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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 Background. The New Medicine Service (NMS) was developed in England more than ten years ago, as a three-stage consultation led by community pharmacists to support patients taking new medication for a chronic disease. In Poland, the scheme was officially introduced in January 2023. However, its implementation into common practice has been presented with various obstacles, including the need to develop relationships with general practitioners, resolve the payment structure, and provide training with adequate supporting materials. Hence, written materials have been designed for use as an optional tool for counselling patients receiving an NMS in community pharmacies. Methods. The present study evaluates the ability of these materials to inform patients about the need to adhere to anti-hypertensive medication. A group of 401 randomly-selected adult visitors to pharmacies and/or healthcare centres were surveyed; one third had hypertension in their history. Results. The structure, grammar and readability of the text achieved the required threshold of 40% according to the Plain Language Index. The designed materials effectively informed the patients about anti-hypertensive medication, reflected in an increased score in a knowledge test, and were rated positively regarding information level, comprehensibility and presentation. Conclusion. The proposed material may serve as an additional, “patient-friendly” educational tool for use as part of an NMS.

Abstract Previous work comparing safety and effectiveness outcomes for new initiators of angiotensin converting‐enzyme inhibitors (ACEi) and thiazides demonstrated more favorable outcomes for thiazides, although cohort definitions allowed for addition of a second antihypertensive medication after a week of monotherapy. Here, we modify the monotherapy definition, imposing exit from cohorts upon addition of another antihypertensive medication. We determine hazard ratios (HR) for 55 safety and effectiveness outcomes over six databases and compare results to earlier findings. We find, for all primary outcomes, statistically significant differences in effectiveness between ACEi and thiazides were not replicated (HRs: 1.11, 1.06, 1.12 for acute myocardial infarction, hospitalization with heart failure and stroke, respectively). While statistical significance is similarly lost for several safety outcomes, the safety profile of thiazides remains more favorable. Our results indicate a less striking difference in effectiveness of thiazides compared to ACEi and reflect some sensitivity to the monotherapy cohort definition modification.

Background. The New Medicine Service (NMS) was developed in England more than ten years ago, as a three-stage consultation led by community pharmacists to support patients taking new medication for a chronic disease. In Poland, the scheme was officially introduced in January 2023. However, its implementation into common practice has been presented with various obstacles, including the need to develop relationships with general practitioners, resolve the payment structure, and provide training with adequate supporting materials. Hence, written materials have been designed for use as an optional tool for counselling patients receiving an NMS in community pharmacies. Methods. The present study evaluates the ability of these materials to inform patients about the need to adhere to anti-hypertensive medication. A group of 401 randomly-selected adult visitors to pharmacies and/or healthcare centres were surveyed; one third had hypertension in their history. Results. The structure, grammar and readability of the text achieved the required threshold of 40% according to the Plain Language Index. The designed materials effectively informed the patients about anti-hypertensive medication, reflected in an increased score in a knowledge test, and were rated positively regarding information level, comprehensibility and presentation. Conclusion. The proposed material may serve as an additional, "patient-friendly" educational tool for use as part of an NMS. [ABSTRACT FROM AUTHOR]

Previous work comparing safety and effectiveness outcomes for new initiators of angiotensin converting‐enzyme inhibitors (ACEi) and thiazides demonstrated more favorable outcomes for thiazides, although cohort definitions allowed for addition of a second antihypertensive medication after a week of monotherapy. Here, we modify the monotherapy definition, imposing exit from cohorts upon addition of another antihypertensive medication. We determine hazard ratios (HR) for 55 safety and effectiveness outcomes over six databases and compare results to earlier findings. We find, for all primary outcomes, statistically significant differences in effectiveness between ACEi and thiazides were not replicated (HRs: 1.11, 1.06, 1.12 for acute myocardial infarction, hospitalization with heart failure and stroke, respectively). While statistical significance is similarly lost for several safety outcomes, the safety profile of thiazides remains more favorable. Our results indicate a less striking difference in effectiveness of thiazides compared to ACEi and reflect some sensitivity to the monotherapy cohort definition modification. [ABSTRACT FROM AUTHOR]

Introduction: Flaxseed and sesame both are capable of reducing blood pressure, but no studies have been done to compare their effects on hypertension. The purpose of this study was to compare the effect of breads containing either milled sesame or flaxseed on blood pressure of patients with type I hypertension. Methods: This was a randomized, single blind clinical trial study. Demographic information was obtained from 100 eligible patients and they were randomly allocated to flaxseed or sesame groups. They received breads containing 30 g of either flaxseed or sesame for 14 weeks. Blood pressure, abdominal circumference, and BMI (body mass index) were measured at the beginning, seventh week, and at the end of study. Questionnaires regarding their eating habits and physical activities were also completed at these times. Data was analyzes by SPSS version 16 and independent sample t test and repeated measurement test. Results: Both sesame and flaxseed significantly reduced systolic and diastolic blood pressure (p=0.001) and there was no significant difference. On average, systolic pressure decreased by 9.5 mmHg with sesame and 10 mmHg with flaxseed. Likewise, diastolic blood pressure decreased by 5.05 mmHg with sesame and 5.8 mmHg with flaxseed. BMI and abdominal circumference reduced in both flaxseed (p= 0.001 and 0.001, respectively) and sesame (p=0.01 and 0.02, in order). No difference was observed between these groups. Conclusion: Both sesame and flaxseed could similarly decrease systolic and diastolic blood pressure, abdominal circumference, and BMI. Therefore, they could be used as supplements in reducing blood pressure.

Critical limb ischemia (CLI) constitutes the most advanced form of peripheral artery disease (PAD) and is characterized by ischemic rest pain, tissue loss and/or gangrene. Optimized medical care and risk factor modification in addition to revascularization could reduce the incidence of cardiovascular events and major adverse limb events, improving patients' quality of life and promising higher survival rates. Adequate adherence to cardioprotective medications, including antithrombotic therapy (e.g., antiplatelets, anticoagulants), cholesterol-lowering agents (e.g., statins, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors), angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), and smoking cessation should be strongly encouraged for patients with CLI. This review examines these guideline-recommended therapies in terms of cardiovascular and limb-related risk reduction in patients with CLI. [ABSTRACT FROM AUTHOR]

Objective: The research aimed to estimate the level of drug adherence, to determine the reasons for non-adherence, and identify risk factors associated with non -adherence among adult hypertensive clients attending an out-patient clinic in Ogun State, Nigeria. Methodology: A descriptive cross-sectional study of adults with hypertension at a medical outpatient clinic in a tertiary hospital. Four hundred and four (404) respondents were selected from November 2015 to April 2016, a validated questionnaire by Morisky Green was adapted and distributed by trained research assistants. The chi-square test was used to compare categorical variables like sex, marital status, and clinic attendance among the two groups of adherent and non-adherent hypertensive. Information was summarized using frequency tables and cross-tabulations. Binary logistic regression analysis was done. The level of significance was set at 5%. Results: Optimal adherence was observed in 281(69.0%) of the respondents. Being a female (OR: 1.833; 1.048 -7.205, p=0.034), being employed (OR: 2.099; 1.097-4.096, p=0.03) and regular clinic attendance (OR: 22.26; 12.647 – 39.107, p

The COVID-19 infection has rapidly spread around the world and a second wave is sweeping in many countries. Different clinical and epidemiological aspects characterize the disease and their understanding is necessary to better face the management of the pandemic in progress. The Italian society of arterial hypertension with the SARS-RAS study has contributed significantly to the knowledge of the interaction between inhibition of the renin-angiotensin system and COVID-19 infection. Furthermore, the study results help to understand some of the main aspects related to mortality and morbidity deriving from the infection through a multicentre analysis throughout the national territory. [ABSTRACT FROM AUTHOR]

The present study investigated the impact of 12 weeks of pulsed electromagnetic field (PEMF) therapy on peripheral vascular function, blood pressure (BP), and nitric oxide in hypertensive individuals. Thirty hypertensive individuals (SBP > 130 mm Hg and/or MAP > 100 mm Hg) were assigned to either PEMF group (n = 15) or control group (n = 15). During pre-assessment, participants underwent measures of flow-mediated dilation (FMD), BP, and blood draw for nitric oxide (NO). Subsequently, they received PEMF therapy 3x/day for 12 weeks and, at conclusion, returned to the laboratory for post-assessment. Fifteen participants from the PEMF group and 11 participants from the control group successfully completed the study protocol. After therapy, the PEMF group demonstrated significant improvements in FMD and FMDNOR (normalized to hyperemia), but the control group did not (P = .05 and P = .04, respectively). Moreover, SBP, DBP, and MAP were reduced, but the control group did not (P = .04, .04, and .03, respectively). There were no significant alterations in NO in both groups (P > .05). Twelve weeks of PEMF therapy may improve BP and vascular function in hypertensive individuals. Additional studies are needed to identify the mechanisms by which PEMF affects endothelial function. [ABSTRACT FROM AUTHOR]

Distinctive feature of hypertension is the high frequency of a komorbidnost. Patients with hypertension, as a rule, have one or several accompanying pathologies, treat the most often meeting: chronic obstructive pulmonary disease, cerebrovascular disease, diabetes mellitus, hypothyroidism and others. The komorbidnost leads to mutual influence on the course of diseases, character and gravity of complications, quite often complicates diagnostics, defines features of the choice of anti-hypertensive drugs. In references of the European society of cardiologists and the European society on hypertension, the American association of heart and the American Association of strokes, the Russian cardiologic society and the Russian medical society on an arterial hypertonia the approaches to tactics of maintaining patients with hypertension and the accompanying pathology based on data of evidential medicine are designated. Existence of a komorbidnost at patients with hypertension defines not only the choice of antihypertensive drugs, but also target values of arterial pressure. Recently the available representations are added with results of new researches and meta-analyses. Patients with hypertension and a komorbidnost demand individual approach, complex diagnostics and treatment taking into account all available pathologies.

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]

BACKGROUND The close relationship between high blood pressure (BP) and atherosclerosis (ATS) is showed by several data. Instead, less information exists about the several factors which play a role in the interaction between these two pathologies. AIM OF THE STUDY To overview the possible mechanisms which explain the close relationship between high BP and ATS and to hypothesise the potential influence on the clinical practice. DISCUSSION Endothelial dysfunction, insulin-resistance and chronic inflammation are involved in the ethiopathogenesis and complications of high BP and ATS. In the last years the interest about protective effect of anti-hypertensive therapy versus ATS, stroke and peripheral arteriopathy is growing up. Several studies reported that calcium channel blockers (CCB), dihydropiridines and not, are able to prevent or to induce the regression of atherosclerotic plaque. Also ACEinhibitors and angiotensin-receptor blockers (ARB), although with less consensus, have demonstrated to slow atherosclerotic process and reduce organ damage. On the other hand, therapies reducing cholesterol, namely statins, have showed to reduce BP. Such effect seems to be due not only to cholesterol reduction but also to direct effect on endothelium. CONCLUSIONS The availability of drugs, which positively influence both BP and ATS in the same time, helps to treat globally the cardiovascular risk instead of correcting singularly the single risk factors.

Objective·To explore changes in myocardial mitochondrial proteinogram in spontaneously hypertensive rats (SHR) with left ventricular hypertrophy (LVH) and to investigate the effects of losartan potassium anti-hypertensive treatment on the proteinogram. Methods·20-week-old SHRs (SHR group) were randomly assigned to the 8-week losartan potassium anti-hypertensive treatment group (therapy group, 28-week-old) and the untreatment group (control group, 28-week-old). Wistar-Kyoto (WKY) rats aged 20 weeks were used as the controls of the SHR group (WKY group). Left ventricular mitochondrial proteinogram was measured using two-dimensional fluorescence difference gel electrophoresis (2D-DIGE) combined with MALDI-TOF/TOF tandem mass spectrometry. Blood pressure and myocardial diameter of rats were also measured. Results·Thirteen mitochondrial protein spots showed alterations by more than 1.3 folds in the SHR group compared with the WKY group. Some spots were identified as the same protein by digestion and mass spectrometry analysis. Five identified proteins were all related to the energy metabolism of mitochondria. No additional different spots were identified after 8 weeks of anti-hypertensive treatment. The therapy group had significantly lower systolic blood pressure and diastolic blood pressure than the control group (P=0.000, P=0.002) and remarkably shorter myocardial diameter in enlarged left ventricles (P=0.000). Conclusion·SHRs with LVH have mitochondrial energy metabolism dysfunction. Losartan potassium can significantly decrease the blood pressure and partially reverse LVH, but has no significant effect on mitochondrial energy metabolism proteins, suggesting changes in mitochondrial proteins are possibly not caused by the load after hypertension. [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]

Hypertension is the single largest risk factor attributed to mortality in the world. Medications are the primary treatment for hypertension; however, adherence to drug regimens is low (~50 %). Low adherence may be a contributing factor leading to uncontrolled blood pressure in patients. An effective alternative or complement to medications in managing hypertension is through lifestyle modifications. Adopting a healthy diet is a valuable strategy. A recent, randomized controlled year-long trial observed impressive reductions in blood pressure in patients with hypertension consuming flaxseed daily. Therefore, attention has been garnered for flaxseed as a potentially valuable strategy for the management of hypertension. This review will highlight the recent data for flaxseed and its extracts in blood pressure regulation in both animal models and clinical trials. Insight into the proposed anti-hypertensive mechanism of flaxseed and the implications of flaxseed as a potential global anti-hypertensive therapy will be discussed. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine how alcohol consumption influences metabolic syndrome in patients with hypertension. The subjects were 3938 male workers being treated with anti-hypertensive drugs and they were divided into four groups by average ethanol intake [non-, light (<22 g/day), moderate (≥≥22 and <44 g/day), and heavy (≥≥44 g/day) drinkers]. The relationships of alcohol intake with atherosclerotic risk factors and metabolic syndrome were investigated. Waist circumference and hemoglobin A1c were significantly smaller and lower, respectively, in light, moderate, and heavy drinkers than in nondrinkers. Systolic blood pressure and log-converted triglyceride were significantly higher in heavy drinkers than in nondrinkers. HDL cholesterol was significantly higher in all of the drinker groups than in nondrinkers and tended to be higher as alcohol intake increased. Prevalence of metabolic syndrome was significantly lower in light, moderate, and heavy drinkers than in nondrinkers. Age- and smoking history-adjusted odds ratios (ORs) vs. nondrinkers for metabolic syndrome were significantly low in light drinkers (OR == 0.71, 95%% confidence interval [CI]: 0.56--0.89), moderate drinkers (OR == 0.64, 95%% CI: 0.54--0.75) and heavy drinkers (OR == 0.68, 95%% CI: 0.57--0.82). The results suggest that alcohol drinking is associated with a lower risk of metabolic syndrome in patients with hypertension. [ABSTRACT FROM AUTHOR]

Limited evidence is available on the safety and efficacy of anticoagulants in non-valvular atrial fibrillation (AF) patients with concomitant hypertension. We investigated the safety and efficacy of 476 consecutive anticoagulated Chinese outpatients with non-valvular AF and hypertension. Occurrence of ischaemic stroke and major bleeding, and international normalized ratio (INR) values during these events were recorded. There was no significant difference in anticoagulation control between patients with or without hypertension. INR-specific incidence rates of the events were calculated, which showed no excessive risk for ischaemic stroke (2.5 vs 1.6% per year, P=0.22) or major bleeding (3.9 vs 3.2% per year, P=0.29) in non-valvular AF patients with or without hypertension. In multivariate analysis, congestive heart failure, smoking and high CHADS2 score were independent predictors for ischaemic stroke, whereas use of antiplatelet agents was an independent predictor for bleeding. It can be noted that hypertension was not associated with ischaemic stroke or major bleeding. Hypertensive patients who achieved target blood pressure control (<130/80 mm Hg) had a lower ischaemic stroke (0.9 vs 3.1% per year, P=0.01), but similar bleeding risk compared with those not achieving target blood pressure. Our findings demonstrate the effects of hypertension on the outcomes of warfarin therapy; further investigation is needed to clarify whether more aggressive antihypertensive therapy could result in better outcomes in hypertensive patients with non-valvular AF. [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]

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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]

Background. In the United Kingdom, diabetic nephropathy is a leading cause of end‐stage renal disease. There is a higher incidence amongst subjects of Indo‐Asian and African‐Caribbean origin compared with Caucasians that is not wholly explained by the differences in the prevalence of diabetes. Therefore, we postulated that this observation could be related to variations in the rate of progression of renal disease according to racial origin. [ABSTRACT FROM PUBLISHER]

The effects of propranolol and verapamil on contractile dysfunction, subcellular remodeling and changes in gene expression in cardiac hypertrophy due to pressure overload were examined. Rats were subjected to banding of the abdominal aorta and then treated with either propranolol (10 mg/kg daily), verapamil (5 mg/kg daily) or vehicle for 8 weeks after the surgery. Depression of the left ventricular function in the hypertrophied heart was associated with decreases in myofibrillar and myosin CA2+ ATPase activities as well as Ca2+-pump and Ca2+-release activities of the sarcoplasmic reticulum (SR). The level of a-myosin heavy chain (α-MHC) mRNA was decreased while that of β-MHC mRNA was increased in the pressure-overloaded heart. The level of SR Ca2+-pump ATPase (SERCA2) mRNA and protein content for SERCA2 were decreased in the pressure overloaded heart. Treatment of the hypertrophied animals with propranolol or verapamil resulted in preservation of the left ventricular function and prevention of the subcellular alterations. Shift in the α- and β-MHC mRNA levels and changes in the expression in SERCA2 mRNA level and protein content were also attenuated by these treatments. The results suggest that blockade of β-adrenoceptors or voltage-dependent calcium channels normalizes the cardiac gene expression, prevents subcellular remodeling and thus attenuates heart dysfunction in rats with cardiac hypertrophy. Furthermore, both cardiac β-adrenoceptors and L-type Ca2+-channels may be involved in the genesis of cardiac hypertrophy due to pressure overload. [ABSTRACT FROM AUTHOR]

Introduction: Hypertension is a leading cause of mortality worldwide and its prevalence is expected to rise over the next decade. Sex differences exist in the epidemiology and pathophysiology of hypertension. It is well established that antihypertensive treatment can significantly reduce the risk for stroke and other cardiovascular disease events. However, it remains unclear whether this effect is dependent on sex. In this protocol, we outlined a systematic review and meta-analysis to evaluate the effects of antihypertensive therapy in (1) reducing blood pressure and (2) preventing cardiovascular morbidity and mortality outcomes for each sex separately., Methods and Analysis: The following electronic databases will be searched: Medline, Embase, The Cochrane Library, PubMed, Cumulative Index of Nursing and Allied Health Literature Plus, Web of Science, grey literature (Google Scholar) and several trial registries. Search strategies will be designed to identify human adult (≥18) randomised (and non-randomised) controlled trials, prospective and retrospective cohort studies, and case-control studies concerning 'sex-specific differences associated with the efficacy of antihypertensive treatment'. A preliminary search strategy was developed for Medline (1946-16 September 2019). Two investigators will independently review each article included in the final analysis. Primary outcomes investigated are cardiovascular morbidity and mortality and systolic and diastolic blood pressure. Pooled analyses will be conducted using the random-effects model. Publication bias will be assessed by visual inspection of funnel plots and by Begg's and Egger's statistical tests. Between-studies heterogeneity will be measured using the I 2 test (p<0.10). Sources of heterogeneity will be explored by sensitivity, subgroup and metaregression analyses., Ethics and Dissemination: This is the first meta-analysis that will comprehensively compare the efficacy of antihypertensive treatment regimens between men and women. Findings will be shared through scientific conferences and societies, social media and consumer advocacy groups. Results will be used to inform the current guidelines for management of hypertension in men and women by demonstrating the importance of implementing sex-specific recommendations. Ethical considerations are not applicable for this protocol., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

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.)