2019 October-December Volume 5 Issue 4
INVITED REVIEWS
Mitochondria - hypertension relationship, a novel ground for crossing the therapy frontier
Lucia-Doina Popov
Nicolae Simionescu Institute of Cellular Biology and Pathology of the Romanian Academy, Bucharest, Romania
Abstract
Mitochondria are viewed nowadays not only as the powerhouse of the cells, but also as a key contributor in signaling regulation of intracellular homeostasis and survival. The role of mitochondria in hypertension is a novel, hot topic. Although the mechanistic involved is only partly deciphered by now, attempts for exploitation of the results in clinical trials are ongoing, aiming alleviation of the hypertension-associated end organ dysfunctions. Here, we briefly examine the progress so far on: (i) the mutations in mitochondrial transfer RNA genes, as risk factors in maternally inherited essential hypertension, (ii) the distinctive mitochondrial traits associated with hypertension (mitochondrial-related oxidative stress, hyperacetylation, and Sirtuin 3 deficiency), and (iii) the state of art on mitochondria-targeted therapies in hypertension. The above topics point not only to the current trends of basic research on mitochondria - hypertension correlation, but also to novel conducts in hypertension prevention and therapy.
J Hypertens Res (2019) 5(4):143–147 [download PDF]
Cardiovascular, cerebrovascular and metabolic risk in primary aldosteronism – beyond hypertension
Raluca-Alexandra Trifanescu, Catalina Poiana
Carol Davila University of Medicine and Pharmacy, C.I. Parhon National Institute of Endocrinology, Bucharest, Romania
Abstract
Primary aldosteronism is the most common cause of endocrine hypertension. 5 to 10% of hypertensive patients had primay aldosteronism. Excessive aldosterone production is associated with hypertension, sodium retention, increased potassium excretion that may lead in 9-37% of cases to hypokalemia. Patients with primary aldosteronism have higher cerebrovascular and cardiovascular morbidity and mortality, higher metabolic risk, higher prevalence of sleep apnea, chronic kidney disease, diabetes mellitus, osteoporotic fractures than matched patients with essential hypertension and similar blood pressure values. From the cardiovascular point of view, both normokalemic and hypokalemic primary aldosteronism patients had higher prevalence of left ventricular hypertrophy, angina pectoris, non fatal myocardial infarction, heart failure and atrial fibrillation. In patients with aldosterone producing adenoma (APA), surgical removal of the tumor was associated with improvement of cardiovascular outcome, with similar events to essential hypertension during follow-up. By contrary, patients with bilateral idiopathic primary aldosteronism treated with mineralocorticoid receptor antagonists (spinolactone, eplerenone) showed persistent increased cardiovascular risk during follow-up if plasma renin activity remained suppressed (<1 μg/L/h). In patients treated with higher mineralocorticoid receptor doses, leading to unsuppressed plasma renin activity (≥1 μg/L/h), cardiovascular outcomes were similar to essential hypertension patients. Due to increased prevalence, high cardiovascular, cerebrovascular and metabolic complications associated to primary aldosteronism, efforts should be made for a proper screening (especially in patients with resistant hypertension, sleep apnea), an early diagnosis, a proper lateralization and treatment, in order to improve the outcome of these patients.
J Hypertens Res (2019) 5(4):148–153 [download PDF]
Primary hyperaldosteronism – a practical approach from the cardiologist perspective
Carina Ureche 1,2, Radu A. Sascau 1,2, Cristian Statescu 1,2
1 Institute of Cardiovascular Disease Prof. Dr. George I.M. Georgescu, Iasi, Romania
2 Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
Abstract
Primary hyperaldosteronism is the most common cause of endocrine secondary hypertension in the general population. Studies report a prevalence of primary hyperaldosteronism ranging from 10% of patients with BP > 180 mmHg and up to 20% of those with resistant hypertension. Regardless of the primary or secondary cause of hyperaldosteronism, increased levels of aldosterone can cause resistant hypertension and electrolyte imbalance. Moreover, individuals with primary hyperaldosteronism have an increased risk of long-term cardiovascular complications (stroke, coronary artery disease, atrial fibrillation, and heart failure) compared with those with essential hypertension. Given the increasing prevalence of primary hyperaldosteronism and the known impact on CV morbidity, early diagnosis is of utmost importance. This article aims to review the topic of primary hyperaldosteronism, with emphasis on patient evaluation and management.
J Hypertens Res (2019) 5(4):154–161 [download PDF]
REVIEW
The obesity paradox: a statistical outcome or a real effect of clinical relevance?
Ivona Mitu 1, Cristina Daniela Dimitriu 2, O. Mitu 3, Manuela Ciocoiu 4
1 Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
2 Department of Morpho-Functional Sciences (II), Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
3 Department of Medical Specialties (I), Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
4 Department of Morpho-Functional Sciences (II), Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
Abstract
Obesity is one of the most important risk factors for morbidity and mortality, especially when referring to cardiovascular diseases. Different obesity phenotypes are presented in the medical literature, each one describing a different cardiovascular risk profile. The most important phenotype that is directly linked to the obesity paradox (OP) is the metabolically healthy obese phenotype, characterizing individuals with a BMI ≥ 30 kg/m2 and no metabolic abnormalities. This phenotype strengthens the true existence of the OP. In the same time we need to consider all the possible influencers when concluding if the OP is real and worth taking into consideration by clinicians. Analyzing studies that mention the OP, we observed several limitations either of the study itself or of the BMI used to classify obese patients. These limitations are described in the present review and they are of great importance in understanding how the OP is defined and how it should be interpreted.
J Hypertens Res (2019) 5(4):162–166 [download PDF]
ORIGINAL ARTICLE
Directly observed treatment intake usefulness on the approach of drug adherence in patients with resistant hypertension
Andre Salgueiro 1, Loide Barbosa 2, Jose Alberto Silva 2, Jorge Polonia 3
1 USF Santa Clara, ACeS Póvoa de Varzim/Vila do Conde, Portugal
2 Unidade Hipertensão e Risco Cardiovascular, Hospital Pedro Hispano, Matosinhos, Portugal
3 Departamento de Medicina Faculdade de Medicina da Universidade do Porto, Porto, Portugal
Abstract
Introduction & aim: We intend to assess the usefulness of directly observed treatment intake (DOTI) in the control of adherence to anti-hypertensive medication in patients with HTAres. Methods: We studied 68 patients with Hres in outpatient hypertension clinic. Four were previously submitted to renal denervation. 24-h ambulatory BP (ABP) was evaluated before the procedure. In DOTI patients took all medications in the morning for 5 days under the supervision of a technician and performing on the fifth day a second ABP. In some patients a third ABP measurement was repeated 3-6 months after DOTI. Results: Out of the 68 patients 76% were female and 21% diabetics in average ageing 62 years and BMI 30 Kg/ m2. The average of antihypertensive agents was 4.6 ± 1.2 /day. After OTI casual, daytime and nighttime BP decreased significantly (24h from 149/82 + 13/13 to 131/74 +13/9 mm Hg, p < 0.01. In 36 patients (52.9%) there was an improvement with DOTI from the previous 24-h monitoring (i.e. the mean 24h BP was reduced to < 130/80 mm Hg or if 24h SBP and 24h DBP were both reduced by > 10%). After DOTI, 27 patients (39.7%) reported new adverse drug reactions. Out of these 36 subjects, 61% returned 3-6 months after DOTI to the previous BP values exhibited before DOTI. Conclusions: OTI can be performed with accuracy, thereby becoming a valuable tool to identify the non-compliance to therapy as a cause of HRes.
J Hypertens Res (2019) 5(4):167–172 [download PDF]
CASE REPORT
A secondary hypertension case report
Georgiana Savu 1, Sebastian Onciul 2, Maria Dorobantu 1,2, Roxana Onut 1, Alexandru Scafa Udriste 1
1 Cardiology Department, Clinical Emergency Hospital Bucharest, Bucharest, Romania
2 Cardiology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Abstract
A 46 years old patient was admitted to our clinic for progressive shortness of breath for two months, palpitations and headache. The patient was a smoker (20 packages/year) and had a history of dyslipidemia and arterial hypertension for a year. He has been taking three antihypertensives. The blood pressure in supine position was 190/100mmHg equally bilateral. The blood tests showed: mild hypokalemia (K 3.1mmol/L). The echocardiography revealed left ventricular hypertrophy, predominantly of the septal wall (12-13mm), without enlargement of the left ventricle and a normal systolic function (55% ejection fraction). Taking into consideration the resistant arterial hypertension in a young patient despite three antihypertensive drugs, a diagnostic work-up for secondary hypertension was initiated. The associated hypokalemia raised the suspicion of hyperaldosteronism. The serum level of aldosterone and renin were detected and the ratio between them showed a hypersecretion of aldosterone. An abdominal CT scan was performed and excluded an adrenal mass or another morphological causes that could emerge to hyperaldosteronism (renovascular causes, renin producing tumors, etc). Consequently, the final diagnostic was idiopathic primary hyperaldosteronism. In our case, the primary aldosteronism it is not associated with a specific secreting mass and thus surgery was not an option. The medical treatment remained the most suitable solution that can adjust the blood pressure values. The patient received Spironolactone 50mg od and Olmesartan/Amlodipine 40/5mg od, having a good outcome regarding blood pressure control..
J Hypertens Res (2019) 5(4):173–179 [download PDF]
LETTER TO THE EDITOR
The 2019 Conference of the Romanian Society of Hypertension
"New perspectives on the management of patients with arterial hypertension" - A conference report
Cornelia Bala
Department of Diabetes, Nutrition and Metabolic Diseases, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
No abstract available.
J Hypertens Res (2019) 5(4):180–183 [download PDF]