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Background: Angiotensin II is a potent activator of the Rho-kinase (ROCK) pathway, through which it exerts some of its adverse vasoconstrictor effects. Clinical evidence on the effects of blocking the angiotensin II receptor 1 on ROCK activity in hypertensive patients is scarce., Objective: To demonstrate that ROCK activity in peripheral blood mononuclear cells (PMBCs) in patients with essential hypertension is reduced earlier than previously observed, along with blood pressure (BP) lowering on treatment with olmesartan., Methods: Prospective pilot open study; 17 hypertensive patients were treated with progressive olmesartan doses starting with 20 mg qd. BP was measured at 3, 6 and 9 weeks after treatment initiation. If treatment failed to normalize BP after 3 weeks, olmesartan dose was increased to 40 mg qd, and if still hypertensive after 6 weeks, 12.5 mg of hydrochlorothiazide qd was added. ROCK activity was measured at baseline and 9 weeks after treatment as myosin phosphatase target subunit 1 phosphorylation (MYPT1-p/T ratio) in PBMC., Results: Mean baseline BP was 162 ± 4.9/101 ± 2.4 mmHg. After 9 weeks of treatment, both systolic and diastolic BP were reduced by 41 and 22 mmHg, respectively (p<0.05). Mean pretreatment MYPT1- p/T ratio in PMBCs was significantly reduced by 80% after 9 weeks with olmesartan (p<0.01)., Conclusion: Normotension achieved after 9 weeks in 82% of the patients treated with olmesartan was associated with a significant reduction of ROCK activity in PBMC., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: Preeclampsia (PE) is a pregnancy disorder that represents a major cause of maternal and perinatal morbidity and mortality. Methods: This network meta-analysis was registered with PROSPERO. We searched the PubMed, ClinicalTrials.gov. and Embase databases for studies published from inception to the 31st of March 2023. RevMan5.3 software provided by the Cochrane Collaboration was used for direct meta-analysis (DMA) statistical analysis. Funnel maps, network meta-analysis (NMA), the surface under the cumulative ranking curve (SUCRA) to rank the different interventions and publication bias were generated by STATA 17.0 software. Results: We included eight randomized controlled trials (RCTs) involving a total of 1192 women with PE; two studies were of high quality and six were of moderate quality. Eight interventions were addressed in the NMA. In the DMA, we found that blood pressure in the Ketanserin group were significantly higher than those in the Nicardipine group. NMA showed that blood pressure in the Dihydralazine group was significantly higher than that in the Methyldopa, Labetalol, Nicardipine and Diltiazem groups. And the blood pressure in the Labetalol group was significantly lower than that in the Nicardipine group. SUCRA values showed that Diltiazem was more effective in lowering blood pressure than other drugs looked at in this study. Conclusion: According to the eight RCTs included in this study, Diltiazem was the most effective in reducing blood pressure in PE patients; Labetalol and Nicardipine also had good effects. Diltiazem is preferred for the treatment of patients with severe PE and high blood pressure. [ABSTRACT FROM AUTHOR]

Abstract The great therapeutical success achieved by oncology is counterbalanced by growing evidences of cardiovascular (CV) toxicity due to many antineoplastic treatments. Cardiac adverse events may cause premature discontinuation of effective oncologic treatments or occur as late events undermining the oncologic success. Arterial hypertension is both the most common comorbidity in cancer patients and a frequent adverse effect of anticancer therapies. A pre-existing hypertension is known to increase the risk of other cardiac adverse events due to oncologic treatments, in particular heart failure. Moreover, as a strict association between cancer and CV diseases has emerged over the recent years, various analyses have shown a direct relationship between hypertension and cancer incidence and mortality. Finally, many antineoplastic treatments may cause a rise in blood pressure (BP) values, particularly the novel anti VEGF agents, this possibly compromising efficacy of chemotherapy. Aim of this review is to revise the topic and the many aspects linking arterial hypertension and cancer, and to provide a comprehensive and practical guide of the current treatment approaches. Highlights • Arterial hypertension is the most common comorbidity of cancer patients. • It is significantly associated with both cancer incidence and mortality. • Arterial hypertension is a risk factor for cancer therapy-related heart failure. • Arterial hypertension is a common adverse effect of many anticancer drugs. • Anti-hypertensive therapy prevents from premature discontinuation of cancer therapy. [ABSTRACT FROM AUTHOR]

Aims The aim of this work was to evaluate the effects of treatment of hypertension on the autoantibodies to apolipoprotein B-derived peptides (anti-ApoB-D peptide Abs) response, inflammation markers and vascular function. Main methods Eighty-eight patients with hypertension (stage 1 or 2) were recruited and advised to receive perindopril (4 mg), hydrochlorothiazide (25 mg), or indapamide (1.5 mg) for 12 weeks in a blinded fashion. Office and 24-h ambulatory blood pressure monitoring (24 h ABPM), flow-mediated dilatation (FMD), nitrate-induced dilatation (NID), titers of IgG and IgM anti-ApoB-D peptide Abs, hsCRP, and interleukins (IL-8 and IL-10) were evaluated at baseline and 12 weeks after therapies. Key findings All treatments reduced office BP, and improved FMD ( P < 0.05 vs . baseline). The NID was improved only in the perindopril arm ( P < 0.05 vs . baseline). The 24 h-ABPM was reduced with perindopril and hydrochlorothiazide therapies ( P < 0.05 vs . baseline), but not with indapamide, and this effect was followed by increase in titers of IgM Anti-ApoB-D peptide Abs ( P < 0.05 vs . baseline), without modifications in titers IgG Anti-ApoB-D peptide Abs and interleukins. Multivariable regression analysis has shown that change in the titers of IgM anti-ApoB-D peptide was associated with the changes in FMD (β − 0.347; P < 0.05). Significance These findings shed light to a possible modulator effect of the antihypertensive therapy on the natural immunity responses and vascular function. [ABSTRACT FROM AUTHOR]

The objective of this study was to assess the effects of pharmaceutical care interventions on blood pressure (BP) and medication adherence of patients with primary hypertension in China. A total of 60 patients with primary hypertension were enrolled in the trial for a 12-month period. Participants were randomized to either control group or intervention group in a 1:1 ratio. During the follow-up period, patients in the control group were given regular medi-care, while patients in the intervention group accepted pharmaceutical care. The dates of baseline demographics, medication lists, measurement of medication adherence, and BP values were collected. Statistical analyses were conducted using t-test or χχ2 test. After 12 months follow-up, 24-h BP was significantly decreased by 9.75 mmHg (7.1%) for systolic blood pressure (SBP) and 5.88 mmHg (6.6%) for diastolic blood pressure (DBP) in the intervention group ( p < 0.05) compared with their initial visit, while there was no significant change in the control group ( p > 0.05). The intervention group demonstrated a higher percentage of patients with high adherence (72.41%) at 12 months, whereas the control group hardly had changes in medication compliance. In conclusion, the results indicate that pharmaceutical care intervention might contribute to better BP control of primary hypertension, and could enhance medication compliance of patients. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate which administration timing of valsartan provides satisfactory blood pressure (BP) control, once daily in the morning, once daily in the evening, or twice daily in total 160 mg. Hypertensive patients with mild-to-moderate diabetic nephropathy were enrolled, but those with more than three anti-hypertensive agents, renal insufficiency (serum creatinine ≥≥ 3 mg// dL), or hepatic insufficiency were excluded. They were randomized to receive valsartan 160mg once daily in the morning, valsartan 160 mg once daily in the evening, or valsartan 80 mg twice daily for 12 weeks according to a three-period crossover design. Office blood pressure (OBP), home blood pressure (HBP) self-measured by patients, and urinary albumin excretion adjusted by creatinine excretion (UAE) were measured every 12 weeks. In 34 patients, (male: 18, mean age: 57.5 ±± 10.3), valsartan with ether all administration timing demonstrated significant reductions in OBP and HBP compared to baseline: valsartan 160 mg once daily in the morning: −−12.2//−−9.5 mmHg (p < 0.01); valsartan 160 mg once daily in the evening: −−14.2//−−10.3 mmHg (p < 0.01); valsartan 80 mg twice daily: −−15.0//−−10.2 mmHg (p < 0.01) There was no statistically significant differences in a decrease in OBP and HBP, and reduction of UAE among three administration timing. In conclusion, these data indicate that the efficacy on BP-lowering does not depend on administration timing of valsartan in patients with diabetic nephropathy. [ABSTRACT FROM AUTHOR]

Our previous data indicated that both home blood pressure and arterial stiffness predicted the progression of renal dysfunction in the patients with chronic kidney diseases. In the present study, we examined both home blood pressure and the parameters of arterial stiffness as the indicator to the progression of chronic kidney diseases. Forty-two nondiabetic chronic kidney disease patients were enrolled and followed for 1 year. Anti-hypertensive therapy was adjusted to achieve office blood pressure below 130/80 mmHg. Home blood pressure was examined twice a day in the morning and evening. Pulse wave velocity (PWV) and augmentation index (AI) were measured as the index of arterial stiffness. The time for reflection (TR) was also determined. The relationship of annual changes in serum creatinine (Scr) with the above parameters was assessed. Multivariate regression analysis revealed that TR inversely correlated to annual increase in Scr (β = -0.03, p < 0.05). Home blood pressure did not correlate to annual changes in Scr in the present study. The present data indicated that arterial stiffness is elevated despite good blood pressure control in chronic kidney disease, especially among the dippings. In addition, our data suggest that PWV and AI correlated to each other, while they were influenced differently by hemodynamic factors. Finally, the present findings provide the evidence that the arterial stiffness parameter is more sensitive than home blood pressure as an indicator to the progression of chronic kidney disease. [ABSTRACT FROM AUTHOR]

Macrovasculature, microvasculature and the heart determine the structure and function of the circulatory system. Due to the viscoelastic properties of large arteries, the pulsatile pressure and flow that result from intermittent ventricular ejection is smoothed out, so that microvasculature mediates the delivery of nutrients and oxygen to tissues steadily. The disruption of this function, which occurs when microvascular structure develops in response to hypertension, leads to end-organ damage. Microvascular structure is not only the site of vascular resistance, but also the origin of most of the wave reflections generating increased central systolic blood pressure (SBP) in the elderly. Nowadays many data of the literature suggest that hypertension-related damage to the micro and macrovascular system may be manageable through pharmacological agents. Among them, β-blocking agents and diuretics poorly modify microvascular structure, whereas angiotensin and calcium entry blockade has an opposite effect, thereby reducing central wave reflections and, finally, causing a selective SBP reduction.Journal of Human Hypertension (2008) 22, 590–595; doi:10.1038/jhh.2008.43; published online 29 May 2008 [ABSTRACT FROM AUTHOR]

The Perindopril pROtection aGainst REcurrent Stroke Study (PROGRESS) showed the efficacy of blood pressure reduction in secondary stroke prevention. This anti-hypertensive treatment (perindopril 4 mg daily plus indapamide 1.5 mg daily) is now routinely proposed to patients referred to our department for stroke or transient ischaemic attack (TIA). The aim of this study was to evaluate the prescription of PROGRESS therapy during hospitalization and to identify the predictors of therapy discontinuation after discharge. Eligible patients admitted to the Amiens University hospital for acute stroke or TIA from January to April 2003 were included ( n = 101). At 1 year, the use of PROGRESS therapy was evaluated by structured phone interviews. In addition, each patient’s general practitioner (GP) was also contacted to provide information. PROGRESS therapy was mentioned on the hospital discharge summary significantly less frequently after cardioembolic stroke (OR: 0.15; 95% CI: 0.05–0.5; P = 0.001) and TIA (OR: 0.12; 95% CI: 0.02–0.7; P = 0.02). At 1 year, only 25.7% of patients were treated with optimal PROGRESS therapy (perindopril 4 mg daily plus indapamide 1.5 mg daily). Mention of PROGRESS therapy in the discharge summary was the main predictor of optimal PROGRESS therapy at 1 year (OR: 10.8; 95% CI: 1.3–88.3; P = 0.03). This study shows that mention of PROGRESS therapy in the discharge summary must be improved as it is associated with a higher use of these anti-hypertensive agents 1 year after stroke/TIA. [ABSTRACT FROM AUTHOR]

Presents several studies related to genetics, gene therapy and proteomics. "The Effect of the Ace Polymorphism on Blood Pressure Response to Calcium Channel Blockers in White and Black Hypertensives," by Maria Carolina Delgado et al; "Methodological Limitations of Pharmacogenomics Studies on Anti-Hypertensive Therapeutics With an Effect on the Renin-Angiotensin-Aldosterone System (RAAS)," by Pendar Farahani et al; "Heredity and Risk Markers for Arterial Hypertension," by Paulo C. Jardim et al.

Presents several clinical trials related to hypertension. "Non-Pharmacological Treatment of Hypertension in Diabetics by Device-Guided Paced Breathing: A Randomized Controlled Study," by Moshe H. Schein et al; "The Effects of Ramipril on Endothelial Functions in Patients With Type II Diabetes Mellitus and Hypertension," by Ali Riza Altunsu et al; "The Presence of White Coat Effect in Resistant Hypertension Does Not Increase End-Organ Damage," by Sinan Aran et al.

There is a continuous relationship between blood pressure (BP) and risk of both first and recurrent stroke. Cardiovascular risk approximately doubles with each increment of 20/10 mm Hg, above 115/75 mm Hg. However, most strokes occur in those with “average” BP. In older trials, testing mainly beta-blockers and/or diuretics, lowering BP reduced stroke risk by about one third, within a few years. In more recent trials, ACE inhibitors and calcium antagonists showed similar effects but the more BP is lowered, the greater the stroke reduction. Benefits extend to isolated systolic hypertension in the elderly and the prevention of recurrent stroke. Lifestyle is important. Thiazide diuretics are often recommended as initial treatment, but comorbidities often influence the initial drug choice and most require two or more agents. [Copyright &y& Elsevier]

Abstract: Betaxolol hydrochloride is a β1-selective antagonist that produces vasodilation in patients with hypertension and ischemic heart disease. The goal of the present study was to characterize the effect of betaxolol on heart rate variability indices (HRV), a well-established prognostic marker. Symptom limited-treadmill exercise testing was performed in 17 hypertensive patients (60.9 ± 14.8 years-old) before and immediately a 3 weeks course of betaxolol hydrochloride (5 mg daily). Frequency domain HRV (high frequency spectra, HF; 0.15–0.40 Hz: low frequency spectra, LF; 0.04–0.15 Hz) was measured during exercise treadmill testing using MemCalc software. Betaxolol hydrochloride significantly decreased the maximal systolic blood pressure and heart rate (184 ± 29 vs. 156 ± 26 mmHg, P < 0.01; 132 ± 21 vs. 113 ± 15 bpm, P < 0.01) and significantly increased HF and LF during exercise treadmill testing (HF, 32 ± 36 vs. 56 ± 55 men/Hz, P < 0.01; LF, 64 ± 58 vs. 95 ± 86 men/Hz, P < 0.01). Thus, treatment with betaxolol hydrochloride resulted in a decrease in blood pressure during exercise treadmill testing and in an increase in HRV. This suggests that this agent could have beneficial effects on long-term prognosis in patients with hypertension. [Copyright &y& Elsevier]