Stefanos Vlachos

Infiltration of the sphenopalatine ganglion decreases blood pressure in newly diagnosed and never treated patients with essential hypertension

BACKGROUND Sphenopalatine ganglion (SPG), an extracranial structure, is connected with the central nervous system (CNS) through sympathetic and parasympathetic nerves. We hypothesized that SPG block through sympathetic nerves anesthesia might decrease blood pressure (BP) in recently diagnosed and never treated middle-aged patients with essential hypertension. METHODS We performed SBG block in 22 hypertensive patients (mean age 45±12years, 15 men). All patients have been subjected to 24hour ambulatory blood pressure monitoring a week prior the procedure as well as in a period of 21-30days after the SBG block in order to estimate differences in 24h average systolic (24h SBP) and diastolic blood pressure (24h DBP), daytime, nighttime, pre-awake and early morning SBP and DBP as well as BP load. RESULTS We found that 24h SBP (p=0.001) and 24h DBP (p<0.001), daytime SBP and DBP (p<0.001) as well as daytime SBP and DBP load (p=0.002 and p<0.001, respectively) were decreased in total population at 21-30days after SPG block. In 11/22 responders (24h SBP decrease ≥5mmHg), SBP and DBP were reduced during overall 24h and daytime (p<0.001) and nighttime periods (p=0.01 and p=0.06, respectively) while pre-awake SBP (p=0.09) along with daytime SBP and DBP load (p=0.07 and p=0.06, respectively) were also almost decreased. CONCLUSIONS SBG block might be a promising, non-invasive, safe, painless and easy to perform therapeutic option of BP decrease. As with renal denervation, SBG should be effective in those hypertensive patients with an activated SNS, so a period of patient selection should precede the application of this procedure.

HDL cholesterol levels and endothelial glycocalyx integrity in treated hypertensive patients

Endothelial dysfunction indicates target organ damage in hypertensive patients. The integrity of endothelial glycocalyx (EG) plays a vital role in vascular permeability, inflammation and elasticity, and finally to cardiovascular disease. The authors aimed to investigate the role of increased HDL cholesterol (HDL‐C) levels, which usually are considered protective against cardiovascular disease, in EG integrity in older hypertensive patients. The authors studied 120 treated hypertensive patients older than 50 years were divided regarding HDL‐C tertiles in group HDLH (HDL‐C ≥ 71 mg/dL, upper HDL‐C tertile) and group HDLL (HDL‐C < 71 mg/dL, two lower HDL‐C tertiles). Increased perfusion boundary region (PBR) of the sublingual arterial microvessels (ranging from 5 to 9 µm) using Sideview Darkfield imaging (Microscan, Glycocheck) was measured as a non‐invasive accurate index of reduced EG thickness. PBR 5‐9 was significantly decreased in group HDLH (P = 0.04). In the whole population, HDL‐C was inversely but moderately related to PBR 5‐9 (r = −0.22, P = 0.01). In a multiple linear regression analysis model, using age, BMI, smoking habit, HDL‐C, LDL‐C, and office SBP, as independent variables, the authors found that BMI (β = 0.25, P = 0.006) independently predicted PBR 5‐9 in the whole population. In older hypertensive patients, HDL‐C ranging between 71 and 101 mg/dL might moderately protect EG and subsequently endothelial function. Future studies in several groups of low‐ or high‐risk hypertensives are needed in order to evaluate the beneficial role of extremely elevated HDL‐C regarding cardiovascular risk evaluation as well as endothelial glycocalyx as a novel index of target organ damage in essential hypertension.

Bilateral sphenopalatine ganglion block reduces blood pressure in never treated patients with essential hypertension. A randomized controlled single-blinded study

BACKGROUND Sympathetic fibers connect sphenopalatine ganglion (SPG) with the central nervous system. We aimed to study the effect of SPG block in blood pressure (BP) in never treated patients with stage I-II essential hypertension. METHODS We performed bilateral SPG block with lidocaine 2% in 33 hypertensive patients (mean age 48±12years, 24 men) and a sham operation with water for injection in 11 patients who served as the control group (mean age 51±12years, 8 men). All patients have been subjected to 24h ambulatory blood pressure monitoring prior and a month after the SBG block in order to estimate any differences in blood pressure parameters. We defined as responders to SBG block those patients with a 24h SBP decrease ≥5mmHg. RESULTS We found that 24h and daytime DBP (p=0.02) as well as daytime DBP load (p=0.03) were decreased in the study group a month after SPG block. In addition, a significant response was noted in 12/33 responders (36%) regarding: a. SBP and DBP during overall 24h and daytime (p<0.001) and night-time periods, b. pre-awake and early morning SBP and c. SBP (daytime and night-time) and DBP (daytime) load. No differences regarding BP were found in the sham operation group. CONCLUSIONS SPG block is a promising, minimally invasive option of BP decrease in hypertensives, probably through SNS modulation. Additionally, due to its anesthetic effect, SPG block might act as a method of selection for those hypertensive patients with an activated SNS before any other invasive antihypertensive procedure.

The independent relationship of blood pressure load with target organ damage in untreated hypertensive patients: the role of dipping status.

BP load is defined as the percentage of abnormally elevated BP readings provided by ABPM [1]. BP load identifies patients with misleading relatively low 24 h average levels of ambulatory systolic blood pressure (SBP) and/or diastolic blood pressure (DBP), daytime and/or night-time, and at the same time bursts of abnormally high BP recordings. It has been proposed that BP load might be a better predictor of cardiac and vascular abnormalities than 24 h average ambulatory BP itself [2]. BP load more than 25% is typically considered elevated, whereas patients with BP load more than 50% are at risk of TOD [1]. In patients with stage I or II arterial hypertension, BP load close to 100% appears to be of greater prognostic interest compared with patients with stage III arterial hypertension. [3].