How to Explore an Endocrine Cause of Hypertension

Hypertension (HTN) is the most frequent modifiable risk factor in the world, affecting almost 30 to 40% of the adult population in the world. Among hypertensive patients, 10 to 15% have so-called “secondary” HTN, which means HTN due to an identified cause. The most frequent secondary causes of HTN are renal arteries abnormalities (renovascular HTN), kidney disease, and endocrine HTN, which are primarily due to adrenal causes. Knowing how to detect and explore endocrine causes of hypertension is particularly interesting because some causes have a cure or a specific treatment available. Moreover, the delayed diagnosis of secondary HTN is a major cause of uncontrolled blood pressure. Therefore, screening and exploration of patients at risk for secondary HTN should be a serious concern for every physician seeing patients with HTN. Regarding endocrine causes of HTN, the most frequent is primary aldosteronism (PA), which also is the most frequent cause of secondary HTN and could represent 10% of all HTN patients. Cushing syndrome and pheochromocytoma and paraganglioma (PPGL) are rarer (less than 0.5% of patients). In this review, among endocrine causes of HTN, we will mainly discuss explorations for PA and PPGL.

The effect of non-invasively obtained central blood pressure on cardiovascular outcome in diabetic patients in Assiut University Hospitals

Background The major cause of morbidity and mortality in diabetes is cardiovascular disease, which is exacerbated by the presence of hypertension. Therefore, proper control of BP in diabetic hypertensive patients is essential. Few studies have specifically investigated the prognostic significance of central BP in Egyptian populations with diabetes and hypertension and its relation with cardiovascular outcome. This study aims to evaluate relation between central BP and diabetic composite cardiovascular complications. Results Diabetic patients with CVD were significantly older (p value < 0.01), obese (p value < 0.01) with long duration of diabetes (p value < 0.001) and had significantly higher peripheral and central systolic and diastolic BP and higher AIx@75(p values < 0.01) than those without CVD. Regarding the metabolic parameters, they had significantly higher fasting blood glucose, HbA1c, and higher blood cholesterol levels (p values < 0.001), higher LDL (p value < 0.01), triglycerides levels (p value = 0.014), and microalbuminuria (p value = 0.028). Logistic regression analysis found increased BMI, central systolic BP, and AIx@75 were independent predictors of composite CVD (p values < 0.05). Conclusions There is a pattern of favorability towards central rather than peripheral BP indices to predict the occurrence of CVD in diabetic patients.

Ethnic differences in right ventricular structure and function in urbanized hypertensive patients in the Gornaya Shoriya region

Objective of this study was to compare right ventricular echocardiography parameters in urbanized hypertensive patients of the Shor and non-indigenous ethnic groups in the Mountain Shoria region. Methods The study included patients with arterial hypertension: 58 Shors and 50 non-indigenous urbanized residents, comparable in age, and divided by ethnicity and gender into 4 groups: Shors men (n = 20), Shors women (n = 38), non-indigenous men (n = 15) and non-indigenous women (n = 35). All underwent echocardiographic examination, and the right heart parameters were studied. Results Shor men with arterial hypertension had the lowest values ​​of the pulmonary artery index, the right atrium dimensions, and the highest values ​​of the blood flow velocity in the right ventricle, et' and st' in comparison with non-indigenous men. Shor women have the lowest values Et and Et/At ratios. RV diastolic dysfunction was detected mainly in women, somewhat more often in Shors. Ethnicity was one of the factors associated with the right ventricular diastolic dysfunction presence. Among the factors associated with the RV diastolic dysfunction were risk factors (smoking, obesity), blood pressure, gender, ethnicity, and left ventricular parameters (diastolic dysfunction and the myocardial mass increase). Conclusion Our study established the influence of ethnic differences on the right heart echocardiographic parameters in Shors and Caucasians with arterial hypertension. The revealed differences should improve the assessment of the right heart structure and function in patients with arterial hypertension from small ethnic groups, which will help to improve the diagnosis and treatment of such patients.

Prevalence and Associated Factors of Chronic Kidney Disease Among Diabetic and Hypertensive Patients at Ambo Town Public Hospitals of West Shewa Zone, Oromia Region, Ethiopia

Background: Chronic kidney disease is a global public health important disease that is associated with life threatening outcomes including renal failure and premature mortality unless diagnosed and treated promptly. Diabetes Mellitus and hypertension are the two major causes of chronic kidney disease worldwide. This study is aimed to determine prevalence and associated factors of chronic kidney disease among diabetes mellitus and hypertensive patients at Ambo town public hospitals, EthiopiaMethods: A cross-sectional study was conducted at Ambo University referral and general hospitals on 308 study participants. The participants were interviewed using interviewer administered questionnaire when they come for follow up at a chronic illness follow-up clinic. The patient charts were reviewed to retrieve information regarding medications, blood pressure, serum Creatinine and glucose level. A chronic kidney disease epidemiology collaboration equation was used to estimate Glomerular filtration rate from serum Creatinine. Data were analyzed SPSS version 23 for statistical analysis. Binary logistic regression analysis was used to identify factors associated with chronic kidney disease. Variables with a p-value below 0.2 at bivariable analysis were entered into the multivariable logistic regression model. Multivariable logistic regression analysis was used to examine the association between dependent and independent variable and p-value less than 0.05 was used to declare statistical significance.Results: A total of 308 diabetes mellitus and hypertensive patients were included in the study from Ambo town public hospitals. Of which 156 (50.6%) participants were female with mean (± SD) age of 47.15 ± 12.06 years. The prevalence of chronic kidney disease (stage 3–5) was 20.5% with (95% CI: 16%-25%). Long duration of hypertension (AOR=4.89, 95% CI=1.93-12.40), elevated systolic blood pressure (>140mmHG) (AOR=3.20, 95% CI=1.36-7.51), family history (AOR=3.36, 95% CI=1.56-7.24) and age greater than 55 years (AOR=2.17, 95% CI=1.09-4.31) were predictors of chronic kidney disease.Conclusion: The prevalence of chronic kidney disease was high. Older age, elevated SBP, long duration of hypertension and family history of kidney disease were independent predictors of chronic kidney disease. A preventive plan is mandatory to reduce the disease and complications in the community.

Interaction of Serum Alkaline Phosphatase and Folic Acid Treatment on Chronic Kidney Disease Progression in Treated Hypertensive Adults

The relation of alkaline phosphatase (ALP) with chronic kidney disease (CKD) is still uncertain. We aimed to examine the prospective association between serum ALP and CKD progression, and the modifying effect of serum ALP on folic acid in preventing CKD progression in treated hypertensive patients. This is a post-hoc analysis of 12,734 hypertensive adults with relevant measurements and without liver disease at baseline from the renal sub-study of the China Stroke Primary Prevention Trial, where participants were randomly assigned to daily treatments of 10 mg enalapril and 0.8 mg folic acid, or 10 mg enalapril alone. The primary outcome was CKD progression, defined as a decrease in estimated glomerular filtration rate (eGFR) of ≥30% and to a level of &lt;60 ml/min/1.73 m2 if baseline eGFR was ≥60 ml/min/1.73 m2; or a decrease in eGFR of ≥50% if baseline eGFR was &lt;60 ml/min/1.73 m2; or end-stage renal disease. Over a median of 4.4 years, in the enalapril only group, participants with baseline serum ALP≥110IU/L (quartile 4) had a significantly higher risk of CKD progression (3.4% vs 2.3%; adjusted OR,1.61; 95%CI:1.11, 2.32), compared with those with ALP&lt;110IU/L. For those with enalapril and folic acid treatment, compared with the enalapril only treatment, the risk of CKD progression was reduced from 3.4 to 2.1% (adjusted OR, 0.53; 95%CI:0.34, 0.83) among participants with baseline ALP≥110IU/L, whereas there was no significant effect among those with ALP&lt;110IU/L. In hypertensive patients, higher serum ALP was associated with increased risk of CKD progression, and this risk was reduced by 47% with folic acid treatment.

Vitamin D Deficiency Is Associated with Glycometabolic Changes in Nondiabetic Patients with Arterial Hypertension

Recent evidence indicates that mildly increased fasting and post-oral load blood glucose concentrations contribute to development of organ damage in nondiabetic patients with hypertension. In previous studies, vitamin D deficiency was associated with decreased glucose tolerance. The aim of this study was to examine the relationships between serum 25(OH)D levels and glucose tolerance and insulin sensitivity in hypertension. In 187 nondiabetic essential hypertensive patients free of cardiovascular or renal complications, we measured serum 25-hydroxyvitamin D (25(OH)D) and parathyroid hormone (PTH) and performed a standard oral glucose tolerance test (OGTT). Patients with 25(OH)D deficiency/insufficiency were older and had significantly higher blood pressure, fasting and post-OGTT (G-AUC) glucose levels, post-OGTT insulin (I-AUC), PTH levels, and prevalence of metabolic syndrome than patients with normal serum 25(OH)D. 25(OH)D levels were inversely correlated with age, blood pressure, fasting glucose, G-AUC, triglycerides, and serum calcium and PTH, while no significant relationships were found with body mass index (BMI), fasting insulin, I-AUC, HOMA index, and renal function. In a multivariate regression model, greater G-AUC was associated with lower 25(OH)D levels independently of BMI and seasonal vitamin D variations. Thus, in nondiabetic hypertensive patients, 25(OH)D deficiency/insufficiency could contribute to impaired glucose tolerance without directly affecting insulin sensitivity.

Metabolic Signatures of Type 2 Diabetes Mellitus and Hypertension in COVID-19 Patients With Different Disease Severity

Introduction: Increased COVID-19 disease severity is higher among patients with type 2 diabetes mellitus and hypertension. However, the metabolic pathways underlying this association are not fully characterized. This study aims to identify the metabolic signature associated with increased COVID-19 severity in patients with diabetes mellitus and hypertension.Methods: One hundred and fifteen COVID-19 patients were divided based on disease severity, diabetes status, and hypertension status. Targeted metabolomics of serum samples from all patients was performed using tandem mass spectrometry followed by multivariate and univariate models.Results: Reduced levels of various triacylglycerols were observed with increased disease severity in the diabetic patients, including those containing palmitic (C16:0), docosapentaenoic (C22:5, DPA), and docosahexaenoic (C22:6, DHA) acids (FDR &lt; 0.01). Functional enrichment analysis revealed triacylglycerols as the pathway exhibiting the most significant changes in severe COVID-19 in diabetic patients (FDR = 7.1 × 10−27). Similarly, reduced levels of various triacylglycerols were also observed in hypertensive patients corresponding with increased disease severity, including those containing palmitic, oleic (C18:1), and docosahexaenoic acids. Functional enrichment analysis revealed long-chain polyunsaturated fatty acids (n-3 and n-6) as the pathway exhibiting the most significant changes with increased disease severity in hypertensive patients (FDR = 0.07).Conclusions: Reduced levels of triacylglycerols containing specific long-chain unsaturated, monounsaturated, and polyunsaturated fatty acids are associated with increased COVID-19 severity in diabetic and hypertensive patients, offering potential novel diagnostic and therapeutic targets.

Dietary Adherence and Associated Factors among Hypertensive Patients in Bahir Dar City Administration, Ethiopia, 2020

Introduction: Hypertension is considered one of the most challenging public health problems worldwide. Adherence to the recommended diet has a key role to reduce uncontrolled hypertension and hypertension-related complications. A study on dietary adherence among hypertensive patients and associated factors are limited in Ethiopia. So,this study aimed to assess dietary adherence and associated factors among hypertensive patients in Bahir Dar city governmental hospitals, Bahir Dar, Ethiopia. Method: A cross-sectional study was conducted at Bahir Dar city governmental hospitals from February- March 2020. Proportional allocation and systematic random sampling techniques were used to select 386 individuals with hypertension. The logistic regression model was used to assess the association between predictors and dietary adherence. The association was interpreted using the odds ratio and 95% confidence interval. Result: In this the proportion of dietary adherence was 32.8% (CI: 28.0, 37.6). Educational level college and above (AOR=3.0, CI=1.26, 7.08), received nutritional education (AOR=1.9, CI=1.05, 3.62), knowledgeable about hypertension (AOR=2.5, CI=1.36, 4.58), who had no co-morbidities (AOR=2.8, CI=1.49, 5.20), who lived two to four years with hypertension (AOR=2.4, CI=1.17, 5.07), and who had strong social support (AOR=7.1, CI=2.85, 17.46) had significantly association with dietary adherence. Conclusion and recommendations: This study demonstrated that low proportion of hypertensive individuals were adhered to recommended diet. Therefore, availed a social network of family and friends; providing dietary education to address the participants’ knowledge of hypertension, promote survival skill to new diagnosed and considered co-morbidities are an integral part of overall health in people with hypertension.