Current Hypertension Reviews - Volume 14, Issue 1, 2018

Background: Aortic stenosis is a common form of valvular heart disease which often coexists with hypertension. These diseases represent two distinct forms of left ventricular systolic overload and in combination may be associated with disadvantageous left ventricular remodeling, increased mortality and heart failure. The treatment of hypertension in aortic stenosis remains a challenging problem with limited data to guide clinical practice. Methods: We performed a comprehensive online literature review to find relevant published literature on the topic of hypertension and aortic stenosis. Results: In the present manuscript, we review the pathophysiology of aortic stenosis in combination with hypertension and the effects on the left ventricle. We also provide general recommendations for medical therapy for treatment of hypertension in aortic stenosis and review the available data on specific antihypertensive agents in this context. Conclusions: Aortic stenosis and hypertension commonly coexist and significantly impact the diagnosis and classification of aortic stenosis severity and symptoms. Treatment of hypertension among patients with severe aortic stenosis can be challenging. Among specific antihypertensive agents studied in this context, ACE-inhibitors are the most well studied.

Arterial hypertension is a disease that still affects a major part of the population worldwide, and leads to fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions. From the CDC statistical analysis, as regarding to United States, 1 of every 3 adults has high blood pressure, and only about half (54%) of them have it under control. Furthermore, all that leads to a nation cost about $46 billion each year. Efforts to find new ways to regulate arterial hypertension are therefore imperative. In our days, a lot of references have been made to the use of a new therapeutic combination, that of azilsartan – an innovative ARB, in combination with chlorthalidone. In fact, it is a combination now prescribed in a number of countries. A significant number of trials shows both azilsartan vs popular antihypertensive drugs, as well as chlorthalidone vs chlorothiazide, to present a better antihypertensive effect. This effect is even greater when the two substances are combined. In this article, we will try to present the latest findings concerning the efficacy, safety and clinical utility of this combination, as well as its adverse events, in comparison with other widely used therapeutic options.

Background: Preeclampsia is a multisystem disorder affecting 5%-8% of pregnant women. Considering the ongoing debate over the predicting value of some commercial first trimester tests, the aim of this study was to compare the existing first-trimester screening tests for preeclampsia. Methods: In this systematic review, relevant articles published during 2000-2017 were extracted from PubMed, Science Direct, Scopus, Cochrane Library, ISI Web of Science, and ProQuest databases. After a thorough evaluation of the 412 potentially eligible papers, only 28 papers were selected based on the inclusion criteria. Results: From a total of 412 retrieved studies, 28 papers were found eligible. Most studies had casecontrol or nested case-control designs. A total of 15164 pregnant women were evaluated in the reviewed studies. Various tests were applied in the first trimester of pregnancy to predict the development of preeclampsia. The most commonly used biomarkers were uterine artery pulsatility index, pregnancy-associated plasma protein A (PAPP-A), adiponectin, human chorionic gonadotropin (hCG) hormone and inhibin-A. Other tests were used in only one or two studies. Conclusion: Based on this review, a combination of markers should be evaluated for the identification of high-risk women. Novel methods measuring multiple markers will hopefully facilitate the development of clinically effective screening programs in the future.

Objectives: Plasma renin activity (PRA) and aldosterone tend to differ between Blacks and Caucasians and studies are very scarce among Africans. We therefore aimed to determine the normative value of plasma renin activity and serum aldosterone among school teachers in Nigeria with normal blood pressure compared with their hypertensive counterparts and relevant clinical/ demographic associations. Methods: Plasma renin activity and serum aldosterone were measured using the kits provided by Diagnostic Biochem, Canada among randomly selected school teachers recruited as part of a study to assess their total cardiovascular risks. Mean serum values were compared between normotensive and hypertensive participants and were correlated with clinical and demographic parameters. Statistical analysis was done using SPSS 17.0, Chicago, Ill, USA. P <0.05 was taken as statistically significant. Result: The mean PRA level of all study participants was 0.80 ± 0.85 ng/mL.h (mean ± SD) while the mean serum level of aldosterone was 93.9 ± 60.9 pg/ml. The mean aldosterone: renin ratio was 446.5 ± 958.2. The frequency of occurrence of hypertension was 29%. Only plasma renin activity was significantly correlated with systolic and diastolic blood pressure, age and the rate pressure product (a measure of cardiovascular risk). The finding of a higher mean PRA among hypertensive subjects is definitely related to the antihypertensive medications being taken including beta blockers and angiotensin converting enzyme inhibitors among others. The prevalence of high aldosterone/ renin ratio which could reflect the proportion of primary aldosteronism was 10.8%. Conclusion: Nigerians have a low renin activity compared to their Caucasian counterpart. PRA may be an important determinant of blood pressure among Nigerians. Appropriate drugs that target phenotypic status of PRA and aldosterone may be useful in the management of hypertension and the choice of pharmacotherapy among Nigerians.

Background and Objective: Previously it was demonstrated that digitalis-like cardiotonic steroid, marinobufagenin (MBG), is implicated in the development of ethanol addiction in rats. We hypothesized that (i) levels of sodium pump ligand, MBG, would be negatively correlated with the amount of ethanol consumed by rats, and (ii) that spironolactone would oppose the MBG induced ethanol-seeking behavior and blood pressure in rats. Methods: Voluntary consumption of 9% alcohol (vs. water) during 10 days period by 11 adult male Wistar rats was studied. Eight weeks after the beginning of the experiment, the animals were divided into two treatment subgroups: high alcohol drinkers (HAD, n=6, daily consumption of ethanol > 4 g/kg) and low alcohol drinkers (LAD, n=5, daily consumption of ethanol < 4 g/kg) rats. Spironolactone treatment (7 days) was started following 3-day habituation to intragastric vehicle administration. Consumption of ethanol and blood pressure were recorded daily. Results: Urinary MBG excretion at baseline was 11.2±0.6 pmoles in HAD rats and 19.1±2.9 pmoles (p<0.05) in LAD rats, respectively. Seven days of spironolactone treatment was associated with reduction in ethanol intake (2.9 g/kg/24 hr), reduction in systolic blood pressure (5 mm Hg), and increase in sodium excretion (1 mmol/24 hr). Conclusion: Levels of MBG may be a predisposing factor to voluntary ethanol intake. Spironolactone, along with antihypertensive effect, decreases ethanol intake.

Background: The HALT PKD trial in early autosomal dominant polycystic kidney disease (ADPKD) showed that intensive control of systolic blood pressure to 95-110 mmHg was associated with a 14% slower rate of kidney volume growth compared to standard control. It is unclear whether this result was due to greater blockade of the renin-angiotensin-aldosterone system (RAAS) by allowing the use of higher drug doses in the low blood pressure arm, or due to the lower blood pressure per se. Methods: In this secondary analysis of HALT PKD Study A, we categorized participants into high and low dose groups based on the median daily equivalent dose of RAAS blocking drugs used after the initial dose titration period. Using linear mixed models, we compared the percent change in total kidney volume and the slope of estimated glomerular filtration rate (eGFR) between the 2 groups. We also assessed the effects of time-varying dose and time-varying blood pressure parameters on these outcomes. Results: Subjects in the high dose group (n=252) did not experience a slower increase in total kidney volume than those in the low-dose (n=225) group, after adjustment for age, sex, genotype, and BP arm. The chronic slope of eGFR decline was similar in the 2 groups. Higher time-varying systolic blood pressure was associated with a steeper decline in eGFR. Conclusion: ADPKD progression (as detected by eGFR decline and TKV increase) was ameliorated by intense blood pressure control as opposed to pharmacologic intensity of RAAS blockade.

Objectives: to compare the prevalence of target-organ damage (TOD), defined as carotid plaque, or intima media thickness, cIMT, >0.9 mm, and that of increased renal resistive index (RRI), among HIV-1-infected patients and uninfected hypertensive patients (HT-non HIV). Methods: HIV-infected patients aged ≥ 18 years and virologically suppressed were matched with pair-age, sex and BMI HT-non HIV. Patients on antihypertensive treatment were excluded. All patients' cIMT and RRI were evaluated with ultrasonography. Data were analysed throughout 2 test, analysis of variance and logistic regression. Results: Fifty-nine HIV-infected patients were enrolled (71% men) and matched with 59 HT-non HIV. No differences were found in cIMT values (p=0.827) and in the prevalence of TOD between HIV-infected patients and HT-non HIV (36% vs 38%, p= 0.79). Among HIV-infected patients, those hypertensive had significantly higher prevalence of TOD (46% vs 21%, P< 0.05) and higher cIMT (0.747 ± 0.104 vs 0.654 ±0.100 mm, p = 0.0185). Patients with TOD were older (p= 0.004) and more frequently current smokers (p= 0.022). At the logistic regression analysis, TOD was significantly related to age (p=0.04, 95%CI 1.0-1.1) and smoke, current (p=0.178, 95%CI1.2-12.8) or previous (p=0.04, 95%CI 1.0-7.2). Mean RRI were identical for both HIV-1 infected and uninfected patients (0.60, SD± 0.05 and 0.60, SD± 0.04, respectively, p=0.996). Conclusions: In our study TOD was associated to hypertension, older age and smoke, but not to HIV serostatus itself, confirming the major importance of traditional risk factors and the need of risk assessment and cardiovascular prevention measures in HIV-infected patients.

Background: We developed a WASHOKU-modified DASH diet named DASH-JUMP. We previously reported the hypotensive effect of the DASH-JUMP diet in Japanese participants with untreated high-normal Blood Pressure (BP) or stage 1 hypertension. Objective: We aim to introduce the DASH-JUMP diet worldwide as a new lifestyle medicine. Accordingly, we prospectively assessed the nutritional characteristics of the DASH-JUMP diet. Methods: Participants were treated with the DASH-JUMP diet for 2 months. Then, for 4 months after the intervention, they consumed their usual diets. We conducted a nutritional survey using the FFQg nutrient questionnaire at baseline and after 1, 2, 3, and 6 months. We received completed questionnaires from 55 participants (28 men and 27 women; mean age 54.2 ± 8.0 years) and analyzed them. Results: The DASH-JUMP diet is rich in green-yellow vegetables, seaweed, milk, and mushrooms, while it has low contents of meat, eggs, confectionery, oils and fats, pickles, shellfish boiled in sweetened soy sauce, and fruits. Nutrients significantly associated with the observed change in systolic BP were niacin (P = 0.005) and carbohydrate (P = 0.033). The results of the FFQg questionnaire revealed that participants who had an increased BP at 1 month after ceasing the intervention had eating habits that broadly imitated the DASH-JUMP diet at 4 months after ceasing the intervention. Therefore, the systolic and diastolic BP values at 4 months after ceasing the intervention decreased significantly compared to those at baseline. Conclusion: The DASH-JUMP diet may represent a new lifestyle medicine for reducing hypertension.

Background: Patients with hypertension have altered autonomic nervous system function, which are increased sympathetic activity. Transcutaneous Electrical Nerve Stimulation (TENS) is a useful modality for pain control and has also been shown to be effective in the reduction of sympathetic activity in healthy subjects and individuals with cardiovascular diseases. Objective: The aim of this study was to verify the effects of transcutaneous electrical nerve stimulation by the evaluation of heart rate variability (HRV) in patients with essential hypertension. Method: Twenty-eight patients received an application of low-frequency TENS(4 Hz) n=8, highfrequency TENS (100 Hz) n=10 or placebo TENS n=10 in paravertebral ganglionar region during thirty minutes. Results: After 4 Hz TENS, there was a decrease in the low-frequency (LFn.u.) component (57.71±9.46 vs 45.58±13.51, p<0.026) and an increase in the high-frequency (HFn.u.) component (33.03±13.83 vs 45.83±20.19, p <0.05) of HRV. After 100 Hz TENS and placebo, there were no changes in the LF and HF components. No significant differences were found in systolic blood pressure with low-frequency TENS (129.37± 15.48 vs 126.69 ± 15.21, p<0.490). There was an increase, although not significant, with high-frequency TENS (131.00 ± 15.97 vs 138.75 ± 25.79, p<0.121) and placebo (133.80 ± 29.85 vs 134.80 ± 29.72, p< 0.800). No differences were found in the diastolic blood pressure with low-frequency TENS and placebo, but there was a significant increase in high-frequency TENS (81.00 ± 11.78 vs 85.65 ± 13.68, p< 0.018). Conclusion: Low-frequency TENS decreases sympathetic nervous system activity and increases parasympathetic nervous system activity and high-frequency TENS increases diastolic blood pressure, when applied on the paravertebral ganglionar region in the hypertensive patients.