Hypertension Canada

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The purpose of this study is to review the current literature related to the role of inorganic phosphate in the pathogenesis of hypertension. An increasing number of publications have revealed a detrimental role of inorganic phosphate, which is commonly used as a flavor enhancer or preservative in the processed food, in promoting hypertension in otherwise healthy individuals. Animal experimental data indicate that dietary phosphate excess engages multiple mechanisms that promote hypertension, including overactivation of the sympathetic nervous system, increased vascular stiffness, impaired endothelium-dependent vasodilation, as well as increased renal sodium absorption or renal injury. These effects may be explained by direct effects of high extracellular phosphate levels or increase in phosphaturic hormones such as fibroblast growth factor 23, or downregulation of klotho, a transmembrane protein expressed in multiple organs which possess antiaging property. Dietary phosphate, particularly inorganic phosphate, is an emerging risk factor for hypertension which is ubiquitous in the western diet. Large randomized clinical trials are needed to determine if lowering dietary phosphate content constitutes an effective nonpharmacologic intervention for prevention and treatment of hypertension.

Carotid-femoral pulse wave velocity (c-f PWV) is considered to be one of the main factors affecting CV risk in the hypertensive population and has been included to the detailed screening of the hypertensive patients according to the ESH guidelines. Despite the large number of studies proving the correlation of blood pressure (BP) and c-f PWV as well as arterial stiffness, there are only few studies to show which BP measurement method can better predict arterial stiffness. Generally, these studies express the superiority of ABPM in the prediction of c-f PWV and early vascular aging (EVA). Furthermore, while guidelines recommend measuring c-f PWV in the hypertensive population, on the other hand it is difficult, time consuming and expensive to measure arterial stiffness in the everyday clinical practice, limiting its use only for experts. These limitations lead to the creation of a new score, the Early Vascular Aging Ambulatory score (EVAAs), which uses parameters from the ABPM and other cardiovascular risk factors in order to identify the possibility of each patient to have EVA. The score should be further studied for its accuracy in a larger population, as well for predicting hard end points in prospective studies.

ABSTRACTBackground: Although inaccurate, non-reproducible blood pressure values can result from non-standardized assessments, recommended approaches to standardize blood pressure measurement are often not followed in research studies. Methods: An expert consensus of national and international health and scientific organizations developed recommended minimum standards for assessing blood pressure in research subjects where: 1) blood pressure or hypertension is a major endpoint, or 2) blood pressure is likely a major mediator of the research outcome. Results: Minimum research standards are presented for training of observers, technical aspects of assessing blood pressure, and equipment for both adults and children. Limitations: The standards are based on prior recommendations some of which did not conform to the current evidence based methods. Conclusions: All new research should require adherence to these minimum standards on the patient populations described above. Readers need to use caution in interpreting studies if the standards are not met in the defined populations.

Background: Central aortic pressure has often been shown to be more closely associated with markers of vascular function and incidence of cardiovascular events compared to peripheral pressure. However, the potential clinical use of central aortic or peripheral haemodynamic indices as markers of target organ damage (TOD) has not been fully established. Methods: We evaluated associations of TOD with central aortic and peripheral haemodynamic indices (central aortic [cPP] and peripheral pulse pressure [pPP], central aortic augmentation index, and central and peripheral waveform factor) in 770 hospital inpatients (age 60 ± 10 years, 473 males) with primary hypertension. TOD was quantified in terms of arterial stiffness as measured by carotid-femoral pulse wave velocity (cfPWV), carotid intima-media thickness (IMT), and urine albumin-to-creatinine ratio (ACR). Subclinical TOD was defined as carotid IMT >0.9 mm, urine ACR >3.5 mg/mmol in females and >2.5 mg/mmol in males and/or cfPWV >12 m/s. Results: Both cPP and pPP showed significant correlation with cfPWV (r = 0.41 vs. 0.40; p < 0.01), ACR (r = 0.24 vs. 0.27; p < 0.01) and carotid IMT (r = 0.14 vs. 0.15; p < 0.01). Each SD increase in pPP and cPP was associated with increased risk of cfPWV >12 m/s (odds ratio [OR] = 2.7 and 2.9 for pPP and cPP, respectively), ACR >2.5 mg/mmol (OR = 1.2 and 1.4, respectively), and carotid IMT >0.9 mm (OR = 1.46 and 1.53, respectively). Compared to pPP, cPP had higher predictive power for TOD for age ≥60 years (OR = 3.07, p < 0.001). Conclusions: Although both pPP and cPP show an association with TOD in a hypertensive population, cPP provides additional information beyond pPP associated with TOD in a hypertensive cohort. Central aortic haemodynamic indices as potential biomarkers of subclinical TOD need to be validated by further prospective studies.

IntroductionThe aim of the study was to assess the relation of baseline mechanical dyssynchrony with the left ventricular end-systolic volume (LVESV) decrease following cardiac resynchronization (CRT) therapy introduction.Material and methodsSixty consecutive patients (aged 66.3 ± 8.7 years; 57 men) with chronic heart failure (71.7% of ischaemic and 28.3% of non-ischaemic origin) and current indications for CRT were assessed before and 3 months after biventricular heart stimulator implantation. Longitudinal movements of twelve segments of the left ventricle (LV) (6 basal and 6 midlevel) and two segments of the right ventricle (RV) were analysed using tissue Doppler imaging (TDI) techniques with time from onset of Q wave in ECG to peak systolic velocity in colour-coded TDI (TTDI), time to peak strain (Tstrain) and time to peak strain rate (Tstrainrate). Minimal and maximal time differences within LV and between LV and RV walls were calculated.ResultsIn the study group LVEF and 6-min walk test distance increased, while NYHA class, NT-proBNP level, left ventricular end-diastolic volume and LVESV decreased. Significant correlations between the magnitude of LVESV reduction with maximal time differences between Tstrain of 12 LV segments (r=0.34, p = 0.017) and time differences between TTDI basal LV-RV segments (r = –0.29, p=0.041) were found.ConclusionsOnly a few TDI-derived parameters such as maximal time differences between Tstrain of 12 LV segments and TTDI difference of LV-RV basal segments can be useful to predict the magnitude of left ventricle reverse remodelling after CRT introduction.

Substantial evidence demonstrates that: 1) heavy alcohol consumption (three or more standard drinks per day) is associated with and predictive of hypertension; 2) reduction in alcohol consumption is associated with a significant dose-dependent lowering of mean systolic and diastolic blood pressure; and 3) physician advice can reduce heavy drinking in hypertensive patients. These findings suggest that the routine evaluation of alcohol consumption in hypertensive patients is warranted. The Alcohol Use Disorders Identification Test-C (AUDIT-C), a brief, three-question screening test, is useful in this regard. Alcohol biomarkers can also play a role in detecting and monitoring heavy drinking in hypertensive patients whose self-reports on the AUDIT-C are suspect. Carbohydrate-deficient transferrin, a new alcohol biomarker with high specificity, can provide objective data for feedback and counseling. A routine search for excessive use of alcohol, along with brief interventions and monitoring, can have a major impact on reducing the prevalence of hypertension in the general population.

Quintessenzb Regelmässiger Alkoholkonsum ist eine der wichtigsten Ursachen für einen erhöhten Blutdruck und/oder eine schwierig einstellbare