Hypertension,social rank,and aortic arteriosclerosis in CBA/J mice

A significant rise in systolic blood pressure and increased aortic arteriosclerosis was observed over a period of four months in dominant male mice as compared to subordinate and control animals. Subordinate animals assuming the dominant position also developed a significant rise in blood pressure and dominant animals removed from social interaction showed a significant decrease in blood pressure. Males that were castrated failed to develop a social hierarchy and exhibited normotensive blood pressure. Also dominant animals exhibited higher plasma testosterone levels and more aortic arteriosclerosis than subordinates.     

Management of chronic heart failure in the older population

Chronic heart failure （CHF） is the leading cause of hospitalization for those over the age of 65 and represents a significant clinical and economic burden. About half of hospital re-admissions are related to co-morbidities, polypharmacy and disabilities associated with CHF. Moreover, CHF also has an enormous cost in terms of poor prognosis with an average one year mortality of 33%–35%. While more than half of patients with CHF are over 75 years, most clinical trials have included younger patients with a mean age of 61 years. Inadequate data makes treatment decisions challenging for the providers. Older CHF patients are more often female, have less cardiovascular diseases and associated risk factors, but higher rates of non-cardiovascular conditions and diastolic dysfunction. The prevalence of CHF with reduced ejection fraction, ischemic heart disease, and its risk factors declines with age, whereas the prevalence of non-cardiac co-morbidities, such as chronic renal failure, dementia, anemia and malignancy increases with age. Diabetes and hypertension are among the strongest risk factors as predictors of CHF particularly among women with coronary heart disease. This review paper will focus on the specific consideration for CHF assessment in the older population. Management strategies will be reviewed, including non-pharmacologic, pharmacologic, quality care indicators, quality improvement in care transition and lastly, end-of-life issues. Palliative care should be an integral part of an interdiscipli-nary team approach for a comprehensive care plan over the whole disease trajectory. In addition, frailty contributes valuable prognostic in-sight incremental to existing risk models and assists clinicians in defining optimal care pathways for their patients.     

纤维支气管镜在ICU肺源性ARDS患者治疗中应用的价值

目的 探讨纤维支气管镜在ICU肺源性ARDS患者治疗中应用的价值.方法 从本院ICU2010年10月至2013年10月收治的ARDS患者中随机选择45例进行研究.随机分为2组,分别予以常规治疗和常规治疗联合纤维支气管镜治疗.结果 观察组经纤维支气管镜支气管肺泡灌洗吸痰治疗,心率、气道压力、氧合指数均显著优于对照组（P值均＜0.05）.结论 纤维支气管镜在ICU肺源性ARDS患者治疗中具有一定的价值.     

江西省九江市老年高血压患者的糖尿病患病情况调查分析

目的对江西省九江市老年高血压患者的糖尿病患病情况进行调查分析。方法选取2013年1—6月在江西省九江市居住的1 507例老年高血压患者,根据糖尿病的诊断标准对其进行诊断,并对糖尿病患病率与年龄、BMI以及性别之间的关系展开研究。结果在1 507例老年高血压患者中共有248例患有糖尿病,患病率为16.46%(248/1 507)。其中男性患病率为16.28%(128/786),女性为16.64%(120/721),男女患病率比较,差异无统计学意义(P0.05)。不同年龄段患者间糖尿病患病率比较,差异有统计学意义(P0.05),其中76~81岁69~75岁62~68岁(P0.05)。不同BMI患者间糖尿病患病率比较,差异有统计学意义(P0.05),其中26.8 kg/m2高于23.8~26.8 kg/m2高于19.3~23.7 kg/m2(P0.05)。结论江西省九江市老年高血压患者的糖尿病患病率较高,高龄、高BMI可能是引发糖尿病的危险因素,针对危险因素进行有效的预防是降低糖尿病发病率、提高生活质量的重要途径。     

Corrélation entre les dosages des dérivés methoxylés urinaires et l’index d’apnée-hypopnée dans une population d’hypertendus : étude pilote

Aims

Sleep disorders like obstructive sleep apnea in adults are associated with increased sympathetic activity, which induced high blood pressure and could be associated with resistant hypertension. Some studies have demonstrated that high urinary catecholamine levels in obstructive sleep apnea patients may be decreased with continuous positive airway pressure therapy. However, very few studies have demonstrated a correlation between apnea-hypopnea index and urinary catecholamine levels in hypertension patients.

Methods

In this pilot study, 20 hypertensive patients referred for hypertension work-up including night-time polygraphy and 24 h urinary catecholamine dosage were included.

Results

Mean age was 51 ± 11 years (30–76), 68% were males. Diagnosis of obstructive sleep apnea was confirmed in 13 patients at the end of the work-up. Mean apnea-hypopnea index was 14 ± 9 (2–32). The only urinary catecholamine parameter significantly increased in patients with obstructive sleep apnea was 24 h urinary normetanephrine (1931 ± 1285 vs 869 ± 293 nmol/24 h; P < 0.05). However, this difference was not significant when this parameter was adjusted to 24 h urinary creatinine. We observed a significant positive correlation between AHI and 24 h urinary normetanephine (r = 0.486; P = 0.035).

Conclusion

This pilot study confirms an isolated elevation of 24 h urinary normetanephrine in hypertensive patients with obstructive sleep apnea and shows a significant correlation between sleep disorders expressed by apnea-hypopnea index and urinary catecholamines excretion.     

Load independent impairment of reverse remodeling after valve replacement in hypertensive aortic stenosis patients

Background

We evaluated the impact of hypertension on the left ventricular mass regression in aortic stenosis after aortic valve replacement.

Methods

We prospectively studied 135 patients with severe aortic stenosis at baseline and 1 year after surgery. In 32 patients we analyzed myocardial gene expression of collagen types I and III, connective tissue growth factor, transforming growth factor-β1, metalloproteinase-2 and its tissue inhibitor and compared its levels vs controls.

Results

Seventy-six patients (56.3%) had a history of hypertension. Hypertensive patients were older, had higher Euroscore-II and NYHA class, with no differences in stenosis severity. At 1 year follow-up there was a median decrease of mass index of 14.2% (P25–75: − 4.3%–30.4%; p < 0.001). Mass regression was significantly higher in patients without hypertension, with a median decrease of 25.9% (P25–75: 12.0%–38.7%) vs 5.4% (P25–75: − 12.5%–20.1%; p = 0.001), despite similar increase in effective orifice area and no differences in valvuloarterial impedance. After 1 year, higher baseline left ventricular mass index (p = 0.005) and the absence of hypertension (p = 0.002) or diabetes (p = 0.041) were the only independent predictors of mass regression higher than the median. Comparing with controls, aortic stenosis patients had an increased expression of collagen types I and III, but only hypertensive patients had higher relative expression of collagen type I vs III. In hypertensive patients TIMP2 expression was up-regulated and correlated with higher baseline left ventricular mass index (r = 0.61; p = 0.020).

Conclusions

In aortic stenosis, hypertension impairs mass regression one year after valve replacement, independently of total afterload. Differences in the expression of extracellular matrix remodeling genes might contribute to this finding.     

Sinoatrial node electrical activity modulates pulmonary vein arrhythmogenesis

Background

Sinoatrial node (SAN) dysfunction increases the occurrences of atrial fibrillation (AF). The pulmonary veins (PVs) play a critical role in the pathophysiology of AF. The purpose of this study was to evaluate whether SAN electrical activity can modulate PV arrhythmogenesis.

Methods

Conventional microelectrodes and multi-electrode array system were used to simultaneously record the electrical activity and conduction properties of rabbit SAN and PV tissue preparations with and without SAN–PV interruptions before and after perfusion with Anemonia sulcata toxin (ATX)-II (100 nM) or isoproterenol (1 μM).

Results

ATX-II significantly increased PV beating rates, which overdrove SAN electrical activity with the occurrences of PV burst firings in 5 (56%) of 9 tissue preparations, and induced SAN–PV conduction block in 6 (67%) of 9 preparations. After SAN–PV disconnection, ATX-II induced burst firing and early afterdepolarizations in 8 (89%) of 9 PVs. Moreover, the multi-electrode array found that ATX-II reversed the electrical conduction between the SAN and PV with an increase in electrical activity from 1.8 ± 0.6 to 2.9 ± 0.6 Hz (P < 0.05) in SAN–PV preparations (n = 7). In contrast, isoproterenol did not reverse electrical conduction between the SAN and PV with an increase in electrical activity from 1.8 ± 0.2 to 3.0 ± 0.3 Hz (P < 0.005) in SAN–PV preparations (n = 7).

Conclusions

SAN electrical activity modulates PV arrhythmogenesis. SAN–PV conduction blocks can increase PV arrhythmogenesis.     

自发性高血压大鼠肾脏血管紧张素转换酶2 mRNA转录及其蛋白表达

目的 观察不同月龄自发性高血压大鼠(SHR)肾脏血管紧张素转换酶2(ACE2)mRNA转录及其蛋白表达,初步探讨ACE2在高血压发生、发展过程中的可能作用.方法 雄性SHR 1月龄组(S1)、2月龄组(S2)、3月龄组(S3)、6月龄组(S6)和9月龄组(S9)共5组,每组各6只,各组均有相应月龄匹配的Wistar-Kyoto(WKY)大鼠作对照.采用RBP-Ⅰ型大鼠血压心率测定仪测量大鼠尾动脉收缩压(SBP);逆转录聚合酶链式反应(RT-PCR)法检测肾脏ACE2 mRNA的转录水平;免疫组化染色结合计算机图像分析方法 测定肾脏ACE2蛋白的表达水平.结果 1)SHR的SBP随着月龄的增加而上升,6月龄后趋于稳定.2)SHR和WKY肾脏ACE2蛋白和mRNA水平均随着月份的增加而增加,3月龄时达高峰,6月龄后趋于稳定;且SHR肾脏ACE2蛋白和mRNA水平均低于同龄的WKY.S1肾脏髓质内侧部ACE2免疫染色阳性面积百分比较皮质和髓质外侧部高,与1月后的分布相反.结论 1)SHR肾脏ACE2 mRNA和蛋白的表达水平比WKY大鼠低.2)大鼠肾脏ACE2 mRNA和蛋白的表达具有时间和部位分布上的差异.     

自发性高血压鼠心脏组织肌球蛋白轻链磷酸酶水平的研究

目的:比较自发性高血压大鼠(SHR)和正常血压大鼠(WKY)心脏组织的心肌肌球蛋白磷酸酶(MLCP)的130000、38000、21000亚单位含量的差异,以探讨MLCP与SHR心脏舒缩机制的关系。方法:在4℃的环境下,取SHR与WKY大鼠各10只断头处死,迅速取其心脏组织,称重速冻后将其磨成匀浆,置于缓冲液中并通过离心提取蛋白质,校正2组总蛋白的浓度后,分别应用SDS-PAGE、Western印迹杂交和化学发光的方法测定SHR与WKY心脏组织MLCP的130000、38000、21000亚单位的含量,对显影结果进一步进行吸光度扫描分析。结果:SHR和WKY大鼠心脏组织的MLCP的亚单位的含量不同,SHR的MLCP的130000、38000、21000亚单位含量均高于WKY大鼠(P<0.01)。结论:SHR与WKY大鼠心脏组织MLCP的130000、38000、21000亚单位含量有着明显的差异,提示心脏组织的MLCP结构或功能的异常可能与SHR高血压的病理机制有关。