We studied all cases of essentialhypertension admit- ted in a four-year period to the Saint Mary Emer- gency Clinical Hospital for Children. Blood pressure was measured using a standardized protocol. Before enrolment, written informed consent was obtained from the parents or guardians of the children. Of the 60 children enrolled after establishing a diagnosis of essentialhypertension, 36 patients had a normal BMI, 14 children were classified as overweight hyperten- sive and 10 patients as obese hypertensive, accord- ing to the age and sex-specific cut-off points of child overweight and obesity defined by the International Obesity Task Force (Cole et al., 2000). None of the patients had received any treatment for the control of hypertension. Regarding weight at birth, the chil- dren were divided into 3 groups: group 1 consisted of THE IMPACT OF BIRTH WEIGHT AND GESTATIONAL AGE ON THE MANAGEMENT OF JUVENILE ESSENTIALHYPERTENSION
Prior to our study, Chen et al. also studied the association of CYP11B2 gene and essentialhypertension in southwest Han Chinese population . Four tag SNPs (rs4536, rs4545, rs3097, and 3802230) within the CYP11B2 gene were selected through HapMap. In addition, C344T (rs1799998) and K173R (rs4539) polymorphisms that previous studies were mostly interested, were also selected for the study. The result showed that among the six SNPs, only the C allele of rs3802230 was significantly more prevalent in the hypertension subjects than in the control subjects (P = 0.006, OR = 1.28, 95% CI: 1.07–1.52). Since the results of both studies were similar, we further calculated the pooled P value and OR. The combined P = 0.001, OR = 1.20, 95% CI = 1.08– 1.34, I 2 = 0.0% (P = 0.39), which means no heterogeneity existed between two studies, and the C allele of rs3802230 might be a risk factor for essentialhypertension in the Han Chinese population. Chen et al. also analyzed these SNPs in Yi and Hani Minorities of China, and found rs4536 was significantly associated with hypertension in the Hani minority, however, no association was found in the Yi minority .
The present investigation showed reduced flow-mediated endothelium-dependent va- sodilation associated with increased levels of LDL-cholesterol oxides and plasma endo- thelin-1. This was accompanied by a de- crease in lipid- and water-soluble antioxi- dants in blood plasma of untreated patients with borderline essentialhypertension. Sev- eral mechanisms implicating the action of ox-LDL have been proposed to account for the impairment of endothelium-dependent vasodilation, such as i) reduced synthesis of
The findings of the present study were different from the results of a previous meta-analysis conducted by Perei- ra et al. (2008), in which a codominant model of T174M polymorphism demonstrated a significant increase in the risk of essentialhypertension in Asians (10 studies were in- cluded and four of them were Chinese) and in mixed/other populations (including African, Indo-European/East Asian, Russian Arab and Turkish) but not in a population of Euro- pean descendants. Upon comparing these two meta- analyses, we found that two studies (Morise et al., 1995; Yi-Yang et al., 2006) conducted among Asian populations (one in Japan and one in Chain) were included in the analy- sis of Pereira et al. (2008) but not in ours. These two studies indicated a significantly increased risk of essential hyper- tension among populations carrying the 174M allele. This may be one reason for the different outcomes of these two meta-analyses. Furthermore, it should be noted that in the study of Pereira et al. (2008) a potential publication bias was present.
Essentialhypertension (EH) is a complex multifactorial disease caused by genetic and environmental factors [1,2] Epidemiological data shows that there are about one billion EH patients in the world. At present, EH is becoming the major risk factor increasing the mortality and the morbidity of coronary heart disease (CHD), ischemic stroke (IS), chronic heart failure and chronic renal failure. Similar as CHD and some type of IS, EH is characterized by chronic inflammation. The inflammation plays an important role in the pathogenesis and the maintenance of EH, which has received increased attention in the past few years. At the same time, a growing body of evidence indicates that oxidative stress is involved in the pathophysiological mechanism and development of hypertension . The levels of oxidative stress markers are significantly higher in hypertensive patients.
patients (n=100). Patients were enrolled at the Chinese PLA General Hospital from September 2010 to April 2011. Because the 2007 GPTBLACA and 2013 American College of Cardiology/American Heart Association guide- lines state different criteria for the treatment of blood cholesterol between men and women, a different age criterion had to be used. The primary outcome in the current study was the arterial stiffness in subjects who received 6 months of xuezhikang treatment. The inclusion criteria were: 1) essentialhypertension; 2) normal or mildly elevated serum lipid proﬁle such as total cholesterol (TC) o 6.19 mmol/L and/or low-density lipoprotein cholesterol (LDL-C) o4.12 mmol/L (14), and 3) aged X45 years for men or X55 years for women.
heterozygous individuals have intermediate ACE levels . It is currently believed that the I/D polymorphism is not directly responsible for inherited ACE serum level variation in humans [10,12,13]. Tiret et al. demonstrated that this polymorphism is in close linkage disequilibrium to at least one, and perhaps more functional polymorphisms determining the phenotypic variations of enzyme levels . Still, other studies have shown loci with variants of this sequence in complete linkage disequilibrium with the I/D polymorphism . The role of ACE gene polymorphisms in hypertension has not been studied in the Mexican population. We selected 9 polymorphisms considering a previous study in which ACE haplotypes were described in African-American and European-American populations . Population LD block differences were observed, as haplotypes were shorter and more diverse in Africans, while Europeans had longer and fewer haplotypes. This suggests that different linkage disequilibrium of the polymorphisms located in the ACE gene can be observed in other populations. On the other hand, the length of the genomic segment covered by the polymorphisms included in our study is 21 kb, increasing the possibility to detect some association with the disease. Thus, the objective of the present study was to analyze whether these polymorphisms or given haplotypes are associated with essentialhypertension and ACE serum levels in Mexican Mestizo individuals.
The study participants, aged 25–65 years with never-treated mild-to-moderate essentialhypertension (EH), with normal sinus rhythm and a resting HR (RHR) of .70 bpm, were recruited from the hypertension clinic at the Ruijin Hospital, Shanghai, between October 2010 and March 2012. Mild-to-moderate EH was defined as a systolic BP of 140–160 mmHg and/or a diastolic BP of 90–100 mmHg on at least three different occasions separated by a month. Subjects with secondary hypertension, diabetes mellitus (DM), bradyarrhythmia/hypotension, bronchial asthma, or liver dysfunction/renal impairment were excluded (please see the online Data Supplement at http://clinicaltrials. gov/ct2/show/NCT01762436). Experimental protocol and in- formed consent were approved by the ethics committee of the Ruijin Hospital, Shanghai Jiaotong University (approval ID 36), and informed consent to participate in the study was provided by the patients or their relatives. All patients signed their informed consent.
Essentialhypertension accounts for 90% of all cases of hypertension. Though it is a one of major risk factors for cardiovascular diseases, it is a condition with its own risk factors. Overall prevalence of hypertension is increasing over the years in India (from 3.57% in 1977 to 20-30% after 1995). Considering the public health importance of ‘EssentialHypertension’ the present study was conducted. The objective was to study role of certain risk factors in essentialhypertension. A case control study was conducted in rural township of Tasgaon; in Sangli district of Maharashtra during 2001-2002, to study role of certain modifiable risk factors in essentialhypertension in 21-60 years age group. 165 cases of essentialhypertension were selected by systematic random sampling from two private hospitals & O.P.D. of RHTC, Tasgaon and 330, age & sex matched controls were selected in the ratio of 1:2. A significant association was found between essentialhypertension and various risk factors including smoking, its frequency and duration, alcoholic status, leisure time physical inactivity, restless sleep, BMI, mental stress, mixed diet and salt intake. Smoking of more than 10 cigarettes or bidi had 3.23 times risk of developing hypertension than smoking up to 10 cigarettes or bidi.
; each n = 11, P.0.05; Figure 4A). In addition, the chemotaxis using an incubation time of 4 h was also used to test monocytes’ migration. Also for a short incubation time of 4 hours we observed an increased fMLP- induced migration of monocytes from patients with essentialhypertension compared to normotensive control subjects (159612% vs 10065%; each n = 8, P,0.01). We were interested whether differences of fMLP-induced migration in patients with essentialhypertension and healthy subjects might be related to differences in the expression of the receptor for fMLP. Our data showed that fMLP receptors were not significantly different between patients with essentialhypertension and normotensive control subjects (P.0.05, Figure 4B). These findings indicate that fMLP receptors may not be responsible for the observed differences of fMLP-induced monocytes migration between Figure 2. Increased fMLP-induced changes of cytosolic calcium in monocytes from patients with essentialhypertension. A, B; Representative fluorescence tracings in monocytes from normotensive control subjects (A) and hypertensive patients (B) after administration of fMLP (100 nm/L) in the absence and presence of TRP channel-inhibitor 2-APB. C; Summary data of changes of intracellular calcium concentration in monocytes from normotensive control subjects (NT; open bars) and patients with essentialhypertension (HT; filled bars) by several doses of fMLP (10 nmol/L, 50 nmol/L, and 100 nm/L). Each n = 10; *p,0.05 for the comparison HT vs. NT. D, E; fMLP-induced cation influx into monocytes indicated by quenching of fura-2 by manganese (Mn 2+ , 1 mmol/L). Representative raw data, showing mamganese quenching with a stimulus (fMLP, 100 nmol/
Series of studies prove the association between the 8 25T allele and LVH in patients with essentialhypertension (EH ) [ 4; 8 ; 9; 10 ; 11]. By contrast, Sedlacek K. et al. 20 0 2 showed any association between T allele GNB3 and cardiac structure . Shlyakhto et al. 20 0 2 also found no association between left ventricular structure or function and the GNB3 gene variant in a St. Petersburg population . Wang X. et al. 20 0 4 did not confer a significantly increased risk for the developm ent of LVH . So, it is not clear understand the role of C8 25T polym orphism in patient with LVH and its association with heart rem odelling and hem odynam ic param eters.
Considering this background, and our findings that both SBP and DBP apart from age are associated with reduced cognitive function, this study may have significant health implication for improving the quality of care and life of patients with essentialhypertension. In resource poor settings it would not be feasible to undertake such costly investigations like MRI to diagnose WML in all hypertensives; therefore assessing the cognitive function would be cost effective approach to suspect early cerebral white matter changes as studies have already established the association of declining cognitive function with WML and subsequently stroke and/or dementia in hypertensive patients. However, this was an observational cross‐ sectional study; inferences regarding a causal relationship between essentialhypertension and cognitive function remain tentative. A more elaborate community based prospective study in needed to examine the temporal relation. Similarly an experimental study would be useful to study the value of assessing cognitive function in hypertensives on their quality of life and care in Indian setting.
Family-based association study. Study subjects from the family association study were enrolled from the Taiwan young-onset hypertension genetic study  and young hypertension probands were identified from four community hospitals located in northwest Taiwan. For each identified proband, family members including their parents, affected or unaffected sib pairs were invited for a BP screening and enrolled into this study. The family structure comprised two generations and was a nuclear-family format. A total of 962 subjects, 495 men and 467 women from 302 nuclear families, were enrolled in this study. Both parents of probands were recruited in 23.1% of the families, and one parent in 27.2% of the families. Four distinct phenotypes, of (1) normotensive and non- metabolic syndrome; (2) HTN without MetS; (3) MetS with HTN, and (4) MetS without HTN, were clearly identified in this family association study database (Figure 1). The diagnosis of HTN was defined as systolic blood pressure .140 mmHg and/or diastolic blood pressure .90 mmHg or currently taking at least one antihypertensive medication. Exclusion criteria were the presence of any of secondary causes of hypertension such as chronic renal disease, renal arterial stenosis, primary aldosteronism, coarctation of the aorta, thyroid disorders, Cushing syndrome, and pheochr- omocytoma through extensive clinical examinations and investigations (including blood chemistry, renal function tests, endocrine examination, and abdominal sonogram). Participants who fulfilled at least three of the following five criteria of MetS were defined as ‘‘affected’’ status for MetS according to the ATPIII criteria. The five criteria included (1) blood pressure $ 130/ 85 mmHg, (2) fasting plasma glucose level .110 mg/dL, (3) hypertriglyceridemia with triglyceride level $150 mg/dL, (4) high-density lipoprotein-cholesterol (HDL-C) level ,1.0 mmol/l in men or ,1.3 mmol/l in women, and (5) central obesity with waist circumference .90 cm in men or .80 cm in women. The definition of central obesity has been modified for the Asian population . Participants were divided into variable phenotypes of HTN and MetS.
dine in patients with either essentialhypertension or pheochromocytoma. Clonidine is a centrally acting alpha-2 agonist that inhibits neurally mediated cate- cholamines release. Clonidine decreases blood pres- sure in patients with pheochromocytoma to the same degree. These results suggest that the SNS is intact in pheochromocytoma. In essentialhypertension, the fall in blood pressure is associated with decreases in circu- lating catecholamines, but in pheochromocytoma, there is no change in plasma catecholamine levels. The demonstration that blood pressure in pheochromocy- toma was lowered despite high levels of circulating catecholamines suggests that the norepinephrine released from axon terminals of sympathetic postgan- glionic neurons is biologically more significant than circulating catecholamines. This difference could be related to the easier access of norepinephrine released from presynaptic sites to its effector site at effector cells.
occurring antioxidant substances found in vegetables, fruits or seeds, and are particularly abundant in Silybum marianum (milk thistle), where Silymarin is an active polyphenolic flavonoid extracted from the seeds of this medicinal plant 27 , and proved to have well documented hepatoprotective effect; meanwhile, many reports indicated also there are some animal and nephro-protective effects 28 . In the present study, adjuvant use of silymarin with the currently followed approach significantly decreases MAU and BP levels; this result was in tune with many in vitro and animal studies, where silymarin improves kidney function 29 . Several studies have clearly shown that induction of oxidative stress initiates hypertension due to enhancement of both superoxide and hydroxyl radical production in animals 30,31 , and treatment with antioxidants lowered blood pressure and increased the bioavailable nitric oxide 32 . However, the nephro-protective effects of polyphenols were attributed to large array of biological actions, such as free radical-scavenging, metal chelation and enzyme modulation abilities 33 . Other biological actions of polyphenols include the reduction in the susceptibility of LDL-c to oxidation both in vitro 34 and in vivo 35 , an effect likely due to the property of these compounds to scavenge free radicals. Polyphenols also may participate in the regulation of vascular tone or in the inhibition of platelet aggregation 36 . The present study indicates also that adjuvant use of silymarin in essentialhypertension significantly improves the impaired lipid profile, revealed by decreasing cholesterol, LDL-c, and triglyceride levels and increasing HDL-c levels. Previous report indicates that administration of silymarin to rats with impaired lipid
characterized by “autonomous” or angiotensin- independent aldosterone excess resulting in sup- pressed levels of plasma renin activity (PRA). Increased aldosterone activation of the mineralocorticoid hor- mone (MCH ) receptor in the distal kidney tubule pro- duces sodium and fluid retention, volume expansion, renin suppression, and potassium wasting (1). H owev- er, a distinctive feature of PA, hypokalemia is seldom observed in current series (2). In contrast with other florid syndromes of steroid excess (cortisol, andro- gens), the clinical picture of PA is pale, confined to hypertension in presence of renal potassium wasting and, only occasionally, hypokalemia. Thus, except for some resistance to conventional medical therapy (3-5) the clinical picture of PA may not be distinct from essentialhypertension.
Blood tests on 4-10-2011 are as follows: -Hb: 8gm%, TC: 50, 400cu. mm, DC: P89% L6%, F4%, M1%, RBC: 3.4 millions/cu. mm, platelet count: 18. 73 lakhs/cu. mm, PCV: 24%. Peripheral smear examination revealed: -RBC: Prominent anisocytosis, Poikilocytosis, Nucleated red cells & small number of fragmented red cells, WBC: Marked neutropyhil leucocytosis, No evidence of blast cells. Platelets: Marked thrombocytosis present. Opinion: Blood picture suggestive of MPD. Ultrasound abdomen was normal, spleen is intact and normal. 11/10/2011: Hb: 6. 7 gm%, TC: 51, 780 cells. Cu. mm, Platelet count 17.28 lakhs/cu.m.m. Real time PCR test: 11/10/2011: - JAK2 V617F mutation was detected (Religare). Pt is diagnosed as MPD: Essential Thrombocythaemia. Patient is prescribed Hydroxyurea 500mg bd along with ferrous sulphate and Folic acid, got discharged on 12-10-2011. Patient has not agreed for Bone marrow examination as he is bedridden and fear of bleeding.
The National Public Health Performance Standards Program of the CDC is currently spearheading a joint effort to develop standards for public health practice. The measurement tools for evaluating public health practice at both the local and state level have been designed in conjunction with other public health organizations. These instruments consist of detailed questionnaires with sections on each of the 10 essential services. Each service is defined in detail, with indicators representing local and state standards, and with measurements and submeasurements for each indicator included. After a three-year design phase, the instruments are being tested in the different state and local situations of the United States.
We have also established that AGT is an effective AS-ODN for hypertension therapy. In human hypertension, the AGT gene has been shown to be linked to and play a role in the disease (4). However, there is no cur- rently available drug to inhibit AGT. We have designed antisense, targeted to AGT mRNA and tested it in vivo and in vitro (5). When given iv the AGT-AS-ODN would reduce blood pressure significantly when delivered with a liposome. These studies have been confirmed by other studies inde- pendently, showing that AGT-AS-ODN re- duces blood pressure for up to 7 days with a single systemic dose (6). A similar story is true for the effects of AT 1 -AS-ODN. This has been tested centrally with icv injections and peripherally. It has been tested in spon- taneously hypertensive rats (SHR) and also in 2 kidney-1 clip animals and environmen- tally induced hypertension. In all cases the antisense produces a decrease in blood pres- sure within 24 h of administration. The ef- fect lasts for up to 7 days and there is no effect on heart rate (7). The distribution of antisense is to be in blood vessels, kidney, liver and heart. Most of the uptake is in the kidney and liver. A reduction in AT 1 -R after treatment with the AT 1 -AS-ODN reveals re- ductions in the protein in kidney, aorta and liver (8).