Current Hypertension Reviews最新文献

Background: Despite advances in managing hypertension, hypertensive emergencies remain a common indication for emergency room visits. Our study aimed to determine the clinical profile of patients referred with hypertensive emergencies.

Methods: We conducted an observational study involving patients aged ≥18 years referred with hypertensive crisis. A diagnosis of hypertensive emergencies was based on a systolic blood pressure (BP) ≥180 mmHg and/or a diastolic BP ≥110 mmHg, with acute hypertension-mediated organ damage (aHMOD). Patients without evidence of aHMOD were considered hypertensive urgencies. Hypertensive disorders of pregnancy and unconscious patients were excluded from the study.

Results: Eighty-two patients were included, comprising 66 (80.5%) with hypertensive emergencies and 16 (19.5%) with hypertensive urgencies. The mean age of patients with hypertensive emergencies was 47.9 (13.2) years, and 66.7% were males. Age, systolic BP, and duration of hypertension were similar in the hypertensive crisis cohort. Most patients with hypertensive emergencies reported nonadherence to medication (78%) or presented de novo without a prior diagnosis of hypertension (36%). Cardiac aHMOD (acute pulmonary edema and myocardial infarction) occurred in 66%, while neurological emergencies (intracranial hemorrhage, ischemic stroke, and hypertensive encephalopathy) occurred in 33.3%. Lactate dehydrogenase (LDH) (P < 0.001), NT-proBNP (P=0.024), and cardiac troponin (P<0.001) were higher in hypertensive emergencies compared to urgencies. LDH did not differ in the subtypes of hypertensive emergencies.

Conclusion: Cardiovascular and neurological emergencies are the most common hypertensive emergencies. Most patients reported nonadherence to medication or presented de novo without a prior diagnosis of hypertension.

Introduction: The extent of maternal morbidity is a good gauge of a nation's maternal health care system. Maternal near-miss (MNM) cases need to be reviewed because they can indirectly contribute significantly to reducing the maternal mortality ratio in India. MNM cases can provide useful information in this context. Such women who survive these life-threatening conditions arising from complications during pregnancy, childbirth and post partum (42 days) share many commonalities with those who die because of such complications.

Aim: To assess the organ dysfunction and the underlying causes, associated/contributory factors associated with "maternal near-miss" cases in pregnant, in labor, post-partum women (upto42 days) in the health care facilities of Doiwala block, district Dehradun.

Materials and methods: The present study was conducted over a period of 6 months under the Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh. The cross-sectional study included the medical record files of all pregnant women attending the Department of Obstetrics and Gynecology, in the selected healthcare facilities of Doiwala block, district Dehradun. This study was conducted as per the WHO criteria for "near-miss" by using convenience sampling for the selection of healthcare facilities. The medical record files of all women who were pregnant, in labor, or who had delivered or aborted up to 42 days were included from a period of 01.06.2021 - 31.05.2022.

Results: It was found that Out of the women with maternal near-miss (n=91), the majority of women had coagulation /hematological dysfunction (n=45, 49.4%), followed by neurologic dysfunction (n=15, 16.4%), cardio-vascular dysfunction (n=11, 12%). Out of the total women with a maternal near-miss (n = 91), 10 women underwent multiple organ dysfunctions. Of the total 91 maternal near-miss cases, the underlying cause of near-miss was obstetric hemorrhage in almost half the participants (n=45, 49.5%) followed by hypertensive disorders (n=36, 39.5%). Eleven women had a pregnancy with abortive outcomes (12%) and 7 women had pregnancy-related infection. It was also seen that, out of 91 near-miss women, the leading contributory /associated cause was Anemia (n=89, 97.8%) followed by women having a history of previous cesarean section (n=63, 69.2%). Sixteen women had prolonged /obstructed labor (n = 16, 17.58%).

Conclusion: Pregnancy should be a positive experience for every woman of childbearing age. A better understanding of pregnancy-related conditions enables early detection of complications and prevents the conversion of mild to moderate maternal morbidity outcomes to severe maternal outcomes with long-term health implications or death. There are already effective measures in place to reduce maternal and newborn mortality and morbidity.

The prevalence of supine and nocturnal hypertension (S-N-HT) is high among patients with orthostatic hypotension (OH), especially in those who have a neurogenic aetiology. The evidence suggests that S-N-HT exacerbates OH, although it is unclear whether pharmacologic treatment of S-N-HT will improve OH. S-N-HT has also been associated with target organ damage. Therefore, assessment and management of S-N-HT should be an integral part of managing OH, but it is often overlooked in clinical practice.

Background: Medicinal plants have been found beneficial in the control and therapy of many ailments as they contain bioactive compounds, and many of them are used as precursors in the biosynthesis of natural medicines. Diuretics are used as a primary treatment in patients with edema associated with liver cirrhosis and kidney diseases, hyperkalemia, hypertension, heart failure, or renal failure. Furthermore, they are also used to increase the excretion of sodium and reduce blood volume. Due to various adverse events associated with synthetic diuretics, there is a need to investigate alternate plant-based bioactive components that have effective diuretic activity with minimal side effects.

Objective: This review compiled the reported bioactive compounds from different plant sources along with their mechanisms of diuretic activity.

Methods: Different sources were used to collect information regarding herbal plants with therapeutic value as diuretics. These included published peer-reviewed journal articles, scholarly articles from StatPearls, and search engines like Google Scholar, PubMed, Scopus, Springer, ScienceDirect, Wiley, etc. Results: In this review, it was found that flavonoids like rutin, acacetin, naringenin, etc. showed significant diuretic activity in experimental models by various mechanisms, but mostly by blocking the sodium-potassium-chloride co-transporter, while some bioactive compounds showed diuretic actions via other mechanisms as well.

Conclusion: Research on clinical trials of these isolated bioactive compounds needs to be further conducted. Thus, this review provides an understanding of the potential diuretic bioactive compounds of plants for further research and pharmaceutical applications.

Hypertension is a significant hazardous aspect for several diseases, like cardiovascular disease, kidney failure, and brain disease. Hypertension has become the most lethal condition globally, affecting approximately 1 billion people aged around 30-79 years worldwide. In the year 2022, India was ranked 170th for men and 193rd for women for HTN diagnosis rates among 200 countries worldwide. The main risk factor for cardiac failure and stroke is hypertension. The conventional classes of antihypertensive medications currently available have some side effects. Previously, hypertension has been discussed by various researchers using conventional drug-targeting methods such as ACE inhibitors, aldosterone inhibitors, or renin inhibitors. Recently, novel drug delivery technologies utilizing nanoparticles and new pharmacological classes like ACE2 and APA inhibitors have been studied for the medication of hypertension. In this review, we have covered the epidemiology of hypertension in India, its pathophysiology, medications used in the management of hypertension using nanotechnology, and antihypertensive drugs currently available in the market that are approved and patented. Finally, we have covered how hypertension can be managed with the help of smart devices and artificial intelligence (AI) for improved therapy.

The efficiency of blood flowing from the heart depends on its electrical properties. Myocardial electrical activity is associated with generating cardiac action potentials in isolated myocardial cells and their coordinated propagation, which are mediated by gap junctions. Atrial fibrillation (AF) is a common cardiac arrhythmia which causes an aggressive disturbance in cardiac electromechanical function. Moreover, AF increases the risk of stroke and mortality and is a major cause of death. The mechanisms underlying AF involve electrophysiological changes in ion channel expression and function. β-blockers may be useful in patients with chronic AF or in preventing postoperative AF in subjects undergoing coronary artery bypass grafting (CABG) or other types of surgery. The reduction in heart rate induced by β1-adrenergic receptor antagonists may be associated with the beneficial effect of this drug class. Second generation beta-blockers may be considered superior to the first generation due to their selectivity to the β1 receptor as well as avoiding pulmonary or metabolic adverse effects. Third generation beta-blockers may be considered a great option for their vasodilation and antioxidant properties. There is also a new β-blocker, named landilol that also results on reduced risk of post operative AF without adverse effects and its use has been increasing in clinical trials.

Background: Pre-eclampsia is a pregnancy-specific multisystemic disorder associated with adverse feto-maternal outcomes. Low-dose Aspirin therapy started in early pregnancy in high-risk women, has significantly reduced the chances of developing PE. Therefore, screening and identification of at-risk mothers are crucial. The present study was planned to study the predictive ability of gestosis score in predicting early-onset pre-eclampsia by comparing it with the multi-marker model.

Material and methods: One hundred sixteen women, more than 19 years of age, with live singleton pregnancy at 11-13 weeks of gestation were recruited from the antenatal outpatient department and formed the study cohort. After a detailed history, screening for pre-eclampsia was performed both by multi-marker screening and by gestosis score. Diagnostic accuracy was compared for the two methods of screening.

Results: The incidence of pre-eclampsia in the present study cohort was 26.7%. The sensitivity of gestosis score >/= 3 was 84.38% (67.21-94.72) and specificity was 93.18% (85.75-97.46 %). The positive predictive value was 81.82% (67.2%-90.81%), and the negative predictive value was 94.25 (87.98 - 97.35%). The diagnostic accuracy of the gestosis score was 90.83%.

Conclusion: Gestosis scoring is a potential tool that can be used as a cost-effective screening method for pre-eclampsia at 11-14 weeks of gestation in low-resource settings. The sensitivity and negative predictive value of the gestosis score is comparable to multi-marker screening using maternal factors, MAP, Uterine artery PI, PAPP-A, and PlGF.

Background: Hypertension is a cardiovascular disorder that is an incurable clinical condition. It requires lifelong therapy for its management along with long terms application of synthetic drugs associated with severe toxicity in multiple organs. However, the therapeutic application of herbal medicines to treat hypertension has gained considerable attention. The limitations and hurdles associated with conventional plant extract medications are their safety, efficacy, dose, and unknown biological activity.

Objective: In the modern era, the active phytoconstituent-based formulation has come into trend. Various extraction techniques have been reported to extract and isolate active phytoconstituents. Pharmacognostic, physiochemical, phytochemical, and quantitative analytical methods were developed for their qualitative and quantitative analysis. The passage of time and changes in lifestyle also modulate the variable cause of hypertension. Single-drug-based approach therapy cannot efficiently control the cause of hypertension. Designing a potent herbal formulation with different active constituents and modes of action against hypertension is necessary to effectively manage hypertension.

Methods: This review comprises a selection of three different plants, Boerhavia diffusa, Rauwolfia Serpentina, and Elaeocarpus ganitrus exhibiting antihypertension activity.

Results: The objective behind selecting individual plants is their active constituents which have different mechanisms of action for the treatment of hypertension. This review comprises the various extraction methods of the active phytoconstituents and pharmacognostic, physiochemical, phytochemical, and quantitative analysis parameters, respectively. It also lists active phytoconstituents present in plants and the different pharmacological modes of action. Selected plant extracts have different antihypertensive mechanisms. Extract of Boerhavia diffusa consisting of Liriodendron & Syringaresnol mono β-D-Glucosidase exhibit Ca²⁺ channel antagonistic activity; where Reserpine is a phytoconstituent of Rauwolfia serpentina, which depletes catecholamine, Ajmalin shows an antiarrhythmic effect by blocking the sodium channel and the aqueous extract of E. ganitrus seeds reduces mean arterial blood pressure by inhibiting the ACE enzyme.

Conclusion: It has been revealed that poly-herbal formulation of respective phytoconstituent can be used as potent antihypertensive medicine to treat hypertension effectively.

Introduction: Although optimal wellbeing of young adults (YA) is a vital asset for productivity and measurable and sustainable development, there is a dearth of information on the wellbeing status of YA, especially after the COVID-19 lockdown in Ghana. The study has established the post-lockdown wellbeing status of YA in the COVID-19 pandemic epicenters of Ghana.

Methods: The wellbeing status of 1783 (24.49 ± 4.62 year) Ghanaian YA from Kumasi, Accra, and Kasoa (known epicentres of COVID) was assessed in this cross-sectional study. Body mass index (BMI) was calculated, and physical, social, emotional, spiritual and intellectual states were assessed.

Results: More females were found to be overweight (315, 17.7%) and obese (160, 9.0%) compared to males. The majority (714; 40.0%) of the young adults were between the ages 25-30 years and overweight, with a mean BMI of 25.46 ± 4.67 kg/m². Overall, 157 (8.8%) had poor, 755 (42.3%) average, 479 (26.9%) good, while 392 (22.0%) had outstanding wellbeing. Specifically, the average grade was recorded for physical (29.07 ± 6.67), spiritual (29.32 ± 6.80), and intellectual (28.29 ± 6.56), while 'good grade' was obtained for social (32.16 ± 5.13) and emotional (31.54 ± 5.07) dimensions of wellbeing.

Conclusion: Average Ghanaian YA in the study were overweight (BMI value) and had average wellbeing, which may suggest the risk of cardiovascular diseases. Educational and physical activity interventions with meticulous dietary control and proper understanding of family history, age and genetic factors will help to improve the wellbeing of Ghanaian YA.

An imbalance between angiogenic and anti-angiogenic factors plays a fundamental role in the pathogenesis of preeclampsia (PE). Studies have shown a dysregulation of sFlt-1 and placental growth factor (PlGF) in PE. However, there are differing reports on the levels of these pro-/antiangiogenic factors in HIV-infected preeclamptic and normotensive pregnancies, possibly due to highly active antiretroviral therapy (HAART) and its immune reconstitution effect. The study aimed to investigate the effect of hypertension and ARVs on circulating and placental pro- and antiangiogenic factors in HIV-infected PE. The level of sFlt-1 expression is elevated in PE compared to normal pregnancies. PlGF was altered by placental dysfunction. Antiretroviral therapy does not impact the angiogenic shift in PE development. The angiogenic imbalance evident in the circulatory system by higher sFlt-1 compared to PlGF levels is replicated in the placenta by reduced expression of PlGF receptors in comparison to sFlt-1 receptors. However, there is a lack of data that explore the relationship between HAART and anti-angiogenic factors in the placenta and the circulation of PE comorbid with HIV infection.