scholarly journals Parameters of Vascular Tone Regulation and Gene Polymorphism Associated With Cardiovascular Risk in Young Subjects

2021 ◽  
Author(s):  
Anastasiya Elkina ◽  
Natalya Akimova ◽  
Yury Shvarts ◽  
Ivan Sokolov
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Healthy Subjects ◽  
Vascular Tone ◽  
Prognostic Significance ◽  
Vascular Pathology ◽  
Exclusion Criteria ◽  
Polymorphic Variants ◽  
Standing Test ◽  
Young Subjects

Abstract Introduction. Dysregulation of vascular tone (VT) is one of the cardiovascular risk factors that significantly worsens the quality of life, and can be a predictor for persistent hypertension (HTN). The identification of preclinical stages of vascular pathology is the most promising for prevention of hypertension. Therefore, it is important to investigate the polymorphism of genes which end products are involved in the regulation of blood pressure (BP) and predispose to VT dysregulation.Objective. To investigate the clinical and prognostic significance of the AGT and AGTR1 polymorphic variants associated with increased cardiovascular risk in young and relatively healthy subjects and patients with HTN. Materials and methods. The study involved 90 young healthy subjects and 62 patients with hypertension. The exclusion criteria for young subjects were as follows: organic cardiovascular and central nervous system disorders and smoking. The exclusion criteria for patients with HTN were identical. Additionally, the patients with uncontrolled HTN were not included. The VT regulation was assessed by the active standing test in which the changes in blood pressure (BP) and heart rate (HR) were measured. The polymorphism was identified using DNA pyrosequencing.Results. The relationship between BP and HR and the AGTR1 A1666C A>C and AGT M268T T>C variants was established. Both in young subjects and hypertensive patients was found that the C allele of the AGTR1 A1666C A>C variant was associated with lower HR in supine compared with subjects without this allele. The risk allele C of the M268T T>C polymorphism was associated with lower sBP and dBP during the 1st minute of upright posture. The identified features can probably be explained by the vascular tone increased at baseline in the presence of these polymorphic variants which was manifested by smaller changes in BP and HR during the active standing test compared to subjects without these allelic variants. The C allele of the AGTR1 A1666C A>C variant was associated with earlier onset of HTN.Conclusion. The identification of the AGTR1 A1666C A>C and AGT M268T T>C variants can be informative for clarifying the risk of HTN when the young subjects are examined, as well as the probability of early onset of hypertension.

Advantages of a personalized approach to the prevention and treatment of cardiovascular diseases in the staff of the INC Of the SBRAS

2017 ◽  
Author(s):  
Виктория Киреева ◽  
Viktoriya Kireeva ◽  
Г. Лифшиц ◽  
G. Lifshic ◽  
Н. Кох ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Vascular Tone ◽  
Molecular Genetic ◽  
Molecular Genetic Testing ◽  
Hypertensive Disease ◽  
Molecular Genetic Study ◽  
Polymorphic Variants ◽  
Personalized Approach ◽  
Regulation Of Blood Pressure ◽  
Regulation Of Vascular Tone

Purpose of the study. To test the functional associations of polymorphic variants of genes in the regulation of blood pressure and vascular tone in employees of the ISC SB RAS. Materials and methods. The study involved patients, employees of the ISC SB RAS, being under care of the outpatient clinic of the Hospital of the ISC SB RAS. During routine laboratory testing the patients were taken 2 ml of blood for genetic analysis and further molecular genetic study on “Hypertension”, “Endothelial dysfunction”, “Pharmacogenetics”, “Inflammatory response” panels. Results. In the analysis of 12 genes coding for key proteins of hormonal enzyme blood pressure regulation systems, polymorphism of CYP11B2 showed statistically significant correlation with the presence of arterial hypertension, which makes its further study promising. The presence of allele C showed protective significance in relation to the development of hypertension with OR = 0,247. When checking associations of functional polymorphic variants of genes, the products of which are involved in the regulation of vascular tone, with hypertension in patients younger than 50 years old we found association of T/T rs5443GNB3 genotype with the debut of hypertensive disease under the age of 50. The data obtained allow the doctor to choose the most personalized and effective safe drug from certain groups, as well as its dose for employees having passed molecular genetic testing. These data can reveal predisposition to the most widespread and socially significant diseases in the surveyed subjects and provide specific personalized recommendations for the prevention of these diseases.

scholarly journals How important is blood pressure variability?

2020 ◽  
Vol 22 (Supplement_E) ◽  
pp. E1-E6 ◽  
Author(s):  
Enrico Agabiti Rosei ◽  
Giulia Chiarini ◽  
Damiano Rizzoni
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Blood Pressure Variability ◽  
Prognostic Significance ◽  
Early Morning ◽  
Continuous Variable ◽  
Short Term ◽  
Arterial Blood ◽  
Relevant Risk Factor

Abstract Arterial blood pressure (BP) is a continuous variable, with a physiology characterized by significant variability stemming from the complex interaction among haemodynamic factors, neuronal reflexes, as well as hormonal, behavioural, and environmental stimuli. The homoeostatic response accounts for the physiologic variability in BP in normotensive individuals, which is more evident in hypertensive patients. Blood pressure variability is a complex phenomenon, which could be classified in various types: very short term (beat to beat), short term (during 24 h), mid-term (day by day), long term (<5 years), and very long term (>5 years). Accurate measurement of BP variability represents a complex and often controversial endeavour, despite several methodological approaches are available. Albeit a prognostic significance has been demonstrated for some indicators of BP variability, the clinical significance of this measurement is still uncertain. In fact, none of the indicators presently available for BP variability, including early morning BP rise, substantially affects, and redefines, the cardiovascular risk of the hypertensive patient, over and beyond the mere BP values. Accordingly, in defining the cardiovascular risk, the focus should be on the absolute BP values, which remain the most relevant risk factor, and the one more susceptible to modification with both non-pharmacologic and pharmacologic treatment.

Cardiovascular Risk Assessment in Hypertensive Patients

2021 ◽  
Author(s):  
Michael C Wang ◽  
Donald M Lloyd-Jones
Keyword(s):  
Blood Pressure ◽  
Risk Assessment ◽  
Cardiovascular Risk ◽  
Risk Prediction ◽  
Clinical Management ◽  
Prognostic Significance ◽  
Quantitative Risk Assessment ◽  
Cardiovascular Risk Assessment ◽  
Hypertensive Patients ◽  
Cardiovascular Risk Prediction

Abstract Hypertension is a highly prevalent and causal risk factor for cardiovascular disease (CVD). Quantititaive cardiovascular risk assessment is a new paradigm for stratifying hypertensive patients into actionable groups for clinical management and prevention of CVD. The large heterogeneity in hypertensive patients makes this evaluation complex, but recent advances have made CV risk assessment more feasible. In this review, we first describe the prognostic significance of various levels and temporal patterns of blood pressure. We then discuss cardiovascular risk prediction equations and the rationale of taking global risk into account in hypertensive patients. Finally, we review several adjunctive biomarkers that may refine risk assessment in certain patients. We observe that, beyond individual cross-sectional measurements, both short-term and long-term blood pressure patterns are associated with incident CVD; that current cardiovascular risk prediction performs well, and its incorporation into hypertension management is associated with potential population benefit; and that adjunctive biomarkers of target organ damage show the most promise in sequential screening strategies that target biomarker measurement to patients in whom the results are most likely to change clinical management. Implementation of quantitative risk assessment for CVD has been facilitated by tools and direct electronic health record integrations that make risk estimates accessible for counseling and shared decision making for CVD prevention. However, it should be noted that treatment does not return an individual to the risk of someone who never develops hypertension, underscoring the need for primordial prevention in addition to continued innovation in risk assessment.

Glucocorticoids and blood pressure: a role for the cortisol/cortisone shuttle in the control of vascular tone in man

1992 ◽  
Vol 83 (2) ◽  
pp. 171-178 ◽  
Author(s):  
Brian R. Walker ◽  
Alan A. Connacher ◽  
David J. Webb ◽  
Christopher R.W. Edwards
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Healthy Subjects ◽  
Vascular Tone ◽  
Dehydrogenase Deficiency ◽  
Lower Body Negative Pressure ◽  
Pressor Response ◽  
Hydroxysteroid Dehydrogenase ◽  
Renal Tubules ◽  
Vascular Sensitivity

1. 11β-Hydroxysteroid dehydrogenase converts cortisol to inactive cortisone in man. In distal renal tubules, this inactivation protects mineralocorticoid receptors from cortisol. Congenital 11β-hydroxysteroid dehydrogenase deficiency and inhibition of 11β-hydroxysteroid dehydrogenase by liquorice or carbenoxolone result in cortisol-dependent hypokalaemia and hypertension. 2. 11β-Hydroxysteroid dehydrogenase is expressed in vascular smooth muscle. Both glucocorticoids and mineralocorticoids potentiate vascular responses to noradrenaline. 11β-Hydroxysteroid dehydrogenase activity may therefore influence vascular tone. 3. Experiments were performed in healthy subjects with and without 7 days of oral administration of 11β-hydroxysteroid dehydrogenase inhibitors (liquorice or carbenoxolone), and in a patient with congenital 11β-hydroxysteroid dehydrogenase deficiency. We measured the following parameters: dermal vasoconstriction after topical application of cortisol, forearm blood flow during brachial artery infusion of cortisol or noradrenaline, and blood pressure during systemic infusion of noradrenaline. 4. Cortisol-induced dermal vasoconstriction was increased by liquorice (23 ± 6 to 52 ± 7 units; P<0.04) and in congenital 11β-hydroxysteroid dehydrogenase deficiency (87 units). In congenital 11β-hydroxysteroid dehydrogenase deficiency intraarterial infusion of cortisol caused vasoconstriction (20% reduction in blood flow in the infused arm) and accentuated the response to application of lower-body negative pressure, which stimulates sympathetically mediated vasoconstriction (35% reduction). However, intra-arterial infusion of cortisol had no effect in healthy subjects either with or without administration of liquorice. 5. Carbenoxolone potentiated both noradrenaline-induced forearm vasoconstriction (P<0.01) and pressor response (P<0.001). 6. We conclude that 11β-hydroxysteroid dehydrogenase modulates the access of cortisol to vascular receptors and thereby influences vascular sensitivity to noradrenaline. Complementary to its role in kidney, 11β-hydroxysteroid dehydrogenase could influence blood pressure by this mechanism, which may underlie our observations of impairment of 11β-hydroxysteroid dehydrogenase and increased dermal vascular sensitivity to cortisol in patients with essential hypertension.

Variability of Near-Fainting Responses in Healthy 6–16-Year-old Subjects

1997 ◽  
Vol 93 (3) ◽  
pp. 205-211 ◽  
Author(s):  
C.E. Catherine ◽  
de Jong-de Vos van Steenwijk ◽  
Wouter Wieling ◽  
Mark P. M. Harms ◽  
Karel H. Wesseling
Keyword(s):  
Blood Pressure ◽  
Healthy Subjects ◽  
Pressure Pulsation ◽  
Left Ventricular ◽  
Individual Variability ◽  
Large Individual ◽  
Common Phenomenon ◽  
Left Ventricular Stroke Volume ◽  
Vasomotor Tone ◽  
Young Subjects

1. Fainting is a common phenomenon in young subjects, but the final events before the actual faint are not well known. The aim of the present study was to study the inter-individual variability of haemodynamic events associated with near-fainting in children and teenagers. 2. Sixty-eight healthy subjects (aged 6–16 years) performed a 70° tilt-up test with intravascular instrumentation for 5 min. Responses in 29 near-fainting subjects were analysed and compared with 39 non-fainting subjects. Arterial pressure was measured by Finapres. Left ventricular stroke volume was computed from the pressure pulsation waveform. 3. Inability to maintain vasomotor tone was the mechanism underlying near-fainting in the vast majority of near-fainting subjects. The three classical haemodynamic responses (vasovagal, vasodepressor and vagal) could be recognized, but large individual differences were found. After tilt back, blood pressure in near-fainters showed a mirror response to the stage before tilt-back; blood pressure gradually increased and was normal at 1 min after tilt-back. 4. The variability in haemodynamic responses on approach of an orthostatic faint is wide in the young.

Abstract 113: Ambulatory Blood Pressure in Hypertensive Patients with Inclusion Criteria for the SPRINT Trial

Hypertension ◽  
2016 ◽  
Vol 68 (suppl_1) ◽  
Author(s):  
Alejandro De La Sierra ◽  
Jose R Banegas ◽  
Juan A Divison ◽  
Manuel Gorostidi ◽  
Ernest Vinyoles ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Antihypertensive Therapy ◽  
Ambulatory Blood Pressure ◽  
Normal Values ◽  
Inclusion Criteria ◽  
High Cardiovascular Risk ◽  
Exclusion Criteria ◽  
Hypertensive Patients ◽  
Mean Values

The SPRINT trial has demonstrated the benefit of intensive BP reduction in hypertensive patients at high cardiovascular risk. Values of ABPM are of potential interest in such patients to better select those who will benefit of a lower BP target. We aimed to evaluate ABPM values in a large cohort of patients potentially candidates (meeting inclusion criteria) for the SPRINT trial. Moreover, in patients on antihypertensive therapy who also fulfill SPRINT criteria, except for clinic SBP ≥ 130 mmHg, we evaluated 24-hour SBP values among those who had clinic SBP < 120; between 120 and 139, or ≥ 140. From the database of the Spanish ABPM Registry containing 115708 patients, we identified 39132 (34%, 51% women, mean age 65 years) who fulfill both inclusion and exclusion criteria of the SPRINT trial. Mean values of clinic SBP were 151±11 mmHg, whereas corresponding values for 24-h SBP were 130±13 mmHg. Overall, 52% of patients had 24-h SBP below 130 mmHg. The proportion varied from 69% in those with clinic BP 130-139 to 34% in those with clinic BP ≥ 170 mmHg. Among 34328 treated patients who fulfilled SPRINT inclusion criteria (except for clinic BP ≥ 130), 1014 (3%) had clinic SBP < 120 mmHg, and 5330 (16%) values between 120 and 139 mmHg. The remaining 27984 patients were not controlled and had clinic SBP ≥ 140 mmHg. Values of 24 h SBP below 130 mmHg were seen in 88% of those with clinic BP < 120, in 74% of those with clinic BP 120-139, and in 47% of those with clinic BP ≥ 140 mmHg. The corresponding proportion of patients having 24-h SBP < 100 mmHg were 7.7%, 1.1%, and 0.6%. We conclude that ABPM assessment could be necessary in the evaluation of hypertensive patients at high CV risk before targeting the BP goal, as roughly half of them may have normal values of 24-h SBP (< 130 mmHg). In addition, targeting clinic BP below 120 mmHg is accompanied by 8% of patients with 24-h SBP below 100 mmHg.

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