of patients require 2 to 4 antihypertensive medications to achive BP levels that correlate with diminished progression of target organ damages. Despite the advantages of renin-angiotensin system inhibitors the initial choice of medications should be based on the evidences of target organ damages. In those patients without any evidence of complications, the primary goal seems to be achieving their BP to < 130/80 mm Hg beyond the differences among antihypertensive drugs classes, while in those with target organ damage evidences maintain BP < 120/75 mm Hg.

Tratamiento de la hipertensión arterial en la diabetes tipo 2: importancia de la selección terapéutica / Treatment of hypertension in type 2 diabetes: importance of therapeutic selection

ANTECEDENTES: La hipertensión y la diabetes son las causas mas comunes de insuficiencia renal terminal en Argentina, Sobre 887 transplantes de órganos efectuados en el año 2004, correspondieron 577 a transplantes renales, Sn poblaciones urbanas y rurales argentinas la hipertensión tiene una prevalencia mas alta en diabéticos, siendo el tipo mas frecuente la hipertensión sistólica. Los estudios sobre la evolución se utilizan para estimar los puntos finales altamente significativos desde la perspectiva clínica. Nuestros conocimientos actuales sobre los efectos del tratamiento de la hipertensión en la diabetes tipo 2 se fundan en los resultados obtenidos en estudios longitudinales randomizados. AMBITO: El presente trabajo, basado sobre una búsqueda en el periodo 19902005 de la literatura MEDLINE, revisa los estudios randomizados con el objetivo de determinar cuales son las mejores estrategias terapéuticas en esta asociación mórbida. La mayoría de los pacientes requieren dos a cuatro drogas antihipertensivas para enlentecer la progresión de daño de órganos nobles. La elección inicial de las drogas a utilizar debería fundarse sobre la presencia o no de complicaciones en órganos blanco. En aquellos pacientes sin evidencias de complicaciones, el objetivo primario es alcanzar niveles de PA < 130/80 mm Hg., mas allá de las diferencias que existen entre las distintas clases de fármacos, mientras que en aquellos con afectaciones de órgano blanco se requiere mantener la PA en < 120/75 mm Hg.(AU)

BACKGROUND: Type 2 diabetes and essential hypertension are the most common causes oi end-stage renal disease in Argentina. Over 887 organ transplantations performed in the year 2004, 577 were kidney transplants. In urban and rural populations hypertension was more prevalent in type 2 diabetics, in particular systolic hypertension, Outcome studies are used to measure clinically meaningful primary end points, such as mortality and cardiovascular morbidity. Our current knowledge of the effects of antihypertensive agents on cardiovascular risk in hypertensive patients with type 2 diabetes has been achieved fram subgroups included in large scale studies. SCOPE: The present study, based on a search of MEDLINE literature in the period 1990-2005, revised major randomised studies with the purpose of finding out which are the most advisable therapeutic strategies against this morbid association. The majority of patients require 2 to 4 antihypertensive medications to achive BP levels that correlate with diminished progression of target organ damages. Despite the advantages of renin-angiotensin system inhibitors the initial choice of medications should be based on the evidences of target organ damages. In those patients without any evidence of complications, fue primary goal seems to be achieving their BP to < 130/80 mm Hg beyond the differences among antihypertensive drugs classes, while in those with target organ damage evidences maintain BP < 120/75 mm Hg.(AU)

Tratamiento de la hipertensión arterial en la diabetes tipo 2: importancia de la selección terapéutica / Treatment of hypertension in type 2 diabetes: importance of therapeutic selection

ANTECEDENTES: La hipertensión y la diabetes son las causas mas comunes de insuficiencia renal terminal en Argentina, Sobre 887 transplantes de órganos efectuados en el año 2004, correspondieron 577 a transplantes renales, Sn poblaciones urbanas y rurales argentinas la hipertensión tiene una prevalencia mas alta en diabéticos, siendo el tipo mas frecuente la hipertensión sistólica. Los estudios sobre la evolución se utilizan para estimar los puntos finales altamente significativos desde la perspectiva clínica. Nuestros conocimientos actuales sobre los efectos del tratamiento de la hipertensión en la diabetes tipo 2 se fundan en los resultados obtenidos en estudios longitudinales randomizados. AMBITO: El presente trabajo, basado sobre una búsqueda en el periodo 19902005 de la literatura MEDLINE, revisa los estudios randomizados con el objetivo de determinar cuales son las mejores estrategias terapéuticas en esta asociación mórbida. La mayoría de los pacientes requieren dos a cuatro drogas antihipertensivas para enlentecer la progresión de daño de órganos nobles. La elección inicial de las drogas a utilizar debería fundarse sobre la presencia o no de complicaciones en órganos blanco. En aquellos pacientes sin evidencias de complicaciones, el objetivo primario es alcanzar niveles de PA < 130/80 mm Hg., mas allá de las diferencias que existen entre las distintas clases de fármacos, mientras que en aquellos con afectaciones de órgano blanco se requiere mantener la PA en < 120/75 mm Hg.

BACKGROUND: Type 2 diabetes and essential hypertension are the most common causes oi end-stage renal disease in Argentina. Over 887 organ transplantations performed in the year 2004, 577 were kidney transplants. In urban and rural populations hypertension was more prevalent in type 2 diabetics, in particular systolic hypertension, Outcome studies are used to measure clinically meaningful primary end points, such as mortality and cardiovascular morbidity. Our current knowledge of the effects of antihypertensive agents on cardiovascular risk in hypertensive patients with type 2 diabetes has been achieved fram subgroups included in large scale studies. SCOPE: The present study, based on a search of MEDLINE literature in the period 1990-2005, revised major randomised studies with the purpose of finding out which are the most advisable therapeutic strategies against this morbid association. The majority of patients require 2 to 4 antihypertensive medications to achive BP levels that correlate with diminished progression of target organ damages. Despite the advantages of renin-angiotensin system inhibitors the initial choice of medications should be based on the evidences of target organ damages. In those patients without any evidence of complications, fue primary goal seems to be achieving their BP to < 130/80 mm Hg beyond the differences among antihypertensive drugs classes, while in those with target organ damage evidences maintain BP < 120/75 mm Hg.