Stress-induced Aldosterone Hyper-Secretion in a Substantial Subset of Patients With Essential Hypertension

Context: Aldosterone (ALD) secretion is regulated mainly by angiotensin II, K+, and adrenocorticotropic hormone (ACTH). Mineralocorticoid receptor antagonists (MRAs) have effectively been used for the treatment of patients with hypertension who do not have primary aldosteronism (PA). Objective: We tested whether chronic stress–related ACTH-mediated ALD hypersecretion and/or zona glomerulosa hypersensitivity could be implicated in the pathogenesis of essential hypertension (ESHT). Patients and Methods: One hundred thirteen hypertensives without PA and 61 normotensive controls underwent an ultralow-dose (0.03-μg) ACTH stimulation and a treadmill test. Patients with ALD hyper-response according to the cutoffs obtained from controls received treatment with MRAs and underwent genomic DNA testing for the presence of the CYP11B1/CYP11B2 chimeric gene and KCNJ5 gene mutations. A control group of 22 patients with simple ESHT received treatment with MRAs. Results: Based on the cutoffs of ALD and aldosterone-to-renin ratio (ARR) post-ACTH stimulation obtained from controls, 30 patients (27%) exhibited an ALD but not cortisol (F) hyper-response (HYPER group). This group had no difference in basal ACTH/renin (REN) concentrations compared with controls and the 83 patients with hypertension (73%) without an ALD hyper-response to ACTH stimulation. Patients in the HYPER group demonstrated significantly higher ALD concentrations, ARR, and ALD/ACTH ratio (AAR) in the treadmill test. Treatment with MRAs alone produced normalization of blood pressure in these patients whereas patients with hypertension with neither PA nor ALD hyper-response to ACTH stimulation who served as a control group failed to lower blood pressure. Also, two novel germline heterozygous KCNJ5 mutations were detected in the HYPER group. Conclusions: A number of patients with hypertension without PA show ACTH-dependent ALD hyper-secretion and benefit from treatment with MRAs. This could be related to chronic stress via ACTH hyper secretion and/or gene-mutations increasing the zona glomerulosa responsiveness to excitatory stimuli.

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Application of the Measurement of Carotid Intima-Media Thickness for Prediction of the Essential Hypertension in Children

Revista de Chimie ◽

10.37358/rc.18.6.6366 ◽

2018 ◽

Vol 69 (6) ◽

pp. 1550-1553

Author(s):

Rosana Manea ◽

Bianca Elena Popovici ◽

Carmen Daniela Neculoiu ◽

Dan Minea ◽

Alina Calin

Keyword(s):

Blood Pressure ◽

Essential Hypertension ◽

Carotid Artery ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

Diagnostic Methods ◽

Control Group ◽

Study Group ◽

Media Thickness ◽

Hypertension In Children

Hypertension is a major risk factor for progression of the atherosclerotic process and for developing of degenerative cardiovascular diseases in adulthood. The aim of this study is to evaluate how the measurement of carotid intima - media thickness for prediction of essential hypertension in children can be used.The study group included 81 children and the control group 61 children, all aged between 5 - 17 years and 11 months old, and admitted in Children Hospital Brasov in the period of 2009 � 2014. The study protocol included: BMI, blood pressure and Doppler echography of the common carotid artery for each group. Mean age of the patients from the study group was 13.67 years, 43.20 % girls and 56.80 % boys, while in the control group, the mean age was 14.07 years, 54.10% girls and 45.90 % boys. 70.37% of the children from the study group presented obesity, while in the control group 40.98% were obese. The IMTC study group ranged from 0.52 - 0.69 mm and the limits of the normotensive subjects were 0.32 -0.54 mm. In both groups the obese patients were found to have increased carotid artery intima-media, which means that IMTC was positively correlated with BMI (p=0.000001).It is necessary to identify diagnostic methods easily applicable for children, allowing involvement of the characteristics of the arterial wall in the degenerative pathological processes. Increased intima-media ratio is positively correlated with high values of blood pressure.

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Effect of intravenous oxycodone on the physiologic responses to extubation following general anesthesia

BMC Anesthesiology ◽

10.1186/s12871-021-01350-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Menglu Jiang ◽

Jiawei Ji ◽

Xin Li ◽

Zhenqing Liu

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

General Anesthesia ◽

Control Group ◽

Study Group ◽

Clinical Trial Registry ◽

Blood Oxygen Saturation ◽

Blood Concentrations ◽

Number Of Patients ◽

Blood Hormones

Abstract Background Endotracheal intubation and extubation may cause undesirable hemodynamic changes. Intravenous oxycodone has recently been introduced and used for relieving hemodynamic alterations in response to intubation, but there is insufficient information regarding its application in stabilizing hemodynamics during extubation in the patients emerging from general anesthesia. Methods One hundred patients, who had undergone assorted laparoscopic surgeries under general anesthesia, were randomly assigned to Control group (saline injection, 50 cases) and Study group (intravenous injection of 0.08 mg/kg oxycodone immediately after completion of the surgical procedure, 50 cases). Blood pressure, heart rate, blood oxygen saturation (SpO2) as well as blood concentrations of epinephrine, norepinephrine, and cortisol were recorded or measured immediately before extubation (T0), during extubation (T1), as well as one minute (T2), 5 min (T3), and 10 min after extubation (T4). In addition, coughing and restlessness, time of eye-opening, and duration from completing surgery to extubation as well as Ramsay Sedation Scale were analyzed. Results Blood pressure and heart rate as well as blood concentrations of epinephrine, norepinephrine, and cortisol were significantly higher in the Control group compared with the Study group at the time of extubation as well as 1, 5, and 10 min after extubation (P < 0.05). When the patients emerged from general anesthesia, 70 % of the Control group had cough, which was significantly higher than that of Study group (40 %, P < 0.05). Significantly higher number of patients manifested restlessness in the Control group before (40 %) and after extubation (20 %) compared with that in the Study group (20 and 2 %, respectively, P < 0.05). In addition, patients of Control group had lower Ramsay score at extubation (1.7 ± 0.7) as well as 30 min after extubation (2.4 ± 0.9) compared to that of the patients of Study group (2.2 ± 0.9, and 3.0 ± 0.8, respectively, P = 0.003 and 0.001). Conclusions Intravenous oxycodone attenuated alterations of hemodynamics and blood hormones associated with extubation during emergence from general anesthesia. Trial registration Chinese Clinical Trial Registry: ChiCTR2000040370 (registration date: 11-28-2020) “‘retrospectively registered”.

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Influence of Mindfulness and Relaxation on Treatment of Essential Hypertension: Meta-Analysis

Journal of Healthcare Engineering ◽

10.1155/2021/2272469 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Fushun Zhang ◽

Yuanyuan Zhang ◽

Nan Jiang ◽

Qiao Zhai ◽

Juanjuan Hu ◽

...

Keyword(s):

Blood Pressure ◽

Essential Hypertension ◽

Systolic Blood Pressure ◽

Publication Bias ◽

Effect Size ◽

Meta Analysis ◽

Biomedical Literature ◽

Cochrane Library ◽

Control Group ◽

Effect Model

Background. Some studies published previously have shown a strong correlation between hypertension and psychological nature including impulsion emotion or mindfulness and relaxation temperament, among which mindfulness and relaxation temperament might have a benign influence on blood pressure, ameliorating the hypertension. However, the conclusion was not confirmed. Objective. The meta-analysis was performed to investigate the influence of mindfulness and relaxation on essential hypertension interventions and confirm the effects. Methods. Systematic searches were conducted in common English and Chinese electronic databases (i.e., PubMed/MEDLINE, EMBASE, Web of Science, CINAHL, PsycINFO, Cochrane Library, and Chinese Biomedical Literature Database) from 1980 to 2020. A meta-analysis including 5 studies was performed using Rev Man 5.4.1 software to estimate the influence of mindfulness and relaxation on blood pressure, ameliorating the hypertension. Publication bias and heterogeneity of samples were tested using a funnel plot. Studies were analyzed using either a random-effect model or a fixed-effect model. Results. All the 5 studies investigated the influence of mindfulness and relaxation on diastolic and systolic blood pressure, with total 205 participants in the control group and 204 in the intervention group. The random-effects model (REM) was used to calculate the pooled effect for mindfulness and relaxation on diastolic blood pressure (I2 = 0%, t2 = 0.000, P = 0.41 ). The random pooled effect size (MD) was 0.30 (95% CI = −0.81–1.42, P = 0.59 ). REM was used to calculate the pooled effect for mindfulness and relaxation on systolic blood pressure (I2 = 49%, t2 = 3.05, P = 0.10 ). The random pooled effect size (MD) was −1.05 (95% CI = −3.29–1.18, P = 0.36 ). The results of this meta-analysis were influenced by publication bias to some degree. Conclusion. All the results showed less influence of mindfulness and relaxation might act on diastolic or systolic blood pressure, when mindfulness and relaxation are used to intervene in treating CVD and hypertension.

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Effects of Qigong on Blood Pressure, Blood Pressure Determinants and Ventilatory Function in Middle-Aged Patients with Essential Hypertension

The American Journal of Chinese Medicine ◽

10.1142/s0192415x03001120 ◽

2003 ◽

Vol 31 (03) ◽

pp. 489-497 ◽

Cited By ~ 44

Author(s):

Myung Suk Lee ◽

Myeong Soo Lee ◽

Euy-Soon Choi ◽

Hun-Taeg Chung

Keyword(s):

Blood Pressure ◽

Essential Hypertension ◽

Vital Capacity ◽

Forced Expiratory Volume ◽

Control Group ◽

Middle Aged ◽

Aged Patients ◽

Urinary Catecholamines ◽

Baseline Values ◽

Sympathetic Nervous

This study was designed to measure changes in blood pressure (BP), urinary catecholamines and ventilatory functions of patients with mild essential hypertension after 10 weeks of Qigong (Shuxinpingxuegong). Fifty-eight patients volunteered to participate in this study and were randomly divided into either a Qigong group (n = 29), or a control group (n = 29). Systolic blood pressure and diastolic blood pressure decreased significantly in the Qigong group such that both became significantly lower after 10 weeks in the Qigong than in the control group. Also, there was a significant reduction of norepinephrine, metanephrine and epinephrine compared to baseline values in the Qigong group. The ventilatory functions, forced vital capacity and forced expiratory volume per sec, were increased in the Qigong group but not the control. These results suggest that Qigong may stabilize the sympathetic nervous system is effective in modulating levels of urinary catecholamines and BP positively, and in improving ventilatory functions in mildly hypertensive middle-aged patients.

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EVALUATION OF CARDIOVASCULAR DYSREGULATION IN PATIENTS AFTER HEMORRHAGIC STROKE AS A COMPLICATION OF ESSENTIAL HYPERTENSION

Ukrainian Scientific Medical Youth Journal ◽

10.32345/usmyj.3(125).2021.32-43 ◽

2021 ◽

Vol 125 (3) ◽

pp. 32-43

Author(s):

Oleksandr Tkachyshyn

Keyword(s):

Blood Pressure ◽

Traumatic Brain Injury ◽

Essential Hypertension ◽

Brain Injury ◽

Systolic Blood Pressure ◽

Mild Traumatic Brain Injury ◽

Hemorrhagic Stroke ◽

Blood Pressure Monitoring ◽

Main Group ◽

Control Group

The aim of the study was to compare blood pressure and electrocardiogram indices, assessed by their daily monitoring, and anamnestic data on mild traumatic brain injury between a group of patients with essential hypertension ≥6 months after a hemorrhagic stroke and a group of patients with essential hypertension without complications. Materials and methods. The total number of examined patients was 198 people, who were divided into 2 groups: the main (n = 94; age – 54,4±8,8 years, M±σ years) and the control (n = 104; age – 53,7±8,9 years) one. Patients in the main group suffered a hemorrhagic stroke as a complication of essential hypertension ≥6 months ago. The control group included patients with essential hypertension, stage II. In both groups of patients, the parameters of 24-hour ambulatory blood pressure monitoring and electrocardiogram were determined. Results. The indices of 24-hour ambulatory blood pressure monitoring in the main group and the control group were the following ones, respectively: the mean daytime systolic blood pressure was 109,6±1,6 and 121,1±1,1 mm Hg, the minimal one was 74,4±2,0 mm Hg and 82,3±12,5 mm Hg, and the maximal one was 168,2±1,9 and 161,9±1,7 mm Hg, p<0,05. The daytime sigma systolic blood pressure (17,9±0,6) and its average real variability of (11,31±2,52 mm Hg) were bigger in the main group (p<0,05). The daytime index of the hyperbaric load of systolic blood pressure was bigger in the main group: it was 403,6±25,9 against 231,7±12,1 mm Hg×h in the comparison group (p<0,05). The mean, minimum and maximum heart rate at night were significantly lower in the main group (p<0,05). The QTcmin index was significantly lower in the main group in contrast to the control one – 286,28±43,34 and 336,69±22,55, and the QT variance was greater – 232,56±44,55 – in comparison to the control group (188,31±33,67) (p<0,05). From the anamnestic data of patients, a significantly higher prevalence of mild traumatic brain injury was found in 37,4% (35 patients out of 94) in the main group relative to the control one – 13,5% (14 out of 104), p<0,05. Conclusions: The results of the study indicate the larger ranges of blood pressure variability in patients with essential hypertension complicated with hemorrhagic stroke, which can be caused by impaired autoregulation according to the QTc interval data. In combination with the disturbances of cerebral circulation, caused by the injury of the brain due to the hemorrhagic stroke alone or in combination with mild traumatic brain injury episode, such a situation may lead to the development of recurrent stroke.

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The effect of three-component antihypertensive treatment on the structural and functional state of the heart and daily blood pressure profile in patients with hypertension grade 3

Kazan medical journal ◽

10.17816/kmj2019-885 ◽

2019 ◽

Vol 100 (6) ◽

pp. 885-891

Author(s):

N R Azaeva

Keyword(s):

Blood Pressure ◽

Diastolic Blood Pressure ◽

Functional State ◽

Fixed Combination ◽

Statistical Significance ◽

Control Group ◽

Daily Monitoring ◽

Number Of Patients ◽

Grade 3 ◽

Experimental Group

Aim. To study the effect of a fixed combination of perindopril arginine (10 mg) + indapamide (2.5 mg) + amlodipine (5 mg) on the daily profile of blood pressure and the structural and functional state of the heart in patients with hypertension grade 3. Methods. 80 patients with hypertension receiving various variants of treatment [50 patients (experimental group) receiving fixed combination of perindopril arginine (10 mg) + indapamide (2.5 mg) + amlodipine (5 mg) and 30 patients (control group) receiving combination of lisinopril with hydrochlorothiazide (10/12.520/25 mg) and amlodipine (5 mg)] underwent electrocardiography, Doppler echocardiography, daily monitoring of blood pressure at there points: at the beginning, after 2 weeks and 6 months of the treatment. Statistical significance of the indicators was determined by Students t-test. To compare the double changes, 2 was used. Statistical difference between the groups was considered significant if p 0.05. Results. In 86% of patients from the experimental group, a decrease in systolic blood pressure by 20 mm Hg or more and/or diastolic blood pressure by 10 mm Hg was noted, which persisted for 6 months. After 6 months of treatment, according to daily monitoring of arterial pressure, the average daily systolic and diastolic blood pressure significantly decreased by 15.9 and 18.6% (р 0.001), and the values of variability of average systolic and average diastolic pressure at night and daytime by 4 and 4.2%, respectively (р 0.001). A decrease in the morning rise rate of systolic and diastolic blood pressure was also achieved (р 0.001). During treatment, a number of patients with a daily curve of the dipper type increased due to a decrease in non-dippers and night pickers (р 0.001). Conclusion. Positive antihypertensive result after treatment with a combination of perindopril arqinine + indapamide + amlodipin was achieved in the early stages of treatment and was observed as a long-term stable hypotensive effect; a number of patients with normal daily rhythm of blood pressure increased, decrease of the severity of hypertrophy and size of the left ventricle was observed and its diastolic function became normal.

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Prophylactic use of tranexamic acid for reducing postpartum hemorrhage in vaginal delivery

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20211153 ◽

2021 ◽

Vol 10 (4) ◽

pp. 1654

Author(s):

Anusha Ginjupalli ◽

Anuradha S. N. ◽

Joshi Suyajna D.

Keyword(s):

Blood Pressure ◽

Blood Loss ◽

Tranexamic Acid ◽

Vaginal Delivery ◽

Pulse Rate ◽

Postpartum Hemorrhage ◽

Control Group ◽

Study Group ◽

Normal Delivery ◽

Number Of Patients

Background: The use of anti-fibrinolytic therapy has potential to reduce obstetric blood loss due to profound changes that take place in the fibrinolytic system during normal childbirth. Objective was to evaluate the efficacy of tranexamic acid in reducing postpartum hemorrhage (PPH) during normal labour.Methods: Patients who planned for normal delivery and fulfilling the inclusion criteria were recruited for the study. The pre-delivery parameters -pulse rate, blood pressure, Hb gm% and PCV% were measured for each patient. The study group received injection oxytocin (10 IU) and injection tranexamic acid (500 mg) slow intravenous route. The control group received injection oxytocin (10 IU) and placebo injection. Immediately after delivery of the anterior shoulder of the baby, when all the liquor was drained, Brasse-V drape is placed under the patient. Then the patient was given pre-weighed pads, which were weighed 2 hours post-partum. Final blood loss was calculated by combining amount of blood collected in the drape and blood absorbed by the pads.Results: The total number of patients studied was 300- equally distributed in both the groups. There was a significant increase in the pulse rate and decrease in blood pressure in the control group compared to the study group. The post-delivery haemoglobin and haematocrit were significantly reduced in the control group. The blood loss was significantly low in the study group. The need for other uterotonics, blood transfusion, and duration of hospital stay, were significantly low in study group.Conclusions: Tranexamic acid, when given prophylactically to the women with vaginal delivery who received prophylactic oxytocin, appears to reduce the blood loss effectively compared to placebo alone.

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Risk factors and AGTR1 gene polymorphism (1166A>C) in patients with essential hypertension

Bukovinian Medical Herald ◽

10.24061/2413-0737.xxiv.4.96.2020.109 ◽

2020 ◽

Vol 24 (4 (96)) ◽

pp. 99-104

Author(s):

M. Semianiv

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Body Mass Index ◽

Essential Hypertension ◽

Diastolic Blood Pressure ◽

Body Mass ◽

Control Group ◽

Blood Pressure Elevation ◽

A1166c Polymorphism ◽

Gender And Age

Objective – to analyze the association of risk factors with the 1666 A>C polymorphism of the AGTR1 gene in patients with essential hypertension.Material and methods. 100 patients were screened, 72 of whom were genotyped. The control group consisted of 48 healthy individuals who did not differ in gender and age, and with the group of patients.Results. The obtained data confirmed that the level of blood pressure elevation is associated, to some extent, with modified (diabetes mellitus 2, smoking, body mass index) and unmodified factors (family history, gender) the risk of essential hypertension. The results of the analysis of blood pressure levels considering the A1166C polymorphism of the AGTR1 gene showed that the values of systolic and diastolic blood pressure in the group of patients with C-allele carriers were higher than in carriers of AA genotype: SBP – by 5.38% (p<0.05), DBP – by 5.15% (p<0.05). Conclusions. The level of blood pressure in patients with essential hypertension depends on body mass index and smoking. In carriers of the C-allele of the AGTR1 gene (A1166C), the level of systolic and diastolic blood pressure exceeds the ones of the carriers of the AA genotype. The presence of the C-allele of the AGTR1 gene (A1166C) almost doubles the risk of severe essential hypertension [OR = 2.75; p = 0.037].

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Abstract 118: Multicentric, Randomized Controlled Phase III Study of Centhaquine (Lyfaquin®) as an Effective First-in-class Resuscitative Agent in Hypovolemic Shock Patients

Circulation ◽

10.1161/circ.142.suppl_4.118 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Anil Gulati ◽

Rajat Choudhuri ◽

Ajay Gupta ◽

Saurabh Singh ◽

S. K. Noushad Ali ◽

...

Keyword(s):

Blood Pressure ◽

Mortality Rate ◽

Blood Lactate ◽

Standard Treatment ◽

Hypovolemic Shock ◽

Base Deficit ◽

Control Group ◽

Number Of Patients ◽

Lactate Levels ◽

Blood Lactate Levels

Background: Centhaquine (CQ) is a novel, first-in-class resuscitative agent for the treatment of hypovolemic shock. Methods: Efficacy of CQ for the treatment of hypovolemic shock as an adjuvant to standard of care (SOC) was evaluated in a prospective, multi-center, randomized, double-blind, placebo-controlled Phase 3 study. Key inclusion criteria were; systolic blood pressure of <90 mm Hg, blood lactate levels of > 2 mmol/L and patients receiving SOC in a hospital or ICU setting. Patients were randomized in a 2:1 ratio either to the CQ group receiving CQ dose of 0.01 mg/kg by IV infusion along with SOC or to the control group receiving SOC plus saline. Primary endpoints of the study were change in systolic blood pressure (SBP) and diastolic blood pressure (DBP), change in blood lactate levels and change in base deficit. Mortality through day 28 was the key secondary endpoint. Results: A total of 197 patients were screened, of which 105 patients met the eligibility criteria and were included in the study. Out of 105 patients, 71 patients were randomized to CQ group and 34 patients to control group. Demographics and baseline characteristics of patients in both groups was comparable. Hemoglobin level was 9.38 ± 0.71 g/dL and 8.73 ± 0.55 g/dL in control and CQ groups, respectively at the time of inclusion in the study. At 24 hours of resuscitation, SBP of more than 110 mmHg was in 59.38% patients of control and 81.82% patients of CQ group (P=0.00842). Similarly, at 24 hours of resuscitation, DBP of more than 70 mmHg was in 50.00% patients in control group and 78.46% patients in CQ group (P=0.002175). The number of patients with blood lactate levels of 1.5 mmol/L or less were 46.88% in the group with standard treatment compared to 69.35% in CQ group (P=0.0168). The number of patients with base-deficit of less than minus 2 were 46.88% in standard treatment group compared to 68.25% in those receiving CQ (P=0.0217). CQ treatment significantly reduced the mortality rate. In the control group, the mortality rate was 11.76% compared to 2.94% in the CQ group (odds ratio: 4.4; 95% CI 0.9651 to 23.74 and P=0.037). No drug related adverse event was reported. Conclusion: Centhaquine (Lyfaquin®) is a highly efficacious resuscitative agent for the treatment of hypovolemic shock as an adjuvant to SOC.

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Men with chronic occupational stress benefit from behavioural/psycho-educational group training: a randomized, prospective, controlled trial

Psychological Medicine ◽

10.1017/s0033291706009445 ◽

2006 ◽

Vol 37 (8) ◽

pp. 1141-1149 ◽

Cited By ~ 10

Author(s):

C. NICKEL ◽

S. TANCA ◽

S. KOLOWOS ◽

F. PEDROSA-GIL ◽

E. BACHLER ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Chronic Stress ◽

Salivary Cortisol ◽

Short Form ◽

Cortisol Concentration ◽

Control Group ◽

Group Training ◽

Educational Group ◽

Sf 36

ABSTRACTBackgroundOverworking is one of the most frequent stressors. The purpose of this study was to determine the effectiveness of behavioural/psycho-educational group training in men who are chronically stressed from overworking.MethodOf 72 male subjects, 36 were randomly assigned to training for 8 weeks and another 36 formed the control group, which received a placebo intervention. Primary outcome measures were systolic blood pressure, salivary cortisol concentration upon awakening, and self-reported changes on the scales of the Trier Inventory for the Assessment of Chronic Stress (TICS), the State-Trait Anger Expression Inventory (STAXI) and the 36-item Short Form Health Survey (SF-36).ResultsA significant reduction in mean values was observed in daily systolic blood pressure and salivary cortisol concentration on all the TICS and most of the STAXI and SF-36 scales.ConclusionsBehavioural/psycho-educational group training appears to be effective in the treatment of men suffering from chronic stress due to overworking.

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