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PURPOSE: Abdominal aorta calcium (AAC) burden and dilatation are associated with an increased risk of mortality. The purpose of this study was to investigate determinants of AAC and abdominal aorta size in patients with essential hypertension. MATERIALS AND METHODS: Patients with uncomplicated essential hypertension who had undergone non-enhanced abdominal CT to rule out secondary hypertension in addition to biological test were recruited between 2010 and 2018. A semi-automatic system was designed to estimate the aortic size (diameter, length, volume) and quantify the AAC from mesenteric artery to bifurcation using the Agatston score. Determinants of aortic size and those related to AAC were searched for using uni- and multivariables analyses. RESULTS: Among 293 randomly selected patients with hypertension (age 52 ± 11 [SD] years) included, 23% had resistant hypertension. Mean abdominal aorta diameter was 20.1 ± 2.1 (SD) mm. Eight (3%) patients had abdominal aorta aneurysm ≥ 30 mm and 58 (20%) had dilated abdominal aorta ≥ 27 mm. Median AAC score was 38 and calcifications were detected in the infra- and supra-renal abdominal aortic portions in 59% and 26% of the patients, respectively. After adjustment for age, male sex and body surface area, abdominal aorta diameter was positively associated with diastolic blood pressure (P = 0.0019). Smoking was the single variable associated with calcified abdominal aorta (P < 0.001) after adjustment for cofactors. In patients with calcifications of abdominal aorta, the score increased with smoking history (P < 0.001), statins treatment (P < 0.01), greater number of anti-hypertensive drugs (P < 0.01), larger abdominal aorta (P < 0.05) and greater systolic blood pressure (P < 0.05). Patients with resistant hypertension had more AAC in the supra-renal abdominal aorta portion than those without resistant hypertension (P < 0.01). CONCLUSION: In patients with essential hypertension, abdominal aorta dilation is related with diastolic blood pressure while AAC is associated with smoking history and resistant hypertension when located to the supra-renal abdominal aorta portion.

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Arterial hypertension is the most important cardiovascular risk factor in chronic non-communicable diseases and is estimated to be responsible for 10.4 million deaths annually. The global prevalence of hypertension is 30% and the majority of people with hypertension do not have a clear identifiable cause and are considered to have primary hypertension. Experimental and clinical investigations from several research groups, including ours, have established that inflammation and autoimmune reactivity play a role in the sodium retention and hemodynamic responses that drive primary hypertension. Hyperuricemia and heat stress proteins (HSP), particularly HSP70, are both associated with the activation of innate immunity that plays a role in the development of inflammatory reactivity in the hypertensive patient. Clinical studies have shown an association between the expression of HSP70 and anti-HSP70 antibodies and primary hypertension. This brief review aims to examine the interrelation between hyperuricemia and extracellular overexpression of HSP70 in the activation of the inflammasome that may have a central role in the pathophysiology of primary hypertension.

La hipertensión arterial es el factor de riesgo cardiovascular más importante de las enfermedades crónicas no transmisibles y se estima que es responsable de 10.4 millones de muertes al año. La prevalencia mundial de la hipertensión es del 30%; la mayoría de las personas con hipertensión no tienen una causa claramente identificable y se considera que tienen hipertensión primaria. Las investigaciones experimentales y clínicas de varios grupos de investigación, incluido el nuestro, han establecido que la inflamación y la reactividad autoinmune desempeñan un papel en la retención de sodio y las respuestas hemodinámicas que provocan la hipertensión primaria. La hiperuricemia y las proteínas del estrés por calor (HSP), particularmente HSP70, están asociadas con la activación de la inmunidad innata que juega un papel en el desarrollo de la reactividad inflamatoria en pacientes hipertensos. Estudios clínicos han demostrado asociación entre la expresión de HSP70 y anticuerpos anti-HSP70 y la hipertensión arterial primaria Esta breve revisión tiene como objetivo examinar la interrelación entre la hiperuricemia y la sobreexpresión extracelular de HSP70 en la activación del inflamasoma, así como su probable papel central en la fisiopatología de la hipertensión primaria.

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BACKGROUND: Angiotensin converting enzyme 2 (ACE2) plays a crucial role in the infection cycle of SARS-CoV-2 responsible for formation of COVID-19 pandemic. In the cardiovascular system, the virus enters the cells by binding to the transmembrane form of ACE2 causing detrimental effects especially in individuals with developed hypertension or heart disease. Zofenopril, a H2S-releasing angiotensin-converting enzyme inhibitor (ACEI), has been shown to be effective in the treatment of patients with essential hypertension; however, in conditions of ACE2 inhibition its potential beneficial effect has not been investigated yet. Therefore, the aim of the study was to determine the effect of zofenopril on the cardiovascular system of spontaneously hypertensive rats, an animal model of human essential hypertension and heart failure, under conditions of ACE2 inhibition induced by the administration of the specific inhibitor MLN-4760 (MLN). RESULTS: Zofenopril reduced MLN-increased visceral fat to body weight ratio although no changes in systolic blood pressure were recorded. Zofenopril administration resulted in a favorable increase in left ventricle ejection fraction and improvement of diastolic function regardless of ACE2 inhibition, which was associated with increased H2S levels in plasma and heart tissue. Similarly, the acute hypotensive responses induced by acetylcholine, L-NAME (NOsynthase inhibitor) and captopril (ACEI) were comparable after zofenopril administration independently from ACE2 inhibition. Although simultaneous treatment with zofenopril and MLN led to increased thoracic aorta vasorelaxation, zofenopril increased the NO component equally regardless of MLN treatment, which was associated with increased NO-synthase activity in aorta and left ventricle. Moreover, unlike in control rats, the endogenous H2S participated in maintaining of aortic endothelial function in MLN-treated rats and the treatment with zofenopril had no impact on this effect. CONCLUSIONS: Zofenopril treatment reduced MLN-induced adiposity and improved cardiac function regardless of ACE2 inhibition. Although the concomitant MLN and zofenopril treatment increased thoracic aorta vasorelaxation capacity, zofenopril increased the participation of H2S and NO in the maintenance of endothelial function independently from ACE2 inhibition. Our results confirmed that the beneficial effects of zofenopril were not affected by ACE2 inhibition, moreover, we assume that ACE2 inhibition itself can lead to the activation of cardiovascular compensatory mechanisms associated with Mas receptor, nitrous and sulfide signaling.

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Background: Essential hypertension is the result of modifiable and genetic factors, and it is associated with increased risk for atherothrombosis. Some polymorphisms are associated with hypertensive disease. The objective was to analyze the association between eNOS Glu298Asp, MTHR C677T, AGT M235T, AGT T174M, and A1166C and ACE I/D polymorphisms with essential hypertension in the Mexican population. Materials and Methods: In the present study, 224 patients with essential hypertension and 208 subjects without hypertension were included. The Glu298Asp, C677T, M235T, T174M, A1166C, and I/D polymorphisms were determined by the PCR-RFLP technique. Results: We found statistical differences in age, gender, BMI, systolic and diastolic blood pressure, and total cholesterol between control and cases. However, we found no significant differences in HbA1c and triglycerides between both groups. We observed statistical significant differences in the genotype distribution of Glu298Asp (P = 0.001), I/D (P = 0.02), and M235T (P = 0.004) polymorphisms between both groups. In contrast, there were no differences related to distribution of genotypes of MTHFR C677T (P = 0.12), M174T (P = 0.46), and A1166C (P = 0.85) between cases and control groups. Conclusions: We identified that Glu298Asp, I/D, and M234T polymorphisms represented an increased risk for essential hypertension and those genetic variants could contribute to the presence of endothelial dysfunction and vasopressor effect, hyperplasia, and hypertrophy of smooth muscle cells, which had an impact for hypertension. In contrast, we found no association between C677C, M174T, and A1166C polymorphisms and hypertensive disease. We suggested that those genetic variants could be identified in individuals with high risk to avoid hypertension and thrombotic disease.

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La hipertensión arterial esencial es una patología de alta prevalencia a nivel mundial, y uno de los determinantes más significativos para enfermedad cardiovascular. Por otra parte, se ha generado un gran interés por la microbiota del cuerpo, y la forma en que se ve alterada por factores tanto internos como externos, ocasionando disbiosis. En la actualidad se viene estudiando el efecto de la microbiota en diferentes enfermedades, entre ellas, la relación entre la microbiota y la hipertensión. En este artículo se hizo una revisión de la literatura, entre 2010 a 2021, con el objetivo de identificar la evidencia científica que sustenta la relación entre la composición de la microbiota y la hipertensión arterial esencial. Se encontró en muchos estudios que los hipertensos tenían una diversidad menor de la microbiota, en comparación con los grupos de control sanos. En los hipertensos se encontraron principalmente bacterias del género Prevotella y en el grupo control predominaba el género Bacteroidetes. Adicionalmente, se observó una disminución de Faecalibacterium, Roseburia y Bifidobacterium en el grupo de hipertensos. Existen varias técnicas de laboratorio para el reconocimiento de la población bacteriana del intestino, tales como la secuenciación de la subunidad de ARNr 16S, la secuenciación del genoma completo y la metagenómica de la microbiota. A pesar de que los estudios realizados sobre la relación microbiota e hipertensión concluyen que existe una relación significativa entre ambas, es necesario hacer más investigaciones en diferentes grupos poblacionales

Essential arterial hypertension is a highly prevalent pathology worldwide and is one of the most significant determinants of cardiovascular disease. On the other hand, great interest has been generated in the microbiota of the body, and how it is altered by both internal and external factors, causing dysbiosis. Currently, the effect of the microbiota in different diseases is being studied, including the relationship between the microbiota and hypertension. In this article, a review of the literature was made, between 2010 and 2021, with the objective of identifying the scientific evidence that supports the relationship between the composition of the microbiota and essential arterial hypertension. It was found in many studies that individuals with high blood pressure had lower microbiota diversity compared to healthy control groups. In hypertensive patients, bacteria of the genus Prevotella were mainly found, while in the control group the genus Bacteroidetes predominated. Additionally, a decrease in Faecalibacterium, Roseburia and Bifidobacterium was observed in the hypertensive group. There are several laboratory techniques for the analysis of the intestinal bacterial population, such as 16S rRNA subunit sequencing, whole genome sequencing, and microbiota metagenomics. Despite the fact that the studies conclude that there is a significant relationship between microbiota and hypertension, it is necessary to do more research in different population groups

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Por medio de la presente queremos comentar acerca del artículo desarrollado por Góngora y otros (2021) acerca del Riesgo estimado de padecer diabetes mellitus tipo 2 (DM2) en pacientes hipertensos con tratamiento farmacológico.(1) Nos parece interesante la manera en la cual se ha desarrollado el artículo, sobre la relación que tiene la hipertensión arterial de debut como factor de riesgo directo para padecer DM2. Sin embargo, creemos que no se les da la debida importancia a otros factores con mayor predominio en el desarrollo de la DM2, como los que detallamos a continuación. Por ejemplo, Soares y otros (2014) demuestran que el factor de riesgo para DM2 más prevalente fue el sedentarismo, seguido por el exceso de peso, obesidad, glucosa plasmática e hipertensión arterial, todo esto ligado a malos hábitos alimenticios(2)(AU)

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Introducción: La evaluación del riesgo cardiometabólico en pacientes con hipertensión arterial esencial es vital y constituye un reto diagnóstico. Objetivo: Evaluar el comportamiento del riesgo cardiometabólico en pacientes con hipertensión arterial esencial no complicada. Métodos: Se realizó una investigación descriptiva y transversal en 100 pacientes hipertensos sin lesión en órgano diana a los que se les realizó historia clínica, glucemia, hemoglobina glicosilada, lipidograma y ácido úrico. Se correlacionaron con el índice de masa corporal, el tiempo de evolución de la hipertensión arterial y el riesgo cardiovascular global. Resultados: De los pacientes, el 56 por ciento fueron hombres, el 31 por ciento fumadores, con sobrepeso y obesidad el 83 por ciento, el 86 por ciento eran sedentarios, 71 por ciento no llevaban dieta saludable y 53 por ciento tenían más de 5 años de hipertensos. En los obesos se encuentra una relación significativa con la circunferencia abdominal (110,9 ± 8,9, p=0,000), los triglicéridos (1,8 ± 0,9, p=0,000) y al ácido úrico (374 ± 100,7, p=0,001). La edad (62,9 ± 7,8, p=0,000), la presión arterial sistólica (151,6 ± 15,6, p=0,021), la disminución del HDL (0,9 ± 0,3, p=0,000) y el ácido úrico (349, 3 ± 115,3, p=0,015) se relacionaron significativamente con el riesgo cardiovascular alto. Conclusiones: Los resultados demostraron el valor de parámetros clínicos como la edad, la circunferencia abdominal, el índice de masa corporal y la presión arterial sistólica, así como de parámetros metabólicos como los triglicéridos, el HDL y el ácido úrico en la evaluación del riesgo cardiometabólico y su relación con el riesgo cardiovascular en pacientes hipertensos(AU)

Introduction: Cardiometabolic risk assessment in patients with essential arterial hypertension is vital and a diagnostic challenge. Objective: To evaluate the behavior of cardiometabolic risk in patients with uncomplicated essential hypertension. Methods: A descriptive, cross-sectional study was carried out in 100 hypertensive patients without target organ damage who underwent clinical history, glycemia, glycosylated hemoglobin, lipidogram and uric acid. They were correlated with body mass index, time of evolution of arterial hypertension and global cardiovascular risk. Results: Of the patients, 56percent were men, 31percent were smokers, 83percent were overweight and obese, 86percent were sedentary, 71percent did not have a healthy diet and 53pwercent had been hypertensive for more than 5 years. In the obese, a significant relationship was found with abdominal circumference (110.9 ± 8.9, p=0.000), triglycerides (1.8 ± 0.9, p=0.000) and uric acid (374 ± 100.7, p=0.001). Age (62.9 ± 7.8, p=0.000), systolic blood pressure (151.6±15.6, p=0.021), lower HDL (0.9±0.3, p=0.000) and uric acid (349, 3 ± 115.3, p=0.015) were significantly related to high cardiovascular risk. Conclusions: The results demonstrated the value of clinical parameters such as age, abdominal circumference, body mass index and systolic blood pressure, as well as metabolic parameters such as triglycerides, HDL and uric acid in the evaluation of cardiometabolic risk and its relationship with cardiovascular risk in hypertensive patients(AU)

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La hipertensión arterial (HTA), o presión arterial elevada, es una enfermedad que se caracteriza por la elevación persistente de la presión arterial sistólica >140 mmHg y diastólica >90 mmHg (1); la cual conlleva al incremento del riesgo de enfermedades en diferentes órganos como el corazón, cerebro, riñón, y otros (2). La Organización Panamericana de la Salud (OPS) menciona que el 20 al 40% de la población adulta padece de HTA, lo cual representa alrededor de 250 millones de personas en Las Américas (3). En el Perú, un estudio publicado en el 2021 mostró una prevalencia agregada de hipertensión de 22.0% (IC 95%: 20.0% - 25.0%; I2=99.2%), y una incidencia global de 4,2 (IC 95%: 2.0 ­ 6.4; I 2=98.6%) por cada 100 personas-año (4). El manejo oportuno y control de los factores de riesgo pueden mejorar el pronóstico de los pacientes con HTA, lo cual reduciría la mortalidad asociada principalmente a enfermedades cardiovasculares. Por ello, el Seguro Social de Salud (EsSalud) priorizó la realización de la presente guía de práctica clínica (GPC) para establecer lineamientos basados en evidencia para gestionar de la mejor manera los procesos y procedimientos asistenciales de la presente condición. Esta GPC fue realizada por la Dirección de Guías de Práctica Clínica, Farmacovigilancia y Tecnovigilancia del Instituto de Evaluación de Tecnologías en Salud e Investigación (IETSI) de EsSalud.

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Cardiovascular diseases (CVD) are the deadliest noncommunicable disease worldwide. Hypertension is the most prevalent risk factor for the development of CVD. Although there is a wide range of antihypertensive drugs, there still remains a lack of blood pressure control options for hypertensive patients. Additionally, natural products remain crucial to the design of new drugs. The natural product 7-hydroxycoumarin (7-HC) exhibits pharmacological properties linked to antihypertensive mechanisms of action. This study aimed to evaluate the vascular effects of 7-HC in an experimental model of essential hypertension. The isometric tension measurements assessed the relaxant effect induced by 7-HC (0.001 µM-300 µM) in superior mesenteric arteries isolated from hypertensive rats (SHR, 200-300 g). Our results suggest that the relaxant effect induced by 7-HC rely on K+-channels (KATP, BKCa, and, to a lesser extent, Kv) activation and also on Ca2+ influx from sarcolemma and sarcoplasmic reticulum mobilization (inositol 1,4,5-triphosphate (IP3) and ryanodine receptors). Moreover, 7-HC diminishes the mesenteric artery's responsiveness to α1-adrenergic agonist challenge and improves the actions of the muscarinic agonist and NO donor. The present work demonstrated that the relaxant mechanism of 7-HC in SHR involves endothelium-independent vasorelaxant factors. Additionally, 7-HC reduced vasoconstriction of the sympathetic agonist while improving vascular endothelium-dependent and independent relaxation.

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INTRODUCTION: In Brazil, arterial hypertension has a high prevalence and low control rate, being a risk factor for cardiovascular diseases, which implies large public health expenses related to hospitalizations resulting from complications. OBJECTIVE: To quantitatively analyze the hospitalizations resulting from hypertensive syndromes in the city of São Paulo in the year 2021. METHODOLOGY: It consists of a descriptive, retrospective, longitudinal epidemiological study, based on the analysis of a econdary source of data, with the aim of the studies being hospital admissions in the Unified Health System of the city of São Paulo, in the year 2021, for causes related to diseases. Hypertensive as inclusion criteria, all hospital admissions were selected through the Hospital Information System (SIH), through DATASUS. The period studied was the year 2021. The morbidities were separated and selected according to the main hospitalization diagnosis and classified according to the International Disease Code 10 (ICD10), the following being selected: I10 - Essential hypertension, I11 - Hypertensive heart disease, I12 - Hypertensive kidney disease, I13 - Hypertensive heart and kidney disease, I15 - Secondary hypertension. Gender, race/color and age group were also taken into account. RESULTS: During the study period, 2219 hospitalizations were performed for hypertensive diseases, of which 49.2% were male and 50.8% female. Among the target audience of the study, when considering race/color, 35.8% of patients consider themselves white, 8% black, 29.5% brown and 0.2% yellow. 26.5% of the registered admissions had no description of race/color. Regarding the age groups studied, there is a gradual increase in the number of hospitalizations as the observed age group also increases, with the group of patients over 80 years of age having the highest number of hospitalizations, corresponding to 14% of all the hospitalizations. CONCLUSIONS: Hospitalizations in the city of São Paulo due to hypertensive syndromes were slightly higher in males, most of whom were white and aged over 80 years.

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