scholarly journals Mechanisms of remodelling of small arteries, antihypertensive therapy and the immune system in hypertension

2015 ◽  
Vol 38 (6) ◽  
pp. 394 ◽  
Author(s):  
Ernesto L Schiffrin
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Drugs ◽  
Clinical Investigation ◽  
Antihypertensive Agents ◽  
Tissue Perfusion ◽  
Vascular Wall ◽  
Resistance Arteries ◽  
Small Arteries ◽  
Small Resistance ◽  
And Function

This review summarizes my lecture for the 2015 Distinguished Scientist Award from the Canadian Society of Clinical Investigation, and is based mainly on studies in my laboratory on the mechanisms of remodelling of small arteries in experimental animal and human hypertension and on treatments that lower blood pressure and improve structure and function of resistance vessels. Small resistance arteries undergo either inward eutrophic or hypertrophic remodelling, which raises blood pressure and impairs tissue perfusion. These vascular changes are corrected by some antihypertensive drugs, which may lead to improved outcomes. Vasoconstriction, growth, oxidative stress and inflammation are some of the mechanisms, within the vascular wall, that can be beneficially affected by antihypertensive agents. These antihypertensive-sensitive mechanisms are reviewed in this review, together with the inflammatory and immune mechanisms that may participate in hypertension and associated cardiovascular injury. Molecular studies, based on this research, will hopefully identify novel diagnostic and therapeutic targets, which will improve our ability to prevent and treat hypertension and cardiovascular disease.

scholarly journals Blood Pressure Control: Stroke and Stroke Prevention

2005 ◽  
Vol 6 (1_suppl) ◽  
pp. S8-S11
Author(s):  
Hans-Christoph Diener
Keyword(s):  
Blood Pressure ◽  
Stroke Prevention ◽  
Antihypertensive Drugs ◽  
Angiotensin Receptor Blockers ◽  
Antihypertensive Agents ◽  
Pressure Control ◽  
Angiotensin Receptor ◽  
Risk Of Death ◽  
Pressure Lowering ◽  
Receptor Blockers

Hypertension is the most important modifiable risk factor for primary and secondary stroke prevention. All antihypertensive drugs are effective in primary prevention: the risk reduction for stroke is 30—42%. However, not all classes of drugs have the same effects: there is some indication that angiotensin receptor blockers may be superior to other classes of antihypertensive drugs in stroke prevention. Seventy-five percent of patients who present to hospital with acute stroke have elevated blood pressure within the first 24—48 hours. Extremes of systolic blood pressure (SBP) increase the risk of death or dependency. The aim of treatment should be to achieve and maintain the SBP in the range 140—160 mmHg. However, fast and drastic blood pressure lowering can have adverse consequences. The PROGRESS trial of secondary prevention with perindopril + indapamide versus placebo + placebo showed a decrease in numbers of stroke recurrences in patients given both active antihypertensive agents, more impressive for cerebral haemorrhage.There were also indications that active treatment might decrease the development of post-stroke dementia.

scholarly journals Clinical Practice Patterns of Hypertensive Disease in Pregnancy among Korean Obstetricians

2021 ◽  
Vol 25 (3) ◽  
pp. 221-229
Author(s):  
Tae Gyu Ahn ◽  
Yeon Hee Kim ◽  
Yun Sook Kim ◽  
Jae Eun Shin ◽  
Young-Lim Oh ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Clinical Practice ◽  
Practice Patterns ◽  
Antihypertensive Drugs ◽  
Antihypertensive Agents ◽  
Delivery Method ◽  
Hypertensive Disease ◽  
Clinical Practice Patterns ◽  
Elevated Liver Enzymes ◽  
Prophylactic Aspirin

Purpose: The purpose of this study was to investigate the clinical practice patterns of Korean obstetricians and gynecologists the diagnosis and management of hypertensive disease in pregnant women. Methods: From April 2015 to October 2015, questionnaire was distributed via email to obstetricians who were members of the Society for Maternal and Fetal Medicine. The survey consisted of 37 questions in 6 categories. Responses to the questions on the management of hypertensive disorders of pregnancy, from diagnosis to treatment, were evaluated. Results: A total of 93 obstetricians and gynecologists responded to the survey. High blood pressure was allocated the highest priority as an index mainly used when deciding to hospitalize patients with hypertensive disease during pregnancy, followed by pregnancy symptoms, proteinuria, and blood test results. Calcium channel blocker (CCB) for oral administration and hydralazine for injection were preferred as antihypertensive drugs mainly used to control severe hypertension. Regarding the delivery method for hypertensive disease during pregnancy, in cases of preeclampsia, 63% of the respondents chose the delivery method according to the cervical status, and in cases of hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome and eclampsia, which increased in severity, 52% and 31% responded that the delivery method was determined according to the cervical status, respectively. In cases of mild preeclampsia, the 70% of respondents preferred 37–38 weeks of gestation for the delivery time. Regarding the use of aspirin in patient with hypertension during pregnancy, 52% of the respondents occasionally administered aspirin, and in patients with a history of hypertensive disease during pregnancy, only 43% were administered prophylactic aspirin. Conclusion: Domestic obstetricians regarded blood pressure as the most meaningful factor when treating women with hypertension during pregnancy and considered blood pressure control as important. The preferred antihypertensive agents were oral CCB and hydralazine injections, and the choice of delivery method was determined according to the condition of the cervix and severity of the disease. Even in women with high risk factors for preeclampsia, prophylactic aspirin was administered in as low as 50%, of patients, possibly may due to the absence of domestic guidelines for aspirin use during pregnancy. Korean guidelines for prophylactic aspirin administration during pregnancy is needed based on additional research on the efficacy of aspirin for domestic women in the future.

scholarly journals The first Russian national multicenter study - ROBLS (Russian Optimal Blood pressure Lowering Study)

2003 ◽  
Vol 9 (5) ◽  
pp. 151-154
Author(s):  
Yu. N. Belenkov ◽  
I. Ye. Chazova
Keyword(s):  
Blood Pressure ◽  
Intensive Care ◽  
Treatment Group ◽  
Multicenter Study ◽  
Antihypertensive Drugs ◽  
Antihypertensive Agents ◽  
Fixed Dose ◽  
Care Group ◽  
Routine Treatment ◽  
Optimal Blood Pressure

ROBIS is the first large multicenter study performed in Russia. The Objective of the study was to compare the efficiency, safely, and impact of two treatment policies (the application of an algorithm to the stepwise use of 4 classes of antihypertensive agents in an intensive care group and random antihypertensive therapy in a routine treatment group) on the incidence of cardiovascular events in patients with arterial hypertension. Design: This is a national multicenter open consecutive prospective study. The patients meeting the criteria of inclusion were randomly divided into two equal groups, one of them (an intensive care group) received therapy with a nifedipine retard in Fixed dose for 4 weeks. In patients who failed to achieve the target level of blood pressure (BP), the therapy was supplemented by enalapril, 20 mg, hydrochlorothiazide, 25 mg, and metoprolol, 50 mg, at a 4-week interval. After achieving the target BP level, the patients continued the treatment with which the level had been attained. If the antihypertensive effect of therapy was found to disappear, the above drugs were successively supplemented. The other group (a routine treatment group) continued to be treated with the antihypertensive drugs prescribed in the polyclinic (Fig. 1). BP and heart rate were monitored and the patients' complaints and adverse reactions were recorded on repeated visits 4, 8, 12, 16, 24, 52, 64, 70, 88, and 104 weeks after the initiation of therapy. Control blood and urine analyses and ECG studies were made 12, 16, 52, and 104 weeks after therapy.

Abstract P287: Endothelial Dysfunction in Small Resistance Arteries of Patients with Severe Obesity: Role of Arginase

Hypertension ◽  
2016 ◽  
Vol 68 (suppl_1) ◽  
Author(s):  
Agostino Virdis ◽  
Emiliano Duranti ◽  
Monica Nannipieri ◽  
Marco Anselmino ◽  
Andrea Grazi ◽  
...  
Keyword(s):  
Endothelial Dysfunction ◽  
Severe Obesity ◽  
Subcutaneous Tissue ◽  
Age Groups ◽  
Inhibitory Effect ◽  
Resistance Arteries ◽  
Small Arteries ◽  
Laparoscopic Surgical Procedure ◽  
Small Resistance

Nitric oxide (NO) is produced by endothelial NO synthase (eNOS) using the aminoacid L-Arginine. Arginase (Arg) also uses L-Arginine as substrate, converting it in L-Ornitine and urea. An increased Arg activity causes a progressive L-Arginine depletion, which in turn determines a lower NO bioavailability. Studies in murine models of obesity identify Arg as a determinant of endothelial dysfunction. In this study, we evaluated whether Arg might play a role in determining the lower bioavailability of NO in small resistance arteries isolated from subcutaneous tissue of patients with severe obesity (Ob), split in age groups (younger than 30 aa, range 21-29, n=5; older than 30 aa, range 35-56, n=5) vs normoweight controls (Ctrl younger 30 years, range 20-29, n=5; older than 30 yrs, range 36-58, n=5). Each patient underwent a subcutaneous biopsy during a laparoscopic surgical procedure. Small arteries, isolated from periadvential fat, were evaluated on a pressurized micromyograph. Endothelium-dependent vasodilation (VD) was assessed by acetylcholine (Ach, 0,001-100μM). NO availability was assessed by repeating Ach with L-NAME (100μM). Ach was also infused in the presence of norNOHA (10μM, Arg inhibitor). In Ctrl, VD induced by Ach was inhibited by L-NAME and not modified by norNOHA. Ob younger exhibited a reduced VD induced by Ach vs Ctrl of the same age, a reduced inhibition by L-NAME, and a potentiating effect by norNOHA, which also normalized the inhibitory effect of L-NAME on Ach. In Ob older, VD induced by Ach was reduced vs Ob younger, resistant to L-NAME and not modified by norNOHA. In conclusions, in small arteries from younger Ob, the Arg inhibition improves endothelial function by increasing the NO availability, while in older Ob Arg does not seem to play any role in endothelial dysfunction.

scholarly journals Therapieresistente und ‑refraktäre Hypertonie

2020 ◽  
Vol 145 (02) ◽  
pp. 87-91
Author(s):  
Rainer Düsing
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Drugs ◽  
Antihypertensive Agents ◽  
Treatment Resistance ◽  
Secondary Hypertension ◽  
White Coat Hypertension ◽  
Diagnostic Challenge ◽  
Refractory Hypertension ◽  
Mineralocorticoid Receptor Antagonist ◽  
Apparent Resistance

AbstractHypertension is defined as resistant to treatment when treatment fails to lower office systolic and diastolic blood pressure values to < 140/90 mmHg. The treatment strategy should include lifestyle measures and appropriate doses of three or more drugs acting by different mechanisms including a diuretic. An updated definition of treatment resistance includes all patients with ≥ 4 antihypertensive agents of different classes irrespective of their on-treatment blood pressure. The term “refractory” hypertension has been suggested for patients with uncontrolled blood pressure on ≥ 5 antihypertensive drugs including the thiazide-like diuretic chlorthalidone and the mineralocorticoid receptor antagonist spironolactone. “Pseudo resistance” especially due to white coat hypertension and non-adherence with the prescribed medication has to be ruled out to be able to identify patients with “true” treatment resistance. Therefore, before distinguishing true from pseudo resistance, the term “apparent” resistance should be used. While the prevalence of apparent resistance may be in the range of 10–15 % of treated patients, the exact prevalence of true resistance remains unknown due to the lack of appropriate studies but is likely to be rather small including a high proportion of patients with secondary forms of hypertension. Once identified most patients with true treatment resistance should receive intensified drug treatment primarily by expanded diuretic usage. Thus, resistant hypertension is primarily a diagnostic challenge: identifying patients with true resistance and those with secondary hypertension.

scholarly journals Emerging Drug Classes and Their Potential Use in Hypertension

Hypertension ◽  
2019 ◽  
Vol 74 (5) ◽  
pp. 1075-1083 ◽  
Author(s):  
Michel Azizi ◽  
Patrick Rossignol ◽  
Jean-Sébastien Hulot
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Drugs ◽  
Generic Drugs ◽  
Antihypertensive Agents ◽  
Uncontrolled Hypertension ◽  
Blood Pressure Lowering ◽  
Receptor Antagonists ◽  
Drug Classes ◽  
Pressure Lowering ◽  
Potential Use

Despite the availability of multiple antihypertensive drugs targeting the different pathways implicated in its pathophysiology, hypertension remains poorly controlled worldwide, and its prevalence is increasing because of the aging of the population and the obesity epidemic. Although nonadherence to treatment contributes to uncontrolled hypertension, it is likely that not all the pathophysiological mechanisms are neutralized by the various classes of antihypertensive treatment currently available, and, the counter-regulatory mechanisms triggered by these treatments may decrease their blood pressure–lowering effect. The development of new antihypertensive drugs acting on new targets, with different modes of action, therefore, remains essential, to improve blood pressure control and reduce the residual burden of cardiovascular risks further. However, the difficulties encountered in the conception, development, costs, and delivery to the market of new classes of antihypertensive agents highlights the hurdles that must be overcome to release and to evaluate their long-term safety and efficacy for hypertension only, especially because of the market pressure of cheap generic drugs. New chemical entities with blood pressure–lowering efficacy are thus being developed more for heart failure or diabetic kidney disease, 2 diseases pathophysiologically associated with hypertension. These include dual angiotensin II receptor-neprilysin inhibitors, soluble guanylate cyclase stimulators, nonsteroidal dihydropyridine-based mineralocorticoid receptor antagonists, as well as sodium-glucose cotransporter 2 inhibitors. However, centrally acting aminopeptidase A inhibitors and endothelin receptor antagonists have a dedicated program of development for hypertension. All these emergent drug classes and their potential use in hypertension are reviewed here.

Marriage of resistance and conduit arteries breeds critical limb ischemia

2005 ◽  
Vol 288 (3) ◽  
pp. H1044-H1050 ◽  
Author(s):  
Paul Coats ◽  
Roger Wadsworth
Keyword(s):  
Blood Supply ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Sudden Increase ◽  
Large Artery ◽  
Resistance Arteries ◽  
Tissue Edema ◽  
Surgical Bypass ◽  
Small Resistance ◽  
And Function

Atherosclerosis in a major leg artery leads to impaired blood supply, which normally progresses to critical limb ischemia. Atherosclerosis produces substantial alterations of structure and endothelial function in the large conduit arteries. Pressure unloading and ischemia in the distal vasculature bring about alterations in microvascular function. Resistance arteries undergo significant wall thinning and changes in their contractile regulation. Optimization of large artery dimensions by the small arteries through flow-mediated vasodilation is impaired. Angiogenesis is stimulated, which can result in the formation of major collateral feeder vessels in addition to small nutritive blood vessels. However, angiogenesis can also contribute to instability of atherosclerotic plaques, which ultimately leads to further deterioration in blood supply. Surgical bypass grafting to restore blood supply to the distal leg generates a sudden increase of pressure in the weakened resistance vasculature, leading to uncontrolled changes in capillary hydrostatic pressure, extravasation of fluid, and tissue edema. This review aims to highlight the importance of the resistance vasculature in critical limb ischemia and the interdependence of pathophysiological changes in the large conduit and small resistance arteries. The major unresolved question is why the physiological mechanisms that regulate vascular structure and function ultimately break down, leading to circulatory failure within the distal limb.

scholarly journals Acupuncture Treatment for Hypertension: A Case Study

2014 ◽  
Vol 32 (1) ◽  
pp. 73-76 ◽  
Author(s):  
Lili Zhang ◽  
Pengfei Shen ◽  
Shu Wang
Keyword(s):  
Blood Pressure ◽  
Side Effects ◽  
Synergistic Effect ◽  
Acupuncture Treatment ◽  
Antihypertensive Drugs ◽  
Antihypertensive Agents

This report describes the regular use of acupuncture treatments for a patient with hypertension who could not tolerate the side effects of the antihypertensive agents. The patient received 60 acupuncture treatments in the course of 12 weeks, during which time his overall wellbeing improved, his blood pressure reduced and the side effects of antihypertensive drugs were removed. Although acupuncture plus the drug appeared to have a substantial synergistic effect that was weakened when the drug was discontinued, acupuncture may still play a role in the management of hypertension, especially for patients who cannot tolerate the side effects of antihypertensive agents.

scholarly journals Vascular stiffness in patients with arterial hypertension: possible antihypertensive therapy

2016 ◽  
Vol 13 (2) ◽  
pp. 17-23
Author(s):  
O D Ostroumova ◽  
A I Kochetkov ◽  
M V Lopukhina
Keyword(s):  
Blood Pressure ◽  
Arterial Stiffness ◽  
Pulse Wave Velocity ◽  
Pulse Wave ◽  
Antihypertensive Drugs ◽  
Vascular Wall ◽  
Cardiovascular Complications ◽  
Increased Risk ◽  
Pharmacokinetic Properties ◽  
Complications And Mortality

The article discusses the factors that increase the arterial stiffness: the blood pressure, atherosclerosis, smoking, diabetes, age. Given evidence that pulse wave velocity and a number of other indicators that reflect the state of the vascular wall, are markers for increased risk of cardiovascular complications and mortality. The influence of antihypertensive drugs of different groups on the stiffness of the vascular wall, with particular attention paid to the effects of drugs from group of diuretics. We discuss possible mechanisms of the influence of indapamide retard on the elastic properties of vessels. It is emphasized that the influence on the stiffness of the arteries of different antigipertenzivny medicines, even belong to the same class, is different, due to differences in pharmacokinetic properties.

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