Blood pressure and atherosclerosis

2005188 No association between 3 polymorphisms of transforming growth factor β3 gene and essential hypertension in Chinese. HU Bang-chuan (呼邦传), et al. Shanghai Instit Hyperten Ruijin Hosp, Shanghai 2nd Med Univ Shanghai 200025. Chin J Cardiol, 2005;33(2):127-130. Objective: To investigate possible association between the single nucleotide polymorphisms (SNPs) of transforming growth factor β3 (TGF-β3) gene and     

Repeated measures of blood pressure and correlations between systolic pressure,pulse pressure and LV mass: a circular debate?

This month's edition of the Journal contains an interesting contribution from Mule and colleagues from Palermo. The structure of the piece is very simple relating ambulatory blood pressure (ABP) measures for systolic, diastolic and pulse pressure to LV mass in hypertensive patients. The technique employed is linear correlation analysis. Pulse pressure is an area of interest of many of the readers, contributors and editorial board of the Journal. This is not a new area nor is this a new approach. The strategy of deriving biological inference from such data relevant to the individual by correlation analysis from a population sample deserves a closer and broader comment.     

Diastolic pressure, systolic pressure, or pulse pressure?

Diastolic pressure, systolic pressure, and pulse pressure have all been assigned the role of the best predictor of cardiovascular events during the 20th century. At the dawn of the new millennium, concepts that draw attention to vascular mechanics reconcile the seemingly conflicting results of epidemiologic studies, better define the hypertensive patient, evaluate more accurately the risk and set its markers, and ultimately optimize treatment through a logical approach that aims at the mechanism and not at the manifestation. Pulse wave analysis and measurement of arterial stiffness are valuable tools in the assessment and management of the hypertensive patient.     

Association and linkage analysis of the α-adducin gene and blood pressure

In Milan hypertensive rats, a variant in the α-adducin gene has been shown to account for approximately 50% of the interindividual variation in blood pressure levels between these animals and their normotensive counterparts. Additional studies have suggested that a polymorphism within exon 10 of the human α-adducin gene (Gly-460-Trp) may be associated with hypertension and salt sensitivity. On the basis of these observations, we investigated variation within or near the human α-adducin gene for linkage and association with a locus influencing blood pressure levels in 281 nuclear families (774 siblings aged 5 to 37 years; 380 parents aged 26 to 57 years), selected from the white population of Rochester, Minnesota, without regard to health. Sib pair linkage analyses (n = 852 sibling pairs) using a dinucleotide repeat marker (D4S43) that maps approximately 660 kb from the α-adducin gene provided no evidence of linkage between this marker locus and a locus influencing systolic, diastolic, or mean blood pressure levels. Allele frequencies for the Gly-460-Trp polymorphism were similar to those reported in other white populations (Gly = 0.812, Trp = 0.188); however, this polymorphism was not associated with any measure of blood pressure level in either parents or siblings. Therefore, variation within the α-adducin gene does not appear to have a major influence on measures of blood pressure in white families from Rochester, Minnesota.     

Diabetic foot ulcers—comparison of performance of ankle-brachial index and transcutaneous partial oxygen pressure in predicting outcome

Diabetic foot ulcer (DFU) is the commonest condition for hospital admission and usually the starting point of most diabetic related lower limb amputations. Considering the significant role played by vascularity in the outcome of ulcer healing, we undertook this study to find out the comparative utility of commonly used vascular assessment methods. This study was a single center prospective non-randomized observational study, conducted for a period of 6 months, in diabetic patients presenting with foot ulcers of Wagner Grade II and III. The aim of our study was to compare the performances of ankle-brachial index (ABI) and transcutaneous partial pressure of oxygen (tcPO₂) measurement in predicting wound healing in diabetic ulcers and to define the optimal cut-off value for Indian patients. Five hundred sixty-four patients were included in this study, with the mean age of 58 years. Eighty-seven patients (15%) had peripheral arterial occlusive disease. Four hundred seventy ulcers (83%) healed with the mean healing days of 42.6 days. Age, duration of diabetes, serum creatinine level, and presence of infection were the factors with negative impact in wound healing. In our study, ABI value of 0.6 was found to have 100% sensitivity and 70% specificity, and tcPO₂ value of 22.5 was found to have 75% sensitivity and 100% specificity in predicting wound healing. Both ABI and tcPO₂ are complementary, but tcPO₂ is a better predictor for amputation while ABI is a better predictor for ulcer healing. While assessing the ischemic status of foot ulcer, the cut-off values should be higher in diabetics than non-diabetics.     

Hypertension and the cardiometabolic syndrome--is it the blood pressure lowering or the blood pressure medication that is important?

Elevated blood pressure and the cardiometabolic syndrome are often difficult clinical challenges specifically related to fusing appropriate lifestyle modifications and antihypertensive agents. This case illustrates some of the factors clinicians have utilized in approaching patients with this common but challenging clinical situation.     

Effects of exercise and β-blocker on blood pressure and baroreflexes in spontaneously hypertensive rats

BackgroundExercise training or β-blocker decreases high blood pressure (BP) and improves abnormal baroreflex function associated with hypertension. This study was undertaken to examine whether the effects of exercise training are additive to β-blocker in spontaneously hypertensive rats (SHR).MethodsAt 5 weeks of age, SHR were allocated to four groups: sedentary control, exercise training, treatment with moderate dose of bisoprolol, and their combination. Systolic BP was monitored by the tail-cuff method under restrained conditions. Sigmoidal mean arterial pressure (MAP)–heart rate (HR) reflex curves were obtained in rats at 17 weeks of age under quiet conditions before and after atenolol to ensure sympathetic blockade and to determine the vagal component of gain. After studying baroreflex function, intrinsic HR was obtained by additional administration of atropine.ResultsBefore atenolol, both exercise training alone and bisoprolol alone lowered resting MAP and HR, and decreased upper plateau (maximal tachycardia) and lower plateau (maximal bradycardia), resulting in decreased sympathetic component of HR range (upper plateau − intrinsic HR) and increased vagal component of HR range (intrinsic HR − lower plateau). After atenolol, both exercise training alone and bisoprolol alone increased the gain of vagal component. Exercise training had no additive effect on any parameters to bisoprolol except for systolic BP and HR measured by the tail-cuff method.ConclusionsExercise training and bisoprolol have similar effects concerning resting hemodynamics and baroreflex function in SHR. Although additive effects of exercise training to bisoprolol are not evident under quiet, nonstressful conditions, some additive effects may be obtained under stress such as restrain.