Low Concordance with the DASH Plan Is Associated with Higher Cardiovascular Risk in Treated Hypertensive Patients

This study aimed at analyzing the alimentary habits of treated hypertensive patients identifying the degree of concordance with Dietary Approaches to Stop Hypertension (DASH) plan. Anthropometry and blood pressure (BP) were evaluated, and the 10-year risk for general cardiovascular disease was estimated and used to calculate vascular age. A DASH concordance score was obtained using food frequency questionnaire and the cut-off points were established for eight food groups. Subjects were divided into two groups according to the median of DASH concordance score: lower concordance (LC group < 4.5 points, n=33) and higher concordance (HC group ≥ 4.5 points, n=47). LC group was associated with higher BP, vascular age, and cardiovascular risk. DASH concordance score was positively correlated with intake of fiber, calcium, potassium, and magnesium (P<0.001) and negatively correlated with BP, cardiovascular risk, and vascular age (P<0.05). After logistic regression adjusted for age and gender, only cardiovascular risk (β=-0.154, P=0.031) was independently associated with DASH concordance score. Hypertensive patients with dietary patterns less concordant with the DASH plan had higher BP levels and increased cardiovascular risk, indicating the relevance of management in the treatment of these patients.

The Influence of Arsenic, Lead, and Mercury on the Development of Cardiovascular Diseases

As a group, cardiovascular disease (CVD) is the leading cause of death worldwide. It killed twice as many people as infectious and parasitic disease and three times as many people as all forms of cancer. There are other crucial risk factors next to the major risk factors identified by the Framingham Heart Study. In the last few years, detailed studies showed the correlation between environmental pollution and the development of CVD. The question, which environmental toxin is particularly harmful, is answered by CERCLA Priority List of Hazardous Substances with the following toxins: arsenic, lead, and mercury. The effect of these potential toxic metals on the development of cardiovascular diseases includes pathomechanisms as the accumulation of free radicals, damage of endothelial nitric oxide synthase, lipid peroxidation, and endocrine influences. This leads to the damage of vascular endothelium, atherosclerosis, high blood pressure, and an increased mortality from cardiovascular diseases. The cardiovascular effects of arsenic, lead, and mercury exposure and its impact on cardiovascular mortality need to be included in the diagnosis and the treatment of CVD.

Serum Asymmetric Dimethylarginine Concentrations in Two Models of Experimentally Induced Hypertension

The aim of this study was to evaluate the effect of two models of hypertension on serum ADMA concentrations and whether the changes of serum ADMA concentrations are reversible by removing the cause of hypertension. Materials and Methods. 48 male wistar rats were randomly assigned into four groups: control, deoxycorticosterone acetate salt (DOCA-Salt), sham, and two kidneys one clip (2K1C). After 12 weeks, in half of the animals (n=6 each group), serums were taken and direct blood pressure was measured. Then, DOCA injection was withdrawn and the animals received tap water and, in 2K1C group, renal clips were removed. After 12 weeks, direct blood pressure was measured and blood samples were taken. Results. Serum ADMA concentration in DOCA-Salt group was slightly higher than control, although it was not statistically significant. In 2K1C hypertensive group, serum ADMA concentration was significantly elevated compared to sham group (P<0.05). Unclipping and reversal of hypertension returned serum ADMA level to sham group. There was a weak positive correlation between systolic blood pressure and serum ADMA concentration. Conclusion. increased serum ADMA concentration during hypertension is dependent on the model of hypertension, and removing the cause of hypertension could reduce it

Racial Disparity in the Associations of Microalbuminuria and Macroalbuminuria with Odds of Hypertension: Results from the NHANES Study in the United States

Background. Limited information is available on whether the associations of microalbuminuria and macroalbuminuria with the odds of hypertension differ among non-Hispanic Whites, non-Hispanic Blacks, and Hispanics. Methods. Cross-sectional data of 24,949 participants aged ≥18 years were collected from the National Health and Nutrition Examination Survey (NHANES) 1999–2008. Odds ratios of hypertension for microalbuminuria and macroalbuminuria were estimated by conducting weighted multiple logistic regression models. Results. After adjustment for extensive confounding factors, microalbuminuria is 1.45 (95% confidence interval (CI) [1.17, 1.80]), 2.07 (95% CI [1.52, 2.83]) and 2.81 (95% CI [2.06, 3.84]) times more likely to be associated with hypertension, and macroalbuminuria is 4.08 (95% CI [1.98, 8.38]), 8.62 (95% CI [3.84, 19.35]), and 4.43 (95% CI [2.13, 9.21]) times in non-Hispanic Whites, non-Hispanic Blacks, and Hispanics, respectively. The odds of hypertension for microalbuminuria (versus normalbuminuria) were 52% higher in non-Hispanic Blacks and 98% higher in Hispanics than in non-Hispanic Whites; the odds of hypertension for macroalbuminuria (versus normalbuminuria) did not differ among racial groups. Conclusion. Racial differences in the relation between microalbuminuria and hypertension are prevalent among non-Hispanic Whites, non-Hispanic Blacks, and Hispanics. More screening efforts should be encouraged in normotensive non-Hispanic Blacks and Hispanics with microalbuminuria.

The Effect of Metabolic Syndrome and Diabetes Mellitus Type 2 on the Arterial Reactivity of Hypertensive Patients during Cold Pressor Test

Background: Arterial hypertension (AH), metabolic syndrome (MS) and diabetes mellitus type 2 (DM2) are interrelated metabolic disorders. The aim of our study was to evaluate how the coexistence of MS or DM2 with AH influences arterial reactivity during cold pressor test (CPT). Methods: We studied 102 patients, 32 with AH (Group A), 38 with AH and MS (Group B) and 32 with AH and DM2 (Group C). All patients underwent full laboratory evaluation and measurement of systolic and diastolic blood pressure (SBP and DBP), heart rate (HR) and carotid-femoral pulse wave velocity (PWVc-f) before and during CPT. Results: During CPT PWVc-f, SBP, DBP and HR were increased significantly in all studied groups, but the change of PWVc-f and HR during CPT was significantly greater in group A compared to group C. On the contrary, the coexistence of MS or DM2 with AH does not alter the response of BP to CPT. Conclusion: The increase of CV risk resulting from the coexistence of MS or DM2 with AH, is best expressed by PWVc-f, while the change of the former and HR during CPT possibly reflects dysfunction of the autonomic nervous system.

Meta-Analysis of the Hemodynamic Properties of Antihypertensive Medications

Background. While all antihypertensive medications lower blood pressure, hemodynamic properties of various classes of antihypertensive medications may differ. Objective. To perform a meta-analysis to compare the hemodynamic properties of different classes of antihypertensive medications. Methods. Studies involving the treatment of hypertension using the effect of ACEIs, β-blockers, CCBs and thiazide diuretics on plasma volume (PV), cardiac output (CO) or stroke volume (SV) were searched using online databases prior to May 2011. Studies had to be written in the English language, studying human subjects with a single pharmacological agent (monotherapy), and with a minimum duration of 4 weeks. Results. Seventy-five (75) studies that enrolled a total of 1522 subjects were included. All four antihypertensive classes lowered blood pressure. β-blockers decreased heart rate; the other classes had no effect upon heart rate. ACEIs increased PV; the other classes had no effect upon PV. β-blockers and thiazide diuretics decreased CO while ACEIs and CCBs had no effect upon CO. β-blockers and CCBs increased SV, thiazide diuretics decreased SV, and ACEIs did not change SV. Conclusion. In the treatment of uncomplicated hypertension, the various classes of antihypertensive medications differ from each other in terms of their non-blood pressure lowering hemodynamic properties.

Perceptions of Community Resources and Insights for Program Development from Southern, Rural Hypertensive Women

Background. Hypertension affects millions of Americans each year and is a significant contributor to the development of cardiovascular disease. African Americans, especially those living in rural locations, experience greater disparities in the incidence and prevalence rates of hypertension and cardiovascular disease. Methods. This study utilizes qualitative descriptive methodology. Focus groups involving African American women reporting hypertension were conducted in a rural community in Alabama. Results. The mean age was 60.3 years of age (SD = 10.3). Most were married and half were college educated. The majority reported an overweight or obese status. Most were aware that they had hypertension for more than five years, all were nonsmokers, and the majority had a family history of heart disease, hypertension, and/or heart attack or stroke. Key themes emerging from the focus groups included strengths of the community, support for the community, support for a healthy lifestyle, and intervention development. Conclusion. Hypertension is a treatable and preventable disease that not only causes disability, but also significantly decreases the quality of life in affected individuals. Findings from this study provide insight into the unique needs and perceptions of African American women residing in rural Alabama as they relate to community resources.

Racial/Ethnic Variability in Hypertension Prevalence and Risk Factors in National Health Interview Survey

Objective. Hypertension is one of the leading causes of death attributed to cardiovascular diseases, and the prevalence varies across racial/ethnic groups, with African Americans being disproportionately affected. The underlying causes of these disparities are not fully understood despite volume of literature in this perspective. We aimed in this current study to examine ethnic/racial disparities in hypertension utilizing Hispanics as the base racial/ethnic group for comparison. Research Design and Methods. We utilized the National Health Interview Survey (NHIS), which is a large cross-sectional survey of the United States non-institutionalized residents to investigate the racial/ethnic disparities in hypertension after the adjustment of other socio-economic, demographic, and prognostic risk factors. The study participants were adults (n = 30,852). Data were analyzed using Chi square statistic, and logistic regression model. Results. There were statistically significant differences by race/ethnicity with respect to income, education, marital status, smoking, alcohol, physical activities, body mass index, and age, P < 0.01, but not insurance coverage, P > 0.01. Hispanic ethnicity (18.9%) compared to either non-Hispanic white (27.7%) or non-Hispanic black (35.5%) was associated with the lowest prevalence of hypertension. Race/ethnicity was a single independent predictor of hypertension, with non-Hispanic black more likely to be hypertensive compare with Hispanic, prevalence odds ratio (POR), 2.38, 99% Confidence Interval (CI), 2.17–2.61 and non-Hispanic white, POR, 1.64, 99% CI, 1.52–1.77. After controlling for the confounding variables, the racial/ethnic differences in hypertension persisted. Conclusions. Racial/ethnic disparities in hypertension persisted after controlling for potential predictors of hypertension in NHIS, implying the inability of known hypertension risk factors to account for racial/ethnic variability in hypertension in US.

Pulmonary Hypertension Is a Probable NO/ONOO− Cycle Disease: A Review

The NO/ONOO− cycle is a primarily local biochemical/physiological vicious cycle that appears to cause a series of chronic inflammatory diseases. This paper focuses on whether the cycle causes pulmonary arterial hypertension (PAH) when located in the pulmonary arteries. The cycle involves 12 elements, including superoxide, peroxynitrite (ONOO−), nitric oxide (NO), oxidative stress, NF-κB, inflammatory cytokines, iNOS, mitochondrial dysfunction, intracellular calcium, tetrahydrobiopterin depletion, NMDA activity, and TRP receptor activity. 10 of the 12 are elevated in PAH (NMDA?, NO?) and 11 have documented causal roles in PAH. Each stressor that initiates cases of PAH acts to raise cycle elements, and may, therefore, initiate the cycle in this way. PAH involves a primarily local mechanism as required by the cycle and the symptoms and signs of PAH are generated by elements of the cycle. Endothelin-1, which acts as a causal factor in PAH, acts as part of the cycle; its synthesis is stimulated by cycle elements, and it, in turn, increases each element of the cycle. This extraordinary fit to the principles of the NO/ONOO− cycle allows one to conclude that PAH is a NO/ONOO− cycle disease, and this fit supports the cycle as a major paradigm of chronic inflammatory disease.