Vascular inflammation in hypertension and diabetes: molecular mechanisms and therapeutic interventions

2007 ◽  
Vol 112 (7) ◽  
pp. 375-384 ◽  
Author(s):  
Carmine Savoia ◽  
Ernesto L. Schiffrin
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Metabolic Disorders ◽  
Molecular Mechanisms ◽  
Vascular Inflammation ◽  
Cardiovascular Morbidity ◽  
Morbidity And Mortality ◽  
Low Grade ◽  
Cardiovascular Morbidity And Mortality

More than 80% of patients with type 2 diabetes mellitus develop hypertension, and approx. 20% of patients with hypertension develop diabetes. This combination of cardiovascular risk factors will account for a large proportion of cardiovascular morbidity and mortality. Lowering elevated blood pressure in diabetic hypertensive individuals decreases cardiovascular events. In patients with hypertension and diabetes, the pathophysiology of cardiovascular disease is multifactorial, but recent evidence points toward the presence of an important component dependent on a low-grade inflammatory process. Angiotensin II may be to a large degree responsible for triggering vascular inflammation by inducing oxidative stress, resulting in up-regulation of pro-inflammatory transcription factors such as NF-κB (nuclear factor κB). These, in turn, regulate the generation of inflammatory mediators that lead to endothelial dysfunction and vascular injury. Inflammatory markers (e.g. C-reactive protein, chemokines and adhesion molecules) are increased in patients with hypertension and metabolic disorders, and predict the development of cardiovascular disease. Lifestyle modification and pharmacological approaches (such as drugs that target the renin–angiotensin system) may reduce blood pressure and inflammation in patients with hypertension and metabolic disorders, which will reduce cardiovascular risk, development of diabetes and cardiovascular morbidity and mortality.

scholarly journals Selenoprotein-P Deficiency Predicts Cardiovascular Disease and Death

Nutrients ◽  
2019 ◽  
Vol 11 (8) ◽  
pp. 1852 ◽  
Author(s):  
Lutz Schomburg ◽  
Marju Orho-Melander ◽  
Joachim Struck ◽  
Andreas Bergmann ◽  
Olle Melander
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Event ◽  
Cardiovascular Mortality ◽  
Cardiovascular Morbidity ◽  
Morbidity And Mortality ◽  
Selenoprotein P ◽  
P Deficiency ◽  
Cardiovascular Morbidity And Mortality ◽  
Increased Risk ◽  
All Cause Mortality

Selenoprotein-P (SELENOP) is the main carrier of selenium to target organs and reduces tissue oxidative stress both directly and by delivering selenium to protective selenoproteins. We tested if the plasma concentration of SELENOP predicts cardiovascular morbidity and mortality in the primary preventive setting. SELENOP was measured from the baseline exam in 2002–2006 of the Malmö Preventive Project, a population-based prospective cohort study, using a validated ELISA. Quintiles of SELENOP concentration were related to the risk of all-cause mortality, cardiovascular mortality, and a first cardiovascular event in 4366 subjects during a median (interquartile range) follow-up time of 9.3 (8.3–11) years using Cox proportional Hazards Model adjusting for cardiovascular risk factors. Compared to subjects in the lowest quintile of SELENOP, the risk of all three endpoints was significantly lower in quintiles 2–5. The risk (multivariate adjusted hazard ratio, 95% CI) decreased gradually with the lowest risk in quintile 4 for all-cause mortality (0.57, 0.48–0.69) (p < 0.001), cardiovascular mortality (0.52, 0.37–0.72) (p < 0.001), and first cardiovascular event (0.56, 0.44–0.71) (p < 0.001). The lower risk of a first cardiovascular event in quintiles 2–5 as compared to quintile 1 was significant for both coronary artery disease and stroke. We conclude that the 20% with lowest SELENOP concentrations in a North European population without history of cardiovascular disease have markedly increased risk of cardiovascular morbidity and mortality, and preventive selenium supplementation studies stratified for these subjects are warranted.

Blood Pressure and Cardiovascular Morbidity and Mortality in a Dutch Population: The Nijmegen Cohort Study

2001 ◽  
Vol 32 (2) ◽  
pp. 142-147 ◽  
Author(s):  
J.C Bakx ◽  
M.I Veldstra ◽  
H.J.M van den Hoogen ◽  
G.A Zielhuis ◽  
Th Thien ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cohort Study ◽  
Cardiovascular Morbidity ◽  
Morbidity And Mortality ◽  
Dutch Population ◽  
Cardiovascular Morbidity And Mortality

scholarly journals Estrogen therapy for arterial hypertension in menopansal females

2003 ◽  
Vol 49 (4) ◽  
pp. 51-54
Author(s):  
A. N. Karachentsev ◽  
I. V. Kuznetsova
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
High Blood Pressure ◽  
Estrogen Therapy ◽  
Cardiovascular Morbidity ◽  
Morbidity And Mortality ◽  
Rational Pharmacotherapy ◽  
Cardiovascular Morbidity And Mortality ◽  
History Of ◽  
Practical Recommendations

The epidemiology of arterial hypertension in women with menopause Arterial hypertension, according to many experts, "is the greatest non-infectious pandemic in the history of mankind that determines the structure of cardiovascular morbidity and mortality"; Thus, only in Russia AG about 40% of the population suffers. Due to the wide prevalence of hypertension, it has become an interdisciplinary problem, and today doctors of different specialties need practical recommendations for rational pharmacotherapy of high blood pressure in specialized patients.

Erythropoietin Treatment Decreases Cardiovascular Morbidity and Mortality in Capd Patients

1997 ◽  
Vol 17 (2) ◽  
pp. 129-135 ◽  
Author(s):  
Maria Auxiliadora Bajo ◽  
Rafael Selgas ◽  
Maria Jose Castro ◽  
Carlos Jiménez ◽  
Maria Jose Fernández-Reyes ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Proportional Hazards Model ◽  
Multiple Logistic Regression Analysis ◽  
Cox Proportional Hazards ◽  
Cardiovascular Morbidity ◽  
Cox Proportional Hazards Model ◽  
Morbidity And Mortality ◽  
University Hospital ◽  
User Group ◽  
Cardiovascular Morbidity And Mortality

Objective To analyze the effects of recombinant human erythropoietin (rHuEPO) therapy on cardiovascular (CV) morbidity and mortality among continuous ambulatory peritoneal dialysis (CAPD) patients. Design Retrospective comparative study. Setting CAPD unit in a university hospital. Patients Forty-two patients on rHuEPO treatment for at least one year were compared with an rHuEPO nonuser group of 113 patients. Subcutaneous rHuEPO doses were adjusted to a hemoglobin objective level of 10.5 -13.5 g/ dL. Fifty-seven patients were considered as high cardiovascular risk (HCVR), 17 in the rHuEPO group and 40 in the rHuEPO nonuser group. Ninety-eight patients were classified as low cardiovascular risk (LCVR), 25 of whom were in the rHuEPO group. Results The incidence of cardiovascular morbidity was more frequent in the rHuEPO nonuser than in the rHuEPO user group (40% vs 22%) and in HCVR than in LCVR patients (59.6% vs 20.4%). By multiple logistic regression analysis, the best model to explain the development of cardiovascular morbidity comprises rHuEPO treatment, CV risk, and age. In the rHuEPO user group, HCVR and LCVR patients did not show significant differences in survival, while in the rHuEPO nonuser group, HCVR patients had a lower survival rate than LCVR patients (p = 0.0003). Cox proportional hazards model revealed that LCVR patients had an excellent prognosis compared with HCVR patients in the rHuEPO nonuser group, but this difference disappeared in the rHuEPO user group. Conclusion These data show a beneficial effect of rHuEPO treatment on cardiovascular morbidity and mortality in CAPD patients, evidenced by the elimination of the correlation between prior cardiovascular risk and subsequent mortality.

scholarly journals Sex differences in the efficacy of antihypertensive treatment in preventing cardiovascular outcomes and reducing blood pressure: protocol for a systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e036128
Author(s):  
Karina Gasbarrino ◽  
Christopher Labos ◽  
Victoria Mastropietro ◽  
Lindsay Hales ◽  
Nadia Khan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Pressure ◽  
Sex Differences ◽  
Antihypertensive Treatment ◽  
Meta Analysis ◽  
Cardiovascular Morbidity ◽  
Morbidity And Mortality ◽  
Cochrane Library ◽  
Men And Women ◽  
Cardiovascular Morbidity And Mortality

IntroductionHypertension is a leading cause of mortality worldwide and its prevalence is expected to rise over the next decade. Sex differences exist in the epidemiology and pathophysiology of hypertension. It is well established that antihypertensive treatment can significantly reduce the risk for stroke and other cardiovascular disease events. However, it remains unclear whether this effect is dependent on sex. In this protocol, we outlined a systematic review and meta-analysis to evaluate the effects of antihypertensive therapy in (1) reducing blood pressure and (2) preventing cardiovascular morbidity and mortality outcomes for each sex separately.Methods and analysisThe following electronic databases will be searched: Medline, Embase, The Cochrane Library, PubMed, Cumulative Index of Nursing and Allied Health Literature Plus, Web of Science, grey literature (Google Scholar) and several trial registries. Search strategies will be designed to identify human adult (≥18) randomised (and non-randomised) controlled trials, prospective and retrospective cohort studies, and case–control studies concerning ‘sex-specific differences associated with the efficacy of antihypertensive treatment’. A preliminary search strategy was developed for Medline (1946—16 September 2019). Two investigators will independently review each article included in the final analysis. Primary outcomes investigated are cardiovascular morbidity and mortality and systolic and diastolic blood pressure. Pooled analyses will be conducted using the random-effects model. Publication bias will be assessed by visual inspection of funnel plots and by Begg’s and Egger’s statistical tests. Between-studies heterogeneity will be measured using the I2test (p<0.10). Sources of heterogeneity will be explored by sensitivity, subgroup and metaregression analyses.Ethics and disseminationThis is the first meta-analysis that will comprehensively compare the efficacy of antihypertensive treatment regimens between men and women. Findings will be shared through scientific conferences and societies, social media and consumer advocacy groups. Results will be used to inform the current guidelines for management of hypertension in men and women by demonstrating the importance of implementing sex-specific recommendations. Ethical considerations are not applicable for this protocol.

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