Independent and interactive effects of blood pressure and cardiac function on brain volume and white matter hyperintensities in heart failure

Background: Renal artery stenosis (RAS) often plays an important role not only in malignant hypertension but also in sudden development of heart failure (HF) so called ‘flash pulmonary edema’ or chronic HF refractory to medical treatment. One of the possible mechanisms whereby RAS affects these unique conditions of HF is suppression of LV compliance through the complex interaction between neurohormonal systems originating from the reduction of renal blood flow. Renal artery angioplasty is expected to be an effective treatment for restoring renal blood flow in patients with RAS. The aim of the present study was whether the angioplasty can improve the impaired neurohormonal systems and diastolic cardiac function in patients with RAS. Methods: A prospective analysis was performed in 18 HF patients with RAS (age: 72±6, 3 females, NYHA I/II/III: 5/9/4) who underwent renal artery angioplasty between 2005 and 2007. Four patients with significant bilateral RAS and 3 patients with unilateral RAS in the vessel supplying a functional solitary kidney were included. We monitored the changes of biochemical and neurohormonal markers and blood pressure. Cardiac function was evaluated by tissue Doppler echocardiogram before and 3 months after the procedure. Results: Technical success was achieved in all interventions. The results are shown in table . Systolic arterial blood pressure significantly decreased by renal angioplasty. B-type natriuretic peptide (BNP) was significantly reduced 3 months after the angioplasty, whereas the change of sCr or angiotensinII was not statistically significant. Myocardial early diastolic velocity (Em), a parameter of diastolic LV function, was significantly improved compared with that measured before the procedure. Conclusions: In patients with either overt or latent HF possessing RAS, renal artery angioplasty not only decreases arterial blood pressure but also improves diastolic cardiac function in parallel with the reduction of BNP level.

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Abstract P045: Sex And Age Specific Circulating Aldosterone Changes In Transgenic Hypertensive (mRen2)27 Rats And Hannover Sprague Dawley (SD) Rats And Its Association With Blood Pressure And Cardiac Function

Hypertension ◽

10.1161/hyp.76.suppl_1.p045 ◽

2020 ◽

Vol 76 (Suppl_1) ◽

Author(s):

Fatima Ryalat ◽

N Cruz-Diaz ◽

W Graham ◽

T Gwathmey-Williams ◽

P E Gallagher ◽

...

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Cardiac Function ◽

Target Organ Damage ◽

Aging Effect ◽

Female Rats ◽

Male Rats ◽

Sprague Dawley ◽

Aldosterone Antagonists ◽

Sd Rats

Aldosterone plays a significant role in hypertension and target organ damage. Aldosterone antagonists are used in the management of heart failure. However, neither the influence of age nor sex on aldosterone pathophysiology is well understood. We investigated the changes in circulating aldosterone with age and its association with cardiovascular function, using male and female hypertensive renin transgenic (mRen2)27 rats and SD rats at 20 and 50 weeks of age. Both male (22 ± 3 vs. 12 ± 2 ng/dL, n = 9 - 12, p < 0.05) and female (59 ± 10 vs. 23 ± 8 ng/dL, n = 6 - 10, p < 0.05) hypertensive rats had higher serum aldosterone compared with SD rats at 20 weeks of age. At 50 weeks of age, the difference persisted in the hypertensive female rats (63 ± 8 vs. SD: 33 ± 7 ng/dL, n = 6 - 7, p < 0.05), but not in the males. SD male rats have higher systolic blood pressure (SBP) as they age, and consequently develop cardiac diastolic dysfunction associated with higher aldosterone at 50 weeks compared to 20 weeks (28 ± 3 vs. 12 ± 2 ng/dL, n = 7 - 9, p < 0.05). This aging effect on aldosterone was not significant in the other groups. We showed previously that SD males treated with polyphenol rich muscadine grape extract (MGE) have lower aldosterone, less aortic stiffness and better cardiac diastolic function (E/e’) than controls at the older age; the MGE effect was not seen in (mRen2)27 males. Sex differences in aldosterone were not significant in the SD rats at either time point. However, (mRen2)27 female rats had higher aldosterone than (mRen2)27 males at both 20 weeks (59 ± 10 vs. 22 ± 3 ng/dL, n = 10 - 12, p < 0.05) and 50 weeks (63 ± 8 vs. 31 ± 7 ng/dL, n = 6 - 7, p < 0.05), despite the lack of significant differences in SBP. (mRen2)27 female rats preserve cardiac function better than males throughout their life span, while males develop indices of heart failure. Our data suggest that lower aldosterone levels in hypertensive males compared with females do not protect against the higher lifetime burden of elevated SBP and also may reflect different mechanisms controlling circulating aldosterone between sexes. In addition, data suggest a potential therapeutic effect of MGE in the management of age-associated moderate hypertension.

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Volume of white matter hyperintensities increases with blood pressure in patients with hypertension

Journal of International Medical Research ◽

10.1177/0300060519858023 ◽

2019 ◽

Vol 47 (8) ◽

pp. 3681-3689 ◽

Cited By ~ 2

Author(s):

Yu Zhao ◽

Zunyu Ke ◽

Wenbo He ◽

Zhiyou Cai

Keyword(s):

Blood Pressure ◽

White Matter ◽

White Matter Hyperintensities ◽

Clinical Analysis ◽

Primary Diagnosis ◽

Mri Findings ◽

Scale Scores ◽

History Of ◽

Magnetic Resonance Imaging Mri ◽

Fazekas Scale

Objective Hypertension is a risk factor for development of white matter hyperintensities (WMHs). However, the relationship between hypertension and WMHs remains obscure. We sought to clarify this relationship using clinical data from different regions of China. Methods We analyzed the data of 333 patients with WMHs in this study. All included patients underwent conventional magnetic resonance imaging (MRI) examination. A primary diagnosis of WMHs was made according to MRI findings. The volume burden of WMHs was investigated using the Fazekas scale, which is widely used to rate the degree of WMHs. We conducted retrospective clinical analysis of the data in this study. Results Our findings showed that WMHs in patients with hypertension were associated with diabetes, cardiovascular diseases, history of cerebral infarct, and plasma glucose and triglyceride levels. Fazekas scale scores for WMHs increased with increased blood pressure values in patients with hypertension. Conclusion This analysis indicates that hypertension is an independent contributor to the prevalence and severity of WMHs.

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Xiao-Qing-Long-Tang Maintains Cardiac Function during Heart Failure with Reduced Ejection Fraction in Salt-Sensitive Rats by Regulating the Imbalance of Cardiac Sympathetic Innervation

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2020/9467271 ◽

2020 ◽

Vol 2020 ◽

pp. 1-11

Author(s):

Zhaoyu Li ◽

Yongcheng Wang ◽

Yuehua Jiang ◽

Dufang Ma ◽

Ping Jiang ◽

...

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Ejection Fraction ◽

Cardiac Function ◽

Sympathetic Nerve ◽

Morphological Changes ◽

Sympathetic Innervation ◽

Nerve Endings ◽

Cardiac Sympathetic Innervation ◽

Reduced Ejection Fraction

Objective. The anatomical and functional imbalances of sympathetic nerves are associated with cardiovascular disease progression. Xiao-Qing-Long-Tang (XQLT), an ancient Chinese herbal formula, has been used to treat cardiovascular diseases in eastern Asia for thousands of years. We determined the effect of XQLT in maintaining cardiac function during heart failure with reduced ejection fraction (HFrEF) with respect to its neurobiological effects in salt-sensitive rats. Methods. Dahl salt-sensitive (DS) rats were fed a high-salt diet to establish an HFrEF model and were divided into model (DS, administered normal saline) and XQL groups (administrated XQLT) randomly, with SS-13BN rats being used as the control. The bodyweight and blood pressure of rats were observed regularly. Electrocardiogram, echocardiography, and plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) were determined to assess cardiac function. The sympathetic tune and myocardial morphological changes were evaluated. Western blot and qRT-PCR were used to assay the expression of the nerve growth factor (NGF) and leukemia inhibitory factor (LIF). Tyrosine hydroxylase (TH), choline acetyltransferase (CHAT), and growth-associated protein 43 (GAP43) were assayed to confirm sympathetic remodeling. The micromorphological changes in cardiac sympathetic nerve endings were observed by transmission electron microscopy. Results. Four weeks after XQLT treatment, cardiac function and bodyweight were higher and blood pressure was lower than that of the DS group. Myocardial noradrenaline (NA) increased, while the plasma NA level decreased significantly. The morphology demonstrated that XQLT significantly alleviated myocardial damage. XQLT decreased the expression of LIF, increased the expression of NGF, enhanced the TH+/GAP43+ and TH+/CHAT + positive nerve fiber density, and improved the TH and GAP43 protein expression, but had no effect on CHAT. Moreover, XQLT improved the micromorphology of sympathetic nerve endings in the myocardium. Conclusion. XQLT maintains cardiac function during HFrEF in salt-sensitive rats, in part, by regulating the imbalance of cardiac sympathetic innervation.

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Aortic stiffness as an independent predictor of cardiac function and cerebral white matter hyperintensities in diabetes mellitus assessed by Magnetic Resonance Imaging

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/1532-429x-11-s1-p169 ◽

2009 ◽

Vol 11 (S1) ◽

Author(s):

Saskia GC van Elderen ◽

Anne Brandts ◽

Jos Westenberg ◽

Jeroen van de Grond ◽

Mark van Buchem ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Diabetes Mellitus ◽

White Matter ◽

Magnetic Resonance ◽

Cardiac Function ◽

Aortic Stiffness ◽

White Matter Hyperintensities ◽

Independent Predictor ◽

Cerebral White Matter ◽

Resonance Imaging

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Nighttime Blood Pressure and White Matter Hyperintensities in Patients With Parkinson Disease

Chronobiology International ◽

10.3109/07420528.2013.766618 ◽

2013 ◽

Vol 30 (6) ◽

pp. 811-817 ◽

Cited By ~ 26

Author(s):

Yoon-Sang Oh ◽

Joong-Seok Kim ◽

Dong-Won Yang ◽

Ja-Seong Koo ◽

Yeong-In Kim ◽

...

Keyword(s):

Blood Pressure ◽

White Matter ◽

Parkinson Disease ◽

White Matter Hyperintensities ◽

Nighttime Blood Pressure

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Slow-wave Sleep and MRI Markers of Brain Aging in a Community-based Sample

Neurology ◽

10.1212/wnl.0000000000011377 ◽

2020 ◽

pp. 10.1212/WNL.0000000000011377

Author(s):

Andree-Ann Baril ◽

Alexa S Beiser ◽

Vincent Mysliwiec ◽

Erlan Sanchez ◽

Charles S DeCarli ◽

...

Keyword(s):

White Matter ◽

Slow Wave ◽

White Matter Hyperintensities ◽

Slow Wave Sleep ◽

Brain Volume ◽

Brain Aging ◽

Brain Mri ◽

Community Based ◽

Brain Infarcts ◽

Absolute Duration

Objective:To test the hypothesis that reduced slow-wave sleep, or N3 sleep, which is thought to underlie the restorative functions of sleep, is associated with MRI markers of brain aging, we evaluated this relationship in the community-based Framingham Heart Study Offspring cohort using polysomnography and brain MRI.Methods:We studied 492 participants (58.8 ± 8.8 years, 49.4% male) free of neurological diseases who completed a brain MRI scan and in-home overnight polysomnography to assess slow-wave sleep (absolute duration and percentage of total sleep). Volumes of total brain, total cortical, frontal cortical, subcortical gray matter, hippocampus, and white matter hyperintensities were investigated as a percentage of intracranial volume and the presence of covert brain infarcts was evaluated. Linear and logistic regression models were adjusted for age, age squared, sex, time interval between polysomnography and MRI (3.3 ± 1.0 years), APOE4 carrier status, stroke risk factors, sleeping pill use, body mass index and depression.Results:Less slow-wave sleep was associated with lower cortical brain volume (absolute duration, β[standard error]: 0.20[0.08], p=0.015; percentage, 0.16[0.08], p=0.044), lower subcortical brain volume (percentage, 0.03[0.02], p=0.034), and higher white matter hyperintensities volume (absolute duration, -0.12[0.05], p=0.010; percentage -0.10[0.04], p=0.033). Slow-wave sleep duration was not associated with hippocampal volume or the presence of covert brain infarcts.Conclusion:Loss of slow-wave sleep might facilitate accelerated brain aging, as evidence by its association with MRI markers suggestive of brain atrophy and injury. Alternatively, subtle injuries and accelerated aging might reduce the ability of the brain to produce slow-wave sleep.

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