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Annals of Clinical and Laboratory... 1981Important advances have been made in understanding the role of the renin-angiotensin-aldosterone system in the pathogenesis and diagnosis of hypertensive disorders.... (Review)
Review
Important advances have been made in understanding the role of the renin-angiotensin-aldosterone system in the pathogenesis and diagnosis of hypertensive disorders. Measurement of plasma renin activity (PRA) and aldosterone is very important in the assessment of secondary hypertension. Hypertensions with increased PRA include renovascular hypertension, some cases of unilateral and bilateral renal parenchymal disease, malignant hypertension, hypertension associated with oral contraceptive agents, and renin-secreting tumors. Hypertension with decreased PRA is observed in four recognized types of primary aldosteronism: adenoma, bilateral hyperplasia, indeterminate aldosteronism, and glucocorticoid-responsive aldosteronism. Other conditions with hypertension and depressed PRA include ACTH and DOC secreting tumors, primary hyperpituitarism, syndromes of 17-hydroxylase and 11-beta-hydroxylase deficiency. Liddle's syndrome, licorice abuse, exogenous administration of mineralocorticoids, and preeclampsia.
Topics: Acute Kidney Injury; Adrenergic beta-Antagonists; Aldosterone; Contraceptives, Oral; Diuretics; Female; Glycyrrhiza; Humans; Hyperaldosteronism; Hypertension; Hypertension, Malignant; Hypertension, Renovascular; Kidney Failure, Chronic; Kidney Neoplasms; Male; Plants, Medicinal; Pre-Eclampsia; Pregnancy; Renin; Renin-Angiotensin System; Substance-Related Disorders
PubMed: 6119955
DOI: No ID Found -
International Journal of Molecular... Aug 2017Multikinase inhibitors (MKI) and mammalian target of rapamycin (mTOR) inhibitors prolong progression-free (PFS) and overall survival (OS) in the treatment of metastatic... (Review)
Review
Multikinase inhibitors (MKI) and mammalian target of rapamycin (mTOR) inhibitors prolong progression-free (PFS) and overall survival (OS) in the treatment of metastatic renal cell carcinoma (mRCC) by reducing angiogenesis and tumor growth. In this regard, the MKI lenvatinib and the mTOR inhibitor everolimus proved effective when applied alone, but more effective when they were administered combined. Recently, both drugs were included in clinical trials, resulting in international clinical guidelines for the treatment of mRCC. In May 2016, lenvatinib was approved by the American Food and Drug Administration (FDA) for the use in combination with everolimus, as treatment of advanced renal cell carcinoma following one prior antiangiogenic therapy. A major problem of treating mRCC with lenvatinib and everolimus is the serious adverse event (AE) of arterial hypertension. During the treatment with everolimus and lenvatinib combined, 42% of the patients developed hypertension, while 10% of the patients treated with everolimus alone and 48% of the of the lenvatinib only treated patients developed hypertension. Lenvatinib carries warnings and precautions for hypertension, cardiac failure, and other adverse events. Therefore, careful monitoring of the patients is necessary.
Topics: Animals; Antineoplastic Agents; Carcinoma, Renal Cell; Everolimus; Humans; Hypertension; Kidney Neoplasms; Neoplasm Metastasis; Phenylurea Compounds; Protein Kinase Inhibitors; Quinolines; TOR Serine-Threonine Kinases
PubMed: 28796163
DOI: 10.3390/ijms18081736 -
The Medical Clinics of North America May 1977Studies on the Kyoto (SHR) and the New Zealand (GHR) strains of genetically predisposed hypertensive rats have shown that in the SHR neurogenic influences, primarily of... (Review)
Review
Studies on the Kyoto (SHR) and the New Zealand (GHR) strains of genetically predisposed hypertensive rats have shown that in the SHR neurogenic influences, primarily of higher central origin, play an important role in the initiation of hypertension. Studies on human essential hypertension indicate that this may also be true for man, although it is far from being the sole explanation. Brookhaven hypertension-prone rats illustrate the interaction between genetic and exogenous factors since they require an overload of salt for the development of high blood pressure. The Milan hypertensive rats (MHS), on the other hand, illustrate a genetic deviation of renal function with imbalance between glomerular filtration and tubular resorption of sodium and water, which may simulate at least some variants of the relatively mild forms of low renin hypertension in man. Structural adaptive vascular changes have been demonstrated in SHR and GHR and in nongenetic renal hypertension in rats, and there are several indications of their presence in MHS. Thus, regardless of the nature of the initiating factors, these secondary but rapidly established changes occur and greatly contribute to the maintenance and acceleration of the hypertensive state. The vascular changes can even be regarded as a common denominator for chronic hypertension and serve as an element which, in fact, reinforces the initiating mechanisms. The progress of the vascular changes can be interfered with by reducing the pressure load. Lowering the blood pressure by pharmacologic treatment is most effective when the treatment is initiated as such an early age when the cardiovascular structural adaptation is still minimal. Treatment in later phases is less successful since the adaptive increases in cardiac and vessel wall thickness can then no longer be fully normalized by pressure reduction because of increased amounts of collagen and other connective tissue elements in the vessel wall, which regress poorly. An increased wall thickness of the resistance vessels implies a vascular hyperreactivity to constricting influences which, in turn, rapidly brings the blood pressure back to supranormal levels as soon as therapy is stopped.
Topics: Animals; Behavior, Animal; Disease Models, Animal; Hemodynamics; Hypertension; Rats; Rats, Inbred Strains
PubMed: 323600
DOI: 10.1016/s0025-7125(16)31319-0 -
Vnitrni Lekarstvi Nov 1999The relationship between the kidneys and hypertension is multiple. Impaired renal function preventing adequate sodium excretion participates in the pathogenesis of...
The relationship between the kidneys and hypertension is multiple. Impaired renal function preventing adequate sodium excretion participates in the pathogenesis of primary hypertension. Renal diseases are the most frequent cause of secondary hypertension. Bilateral and unilateral parenchymatous affections predominate (5% of all hypertensions) over renovascular causes (2%). In the course of hypertension regardless of its etiology renal damage may develop--nephroangiosclerosis or atherosclerosis of the renal arteries with unilateral or bilateral affection (renal ischaemic disease). Hypertension is an important factor in progression of chronic renal diseases towards irreversible renal failure.
Topics: Humans; Hypertension; Hypertension, Renal; Kidney
PubMed: 10951852
DOI: No ID Found -
Neurologic Clinics May 2014This article discusses headaches secondary to disorders of homeostasis, which include headaches attributed to (1) hypoxia and/or hypercapnia (high-altitude, diving, or... (Review)
Review
This article discusses headaches secondary to disorders of homeostasis, which include headaches attributed to (1) hypoxia and/or hypercapnia (high-altitude, diving, or sleep apnea), (2) dialysis, (3) arterial hypertension (pheochromocytoma, hypertensive crisis without hypertensive encephalopathy, hypertensive encephalopathy, preeclampsia or eclampsia, or autonomic dysreflexia), (4) hypothyroidism, (5) fasting, (6) cardiac cephalalgia, and (7) other disorder of homeostasis. Clinical features and diagnosis as well as therapeutic strategies are discussed for each headache type.
Topics: Aged; Headache; Humans; Hypercapnia; Hypertension; Hypoxia; Male; Sleep; Treatment Outcome
PubMed: 24703539
DOI: 10.1016/j.ncl.2013.11.011 -
American Journal of Hypertension Jan 1992The insulin sensitivity of five essential hypertensive patients was compared to five patients with renovascular hypertension, five patients with primary... (Comparative Study)
Comparative Study
The insulin sensitivity of five essential hypertensive patients was compared to five patients with renovascular hypertension, five patients with primary hyperaldosteronism, and five normotensive subjects, using the euglycemic hyperinsulinemic clamp technique. Essential hypertensive patients had significantly lower insulin sensitivity than patients with hyperaldosteronism and renovascular hypertensive patients (P = .0066, P = .004, respectively). Hyperaldosteronism patients also had less insulin sensitivity than renovascular hypertensive patients (P = .016). A significant negative correlation was found between body mass index and insulin sensitivity index for essential hypertension patients only (r = -0.87, P less than .003). No such correlation was found in the secondary hypertension patients. The findings suggest a causal relationship between insulin resistance and the development of essential hypertension. Secondary hypertension, on the other hand, is not such an insulin resistant state.
Topics: Adult; Body Mass Index; Female; Humans; Hyperaldosteronism; Hypertension; Hypertension, Renovascular; Insulin Resistance; Male; Middle Aged
PubMed: 1736930
DOI: 10.1093/ajh/5.1.26 -
Scientific Reports Feb 2021We examined the choriocapillaris microvasculature using a non-invasive swept-source optical coherence tomography angiography (SS-OCTA) in 41 healthy controls and 71...
We examined the choriocapillaris microvasculature using a non-invasive swept-source optical coherence tomography angiography (SS-OCTA) in 41 healthy controls and 71 hypertensive patients and determined possible correlations with BP and renal parameters. BP levels, serum creatinine and urine microalbumin/creatinine ratio (MCR) specimens were collected. The estimated glomerular filtration rate (eGFR) was calculated based on CKD-EPI Creatinine Equation. The main outcome was choriocapillaris flow deficits (CFD) metrics (density, size and numbers). The CFD occupied a larger area and were fewer in number in the hypertensive patients with poor BP control (407 ± 10 µm; 3260 ± 61) compared to the hypertensives with good BP control (369 ± 5 µm; 3551 ± 41) and healthy controls (365 ± 11 µm; 3581 ± 84). Higher systolic BP (β = 9.90, 95% CI, 2.86-16.93), lower eGFR (β = - 0.85; 95% CI, - 1.58 to - 0.13) and higher urine MCR (β = 1.53, 95% CI, 0.32-2.78) were associated with larger areas of CFD. Similar significant associations with systolic BP, eGFR and urine MCR were found with number of CFD. These findings highlight the potential role of choriocapillaris imaging using SS-OCTA as an indicator of systemic microvascular abnormalities secondary to hypertensive disease.
Topics: Blood Pressure; Case-Control Studies; Choroid; Ciliary Arteries; Creatinine; Female; Humans; Hypertension; Male; Middle Aged; Tomography, Optical Coherence
PubMed: 33633311
DOI: 10.1038/s41598-021-84136-6 -
Internal and Emergency Medicine Jun 2012Regardless of the mechanisms that initiate the increase in blood pressure, the development of structural changes in the systemic vasculature is the end result of... (Review)
Review
Regardless of the mechanisms that initiate the increase in blood pressure, the development of structural changes in the systemic vasculature is the end result of established hypertension. In essential hypertension, the small arteries smooth muscle cells are restructured around a smaller lumen, and there is no net growth of the vascular wall, while in some secondary forms of hypertension, a hypertrophic remodeling may be detected. Also, in non-insulin-dependent diabetes mellitus, a hypertrophic remodeling of subcutaneous small arteries is present. The results from our own group have suggested that indices of small resistance artery structure, such as the tunica media to internal lumen ratio, may have a strong prognostic significance in hypertensive patients, over and above all other known cardiovascular risk factors. Therefore, the regression of vascular alterations is an appealing goal of antihypertensive treatment. Different antihypertensive drugs seem to have different effect on vascular structure, both in human and in animal models of genetic and experimental hypertension. A complete normalization of small resistance artery structure is demonstrated in hypertensive patients, after long-term and effective therapy with ACE inhibitors, angiotensin II receptor blockers and calcium antagonists. Few data are available in diabetic hypertensive patients; however, blockade of the renin-angiotensin system seems to be effective in this regard. In conclusion, there are several pieces of evidence that suggest that small resistance artery structure may be considered an intermediate endpoint in the evaluation of the effects of antihypertensive therapy; however, there are presently no data available about the prognostic impact of the regression of vascular structural alterations in hypertension and diabetes.
Topics: Antihypertensive Agents; Arteries; Diabetes Mellitus; Humans; Hypertension; Microcirculation; Prognosis
PubMed: 21380549
DOI: 10.1007/s11739-011-0548-0 -
Current Hypertension Reviews 2019Primary aldosteronism (PA) is not only a leading cause of secondary and resistant hypertension, but is also quite frequent in unselected hypertensive patients. Moreover,... (Review)
Review
Primary aldosteronism (PA) is not only a leading cause of secondary and resistant hypertension, but is also quite frequent in unselected hypertensive patients. Moreover, PA is associated with increased cardiovascular risk, which is disproportionate to BP levels. In addition, timely diagnosis of PA and prompt initiation of treatment attenuate this increased risk. On the other hand, there are limited data regarding the usefulness of screening for PA in all asymptomatic or normokalemic hypertensive patients. More importantly, until now, no well-organized, large-scale, prospective, randomized controlled trial has proved the effectiveness of screening for PA for improving clinical outcome. Accordingly, until more relevant data are available, screening for PA should be considered in hypertensive patients with spontaneous or diuretic-induced hypokalemia as well as in those with resistant hypertension. However, screening for PA in all hypertensive patients cannot be currently recommended.
Topics: Antihypertensive Agents; Blood Pressure; Clinical Decision-Making; Drug Resistance; Humans; Hyperaldosteronism; Hypertension; Mass Screening; Patient Selection; Predictive Value of Tests; Risk Assessment; Risk Factors
PubMed: 29737255
DOI: 10.2174/1573402114666180507153549 -
Medicina Clinica Nov 2006Hypertension is one of the most prevalent cardiovascular risk factors. Most of the cases are not due to secondary causes and are diagnosed as essential hypertension,... (Review)
Review
Hypertension is one of the most prevalent cardiovascular risk factors. Most of the cases are not due to secondary causes and are diagnosed as essential hypertension, although a common physiopathologic link underlies for diabetes and dyslipidemia that are usually present. Most hypertensive patients have also obesity and insulin resistance and this may be more than an epidemiologic association, but one of the main physiopathologic basis of essential hypertension.
Topics: Humans; Hypertension
PubMed: 17169299
DOI: 10.1157/13095098