Pemberian Terapi Jus Wortel Pada Penderita Hipertensi Di Desa Bauh Gunung Sari Lampung Timur

ABSTRAK Hipertensi merupakan masalah kesehatan dengan prevalensi yang tinggi, yaitu sebesar 25,8%, pengobatan farmakologi, penurunan Hipertensi Pada pasien hipertensi dpat dilakukan dengan pengobatan non farmakologi. Salah satu alternatif pengobatan non farmakologi pada pasien hipertensi adalah pemberian pola makan DASH yang kaya akan kalium dan kalsium; diet rendah natrium. JNC VII menyarankan pola makan DASH yaitu diet yang kaya dengan buah, sayur, dan produk susu redah lemak dengan kadar total lemak dan lemak jenuh .Natrium yang direkomendasikan < 2.4 g (100 mEq)/hari. Tujuan Asuhan Keperawatan Komprehensif Pada klien Hipertensi Dengan Terapi Komplementer Jus Wortel di Desa Bauh Gunung Sari Lampung Timur Tahun 2020. Metode terapi dengan Wortel diblender 150 gram ditambah ±100cc air mineral + 1 sendok makan madu (sebagai pemanis ) diberikan kepada responden sebanyak ±200gram /hari selama 5 hari berturut-turut pada pukul 13.00-15.00wib. masalah hipertensi teratasi dengan terapi jus wortel dengan hasil efektif pada kedua pasien hanya saja kadar penurunan tekanan darah dan waktu penurunan berbeda diantara kedua pasien dikarenakan intensitas nyeri antara kedua pasien, dan kadar tekanan darah kedua pasien yang berbeda. Kata Kunci : Hipertensi, Komplikasi, Terapi Jus Wortel ABSTRACT Hypertension is a health problem with a high prevalence, which is 25.8%, pharmacological treatment, hypertension reduction in hypertensive patients can be done with non-pharmacological treatment. One alternative non-pharmacological treatment in hypertensive patients is the administration of a DASH diet that is rich in potassium and calcium; a low sodium diet. JNC VII recommends the DASH diet, which is a diet rich in fruits, vegetables, and low-fat dairy products with total fat and saturated fat content. The recommended sodium is <2.4 g (100 mEq) / day. Purpose of Comprehensive Nursing Care for Hypertension clients with Complementary Carrot Juice Therapy in Bauh Gunung Sari Village, East Lampung in 2020. The therapeutic method with Blender Carrot 150 grams plus ± 100cc mineral water + 1 tablespoon of honey (as a sweetener) is given to respondents as much as ± 200gram / days for 5 consecutive days from 1:00 to 15:00 a.m. the problem of hypertension is resolved with carrot juice therapy with effective results in both patients except that the level of blood pressure drops and the time of decrease is different between the two patients due to the intensity of pain between the two patients, and the blood pressure levels of the two patients are different. Keywords: Hypertension, Complications, Carrot Juice Therapy

Abstract MP11: Decreased Expression Of Ace2 Is Associated Urine Derived Human Renal Proximal Tubule Cells From Inverse Salt Sensitivity Participants Cultured In Low Salt Conditions

Increased morbidity and mortality occurs in some individuals consuming low sodium diets. Inverse salt sensitivity (ISS) is the paradoxical increase in blood pressure of individuals to a low sodium diet. Our group previously reported decreased expression of dopamine type 2 receptor (D 2 R), increased expression Aminopeptidase N, and increased Ang II dependent sodium transport in human urine derived renal proximal tubule cells isolated from ISS participants. In an attempt to understand the increased Ang II sensitivity demonstrated in ISS cells, we examined angiotensin converting enzyme 2 (ACE2), a membrane associated enzyme involved in the metabolism of Ang II. Urine derived renal proximal tubule cells grown and immortalized from ISS participants were compared to cells from salt resistant (SR) participants cultured in iso-osmotic media with low salt (LS, 90 mM NaCl) normal salt (NS, 140 mM NaCl) and high salt (HS, 190 mM NaCl). Cells were incubated in LS, NS, and HS media with and without losartan (LOS,1 μM) overnight (18 hours) and ACE2 expression levels determined by in-cell western blot. A monoclonal antibody specific to an extracellular epitope of ACE2 was used as the primary antibody and an Alexa-647 anti-mouse secondary antibody. ACE2 expression was only reduced in ISS cells in LS condition (28.7±2.1 % reduction, ISS LS vs SR LS, N=4 per group, p<0.05). Addition of losartan completely blocked the decrease in ACE2 expression in low salt conditions in ISS in urine derived human renal proximal tubule cells. No other changes in ACE2 expression were found between ISS and SR in either NS or HS conditions and with or without losartan. In conclusion, a decreased expression of ACE2 in ISS urine proximal tubule cells could explain the previously reported increased sensitivity of ISS cells to Ang II by increasing the half-life of Ang II under low salt conditions.

Abstract P163: Prevention Of Cardiac Fibrosis By Dietary Sodium Restriction During Metabolic Syndrome: Involvement Of Endothelial To Mesenchymal Transition

In a rat model of metabolic syndrome (MS), our previous studies have shown that dietary sodium restriction prevents both metabolic and cardiac damages associated with MS. Our aim is now to investigate whether the beneficial effects of sodium restriction could be mediated by endothelial to mesenchymal (EndoMT) transition in the myocardium thereby preventing cardiac fibrosis.High fructose (60%) Sprague Dawley rats were divided into 2 groups: low sodium (<0.01% NaCl, N=20) or normal sodium (0.65% NaCl, N=20) diet for 8 weeks. EndoMT was investigated by q-PCR, WB, and IF on the left ventricles. Transcriptomic analysis was performed using Agilent Rat Gene Expression Microarray. After 8 weeks, fructose-fed rats on normal sodium diet were insulin-resistant and hypertensive, both abnormalities being significantly prevented by sodium restriction. In left ventricles, two mesenchymal proteins, α-smooth muscle actin (αSMA) and vimentin were found significantly reduced using qPCR and WB by sodium restriction (P<0.05), as compared to normal sodium diet. At the opposite, we observed a significant increase in Pecam-1, a specific protein of vascular endothelial cells (P<0.05). Using IF, we detected a co-expression of αSMA and Pecam-1 in 67.3%±4.9 (54 of 88) of cardiac vessels of rats fed normal sodium diet, as compared to 42.3%±3.8 (37 of 88) in rats fed low sodium diet (P<0.05). The transcriptomic study showed that 22 genes, involved in fibrosis, were down-regulated in left ventricles of sodium-restricted rats (P<0.05). By q-PCR, we confirmed that 17 of them were significantly reduced by the low sodium diet (P<0.05). Finally, we established an in vitro model of EndoMT, using primary human aortic endothelial (HAoE) cells that were transdifferentiated with TGF-β2 (10ng/ml). We evidenced in HAoE cells the co-expression of Pecam-1 and collagen-1, as a signature of EndoMT. Especially, fibulin 5, one of the genes identified by transcriptomics was found upregulated (13 folds) in the presence of TGF-β2, confirming its potential role in EndoMT. Our study shows that EndoMT is involved in the prevention of cardiac fibrosis by sodium restriction in our rat model of MS. We also confirmed the involvement of ew genes that could be of interest to improve the management of cardiac fibrosis.

Abstract MP29: A Cloned Anti-aminopeptidase N Scfv Antibody Blocks Enzymatic Activity And Rescues A Low Sodium Phenotype In Proximal Tubule Cells Isolated From Inverse Salt Sensitive Participants

Inverse Salt Sensitivity (ISS), defined as the paradoxical increase in blood pressure of individuals on a low sodium diet compared to a high sodium diet, may be associated with the increase in mortality and morbidity found in individuals on a low sodium diet. Our group has previously found that urine derived human renal proximal tubule cells (RPTC) isolated from ISS participants express higher Aminopeptidase N (APN) protein than cells isolated from salt resistant (SR) participants. An anti-Aminopeptidase N (APN) hybridoma was used construct a single chain variable fragment (scFv) into a bacterial expression system. The purified anti-APN scFv bound to live human renal proximal tubule cells, detected using an Alexa594 directly labelled anti-myc monoclonal antibody by immunofluorescent confocal microscopy. The anti-APN scFv was then tested to determine if it blocks APN enzymatic activity. We have previously shown that under low sodium conditions the amount of reduced-glutathione as determined by live cell fluorescence staining with the redox sensitive dye, monochlorobimane (mBCl), is decreased only in ISS cells under low sodium conditions at the two-hour time point. We hypothesized that the decreased mBCl signal may be due to the increased APN expression and activity altering the Ang II/Ang III ratio and reducing the Ang III activation of the AT 2 R. Low sodium reduced the mBCl signal in ISS (-29.2±4.3%, ISS vs SR, N=3 per group, p<0.05) and the addition of the anti-APN scFv at 1 ug/ml completely blocked the mBCl signal back to levels found in SR in normal salt conditions. In order to verify that the full rescue of this ISS specific response is due to enhanced Ang III – AT 2 R signaling, we next tried to block the effect of the anti-APN scFv by the addition of the AT 2 R antagonist, PD123319 (PD, 1 uM). Addition of PD alone to the ISS LS RPTCs did not significantly alter the mBCl signal, but when PD and anti-APN scFv are added to the LS treated ISS cells, there is complete reversal of the effect of anti-APN scFv alone (-38.1±3.9%, ISS anti-APN scFv + PD vs ISS anti-APN scFv, N=3 per group, p<0.05). The anti-APN scFv has potential therapeutic value by reducing APN enzymatic activity in ISS individuals and inducing the protective AT 2 R arm of the renin angiotensin system in low sodium conditions.

Nox4 Maintains Blood Pressure during Low Sodium Diet

The NADPH oxidase Nox4 is a hydrogen peroxide (H2O2)-producing enzyme, with the highest expression in the kidney. As the kidney is involved in volume and blood pressure control through sodium handling, we set out to determine the impact of a low sodium diet on these parameters in WT and Nox4-/- mice. Nox4 expression in the murine kidney was restricted to the proximal tubule. Nevertheless, low-sodium-induced weight loss and sodium sparing function was similar in WT and Nox4-/- mice, disputing an important function of renal Nox4 in sodium handling. In contrast, a low sodium diet resulted in a reduction in systolic blood pressure in Nox4-/- as compared to WT mice. This was associated with a selectively lower pressure to heart-rate ratio, as well as heart to body weight ratio. In general, a low sodium diet leads to activation of sympathetic tone and the renin angiotensin system, which subsequently increases peripheral resistance. Our observations suggest that the control by this system is attenuated in Nox4-/- mice, resulting in lower blood pressure in response to low sodium.

Prevalence Des Maladies Stomatologiques En Milieu Cardiologique Dans Les Hopitaux Nationaux De Niamey

Objectif: Déterminer la prévalence des maladies stomatologiques en milieu cardiologique dans le service de stomatologie de l’Hôpital National de Niamey. Patients et Méthodes: Il s’agissait d’une étude prospective à-propos de 104 cas recensés en 5 mois (1er Novembre 2017 au 31 Mars 2018). Ont été inclus dans l’étude, les patients hospitalisés ou envoyés par le service de cardiologie ayant consenti à l’étude et présentant une (ou des) affection stomatologique. N’ont pas fait partie de l’étude tous les patients ne répondant pas aux critères sus cités. Les variables étudiées étaient le sexe, l’âge, la clinique, l’épidémiologie et la thérapeutique. Résultats: Soixante-dix patients avec une affection stomatologique soit 67,3% ont été adressés par le service de cardiologie et 34 patients avec une affection cardiologique soit 32,7% ont été vus au service service de stomatologie. 62 patients soit 59,6% étaient vus en consultation et 42 patients soit 40,4% étaient hospitalisés. Une prédominance féminine était notée dans 58,7% des cas. La tranche d’âge de 50 et 59 ans était la plus concernée avec un âge moyen de 30,8ans. La carie dentaire était retrouvée dans 59,6% des cas et la cardiopathie hypertensive dans 65,4 %. Le traitement était axé sur le brossage dentaire effectué dans 40,4% des cas, le régime hyposodé dans 90,4% des cas, les IEC dans 50% des cas, les diurétiques dans 35,6% des cas et l’antibiothérapie dans 34,6%. L’évolution sous traitement des deux affections était favorable à plus de 80%. Conclusion: L’étude a permis de dégager la prévalence des maladies stomatologiques et cardiovasculaires à l’Hôpital National de Niamey et l’Hôpital National de Lamordé et d’avoir une perspective thérapeutique adéquate permettant une bonne évolution de l’état de santé des patients. Aim: To determine the prevalence of stomatological diseases in a cardiological environment in the stomatology department of the National Hospital of Niamey. Patients and Methods: This was a prospective study of 104 cases identified in 5 months (November 1, 2017 to March 31, 2018). Included in the study were patients hospitalized or referred by the cardiology department, who consented to the study and presented one or more stomatologic disease. All patients who meet the above criteria were included in the study. The variables studied were sex, age, clinic, epidemiology, and therapy. Results: Seventy patients with a stomatological condition, i.e., 67.3%, were referred by the cardiology service. 34 patients with a cardiological condition or 32.7% of them were seen in the stomatology service. 62 patients or 59.6% were seen in consultation and 42 patients or 40.4% were hospitalized. A female predominance was noted in 58.7% of cases. The 50 and 59 age group was the most affected with an average age of 30.8 years. Dental caries was found in 59.6% of cases and hypertensive heart disease in 65.4%. The treatment focused on tooth brushing performed in 40.4% of cases, a low sodium diet in 90.4% of cases, ACE inhibitors in 50% of cases, diuretics in 35.6% of cases, and antibiotic therapy in 34.6% of cases. The outcome under treatment for both conditions was more than 80% favorable. Conclusion: The study made it possible to identify the prevalence of stomatological and cardiovascular diseases at the National Hospital of Niamey and the National Hospital of Lamordé. It also provided an adequate therapeutic perspective that allows a good evolution of the state of health of the patients.

A Low-Sodium Diet Boosts Ang (1–7) Production and NO-cGMP Bioavailability to Reduce Edema and Enhance Survival in Experimental Heart Failure

Sodium restriction is often recommended in heart failure (HF) to block symptomatic edema, despite limited evidence for benefit. However, a low-sodium diet (LSD) activates the classical renin-angiotensin-aldosterone system (RAAS), which may adversely affect HF progression and mortality in patients with dilated cardiomyopathy (DCM). We performed a randomized, blinded pre-clinical trial to compare the effects of a normal (human-equivalent) sodium diet and a LSD on HF progression in a normotensive model of DCM in mice that has translational relevance to human HF. The LSD reduced HF progression by suppressing the development of pleural effusions (p < 0.01), blocking pathological increases in systemic extracellular water (p < 0.001) and prolonging median survival (15%, p < 0.01). The LSD activated the classical RAAS by increasing plasma renin activity, angiotensin II and aldosterone levels. However, the LSD also significantly up-elevated the counter-regulatory RAAS by boosting plasma angiotensin converting enzyme 2 (ACE2) and angiotensin (1–7) levels, promoting nitric oxide bioavailability and stimulating 3′-5′-cyclic guanosine monophosphate (cGMP) production. Plasma HF biomarkers associated with poor outcomes, such as B-type natriuretic peptide and neprilysin were decreased by a LSD. Cardiac systolic function, blood pressure and renal function were not affected. Although a LSD activates the classical RAAS system, we conclude that the LSD delayed HF progression and mortality in experimental DCM, in part through protective stimulation of the counter-regulatory RAAS to increase plasma ACE2 and angiotensin (1–7) levels, nitric oxide bioavailability and cGMP production.