| For medical practitioners and the general public - High Blood Pressure Journal Article Catalog. |
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| Altered blood pressure course during normal pregnancy and increased preeclampsia at high altitude (3100 meters) in Colorado Palmer, S. K., L. G. Moore, et al. (1999), Am J Obstet Gynecol 180(5): 1161-8. Abstract: OBJECTIVE: Our purpose was to determine the case incidences of preeclampsia at low and high altitudes and whether maternal blood pressure course during pregnancy differs between low and high altitudes. STUDY DESIGN: This was a retrospective cohort study of pregnancies in sociodemographically matched communities at low and high altitudes in Colorado; each community had a small hospital served by family practitioners and was located >100 miles from major urban areas. Included were consecutive singleton pregnancies of women without chronic disease that resulted in live-born infants at >28 weeks' gestation during an 18-month period (n = 116 at 1260 m, n = 93 at 3100 m). Clinic and hospital medical records were searched and data pertaining to hypertensive complications of pregnancy and serial blood pressure measurements were abstracted. RESULTS: Despite similar maternal risk factors, the case incidences of preeclampsia were 16% at 3100 m and 3% at 1260 m. As in sea-level pregnancies, mean blood pressure fell until week 20 in normotensive pregnancy at 1260 m. Mean pressure rose linearly, however, in normotensive women at 3100 m and in women with preeclampsia at both 1260 m and 3100 m. High altitude acted independently of known risk factors and yielded an odds ratio for preeclampsia of 3.6 (95% confidence interval 1. 1-11.9). Birth weight was 285 g lower at 3100 m despite similar gestational ages. CONCLUSION: The normal pregnancy-associated fall in blood pressure was absent at 3100 m, even in women who remained normotensive. The incidence of preeclampsia was increased at high altitude. Residence at high altitude interferes with the normal vascular adjustments to pregnancy, increasing the incidence of preeclampsia, and is perhaps analogous to other conditions that decrease uteroplacental oxygen delivery. |
| Ambulatory blood pressure and metabolic abnormalities in hypertensive subjects with inappropriately high left ventricular mass Palmieri, V., G. de Simone, et al. (1999), Hypertension 34(5): 1032-40. Abstract: Appropriateness of left ventricular (LV) mass to cardiac workload can be evaluated by the ratio of observed LV mass to the value predicted for an individual's gender, height(2.7), and stroke work at rest (%PLVM). It is unclear which pathophysiological factors are associated with inappropriately high LV mass in hypertensive subjects. Adequate LV mass was defined by the 90% confidence interval (73% to 128%) of the distribution of %PLVM in 393 normal-weight normotensive subjects. In 185 hypertensive subjects (aged 56+/-11 years; 60% male, 29% black), according to %PLVM, 164 (88%) had adequate LV mass, 16 (9%) had inappropriately high LV mass (%PLVM >128%), and 5 (3%) had %PLVM <73% (low LV mass). Age, gender, smoking habit, proportion of never-treated subjects, total cholesterol, triglycerides, and creatinine levels did not differ significantly between subjects with adequate and inappropriately high LV mass. Body mass index, fasting glucose, and proportion of black subjects were higher (all P<0.05), while HDL cholesterol was lower (P<0.05) in subjects with inappropriately high LV mass. Blood pressure at the echocardiogram was comparable between subjects with adequate and inappropriately high LV mass, but the latter group had higher ambulatory blood pressure (P<0.01). Subjects with inappropriately high LV mass also had higher aortic root dimension and LV relative wall thickness and relatively lower LV systolic performance than those with adequate LV mass (all P<0.001). Larger aortic root diameter and lower systolic function were also found in hypertensive subjects with inappropriate LV hypertrophy compared with those with adequate LV hypertrophy. In an exploratory case-control study that compared subjects with low %PLVM with age-matched counterparts with adequate LV mass, low %PLVM was associated with lower body mass index, more favorable metabolic profile, and higher LV myocardial contractility. Higher body mass index, larger aortic root, and black race were independent correlates of increased %PLVM. Thus, in arterial hypertension, levels of LV mass inappropriately high for gender, cardiac workload, and height(2.7) are associated with higher body mass index, higher ambulatory blood pressure, larger aortic root diameters, and relatively low myocardial contractility. |
| Ambulatory blood pressure measurements in children and young adults selected by high and low casual blood pressure levels and parental history of hypertension: the Bogalusa Heart Study Berenson, G. S., E. Dalferes, Jr., et al. (1993), Am J Med Sci 305(6): 374-82. Abstract: Ambulatory blood pressure measurements were obtained in 57 children and young adults selected by prior high or low casual blood pressure levels and parental history of hypertension. Considerable variation in blood pressure levels occurred over 24 hours, with generally higher levels occurring in those so selected. Parental history had a small influence on higher levels, although statistical significance was not shown. Persons with higher blood pressure levels did not reach levels as low during sleep, especially with regard to the systolic measurement, and a greater variability was noted in those selected for higher levels. Although differentiation of persons with high and low blood pressure levels can be obtained by noting average levels persisting above a cut point, for example, 140/85, in growing children an arbitrary 90th percentile based on age, height, and weight may be more appropriate. Ambulatory monitoring showed that young persons, selected by casual measurements as having high blood pressure, have a greater percentage of high levels persisting over a 24-hour period, comprising a greater blood pressure load. These observations also showed that even two series of casual measurements may misclassify a person as having hypertension. Ambulatory blood pressure monitoring will enhance understanding of the early natural history of hypertension and allow improved prevention of the disease. |
| Ambulatory blood pressure monitoring in patients with hypertension on days of high and low geomagnetic activity Stoupel, E., C. Wittenberg, et al. (1995), J Hum Hypertens 9(4): 293-4. |
| Ambulatory blood pressure monitoring in physicians working in a hospital: is there an increase in the number of subjects with high workplace blood pressures? Stiefel, P., J. Gimenez, et al. (1994), Int J Cardiol 45(3): 183-9. Abstract: Sixty-two physicians from our hospital who were normotensives, as supported by casual blood pressure measurements, underwent 24-h blood pressure monitoring which included their normal work, home rest and sleep periods. During working hours, 19% of the subjects showed mean diastolic and/or diastolic plus systolic blood pressures higher than those admitted as normal by the WHO for casual measurements for out of work subjects. Both mean systolic and diastolic blood pressure measurements, during the work at the hospital, were significantly higher in males (P < 0.01 and P < 0.005, respectively) than the mean of the readings obtained during the 24-h period, but this phenomenon did not occur among the females. Male's mean systolic (129.8 +/- 10.6 vs. 117.1 +/- 9.7 mmHg, P < 0.0001) and diastolic pressures (83.4 +/- 8 vs. 74.9 +/- 7.3 mmHg, P < 0.001) were significantly higher during the working period in relation to those of the female group. Discussing the influence of the kind of work on blood pressure, we came to the conclusion of the existence in our environment of a group of subjects (generally males), presenting high blood pressure values during their working period at the hospital and normal or borderline values during the rest of the day. This should be of interest, since it has been reported that subjects with high workplace blood pressure have an increased risk of hypertension and target-organ damage. |
| Ambulatory blood pressure monitoring to screen for high-risk renal hypertensive patients Timio, M., S. Venanzi, et al. (1994), Contrib Nephrol 106: 141-7. |
| Ambulatory care for children and adolescents with high blood pressure Briedigkeit, W. and C. Reitzig (1977), Z Arztl Fortbild (Jena) 71(1): 10-3. |
| Ambulatory monitoring predicts development of drug-treated hypertension in subjects with high normal blood pressure Pannarale, G., C. Gaudio, et al. (2004), Blood Press 13(4): 247-51. Abstract: BACKGROUND: High normal blood pressure (HNBP), i.e. blood pressure (BP) > or = 130/85 mmHg and <140/90 mmHg, is an important predictor of progression to established hypertension. DESIGN: The purpose of this retrospective study was the evaluation of the predictive value of ambulatory blood pressure monitoring (ABPM) for the development of drug-treated hypertension in subjects with HNBP and other risk factors. METHODS: We studied 127 subjects (69 M, 58 F, age 50 +/- 14 years): 59 subjects had normal BP (NBP: < 130/85 mmHg), 68 subjects had systolic and/or diastolic HNBP. All the subjects underwent ABPM. There were 21/68 (30.9%) subjects in the HNBP group vs. 1/59 (1.7%) in the NBP group with an elevated (>135/85 mmHg) daytime ambulatory blood pressure (ABP) (p < 0.01). RESULTS: After an average follow-up of 103 +/- 28 months, 27 subjects (39.7%) in the HNBP group and 4 subjects (6.8%) in the NBP group developed drug-treated hypertension (p < 0.01). An elevated daytime ABP correctly predicted development of drug-treated hypertension in 17/21 subjects (81%) of the HNBP group and in the only subject of the NBP group. Development of drug-treated hypertension was associated with higher office and ambulatory BP (p < 0.01) and pulse pressures (p < 0.05), longer follow-up (p < 0.05) and higher prevalence of hypercholesterolaemia and smoking (p < 0.01). CONCLUSIONS: We conclude that ABPM correctly predicts development of drug-treated hypertension in most subjects who were identified early as having a daytime mean ABP >135/85 mmHg. ABPM appears to be a useful clinical tool in the early diagnosis of hypertension in subjects with metabolic risk factors and smoking. |
| Amelioration of high blood pressure in the elderly Priddle, W. W., S. F. Liu, et al. (1968), J Am Geriatr Soc 16(8): 887-92. |
| An 8-month-long controlled trial of low fat/high fiber diet. Effect on blood lipids and blood pressure in young healthy individuals Sandstrom, B., P. Marckmann, et al. (1993), Ugeskr Laeger 155(17): 1289-93. |
| An appraisal of the genetic approaches to high blood pressure Harrap, S. B. (1996), J Hypertens Suppl 14(5): S111-5. Abstract: BACKGROUND: The genetics of high blood pressure is a growing field. Remarkable discoveries have been made in the rare genetic causes of hypertension. However, if molecular biology is to achieve its full potential it must address more common forms of high blood pressure. The genetics of essential hypertension offers great potential but also presents special challenges. This review examines how genes might influence blood pressure, how we might organize the search for underlying genes, where we should look and the way in which genetic knowledge might be used. NEED FOR BROAD APPROACH: For reasons related to informative research design and the prevention of cardiovascular disease, genetic approaches need to address the variation of blood pressure from low to high levels, not only hypertension. NEED FOR GENETIC MARKERS: If there is to be a time when DNA testing will be routine, then it will depend on discovering genetic markers that are informative, reliable and cost-beneficial. |
| An approach to primary preventive treatment for children with high blood pressure in a total community Frank, G. C., R. P. Farris, et al. (1982), J Am Coll Nutr 1(4): 357-74. Abstract: A model designed as primary hypertension prevention for children ranking high in blood pressure, selected from a total population, was applied to a semirural, biracial community. A Dietary/Exercise Alteration Program Trial (ADAPT), in combination with low-dose medication, was tested on 48 children aged 8-18 years who were randomly selected from 100 children consistently in the upper blood pressure decile. The interactive model a) focuses on a major public health problem that is measurable and modifiable, b) outlines a preventive approach to involve children and parents in establishing healthy life styles, and c) converts community limitations into resources. The comprehensive program was developed to support eating and exercise modifications accepted for hypertension treatment without placing children in a sick role. Sodium reduction, weight control, and regular exercise are the life-style changes promoted. Indicators for evaluating development and implementation of ADAPT are presented. The commitment to written pledges, ie, making simple behavioral changes, had a significant inverse association with post-treatment sodium and energy intakes in regression models that included the child's curriculum and physical activity class attendance. ADAPT represents an initial approach for developing primary preventive treatment of early essential hypertension in a pediatric population. |
| An eight-month controlled study of a low-fat high-fibre diet: effects on blood lipids and blood pressure in healthy young subjects Sandstrom, B., P. Marckmann, et al. (1992), Eur J Clin Nutr 46(2): 95-109. Abstract: The effects on blood lipids and blood pressure of a diet corresponding to present Nordic Nutrition Recommendations, i.e. less than 30% of energy from fat and with a fibre content exceeding 3 g/MJ, were studied in 18 men and 12 women (mean age, 24 years) under strict dietary control over 8 months. Blood sampling, blood pressure and body weight measurement were performed at four occasions on their habitual diet and once a month during the intervention period. An age-matched control group (17 men, 8 women) was followed with monthly measurements parallel to the intervention group. The habitual diets, assessed by 7-day records, showed an average fat content corresponding to 36% of energy. Initial levels of total cholesterol and HDL cholesterol (X +/- SD) were 4.21 +/- 0.61 and 1.23 +/- 0.23 mmol/l for the men in the intervention group; 4.35 +/- 0.79 and 1.21 +/- 0.26 mmol/l for the male controls; 4.61 +/- 0.59 and 1.46 +/- 0.31 mmol/l for the women in the intervention group and 4.48 +/- 0.64 and 1.48 +/- 0.29 mmol/l for the female controls. Significantly decreased levels of total cholesterol and HDL cholesterol throughout the experimental period were seen for both sexes in the intervention group. Total cholesterol fell 0.49 mmol/l (95% CI: 0.41-0.56) in the male subjects and 0.49 mmol/l (95% CI: 0.39-0.59) in the female subjects. The fall in HDL cholesterol was 0.16 mmol/l (95% C: 0.13-0.18) and 0.18 mmol/l (95% CI: 0.12-0.23), respectively. Total cholesterol changes were independent of initial values. All subjects were normotensive at the start of the study with an average blood pressure of 122/68 mmHg for men and 112/68 mmHg for the women. Systolic blood pressure dropped gradually and significantly in the male subjects of the intervention group. A minimum of 6 mmHg below initial values was noted after six months of dietary intervention. No significant changes in dietary intake and blood lipids were observed in the control group. Thus, changes of present dietary habits of young healthy Danish subjects to an intake in accordance with the Nordic Nutrition Recommendations 1989 will favourably affect suggested risk factors for disease. |
| An epidemiologic approach to the study of high blood pressure Clark, E. G. and J. A. Morsell (1952), Am J Public Health 42(5:1): 542-8. |
| An Epidemiological Study Of High Blood Pressure, With Special Reference To The Influence Of Blood Pressure And Age On Cardiac Signs And Symptoms Humerfelt, S. B. (1963), Acta Med Scand 175: SUPPL407:1-233. |
| An epidemiological study on arterial blood pressure in 504 junior high school students of a Rome district Santucci, A., F. Aguglia, et al. (1980), Panminerva Med 22(4): 235-8. |
| An evaluation of the utility of high blood pressure detection fairs Wassertheil-Smoller, S., P. Bijur, et al. (1978), Am J Public Health 68(8): 765-70. Abstract: Our data indicate that voluntary casual screenings in essentially middle class locations may be of limited value in attracting the young, the black, and the male relative to the target population. Our screens attracted a large proportion of individuals who where already aware of their high blood pressure. Nevertheless, these screens can be useful in getting and keeping individuals under medical care: newly detected hypertensives, those who knew they have it and even some of those under treatment for it. |
| An osteopathic cardiologist's review of hypertension: beyond the Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure Williams, A. M. (1994), J Am Osteopath Assoc 94(10): 833-47. Abstract: Although hypertension was defined more than 100 years ago, it remains the leading cause of office visits and use of prescription drugs. Because hypertension is one of the major risk factors for premature death and disability, the medical community continues to strive toward more aggressive detection, follow-up, and treatment. The Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure provides an excellent guide for all health practitioners. This publication, along with several recent articles, have provided a comprehensive approach to the hypertensive patient. Although cerebrovascular events have been dramatically reduced by the treatment of hypertension, results regarding cardiac morbidity and mortality have been disappointing. Therefore, from a cardiologists' standpoint, the concept of cardioprotection has evolved into an important component in the treatment of the hypertensive patient. |
| Anger inhibition potentiates the association of high end-tidal CO2 with blood pressure in women Scuteri, A., D. Parsons, et al. (2001), Psychosom Med 63(3): 470-5. Abstract: OBJECTIVE: High resting end-tidal CO2 (PetCO2) has been shown to be an independent predictor of systolic blood pressure (SBP) in women, particularly older women. The study reported in this article investigated whether the tendency to experience, express, and/or suppress anger contributes to the association of PetCO2 and SBP in women and in men. METHODS: The Spielberger Anger Expression Inventory was administered to 403 healthy male and female participants in the Baltimore Longitudinal Study on Aging. Resting PetCO2 was obtained by means of a respiratory gas monitor, and resting blood pressure was obtained with an oscillometric device. The associations of resting PetCO2 and the anger scales with SBP and diastolic blood pressure (DBP) were investigated using multivariate regression analyses. RESULTS: PetCO2, as well as age and body mass index, was an independent predictor of SBP in women with low, but not high, trait anger and in women with low, but not high, anger-out. PetCO2 was not an independent predictor of SBP in men with either high or low anger. In addition, PetCO2 was not an independent predictor of DBP in either men or women. CONCLUSIONS: The results of this study indicate that inhibition of anger potentiates the relationship of high PetCO2 with SBP in women but not men. Additional studies are needed to determine the origins of the observed gender differences and the psychophysiological pathways by which high resting PetCO2 contributes to elevated resting blood pressure in women. |
| Angiotensin converting enzyme inhibition reveals an important role for the renin system in the control of normal and high blood pressure in man MacGregor, G. A., N. D. Markandu, et al. (1983), Clin Exp Hypertens A 5(7-8): 1367-80. Abstract: Captopril, given for 5 days to normotensive healthy subjects caused a significant fall in blood pressure. The fall in mean supine blood pressure was greater on a low sodium diet (10 mmols/day) - 19.6% and was less on a high sodium diet (350 mmols/day) - 11% compared to the normal sodium intake (120 mmols/day) when the fall in blood pressure was 16.5%. Patients with essential hypertension who were studied on their normal diet had a similar fall in blood pressure for a given plasma renin activity. It seems likely that the predominant mechanism whereby captopril lowers blood pressure is through the inhibition of the formation of angiotensin II. If this is so, our results suggest that the renin system is an important control of both normal and high blood pressure when on a normal sodium intake. |
| Angiotensin I-converting enzyme antisense prevents altered renal vascular reactivity, but not high blood pressure, in spontaneously hypertensive rats Gelband, C. H., H. Wang, et al. (2000), Hypertension 35(1 Pt 2): 209-13. Abstract: The renin-angiotensin system plays a critical role in the control of blood pressure, and its hyperactivity is associated with the development of human primary hypertension. Because low-dose angiotensin I-converting enzyme (ACE) inhibitors cause small reductions in blood pressure that are associated with the complete reversal of altered vascular pathophysiology, our objective in this study was to determine whether ACE antisense (ACE-AS) gene delivery prevents alterations in renal vascular physiology in the parents and F(1) offspring of AS-treated spontaneously hypertensive rats (SHR). A single bolus intracardiac injection of ACE-AS (2x10(8) colony-forming units) in SHR neonates caused a modest (18+/-3 mm Hg, n=7 to 9) lowering of blood pressure, which was maintained in the F(1) generation offspring (n=7 to 9). Alterations in renal vascular reactivity, electrophysiology, and Ca(2+)(i) homeostasis are underlying mechanisms associated with the development and establishment of hypertension. Renal resistance arterioles from truncated ACE sense-treated SHR showed a significantly enhanced contractile response to KCl and phenylephrine (n=24 rings from 6 animals, P<0.01) and significantly attenuated acetylcholine-induced relaxations (n=24 rings from 6 animals, P<0.01) compared with arterioles from ACE-AS-treated SHR. In addition, compared with cells dissociated from arterioles of ACE-AS-treated SHR, cells from truncated ACE sense-treated animal vessels had a resting membrane potential that was 22+/-4 mV more depolarized (n=38, P<0.01), an enhanced L-type Ca(2+) current density (2.2+/-0.3 versus 1.2+/-0.2 pA/pF, n=23, P<0.01), a decreased Kv current density (16.2+/-1.3 versus 5.4+/-2.2 pA/pF, n=34, P<0.01), and increased Ang II-dependent changes in Ca(2+)(i) (n=142, P<0.01). Similar effects of ACE-AS treatment were observed in the F(1) offspring. These results demonstrate that ACE-AS permanently prevents alterations in renal vascular pathophysiology in spite of the modest effect that ACE-AS had on high blood pressure in SHR. |
| Angiotensin II participates in stress-induced high blood pressure via stimulating hypothalamic vasopressin synthesis and release Lu, L. M., J. Wang, et al. (2000), Sheng Li Xue Bao 52(5): 371-4. Abstract: Experiments were carried out in male Sprague-Dawley rats. The animals were randomly divided into three groups: control, stressed and stress + captopril. Stress stimulations were composed of repeated electric foot-shock combined with noise, twice one day (2 h each session) for 15 consecutive days. Animals in the stress+captopril group were administered with captopril (50 mg/kg.d) intraperitoneally. The results showed that at the end of the 15-day experiment the systolic pressure of the tail artery in stressed rats was significantly higher than that of the control rats, i.e., 19.75+/ C1.0 kPa (n=8, P<0.05) versus 16.32+/ C0.55 kPa (n=7); the vasopressin (AVP) mRNA level in the hypothalamus of the stressed rats also increased significantly compared with that of the control rats, i.e., 12990.33+/ C1533.58 (n=6, P<0.001) versus 7332.66+/ C522.65 (n=6). However, in the stress + captopril rats, both the tail artery systolic pressure and hypothalamic AVP mRNA level were significantly higher than those of the control rats, but lower than those of the stressed rats. In the control rats, no significant change in mean blood pressure (MBP) was observed after intracerebroventricular (icv) injection of 0.3 microgram of d(CH(2))(5)Tyr(Me)AVP, a selective AVP V(1) receptor antagonist; however, a decrease in MBP was observed in both stressed and stress+captopril rats (P<0.05), but the decrease in stress+captopril rats was more obvious than that of the stressed rats after icv a same dose of d(CH(2))(5)Tyr(Me)AVP. These results indicate that the endogenous renin-angiotensin system participates in the mechanism of the stress-induced high blood pressure in rats, and that the effect of Ang II is mediated mainly by stimulating hypothalamic AVP synthesis and release, which in turn result in an increase in blood pressure by acting on the central V (1) receptors. |
| Angiotensin, high blood pressure and glomerular autoregulation Regoli, D. (2004), J Hypertens 22(4): 687-8. |
| Angiotensin, Sodium And High Blood Pressure. Mathisen, H. S. (1964), Tidsskr Nor Laegeforen 84: 1055-6. |
| Angiotensin-II blockade in man by sar1-ala8-angiotensin II for understanding and treatment of high blood-pressure Brunner, H. R., H. Gavras, et al. (1973), Lancet 2(7837): 1045-8. |
| Angiotensinogen dependency of blood pressure in two high-renin hypertensive rat models Gahnem, F., N. von Lutterotti, et al. (1994), Am J Hypertens 7(10 Pt 1): 899-904. Abstract: In this analysis we investigated whether angiotensinogen (Aogn) levels were related to blood pressure (BP) in two hypertensive rat models when renin secretion was either under physiologic regulation or out of control. These relationships were investigated using BP data from previous reports in which SHRsp and Dahl S rats were studied for 10 to 12 weeks while ingesting a high-salt diet with and without the angiotensin II (AngII) antagonist losartan. During the first 4 weeks of high-salt diet, plasma renin concentration (PRC) was appropriately suppressed but it subsequently increased paradoxically in both strains. During the first 4 weeks, when renin secretion was under normal control, as indicated by its suppression by the high-salt diet and by an inverse relationship between PRC and BP (r = -0.69, P <.001 and r = -0.53, P <.01 in Dahl S and SHRsp, respectively), there was no relationship between BP and plasma Aogn. In contrast, when renin secretion increased paradoxically, the inverse relationship between BP and PRC was lost and a positive relationship was found between BP and plasma Aogn in both Dahl S rats (r = 0.70, P <.01) and SHRsp (r = 0.57, P <.01). There was no relationship between BP and Aogn in either strain during treatment with losartan either before or after 4 to 6 weeks of salt feeding. These results show Aogn dependency of BP, but only under conditions in which renin cannot feed back normally. The Aogn relationship to BP was most likely dependent on the vasoconstrictor effect of AngII since it was lost during AngII AT1 receptor antagonism. |
| Another nobel laureate honored by the council for high blood pressure research Frohlich, E. D. and L. G. Navar (1999), Hypertension 34(4 Pt 1): 533. |
| Antibody to marinobufagenin lowers blood pressure in pregnant rats on a high NaCl intake Fedorova, O. V., N. I. Kolodkin, et al. (2005), J Hypertens 23(4): 835-42. Abstract: OBJECTIVE: The pathogenesis of pre-eclampsia (PE), a major cause of maternal and fetal mortality, is not fully understood. Digitalis-like sodium pump ligands (SPLs) are believed to be implicated in PE, as illustrated by clinical observations that DIGIBIND, a digoxin antibody that binds SPLs, lowers blood pressure (BP) in PE. We recently reported that plasma levels of marinobufagenin (MBG), a vasoconstrictor SPL, are increased four-fold in patients with PE. In the present study, we tested whether a polyclonal antibody to MBG can lower BP in rats with pregnancy-associated hypertension. METHODS: Systolic BP (SBP), 24-h renal excretion of MBG and endogenous ouabain (EO), and sodium pump activity in the thoracic aortae were measured in virgin and pregnant Sprague-Dawley rats without and with NaCl supplementation (drinking 1.8% NaCl solution). RESULTS: NaCl supplementation of virgin rats stimulated renal excretion of MBG by 60%, but not that of EO, and did not change the BP. Compared with virgin rats, the last week of pregnancy in non-NaCl-loaded rats was associated with a decrease in SBP (106 +/- 2 versus 117 +/- 2 mmHg); a moderate increase in renal excretion of MBG (97.6 +/- 4.9 versus 57.4 +/- 7.0 pmoles/24 h) and EO (36.2 +/- 4.3 versus 24.1 +/- 3.2 pmoles/24 h). NaCl-loaded pregnant rats exhibited elevation in SBP (139 +/- 3 mmHg; P < 0.01 versus non-NaCl-loaded pregnant rats), in renal excretion of MBG (160.0 +/- 17.5 pmoles/24 h; P < 0.01 versus non-NaCl-loaded pregnant rats), but not in EO, and showed fetal growth retardation. Administration of the anti-MBG antibody to NaCl-loaded pregnant rats lowered SBP (111 +/- 2 mmHg; P < 0.01) and increased aortic sodium pump activity (144 +/- 3 versus 113 +/- 5 nmol Rb/g per min; P < 0.01 versus non-NaCl-loaded pregnant rats). CONCLUSIONS: These observations provide evidence that MBG contributes to BP elevation in pregnant rats rendered hypertensive by NaCl supplementation. |
| Anticipatory blood pressure response to exercise predicts future high blood pressure in middle-aged men Everson, S. A., G. A. Kaplan, et al. (1996), Hypertension 27(5): 1059-64. Abstract: Increases in blood pressure during the period of emotional arousal attendant to impending exertion are well documented, yet the etiologic significance of these elevations is unknown. Research suggests that exaggerated cardiovascular responses to psychological stress may be importantly related to hypertension. We examined blood pressure reactivity in anticipation of an exercise stress test in relation to future hypertension in the Kuopio Ischemic Heart Disease Risk Factor Study, a population-based study of middle-aged men from Eastern Finland. Subjects were 508 unmedicated men with resting blood pressure less than 165/95 mm Hg who completed a bicycle ergometer stress test at baseline and whose hypertensive status was assessed at 4 years of follow-up. Systolic and diastolic reactivity were calculated as the difference between blood pressure measured after seated rest on the bicycle ergometer before initiation of exercise and mean seated resting blood pressure measured 1 week earlier. Logistic regression models adjusted for age and resting blood pressure revealed a graded association between quartiles of reactivity and risk of subsequent hypertension (> or = 165/95 mm Hg), with men showing systolic responses greater than or equal to 30 mm Hg or diastolic responses greater than 15 mm Hg at nearly four times the risk of becoming hypertensive (odds ratios, 3.80 95% confidence interval, 1.90 to 7.63 and 3.65 95% confidence interval, 1.86 to 7.17, respectively) relative to the least-reactive groups (systolic response, < 10 mm Hg; diastolic response, < 5 mm Hg). Adjustments for traditional risk factors for hypertension did not alter these associations. Results demonstrate the clinical significance of the pressor response in anticipation of exercise and support the hypothesis that cardiovascular reactivity to psychological challenge plays a role in the etiology of hypertension. |
| Antihypertensive effect and safety evaluation of vegetable drink with peptides derived from sardine protein hydrolysates on mild hypertensive, high-normal and normal blood pressure subjects Kawasaki, T., C. J. Jun, et al. (2002), Fukuoka Igaku Zasshi 93(10): 208-18. Abstract: A randomized double-blind placebo-controlled study was conducted on 63 subjects to determine the antihypertensive effect of a vegetable drink in which sardine protein hydrolysates containing a dipeptide, Valyl-Tyrosine (VY), were incorporated. The subjects, consisting of people with mild hypertension, high-normal blood pressure and normal blood pressure, were randomly divided into test (male/female = 25/6, average age 50.1 +/- 10.4 years old) and control groups (26/6, 49.0 +/- 5.0). Each subject in the test group was given 195 g of the vegetable drink containing 0.5 g of sardine peptides (sardine protein hydrolysates) with 0.4 mg of VY (test drink) once a day for 13 weeks in a row, and subjects in the control group were given the same amount of the vegetable drink without sardine peptides (control drink) in the same manner. In the test group, 40 subjects with mild hypertension or high-normal blood pressure (130 mmHg < or = systolic blood pressure (SBP) < 160 mmHg and/or 80 mmHg < or = diastolic blood pressure (DBP) < 100 mmHg) showed a significant decrease in SBP, from 142.0 +/- 10.3 mmHg at the start of the test to 134.4 +/- 11.1 mmHg during the first week of the test period, after which similar values were seen throughout the test period (13 weeks). Compared to the control group, the difference in SBP from baseline was statistically significant in the test group throughout the intake period. DBP also decreased significantly from 88.0 +/- 7.9 mmHg at baseline to 83.5 +/- 8.6 mmHg after 13 weeks. In the control group, SBP and DBP were 140.8 +/- 8.4 mmHg and 90.5 +/- 6.6 mmHg respectively at the start of the test, and neither decreased during the test period. In subjects with normal blood pressure, neither those in the test group nor those in the control group showed a significant change in SBP and DBP during the test period. An excessive ingestion test was performed on 25 subjects with hypertension, mild hypertension, high-normal blood pressure, and normal blood pressure by giving 585 g (3 times the recommended amount of intake) of the test drink for 14 days in a row. As a result, a significant decrease of blood pressure was observed in the hypertension, mild hypertension and high-normal blood pressure groups, but no excessive decline in blood pressure or any side-effects were associated with any subjects during the test period. In the groups with normal blood pressure, the excessive ingestion of the test drink did not affect blood pressure. In these two studies, physical check-ups and biochemical analyses of blood and urine were also conducted in all subjects, and no abnormalities were observed. These results suggest that the test drink containing sardine protein hydrolysates exhibited the antihypertensive effect in only the subjects with mild hypertension or high-normal blood pressure. No adverse effects were observed in either hypertensive or normotensive subjects. |
| Antihypertensive effect of casein hydrolysate in a placebo-controlled study in subjects with high-normal blood pressure and mild hypertension Mizuno, S., K. Matsuura, et al. (2005), Br J Nutr 94(1): 84-91. Abstract: We describe a clinical trial to study the efficacy of a casein hydrolysate, prepared using an Aspergillus oryzae protease, containing the major angiotensin-I-converting enzyme inhibitory peptides Val-Pro-Pro (VPP) and Ile-Pro-Pro (IPP) in a single-blind, placebo-controlled study. A total of 131 volunteers with high-normal blood pressure and mild hypertension were randomly divided into four groups (n 32 or 33 in each group). Each volunteer was given two tablets containing four different dosages of VPP and IPP (VPP+IPP: 0, 1.8, 2.5 and 3.6 mg), daily for 6 weeks. A significant decrease in systolic blood pressure was observed at 6 weeks in the active group receiving 1.8 mg (P<0.01) VPP and IPP; in the active groups receiving either 2.5 mg or 3.6 mg, systolic blood pressure was decreased at both 3 weeks (P<0.05 and P<0.05) and 6 weeks (P<0.001 and P<0.0001) compared with systolic blood pressure measured before treatment. Changes in the systolic blood pressure after 6 weeks of treatment in the four groups were --1.7, --6.3, --6.7 and --10.1 mmHg, and these effects were dose dependent. In addition, a significant difference in systolic blood pressure between the placebo group and the VPP and IPP group receiving 3.6 mg was observed (P<0.001) by two-way ANOVA. The antihypertensive effect was greater in mildly hypertensive subjects (n 20 or 21 in each group) than in any of the other subjects. No significant change of diastolic blood pressure was observed for all the test groups, and no differences in diastolic blood pressure in the test sample groups compared with the placebo group were observed during the test period. |
| Antihypertensive therapy in elderly patients. Pilot trial of the European Working Party on High Blood Pressure in the Elderly Amery, A., P. Berthaux, et al. (1977), Gerontology 23(6): 426-37. Abstract: A study protocol for a double-blind randomised control trial of hypotensive treatment in elderly hypertensive patients has been tested in a number of pilot centres throughout Europe. It was shown that this study is possible from the logistic point of view. In these elderly patients, hydrochlorothiazide + triamterene treatment with or without methyldopa, maintained a significant hypotensive effect in the absence of major electrolyte disturbances. The initiation of hypotensive therapy did not provoke an excess of cardiovascular complications. The influence of hypotensive therapy on the general well-being and on the morbidity and the mortality of elderly patients with high blood pressure, is thereby being assessed. The study will continue for 5 years and other centres are invited to join. |
| Antihypertensive therapy in patients above age 60 with systolic hypertension. A progress report of the European Working Party on High Blood Pressure in the Elderly (EWPHE) Amery, A., W. Birkenhager, et al. (1982), Clin Exp Hypertens A 4(7): 1151-76. Abstract: 1. Although systolic blood pressure elevation is responsible for increased incidence of cardiovascular accidents in old people, the preventive benefit of lowering systolic hypertension in elderly has not been confirmed. 2. A double blind study comparing the effects of a placebo and of an active regimen (hydrochlorothiazide-triamterene with or without methyldopa) in people over 60 years with isolated systolic hypertension has been undertaken by the European Working Party on High blood pressure in the Elderly (EWPHE). 3. The actively treated group shows a lowered sitting blood pressure (-15/6 mm Hg), a mild increase of serum creatine, serum uric acid and blood glucose and a mild decrease of serum potassium after two years of treatment when compared to the spontaneous changes observed in the placebo treated group. 4. The study is continuing to evaluate if the blood pressure reduction prevents or reduces the incidence of cardiovascular accidents, although some biochemical changes were provoked by the treatment. |
| Antihypertensive therapy in patients above age 60 years (Fourth Interim report of the European Working Party on High Blood pressure in Elderly: EWPHE) Amery, A., P. Berthaux, et al. (1978), Clin Sci Mol Med Suppl 4: 263s-270s. |
| Antihypertensive therapy in patients above age 60. Third interim report of the European Working Party on High blood pressure in Elderly (EWPHE) Amery, A., P. Berthaux, et al. (1978), Acta Cardiol 33(2): 113-34. Abstract: Three hundred forty nine hypertensive patients above the age of 60 have entered the double-blind multicentre trial of the European Working Party on High blood pressure in the Elderly (EWPHE). After stratification and randomisation half were treated with one or two capsules containing 25 mg hydrochlorothiazide and 50 mg triamterene and if blood pressure control was insufficient methyldopa was added up to 2 g daily; the other half received matching placebo. No significant differences between the groups were present prior to randomisation. A significant blood pressure difference of 25/10 mm Hg was obtained between the groups and maintained during two years of follow-up. No major disturbances in serum potassium or serum sodium were noted with the present drug combination. However, during the initial phase an increase in serum creatinine and serum uric acid was noted in the actively treated group, which was maintained for two years. Also glucose tolerance was impaired after 2 years in the actively treated group. A favourable influence on prognosis by active treatment can be expected on the basis of the blood pressure reduction and in the absence of major electrolytes disturbances. But this benefit must be proven by observed statistical differences in terminating events between the groups. Therefore the patients are being followed for a longer period of time and more patients are admitted into the trial. |
| Antihypertensive therapy: lessons learned from the national high blood pressure education program Cheitlin, M. (1975), Compr Ther 1(2): 34-8. |
| Antisense inhibition of beta(1)-adrenergic receptor mRNA in a single dose produces a profound and prolonged reduction in high blood pressure in spontaneously hypertensive rats Zhang, Y. C., J. D. Bui, et al. (2000), Circulation 101(6): 682-8. Abstract: BACKGROUND: beta-Blockers are the first line of therapy for hypertension. However, they are associated with side effects because of central nervous system (CNS) effects and beta(2)-adrenergic antagonism. To overcome these problems and provide a long-term beta(1)-blockade, antisense oligonucleotides against rat beta(1)-adrenergic receptor (beta(1)-AR) mRNA (beta(1)-AS-ODN) were designed and tested for the ability to inhibit cardiac beta(1)-ARs as well as lower blood pressure in spontaneously hypertensive rats (SHRs). METHODS AND RESULTS: Radioligand binding assay showed that a single intravenous injection of beta(1)-AS-ODN delivered in cationic liposomes significantly decreased cardiac beta(1)-AR density by 30% to 50% for 18 days (P<0.01), with no effect on beta(2)-ARs. This was accompanied by marked attenuation of beta(1)-AR-mediated positive inotropic response in isolated perfused hearts in vitro (P<0.02) and in conscious SHRs monitored by telemetry in vivo (P<0.02). Furthermore, the blood pressure of SHRs was reduced for 20 days, with a 38 mm Hg maximum drop. Heart rate was not significantly decreased. Quantitative autoradiography was performed to assess beta(1)-AS-ODN effects on the CNS, which demonstrated no changes in beta(1)-ARs in brain, in contrast to a significant reduction in heart and kidney (P<0.05). For comparison with beta-blockers, the effects of atenolol on cardiovascular hemodynamics were examined, which lowered blood pressure for only 10 hours and elicited appreciable bradycardia in SHRs. CONCLUSIONS: These results indicate that beta(1)-AS-ODN, a novel approach to specific beta(1)-blockade, has advantages over currently used beta-blockers in providing a profound and prolonged reduction in blood pressure without affecting heart rate, beta(2)-ARs, and the CNS. Diminished cardiac contractility resulting from less beta(1)-AR expression contributes to the antihypertensive effect. |
| Anti-sympathetic ganglia antibodies and postural blood pressure in IDDM subjects of varying duration and patients at high risk of developing IDDM Rabinowe, S. L., F. M. Brown, et al. (1989), Diabetes Care 12(1): 1-6. Abstract: We examined the sera of 94 subjects with insulin-dependent diabetes mellitus (IDDM) for the presence of complement-fixing sympathetic ganglia (CF-SG) antibodies. In a cross-sectional analysis (duration 0-43 yr), 22% had detectable CF-SG antibodies. Subjects at high risk for IDDM were also studied. Four groups were studied: group 1 (aged 4-64 yr) islet cell antibody-positive (ICA+) prediabetic subjects, 10 of 19 (53%) were CF-SG+; group 2 (aged 6-14 yr) ICA- prediabetic subjects (first-degree relatives of IDDM subjects with either transient hyperglycemia, impaired oral glucose tolerance, and/or first-phase insulin release after intravenous glucose tolerance testing), 4 of 9 (44%) were CF-SG+ (2 of the 4 ICA- CF-SG+ subjects have progressed to IDDM); group 3 (aged 1.5-43 yr) ICA+ IDDM subjects (less than or equal to 1 yr duration) 6 of 10 (60%) were CF-SG+; and group 4 (aged 8-59 yr) ICA- IDDM subjects (less than or equal to 1 yr duration), 2 of 11 (18%) were CF-SG+. All groups had increased CF-SG compared with controls. Postural blood pressure and simultaneous CF-SG antibody measurements were performed in 28 IDDM subjects. The drop in systolic blood pressure was greater in the CF-SG+ subjects (P less than.05), and the frequency of CF-SG was greater in the mean to -2SD group (P less than.03) when data were analyzed within mean +/- 2SD of the normal blood pressure response. |
| Antithrombin III prevents blood pressure elevation and proteinuria induced by high salt intake in pregnant stroke-prone spontaneously hypertensive rats Shinyama, H., K. Yamanaga, et al. (1996), Biol Pharm Bull 19(6): 819-23. Abstract: In pregnant stroke-prone spontaneously hypertensive rats, salt-loading causes symptoms similar to those of human preeclampsia, such as hypertension and proteinuria. To seek evidence of the therapeutic potential in preeclampsia of antithrombin III (AT III), which is a serine protease inhibitor active on various enzymes of the coagulation cascade, we examined the effect of consecutive treatment with AT III on hypertension and proteinuria in this animal model. Salt-loading (2% NaCl diet) caused a significant elevation of systolic blood pressure on day 15-17 and of urinary protein excretion on day 17-19 of gestation, as compared with animals fed a normal diet. AT III, administered i.v. at a dose of 60 or 300 U/kg/d for 10 d from day 9-11 to 18-20, attenuated these pathological changes in a dose-dependent manner. Histological examination of the kidney revealed that AT III prevented the occurrence of arteriosclerosis and thickening of the capillary basement membrane. However, the pathological changes induced by salt-loading were not attributable to activation of the blood coagulation system. These results demonstrate that AT III has preventive action against salt-induced hypertension and proteinuria in pregnancy through a mechanism largely independent of its anticoagulant action. AT III may thus be beneficial for the treatment of clinical symptoms of preeclampsia. |
| Apolipoprotein E epsilon4 allele, elevated midlife total cholesterol level, and high midlife systolic blood pressure are independent risk factors for late-life Alzheimer disease Kivipelto, M., E. L. Helkala, et al. (2002), Ann Intern Med 137(3): 149-55. Abstract: BACKGROUND: Presence of the apolipoprotein E (apoE) epsilon4 allele, which is involved in cholesterol metabolism, is the most important genetic risk factor for Alzheimer disease. Elevated midlife values for total cholesterol level and blood pressure have been implicated recently as risk factors for Alzheimer disease. OBJECTIVE: To study the relative importance and the putative relationship among the apoE epsilon4 allele, midlife total cholesterol level, and midlife blood pressure as risk factors for late-life Alzheimer disease. DESIGN: Prospective population-based study. SETTING: Kuopio and Joensuu, eastern Finland. PARTICIPANTS: Participants were derived from random population surveys from 1972, 1977, 1982, and 1987. A total of 1449 persons (73%), 65 to 79 years of age, participated in the reexamination in 1998 (mean follow-up, 21 years). MEASUREMENTS: Midlife blood pressure and total cholesterol level, apoE genotype, and development of Alzheimer disease during follow-up. RESULTS: The apoE epsilon4 allele was an independent risk factor for Alzheimer disease, even after adjustment for midlife vascular risk factors and other confounders (odds ratio, 2.1 95% CI, 1.1 to 4.1). Similarly, elevated midlife values for serum total cholesterol level (odds ratio, 2.8 CI, 1.2 to 6.7) and systolic blood pressure (odds ratio, 2.6 CI, 1.1 to 6.6) were independent risk factors for Alzheimer disease, even after adjustment for apoE genotype and other confounding factors. CONCLUSIONS: The association between the apoE epsilon4 allele and Alzheimer disease does not seem to be mediated by vascular factors. The apoE epsilon4 allele, elevated midlife total cholesterol level, and high midlife systolic blood pressure are independent risk factors for Alzheimer disease. The risk for Alzheimer disease from treatable factors--elevated total cholesterol level and blood pressure--appears to be greater than that from the apoE epsilon4 allele. |