Current Hypertension Reviews - Volume 18, Issue 1, 2022

Background: Recent studies suggested that patients with coronavirus disease 2019 (COVID-19) who use renin-angiotensin system (RAS) inhibitors have an increased risk of respiratory failure and death. The hypothesis was that angiotensin-converting enzyme inhibitor (ACEIs) or angiotensin receptor blocker (ARBs) might up-regulate ACE2 expression that is used as a receptor for viral entry into cells. Objective: The purpose of this review is to discuss the existing evidence on the interaction between COVID-19 infection, ACE2 and ACEIs or ARBs and to examine the main implications for clinical practice. In addition, novel therapeutic strategies for blocking ACE2-mediated COVID-19 infection will be displayed. Methods: We performed a comprehensive review of the literature to identify data from clinical and experimental studies for the association between COVID-19 infection, ACE2 and RAS inhibition. Results: The current clinical and experimental evidence for ACEIs or ARBs to facilitate severe acute respiratory distress syndrome-coronavirus-2 (SARS-CoV-2) is insufficient to suggest discontinuing these drugs. Several observational studies arrive at the conclusion that the continued use of RAS inhibitors is unlikely to be harmful in COVID-19-positive patients. Conclusions: Further randomized trials are needed to answer the question of whether RAS inhibitors are harmful or beneficial to patients with COVID-19.

For all lives regardless of sex, the longitudinal increase in blood pressure (BP) with age is attributed to lifestyle, internal environments like systemic brain-derived neurotrophic factor (BDNF) signaling, and external environments, allowing the individuals to better adapt to the developmental and environmental changes. Basic levels of renin-angiotensin-aldosterone system (RAAS) components in males and females define the fundamental sex difference in BP, which may be set by prenatal programming and the profound influence of BP after birth. The innate sex difference in BP is magnified during puberty growth and later on, affected and modified by menopause in women. At the age of 70 and older, blood pressure has been found to be similar for men and women. Understanding the prenatal setup and development of sexual dimorphism in BP may provide preventative therapeutic strategies, including timing and choice of drugs, for individuals with abnormal BP.

Background: Preeclampsia (PE) is a pregnancy complication with serious maternal and neonatal consequences worldwide. Our understanding of PE pathophysiology has significantly evolved over the last decades by recognizing that endothelial dysfunction and systemic inflammation, with an associated angiogenic imbalance, are key pieces of this incomplete puzzle. In the present era, where no single treatment to cure or treat this obstetric condition has been developed so far, PE prevention and early prediction are the most useful clinical approach to reduce the PE burden. Introduction: Although most PE episodes occur in healthy nulliparous women, the identification of specific clinical conditions that increase the risk of PE dramatically provides a critical opportunity to improve outcomes by acting on potentially reversible factors, and also contributes to better understand this pathophysiologic enigma. Methods: Pertinent studies were searched in PubMed/Medline and Google Scholar (updated August 2020) using common keywords applied in the field of preeclampsia, inflammation and endothelial dysfunction. Given the design of this work as a narrative review, no formal criteria for study selection or appraisal were utilized. Conclusion: In this review, we highlight major clinical contributors of PE and shed light on their potential link with endothelial dysfunction and inflammation.

Hypertension is a major public health problem, affecting more than a quarter of the world's population causing serious cardiovascular problems. In recent years, different polymorphisms have been studied and helped to identify some candidate genes and hereditary syndromes associated with the molecular mechanisms involved in the development of hypertension. Therefore, it is important to identify these molecular mechanisms. This review exposes all the genes and polymorphisms that increase or decrease the risk of hypertension in different populations that are related to the renin angiotensin aldosterone system, G protein, salt excretion, aldosterone synthesis, lipid metabolism, mechanism of insulin resistance, vitamin metabolism, purines and sodium reabsorption. This document can be a useful tool in clinical practice, in addition to serving as a support for future research on this topic.

Hypertension is one of the most well-established risk factors for atrial fibrillation. Longstanding untreated hypertension leads to structural remodeling and electrophysiologic alterations, causing an atrial myopathy that forms a vulnerable substrate for the development and maintenance of atrial fibrillation. Hypertension-induced hemodynamic, inflammatory, hormonal, and autonomic changes all appear to be important contributing factors. Furthermore, hypertension is also associated with several atrial fibrillation-related comorbidities. As such, hypertension may represent an important target for therapy in atrial fibrillation. Clinicians should be aware of the pitfalls of blood pressure measurement in atrial fibrillation. While the auscultatory method is preferred, the use of automated devices appears to be an acceptable method in the ambulatory setting. There are pathophysiologic basis and emerging clinical evidence suggesting the benefit of renin-angiotensin system inhibition in risk reduction of atrial fibrillation development, particularly in patients with left ventricular hypertrophy or left ventricular dysfunction. A better understanding of hypertension’s pathophysiologic link to atrial fibrillation may lead to the development of novel therapies for the primary prevention of atrial fibrillation. Finally, future studies are needed to address the strategies of optimal blood pressure to minimize the risk of atrial fibrillation-related complications.

Background: Polymeric nanomaterials with sizes ranging from 10 to 1000 nm are one of the most widely used types of nanoparticles with ideal properties in the drug delivery systems. Here, we decided to systematically review the antihypertensive effects of polymeric nanomaterials in vitro, in vivo, and clinical trials. Methods: The present review was conducted based on the 06- PRISMA guideline; whereas five English databases, including Scopus, PubMed, Web of Science, EMBASE, and Google Scholar without time limitation were used for searching the publications related to antihypertensive effects of natural and synthetic polymeric nanoparticles. Results: The results demonstrated that among 1701 papers, 25 papers including 11 in vitro (44%), 6 in vivo (24%), 7 in vitro / in vivo (28%), and 1 in vitro / ex vivo (4%) up to 2020, met the inclusion criteria for discussion in this systematic review. The most used nanoparticles were poly-(lactic- co-glycolic) acid nanoparticle (PLGANPs) (7, 29.2%), chitosan based nanoparticles (6, 25%), followed by polylactide acid nanoparticles (5, 20.8%). Conclusion: We concluded that the high potency of polymeric nanoparticles in the drug delivery system was for hypertension treatment. Although the accurate mechanisms are not fully understood; however, some mechanisms, such as sustained release forms with increased bioavailability, increasing oral bioavailability and improving the oral and non-oral absorption, counteracting excessive superoxide and decreasing blood pressure, etc. can be related to these nanoparticles.

Background: Acute stress is known to be associated with both negative and positive influences on cognitive performance. Hypertension is one of the risk factors for lowered cognitive performance. Mental stress testing is easier to administer and can be regulated by the investigator. Mental arithmetic using serial subtraction is the most widely used method to administer stress. Reaction time (RT) is widely used to assess cognitive domains like attention, execution and psychomotor speed. Researchers have shown choice reaction times are delayed in hypertension. It is not known whether acute mental stress improves or deteriorates attention, execution and psychomotor speed in hypertension. We hypothesized in the present study that acute mental stress deteriorates cognitive function in hypertensives without overt cerebrovascular disease or other vascular risk factors. Methods: After getting medical ethical clearance from our institution, this case-control study was carried out over eight months (January 2017 to September 2017). 60 subjects between the age group of 35 to 55 years were included in the study. They were divided into 2 groups. Group 1 consisted of 30 diagnosed cases of hypertension at least two years of duration. Group 2 consisted of 30 sex and age-matched controls. MMSE was performed to assess the cognitive function in these groups. Simple (S) and choice (C) auditory reaction time (ART) and visual reaction time (VRT)s were measured at rest and acute mental stress in these groups to assess cognitive function. Predictive value of VRTC resting and VRTC during acute mental stress among hypertensives for cognitive dysfunction was calculated using the receiver operating characteristic (ROC) curve. Results: There was significant difference ART and VRT, both simple and choice, in hypertensive and nonhypertensive subjects and these reaction times further increased during mental stress (P<0.001). VRTC can be a predictor of cognitive dysfunction in hypertensives and during acute mental stress. Conclusion: A significant difference in cognitive functions in hypertensive and nonhypertensive subjects exists and this further deteriorates with acute mental stress.

Background: The assessment of the longitudinal component of left ventricular (LV) function is of major clinical importance for the early detection of LV contractile impairment. The aim of this study was to determine the impact of uncontrolled hypertension, on LV longitudinal systolic performance. Methods: The study population included 400 hypertensive patients: 271 patients with uncontrolled blood pressure (BP) and 112 without controlled BP, all patients underwent a complete ultrasound evaluation with the calculation of the LV mass, evaluation of diastolic function as well as longitudinal systolic function. Results: Conventional echo demonstrated that uncontrolled patients had increased LV mass (P 0.007), LA (left auricular) dimension (P 0.004), left ventricular wall thickness and impairment of diastolic function (E/E’6 ± 2.1 vs 7.4 ±3.0 P=0.001) while no affection of systolic function could be detected. By deformation imaging, there was a reduction in longitudinal strain (apical 4 view -16.2 ±2.9 vs -18.2± 2.6 P 0.02, apical 3 view -17.3 ± 3.3 vs. -18.9 ± 4.1 P 0.01). Similarly, systolic strain rate (SRsys) and early diastolic SR (SRe) reduced significantly in longitudinal direction. Conclusion: Although EF was not different between uncontrolled patients and controls, LV longitudinal strain and strain rate by 2D speckle tracking were lower in the uncontrolled group.

Background: Hypertension is a leading risk factor for morbidity and mortality around the world. Preventing this health problem is considered an important priority. The aim of this study was to investigate the predictive factors for care and control of hypertension (CCH) according to the health belief model (HBM), in patients with hypertension during the COVID-19 epidemic in Sirjan, Iran. Methods: In this cross-sectional study, participants were chosen by simple random sampling. Data were collected by a valid and reliable researcher-made questionnaire from 200 patients with high blood pressure aged 30-60 years. Data were analyzed by SPSS21 and analysis based on descriptive statistics, Pearson correlation coefficients, and linear regression was conducted. Results: The results of Pearson correlation coefficients showed that there was a significant correlation among almost all constructs of the Health Belief Model (HBM), but the strongest correlations were between self-efficacy and perceived susceptibility (r = 0.940, P ≤ 0.001), and between perceived barriers with perceived benefits (r = -0.615, P ≤ 0.001). According to linear regression, perceived barriers (β = -0.291), cues to action (β = -0.590), and knowledge (β = 0.973) predicted more than 26% of CCH variability. Knowledge had a stronger role than other variables. Conclusion: The results of this study show that the constructs of the Health Belief Model can predict CCH in hypertensive patients. This model can be used as a tool for designing and implementing educational interventions to increase CCH among hypertensive patients.

Background: As a syndrome of physiological vulnerability and multifactorial progressive decline tightly related to age, frailty has been associated with several illnesses, and in particular cardiovascular disease. Objective: To assess the factors associated with the frailty syndrome in older adults evaluated in the outpatient clinic of a tertiary hospital from Maracaibo city, Venezuela. Materials and Methods: An observational, analytical, cross-sectional study was performed on subjects of both genders, over 60 years old that went to the Internal Medicine outpatient clinic of the Hospital General del Sur “Dr. Pedro Iturbe” from Maracaibo city, Venezuela. Sampling was performed via a non-probabilistic, intentional method. For each subject with frailty or pre-frailty, a control subject was selected in a 1:1 ratio according to gender; several risk factors were interrogated. The state of frailty was determined through the FRAIL scale. Results: Of the 201 assessed patients, 49.3% (n=99) were non-frail, 19.9% (n=40) were pre-frail and 30.8% (n=62) were frail. The population's overall age was 68.8±6.8 in non-frails, 69.1±7.7 in pre-frails, and 68.6±7.1 in frails. In the multivariate analysis, subjects with frailty and pre-frailty were most likely to be receiving polypharmacy (OR: 2.36, CI95%: 1.05-5.37; P=0.04) and have hypertension during the study (OR: 10.19, CI95%: 3.86-26.89; P<0.01). Conclusion: The newly diagnosed hypertension and presence of polypharmacy were the factors most associated with frailty and pre-frailty in older adults evaluated in a tertiary hospital from Maracaibo city, Venezuela.