Journal of Hypertension: Open Access

We report a single case of severe hypertension which presented many challenges in the management and even more in the resolution. Learning Points 1) That there can be unanticipated causes of hypertension 2) That difficult to control blood pressure should cause medical advisers to consider unusual causes of hypertension 3) That hypertension may respond to testosterone withdrawal.

Objectives: MMP-9 is involved in degrading the Extracellular Matrix (ECM); specifically elastin, which provides elasticity to the arterial wall. Elastin degradation and restructuring of the ECM results in increased vascular remodelling and arterial stiffness. Conversely, exercise improves age-related vascular stiffening. Therefore, this study aimed to investigate whether participation in a green-exercise programme affects vascular haemodynamics and mRNA expression of MMP-9.

Methods: Thirty-six healthy, sedentary individuals (44 ± 2yrs; not taking any cardiovascular-acting medication) joining a moderate-intensity, aerobic green-exercise programme, were recruited. At baseline and 8-weeks into the programme, physical activity (measured in weekly MET-minutes [IPAQ]), supine Mean Arterial Blood Pressure (MAP), Augmentation Index (AIx) and aortic Pulse Wave Velocity (aPWV) data were collected and blood samples were obtained. Leukocytic MMP-9 mRNA expression (RT-PCR) and plasma protein levels (ELISA) were analysed; AIx and aPWV were measured via applanation tonometry (SphygmoCor, Atcor Medical, Australia).

Results: The cohort was split into those who adhered (n=17) and did not adhere (n=19) to the programme. MMP-9 expression, MAP and AIx all decreased significantly in the exercise-adherent group (cf. the non-adherent group), while significant correlations were seen between: (i) ΔMMP-9 expression and ΔMET-minutes/wk; (ii) ΔMMP-9 expression and ΔAIx; (iii) ΔAIx and ΔMET-minutes/wk (P<0.05 in all cases). aPWV did not change significantly between the groups.

Conclusions: These findings suggest that exercise-induced down-regulation of MMP-9 may contribute to reduced ECM degradation and therefore ameliorate vascular remodelling. Additional studies are needed to explore these findings further; however, these data may provide a biomolecular mechanism for aerobic exercises ability to delay age-related increases in arterial stiffening.

Prevalence of hypertension in children has increased significantly in recent times, in part related to the epidemic of childhood obesity. Identification and treatment of hypertension in childhood is likely to favorably impact on cardiovascular disease in adulthood. Identification of hypertensive children continues to be problematic because of incomplete blood pressure screening during routine pediatric clinical visits. The blood pressure norms are based on age, gender and height specific values in contradistinction to adults where a single value suffices. Childhood hypertension is either primary or secondary and is categorized as prehypertension (between 90th to 95th percentile), stage 1 (95th to 99th percentile plus 5 mmHg) and stage 2 (≥ 99th percentile plus 5 mmHg) hypertension. Ambulatory blood pressure monitoring is useful in confirming the diagnosis and in helping diagnose white coat and masked hypertension. Once diagnosed as definitive hypertension, the causes of secondary hypertension should be determined and appropriately treated. In children with primary hypertension, a combination of life-style changes (diet and exercise) and drug therapy should be instituted depending upon the stage of the hypertension. Continued follow-up to ensure compliance with treatment regimen and to monitor blood pressure control is mandatory.

Water ingestion induces a robust increase in blood pressure (BP) and vascular resistance in patients with an impaired efferent baroreflex. The mild pressor response was also present in elderly healthy subjects; however, there was no change in arterial blood pressure and notably no change, or even a slight reduction in heart rate in young healthy subjects. Nitric oxide (NO) has emerged as a major regulator mechanism of the cardiovascular system and the stressful situation has been linked to a reduction in serum NO.Thus we hypothesized that the exhaled nitric oxide(eNO) might be feasible to be a biomarker that can aid in the research of the osmopressor responses. The purpose of the present study was to examine whether the non-invasive monitor of eNO could reflect the osmopressor response after water ingestion. In a randomized, controlled, crossover fashion, 34 young healthy subjects (age, 22–35 years) ingested either 500 or 50 mL of water. Heart rate, BP, cardiac index, and total peripheral vascular resistance were measured using a Finometer hemodynamic monitor. eNO was determined by a chemiluminescence analyser before and after subjects ingested either 500 or 50 mL of water. Blood sampling for plasma osmolality was performed at 5 min before and at 25 min after either the water ingestion or control session. At 25 min after the ingestion of 500 mL of water, total peripheral resistance increased significantly, and plasma osmolality decreased. eNO decreased significantly at 25 min after ingestion of 500 mL water. This study suggests that water ingestion induced decrease of the eNO might be used as a novel biological marker in the course of the osmopressor response.

The 2013 European Society of Hypertension guidelines recommended that lowering the blood pressure to less than 130/80 mmHg in patients with hypertension at high risk for cardiovascular events was unsupported by prospective trial data, and that the systolic Blood Pressure (BP) should be decreased to less than 140 mmHg in these patients and the systolic BP reduced to between 140 to 150 mmHg in patients aged 80 years and older with an initial systolic BP of 160 mmHg or higher provided they are in good physical and mental condition. The American College of Cardiology Foundation/American Heart Association 2011 expert consensus document on hypertension in the elderly recommended that the BP should be lowered to less than 140/90 mmHg in adults with hypertension younger than 80 years at high risk for cardiovascular events. On the basis of data from the Hypertension in the Very Elderly trial, these guidelines recommended that the systolic BP should be reduced to 140 to 145 mmHg if tolerated in adults aged 80 years and older. This article discusses the clinical trial data supporting these guidelines in patients at high risk for cardiovascular events because of coronary artery disease, diabetes mellitus, chronic kidney disease, and heart failure.

Noncommunicable diseases (NCD) caused an estimated 36 million deaths in 2008. Recognizing that NCD are a global health and development priority, Heads of State and Government adopted the Political Declaration on NCD at the United Nations General Assembly in September 2011. The six objectives focus on international cooperation and advocacy, country led multisectoral response, risk factors and determinants, health systems and universal health coverage, research development and innovation and surveillance and monitoring. The overall aim of the action plan is to operationalize the commitments of the UN Political Declaration on Noncommunicable Diseases, building on what has already been initiated and achieved.