scholarly journals Chronopharmacology of high blood pressure—a critical review of clinical evidence

2019 ◽  
Vol 66 (2) ◽  
pp. 32-36
Author(s):  
P. Potucek ◽  
J. Klimas
Keyword(s):  
Blood Pressure ◽  
Clinical Evidence ◽  
Normal Function ◽  
Pharmacological Intervention ◽  
Cyclic Variation ◽  
Endogenous Factors ◽  
Cardiovascular Damage ◽  
Circadian Patterns ◽  
Evening Administration ◽  
Therapy Of Hypertension

Abstract Physiological functions of cardiovascular system (CVS) are exhibiting circadian patterns regulated by complex system of endogenous factors. Preserving this rhythmicity is important for its normal function, whereas disturbing the synchronization with natural day–night cycle can increase the risk of cardiovascular damage. Cardiovascular pathophysiology also follows cyclic variation; time susceptibility and period with maximum risk associated with elevated blood pressure (BP) can be predicted. Given this rhythmic nature, significant changes in efficacy between morning and evening administration of the drug may occur; appropriate timing of pharmacological intervention in therapy of hypertension may affect the efficacy of the treatment.

Vasopressin Deficiency and Pressor Hypersensitivity In Hemodynamically Unstable Organ Donors

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
Jonathan M. Chen ◽  
Suzanne Cullinane ◽  
Talia B. Spanier ◽  
John H. Artrip ◽  
Ranjit John ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Diabetes Insipidus ◽  
Low Dose ◽  
Clinical Evidence ◽  
Pressor Response ◽  
Hemodynamic Instability ◽  
Solid Organ ◽  
Organ Donors ◽  
Plasma Vasopressin ◽  
Before And After

Background —Solid organ donors often develop hypotension due to vasodilation, and recently we observed that a variety of vasodilatory states are characterized by vasopressin deficiency and hypersensitivity. Thus, we investigated the prevalence of vasopressin deficiency in hypotensive solid organ donors without clinical evidence of diabetes insipidus; we also investigated the vasopressor effect of vasopressin replacement in hypotensive donors. Methods and Results —Fifty organ donors were evaluated for hemodynamic instability, (mean arterial pressure [MAP]≤ 70 mm Hg despite the use of catecholamine vasopressors), and in those unstable donors who were not already receiving exogenous vasopressin, low-dose vasopressin was administered as a continuous infusion (0.04 to 0.1 U/min). MAP, catecholamine requirements, serum vasopressin, and serum osmolality were obtained before and after vasopressin administration. Ten patients meeting the enrollment criteria received vasopressin and MAP increased from 72.2±3.5 to 89.8±4.2 mm Hg, ( P <0.05), allowing for complete discontinuation of catecholamine pressors in 4 (40%) patients and a decrement in pressor dose in 4 (40%). Plasma vasopressin levels (2.9±0.8 pg/mL) were low for the degree of hypotension. Conclusions —Hemodynamically unstable organ donors without clinically apparent diabetes insipidus display a defect in the baroreflex-mediated secretion of vasopressin. In these patients, low-dose vasopressin significantly increases blood pressure with a pressor response sufficient to reduce catecholamine administration.

Abstract P173: Role Of Potassium Intake On Hypertensive Cardiovascular Damage In Apolipoproteine-deficient Mice Under Normal And High Salt Conditions

Hypertension ◽  
2020 ◽  
Vol 76 (Suppl_1) ◽  
Author(s):  
Mina Yakoub ◽  
Denada Arifaj ◽  
Doron Argov ◽  
Masudur Rahman ◽  
Sebastian Temme ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiac Hypertrophy ◽  
Aortic Arch ◽  
High Salt ◽  
Ang Ii ◽  
Cardiac Damage ◽  
High Sodium ◽  
Cardiovascular Damage ◽  
High K ◽  
Deficient Mice

Reduced potassium (k+) intake has been linked to cardiovascular diseases. The underlying mechanisms remain unknown. Here, we investigate the effect of low (0%), normal (0.5%) and high K+ (5%) diet on the development of atherosclerosis and hypertensive cardiac damage. To induce atherosclerosis, apolipoprotein-deficient mice were infused with angiotensin (Ang) II (500ng/kg/min) for 28 days. Potassium treatment was initiated 2 weeks before Ang II infusion. Cardiac function was assessed by MRI. Levels of K+ in the serum and urine were significantly different between groups. The Ang II infused mice from the K+ low group had significantly higher atherosclerotic plaques in the aortic arch (21±3%) compared to K+ high (10±2%) and K+ normal (11±2%) groups. The atherosclerosis development was blood pressure independent since no differences in blood pressure between the groups were observed. Although heart to body-weight ratio did not differ between three groups, K+ low diet was associated with a lower ejection fraction rate and increased mRNA expression levels of cardiac ANP, BNP, collagen and fibronectin compared to the K+ normal and K+ high group. After Ang II infusion, assessment of aldosterone levels in urine showed significant higher aldosterone levels in the high K+ (214±72ng/24h) compared to normal K+ (26±6ng/24h) and low K+ (18±4ng/24h) groups. Aldosterone induced cardiovascular damage is known to be aggravated by sodium. To, evaluate whether high sodium diet unmask aldosterone mediated cardiovascular damage in the high K+ group, mice fed a high or normal K+ diet were additionally treated with high sodium (1% NaCl) in the drinking water. During Ang II treatment, high salt diet accelerated atherosclerosis in the aortic arch of both groups but no differences were observed between the high K+ high/high Na+ (41±7%) and normal K+/high Na+ (49±2%) group. In contrast, high K+/high Na+ group have significantly more severe cardiac hypertrophy compared to normal K+ high Na+ group (8.9±0.7 vs 6.4±0.7mg/g). These results were confirmed by MRI. K+ deficient diet induces atherosclerosis and cardiac damage during Ang II induced hypertension. K+ enriched diet exacerbates cardiac hypertrophy only under high Na+ conditions most likely in an aldosterone-dependent mechanism.

scholarly journals Sex, Oxidative Stress, and Hypertension: Insights From Animal Models

Physiology ◽  
2019 ◽  
Vol 34 (3) ◽  
pp. 178-188 ◽  
Author(s):  
Jane F. Reckelhoff ◽  
Damian G. Romero ◽  
Licy L. Yanes Cardozo
Keyword(s):  
Oxidative Stress ◽  
Blood Pressure ◽  
Animal Models ◽  
Blood Pressure Control ◽  
Clinical Studies ◽  
Pressure Control ◽  
Pharmacological Intervention ◽  
Preclinical Studies ◽  
Initial Development ◽  
And Oxidative Stress

One of the mechanisms responsible for blood pressure (BP) regulation is thought to be oxidative stress. In this review, we highlight preclinical studies that strongly support a role for oxidative stress in development and maintenance of hypertension in male animals, based on depressor responses to antioxidants, particularly tempol and apocynin. In females, oxidative stress seems to be important in the initial development of hypertension. However, whether maintenance of hypertension in females is mediated by oxidative stress is not clear. In clinical studies, pharmacological intervention to reduce BP with antioxidants has conflicting results, mostly negative. This review will discuss the uncertainties regarding blood pressure control and oxidative stress and potential reasons for these outcomes.

scholarly journals Does Smoking Act as a Friend or Enemy of Blood Pressure? Let Release Pandora's Box

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Aurelio Leone
Keyword(s):  
Blood Pressure ◽  
Carbon Monoxide ◽  
Passive Smoking ◽  
Chronic Exposure ◽  
Arterial Wall ◽  
Antihypertensive Drugs ◽  
Epidemiological Studies ◽  
Cardiovascular Damage ◽  
Long Run ◽  
Experimental Findings

In spite of the great number of observations which show the certainty of cardiovascular damage from smoking, the opinions on that are not yet unanimous. There is a discrepancy that could be attributed to the lack of reproducible data particularly in some epidemiological studies. On the contrary, experimental findings conducted on both animals and humans give evidence of exactly reproducible results of cardiovascular alterations and among these the course of Blood Pressure (BP). Findings identify an increase in BP of active smokers or non-smokers exposed to passive smoking, while a lot of others refer a lowering of BP due to smoking. This discrepancy could be explained as follows. Initially, a vasoconstriction mediated by nicotine causes acute but transient increase in systolic BP. This phase is followed by a decrease in BP as a consequence of depressant effects played chronically by nicotine itself. Simultaneously, carbon monoxide is acting directly on the arterial wall causing, in the long run, structurally irreversible alterations. At this time, there is a change in BP that increases again, and often constantly, its levels following chronic exposure. Changes in response to antihypertensive drugs have been observed in hypertensive smokers since smoking influences metabolic steps of the drugs.

scholarly journals Nutraceuticals and Hypertensive Disorders in Pregnancy: The Available Clinical Evidence

Nutrients ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 378 ◽  
Author(s):  
Silvia Fogacci ◽  
Federica Fogacci ◽  
Arrigo F.G. Cicero
Keyword(s):  
Blood Pressure ◽  
Dietary Supplements ◽  
Search Strategy ◽  
Clinical Evidence ◽  
Meta Analysis ◽  
Cochrane Collaboration ◽  
Hypertensive Disorders ◽  
Pressure Lowering ◽  
Hypertensive Disorders In Pregnancy ◽  
In Pregnancy

The aim of the present critical review is to summarize the available clinical evidence supporting the use of some dietary supplements that have been shown to lower blood pressure in hypertensive pregnant women. A systematic search strategy was carried out to identify trials in MEDLINE (National Library of Medicine, Bethesda, Maryland, MD, USA; January 1980 to September 2019) and the Cochrane Register of Controlled Trials (The Cochrane Collaboration, Oxford, UK). The terms ‘nutraceuticals’, ‘dietary supplements’, ‘pregnancy’, ‘pre-eclampsia’, ‘clinical trial’, and ‘human’ were incorporated into an electronic search strategy. The references of the identified studies and review articles were reviewed to look for additional studies of interest. We preferably selected papers that reported recent comprehensive reviews or meta-analysis, or original clinical trials of substances with blood pressure-lowering or vascular protective effect in pregnancy. There is a relative body of evidence that supports the use of calcium, vitamin D, folic acid, and resveratrol in preventing the development of hypertensive disorders in pregnancy, and evidence supporting drug treatment too. Further clinical research is advisable to identify the dosage and timing of the supplementation, the group of women that might benefit the most from this approach, and the nutraceuticals with the best cost-effectiveness and risk-benefit ratio for widespread use in clinical practice.

scholarly journals The Association Between Inflammatory Markers and Hypertension. A Call for Anti-Inflammatory Strategies?

2006 ◽  
Vol 6 ◽  
pp. 1262-1273
Author(s):  
Néstor H. García ◽  
Luis I. Juncos
Keyword(s):  
Blood Pressure ◽  
Endothelial Dysfunction ◽  
Beta Blockers ◽  
Organ Damage ◽  
Left Ventricular ◽  
Cardiovascular Damage ◽  
Inflammatory State ◽  
Anti Inflammatory ◽  
Stage Renal Disease ◽  
End Stage

The most important goal of antihypertensive therapy is to prevent the complications associated with hypertension (stroke, myocardial infarction, end-stage renal disease, etc). For this, secondary targets such as left ventricular hypertrophy, proteinuria, dementia, and other signs of hypertension-induced organ damage help the physician to assess risks and monitor treatment efficacy. New treatment targets may be arising, however. One such target may be endothelial dysfunction. In effect, endothelial dysfunction not only may precede the elevation of blood pressure, but may also pave the way to conditions often associated with hypertension, such as diabetes, arteriosclerosis, microalbuminuria, congestive heart failure, and tissue hypertrophy. Because inflammation often accompanies endothelial dysfunction, approaches to counteract inflammation are now being evaluated. For this, antagonists of the renin-angiotensin-aldosterone system, statins, and beta blockers are all being tested. All of these agents seem to prevent or delay the induction of proinflammatory molecules aside from, and in addition to, their specific effects on blood pressure. The focus of this review is to update some of the animal and human research showing that hypertension sets off an inflammatory state and also to consider some of the anti-inflammatory approaches that may prevent the development of endothelial dysfunction, and the subsequent renal and cardiovascular damage.

scholarly journals Prevalence of Arterial Hypertension and Characteristics of Nocturnal Blood Pressure Profile of Asthma Patients According to Therapy and Severity of the Disease: The BADA Study

2020 ◽  
Vol 17 (18) ◽  
pp. 6925
Author(s):  
Domenico Di Raimondo ◽  
Gaia Musiari ◽  
Alida Benfante ◽  
Salvatore Battaglia ◽  
Giuliana Rizzo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Blood Pressure Monitoring ◽  
Pressure Profile ◽  
Control Group ◽  
Cardiovascular Comorbidities ◽  
Cardiovascular Damage ◽  
Increased Risk ◽  
Asthma Patients ◽  
Severity Of The Disease

Background: several studies report an increased risk for asthmatic subjects to develop arterial hypertension and the relationship between these two diseases, frequently co-existing, still has some unclear aspects. Methods: The BADA (blood pressure levels, clinical features and markers of subclinical cardiovascular damage of asthma patients) study is aimed to evaluate the prevalence of the cardiovascular comorbidities of asthma and their impact on the clinical outcome. The main exclusion criteria were the presence of other respiratory diseases, current smoking, any contraindication to ambulatory blood pressure monitoring (ABPM). Results: The overall percentage of asthmatics having also hypertension was 75% (30 patients) vs. 45% (18 patients) of the control group (p: 0.012). Reduced level of FEV1 (but not inhaled steroid therapy) was associated to newly-diagnosed hypertension (p: 0.0002), higher day SBP levels (p: 0.003), higher day DBP levels (p: 0.03), higher 24 h-SBP levels (p: 0.005) and higher 24h-DBP levels (p: 0.03). The regression analysis performed taking into account sex, age, diabetes, fasting glucose, and body mass index confirms the independent role played by asthma: odds ratio (OR): 3.66 (CI: 1.29–11.1). Conclusions: hypertension is highly prevalent in asthma; the use of ABPM has allowed the detection of a considerable number of unrecognized hypertensives.

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