Current Hypertension Reviews (v.10, #4)

Heart failure with preserved ejection fraction (HFPEF) is a syndrome that frequently occurs in older people and patients with cardiovascular risk factors, particularly hypertension. This syndrome is not a specific disease process, whereas is associated with high morbidity and mortality in patients with heart failure with reduced ejection fraction (HFREF) as well. Therefore, a “one size fits all” diagnosis strategy is unlikely to operate for patients with HFPEF. Assessment of left atrial (LA)-left ventricular (LV)-arterial coupling seems to have a clinical impact on hypertensive patients, because HF signs and symptoms have been found to be significantly related to inappropriate LA-LV interaction during diastole and LV-arterial interaction during systole. Two-dimensional speckle tracking echocardiography (2DSTE) is a new tool that may have a role in earlier detecting the impaired LA, LV, and arterial function in asymptomatic patients. This review explored the impact of LA-LV-arterial coupling in understanding the pathophysiology of hypertension as a road to HFPEF, and the possibilities of clinical application by using 2DSTE.

The Clinical Utility of Ambulatory Blood Pressure Monitoring (ABPM): A Review by Harry Harianto, Michael Valente, Soenarno Hoetomo, Mahesan Anpalahan (189-204).
The current evidence suggests that ambulatory blood pressure monitoring (ABPM) should be an integral part of the diagnosis and management of hypertension. However, its uptake in routine clinical practice has been variable. This paper reviews the current evidence for the role of ABPM in clinical practice, including in hypotensive disorders and in specific comorbidities. It further discusses the clinical significance of abnormal ambulatory blood pressure patterns and hypertensive syndromes such as white coat, masked and resistant hypertension.

Neonatal Hypertension: An Underdiagnosed Condition, A Review Article by Deepak Sharma, Aakash Pandita, Sweta Shastri (205-212).
Advances in neonatology and intensive monitoring has increased our ability to identify and measure blood pressure in sick premature and term infants and this has contributed to an increased awareness of hypertension in the NICU. A few recent studies done by Zubrow and others have offered many new information on blood pressure values over the first month after birth and on other many intrinsic and extrinsic factors that can cause effects on the blood pressure in the neonatal period. There are no definite cut off for labelling hypertension in newborn period and also doubts are there on the pharmacological treatment. This is a field in neonatology which is least studied hence requires further inquiry. This review article will cover several aspects of neonatal hypertension like definition, normotensive data, etiology, clinical characteristics, diagnostic modalities, treatment choices and long term effect of these newborns.

Vascular Oxidative Stress: A Key Factor in the Development of Hypertension Associated with Ethanol Consumption by Carla S. Ceron, Katia C. Marchi, Jaqueline J. Muniz, Carlos R. Tirapelli (213-222).
The observation that the excessive consumption of ethyl alcohol (ethanol) is associated with high blood pressure is nearing its centennial mark. Mechanisms linking ethanol consumption and hypertension are complex and not fully understood. It is established that chronic ethanol consumption leads to hypertension and that this process is a multimediated event involving increased sympathetic activity, stimulation of the renin-angiotensin-aldosterone system with a subsequent increase in vascular oxidative stress and endothelial dysfunction. Under physiological conditions, reactive oxygen species (ROS) play an important role as a signaling molecule in the control of vascular tone and endothelial function. Increased ROS bioavailability is associated with important processes underlying vascular injury in cardiovascular disease such as endothelial dysfunction, vascular remodeling, and inflammation. Studies focusing on molecular mechanisms showed a link between overproduction of ROS in the vasculature and ethanol-induced hypertension. Of the ROS generated in vascular cells, superoxide anion (O2-) and hydrogen peroxide (H2O2) appear to be especially important. Ethanol-mediated generation of O2- and H2O2 in vascular tissues is associated with elevations in intracellular calcium ([Ca2+]i), reduced nitric oxide (NO) bioavailability, endothelial dysfunction and vasoconstriction. O2- can also act as a vascular signaling molecule regulating signaling pathways that lead to vascular contraction. Thus, through increased generation of ROS and activation of redox-sensitive pathways, ethanol induces vascular dysfunction, a response that might contribute to the hypertension associated with ethanol consumption. The present article reviews the role of ROS in vascular (patho)biology of ethanol.

The Role of Transforming Growth Factor β1 in the Regulation of Blood Pressure by Kota Matsuki, Catherine K. Hathaway, Marlon G. Lawrence, Oliver Smithies, Masao Kakoki (223-238).
Although human association studies suggest a link between polymorphisms in the gene encoding transforming growth factor (TGF) β1 and differing blood pressure levels, a causative mechanism for this correlation remains elusive. Recently we have generated a series of mice with graded expression of TGFβ1, ranging from approximately 10% to 300% compared to normal. We have found that blood pressure and plasma volume are negatively regulated by TGFβ1. Of note, the 10% hypomorph exhibits primary aldosteronism and markedly impaired urinary excretion of water and electrolytes. We here review previous literature highlighting the importance of TGFβ signaling as a natriuretic system, which we postulate is a causative mechanism explaining how polymorphisms in TGFβ1 could influence blood pressure levels.

Hypertensive Cardiomyopathy in Asymptomatic Patients: A Neglected Diagnosis by Pasquale Palmiero, Maria Maiello, Annapaola Zito, Marco M. Ciccone (239-245).
Hypertensive Cardiomyopathy diagnosis includes different clinical conditions, on asymptomatic patients, assessed by LV changes in geometry, mass and function, i.e. concentric remodeling, concentric or eccentric hypertrophy and filling impairment or early stage of diastolic dysfunction. Often LA is involved and increases its volume and undergoes to geometrical remodeling. Sometimes it occurs clinical heart failure, the patients became symptomatic, with either a preserved or a reduced LVEF. There is considerable variability in the progression from hypertension to Hypertensive Cardiomyopathy, according to differences in the pressure or volume load and to underlying neurohormonal status; but these differences in LV geometry probably are influenced on genetic basis too. A better comprehension of the mechanisms underlying the development of Hypertensive Cardiomyopathy on hypertensive patients will help to prevent among them the onset of cardiovascular events.