The relationship between the systemic immune-inflammation index and reverse-dipper circadian pattern in newly diagnosed hypertensive patients.

Although hypertension is considered high intravascular pressure, impairing circadian blood pressure (BP) has been shown to potentially contribute to poor clinical outcomes. Systemic immune-inflammation index (SII), based on platelet, neutrophil, and lymphocyte counts, has been established as a strong prognostic marker in cardiovascular disease. The role of inflammation in the pathogenesis of hypertension is a well-known issue and inflammatory markers are associated with BP variability. We aimed to investigate whether there is a relationship between circadian BP changes and SII in newly diagnosed hypertensive patients. The study population consisted of 196 newly diagnosed hypertensive patients without LVH. In total, 76 (38%) patients had a dipper BP pattern, 60 (31%) patients had a non-dipper BP pattern, and 60 (31%) patients had a reverse-dipper BP pattern. SII was calculated according to Multivariate logistic regression analysis revealed SII and HDL-C as an independent predictors of reverse-dipper circadian pattern in newly diagnosed hypertensive patients. The cut-off value of the SII for reverse-dipper hypertension in a ROC curve analysis was >639.73 with 63.3% sensitivity and 84.2% specificity. Our study showed that the SII level was higher in the reverse-dipper hypertension patient group than in the dipper and non-dipper hypertension groups. Furthermore, SII was an independent predictor of newly diagnosed reverse-dipper hypertensive patients. The high SII value in newly diagnosed hypertensive patients can be used as an early warning parameter to identify reverse-dipper hypertension patients.

Contribution of Snacks and Physical Activities to Elevated Blood Pressure of Adolescent Girls in West Java, Indonesia

@#Introduction: The prevalence of hypertension in Indonesia has continued to increase over the last few years. An unhealthy diet and lack of physical activity can elevate blood pressure, particularly if an unhealthy lifestyle has been followed since adolescence. This study aimed to analyze the correlation between snack consumption and physical activity with blood pressure in adolescent girls. Methods: A cross-sectional study was conducted with 349 adolescent girls from seven Islamic boarding schools in West Java, Indonesia. Data on daily food and snack consumption were obtained by the 24-hour recall for 3 non-consecutive days. Blood pressure was measured using a digital blood pressure instrument, and the results were categorized by age, gender, and height. Linear regression analyses were performed to investigate determinants of blood pressure. Results: A total of 120 (34.4%) of the adolescent girls in the study had hypertension. A majority of girls had inadequate daily intake (energy, fat, carbohydrates, and sodium; only total protein intake met Indonesia’s recommended dietary allowance). Snacks were found to be high in protein, fat, and carbohydrates, with consumption levels above 15%. More than half (61.9%) of the subjects’ daily sodium intake came from snacks. Low-fat intake from snacks was associated with an increase in blood pressure in this study. Daily nutritional intake affecting blood pressure included sodium and total fat intake. Lack of physical activity in adolescent girls was not a risk factor for elevated blood pressure. Conclusion: Fat and sodium intake was associated with elevated blood pressure in adolescent girls.

Medical Follow-Up Received by Women with Blood Pressure Alerts in the WISEWOMAN Program by Race and Ethnicity, 2014-2018.

Background: Hypertension is a preventable risk factor for heart disease and stroke. Immediate reduction in blood pressure (BP) is necessary for a person with dangerously high BP to prevent injuries related to heart disease and stroke. Differences in the prevalence of hypertension and dangerously high BP (BP alerts) and the distribution of medical follow-ups were examined by race and ethnicity among participants in the Well-Integrated Screening and Evaluation for WOMen Across the Nation (WISEWOMAN) program. Materials and Methods: Data (January 2014 through June 2018) were used to identify women, aged 40-64 years, with hypertension at their first WISEWOMAN screening. Women with BP alerts were identified as having an average systolic BP >180 mm Hg or diastolic BP >110 mm Hg at WISEWOMAN baseline screening or rescreening. CDC's WISEWOMAN program is a public health practice program and does not conduct human subject research. Results: Among 65,189 WISEWOMAN participants, 25,098 (38.5%) women had hypertension and 586 (2.3%) of those women had BP alerts. There were significant differences among Hispanic, non-Hispanic black (NHB), and non-Hispanic white (NHW) women in the prevalence of hypertension (26.5%, 67.1%, and 40.2%, respectively, p < 0.001) and BP alerts (1.7%, 3.4%, and 2.1%, respectively, p < 0.001). Among women with BP alerts, 74.7% received a medical follow-up within 7 days and 12.4% received a medical follow-up after 7 days. There were no significant differences in the percentage of women with BP alerts who received a follow-up within 7 days among Hispanic, NHB, and NHW women (71.1%, 77.1%, and 74.4%, respectively, p = 0.085). Conclusions: BP alerts occurred in 2.3% of the WISEWOMAN hypertensive population, and approximately three in four women with BP alerts, regardless of race and ethnicity, received timely follow-up care within 7 days.

Does Losartan reduce the severity of COVID-19 in hypertensive patients?

BACKGROUND: One of the global problems is to control the coronavirus epidemic, and the role of different medicines is still unknown to policymakers. This study was conducted to evaluate the effects of losartan on the mortality rate of COVID-19 in hypertensive patients. METHODS: The research sample of analytical study included 1458 patients presenting to COVID-19 diagnostic centers in Yazd that were examined in the first six months of 2020. Data were analyzed using descriptive statistics as well as chi-square, Fisher's exact test, t test, and logistic regression. RESULTS: Of 1458 subjects that were studied, 280 were hypertensive of whom 179 tested positive for SARS-CoV-2 PCR. The results showed a lower chance of death by more than 5 times in hypertensive patients who used losartan (P = 0.003). Moreover, regarding the effect of losartan on the prevention of COVID-19 in hypertensive patients, it was found that this medicine played a protective role although this relationship was not statistically significant (P = 0.86). CONCLUSIONS: The results showed that losartan reduced the chance of mortality in hypertensive patients. It is recommended that the effect of losartan and other blood pressure medicines on COVID-19 patients be investigated in larger studies as well as laboratory investigations.

Herb-drug interaction: pharmacokinetics and pharmacodynamics of anti-hypertensive drug amlodipine besylate in presence of Lepidium sativum and Curcuma longa.

Effects of Lepidium sativum and Curcuma longa were investigated on pharmacokinetics and pharmacodynamics of antihypertensive drug (amlodipine).Hypertensive rats were treated with amlodipine, Lepidium sativum, Lepidium sativum + amlodipine, Curcuma longa and Curcuma longa + amlodipine, and their blood pressures were measured. Amlodipine in plasma samples was analysed using UPLC-TQD. Product ions of amlodipine were monitored at m/z 409.18 > 238 and 409.18 > 294, and of nitrendipine at m/z 361.16 > 315.1 and 361.16 > 329.10.Lepidium sativum + amlodipine treatment showed highest reduction in systolic blood pressure (SBP). Mean anti-hypertensive effect of Lepidium sativum and Curcuma longa was similar to amlodipine. Mean SBPs (1-24 h) of amlodipine, Lepidium sativum, Lepidium sativum + amlodipine, Curcuma longa and Curcuma longa + amlodipine-treated animals were found as 149.5 ± 2.4 mmHg, 151.6 ± 1.09 mmHg and 141.8 ± 2.5 mmHg, 154.9 ± 2.2 mmHg and 144.4 ± 2.6 mmHg (p-value ≤0.05), respectively. Lepidium sativum and Curcuma longa significantly increased amlodipine Cmax by 83% (p-value 0.018) and 53% (p-value 0.035), and AUC0-t by 48% (p-value >0.05) and 56% (p-value 0.033), respectively.Results of pharmacokinetic and pharmacodynamic studies are in agreement. Lepidium sativum and Curcuma longa augment antihypertensive effect of amlodipine, which is also supported by pharmacokinetic observations.

Regulatory T Cells in Pregnancy Adverse Outcomes: A Systematic Review and Meta-Analysis.

Background: Several studies report the role of Regulatory T-cells (Tregs) in the pathophysiology of pregnancy adverse outcomes. Objective: The aim of this systematic review and meta-analysis was to determine whether there is an association between regulatory T cell levels and pregnancy adverse outcomes (PAOs), including pre-eclampsia and preterm birth (PTB). Method: Literature searches were conducted in PubMed/MEDLINE, Embase, and Cochrane CENTRAL databases. Inclusion criteria were original articles (clinical trials, case-control studies and cohort studies) comparing Tregs, sampled from the decidua or maternal blood, in healthy pregnant women versus women with pre-eclampsia or PTB. The outcome was standardised mean difference (SMD) in Treg numbers. The tau-squared (Tau²), inconsistency index (I²), and chi-squared (χ²) test quantified heterogeneity among different studies. Analyses were performed in RevMan software V.5.4.0 for Mac using a random-effects model with outcome data reported with 95% confidence intervals (CI). This study was prospectively registered with PROSPERO (CRD42020205469). PRISMA guidelines were followed. Results: From 4,085 unique studies identified, 36 were included in qualitative synthesis, and 34 were included in quantitative synthesis (meta-analysis). In total, there were 1,783 participants in these studies: healthy controls=964, pre-eclampsia=759, PTB=60. Thirty-two studies compared Tregs in healthy pregnant women and women with pre-eclampsia, and 30 of these sampled Tregs from peripheral blood showing significantly higher Treg numbers in healthy pregnancies (SMD; 1.46; 95% CI, 1.03-1.88; I²=92%). Four studies sampled Tregs from the maternal decidua showing higher Tregs in healthy pregnancies (SMD, 0.76; 95% CI, -0.13-1.65; I²=84%). No difference was found in the number of Tregs between early versus late pre-eclampsia (SMD,-1.17; 95% CI, -2.79-0.44; I²=94%). For PTB, two studies compared Tregs sampled from the peripheral blood with a tendency for higher Tregs in healthy pregnancies but this did not reach significance (SMD, 2.18; 95% CI, -1.34-5.70; I²=96%). Subcohort analysis using Treg analysis (flow cytometry vs. qPCR vs. immunofluorescence tissue staining) showed similar associations. Conclusion: Lower Tregs in pregnancy, sampled from the maternal peripheral blood, are associated with pre-eclampsia. There is a need for further studies to confirm a relationship between low Tregs and PTB. As the precise mechanisms by which Tregs may mediate pre-eclampsia and PTB remain unclear, further fundamental research is necessary to elucidate the underlying processes and highlight the causative link. Systematic Review Registration: PROSPERO, identifier CRD42020205469.

Evaluating the association between neonatal mortality and maternal high blood pressure, heart disease and gestational diabetes: A case control study.

BACKGROUND: Prevention of noncommunicable diseases (NCDs) during pregnancy is recommended due to severe complications for mothers and infants. Considering that NCDs have a significant impact on infant mortality, this study was conducted to investigate the relationship between mothers' underlying diseases and gestational diabetes and infant mortality in Iran. MATERIALS AND METHODS: Mothers who referred to the health centers in nine provinces of Iran were included. This case-control study used data collected from pregnant women. There were 1162 cases and 1624 controls. The required data were collected from mothers' health records and through interviews. RESULTS: The chances of neonatal mortality in women with a body mass index (BMI) of 30-35, 1.7 times (odds ratio [OR] = 1.7, confidence interval [CI]: 1.19-2.44, P = 0.003) was higher compared with women with a normal BMI. The chance of neonatal mortality among mothers with high blood pressure was three times higher compared with healthy mothers (OR = 3.04, 95% CI: 1.98-4.65, P < 0.001). The chance of neonatal mortality in women with kidney disease was also 1.64 times higher than mothers without kidney problems (OR = 1.64, 95% CI: 1.1-2.45, P = 0.015). In the study of gestational diabetes, the chance of neonatal mortality among the mothers who had at risk was 1.63 times higher than mothers without gestational diabetes (OR = 1.63, 95% CI: 0.84-3.16, P = 0.014). Furthermore, the chance of neonatal mortality among the mothers who had heart disease was 1.10 times higher than mothers without heart disease (OR = 2.10, 95% CI: 0.88-4.99, P = 0.014). CONCLUSION: This study showed that undiagnosed underlying diseases were related to neonatal mortality, which highlights the importance of caring for and counseling about the underlying diseases, screening, and controlling blood sugar levels before and during pregnancy to prevent infant mortality by all means possible.

Association of Sleep Duration and Blood Pressure in Adolescents: A Multicenter Study.

BACKGROUND: Evidence suggests that sleep duration is related to blood pressure (BP), but the findings are still inconsistent for adolescents. OBJECTIVE: To analyze the association between sleep duration and BP in Brazilian adolescents between 12 and 17 years of age. METHODS: This study is part of the Study of Cardiovascular Risk in Adolescents (ERICA), a multicenter, school-based, cross-sectional study in 273 municipalities in Brazil. The sample consisted of 65,643 adolescents. Sleep duration was measured by a subjective method, and BP was measured by the oscillometric method. Multiple linear regression analyses were performed to evaluate the association between sleep duration and BP. RESULTS: The mean sleep duration was 8.14 hours (± 1.40), with significant difference between the groups according to BP levels (P < 0.0001). The mean systolic and diastolic BP were 110.59 (± 11.87) and 65.85 (± 7.94) mm Hg, respectively, in the group of adolescents. Sleep duration was significantly associated with BP. Each increase 1 hour in sleep was associated with BP reduction in both sexes combined (P < 0.0001). Considering the effects of covariates, each increase 1 hour in sleep was associated with systolic BP (SBP) reduction among boys (P = 0.004) and SBP elevation among girls (P = 0.009), after full adjustment. CONCLUSION: The results suggest that each increase in sleep duration was associated with SBP elevation among girls. Such findings may have important implications for cardiovascular health in adolescence.

The Association between Night Shift Work and Hypertension Among Workers at A Construction Company in Jakarta

@#Introduction: Night shift work, which can cause circadian misalignment, may be associated with increased blood pressure. The purpose of this research was to find out the prevalence of hypertension and the associated factors of hypertension among night shift and day shift workers at a construction company in Jakarta. Methods: The data used in this study was taken from records of general medical checkup which was held in August 2019. Data of 107 male workers (28 day shift workers, 79 night shift workers) were gathered. Results: The prevalence of hypertension in night shift workers (59.5%) was higher compared to that in the day shift workers (17.9%). Systolic blood pressures (SBPs) of the night shift workers (mean SBP = 137.58; SD = 15.05; CI 95% = 134.58-141.32) were significantly higher compared to day shift workers’ (mean SBP = 122.14, SD = 13.24; CI 95% = 117.01-127.07). Diastolic blood pressures (DBPs) of night shift workers (mean DBP = 84.90; SD = 10.59; CI 95% = 82.53-87.27) were also significantly higher than day shift workers’ (mean DBP = 76.54; SD = 10.85; CI 95% = 72.33-80.74). According to multiple logistic regression analysis, workers with night shifts (OR = 7.47; CI 95% = 2.48-22.51) and overweight (OR = 2.73; CI 95% = 1.04-7.18) were significantly associated with hypertension compared to day shift workers and normal weight workers, respectively, after adjusted by other covariates. Conclusion: Night shift workers faced higher risk of hypertension compared to day shift workers, particularly for those who were overweight.

Prevalence of Hypertension in Adult Population of A Village of Nepal.

INTRODUCTION: Hypertension is a cardiovascular disorder rapidly emerging as a major health problem in developing countries. Uncontrolled or poorly managed hypertension leads to several complications such as coronary heart disease, peripheral vascular disease and kidney disease. These complications account for approx 9.4 million deaths worldwide every year. Consequently, it is an urgent need for authorities to act upon this issue. This study was done to determine the prevalence of Hypertension in Deurali village of Nuwakot. METHODS: A descriptive cross-sectional study was done in the Deurali Village of Nuwakot district from May 2019 to July 2019. Ethical approval was taken from the Ethical Review Board of Nepal Health Research Council. A simple random sampling method was applied. Blood pressure was measured on three occasions along with the use of a self-administered questionnaire. Descriptive statistical analysis was done. RESULTS: The study showed the prevalence of hypertension among the adult population to be 20 (8.5%) [8.5%±1.83% at 95% CI]. Prevalence was found to be higher among female than male. Age group more than 60 were major sufferers of the condition. The study population consisted of the majority of Tamang community. Almost 213 (91%) participants were reported to have taken alcohol at some point in their life whereas only 104 (45%) were smokers. CONCLUSIONS: The prevalence of hypertension was found to be lower than the previous study done in similar settings.

Association between blood pressure and acute phase stroke case fatality rate: a prospective cohort study / Associação entre níveis de pressão arterial e letalidade na fase aguda do acidente vascular cerebral: estudo de coorte prospectivo

ABSTRACT Objective ed to investigate the association between blood pressure and acute phase stroke lethality in a Brazilian intensive care unit. Methods This was an observational, prospective cohort study of hemorrhagic and ischemic stroke intensive care patients. The primary outcome was all-cause mortality during the first seven days. Results There were 146 patients, aged 66 ± 13.4 years, 56% men, 89% Caucasian, 69% had ischemic stroke, and 80% were hypertensive. The median of the National Institutes of Health Stroke Scale score was 16. There were 101 ischemic stroke patients and 45 hemorrhagic stroke patients. In the ischemic stroke patients, logistic regression analysis identified low systolic blood pressure as an independent ominous prognostic factor and the optimal cut off was a mean of systolic blood pressure ≤ 131 mmHg during the first 48 hours from admission for prediction of death. No association was found for hemorrhagic stroke. Conclusions There was a negative association between systolic blood pressure and case fatality ratio of acute phase stroke in ischemic stroke intensive care patients.

RESUMO Objetivo Investigar a associação entre pressão arterial e letalidade do acidente vascular cerebral (AVC) em uma unidade de terapia intensiva brasileira. Métodos estudo de coorte prospectivo de pacientes com AVC hemorrágico (AVC-H) ou isquêmico (AVC-I) internados em terapia intensiva. O desfecho primário foi a letalidade por todas as causas nos primeiros sete dias. Resultados Avaliados 146 pacientes, idade: 66 ± 13,4 anos, 56% homens, 89% brancos, 69% AVC-I e 80% hipertensos. A mediana do NIH foi de 16. Os pacientes com AVC-I foram 101 e 45 com AVC-H. Para AVC-I, a análise de regressão logística identificou baixa pressão arterial sistólica como um fator prognóstico negativo e o melhor corte foi uma média da pressão arterial sistólica nas primeiras 48 h de admissão ≤ 131 mmHg para a predição da morte. Para o AVC-H, nenhuma correlação foi encontrada. Conclusões houve associação negativa entre a pressão arterial sistólica e a letalidade do AVC-I em fase aguda em pacientes de terapia intensiva.

Bivariate longitudinal data analysis: a case of hypertensive patients at Felege Hiwot Referral Hospital, Bahir Dar, Ethiopia.

OBJECTIVE: Longitudinal data are often collected to study the evolution of biomedical markers. The study of the joint evolution of response variables concerning hypertension over time was the aim of this paper. A hospital based retrospective data were collected from September 2014 to August 2015 to identify factors that affect hypertensive. The joint mixed effect model with unstructured covariance was fitted. A total of 172 patients screened for antihypertensive drugs treated were longitudinally considered from Felege Hiwot referral. RESULTS: The joint mixed effect model with unstructured covariance (AIC: 12,236.9 with [Formula: see text] = 1007.8, P < 10-4) was significantly best fit to the data. The correlation between the evolutions of DBP and SBP was 0.429 and the evolution of the association between responses over-time was found 0.257. Among all covariates included in joint-mixed-effect-models, sex, residence, related disease and time were statistically significant on evolution of systolic and diastolic blood pressure. The joint modeling of longitudinal bivariate responses is necessary to explore the association between paired response variables like systolic and diastolic blood pressure. Fitting joint model with modern computing method is recommended to address questions for association of the evolutions with better accuracy.

Renin-angiotensin system gene polymorphisms and high blood pressure in Lithuanian children and adolescents.

BACKGROUND: Epidemiological studies have demonstrated the influence of environmental factors on HBP in the population of Lithuanian children, although the role of genetic factors in hypertension has not yet been studied. The aim of this study was to assess the distribution of AGTR1, AGT, and ACE genotypes in the Lithuanian child population and to determine whether these genotypes have an impact on HBP in childhood. METHODS: This cross-sectional study enrolled 709 participants aged 12-15 years. The subjects were genotyped for AGT (M235 T, rs699), AGTR1 (A1166C, rs5186), and ACE (rs4340) gene polymorphisms using real-time and conventional polymerase chain reactions. Blood pressure and anthropometric parameters were measured. RESULTS: The prevalence of HBP was 38.6% and was more frequently detected in boys than in girls (47.9% vs. 29.5%; p < 0.001). No significant differences in the frequencies of the AGT or AGTR1 genotypes or alleles between boys and girls were observed, except for ACE genotypes. The mean SBP value was higher in HBP subjects with ACE ID genotype compared to those with ACE II homozygotes (p = 0.04). No significant differences in BP between different AGT and AGTR1 genotype groups were found. Boys who carried the ACE ID + DD genotypes had higher odds of having HBP than carriers of the ACE II genotype did (controlling for the body mass index (BMI): ORMH = 1.83; 95% CI, 1.11-3.02, p = 0.024; and controlling for waist circumference (WC): ORMH = 1.76; 95% CI, 1.07-2.92, p = 0.035). These associations were not significant among girls. The same trend was observed in the multivariate analysis - after adjustment for BMI and WC, only boys with ACE ID genotype and ACE ID + DD genotypes had statistically significantly increased odds of HBP (aOR = 2.05; 95% CI, 1.19-3.53 (p = 0.01) and aOR = 1.82; 95% CI, 1.09-3.04 (p = 0.022), respectively). CONCLUSIONS: The evaluated polymorphisms of the AGT and AGTR1 genes did not contribute to the presence of HBP in the present study and may be seen as predisposing factors, while ACE ID genotypes were associated with significantly increased odds for the development of HBP in the Lithuanian child and adolescent population - especially in boys.

Regional Fat Distribution and Blood Pressure Level and Variability: The Dallas Heart Study.

Our aim was to investigate the associations of regional fat distribution with home and office blood pressure (BP) levels and variability. Participants in the Dallas Heart Study, a multiethnic cohort, underwent 5 BP measurements on 3 occasions during 5 months (2 in home and 1 in office) and quantification of visceral adipose tissue, abdominal subcutaneous adipose tissue, and liver fat by magnetic resonance imaging, and lower body subcutaneous fat by dual x-ray absorptiometry. The relation of regional adiposity with short-term (within-visit) and long-term (overall visits) mean BP and average real variability was assessed with multivariable linear regression. We have included 2595 participants with a mean age of 44 years (54% women; 48% black), and mean body mass index was 29 kg/m(2) Mean systolic BP/diastolic BP was 127/79 mm Hg and average real variability systolic BP was 9.8 mm Hg during 3 visits. In multivariable-adjusted models, higher amount of visceral adipose tissue was associated with higher short-term (both home and office) and long-term mean systolic BP (ß[SE]: 1.9[0.5], 2.7[0.5], and 2.1[0.5], respectively; all P<0.001) and with lower long-term average real variability systolic BP (ß[SE]: -0.5[0.2]; P<0.05). In contrast, lower body fat was associated with lower short-term home and long-term mean BP (ß[SE]: -0.30[0.13] and -0.24[0.1], respectively; both P<0.05). Neither subcutaneous adipose tissue or liver fat was associated with BP levels or variability. In conclusion, excess visceral fat was associated with persistently higher short- and long-term mean BP levels and with lower long-term BP variability, whereas lower body fat was associated with lower short- and long-term mean BP. Persistently elevated BP, coupled with lower variability, may partially explain increased risk for cardiac hypertrophy and failure related to visceral adiposity.

A imunidade na hipertensão arterial: o papel dos linfócitos eda resposta humoral / Immunity and hypertension: role of lymphocytes and humoral response

A hipertensão arterial é um dos maiores fatores de risco a eventos cérebro e cardiovasculares, com alta prevalência na população mundial. Diversos fatores podem conduzir à elevação da pressão arterial; no entanto, estudos recentes têm demonstrado o papel do sistema imune na modulação da pressão e no surgimento da hipertensão. Ainfiltração de células imunes nos rins provoca uma inflamação crônica que, por sua vez, altera o sistema de controle da pressão arterial. Além disso, outros estudos revelam que o sistema imune pode provocar mudanças no sistema nervoso central que podem alterar o controle da pressão arterial. Diferentes subtipos de linfócitos estão relacionados à modulação da pressão arterial, bem como à resposta humoral a antígenos que possuem a capacidade de alterar o endotélio. Aresposta autoimune também se apresenta como um possível fator causador da hipertensão. Este manuscrito teve por objetivo abordar os mecanismos pelos quais os linfócitos e as respostas humorais contribuem para a modulação da pressão arterial.

Hypertension is a major risk factors to stroke and acute coronary syndromes events with high prevalence in the world population. Several factors can lead to high blood pressure, however recently studies have shown the role of the immune system in the pressure modulation and in the occurrence of hypertension. The infiltration of immune cells in the kidney leads to a chronic inflammation which in turn changes the blood pressure. In addition, other studies have shown that the immune system activity central nervous system with changes in blood pressure control. Subtypes of lymphocytes are related to the modulation of blood pressure and the humoral immune response to antigens which have thecapacity to change the endothelium. The autoimmune response also appears as a possible causing factor of hypertension. This manuscript will address mechanisms by which lymphocytes and humoral responses contribute to the modulation of blood pressure.

Plasma and Kidney Angiotensin Peptides: Importance of the Aminopeptidase A/Angiotensin III Axis.

BACKGROUND: The renin-angiotensin system is a complex regulatory hormonal network with a main biological peptide and therapeutic target, angiotensin (Ang) II (1-8). There are other potentially important Ang peptides that have not been well evaluated. METHODS: Liquid chromatography-tandem mass spectrometry (LC-MS/MS) was used for concurrent evaluation of multiple Angs downstream of Ang I (1-10) and Ang II (1-8) in kidney and plasma from wild-type (WT) mice. Angiotensin converting enzyme 2 knockout (ACE2KO) was also used as a way to examine the Angs profile in the absence of ACE2, an enzyme that cleaves both Ang I (1-10) and Ang II (1-8). RESULTS: In plasma from both WT and ACE2KO, levels of Ang I (1-10), Ang III (2-8), and Ang (2-10) were the highest of all the renin-angiotensin system (RAS) peptides. The latter two peptides are products of aminopeptidase A cleavage of Ang II (1-8) and Ang I (1-10), respectively. In contrast, plasma levels of Ang II (1-8), and Ang (1-7), the product of Ang II (1-8) cleavage by ACE2, were low. In kidney from both WT and ACE2KO, Ang II (1-8) levels were high as compared to plasma levels. In the ACE2KO mice, a significant increase in either Ang II (1-8) or a decrease in Ang (1-7) was not observed in plasma or in the kidney. CONCLUSION: RAS-focused peptidomic approach revealed major differences in Ang peptides between mouse plasma and kidney. These Ang peptide profiles show the dominance of the aminopeptidase A/Ang (2-10) and aminopeptidase A/Ang III (2-8) pathways in the metabolism of Ang I (1-10) and Ang II (1-8) over the ACE2/Ang (1-7) axis. Ang III (2-8) and other peptides formed from aminopeptidase A cleavage may be important therapeutic RAS targets.

Nigerian Population Research on Environment, Gene and Health (NIPREGH) - objectives and protocol.

Sub-Saharan Africa is currently undergoing an epidemiological transition from a disease burden largely attributable to communicable diseases to that resulting from a combination of both communicable and chronic non-communicable diseases. Data on chronic disease incidence, lifestyle, environmental and genetic risk factors are sparse in this region. This report aimed at providing relevant information in respect to risk factors that increase blood pressure and lead to development of intermediate cardiovascular phenotypes. We presented the rationale, objectives and key methodological features of the Nigerian Population Research on Environment, Gene and Health (NIPREGH) study. The challenges encountered in carrying out population study in this part of the world and the approaches at surmounting them were also presented. The preliminary data as at 20 November 2013 showed that out of the 205 individuals invited starting from early April 2013, 160 (72 women) consented and were enrolled; giving a response rate of 78%. Participants' age ranged from 18 to 80 years, with a mean (SD) of 39.8 (12.4) years and they were of 34 different ethnic groups spread over 24 states out of the 36 states that constitute Nigeria. The mean (SD) of office and home blood pressures were 113.0 (15.2) mm Hg systolic, 73.5 (12.5) mm Hg diastolic and 117.3 (15.0) mm Hg systolic, and 76.0 (9.6) mm Hg diastolic, respectively. Forty-three (26.8%) participants were hypertensive and 8 (5.0%) were diabetic. In addition to having the unique potential of recruiting a cohort that is a true representative of the entire Nigerian population, NIPREGH is feasible and the objectives realisable.

The Prevalence Of Hypertension And Its Associated Risk Factors In Two Rural Communities In Penang, Malaysia

Background: Hypertension is estimated to cause 4.5% of the global disease burden. The prevalence of hypertension in Malaysia is 32.2%. Objective: To determine the prevalence of hypertension and its associated risk factors in two rural communities in Penang, Malaysia. Methods: This cross sectional study was conducted among all consenting residents aged 18 years and above from two villages in Penang. Besides the baseline demographic information, blood pressure was measured using a manual sphygmomanometer according to the American Heart Association Guidelines. Results: 50 out of 168 people were hypertensive, giving a prevalence rate of 29.8%. 50.0% of those found with hypertension were undiagnosed and 48.0% of those who were diagnosed with hypertension had uncontrolled blood pressure. Logistic regression analysis showed that age, history of alcohol consumption and BMI were found to be independently associated with hypertension. Conclusions: Age, education level, alcohol consumption and BMI are important risk factors associated with the prevalence of hypertension among the villagers. These risk factors are comparable to those reported in National Health and Morbidity Survery 2006 in Malaysia.

Prehypertension: what is the current status?

Cardiovascular disease (CVD) risk is a continuum across blood pressure. The term prehypertension was introduced because it is now recognized that blood pressure readings between what is deemed optimal and hypertension is associated with increased CVD risk. The prevalence of prehypertension is high and the progression to hypertension is also high. Prehypertension is also commonly associated with other CVD risk factors namely dyslipidaemia, dysgylcaemia and overweight/obesity. Eighty-five percent of prehypertensives have one other or more CVD risk factor compared to normotensives. A recent study has shown a reduction in the development of hypertension from prehypertension with the use of an angiotensin receptor blocker. Unfortunately to date, the impact of treatment of prehypertension on CVD outcome is still unknown except in those with high CVD risk like diabetes or established CVD. However this does not mean nothing can be done for those with prehypertension. The aim of managing prehypertension is to lower the BP, prevent progression to hypertension and to prevent BP related CVD deaths. Lifestyle changes can reduce BP and this by itself can lower CVD risk. Until more evidence about other modalities of treatment become available this is a sensible and cost-effective way to manage prehypertension.