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Hypertension - recientes

Correction to: Angiotensin-(1-7) and Vascular Function: The Clinical Context [Correction]
7/2/2018
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Correction to: Cyclooxygenase-2 Selectively Controls Renal Blood Flow Through a Novel PPAR{beta}/{delta}-Dependent Vasodilator Pathway [Correction]
7/2/2018
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Clinical Implications [Clinical Implications]
7/2/2018
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A Universal Standard for the Validation of Blood Pressure Measuring Devices [Consensus Documents]
7/2/2018
George S. Stergiou, Bruce Alpert, Stephan Mieke, Roland Asmar, Neil Atkins, Siegfried Eckert, Gerhard Frick, Bruce Friedman, Thomas Grassl, Tsutomu Ichikawa, John P. Ioannidis, Peter Lacy, Richard McManus, Alan Murray, Martin Myers, Paolo Palatini, Gianfranco Parati, David Quinn, Josh Sarkis, Andrew Shennan, Takashi Usuda, Jiguang Wang, Colin O. Wu, Eoin O’Brien
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In the past 30 years, several organizations, such as the US Association for the Advancement of Medical Instrumentation (AAMI), the British Hypertension Society, the European Society of Hypertension (ESH) Working Group on Blood Pressure (BP) Monitoring, and the International Organization for Standardization (ISO), have developed protocols for clinical validation of BP measuring devices. However, it is recognized that science, as well as patients, consumers, and manufacturers, would be best served if all BP measuring devices were assessed for accuracy according to an agreed single validation protocol that had global acceptance. Therefore, an international initiative was taken by the AAMI, ESH, and ISO experts who agreed to develop a universal standard for device validation. This statement presents the key aspects of a validation procedure, which were agreed by the AAMI, ESH, and ISO representatives as the basis for a single universal validation protocol. As soon as the AAMI/ESH/ISO standard is fully developed, this will be regarded as the single universal standard and will replace all other previous standards/protocols.

Consensus Document on Improving Hypertension Management in Asian Patients, Taking Into Account Asian Characteristics [Consensus Documents]
7/2/2018
Kazuomi Kario, Chen-Huan Chen, Sungha Park, Chang-Gyu Park, Satoshi Hoshide, Hao-Min Cheng, Qi-Fang Huang, Ji-Guang Wang
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Catheter-Based Renal Nerve Ablation as a Novel Hypertension Therapy [Recent Advances in Hypertension]
7/2/2018
John W. Osborn, Christopher T. Banek
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Strategies for Achieving Healthy Vascular Aging [Brief Reviews]
7/2/2018
Kristen L. Nowak, Matthew J. Rossman, Michel Chonchol, Douglas R. Seals
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Atherosclerosis and Blood Pressure Variability [Editorial Commentary]
7/2/2018
Michael G. Ziegler
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Transcriptomics in Twins Separates Genetic From Environmental Effects on Gene Expression and Blood Pressure [Editorial Commentary]
7/2/2018
Brian J. Morris
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Does Chronic Obstructive Pulmonary Disease Cause Cardiovascular Disease? [Editorial Commentary]
7/2/2018
G.B. John Mancini, John A. Fleetham
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Parameters of Left Ventricular Mass and Dementia [Editorial Commentary]
7/2/2018
Merrill F. Elias, Rachael V. Torres, Adam Davey
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Primary Aldosteronism and Cardiovascular Events [Editorial Commentary]
7/2/2018
Martin Reincke
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Central and Brachial Blood Pressures, Statins, and Low-Density Lipoprotein CholesterolNovelty and Significance [Epidemiology/Population]
7/2/2018
Florence Lamarche, Mohsen Agharazii, Annie–Claire Nadeau–Fredette, Francois Madore, Remi Goupil
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Central blood pressure may be a better predictor of cardiovascular disease than brachial pressure. Although statins reduce brachial pressure, their impact on central pressure remains unknown. Furthermore, whether this effect is mediated through a decrease in low-density lipoprotein cholesterol (LDL-c) is unknown. This study aims to characterize the association of statins and LDL-c with central and brachial blood pressures and to quantify their respective effects. Of the 20 004 CARTaGENE participants, 16 507 had available central blood pressure, LDL-c, and Framingham risk score. Multivariate analyses were used to evaluate the association between central pressure and LDL-c in subjects with or without statins. The impact of LDL-c on the association between statin and pressure parameters was determined through mediation analyses. LDL-c was positively associated with systolic and diastolic central pressure in nonusers (β=0.077 and 0.106; P<0.001) and in participants with statins for primary (β=0.086 and 0.114; P<0.001) and secondary prevention (β=0.120 and 0.194; P<0.003). Statins as primary prevention were associated with lower central systolic, diastolic, and pulse pressures (−3.0, −1.6, and −1.3 mm Hg; P<0.001). Mediation analyses showed that LDL-c reduction contributed to 15% of central systolic and 44% of central diastolic pressure changes associated with statins and attenuated 22% of the effects on central pulse pressure. Similar results were found with brachial pressure components. In conclusion, reduction of LDL-c was associated with only a fraction of the lower blood pressures in statin user and seemed to be mostly associated with improvement of steady (diastolic) pressure, whereas non–LDL-c–mediated pathways were mostly associated with changes in pulsatile pressure components.

Hypertension and Diabetes MellitusNovelty and Significance [Epidemiology/Population]
7/2/2018
Vasilis Tsimihodimos, Clicerio Gonzalez-Villalpando, James B. Meigs, Ele Ferrannini
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Type 2 diabetes mellitus and hypertension overlap in the population. In many subjects, development of diabetes mellitus is characterized by a relatively rapid increase in plasma glucose values. Whether a similar phenomenon occurs during the development of hypertension is not known. We analyzed the pattern of blood pressure (BP) changes during the development of hypertension in patients with or without diabetes mellitus using data from the MCDS (Mexico City Diabetes Study; a population-based study of diabetes mellitus in Hispanic whites) and in the FOS (Framingham Offspring Study, a community-based study in non-Hispanic whites) during a 7-year follow-up. Diabetes mellitus at baseline was a significant predictor of incident hypertension (in FOS, odds ratio, 3.14; 95% confidence interval, 2.17–4.54) independently of sex, age, body mass index, and familial diabetes mellitus. Conversely, hypertension at baseline was an independent predictor of incident diabetes mellitus (in FOS, odds ratio, 3.33; 95% CI, 2.50–4.44). In >60% of the converters, progression from normotension to hypertension was characterized by a steep increase in BP values, averaging 20 mm Hg for systolic BP within 3.5 years (in MCDS). In comparison with the nonconverters group, hypertension and diabetes mellitus converters shared a metabolic syndrome phenotype (hyperinsulinemia, higher body mass index, waist girth, BP, heart rate and pulse pressure, and dyslipidemia). Overall, results were similar in the 2 ethnic groups. We conclude that (1) development of hypertension and diabetes mellitus track each other over time, (2) transition from normotension to hypertension is characterized by a sharp increase in BP values, and (3) insulin resistance is one common feature of both prediabetes and prehypertension and an antecedent of progression to 2 respective disease states.

Left Ventricular Hypertrophy and Remodeling and Risk of Cognitive Impairment and DementiaNovelty and Significance [Epidemiology/Population]
7/2/2018
Kasra Moazzami, Mohammad Reza Ostovaneh, Bharath Ambale Venkatesh, Mohammadali Habibi, Kihei Yoneyama, Colin Wu, Kiang Liu, Isabel Pimenta, Annette Fitzpatrick, Steven Shea, Robyn L. McClelland, Susan Heckbert, Rebecca F. Gottesman, David A. Bluemke, Timothy M. Hughes, Joao A.C. Lima
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Limited information exists on the longitudinal association between the left ventricular (LV) structure and function and future cognitive impairment and dementia in a large population without clinically recognized cardiovascular disease at baseline. The aim of the present study was to investigate the association between cardiac structure and function and risk of dementia and cognitive impairment in the MESA (Multi-Ethnic Study of Atherosclerosis) cohort. Measures of LV structure and function were determined using magnetic resonance imaging at baseline in 4999 participants free of clinically diagnosed cardiovascular disease and dementia. Probable incident clinical dementia was ascertained from hospitalization discharge records. Cognitive function was evaluated using tests addressing global cognitive function, processing speed, and memory. Associations of measures of LV structure and function with the incidence of clinically diagnosed dementia and cognitive performance were evaluated using Cox proportional hazard regression models adjusted for demographics, cardiovascular risk factors, and cardiovascular events. During a median follow-up of 12 years, 130 probable incident dementia cases were documented. Higher LV mass index (hazard ratio, 1.01; 95% confidence interval, 1.00–1.02) and LV mass-to-volume ratio (hazard ratio, 2.37; 95% confidence interval, 1.25–4.43) were independently associated with incident dementia and impaired cognitive function. Measures of LV function were not associated with risk of dementia or cognitive impairment. In conclusion, in a multiethnic cohort of participants without clinically detected cardiovascular disease and dementia at baseline, LV hypertrophy and concentric remodeling were independently associated with incident dementia and cognitive impairment.

Determinants of Cardiometabolic Risk Factors in the First Decade of LifeNovelty and Significance [Childhood Cardiometabolic Risk Factors]
7/2/2018
Empar Lurbe, Francisco Aguilar, Julio Alvarez, Pau Redon, Maria Isabel Torro, Josep Redon
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The present prospective study assessed the association of birth weight (BW) and growth pattern on cardiometabolic risk factors in a cohort followed from birth to 10 years of age. One hundred and forty-five subjects (73 girls) who fulfilled the inclusion criteria and had all their data recorded at birth and at 5 years were enrolled. Of these, 100 (52 girls) also recorded data at 10 years. Anthropometric measurements, office and 24-hour blood pressure, and metabolic parameters were obtained. At 5 years, both BW and current weight were determinants of blood pressure and metabolic parameters; however, as the subjects got older, the impact of body size increased. Higher BW and maternal obesity increased the risk of becoming obese at 5 years while this was reduced if breastfeeding. Maternal obesity was the only factor associated with becoming obese at 10 years. Twenty-two children at 10 years had insulin values ≥15 U/L, some of whom were persistent from 5 years while in others it increased afterward. Subjects with insulin values ≥15 U/L showed significant higher values of office systolic blood pressure, triglycerides, and uric acid and lower values of high-density lipoprotein than did those with normal insulin values. Highest weight gain from 5 to 10 years and lowest BW were the main determinants of high insulin levels. In conclusion, although BW was a proxy of the events during fetal life and projected its influence later, the influence of gaining weight was a key determinant in the risk to develop obesity and metabolic abnormalities.

Is Blood Pressure Improving in Children With Chronic Kidney Disease?Novelty and Significance [Hypertension in Children With Kidney Disease]
7/2/2018
Gina-Marie Barletta, Christopher Pierce, Mark Mitsnefes, Joshua Samuels, Bradley A. Warady, Susan Furth, Joseph Flynn
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Uncontrolled hypertension in children with chronic kidney disease (CKD) has been identified as one of the main factors contributing to progression of CKD and increased risk for cardiovascular disease. Recent efforts to achieve better blood pressure (BP) control have been recommended. The primary objective of this analysis was to compare BP control over 2 time periods among participants enrolled in the CKiD study (Chronic Kidney Disease in Children). Casual BP and 24-hour ambulatory BP monitor data were compared among 851 participants during 2 time periods: January 1, 2005, through July 1, 2008 (period 1, n=345), and July 1, 2010, through December 31, 2013 (period 2, n=506). Multivariable logistic regression to model the propensity of a visit record being in period 2 as a function of specific predictors was performed. After controlling for confounding variables (age, sex, race, socioeconomics, CKD duration, glomerular filtration rate, proteinuria, body mass index, growth failure, and antihypertensives), no significant differences were detected between time periods with respect to casual BP status (prehypertension: 15% versus 15%; uncontrolled hypertension: 18% versus 17%; P=0.87). Analysis of ambulatory BP monitor data demonstrated higher ambulatory BP indices, most notably masked hypertension in period 2 (36% versus 49%; P<0.001). Average sleep BP index (P<0.05) and sleep BP loads (P<0.05) were higher in period 2. Despite publication of hypertension recommendations and guidelines for BP control in patients with CKD, this study suggests that hypertension remains undertreated and under-recognized in children with CKD. This analysis also underscores the importance of routine ambulatory BP monitor assessment in children with CKD.

Pulse Wave Velocity Predicts the Progression of Blood Pressure and Development of Hypertension in Young AdultsNovelty and Significance [Predicting Hypertension in Young Adults]
7/2/2018
Teemu Koivistoinen, Leo–Pekka Lyytikainen, Heikki Aatola, Tiina Luukkaala, Markus Juonala, Jorma Viikari, Terho Lehtimaki, Olli T. Raitakari, Mika Kahonen, Nina Hutri–Kahonen
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The aim of the present study was to examine whether pulse wave velocity (PWV) predicts the progression of blood pressure and the development of hypertension in young adults. In addition, we studied whether PWV improves the risk prediction of incident hypertension beyond traditional cardiovascular risk factors. Systolic and diastolic blood pressures were measured in 2007 and 2011 for 1449 Finnish adults (aged 30–45 years). In addition, PWV and other cardiovascular risk factors were measured in 2007. The association between PWV (in 2007) and blood pressure (in 2011) was studied in the whole population (n=1449) and in a normotensive subpopulation (n=1183). The ability of PWV measured in 2007 to predict incident hypertension in 2011 was investigated in the subpopulation (n=1183). PWV measured in 2007 was directly and independently associated with systolic and diastolic blood pressures measured in 2011 (P<0.001 for both). PWV measured in 2007 was also an independent predictor of incident hypertension in 2011 (odds ratio, 1.96 per 1-SDincrease; 95% confidence interval, 1.51–2.57; P<0.001). The extended prediction model (including PWV) improved the incident hypertension risk prediction beyond traditional cardiovascular risk factors, the area under receiver operating characteristics curve being 0.833 versus 0.809 (P=0.040), and the continuous net reclassification improvement 59.4% (P<0.001). These findings suggest that PWV predicts the progression of blood pressure and could provide a valuable tool in hypertension risk prediction in young adults.

Genetic and Environmental Effects on Gene Expression Signatures of Blood PressureNovelty and Significance [Genetics]
7/2/2018
Yisong Huang, Miina Ollikainen, Pyry Sipila, Linda Mustelin, Xin Wang, Shaoyong Su, Tianxiao Huan, Daniel Levy, James Wilson, Harold Snieder, Jaakko Kaprio, Xiaoling Wang
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Recently, 2 transcriptome-wide studies identified 40 genes that were differentially expressed in relation to blood pressure. However, to what extent these BP-related gene expression signatures and their associations with BP are driven by genetic or environmental factors has not been investigated. In this study of 391 twins (193 twin pairs and 5 singletons; age 55–69 years; 40% male; 57% monozygous) recruited from the Finnish Twin Cohort, transcriptome-wide data on peripheral leukocytes were obtained using the Illumina HT12 V4 array. Our transcriptome-wide analysis identified 1 gene (MOK [MAPK/MAK/MRK overlapping kinase], P=7.16×10−8) with its expression levels associated with systolic BP at the cutoff of false-discovery rate <0.05. This association was further replicated in the Framingham Heart Study (P=1.02×10−5). Out of the 40 genes previously reported, 12 genes could be replicated in the twin cohort with false-discovery rate <0.05 and consistent direction of effect. Univariate twin modeling showed that genetic factors contributed to the expression variations of 12 genes with heritability estimates ranging from 6% to 65%. Bivariate twin modeling showed that 53% of the phenotypic association between systolic BP and MOK expression, and 100% of the phenotypic association of systolic and diastolic BP with CD97 (cluster of differentiation 97), TIPARP (TCDD-inducible poly[ADP-ribose] polymerase), and TPPP3 expression could be explained by genetic factors shared in common. In this study of adult twins, we identified one more gene, MOK, with its expression level associated with BP, and replicated several previously identified signals. Our study further provides new insights into the genetic and environmental sources of BP-related gene expression signatures.

Proteomic Profiling for Cardiovascular Biomarker Discovery in Orthostatic HypotensionNovelty and Significance [Proteomic Profiling in Orthostatic Hypotension]
7/2/2018
Madeleine Johansson, Fabrizio Ricci, Nay Aung, Richard Sutton, Olle Melander, Artur Fedorowski
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Orthostatic hypotension (OH) has been linked with higher incidence of cardiovascular disease, but little is known about the mechanisms behind this association. We aimed to identify cardiovascular disease biomarkers associated with OH through a proteomic profiling approach. Seven hundred seventy-eight patients with unexplained syncope or orthostatic intolerance underwent head-up tilt test and supine blood samples. Of these, 220 met diagnostic criteria of OH, and 179 demonstrated normal hemodynamic response during head-up tilt test. Blood samples were analyzed by antibody-based Proximity Extension Assay technique simultaneously measuring 92 cardiovascular disease-related human protein biomarkers. The discovery algorithm was a sequential 2-step process of biomarker signature identification by supervised, multivariate, principal component analysis and verification by univariate ANOVA with Bonferroni correction. Patients with OH were older (67 versus 60 years; P<0.001) and more likely to be women (48% versus 41%; P>0.001) but did not differ from OH-negative patients in medical history. Principal component analysis identified MMP-7 (matrix metalloproteinase-7), TM (thrombomodulin), MB (myoglobin), TIM-1 (T-cell immunoglobulin and mucin domain-1), CASP-8 (caspase-8), CXCL-1 (C-X-C motif chemokine-1), Dkk-1 (dickkopf-related protein-1), lectin-like LOX-1 (oxidized low-density lipoprotein receptor-1), PlGF (placenta growth factor), PAR-1 (proteinase-activated receptor-1), and MCP-1 (monocyte chemotactic protein-1) as the most robust proteomic signature for OH. From this proteomic feature selection, MMP-7 and TIM-1 met Bonferroni-adjusted significance criteria in univariate and multivariate regression analyses. Proteomic profiling in OH reveals a biomarker signature of atherothrombosis and inflammation. Circulating levels of MMP-7 and TIM-1 are independently associated with OH and may be involved in cardiovascular disease promotion.







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