Arterial stiffness and dipper/nondipper blood pressure status in women with preeclampsia

Introduction  The aim of this study was to investigate the clinical relevance of dipper status in women with preeclampsia by comparing arterial stiffness index (SI) values, and dipper and nondipper status. Methods  A total of 60 pregnant women in their third trimester were enrolled in the study. SI values were measured using a digital photoplethysmographic method (Pulse Trace System, Micro Medical Ltd., Gillingham, Kent, UK). Twenty-four-hour ambulatory blood pressure was measured by a SpaceLabs 90217 oscillometric device (SpaceLabs Inc., Redmond, WA, USA). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP) were recorded. Those preeclamptic women whose mean nighttime blood pressure measurements were at least 10% lower compared with mean daytime measurements were classified as dipper status, and those with a decrease of less than 10% were classified as nondipper status. Results  Seventeen women were preeclamptic with a dipper status, 13 women had nondipper status preeclampsia, and 30 women were normotensive. SI values were significantly higher in preeclamptic women compared with normotensive women (8.8±1.2 m/s vs. 5.9±0.8 m/s, P<0.001), but SI values of preeclamptic women with dipper status and preeclamptic women with nondipper status did not differ significantly from each other (P=0.485). Conclusion  There was no significant difference in SI values between the dipper and nondipper preeclamptic groups. These results indicate that dipper and nondipper measurements may not be suitable for clinical follow-up of preeclamptic women.     

不同给药时间对非杓型高血压病患者血压影响的探讨

目的通过临床观察和指导用药获得合理有效的给药时间,从而有效控制非杓型高血压患者血压水平。方法对30例非杓型高血压患者采用自身对照法,分别采用不同时间给予Ca2+通道阻滞剂和ACEI类药物进行治疗。先清晨服用Ca2+通道阻滞剂和ACEI类长效制剂,随后改为清晨(6:00～7:00)服用Ca2+通道阻滞剂,晚上(20:00～21:00)服用ACEI类长效制剂。两种给药方式均在实施4周后进行24h动态血压监测。结果分开给药后患者血压均得到了有效控制,分时段给药后24h平均压,nDBP,夜间平均压,dDBP,白昼平均压都显著降低,自身血压比较差异有显著意义(P0.05)。结论采用分时段给药可以达到有效平稳降压,从而有助于保护靶器官的结构和功能,最大程度地减少高血压相关并发症的发生。     

Patient‐tailored self‐management intervention for older adults with hypertension in a nursing home

Aims and objectives. This study was to evaluate the effects of a patient‐tailored self‐management intervention on (1) blood pressure control and (2) self‐care behaviour, exercise self‐efficacy and medication adherence among Korean older hypertensive patients in a nursing home. Background. Little is known about whether a patient‐tailored self‐management for nursing home residents with hypertension is likely to advance the care of this growing population worldwide. Design. A non‐equivalent comparison group design. Methods. Forty‐seven patients (23 and 24 in the intervention and comparison groups, respectively) participated in the study. No one withdrew during the eight‐week study period. Hypertensive patients in the intervention group received health education and tailored individual counselling for eight weeks to enhance the self‐management. Results. The mean age of patients was 77·4 years. Patients were on hypertensive medications for 11·8 years; only 36 of them took medications without assistance. The baseline comparisons of the patients with and without 8‐week intervention did not differ for clinical and demographic variables and outcome measures. Blood pressure decreased when comparing the baseline to eight weeks later from baseline; moreover, blood pressure was significantly reduced only in patients who received the intervention. Self‐care behaviour and exercise self‐efficacy significantly increased over time only in those who were in the intervention group. However, no significant difference was observed in medication adherence between the two groups. Conclusions. Patient‐tailored self‐management intervention was a practical approach for decreasing blood pressure and increasing self‐care behaviour in older hypertensive patients in a nursing home. Further studies are needed to validate these findings using a larger sample with long‐term follow‐up. Relevance to clinical practice. A patient‐tailored intervention is feasible not only to empower nursing home residents with hypertension for their care, but also to offer a qualified training and guidelines to nursing home staffs, expanding their professional competence in clinical practice.     

Development of the salt‐reduction and efficacy‐maintenance program in Indonesia

We conducted a randomized, controlled trial to examine the effects of a salt‐reduction and efficacy‐maintenance program on the improvement and maintenance of self‐care and self‐efficacy in reducing the salt intake of older people with high blood pressure. A total of 51 participants with hypertension/prehypertension in Indonesia were randomly assigned to a control group or one of two intervention groups: salt‐reduction training or salt‐reduction and efficacy‐maintenance. The salt‐reduction and efficacy‐maintenance group received educational training and a maintenance meeting; the participants' knowledge, attitudes, self‐care practices, and self‐efficacy significantly improved after training and were maintained after the maintenance meeting. Participants in the salt‐reduction training group showed significant effects for the same variables; however, their food salt concentrations rebounded after the maintenance meeting. No significant improvement was found in the control group. The salt‐reduction and efficacy‐maintenance group participants reported positive effects of salt reduction and different practices based on who prepared their meals. The salt‐reduction and efficacy‐maintenance group program was effective in improving and maintaining knowledge, attitudes, and self‐efficacy of salt‐reduction practices and could be applied with community‐dwelling older people with high blood pressure.     

Double‐stranded RNA‐dependent protein kinase signalling and paradigms of cardiometabolic syndrome

Metabolic syndrome (Met S) is a collection of the most severe cardiometabolic risk factors that encompasses raised fasting plasma glucose, dyslipidaemia, insulin resistance, obesity and hypertension. The precise mechanism underlying the pathogenesis of Met S remains unclear. More often oxidative stress, inflammation and apoptosis are implicated in its aetiology. Recently, double‐stranded RNA‐dependent protein kinase has been found to intersect at the cross‐road of oxidative stress, inflammation and apoptosis in several metabolic diseases. Therefore, an effort has been made in the present review to discuss the role of double‐stranded RNA‐dependent protein kinase and above‐mentioned mechanisms in the progression of Met S, along with its interlinking in major clinical manifestations of Met S such as hypertension and diabetic cardiomyopathy.     

E‐selectin gene in essential hypertension: a case‐control study

Background

Hypertension is associated with endothelial cell dysfunction. E‐selectin, an endothelial cell adhesion molecule, is specific for endothelial cell activation. Polymorphism in E‐selectin gene has recently been identified among which Leu554Phe E‐selectin gene polymorphism is least investigated in essential hypertension. This study reports the association of E‐selectin gene Leu554Phe polymorphism and the expression of E‐selectin gene in patients with essential hypertension.

Materials and methods

We analysed the Leu554Phe polymorphism and expression of E‐selectin gene in 250 patients with essential hypertension and 250 normal healthy controls. Genotyping of Leu554Phe polymorphism was performed by polymerase chain reaction‐restriction fragment length polymorphism (PCR‐RFLP), and the expression of E‐selectin gene at mRNA and protein levels were carried out by real‐time PCR and Western blot, respectively.

Results

A significant association of E‐selectin genotypes (CT + TT) with essential hypertension (P < .0001, Odds ratio = 2.2 [1.58‐3.24] at 95% CI) was observed. The expression of mRNA for E‐selectin gene in patients with essential hypertension was ~12‐fold higher as compared to control. We observed an elevated level of E‐selectin protein expression (up to 1.9 times) in patients as compared to controls.

Conclusions

A significant association of E‐selectin (Leu554Phe) gene and increased expression of E‐selectin gene at mRNA and protein levels in patients might be related to the genetic predisposition to develop essential hypertension.     

Do all antihypertensive drugs improve carotid intima‐media thickness?A network meta‐analysis of randomized controlled trials

The many clinical trials investigating the effect of various antihypertensive drugs on carotid intima‐media thickness (CIMT) produced conflicting results. We used meta‐analysis to evaluate CIMT changes and network meta‐analysis to rank drugs according to the magnitude of these changes. We identified 31 randomized controlled trials listed in three databases as of January 2008. Using a random‐effects model, we found a significant CIMT decrease with antihypertensive drugs compared to placebo (?0.10 [?0.16; ?0.04]). Overall effect sizes vs. placebo were significant for angiotensin‐converting enzyme (ACE) inhibitors (?0.08 [?0.14; ?0.02]), and a trend was found for beta‐blockers (?0.09 [?0.19; 0.01]). The data did not allow other direct comparisons vs. placebo. Significant benefits were found for calcium‐channel blockers (CCBs) compared to both ACE inhibitors (0.37 [0.20; 0.54]), as well as for angiotensin II receptor blockers (ARBs) compared to beta‐blockers (0.42 [0.29; 0.55]). Diuretics were less efficient than CCBs (?0.09 [?0.16; ?0.02]). Indirect comparisons with network meta‐analysis showed significant effects of CCBs and ARBs vs. placebo (both P < 0.05) and vs. diuretics (both P < 0.001). The CIMT decrease with ACE inhibitors and beta‐blockers was greater than with diuretics (both P < 0.05) but was not different from the placebo effect. In subgroup analyses, significant benefits occurred with lower baseline CIMT values and shorter treatment durations but were unrelated to the size of the blood pressure decrease. In conclusion, among antihypertensive drugs, CCBs and ARBs have the greatest effect on CIMT.     

Emergency management of eclampsia and severe pre‐eclampsia

Eclampsia and severe pre‐eclampsia are rare, but potentially life‐threatening conditions that emergency physicians must be able to diagnose and treat promptly, because initial presentations to the ED are real possibilities. The treatment of the major complications of this disorder, hypertension and seizures, have been the focus of much research. Magnesium sulphate is now the first line agent for acute treatment and prophylaxis of seizures in eclampsia and pre‐eclampsia. Severe pre‐eclampsia should be treated with magnesium to prevent progression to eclampsia. Severe hypertension requires treatment with an intravenous antihypertensive agent familiar to the clinician. No single antihypertensive has been proven to be better than another, although in Australia, hydralazine is probably the initial intravenous agent of choice. Routine use of invasive haemodynamic monitoring and volume expansion is not recommended and consultation with obstetric colleagues is essential.     

Isolated interrupted aortic arch in 42‐year‐old adult—case report

Interrupted aortic arch (IAA) is a rare congenital anomaly characterized by a complete luminal and anatomical interruption between the ascending and descending thoracic aorta. It is usually detected in the perinatal period or during infancy, but a very few cases have been reported in adults. Here, we present the case of a 42‐year‐old man who visited our hospital for arterial hypertension and in whom IAA was diagnosed with echocardiography and confirmed by computed tomography angiography. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound, 41:521–523, 2013;     

A new method to quantify postexercise ST‐deviation – the ST‐deficit. A study in men at high and low‐risk for coronary heart disease

Background Quantitative heart rate adjusted exercise ST criteria like μV/beats per minute (bpm) improve the diagnostic accuracy of the exercise ECG. However, there are few quantitative HR adjusted postexercise variables available. The aim of the present exercise study was to evaluate a new such variable from computerized averaging of the postexercise ECG. Methods The presence of possible myocardial ischaemia in a population based sample of 74 elderly male hypertensives at high‐risk of coronary heart disease, and in 42 age‐matched clinically healthy males (reference group) at low‐risk was assessed by exercise ECG. All men had a normal resting ECG without signs of ischaemia. Variables studied: standard ST‐criteria, ST/HR slope ≤–2·4 μV · bpm^–1, shape of the rate‐recovery loop, the latter also with a new quantitative variable, the ST‐deficit. Results In spite of a normal resting ECG many subjects showed an abnormal ST/HR slope during exercise, 43% in the hypertension group and 26% in the reference group. An abnormal rate‐recovery loop (ST‐deficit) also contributed substantially to identify patients with possible myocardial ischaemia, 30 vs. 10%, respectively (P<0·02); cumulatively for the two HR adjusted criteria 53% vs. 29%, respectively (P<0·02). Mean ST‐deficit was significantly lower in the high‐risk group. Conclusions Effort‐related myocardial ischaemia is frequently silent in elderly high‐risk hypertensives and necessitates testing, preferably with computerized exercise ECG and heart rate adjusted ST criteria. A new quantitative variable to assess the postexercise rate‐recovery loop in the time domain, the ST‐deficit is described. This variable seems to effectively discriminate between subjects with low and high‐risk for coronary heart disease and thus provides new information. Further studies are warranted to validate this variable against myocardial perfusion scintigraphy and coronary angiography.