Journal of Hypertension: Open Access

Purpose: This study aimed to evaluate the effect of bioelectrical obesity indices (percentage body fat, PBF; visceral fat index, VFI) on cardiovascular disease (CVD) and evaluate the optimal cut-off values for myocardial infarction (MI) and stroke.

Method: A community-based cross-sectional study including 6027 males and 8874 females aged ≥ 35 years was conducted in 66 sample sites by multistage random sampling method from Henan Province, China.

Result: The area under receiver operating characteristic curves (AUCs) of PBF was highest in males for MI (0.651) and stroke (0.623) and in females for MI (0.618) and stroke (0.611). VFI and PBF had better discriminatory power in males of 35~54 age groups for MI (AUC=0.667) and stroke (AUC=0.702), respectively. Optimal cut-off values for VFI and PBF in males/females were approximately 15 /10 and 25% /36%, respectively. Combined two high levels of waist-to-height ratio (WHtR), VFI and PBF could increase higher adjusted OR for MI (1.41-2.81) and stroke (1.49-2.08).

Conclusion: High level of PBF and VFI could increase the risk of CVD. PBF may be a more sensitive indicator of CVD. The combination of WHtR, PBF and VFI was found to be associated with greater OR of CVD than them alone.

Objective: This study aimed to examine the expression of M-CSF, TNF-β, IFN-γ, and IL-10 in rats with liver cirrhosis and hypersplenism, and to investigate its significance.

Methods: Seventy-two healthy male SD rats were randomly divided into a model group (n=60) and a control group (n=12). The rats in the model group were first gavaged with a 40% CCL4/peanut oil solution to develop cirrhosis and hypersplenism. The expression rates and intensities of the pro-inflammatory cytokines M-CSF, TNF-β, and IFN-γ, and the anti-inflammatory cytokine IL-10 in the spleen were measured and compared with the control group. The pro-inflammatory/anti-inflammatory cytokine ratio and its role were analyzed.

Results: The positive expression rates of M-CSF, TNF-β, IFN-γ, and IL-10 in the model group (cirrhosis and hypersplenism) were 61.76%, 79.41%, 64.70%, and 88.24%, respectively, which were significantly different (P<0.05) from the 25%, 33.33%, 16.67%, and 50% in the control group. The relative protein expression intensities of M-CSF, TNF-β, IFN-γ, and IL-10 in the model group were 0.63 ± 0.58, 1.06 ± 0.49, 0.99 ± 0.38, and 1.12 ± 0.42, respectively, and were significantly different (P<0.05) from the 0.18 ± 0.12, 0.52 ± 0.27, 0.38 ± 0.28, and 0.60 ± 0.32 in the control group. The relative mRNA expression levels of M-CSF, TNF-β, IFN-γ, and IL-10 in the model group were 2.06 ± 0.11, 4.07 ± 0.19, 2.98 ± 0.11, and 7.94 ± 0.27, respectively, and were significantly different (P<0.05) from the 1.01 ± 0.05, 1.06 ± 0.11, 1.00 ± 0.31, and 1.02 ± 0.08 in the control group.

Conclusion: The abnormally increased expression of M-CSF, TNF-β, IFN-γ, and IL-10 in rats with liver cirrhosis and hypersplenism, as well as the abnormal pro-inflammatory/anti-inflammatory cytokine ratio and regulation may play an important role in enhancing the phagocytosis of macrophages and causing peripheral cytopenias.

Objectives: Previous research discovered single nucleotide polymorphism (rs2383206 and rs2383207) on chromosome 9p21 that is associated with coronary heart disease in a Chinese population. However, few data are available on the association of other single nucleotide polymorphism with cardiovascular disease in a Chinese population. This study aimed to determine whether the single nucleotide polymorphisms on chromosome 1p13, 1p32, 9p21 and 19p13 were associated with coronary artery disease in a Chinese population.

Methods: We conducted a case-control study. Cases were coronary artery disease (n=670) between 2010 and 2015. Controls (n=1340) were randomly selected and frequency matched to cases on age and gender. All of the participants were selected to study 18 single nucleotides using allele-specific real-time polymerase chain reaction method.

Results: Four single nucleotides in 9p21, two single nucleotides in 1p13 and one single nucleotide in 1p32 were associated with cardiovascular disease risk in Chinese population (Global P value for multiple logistic regression, <0.0001, respectively). rs10757274 showing the strongest association with cardiovascular disease. GG carriers of four SNPs (rs10757274, rs2383206, rs10757278 and rs1333049) in 9p21 had higher risk (Odds ratio=1.40, 95% Confidence interval: 1.10-1.79; Odds ratio=1.33, 95% Confidence interval: 1.04-1.69; Odds ratio=1.35, 95% Confidence interval: 1.07-1.72; Odds ratio=1.34, 95% Confidence interval: 1.06-1.71).

Conclusion: rs10757274, rs2383206, rs10757278 in 9p21, rs562556 in 1p32, and rs646776 in 1p13 may serve as a novel genetic marker for the risk of significant cardiovascular disease in Chinese Han population.

Introduction: Hypertension (HT) is a prevalent contributor to cardiovascular diseases. To evaluate the incidence of HT and its relationship with other cardio metabolic risk factors changes and lifestyle components, Healthy Heart Project follow up data for 8 years were analyzed.

Methods: A total of 283 unique normotensive participants of Yazd Healthy Heart Project (1169 observations) attended blood pressure longitudinal study. Multi-level model and Generalized estimation equation (GEE) model with an unstructured correlation matrix were used to analyze the longitudinal data by Stata/MP 11.2.

Results: The incidence rates of HT and prehypertension were 39.5 and 77.93 in each 1000 person-year followup, respectively. In addition, systolic blood pressure was significantly predicted by diastolic blood pressure (B=1.09, 95% CI=0.99-1.19, P<0.0001), uric acid (B=1.04, P=0.003), and waist circumference (B=0.131, P=0.033). Moreover, GEE model with logit link function showed that hypertension was significantly predicted by triglyceride (OR=1.003, P=0.044), cholesterol (OR=0.97, P=0.004), LDL-cholesterol (OR=1.02, P=0.003), uric acid (OR=1.19, P=0.023), body mass index (OR=1.09, P=0.028), and also significantly predicted by obesity (B=1.85, P=0.007), abdominal obesity (B=1.85, P=0.007), age (B=1.47, P=0.017), and diabetes mellitus (B=2.14, P=0.003).

Conclusion: The study results showed that the incidence rate of HT was high in Yazd and the major predictors of systolic blood pressure were abdominal obesity and diastolic blood pressure. Besides, diastolic blood pressure was significantly determined by systolic blood pressure and general obesity. Moreover, both systolic and diastolic blood pressures were independently predicted by serum uric acid level.

Background: Normal blood pressure (BP) follows a circadian rhythm, with dipping of BP at night. However, little has been done to show how the dipping groups vary amongst the White and Asian population at different periods of the year. This study aims to examine the pattern of nocturnal dipping between the White and Asian population, as well as to compare it to the different timings of the year, between summer and winter.

Methods: Ambulatory Blood Pressure Monitor recordings were obtained from 220 patients, half were White patients obtained from Mercy University Hospital, Cork, Ireland and half were Asian patients from National Heart Centre, Singapore during the summer period from May to June and the winter period from October to December.

Results: Both the Irish and Singaporeans exhibit a decrease in total number of reverse dipper from summer to winter. However, the redistribution of reverse dipper was mainly to the dippers in Singapore, while in Ireland it was to both the extreme dipper and dipper. Irish seasonal changes also resulted in an increase in nocturnal diastolic pressure (95% CI, 0.72 to 6.03, 3.37 mm Hg; p<0.05) and a change in the duration of dipping at night (95% CI, 0.045 to 1.01, 0.53 Hours; p<0.05).

Conclusion: Regardless of race or temperature, reverse dippers seem to decrease in winter. However, the racial differences dictate the redistribution of the fall in number of dippers. This has implications on how reverse dippers should be treated at different periods of the year.

Background: The rate of resistant hypertension (RH) in Trinidad is unknown. Several studies have shown that 12% to 30% of patients with hypertension in western countries may have RH. This is the first study to describe RH in Trinidad. RH increases the risk of type 2 diabetes, chronic kidney disease, coronary heart disease, heart failure and stroke.

Objective: The aim of the study is to measure the proportion of patients with hypertension who meet the criteria for RH among patients attending primary health care facilities in Trinidad and describe its epidemiological features.

Design and methods: We used a cross-sectional study design. Participants were selected using a clustered sampling technique from primary care clinics throughout the island. Data were collected by the administration of a pretested structured questionnaire. Apart from demographics, data was collected on the duration of hypertension and predisposing risk factors, and the presence of chronic kidney disease (CKD) and the metabolic syndrome.

Results: Initially 428 patients with hypertension were recruited, however only 391 entered the study of which 64 (16.4%, 95% CI 13- 20.3) met the criteria for RH. RH was found to be more common in patients 61-70 years, females and patients of African descent. Half of the patients classified as resistant hypertensive were obese, both CKD abd the metabolic syndrome were higher in patients with RH compared to non-resistant hypertension.

Conclusion: We provide evidence for the first time that the occurrence of RH in patients attending primary health care facilities in Trinidad was 16%. RH in Trinidad patients is associated with overweight/obesity, type 2 diabetes, chronic kidney disease and the metabolic syndrome. (266 words)

The prevalence of hypertension is increasing worldwide, with an estimated 972 million adults with hypertension in 2000 that is predicted to grow to 1.56 billion by 2025, while diabetes worldwide prevalence is estimated as 382 million in 2012 projected to reach 592 billion in 2030. Diabetes mellitus and hypertension are interrelated diseases that strongly expose patients to increased risk of atherosclerotic cardiovascular and kidney disease. The prevalence of coexisting hypertension and diabetes appears to be increasing in industrialized nations because populations are aging and both hypertension and T2DM (type2 diabetes mellitus) incidence increases with age. A number of possible reasons have been adduced for this coexistence and it is postulated that both diseases share common pathogenetic factors such as insulin resistance, aging, obesity, chronic subclinical inflammatory processes beside the use of thiazide diuretics in subjects initially with hypertension and the development of nephropathy in those initially with diabetes, especially type 1. Diabetes may also be associated with systolic hypertension secondary to atherosclerosis. In addition both conditions show familiar clustering, which makes it likely to be polygenic in origin. In Diabetics, increased plasma viscosity, stiffness of large arteries, increased production of oxidative radicals and excessive AGEs formation (Advanced Glycation End products) are relevant factors for the development of hypertension. Data from clinical trials emphasize the need for vigilant blood pressure control in patients with diabetes and hypertension. A target blood pressure goal < 140/90 mmHg is recommended by some guidelines while others still recommend more tight control of <130/80. Evidence shows that, to achieve the set goal, use of multipledrug antihypertensive therapy is required. Agents should be used that have been shown to reduce cardiovascular risk, while not worsening concomitant conditions. It is appropriate that an agent that can block RAAS, such as an ACE inhibitor or an ARB should be the first choice in monotherapy and should be one of the partner drugs used in combination in hypertensive patients with diabetes or glucose intolerance.

ACE inhibitors and sartans are two broadly used groups of drugs in the treatment of essential arterial hypertension. Even though they possess similar efficacy, there has been a continuous discussion concerning their preferences. Hence, the authors consider the pros and cons regarding the efficacy of these two groups in the context of relevant published data.

Background: The incidence of diabetes mellitus is rapidly increasing worldwide and over 366 million people have diabetes and according to the Kenyan Ministry of Health over 2 million Kenyans are affected by diabetes. In Kenya about 60% and 50% of patients with renal and cardiac complications respectively are as a result of diabetes, and about three quarter of these patients attend the diabetes clinic. It is therefore critical to examine the care provided especially the healthcare practitioner’s adherence to diabetes care guidelines. Such guidelines offer a practical way of ensuring standardized care for diabetics and reduce morbidity.

Methods: A retrospective study based on a record review of 377 outpatient files to assess diabetes care practices at Kenyatta National Hospital. The sample consisted of diabetics who have utilised the diabetes clinic for a period of two years. A structured questionnaire and checklist were used to collect data. Randomly selected patient files were reviewed to collect information on the diabetes care practices recommended by the national guidelines. Data was analyzed using SPSS to establish the health care professionals’ adherence to National Diabetes Care Guidelines.

Results: Despite almost all patients having an initial evaluation done and management goals were stated in 99.5% in the files, 24.7% and 10.8% of patients were referred for medical nutrition therapy and diabetes self-management education respectively showing that preventive measure were poorly executed. Yearly risk assessment surveillance was poor with only 30.2% and 47.2% patients referred for micro albuminuria, and lipid assessment respectively.

Conclusion: Adherence to diabetes guidelines by healthcare professionals at the hospital was poor and this worsen during patients’ subsequent visits. There was also poor adherence to annual risk assessment. Together, these deficiencies represent a lost opportunity for early detection of preventable complications that are major contributors to care costs and poor quality of life.

Objective: Recent studies have implicated an enhanced secretion of IL1β through activation of the Nod-like receptor family, pyrin domain containing 3 (Nlrp3)-inflammasome as the pro-inflammatory signal in animal models of the gout, chronic kidney disease (CKD), atherosclerosis, metabolic syndrome, type 2 diabetes mellitus, but its contribution to hypertension is not established. We aimed to demonstrate the role of the Nlrp3-inflammasome in the two-kidneys, one clip (2K1C) Goldblatt model of hypertension in Nlrp3-/- and apoptosis-associated speck-like protein containing a caspase recruitment domain (Asc)-/- and wild type control male mice.

Study design: 2K1C hypertension was generated by narrowing left renal artery using U-shaped stainless steel clip. BP and heart rate were recorded intra-arterially with a computerized data-acquisition system in conscious mice. Plasma renin activity and concentration were measured by radioimmunoassay. Renal transcript levels of Nlrp3, Asc, Casp1, IL1A, IL1β, and IL6 were assessed by RT-Q-PCR.

Results: Results show that Nlrp3-/- and Asc-/- mice are protected from developing hypertension and have lower circulating levels of plasma renin and serum amyloid A (SAA) and IL6, in comparison to wild type (WT) control mice. RNA levels of SAA, Nlrp3, and IL1β are increased in the ischemic kidney of the WT control mice. Administration of anti-IL1β antibody to the WT control mice attenuated the increase of blood pressure and renin in the 2K1C model. The results suggest that NALP3 inflammasome has an impact on blood pressure and renin secretion during renal hypoperfusion induced by renal arterial clip and contributes to renin-dependent renovascular hypertension.

Conclusion: These findings show that Nlrp3-inflammasome mediated production of IL1 is linked to the development of renovascular hypertension and might be a novel target for the treatment of renovascular hypertension, CKD and other inflammatory diseases with hypertension.

Introduction: Hypertension is a major cardiovascular disease and is responsible for fatal cardiovascular outcomes such as stroke, myocardial infarction, heart failure and renal failure. In Nigeria, the prevalence of hypertension and its associated complications is increasing at an alarming rate. Whereas excess weight is associated with increased rate of death from cardiovascular diseases, data on association between excess weight and hypertension in Nigerian population are sparse. In the present study we investigated the association between excess body weight and hypertension in a Nigerian semi-urban settlement.

Methods: A cross-sectional survey was carried out at the Kumapayi settlement located in the suburb of Ibadan in southwestern Nigeria. A total of 293 subjects, comprising 40% males, aged 18 years and above who consented to the study following a period of publicity and invitations to all residents of the settlement were enrolled into the study. Demographic, anthropometry and blood pressure measurements were carried out on all the subjects by trained health personnel.

Results: Mean subject age was 47.3 ± 15.2 years with 28.9% overweight (BMI 25-29 kg/m2) and 21.6% obese (BMI ≥ 30 kg/m2). The prevalence of overweight and obesity increased with age peaking at age 40-64 years and then falling. The prevalence of hypertension (BP ≥ 140/90 mmHg) was 43.3%. There was significant association between increased BMI and both systolic (P<0.001) and diastolic (P<0.002) pressure.

Conclusion: This study confirmed the association between overweight/ obesity and hypertension. Lifestyles changes targeted at weight reduction may help to stem the increasing trend of cardiovascular diseases in the community.

Introduction: Hypertension is the most common disease in industrialized countries, and it is responsible for the major risk factor for developing cardiovascular diseases. Aging increases the prevalence of hypertension and the loss of muscle mass. The aim of the present study was to evaluate the effect of resistance training on blood pressure and inflammatory markers in hypertensive elderly.

Methods: One hundred thirty-five hypertensive elderly were distributed into two groups: training (TG, n=86), and control (CG, n=49). TG underwent 16 weeks of resistance training with three sets of 12 repetitions in eight exercises (50% of one maximal repetition) and the CG remained sedentary. Twenty-four-hour ambulatory blood pressure was recorded.

Results: Resistance training increased muscle strength (21.10 ± 0.71 vs. 25.76 ± 0.80 kg [p<0.01] chest press; 9.93 ± 0.29 vs. 14.41 ± 0.45 kg [p<0.01] knee extension), as well as reduced systolic blood pressure (126.79 ± 1.29 vs. 124.32 ± 1.37 mmHg [p<0.05] daytime; 125.11 ± 1.28 vs. 122.50 ± 1.38 mmHg [p<0.05] 24-h period) in TG. In addition, resistance training increased the circulating levels of adiponectin (4.61 ± 0.24 vs. 5.32 ± 0.25 pg/mL [p<0.01]) and reduced the circulating levels of ICAM-1 (334.38 ± 10.89 vs. 293.05 ± 9.78 pg/mL [p<0.01]).

Conclusion: Our results suggest that resistance training is an important tool to reduce blood pressure and improve muscle strength in hypertensive elderly. Besides that, resistance training increase circulating levels of adiponectin, and reduce the levels of plasma ICAM-1 in hypertensive elderly.

Kidney disease could result from hypertension and ischemia/hypoxia. Key mediators of cellular adaptation to hypoxia are oxygen-sensitive hypoxia inducible factor (HIF)s which are regulated by prolyl-4-hydroxylase domain (PHD)-containing dioxygenases. However, HIF activation can be protective as in ischemic death or promote renal fibrosis in chronic conditions. This study tested the hypothesis that increased HIF-1α consequent to reduced PHD expression contributes to the attendant hypertension and target organ damage in deoxycorticosterone acetate (DOCA)/ salt hypertension and that PHD inhibition ameliorates this effect. In rats made hypertensive by DOCA/salt treatment (DOCA 50 mg/kg s/c; 1% NaCl orally), PHD inhibition with dimethyl oxallyl glycine (DMOG) markedly attenuated hypertension (P<0.05), proteinuria (P<0.05) and attendant tubular interstitial changes and glomerular damage (P<0.05). Accompanying these changes, DMOG blunted the increased expression of kidney injury molecule (KIM)-1 (P<0.05), a marker of tubular injury and reversed the decreased expression of nephrin (P<0.05), a marker of glomerular injury. DMOG also decreased collagen I staining (P<0.05), increased serum nitrite (P<0.05) and decreased serum 8-isopostane (P<0.05). However, the increased HIF-1α expression (P<0.01) and decreased PHD2 expression (P<0.05) in DOCA/salt hypertensive rats was not affected by DMOG. These data suggest that reduced PHD2 expression with consequent increase in HIF-1α expression probably results from hypoxia induced by DOCA/salt treatment with the continued hypoxia and reduced PHD2 expression evoking hypertensive renal injury and collagen deposition at later stages. Moreover, a PHD inhibitor exerted a protective effect in DOCA/salt hypertension by mechanisms involving increased nitric oxide production and reduced production of reactive oxygen species.

Background: Splenomegaly due to hepatitis B cirrhotic portal hypertension is common in clinical practice, and it is often complicated by monolineage or multilineage cytopenias. We attempted to answer the following questions based on our 20 years of observation and research: can peripheral cytopenias be graded and what are the effects of peripheral cytopenia grades on clinical outcomes?

Objectives: This study aimed to investigate the grading of peripheral cytopenia in patients with splenomegaly due to hepatitis B cirrhotic portal hypertension and its effect on clinical outcomes.

Methods: Data from 330 patients with splenomegaly due to hepatitis B cirrhotic portal hypertension were collected from January 1991 to December 2011. All data were analysed with SPSS 13.0. Univariate and multivariate analyses were performed. The various forms of cytopenia were scored and graded according to the F value of the multiple linear regression equation. Depending mainly on the severity, cytopenia was graded as mild, moderate, or severe, and was given a total score of 3 points, respectively. Their relationships with clinical outcomes on follow up (cured, improved, no change or dead) were then compared.

Results: All patients in this study were treated with splenectomy +/- devascularization or total porto-systemic shunting operation. Of 330 patients, 99 (30%) patients had monolineage cytopenia, 118 (35.8%) bilineage cytopenia, and 113 (34.2%) trilineage cytopenia. On univariate analysis, severity of erythropenia was related to a significant difference in surgical outcome on intra-group comparison (P<0.05). On multivariate analysis, thrombocytopenia was related to a significant difference in surgical outcome when compared with leukopenia and erythropenia (P<0.05). A significant difference in surgical outcome existed among the three grades (mild, moderate, and severe) of cytopenia (P<0.05).

Conclusion: Peripheral cytopenias had significant impact on clinical outcomes. The more severe the cytopenias, the worse the surgical outcomes. Thrombocytopenia was a major factor affecting surgical outcomes. The thrombocytopeniabased three-level grading of cytopenia provided a basis for analyzing individual patients, planning treatment, and assessing prognosis in clinical practice.