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Current Hypertension Reviews - Volume 20, Issue 3, 2024

Volume 20, Issue 3

Volume 20, Issue 3, 2024

    • Polyphenol-Mediated Modulation of Non-Coding RNAs: A New Therapeutic Approach for Hypertension - A Review

      https://doi.org/10.2174/0115734021334958240903072642

      Hypertension (HTN) is a leading risk factor for cardiovascular diseases (CVDs) and a major contributor to global morbidity and mortality. Conventional pharmacological treatments have been effective but are often accompanied by side effects and do not address all pathological aspects of the disease. Recent advances in molecular biology have identified non-coding RNAs (ncRNAs), including microRNAs (miRNAs) and long non-coding RNAs (lncRNAs), as key regulators in the pathogenesis of hypertension. These ncRNAs influence various cellular processes, such as gene expression, vascular tone, and inflammation, making them promising targets for therapeutic intervention. This review explores the potential of polyphenols, a diverse group of phytochemicals with potent antioxidant and anti-inflammatory properties, in modulating ncRNA expression and function. We discuss how polyphenols, such as epigallocatechin-3-gallate (EGCG), resveratrol, curcumin, and quercetin impact the regulation of ncRNAs, particularly focusing on their roles in reducing oxidative stress, improving endothelial function, and ameliorating vascular remodeling associated with hypertension. The review synthesizes current evidence from both and studies, highlighting significant findings and the mechanisms by which polyphenols exert their effects on ncRNA-mediated pathways.

      Moreover, we address the challenges of translating these findings into clinical applications, including issues related to bioavailability, dosing, and the complex interactions of polyphenols with other cellular components. Future directions for research are suggested, with an emphasis on the need for comprehensive clinical trials to establish the efficacy of polyphenol-based therapies targeting ncRNAs in hypertension management. By targeting ncRNAs, polyphenols offer a novel therapeutic strategy that could enhance the treatment landscape for hypertension and potentially other cardiovascular conditions.

    • Supplementation of Olive Oil and Flaxseed Oil on Blood Pressure and Inflammation in Healthy and At-Risk Adults: A Systematic Literature Review and Meta-Analysis

      https://doi.org/10.2174/0115734021337760241104063418
      Background

      Adding olive oil (OO) and flaxseed oil (FLO) to the diet has been reported to improve endothelial function and reduce inflammation. However, the efficacy of supplementing OO and FLO on blood pressure (BP) in normo-, pre-, and hypertensive stage 1 adults is uncertain.

      Objective

      This study aimed to systematically review the literature on OO and FLO supplementation on BP and select inflammatory markers in healthy adults and adults at risk of hypertension.

      Methods

      Four databases, PubMed, CINHAL, Web of Science, and Medline (Ovid), were searched from inception until October 2023 for randomized control trials (RCTs) comparing OO and FLO supplementation in normotensive or adults at risk of hypertension. The outcomes included were systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) and at least one inflammatory marker, C-reactive protein (CRP), interleukin6 (IL6), or tumor necrosis factor alpha (TNFα). The risk of bias was assessed using version 2 of the Cochrane risk of bias tool for RCTs, publication bias visualization was performed using funnel plots, and meta-analysis was completed to generate average estimates of effects in 2024.

      Results

      Seventeen RCTs, comprising 14 studies on OO and 3 on FLO, met the inclusion criteria. Meta-analysis using a random-effects model reported no significant effect on SBP n=17 mean difference (MD) -0.48; 95% CI: -1.76, 0.80; =0.65, =0%) and DBP (n=16, MD -0.47; 95% CI: -1.33, 0.39; =0.65, =0%) or inflammatory markers, CRP (n=8, MD 0.11; 95% CI: -1.18, 0.40; =0.98, =0%), IL6 (n=3, MD -0.15; 95% CI: -0.57, 0.27; =0.87, =0%), and TNFα (n=3, MD-0.08; 95% CI: -0.12, -0.03; =0.98, =0%).

      Conclusion

      Longer-duration, higher-dose, and larger-scale RCTs are needed to better understand the efficacy of OO and FLO supplementation on BP. Further insight will better inform dietary supplement use for preventing hypertension.

    • Exploring the Challenges of Recruiting Older People for a Randomised Trial Assessing the Feasibility of Treating White Coat Hypertension in the UK General Practices: A Mixed-methods Study

      https://doi.org/10.2174/0115734021299574240809114921
      Introduction

      There is a recognised association between white coat hypertension (WCH) and adverse cardiovascular outcomes in older adults. However, there is no consensus on the management of WCH in this group. The objective of the Hypertension in the Very Elderly Trial (HYVET-2) study was to assess the feasibility of randomising 100 patients > 75years with WCH from General Practice in the UK to treatment or usual care. The study did not randomise any patients. In this follow-up study, we sought to explore the reasons for not recruiting.

      Methods

      Furthermore, using a mixed-methods study design, staff from 29 General Practice (GP) sites and the Clinical Research Network (CRN) in Kent, Surrey, and Sussex (KSS), UK, were sent an online questionnaire about local research facilities and infrastructure, and HYVET-2 study methodology and target population demographics.

      Results

      Nineteen (19) individuals responded to the online questionnaires (15 primary care staff, 4 CRN staff). Moreover, using a framework approach, we identified six themes summarising challenges to HYVET-2 recruitment. These themes are established approaches of primary care towards managing WCH in older people, target patient demographics, study design complexity, patient-facing study documents, limited research resources in primary care, and identification of eligible patients using existing coding.

      Conclusion

      Our experience showed that recruiting older people from primary care to a WCH study was not feasible. A national scoping survey amongst primary care physicians in the UK, as well as robust patient and public involvement (PPI) targeting older people with WCH, might improve recruitment in future studies addressing the management of WCH in older people.

    • Association of Angiotensin Converting Enzyme Phenotypes and Polymorphisms with Clinical Outcomes in SARS-CoV2 Patients with Hypertension in an Urban Emergency Department

      https://doi.org/10.2174/0115734021315730240919062555
      Introduction: 
      The role of Angiotensin-converting enzyme (ACE and ACE2) phenotypes and polymorphisms in modulating severe acute respiratory syndrome coronavirus (SARSCoV-2) infection in hypertensive patients remains unclear. Our objective was to determine the distribution of ACE and ACE2 receptor phenotypes by patient demographics and correlate ACE and ACE2 levels of activity with SARS-CoV-2 outcomes. 
      Methods: 
      Hypertensive patients treated for SARS-CoV-2 at an urban emergency department (ED) were prospectively enrolled in a cohort study between August 2020 and April 2021. Blood samples were collected during ED visits or hospitalization. Outcome measures including hospitalization, intensive care unit (ICU) admission, and 30-day mortality were obtained from electronic health records. Multivariable logistic regression was used. 
      Results: Of the 150 patients enrolled, 60% were Black, 32% Hispanic/Latinx, 4% Non-Hispanic Whites, and 4% others. The mean age was 59 (+/-14) years. The rate of hospitalization was high (86%) and Hispanic/Latinx had a higher likelihood of ICU admission. Patients harboring the rs2285666 genotype TT, AA, and GC alleles were more likely to be admitted to ICU, and those with TT and AA had higher mortality. The ACE level was a significant predictor of hospitalization with a protective effect in both unadjusted and adjusted results. Hispanics/Latinx had a four times higher likelihood of ICU admission compared to all others, and age was significantly associated with 30-day mortality. 
      Conclusion: Our results show that even after adjusting for age, race, and sex, ACE levels remained a predictor of hospitalization. ACE/ACE2 phenotypes and genotypes potentially play an important role in disease progression in SARS-CoV-2 patients.

    • Investigating the Effect of COVID-19 on Pregnancy-Induced Hypertension (HTN): A Case-Control Study

      https://doi.org/10.2174/0115734021319741240905163734
      Background

      Suppression of the body's immune system can cause high blood pressure. Also, many people with COVID-19 have underlying diseases, including high blood pressure.

      Aim

      This study was conducted to investigate the effect of COVID-19 infection on blood pressure caused by pregnancy in women referred to Kashani Hospital in Jiroft City.

      Methods

      This study was a case-control study with a census sampling method on 266 pregnant women referring to Kashani Hospital in Jiroft City in 2021-2022. Pregnant women were divided into two control groups (pregnant women without COVID-19) and intervention (pregnant women with COVID-19). SPSS software version 22 was analyzed.

      Results

      266 pregnant women participating in the study were divided into two equal control (133) and intervention (133) groups. The average age of pregnant women was 29 ± 6.8 years. The average systolic and diastolic blood pressure in the intervention group was 112.6 and 70, and in the control group, it was 107.8 and 66.6, which was not statistically significant (_Value>0.05). Also, the results showed that there was a difference between home blood pressure during pregnancy and there is a statistically significant relationship between the age of pregnant women (_Value<0.05). While there is no significant statistical relationship between gestational age and body mass index (_Value>0.05).

      Conclusion

      According to the results of this study, COVID-19 affects blood pressure caused by pregnancy, and gestational age is an important factor in the prevalence of high blood pressure in women with COVID-19.

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