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Cardiovascular and Renal Damage in Hypertension: Prognostic Role and a Guide for Treatment

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (20 December 2021) | Viewed by 24435

Special Issue Editor

Prof. Dr. Francesca Chiara Viazzi

E-Mail Website
Guest Editor
Department of Cardionephrology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy
Interests: hypertension; albuminuria; serum uric acid; cardiovascular risk; diabetes; chronic kidney disease

Special Issue Information

Dear Colleagues,

The prevalence of hypertension (HT) in adults is around 30%–45% worldwide and becomes progressively higher with advancing age. Furthermore, HT is often associated with many highly prevalent comorbidities such as obesity, diabetes, and chronic kidney disease (CKD).

In addition to the severity of blood pressure (BP) increase and systemic hemodynamic load, there are other clinical variables that strongly influence the risk of acute and chronic complications in patients with HT. Among these concomitant conditions, the presence of so-called hypertension-mediated organ damage (HMOD) at the cardiac renal and vascular level plays a strong role in long-term clinical outcomes. Furthermore, there is clear evidence that other mediators (hyperuricemia, metabolic syndrome, hyperlipidemia, mineral bone disease, etc.) are also crucially involved in the transition from a healthy to a diseased state of target organs.

The clinical relevance of HMOD detection is due to the fact that it is not only a marker of elevated BP, but also an important predictor of CV events and, above all, changes in its severity are an important modulator of overall prognosis. This has obvious consequences for a multifactorial approach aimed not only at achieving target BP levels but also at preventing the development or the progression of HMOD in order to optimally reduce the overall cardiovascular risk for patients.

This review will thus focus on several aspects of HMOD in different clinical settings, with a particular attention to mechanisms of its development, noninvasive tools useful in its detection and to multifactorial therapeutic strategies aimed at reducing CV and renal risk.

Prof. Dr. Francesca Chiara Viazzi
Guest Editor

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Keywords

  • Blood pressure behavior
  • Resistant hypertension
  • Diabetes
  • Chronic kidney disease
  • Serum uric acid
  • Albuminuria
  • Left ventricular hypertrophy
  • Vascular stiffness
  • Renin–angiotensin–aldosterone system

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Published Papers (5 papers)

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Research

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10 pages, 1728 KiB  
Article
Calcium Channel Blockers Are Associated with Nocturia in Men Aged 40 Years or Older
by Satoshi Washino, Yusuke Ugata, Kimitoshi Saito and Tomoaki Miyagawa
J. Clin. Med. 2021, 10(8), 1603; https://doi.org/10.3390/jcm10081603 - 9 Apr 2021
Cited by 6 | Viewed by 4783
Abstract
Background: The associations of nocturia with hypertension and anti-hypertensive agents (AHTs) remain to be validated. Methods: This cross-sectional study examined whether blood pressure and/or frequently used classes of AHTs had consistent associations with nocturia. Methods: A total of 418 male patients aged ≥ [...] Read more.
Background: The associations of nocturia with hypertension and anti-hypertensive agents (AHTs) remain to be validated. Methods: This cross-sectional study examined whether blood pressure and/or frequently used classes of AHTs had consistent associations with nocturia. Methods: A total of 418 male patients aged ≥ 40 years were retrospectively assessed in terms of the International Prostate Symptom Score (IPSS), prescription medications, and blood pressure. Nocturia was evaluated using item 7 of the IPSS, and two or more episodes of nocturia per night was considered to indicate clinically important nocturia. Results: Patients taking calcium channel blockers (CCBs), but not other AHTs, experienced more episodes of nocturia than patients not taking AHTs (1.77 ± 1.07, 1.90 ± 1.19, and 1.48 ± 0.98 in CCBs alone, CCBs + other AHTs, and other AHTs alone, vs. 1.35 ± 1.08 in not taking AHTs; p = 0.014, p < 0.0001, and p = 0.91, respectively), whereas there was no significant difference in the number of nocturia episodes between patients with elevated and normal blood pressure. In multivariate analysis, CCB (odds ratio (OR) = 2.68, p < 0.0001) and age (OR = 1.06, p < 0.0001) were independently associated with clinically important nocturia. Conclusion: CCB was associated with nocturia, while AHTs other than CCBs and elevated blood pressure were not. Full article
(This article belongs to the Special Issue Cardiovascular and Renal Damage in Hypertension: Prognostic Role and a Guide for Treatment)
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15 pages, 1786 KiB  
Article
Syndecan-4 as a Marker of Endothelial Dysfunction in Patients with Resistant Hypertension
by Mark Lipphardt, Hassan Dihazi, Jens-Holger Maas, Ann-Kathrin Schäfer, Saskia I. Amlaz, Brian B. Ratliff, Michael J. Koziolek and Manuel Wallbach
J. Clin. Med. 2020, 9(9), 3051; https://doi.org/10.3390/jcm9093051 - 22 Sep 2020
Cited by 16 | Viewed by 3185
Abstract
(1) Background: Arterial hypertension (HTN) is one of the most relevant cardiovascular risk factors. Nowadays multiple pharmaceutical treatment options exist with novel interventional methods (e.g., baroreflex activation therapy (BAT)) as a last resort to treat patients with resistant HTN. Although pathophysiology behind resistant [...] Read more.
(1) Background: Arterial hypertension (HTN) is one of the most relevant cardiovascular risk factors. Nowadays multiple pharmaceutical treatment options exist with novel interventional methods (e.g., baroreflex activation therapy (BAT)) as a last resort to treat patients with resistant HTN. Although pathophysiology behind resistant HTN is still not fully understood. There is evidence that selected biomarkers may be involved in the pathophysiology of HTN. (2) Methods: We investigated serum SDC4-levels in patients suffering from resistant HTN before and 6 months after BAT implantation. We collected 19 blood samples from patients with resistant HTN and blood pressure above target and measured serum SDC4-levels. (3) Results: Our results showed high serum SDC4-levels in patients with resistant HTN as compared to a healthy population. Patients with both, resistant HTN and diabetes mellitus type II, demonstrated higher serum SDC4-levels. β-blockers had lowering effects on serum SDC4-levels, whereas calcium channel blockers were associated with higher levels of serum SDC4. BAT implantation did not lead to a significant difference in serum SDC4-levels after 6 months of therapy. (4) Conclusion: Based on our results we propose SDC4 is elevated in patients suffering from resistant HTN. Thus, SDC4 might be a potential marker for endothelial dysfunction in patients with resistant hypertension. Full article
(This article belongs to the Special Issue Cardiovascular and Renal Damage in Hypertension: Prognostic Role and a Guide for Treatment)
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12 pages, 952 KiB  
Article
Blood Pressure and Body Weight Have Different Effects on Pulse Wave Velocity and Cardiac Mass in Children
by Simonetta Genovesi, Paolo Salvi, Elisa Nava, Elena Tassistro, Marco Giussani, Ilaria Desimone, Antonina Orlando, Mariagrazia Battaglino, Giulia Lieti, Massimo Montemerlo, Laura Antolini and Gianfranco Parati
J. Clin. Med. 2020, 9(9), 2954; https://doi.org/10.3390/jcm9092954 - 12 Sep 2020
Cited by 12 | Viewed by 2704
Abstract
Background: High blood pressure (BP) and excess weight can lead to early cardiovascular organ damage already in children. Carotid-femoral pulse wave velocity (cf-PWV) is the non-invasive gold standard method for assessing aortic stiffness, while carotid-radial PWV (cr-PWV) provides information on the distensibility of [...] Read more.
Background: High blood pressure (BP) and excess weight can lead to early cardiovascular organ damage already in children. Carotid-femoral pulse wave velocity (cf-PWV) is the non-invasive gold standard method for assessing aortic stiffness, while carotid-radial PWV (cr-PWV) provides information on the distensibility of the upper limb arteries. The aim of this study was to evaluate the relationship of BP and BMI z-scores with arterial stiffness and left ventricular mass index (LVMI) in a pediatric population. Methods: In 343 children (57.7% males; age ± SD 11.7 ± 2.9 years), systolic (SBP) and diastolic (DBP) BP, BMI, cf-PWV, cr-PWV and LVMI were measured. A multiple linear regression model was used to assess the impact of BMI and SBP (or DBP) z-scores on cf-PWV, cr-PWV and LVMI. Results: About 21% of children were normal weight, 34% were overweight and 45% obese. Adjusted for possible confounders, SBP and DBP z-scores were significantly associated with cf-PWV (p < 0.001), while only DBP z-scores were related to cr-PWV (p < 0.01). BMI was neither associated with cf-PWV nor with cr-PWV values but was a strong predictor of LVMI (<0.001), whereas cardiac mass and BP z-scores were not related. Conclusions: Our study suggests that, in children, elevated BP values and excess weight may have different effects on the heart and the vessels in causing early cardiovascular alterations. Full article
(This article belongs to the Special Issue Cardiovascular and Renal Damage in Hypertension: Prognostic Role and a Guide for Treatment)
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Review

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9 pages, 492 KiB  
Review
Blood Pressure Profiles and Cognitive Function from Adulthood to Old Age: Chasing a Golden Middle Way?
by Rita Del Pinto, Davide Grassi, Raffaella Bocale, Francesco Carubbi, Claudio Ferri and Giovambattista Desideri
J. Clin. Med. 2021, 10(15), 3243; https://doi.org/10.3390/jcm10153243 - 23 Jul 2021
Cited by 6 | Viewed by 3545
Abstract
With the demographic shift toward advanced ages, it is imperative to understand the biological mechanisms behind common, disabling age-related diseases such as cognitive impairment in its mild form to overt dementia. Hypertension, a major cardiovascular risk factor, is epidemiologically linked to vascular and [...] Read more.
With the demographic shift toward advanced ages, it is imperative to understand the biological mechanisms behind common, disabling age-related diseases such as cognitive impairment in its mild form to overt dementia. Hypertension, a major cardiovascular risk factor, is epidemiologically linked to vascular and Alzheimer-type dementia, with possible mechanisms being atherosclerotic macro- and microvascular damage leading to neuronal cell death, as well as proinflammatory events responsible for neurodegeneration. Nevertheless, there is currently a knowledge gap as to which population to target, what the diagnostics test, and how to manage early pathogenic events in order to prevent such a dramatic and disabling condition. While clinical trials data support the benefit of active BP control with antihypertensive medications on the risk of future cognitive impairment, hypotension appears to be related to accelerated cognitive decline in both the fit and the cognitively frail elderly. Dedicated, technologically advanced studies assessing the relation of BP with dementia are needed to clarify the pathophysiological mechanisms in the association before a tailored preventive, diagnostic, and therapeutic approach to one of the most widespread modern medical challenges becomes a reality. Full article
(This article belongs to the Special Issue Cardiovascular and Renal Damage in Hypertension: Prognostic Role and a Guide for Treatment)
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15 pages, 322 KiB  
Review
Uric Acid and Hypertension: Prognostic Role and Guide for Treatment
by Federica Piani, Arrigo F. G. Cicero and Claudio Borghi
J. Clin. Med. 2021, 10(3), 448; https://doi.org/10.3390/jcm10030448 - 24 Jan 2021
Cited by 37 | Viewed by 9083
Abstract
The relationship between serum uric acid (SUA) and hypertension has been a subject of increasing interest since the 1870 discovery by Frederick Akbar Mahomed. Several epidemiological studies have shown a strong association between high SUA levels and the presence or the development of [...] Read more.
The relationship between serum uric acid (SUA) and hypertension has been a subject of increasing interest since the 1870 discovery by Frederick Akbar Mahomed. Several epidemiological studies have shown a strong association between high SUA levels and the presence or the development of hypertension. Genetic analyses have found that xanthine oxidoreductase (XOR) genetic polymorphisms are associated with hypertension. However, genetic studies on urate transporters and Mendelian randomization studies failed to demonstrate a causal relationship between SUA and hypertension. Results from clinical trials on the role of urate-lowering therapy in the management of patients with hypertension are not uniform. Our study sought to analyze the prognostic and therapeutic role of SUA in the hypertensive disease, from uric acid (UA) biology to clinical trials on urate-lowering therapies. Full article
(This article belongs to the Special Issue Cardiovascular and Renal Damage in Hypertension: Prognostic Role and a Guide for Treatment)
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