Current Hypertension Reviews - Volume 19, Issue 1, 2023

Oxidative stress is one of the main mechanisms involved in the pathophysiology of arterial hypertension, inducing direct effects on the vasculature, and contributing to endothelial dysfunction and consequent impairment of vascular relaxation. Despite a large number of pharmacological treatments available, intolerable side effects are reported, which makes the use of natural antioxidants a promising and complementary alternative for the prevention and treatment of hypertension. From this perspective, the current review aims to investigate and characterize the main antioxidants of natural origin for the treatment of hypertension. Antioxidants act in the inhibition or extinction of chemical reactions involving free radicals and consequently reduce the occurrence of damage caused by these cellular components. The main natural antioxidants for treating hypertension include caffeic acid, ferulic acid, curcumin, apocynin, quercetin, lipoic acid, and lycopene. The effects associated with these antioxidants, which make them therapeutic targets for decreasing high blood pressure, include increased activation of antioxidant enzymes, stimulation of nitric oxide bioavailability, and reduction in angiotensin-converting enzyme activity, arginase, and NADPH oxidase, whose effects contribute to reducing oxidative stress, improving endothelial function, and preventing cardiovascular dysfunctions. Thus, several products with antioxidant properties that are available in nature and their application in the treatment of hypertension are described in the literature. The therapeutic effects of these products seem to regulate several parameters related to arterial hypertension, in addition to combating and preventing the deleterious effects related to the disease.

The prevalence of supine and nocturnal hypertension (S-N-HT) is high among patients with orthostatic hypotension (OH), especially in those who have a neurogenic aetiology. The evidence suggests that S-N-HT exacerbates OH, although it is unclear whether pharmacologic treatment of S-N-HT will improve OH. S-N-HT has also been associated with target organ damage. Therefore, assessment and management of S-N-HT should be an integral part of managing OH, but it is often overlooked in clinical practice.

An imbalance between angiogenic and anti-angiogenic factors plays a fundamental role in the pathogenesis of preeclampsia (PE). Studies have shown a dysregulation of sFlt-1 and placental growth factor (PlGF) in PE. However, there are differing reports on the levels of these pro-/antiangiogenic factors in HIV-infected preeclamptic and normotensive pregnancies, possibly due to highly active antiretroviral therapy (HAART) and its immune reconstitution effect. The study aimed to investigate the effect of hypertension and ARVs on circulating and placental pro- and antiangiogenic factors in HIV-infected PE. The level of sFlt-1 expression is elevated in PE compared to normal pregnancies. PlGF was altered by placental dysfunction. Antiretroviral therapy does not impact the angiogenic shift in PE development. The angiogenic imbalance evident in the circulatory system by higher sFlt-1 compared to PlGF levels is replicated in the placenta by reduced expression of PlGF receptors in comparison to sFlt-1 receptors. However, there is a lack of data that explore the relationship between HAART and anti-angiogenic factors in the placenta and the circulation of PE comorbid with HIV infection.

The efficiency of blood flowing from the heart depends on its electrical properties. Myocardial electrical activity is associated with generating cardiac action potentials in isolated myocardial cells and their coordinated propagation, which are mediated by gap junctions. Atrial fibrillation (AF) is a common cardiac arrhythmia which causes an aggressive disturbance in cardiac electromechanical function. Moreover, AF increases the risk of stroke and mortality and is a major cause of death. The mechanisms underlying AF involve electrophysiological changes in ion channel expression and function. β-blockers may be useful in patients with chronic AF or in preventing postoperative AF in subjects undergoing coronary artery bypass grafting (CABG) or other types of surgery. The reduction in heart rate induced by β1-adrenergic receptor antagonists may be associated with the beneficial effect of this drug class. Second generation beta-blockers may be considered superior to the first generation due to their selectivity to the β1 receptor as well as avoiding pulmonary or metabolic adverse effects. Third generation beta-blockers may be considered a great option for their vasodilation and antioxidant properties. There is also a new β-blocker, named landilol that also results on reduced risk of post operative AF without adverse effects and its use has been increasing in clinical trials.

large number of clinical symptoms, adversely impacts the quality of life, and can even initiate serious arrhythmias, such as ventricular tachycardia or ventricular fibrillation. The incidence of premature ventricular contraction is higher in hypertensive patients, particularly if concomitant left ventricular hypertrophy (LVH) is present. Objectives: This study was conducted on the characteristics of PVC in hypertensive patients with left ventricular hypertrophy and aimed to evaluate the effect of bisoprolol on PVC in Vietnamese patients with hypertension and LVH. Materials and Methods: We conducted a study to determine how bisoprolol potency affected PVC management in the group with both high blood pressure and LVH. We selected a convenient sample of all patients who came to the Medical Examination Department at the Can Tho University of Medicine and Pharmacy Hospital and met sampling criteria with hypertension, LVH on echocardiography, and PVC on 12-leads electrocardiogram. Over 2 years, we collected 76 patients who satisfied the above conditions. Out of which, 50 patients were indicated for management with bisoprolol, and 26 patients were excluded from the study, including 7 patients with asthma and 19 patients who had simple PVC on a 24-hour Holter ECG. Data were analyzed with SPSS version 22. Results: Fifty patients participated in the study, of whom 70% were female. It is clear that palpitation was the most prevalent symptom (66%), and 38% of patients had complicated PVC (Lown III-V). When treating PVC with bisoprolol, 50% of patients achieved the treatment goal with a decrease in the number of PVCs of more than 70%, accompanied by symptom relief and eradication of dangerous PVCs. After 4 weeks of treatment, bisoprolol decreased the number of PVCs, heart rate, and blood pressure while also easing PVC-related symptoms (p < 0.05). Conclusion: Low-dose bisoprolol effectively reduces the number of PVCs in hypertensive patients with LVH.

Introduction: Although optimal wellbeing of young adults (YA) is a vital asset for productivity and measurable and sustainable development, there is a dearth of information on the wellbeing status of YA, especially after the COVID-19 lockdown in Ghana. The study has established the post-lockdown wellbeing status of YA in the COVID-19 pandemic epicenters of Ghana. Methods: The wellbeing status of 1783 (24.49 ± 4.62 year) Ghanaian YA from Kumasi, Accra, and Kasoa (known epicentres of COVID) was assessed in this cross-sectional study. Body mass index (BMI) was calculated, and physical, social, emotional, spiritual and intellectual states were assessed. Results: More females were found to be overweight (315, 17.7%) and obese (160, 9.0%) compared to males. The majority (714; 40.0%) of the young adults were between the ages 25-30 years and overweight, with a mean BMI of 25.46 ± 4.67 kg/m&². Overall, 157 (8.8%) had poor, 755 (42.3%) average, 479 (26.9%) good, while 392 (22.0%) had outstanding wellbeing. Specifically, the average grade was recorded for physical (29.07 ± 6.67), spiritual (29.32 ± 6.80), and intellectual (28.29 ± 6.56), while ‘good grade’ was obtained for social (32.16 ± 5.13) and emotional (31.54 ± 5.07) dimensions of wellbeing. Conclusion: Average Ghanaian YA in the study were overweight (BMI value) and had average wellbeing, which may suggest the risk of cardiovascular diseases. Educational and physical activity interventions with meticulous dietary control and proper understanding of family history, age and genetic factors will help to improve the wellbeing of Ghanaian YA.

Aims: In this study, we aimed to appraise the effects of interrupting (discontinuing) vs. continuing Angiotensin receptor blockers (ARBs) and Angiotensin-Converting Enzyme Inhibitors (ACEIs) on the hemodynamic changes of patients during and after cataract surgery. Methods and Materials: Patients aged 40-70 years, American society of anesthesiologist (ASA) class II, taking ACEI/ARB medications, who were admitted to Khalili hospital (Shiraz, South of Iran) for cataract surgery, were enrolled in the study. Patients were randomly divided into two groups for continuing or withdrawing the use of ACEI/ARBs. Group 1 included the patients who continued ACEI/ARB administration, and group 2 included those who discontinued them before surgery. In the operating room, relevant demographic information was collected in addition to the data on patients’ basic clinical status, including heart rate and blood pressure, before induction of anesthesia, during, and after that. The collected data were analyzed using SPSS 21, and p-values < 0.05 were considered statistically significant. Results: Any significant differences were not revealed in demographic variables (age, sex, diabetes, hypertension, Myocardial infarction, Smoking, and duration of drug therapy) between the two groups. Time effect was significant (p<0.001) for systolic blood pressure, diastolic blood pressure, and heart rate, and interaction between time*group was not significant (p = 0.431, p = 0.566, and p = 0.355) for systolic blood pressure, diastolic blood pressure, and heart rate. However, the group effect wasn’t significant (p=0.701, p=0.663, and p=0.669) for systolic blood pressure, diastolic blood pressure, and heart rate. Conclusion: It seems that in some minor surgeries, such as cataract surgery, withdrawal or continuation of ACEIs/ARBs have no significant effect on the hypotension and heart rate of patients during orafter an operation.