Maria Baltatzi

Neuropeptide Y and alpha-melanocyte-stimulating hormone: interaction in obesity and possible role in the development of hypertension

Aim:  Obesity and hypertension frequently coexist and both represent important risk factors for cardiovascular disease. The mechanisms implicated in the regulation of food intake have not been completely elucidated. Recent data suggests that peripheral and central neuropeptides play an important role in the maintenance of energy balance. More specifically, leptin, neuropeptide Y (NPY) and alpha‐melanocyte‐stimulating hormone (a‐MSH) appear to be implicated in the pathogenesis of obesity and also contribute to the development of hypertension in obesity.

Is the Anti-Hypertensive Effect of Dietary Supplements via Aldehydes Reduction Evidence Based? A Systematic Review

Growing evidence indicates that insulin resistance and oxidative stress are involved in the pathogenesis of essential hypertension. In insulin-resistant states, like obesity and type 2 diabetes, altered glucose metabolism may lead to increased formation of methylglyoxal and other ketoaldehydes. Animal studies have shown that increased levels of endogenous aldehydes may lead to hypertension and oxidative stress. In animal models, the administration of vitamin C, vitamin B6 or alpha-lipoic acid reduced tissue levels of aldehydes, prevented oxidative stress, and lowered blood pressure. The purpose of this review article is to critically evaluate the available evidence for the role of dietary supplements in hypertension treatment.

Implementation of Guidelines for the Management of Arterial Hypertension. The Impulsion Study

This study assessed the effects of a pilot best practice implementation enhancement program on the control of hypertension. We enrolled 697 consecutive known hypertensive patients with other vascular risk factors but free from overt vascular disease. There was no “control” group because it was considered unethical to deprive high-risk patients from “best medical treatment”. Following a baseline visit, previously trained physicians aimed to improve adherence to lifestyle measures and drug treatment for hypertension and other vascular risk factors. Both at baseline and at study completion (after 6 months), a 1-page form was completed showing if patients achieved treatment targets. If not, the reasons why were recorded. This program enhanced compliance with lifestyle measures and increased the use of evidence-based medication. There was a substantial increase in the number of patients who achieved treatment targets for blood pressure (p<0.0001) and other vascular risk factors. In non-diabetic patients (n=585), estimated vascular risk (PROCAM risk engine) was significantly reduced by 41% (p<0.0001). There was also a 12% reduction in vascular risk according to the Framingham risk engine but this did not achieve significance (p=0.07). In conclusion, this is the first study to increase adherence to multiple interventions in hypertensive patients on an outpatient basis, both in primary care and teaching hospitals. Simple, relatively low cost measures (e.g. educating physicians and patients, distributing printed guidelines/brochures and completing a 1-page form) motivated both physicians and patients to achieve multiple treatment goals. Further work is needed to establish if the improvement observed is sustained. [ClinicalTrials.gov NCT00416611].

Trend in incidence of cardiovascular risk factors in elderly and over-aged stroke patients between 2003 and 2007 in Greece

The aim of this study is to identify the main cardiovascular risk factors (CRFs) in patients over 65 years with ischemic stroke. This is a retrospective study in 175 patients that were hospitalized in our department due to ischemic stroke in the period 2006-2007. The patients were divided in two groups: Group I--elderly (65-80 years) and Group II--over-aged (>or=81 years). The results were compared with a similar study performed in our department in the period 2002-2003 in 160 ischemic stroke patients. Statistical analysis was made by the chi2-test. Hypertension, either alone or in combination with other CRFs, constitutes the main CRF. Diabetes mellitus (DM) is not frequently the sole CRF but its coexistence with other CRFs ranks DM as the second most important CRF, with the largest percentage in the elderly. Dyslipipidemia is 4th CRF in order following the coronary heart disease (CHD). Taking into account that the provision of acute therapeutic intervention in elderly and over-aged ischemic stroke patients is in most cases difficult, because of their age and the high risk of thrombolysis in these patients, there is increased need to focus on primary prevention of ischemic stroke by treating associated CRF.

Neuro‐Behçet's syndrome may present with peripheral paresis of the facial nerve

Dear Editor, We present to you an interesting case concerning the difficulty in differential diagnosis of peripheral paresis of the facial nerve in a patient with Adamantiadis–Behc et’s disease (ABD). A 61-year-old man was admitted to our department with peripheral paresis of the right facial nerve, of sudden installation, accompanied by mild retroauricular ache, decrease of saliva, and of lachrymal secretion. The patient’s medical history was free of arterial hypertension, diabetes mellitus, hyperlipidemia, smoking or other causes of angiopathy. He was a carrier of the hepatitis B surface antigen (HBsAgþ), without ever a manifestation of hepatitis. Last but not least, as we have already mentioned, he reported ABD, diagnosed nearly a decade before. The first manifestation of the disease was at least 30 years ago, producing characteristic symptomatology of aphthae of the buccal cavity and of the genitals, iridocyclitis, thrombophlebitis of the lower extremities, and erythema nodosum. During the first period, the disease had followed a fluctuant course, but in the last years, the patient was in very good clinical condition without following any treatment (specific or not). It must be noted that obvious damage of the nervous system was never observed. Physical examination revealed only two small ulcerous lesions at the left cheek and one larger at the verge.Neurological examinationdemonstrated right facial nerve paresis of peripheral type, while the rest of the exam did not reveal any other abnormal neurological signs. Ophthalmologic examination showed bilateral cataract in evolution, without pathologic findings in the funduscopy. The only abnormal results of constant laboratory exams were an elevated value of the erythrocyte sedimentation rate (ESR) (ESR1⁄4 45/first hour) and an augmentation of serum proteins (total proteins1⁄4 8.42g/dL, albumin1⁄4 4.3 g/dL, and globulins 1⁄4 4.12g/dL). Qualitative and quantitative determination of globulins demonstrated a small increase of polyclonal immunoglobulin G (IgG) (IgG1⁄4 1650mg/dL, r.i.1⁄4 751–1560mg/dL). Antibodies against Herpes simplex virus (HSV) type 1 were present but did not indicate a recent infection (IgM antibodies were negative and IgG were positive but near to the lower limits of normal, without progressive elevation). Serologic control for hepatitis B showed that the patient was a chronic carrier of the disease (HBsAg1⁄4þ, anti-HBs1⁄4 –, HBeAg1⁄4 –, anti-HBe 1⁄4þ, anti-HBcIgM1⁄4 –, IgG1⁄4þ, HBVDNAPCR1⁄4 –). Imaging control, comprising chest radiography and brain computed tomography (CT), was normal. Electroencephalogram (EEG) and triplex of carotids and vertebral artery were also into the normal limits. Magnetic resonance imaging (MRI) revealed no abnormal signal intensity, neither on T2nor on T1-weighted images with enhancement after gadolinium injection. The patient, feeling his status ameliorated, denied the proposed lumbar puncture. Hence, a symptomatic treatment of the mononeuritis was started including per os administration of anti-inflammatory drugs and of vitamin B1-12 complex for a 1-week period. Cortisone was not included in the therapeutic scheme because of the positive results for HBsAg and the existing danger for a vivification of the hepatitis B virus. After the third day of hospitalization, the patient’s status was improved, and hence, he left the hospital on the fifth day. Three months later, the paresis was in almost complete remission, leaving only a mild fall of the corner of the mouth (right), but 4 months later the patient presented a recrudescence of the paresis in the same territory. A second laboratory control was effectuated revealing an elevation of ESR (ESR1⁄4 66/ first hour), C-reactive protein (CRP) (CRP1⁄4 3.1mg/dL) and IgG globulins (IgG1⁄4 1983mg/dL). Brain CT and MRI proved normal for a second time. A lumbar puncture was effectuated this time, presenting an Address correspondence to: ApostolosHatzitolios,AssociateProfessor of Internal Medicine, AHEPA Hospital, Stilponos Kyriakidi 1, PC 546 36 Thessaloniki, Greece. Tel: þ30-231-099-3480; Fax: þ30-231-028-5128; E-mail: aee@med.auth.gr Journal of the Peripheral Nervous System 9:59–61 (2004)

Prevalence of resistant hypertension in 1810 patients followed up in a specialized outpatient clinic and its association with the metabolic syndrome.

Abstract We aimed to assess the prevalence of resistant hypertension (RH) in patients attending hypertension outpatient clinics and to identify risk factors for RH. We studied the medical records of the last visit of all patients (n = 1810; 40.4% males, age 56.5 ± 13.5 years) who attended at least once our hypertension outpatient clinic during the last decade. RH was defined as blood pressure (BP) > 140/90 mmHg in patients without diabetes or chronic kidney disease (or BP > 130/80 mmHg in patients with the latter diseases) despite treatment with full doses of three antihypertensive agents from different classes or controlled BP on four or more different antihypertensive agents. The prevalence of RH was 12.3%, whereas 22.2% of the patients had well-controlled hypertension and 65.5% had uncontrolled hypertension but were on less than three antihypertensive agents. Independent predictors of RH were age (risk ratio, RR = 1.08, 95% confidence interval, CI 1.05–1.12, p < 0.001), body mass index (RR = 1.06, 95% CI 1.00–1.13, p < 0.05) and the presence of the metabolic syndrome (MetS) (RR = 2.01, 95% CI 1.03–3.91, p < 0.05). Conclusions. RH is frequent in patients followed up in hypertension outpatient clinics. In addition to age and obesity, MetS appears to be associated with increased risk for RH. Clarification of the mechanisms underpinning the association between MetS and hypertension might reduce the prevalence of RH.

Sex-specific differences in cardiovascular risk factors and blood pressure control in hypertensive patients.

Cardiovascular disease (CVD) and cardiovascular risk factors are frequently undertreated in women. However, it is unclear whether the prevalence of additional cardiovascular risk factors and the total cardiovascular risk differ between hypertensive men and women. There are also limited data regarding rates of blood pressure control in the two sexes outside the United States. The authors aimed to compare the cardiovascular risk profile between sexes. A total of 1810 hypertensive patients (40.4% men, age 56.5±13.5 years) attending the hypertension outpatient clinic of our department were studied. Men were more frequently smokers than women and were more heavy smokers than the latter. Serum high‐density lipoprotein cholesterol levels were lower and serum triglyceride levels were higher in men. On the other hand, abdominal obesity and chronic kidney disease were more prevalent in women. The estimated cardiovascular risk was higher in men than in women but the prevalence of established CVD did not differ between the sexes. The percentage of patients with controlled hypertension and the number of antihypertensive medications were similar in men and women. In conclusion, hypertensive men have more adverse cardiovascular risk factor profile and greater estimated cardiovascular risk than women. However, the prevalence of established CVD does not differ between sexes. These findings further reinforce current guidelines that recommend that management of hypertension and of other cardiovascular risk factors should be as aggressive in women as in men in order to prevent cardiovascular events.

Effects of moxonidine on sympathetic nervous system activity: An update on metabolism, cardio, and other target-organ protection

Moxonidine is the newest, second-generation, centrally acting antihypertensive agent. It has selective agonist activity at imidazoline I1 receptors and less adverse effects than the other centrally acting drugs. This fact authorizes the frequent use of moxonidine in clinical practice, as monotherapy or in combination with other antihypertensive agents. Also, moxonidine has beneficial effects in obese and metabolic syndrome and in target-organs, such as heart and kidneys.

Impaired Fasting Glucose in Hypertensive Patients: Prevalence and Cross-Sectional Analysis of Associations with Cardiovascular Disease

BACKGROUND Impaired fasting glucose (IFG) is frequently present in hypertensive patients and might be induced or aggravated by antihypertensive treatment. However, it is unclear whether IFG is associated with increased cardiovascular risk in this population. PATIENTS AND METHODS We performed a cross-sectional study in 1,810 hypertensive patients and recorded the presence of IFG, coronary heart disease (CHD), and ischemic stroke. RESULTS IFG was present in 567 patients (31.3%). The prevalence of CHD or ischemic stroke did not differ between patients with IFG and in patients with serum glucose levels <100 mg/dL. Among patients with IFG, 267 (47.0%) were on β-blockers, diuretics, or both β-blockers and diuretics. The prevalence of CHD was numerically but not significantly higher in patients with IFG treated with β-blockers or both β-blockers and diuretics than in patients with IFG treated with diuretics or not treated with either β-blockers or diuretics and patients with serum glucose levels <100 mg/dL (11.1%, 13.6%, 1.4%, 3.7%, and 5.9%, respectively; P=not significant). The prevalence of ischemic stroke did not differ among these groups. CONCLUSIONS IFG does not appear to be associated with increased prevalence of cardiovascular disease in hypertensive patients, regardless if it is associated with the antihypertensive treatment or not.

Sodium-lithium countertransport activity in healthy, dyslipidemic, and hypertensive individuals.

The aim of our study was to investigate the role of dyslipidemia on red blood cell sodium-lithium countertransport activity in healthy and hypertensive individuals. A total of 128 Caucasian individuals, aged 20 to 60 years old, were divided into 4 groups: dyslipidemic/ hypertensive, dyslipidemic/normotensive, normolipidemic/hypertensive, and normolipidemic/ normotensive (controls). Sodiumlithium countertransport activity was determined based on the Canessa et al method. Sodium-lithium countertransport activity was significantly higher in all patient groups compared with controls (P < .001) and similar in the 3 patient groups. Sodium-lithium countertransport activity was significantly and positively associated with triglyceride levels (P < .001), body mass index (P < .001), total cholesterol levels (P = .001), and systolic (P = .001) and diastolic blood pressure (P = .001). In multivariate regression analysis, triglycerides made the largest contribution to sodiumlithium countertransport variation among the variables tested (R 2 = 0.273). Our results suggest that dyslipidemia affects sodium-lithium countertransport activity independently of essential hypertension and even to a greater extent than hypertension.