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  • ISSN: 2373-9258
    Early Online
    Volume 4, Issue 2
    Mini Review
    Khaled S Abdelkawy and Fawzy Elbarbry*
    Epicatechin is a flavonol with demonstrated arginase inhibition activity in both in-vitro and animal models. Compared to other polyphenols and arginase inhibitors, epicatechin has promising pharmacokinetic properties. According to the reported pharmacokinetic studies of epicatechin, it follows two compartment models with Tmax about 1.5 h and Vd 1.13 L/kg. These studies differ in the source of epicatechin used which explain the wide variation in the reported half-life (2.5-7.9 h). Therefore, the use of pure Epi powder is recommended in future pharmacokinetic studies to avoid results variations. Several in-vitro and in-vivo studies as well as meta analyses have confirmed the blood pressure lowering effect of epicatechin or dietary supplements rich in epicatechin. This manuscript reviews the available reports regarding absorption, distribution, metabolism, and excretion of epicatechin with reflection on its potential clinical use for hypertension.
    Case Report
    Beatrice Carloni and Natale R. Musso*
    In this report we describe a pregnant obese patient where an emergency cesarean section was decided following the detection of blood pressure (BP) levels well above the thresholds for a hypertensive urgency/emergency (i.e. 290/160 mmHg), unresponsive to usual iv drugs (namely labetalol, being hydralazine unavailable in our country). After the delivery BP remained severely elevated even under i.v. labetalol (i.e. 230/135). At the first day after the procedure an endocrinological advice was sought for the evaluation of a possible secondary hypertension. At our observation the patient was presented with a monitor for continuous BP recording, where a standard cuff was attached. A severe under cuffing showed to be the cause of a severe overestimation of BP, since the BP measured with the appropriate cuff was lower than 110/60 mmHg. The overestimation of BP due to the too frequent under cuffing is able to induce invasive procedures, when a simple measure of the arm size would be able to prevent such large mistakes and this grade of malpractice.
    Research Article
    Antonio Mendez Duran* and Julen Ocharan Corcuera
    The Angiotensin Receptor Blockers (ARB) is the first-line antihypertensive drugs. The Fimasartan (FIMA), the last one of this family, has showed efficacy and antihypertensive security. Research objective is to identify the antihypertensive and antiproteinuric effect of Fimasartan on patients with type 2 Diabetes Mellitus (DB), High Blood Pressure (HBP) or Chronic Kidney Disease (CKD).
    Material and methods: 24-Week Prospective Study (November 2014 February 2015). Including subjects > 18 years old, CKD with RF > 30 mL/min or Albuminuria <500 mg/day; without severe or untreated hypertension, infectious of acute cardiac events. Those who discontinued the treatment, voluntary dropped out of the study, had an alteration of the TGF (>2 mL/month), increased serum creatinine >1 mg /month, or uncontrolled High Blood Pressure (FIMAs Dmax and addition of Thiazide Diuretic) were excluded.
    BP target <130/80 and no <115/75 mm Hg. Variables: age, sex, TGF, determinations of urea in serum samples, creatinine, uric acid, albumin, calcium, phosphorus, hemoglobin, hematocrit and liver function; albuminuria. The percentage of patients who reached the antihypertensive objective with 60 and 120 mg/day and decreased albuminuria was estimated.
    Results: 40 patients, 20 male and 20 female, 55,9 years old (mg: 30-74), 21 DM and 19 HBP. The Baseline Proteinuria 4, 8, 12, 16, 20 and 24 weeks were: 383, 355, 346, 280, 198, 210 and 201 (p >0,5); TFG 38,5, 38,9, 38,7, 41,6, 40,2, 39,1 and 40,6 (p >0.01); and DBP 95, 82, 75, 75, 78, 80 and 80 (p <0,01); respectively. Conclusions: The Fimasartan kept an adequate control of the systolic and diastolic blood pressure with a decrease on the proteinuria on a medium term (56, 6% at 24 weeks), which confirms its renoprotective effect, non-antihypertensive-dependent.
    Csaba P. Kovesdy, Susan Furth, Carmine Zoccali and on behalf of the World Kidney Day Steering Committee*
    Obesity has become a worldwide epidemic, and its prevalence has been projected to grow by 40% in the next decade. This increasing prevalence has implications for the risk of diabetes, cardiovascular disease and also for Chronic Kidney Disease. A high body mass index is one of the strongest risk factors for new-onset Chronic Kidney Disease. In individuals affected by obesity, a compensatory hyper filtration occurs to meet the heightened metabolic demands of the increased body weight. The increase in intraglomerular pressure can damage the kidneys and raise the risk of developing Chronic Kidney Disease in the long-term. The incidence of obesity-related glomerulopathy has increased ten-fold in recent years. Obesity has also been shown to be a risk factor for nephrolithiasis, and for a number of malignancies including kidney cancer. This year the World Kidney Day promotes education on the harmful consequences of obesity and its association with kidney disease, advocating healthy lifestyle and health policy measures that make preventive behaviors an affordable option.
    Review Article
    Umesh Jayarajah*, Shania N Gunesekera, and Suranjith L Seneviratne
    Hypertension in the acute setting of stroke is a commonly encountered scenario. It is well recognized that prompt management of hypertensive crisis in neurovascular emergencies is important for both recovery and survival and has prognostic significance. Management of hypertension in stroke patients needs to be done so as to ensure adequate cerebral perfusion is maintained while preventing the detrimental systemic effects of high blood pressure. This review summarizes recent evidence and current recommendations on management of hypertension in the context of ischemic and haemorrhagic stroke. The gaps in current research evidence that need future large scale randomized clinical trial data are highlighted.
    Mini Review
    Luis Dabul, Bishoy Goubran, Gerardo F. Ferrer, Juan D. Oms, Mohamed El Khashab, and Marcos A Sanchez-Gonzalez
    Patients with schizophrenia have twice higher mortality rate compared with the general population, a 20 year reduction in life expectancy, and increased risk of cardio metabolic diseases. The anatomical and physiological changes in heart structures are yet to be elucidated in hypertensive patients with schizophrenia. We have investigated echocardiographic parameters in two groups of hypertensive patients of different ages and compared them with the parameters of schizophrenic patients with hypertension. We retrospectively examined 250 patients with diagnoses of hypertension, and after excluding comorbid diabetes or metabolic syndrome allocated them to three groups: middle age (50-65 years; MN; n = 11), middle age with schizophrenia (MS; n = 9), and elderly (= 70; EN; n = 15). Non-parametric Jonckheere-Terpstra trend analysis was used for identifying linear trends across the three groups. Significant interaction effects (p < 0.05) were identified for ECHO variables LAD, LVDD, PWD, EF, and LVOT indicating a linear trend between the groups, such that there was an age and schizophrenia dependent linear decrease in PWD, EF, and LVOT (MN > MS >EN), but a linear increase of LVDD and LAD (MN< MS
    A Kaul*, MR Behera, S Bhat, and N Kumari
    American College of Obstetricians and Gynecologists (ACOG) Task Force on Hypertension in Pregnancy has modified the diagnosis of preeclampsia (PE) by eliminating the dependence of PE diagnosis on proteinuria. Proteinuria in PE may be a late marker of renal injury; and podoctyuria which appears much before proteinuria may serve as an early marker of renal injury. Thus biomarkers influencing endothelial dysfunction and renal damage in PE may need to be looked into and compared with internationally accepted risk stratification model. These women experience a 2-fold increased risk of long-term cardiovascular disease (CVD) and an approximate 512-fold increased risk of end-stage renal disease (ESRD). Hence, the objectives of screening tests for PE should be such that it can help in predicting and reducing the prevalence of the disease through early pharmacological intervention along with measures to minimize maternal and perinatal morbidity and mortality.
    Case Report
    Brandon E. Cave and Augustus R. Hough*
    In this case report, we describe the use of impedance cardiography (ICG) to guide antihypertensive therapy in a patient with difficult-to-treat hypertension illustrating the potential benefit of use in clinical practice. Through the identification of our patients hemodynamic phenotype, low cardiac index and elevated systemic vascular resistance index, and medication changes directed toward these patient-specific parameters therapy was streamlined to achieve target blood pressure with a net reduction in medications. Despite decades of research and guideline publications aiming to improve hypertensive control approximately half of hypertensive patients fail to reach BP targets using a stepped-care approach. Recent evidence advocates for more intensive BP goals in select patient populations, which would require therapy intensification for millions of hypertensive adults. Utilizing novel strategies, such as ICG, to personalize antihypertensive regimens has the potential to improve overall BP control without an increase in medications, or in certain cases, a reduction in medication. This case report illustrates the utilization of ICG as a method of providing more effective BP control while potentially decreasing burden on patients, and the healthcare system, through avoiding use of likely ineffective and potentially harmful therapies.
    Roger A. McMaster-Fay*
    This is a review of the roles of an abnormal uteroplacental circulation (UPC) and oxidative stress pathogenesis of preeclampsia (PE), as well as aspirin prophylaxis.
    Two models of the pathogenesis (PE); Redman and Sergeants (1991) and McMaster-Fays (2008) are used in this review and are analysed in relation to the results of recent publications.
    Both models agree on the primary importance of the development of an abnormal UPC or the failure to develop normal UPC. They also both agree on the importance of oxidative stress in the disease process but Redman and Sargent believe its importance is only in the clinical phase of the disease as McMaster-Fay believes it is important throughout the PE pregnancy. Recently published data would tend to confirm the later hypothesis.
    Aspirin is known to ameliorate PE, with recent studies showing a delay the onset of the disease. The mechanisms by which this occurs are probably due to both aspirins antiplatelet and antioxidant activities. Controversy exists around when the therapy should start.
  • Recent Research
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    Telehealth Technologies - Are They Useful or Simply Risky and Costly for Patients with Hypertension?
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