A case of Stage III essential hypertension treated with homoeopathy through the windows of the unconscious mind: A case report

A 36-year-old man presented with Stage III accelerated hypertension and reluctance to start anti-hypertensive medication. This case is an attempt to demonstrate the importance of unconscious emotions and dreams with their psychodynamic correlations in essential hypertension through the portrait of disease. Mag carb was selected based on the totality of symptoms in view of the evolution of person, dispositions and adaptive patterns along with available physical characteristics through the psychodynamic study.

Distribution of Polymorphic Markers of Genes Encoding the Renin-angiotensin System (ACE, AGT, AGTR1), ITGB3, PPARG, Pparg in Patients With Essential Hypertension Depending on the Age

Essential hypertension (EH) is a multifactorial disease with a hereditary predisposition. Genes encoding the renin-angiotensin system (RAS) play a leading role in the stabilization of elevated BP in the course of EH, which determines the relevance of our clinical and genetic study. The study was based on the determination of the frequencies of polymorphic markers of the AGT, AGTR1, ACE, ITGB3, PPARG genes in 2 groups, depending on the age of patients (up to 60 years - group1, n=18, and after 60 years - group2, n=31), for the intergroup frequencies comparison and comparison of group frequencies with population data. Genotyping by gene polymorphisms was performed by real-time polymerase chain reaction. 24-hour ambulatory BP monitoring (ABPM) and Holter HR monitoring were conducted. Phenotypic features of the course of EH were accompanied by changes in the frequency characteristics of the studied genotypes. In patients of group 1, an increase in the frequency of protective genotypes of the ACE(II) and ITGB3(TT) genes was observed (p=0.004;0.015), which confirms the hypothesis of a possible favorable course of EH in patients under 60 years.

Relationship between serum 25-hydroxyvitamin D and target organ damage in children with essential hypertension

Researchers have shown that 25-hydroxyvitamin D (25[OH] D), a kind of active vitamin D in the human body, plays a role in cardiovascular disease (CVD). Low serum 25(OH) D levels have been found to be associated with elevated blood pressure (BP) in adults. However, measurement of 25(OH) D in hypertensive children has not been documented. The aim of this study was to investigate the relationship between 25(OH) D and target organ damage (TOD) in children with essential hypertension. We recruited a total of 346 children with essential hypertension and analyzed the correlation between serum 25(OH) D and TOD. Serum 25(OH) D concentration was significantly lower in the TOD than in the no-TOD group (t = 2.416, P = 0.016), as well as significantly lower in the two-organ damage than in the single-organ damage group (t = 3.140, P = 0.002). Pearson’s correlation coefficient (PCC) indicated that serum 25(OH) D levels were negatively correlated with left ventricular mass index (LVMI; r = −0.110, P = 0.041) and albuminuria (r = −0.120, P = 0.026). Linear- regression analysis showed that 25(OH) D was a risk factor for left ventricular hypertrophy (LVH; β ± s.e. =−0.074 ± 0.036; 95% confidence interval [CI], − 0.145 to –0.003; P < 0.001) and renal damage (β ± s.e.= −0.018 ± 0.008; 95% CI, − 0.035 to –0.002; P = 0.004). In total, our data revealed that serum 25(OH) D was independently associated with hypertensive cardiac and renal damage, meaning that it was a risk factor for LVH and albuminuria in childhood hypertension.

A Prospective Study of Azilsartan Medoxomil in the Treatment of Patients with Essential Hypertension and Type 2 Diabetes in Asia

This phase 4 study evaluated the efficacy and safety of azilsartan medoxomil (AZL-M) in patients with essential hypertension and type 2 diabetes mellitus (T2DM) in Hong Kong, Taiwan, and Thailand. This was a prospective, multicenter, single-arm, open-label study with patients aged 18–75 years with T2DM and essential hypertension and on stable treatment for T2DM. Patients with uncontrolled hypertension were treated with AZL-M 40 mg daily, with the option to uptitrate to 80 mg at 6 weeks. In all, 380 of the 478 patients screened in Hong Kong, Taiwan, and Thailand were enrolled. At week 6, 97 patients (25.5%) were titrated up to AZL-M 80 mg based on BP readings. At 12 weeks, 54.8% of patients reached the blood pressure (BP) goal of <140/85 mm Hg by trough sitting clinic BP (primary endpoint), and 62.8% and 27.0% achieved a BP of <140/90 mm Hg and <130/80 mm Hg, respectively. The efficacy of AZL-M over 12 weeks was also seen in different age and body mass index groups. The incidence of treatment emergent adverse events (TEAEs) was 12.9% before 6 weeks and 16.1% after 6 weeks, and they were mostly mild in severity. The most frequent TEAE was dizziness (4.7%). The incidence of TEAEs leading to study drug discontinuation (4.5%) and drug-related TEAEs (5.0% before 6 weeks; 3.9% after 6 weeks) was low. In patients with essential hypertension and T2DM in Asia, treatment with AZL-M indicated a favorable efficacy and safety profile in achieving target BP.

Association of lncRNA PVT1 Gene Polymorphisms with the Risk of Essential Hypertension in Chinese Population

Vascular dysfunction and hyperlipidemia are essential risk factors contributing to essential hypertension (EH). The plasmacytoma variant translocation 1 (PVT1) is involved in modulating angiogenesis in tumor tissues and plays an important role in fat differentiation in the progress of obesity. Therefore, we selected two tagSNPs of PVT1 (rs10956390 and rs80177647) to investigate whether they are contributing to the risk of hypertension in Chinese patients. In total, 524 adult patients with EH and 439 matched healthy controls were enrolled for two central of China. Results. PVT1 rs10956390 and rs80177647 polymorphisms were genotyped by using TaqMan assay. PVT1 rs10956390 TT genotype was associated with a decreased risk of EH ( OR = 0.561 , 95% CI = 0.372 -0.846, P = 0.006 ), while rs80177647 TA genotype was associated with an increased risk ( OR = 2.236 , 95% CI = 1.515 -3.301, P < 0.001 ). Rs10956390 T allele was associated with lower triglyceride levels in the plasma both from healthy and EH donors. What is more, there is an association between rs10956390 polymorphism and HDL-C level, as well as LDL-C. Conclusion. PVT1 rs10956390 and rs80177647 polymorphisms may contribute to the risk of EH in Chinese population by regulating blood lipid levels.

Effects and Safety of Allisartan Isoproxil Combined With Amlodipine or Indapamide in Patients With Hypertension Who Failed Allisartan Monotherapy

Background To primarily evaluate the effects and safety of a selective angiotensin II type 1 (AT1) receptor blocker (ARB) allisartan isoproxil combined with amlodipine or indapamide in the treatment of patients with essential hypertension who failed allisartan monotherapy. Methods Patients aged 18–75 years with mild-to-moderate essential hypertension [office systolic blood pressure (SBP) 140 to &lt;180 and/or office diastolic blood pressure (DBP) 90 to &lt;110 mm Hg] in 44 study centers between 2016 and 2018 were recruited. Allisartan isoproxil tablet 240 mg was administered per day for 4 weeks, and continued for 8 weeks if office blood pressure (BP) achieved the target of SBP/DBP &lt;140/90 mm Hg. The nonachievers were 1:1 randomly divided into allisartan isoproxil 240 mg + indapamide sustained-release tablet 1.5 mg, or allisartan isoproxil 240 mg + amlodipine besylate 5 mg groups for further 8 weeks of combined therapy. The BP target achieving rate, reduction of sitting BP from baseline, safety and compliance were evaluated as the primary efficacy endpoint. Results A total of 2,212 patients were enrolled, among them 2,126 patients were included in the efficacy analysis, with an average age of 55.1 ± 10.2 years. A total of 1,463 cases (68.8%) were effective after 4 weeks allisartan treatment, and the mean SBP and DBP were significantly decreased by 14.7 ± 12.2 and 8.0 ± 8.4 mm Hg compared with the baseline levels (all P &lt; 0.001). In nonachievers, allisartan combined with indapamide for 8 weeks significantly lowered the sitting BP (SBP/DBP) by 14.0 ± 12.2/8.3 ± 9.2 mm Hg, respectively, compared with 4 weeks monotherapy with allisartan with a BP targeting rate of 57.7% (169/293). In the allisartan + amlodipine group, the SBP/DBP were significantly decreased by (14.4 ± 12.1/8.2 ± 8.2) mm Hg, respectively, with a BP targeting rate of 62.8% (181/288). There was no statistical significance in BP reduction, targeting rate, or adverse reactions between the 2 combined therapies. Conclusions Allisartan isoproxil combined with indapamide or amlodipine can further improve the BP targeting rate when allisartan monotherapy failed in essential hypertension. The 2 combined therapies have similar efficacy and safety.

Quality of Life and Respiratory Disorders in Patients with Chronic Obstructive Pulmonary Diseases and Essential Hypertension: Look through the Prism of Apoptosis and Thiol-Disulfide Balance

The purpose of the study was an assessment of the quality of life and respiratory disappearances in patients with chronic obstructive pulmonary disease and essential hypertension in the context of the study of apoptosis markers and a thiol-disulfide balance. Materials and methods. The results of the study are based on the data of a comprehensive examination and dynamic observation of 121 patients of both sexes aged 30 to 67 years, who were examined in the period 2016-2018 and received inpatient treatment at the municipal non-profit enterprise "Zaporizhzhya Regional Clinical Hospital" of Zaporizhzhya regional council. The patients were divided into 3 groups, comparable in age and sex: the main group included 40 patients with chronic obstructive pulmonary disease stage II-III (moderate) in combination with essential hypertension stage II of different cardiovascular risk (mean age 50.81±0.99 years); the 1st comparison group included 48 patients with chronic obstructive pulmonary disease stage II-III (mean age 50.7±1.53 years); the second comparison group consisted of 33 patients with essential hypertension stage II with different cardiovascular risk (mean age 51.68±1.22 years). To determine the reference values of the studied indicators, 20 healthy individuals were examined as a control group. Results and discussion. In patients with chronic obstructive pulmonary disease, in combination with essential hypertension, a reliable element of the pro-apoptotic marker of Caspase-7 was established compared with the group of patients with an isolated essential hypertension and a group of patients with chronic obstructive pulmonary disease (by 3.73 and 2.16 times, respectively; p <0.05). The highest level of Caspase-9 was noted in the group of patients with the comorbidity of the chronic obstructive pulmonary disease and essential hypertension, and exceeded the same indicator in patients with essential hypertension by 60% and chronic obstructive pulmonary disease by 85.83% (p <0.05). The comorbidity of the flow of chronic obstructive pulmonary disease and essential hypertension is accompanied by a violation of thiol-disulfide balance and the antioxidant properties of the body. This is confirmed by the lower activity of antioxidant glutathion-dependent enzymes (glutathione transferase, glutathione reductase and glutathione peroxidase) compared with patients with monopathology (2.57±0.32, 0.87±0.13 and 4.25±0.63 μmol/(min*g protein), respectively; p <0.05), with a decrease in the ratio of reduced/oxidized glutathione forms (3.81±0.34 conventional units; p <0.05). At the same time, in patients with chronic obstructive pulmonary disease and essential hypertension, a decrease in the potential of a thiol-disulfide system was noted by 2 times when compared with essential hypertension patients and 1.7 times – when compared with the chronic obstructive pulmonary disease group (p <0.05). Conclusion. According to the results of single-factor dispersion analysis, the key characteristic of the quality of life (on the St. George’s Respiratory Questionnaire scale) the following factors are most significantly influenced: the index of patch-years (F = 21.80; p <0.01), the duration of the chronic obstructive pulmonary disease (f = 19.35; p <0.01), forced expiratory volume 1 (F = 21.80; p <0.01), elderly age (F = 9.49; p <0.01), as well as activation of apoptotic mechanisms (F = 11.90; p <0.01), the intensification of free-radical reactions (F = 8.60; p <0.01), a violation of a thiol-disulfide balance (F = 10.69; p <0.01), the expression level of the ST2 protein (F = 14.42; p <0.01)

Vascular Effects of Low-Dose ACE2 Inhibitor MLN-4760—Benefit or Detriment in Essential Hypertension?

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infects host cells through angiotensin-converting enzyme 2 (ACE2). Concurrently, the product of ACE2 action, angiotensin 1–7 (Ang 1–7), binds to Mas receptors within the cardiovascular system and provides protective effects. Therefore, it is crucial to reveal the role of ACE2 inhibition, especially within pre-existing cardiovascular pathologies. In our study, we imitated the action of SARS-CoV-2 in organisms using the low dose of the ACE2 inhibitor MLN-4760 with the aim of investigating to what degree ACE2 inhibition is detrimental to the cardiovascular system of spontaneously hypertensive rats (SHRs), which represent a model of human essential hypertension. Our study revealed the complex action of MLN-4760 in SHRs. On the one hand, we found that MLN-4760 had 1) (pro)obesogenic effects that negatively correlated with alternative renin-angiotensin system activity and Ang 1–7 in plasma, 2) negative effects on ACE1 inhibitor (captopril) action, 3) detrimental effects on the small arteries function and 4) anti-angiogenic effect in the model of chick chorioallantoic membrane. On the other hand, MLN-4760 induced compensatory mechanisms involving strengthened Mas receptor-, nitric oxide- and hydrogen sulfide-mediated signal transduction in the aorta, which was associated with unchanged blood pressure, suggesting beneficial action of MLN-4760 when administered at a low dose.