updated 9:24 PM BST, Apr 8, 2020

2020 January-March Volume 6 Issue 1

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INVITED REVIEW

Fibromuscular dysplasia – underestimated cause of renovascular hypertension?

Ewa Warchoł-Celińska, Aleksander Prejbisz, Andrzej Januszewicz
Department of Hypertension, Institute of Cardiology, Warsaw, Poland

Abstract

Based on a current definition, fibromuscular dysplasia (FMD) is an idiopathic, segmental, non-atherosclerotic and non-inflammatory disease of the musculature of arterial walls leading to the stenosis of small and medium-sized arteries. For many decades, FMD was believed to be solely a disease of the renal arteries being a cause of renovascular hypertension in young women, which only occasionally affected the carotid arteries. Over the last years, however, there is growing evidence that FMD is not a local disease of one or two arteries, but in fact, a systemic arteriopathy that can affect practically every medium-sized artery. The large international registries and prospective studies not only showed the multivessel involvement of stenotic FMD lesions but also proved frequent coexistence of vascular complications such as dissections and aneurysms in FMD patients. Also, tortuosity and S-shaped cervical arteries were documented to be highly frequent in FMD patients. Recent study showed that FMD patients had smaller visceral arterial diameters when compared to patients without FMD. If all these findings reflect a new phenotype of FMD, as a generalized arteriopathy, needs further investigation and confirmation in larger cohorts. Also, there is a need to conduct further research on the genetic background as well as the emerging biomarkers of the disease to better characterize the pathophysiology of FMD.

J Hypertens Res (2020) 6(1):1–9 [download PDF]

REVIEW

Metabolic syndrome, nutritional deficits and heart failure

Nicoleta-Monica Popa-Fotea 1,2, Miruna Mihaela Micheu 2, Maria Dorobantu 1,2
1 Cardiology Department, Carol Davila University of Medicine and Pharmacy, Clinical Emergency Hospital, Bucharest, Romania 
2 Cardiology Department, Clinical Emergency Hospital, Bucharest, Romania

Abstract

Heart failure (HF) is the most common cause of death in subjects over 65 years old. Despite the new pharmacological and non-pharmacological developments, HF remains a challenge for physicians worldwide. There is a high correlation between the components of metabolic syndrome (MS) and the incidence of HF, but the mechanisms through which these cluster of factors influence HF is still under debate; furthermore, in chronic, advanced HF, obesity and arterial hypertension have paradoxical effects, being associated with better outcomes. In this article, will revise the role of each individual risk factor for the development of HF with a focus on the therapeutic windows for major adverse cardiac events reduction. HF is also highly associated with various nutritional deficits that may influence the overall outcome; some of the most important nutritional deficits will be discussed related to the impact of diet supplementation in HF.

J Hypertens Res (2020) 6(1):10–18 [download PDF]

ORIGINAL ARTICLES

Ambulatory blood pressure variability and elevated non-specific inflammatory markers

Annamária Magdás 1,2, Anna-Boróka Tusa 2, Ioana Coman 2, Cristian Podoleanu 1,2
1 University of Medicine, Pharmacy, Sciences and Technology of Tirgu Mures, Tîrgu Mureș, Romania
2 Department for Internal Medicine III, County Clinical Hospital Mures, Tîrgu Mureș, Romania

Abstract
Objective: In the age of the biomarkers, costly and unnecessary determinations are frequent. It has been observed that hypertension is associated with abnormalities of the erythrocyte series by increasing the level of red blood cell distribution width (RDW) and neutrophil-lymphocyte ratio (NLR). Blood pressure variability (BPV) seems to be a surrogate risk factor in hypertension. The goal was to test the relationship between BPV and “non-specific” markers of inflammation. Method: A number of 53 treated hypertensive patients were included. From the complete blood count (CBC) neutrophil-lymphocyte percentage ratio and red cell distribution width (RDW) were calculated. Based on 24-hour ambulatory BP monitoring (ABPM), BPV was calculated by the average real variability (ARV). Using the median of this value, the subjects were divided into low and high variability groups. The inflammatory status of the groups, the correlation between biomarkers of inflammation and BPV were analyzed. Result: The median ARV was 10.89 mmHg, the NLR in the low versus increased variability group was 2.83±0.14 vs. 2.32±0.2, p=0.04, and the RDW was 13.2±0.34% vs 12.52±0.20% in the high variability group, p=0.03. We found a positive correlation between RDW and BP variability, p=0.00, r2=0.19, CI 0.1220 to 0.6009. The correlation between NLR and ARV was statistically less significant, p=0.05, r2=0.07, CI: 0.01101- 0.5087. Conclusions: Increased blood pressure variability appears to be associated with a more pronounced inflammatory status. The NLR and RDW as parts of the routine investigations are cost-effective and could be useful for screening of patients with high cardiovascular risk for specific investigations.

J Hypertens Res (2020) 6(1):19–22 [download PDF]

The importance of cardiac rehabilitation for chronic hypertensive patients with coronary artery disease

Teodor Vasilcu 1, Radu Sebastian Gavril 1, Bararu Iris 1, Gavril Irina Oana 2, Mihai Roca 2, Maria Magdalena Leon Constantin 1, Madalina Chiorescu 2, Florin Mitu 1
1 First Medical Department, Faculty of Medicine, Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania
2 Faculty of Medicine, Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania

Abstract
Arterial chronic hypertension represents a very important risk factor regarding the development of atherosclerosis which in turn can progress to acute coronary syndromes. Cardiopulmonary exercise testing (CPET) has become a very important investigation in the assessment of exercise capacity and intensity of the patients who are performing cardiac rehabilitation. The purpose of our study was to objectify the relationships between the parameters of CPET and the echocardiographic parameters after the cardiovascular rehabilitation. We found a significant increase in oxygen consumption (VO2) values, anaerobic threshold, effort capacity and maximum heart rate and an improvement in the systolic function, marking a reduced cardiovascular risk.

J Hypertens Res (2020) 6(1):23–28 [download PDF]

CASE REPORT

Resistant hypertension, obstructive sleep apnea and chronic kidney disease: a menacing triangle

Mihaela Ionescu, Angela Sazie Gheorghe, Bogdan Cimpineanu, Laura Mazilu, Andra Iulia Suceveanu, Liliana Ana Tuta, Irinel Raluca Parepa
Faculty of Medicine, Ovidius University, Constanta, Romania

Abstract

We present a case study of a 49-years-old male patient with type 2 diabetes mellitus, renal pathology (right kidney lithiasis, stage IIIA-chronic kidney disease) and resistant hypertension in spite of five antihypertensive drugs combination. In our attempt to further refine the diagnosis, we excluded the causes of secondary hypertension such as renovascular and endocrine disorders. Because our patient was experiencing hypersomnia, prolonged asthenia and a higher-normal daytime sleepiness score (Epworth Sleepiness Scale = 6), we decided to perform respiratory polygraphy which identified a severe form of obstructive sleep apnea. After all these findings we concluded that obstructive sleep apnea was the aggravating setting for hypertension, so we added a nocturnal Continuous-Positive Airway Pressure (C-PAP) to the ambulatory treatment, with a significant improvement of patient’s outcome (target values achieved, serum lactate decreased).

J Hypertens Res (2020) 6(1):29–32 [download PDF]