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  • ISSN: 2373-9258
    Current Issue
    Volume 4, Issue 2
    Research Article
    Saurus Mayer Coutinho*, Cristina Bergman Triches, Beata Marie Redublo Quinto, Cassio Jose de Oliveira Rodrigues, Marcelo Costa Batista
    Introduction: The chronic inflammatory state in atherosclerosis is an important risk factor for cardiovascular (CV) outcomes. The influence of the genetic polymorphism of interferon (IFN)-gamma on such outcomes needs to be evaluated.
    Objective: The aim of this study is to investigate the association between genetic polymorphism of IFN-gamma and the risk of CV event and/or death.
    Patients and Methods: A prospective study was conducted including 208 hypertensive patients, where the polymorphism of IFN-gamma (+874 A → T) was analyzed. We evaluated as outcomes the occurrence of a CV event with (combined endpoint) or without death and the association between IFN-gamma polymorphism and the outcomes was analyzed.
    Results: The patients had a mean age of 59.7 ± 9.3 years, with 57.2% being white, 37% having type 2 diabetes mellitus (DM) and 59.1% having metabolic syndrome (MS). Regarding IFN-gamma polymorphism, 17.7% had a TT genotype, 37.5% a TA genotype and 44.8% an AA genotype. After the follow-up, there were 7 deaths and 8 CV events. The frequency of the TT genotype was higher in patients who had a CV event (60 versus 15% in those who did not) and combined endpoint (55.6% versus 15%). Even after adjusting for age, gender, DM, total cholesterol, uric acid and MS, the presence of the TT genotype was an independent predictor for the occurrence of a CV event (RR: 10.12, CI: 1.16 - 87.79, p < 0.05) and combined outcome (RR: 10.74, CI: 1.909 - 60.47, p < 0.05).
    Conclusion: In individuals with hypertension, the presence of the TT genotype of the IFN-gamma polymorphism resulted in a higher incidence of CV event and death.
    Antonio Del Giudice*, Andrea Fontana, and Filippo Aucella
    With the aim to investigate whether the prevalence of blood pressure (BP) control in the elderly changes over time and according to the presence of comorbidities, as much as 123 elderly hypertensive outpatients were selected and followed for at least one year and within four years from their enrollment. BP control was considered to be achieved when BP was < 140/90 mmHg (< 130/80 mmHg for patients with type 2 diabetes mellitus and/or chronic kidney disease). Estimates of prevalence of BP control (PBPC) over follow-up time were derived using generalized random-effects pattern-mixture models for longitudinal studies. At four years of follow-up the estimated PBPC increased from 58.5% (baseline) to 85.5% (p for trend=0.010), and was lower in patients with type 2 diabetes mellitus and/or chronic kidney disease (from 38.2% to 68.3%, p for trend=0.062) than in patients with other comorbidities (from 76.4% to 94.5%, p for trend=0.020). Compliancy with the doctor plays a key role for BP control, even for patients with comorbidities.
    Kamna Srivastava*, Swati Chauhan, Sudhir Chandra, Rajiv Narang, Jagriti Bhatia, Daman Saluja
    Background: Essential hypertension affects major parts of worldwide population and is a potential risk factor for coronary artery disease and myocardial infarction, heart failure, stroke and renal failure. The present study aims to investigate the involvement of gene variants of HS70/1, HSP70/2 and HSP70/hom in essential hypertension in Northern Indian population.
    Methods: 280 patients with essential hypertension and 261 healthy controls were recruited for the investigation. Genotyping of HSP70 polymorphisms (HSP70/1: +190G/C (rs1043618), HSP70/2:+1267A/G (rs1061581), and HSP7/hom: +2437T/C (rs2227956), were identified by PCR-RFLP techniques.
    Results: A statistically significant difference in genotype distribution was found in HSP70/1 +190G/C [?2= 5.84, p = 0.015, Odds ratio = 1.53 (1.08-2.17) at 95% CI] and HSP70/hom +2437T/C [?2= 7.46, p = 0.006, Odds ratio = 1.60 (1.14-2.25) at 95% CI] polymorphisms in patients with essential hypertension in comparison to control group. Haplotype analysis indicated a significant r2 value (0.8) for HSP70/1 (rs1043618) and HSP70/2 (rs1061581) genotypes in patient group, whereas HSP70/hom (rs2227956) stands independently and do not shows any association with other polymorphisms.
    Conclusions: Our findings indicate that functional polymorphisms in HSP70 gene and their interaction are associated with the risk of essential hypertension in North Indian subjects.
    Mahoto Kato*, Kazuhiko Hashimura, Masafumi Kitakaze, and Astushi Hirayama
    Background: A recombinant human atrial natriuretic peptide (ANP) has been reported to have multiple cardiovascular effects such as diuresis, vasodilation, and suppression of neurohormonal activity. However, few clinical investigations exist for the immune-modulating effects of ANP. Thus, we investigated if ANP modulates inflammatory cytokines as well as hemodynamics and neurohormonal factors in patients with compensated heart failure (CHF) due to idiopathic dilated cardiomyopathy (DCM).
    Methods: Sixty DCM patients were recruited and divided randomly into two groups, the placebo group and the ANP group. In the ANP group, blood sampling for the measurements of norepinephrine (NE), brain natriuretic peptide (BNP), rennin (PRA), aldosterone (PAC), tumor necrosis factor-alpha (TNF-a), interleukin-6 (IL-6) and interleukin-10 (IL-10) and tissue Doppler echocardiography were performed five days before and just before continuous infusion of ANP for 96 hours and immediately and seven days after termination.
    Results: ANP significantly improved left ventricular filling and decreased BNP, NE, PAC and TNF-a, IL-6 levels, whereas significantly increased IL-10 levels from 0.78 ± 0.05 pg/ml to 8.63 ± 0.64 pg/ml (p < 0.001). In ANP group, both TNF-a/IL-10 and IL-6/IL-10 decreased from 57.03 ± 4.76 to 3.41 ± 0.46 (p < 0.001) and from 6.72 ± 0.63 to 0.23 ± 0.03 (p < 0.001), respectively and these effects remained unchanged for seven days after termination.
    Conclusion: ANP improved an imbalance in the cytokine network as well as hemodynamics and neurohormonal factors of CHF due to DCM.
    Case Report
    Xianzheng Zeng, You Zhang, Shuting Li, Guo Chen*, Dongmei Chi, and Yi Teng
    Malignant hyperthermia (MH) crisis could be fatal during general anesthesia. We report a case of a 34-year old male who was scheduled to undergo bilateral tonsillectomy with diagnosis of left tonsil mass, chronic tonsillitis and obstructive sleep apnea-hypopnea syndrome (OSAHS). The patient inhaled 3% sevoflurane for 5 minutes mask ventilation with bag was well for his pre-oxygenation procedure. During induction of anesthesia, the patient developed masseter muscle rigidity (MMR) rapidly following administration of succinylcholine, but laryngoscopy was still available. Low-flow sevoflurane was inhaled after the intubation. The patient suffered from hypercapnia (55mmHg), slightly increase of temperature, sinus tachycardia, combined metabolic-respiratory acidosis during intraoperative period. The patient was temporary diagnosed with malignant hyperthermia and treated accordingly. Further the patient was carefully monitored and investigated to exclude other possible conditions in postoperative period. The patient was highly suspected MH according to the DNA analysis. He was discharged from the hospital without any complication and discomfort.
    Mini Review
    HS Natraj Setty*, Vijay kumar, BC Srinivas, Nagesh Dabu Reddy, and CN Manjunath
    Hypertensive disorders of pregnancy, including preeclampsia, complicate up to 10% of pregnancies worldwide, constituting one of the greatest causes of maternal and perinatal morbidity and mortality worldwide. Preeclampsia is a leading cause of maternal and perinatal morbidity mortality, with an estimated 50,000-60,000 Preeclampsia - related deaths per year worldwide. Hypertensive disorders of pregnancy are major contributors to prematurity. Preeclampsia is a risk factor for future cardiovascular disease and metabolic disease in women. Within the past 10 years substantial advances in the understanding of preeclampsia pathophysiology as well as increased efforts of obtain evidence to guide therapy have emerged. However, this information has not translated into improved clinical practice. New best practice recommendations are greatly needed to guide clinicians in the care of women with all forms of preeclampsia and hypertension that occur during pregnancy, particularly women with severe hypertension and superimposed preeclampsia. Also needed is a system for continually updating these guidelines integrating them into daily obstetric practice.
    Review Article
    Milagros Flores Fonseca and Jorge Andrade Sierra*
    Hypertension is one of the most important and growing problems listed as a major risk factor for cardiovascular disease (CVD) and premature death. An advanced study around centuries gives us the idea that the kidney and its physiological adaptive response governs the regulation of blood pressure. These link between kidney and blood pressure remains controversial in understanding completely the pathogenesis of it. Moreover, the precise cause of hypertension is not apparent in the vast majority of patients. This review focuses on the pathophysiological mechanisms of hypertension, defining the kidney as the culprit or victim for hypertension and understands our limitations and obstacles to apply individualized approaches for prevention, treatment and identifying new specific therapies.
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