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Persistent hypertension in lupus nephritis and the associated risk factors

Shaharir SS, Mustafar R, Mohd R, Mohd Said MS, Gafor HA

Clin Rheumatol, 2015 Jan;34(1):93-7.
PMID: 25373448 DOI: 10.1007/s10067-014-2802-0

Arterial hypertension (HPT) burden up to two third of systemic lupus erythematosus (SLE) patients and contributes to accelerated atherosclerosis and cardiovascular (CV) risk. We aim to determine the prevalence of HPT among lupus nephritis (LN) patients who were in complete remission (CR) for a minimum of 6 months, with estimated glomerular filtration rate (eGFR) of >60 mL/min/1.73 m(2). This is a cross-sectional study of 64 LN patients who attended Nephrology/SLE Clinic at The National University of Malaysia Medical Centre (UKMMC). Persistent hypertension (blood pressure (BP) ≥140/90 mmHg for at least two occasions), CR for a minimum of 6 months and eGFR of >60 mL/min/1.73 m(2) were identified. Univariate and multivariate analyses were performed to determine the demographic and disease characteristics associated with HPT. Thirty-four of them (53.1 %) were hypertensive. Persistent HPT was associated with disease duration, acute kidney injury and high BP at the onset of LN, longer duration interval to achieve CR, number of relapses and cyclosporine A (CyA) use. There were no associations between histological classes, nephrotic range proteinuria, body mass index and waist circumference with HPT. Factors independently associated with HPT were disease duration OR 1.06 [95 %CI (0.91-1.24)], longer duration interval to achieve CR OR 1.104 [95 %CI (1.02-1.19)], number of relapses OR 2.53 [95 % CI (1.01-6.3)] and CyA use OR 5.3 [95 % CI (1.14-23.9)]. The prevalence of HPT among LN is high despite in remission. Aggressive treatment is important to achieve early CR and to prevent relapses.
Study site: Nephrology/SLE clinics, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia

Matched MeSH terms: Hypertension/complications*; Hypertension/diagnosis; Hypertension/epidemiology*
Fulltext Portal biliopathy

Ho C, Gunn A, Noordin M

Med J Malaysia, 2014 Oct;69(5):236-7.
PMID: 25638241 MyJurnal

Portal biliopathy is a term to describe the spectrum of abnormalities of the entire biliary tract or gallbladder associated with portal hypertension. The most common cause of portal biliopathy is extra-hepatic portal vein obstruction (EHPVO). We report a case of patient with portal biliopathy presenting with bleeding varices.

Matched MeSH terms: Hypertension, Portal
Fulltext Association between hypertension and periodontitis: possible mechanisms

Leong XF, Ng CY, Badiah B, Das S

ScientificWorldJournal, 2014;2014:768237.
PMID: 24526921 DOI: 10.1155/2014/768237

This review is to examine the current literatures on the relationship between periodontitis and hypertension as well as to explore the possible biological pathways underlying the linkage between these health conditions. Hypertension is one of the major risk factors for cardiovascular diseases. Oxidative stress and endothelial dysfunction are among the critical components in the development of hypertension. Inflammation has received much attention recently and may contribute to a pivotal role in hypertension. Periodontitis, a chronic low-grade inflammation of gingival tissue, has been linked to endothelial dysfunction, with blood pressure elevation and increased mortality risk in hypertensive patients. Inflammatory biomarkers are increased in hypertensive patients with periodontitis. Over the years, various researches have been performed to evaluate the involvement of periodontitis in the initiation and progression of hypertension. Many cross-sectional studies documented an association between hypertension and periodontitis. However, more well-designed prospective population trials need to be carried out to ascertain the role of periodontitis in hypertension.

Matched MeSH terms: Hypertension/diagnosis; Hypertension/metabolism*; Hypertension/epidemiology*
Fulltext The improvement of hypertension by probiotics: effects on cholesterol, diabetes, renin, and phytoestrogens

Lye HS, Kuan CY, Ewe JA, Fung WY, Liong MT

Int J Mol Sci, 2009 Sep;10(9):3755-75.
PMID: 19865517 DOI: 10.3390/ijms10093755

Probiotics are live organisms that are primarily used to improve gastrointestinal disorders such as diarrhea, irritable bowel syndrome, constipation, lactose intolerance, and to inhibit the excessive proliferation of pathogenic intestinal bacteria. However, recent studies have suggested that probiotics could have beneficial effects beyond gastrointestinal health, as they were found to improve certain metabolic disorders such as hypertension. Hypertension is caused by various factors and the predominant causes include an increase in cholesterol levels, incidence of diabetes, inconsistent modulation of renin and imbalanced sexual hormones. This review discusses the antihypertensive roles of probiotics via the improvement and/or treatment of lipid profiles, modulation of insulin resistance and sensitivity, the modulation of renin levels and also the conversion of bioactive phytoestrogens as an alternative replacement of sexual hormones such as estrogen and progesterone.

Matched MeSH terms: Hypertension/blood; Hypertension/etiology; Hypertension/therapy*
Ethnicity and drug therapy for hypertension

Amudha K, Wong LP, Choy AM, Lang CC

Curr Pharm Des, 2003;9(21):1691-701.
PMID: 12871202

Physiological and pharmacological responses may be influenced by ethnicity as a result of genetic factors, environmental factors and/or their interaction. This review is divided into 2 parts. Firstly, there will be overview of ethnicity as a determinant of drug metabolism and response with reference to antihypertensive agents. The concept of ethnicity has been applied extensively to the study of hypertension especially in American blacks in whom the hypertension is more common and more aggressive. Thus, the second part of this review will then focus on examining the black-white differences in physiological responses to pharmacological challenge that may provide a link between these models and known ethnic differences in drug responses. We will discuss the hypertension studies that have examined the relative effectiveness of different classes of antihypertensive agents including several recent cardiovascular outcome trials that either have a high proportion of blacks or were conducted entirely in black subjects.

Matched MeSH terms: Hypertension/drug therapy*; Hypertension/ethnology*; Hypertension/metabolism
ISH ADA-04 TRANSCRIPTOME PATHWAY ANALYSIS OF AUTONOMOUS AND PHYSIOLOGICAL ALDOSTERONE-PRODUCING HUMAN TISSUE

Zhou J, Lam B, Neogi S, Yeo G, Azizan E, Brown M

J Hypertens, 2016 Sep;34 Suppl 1 - ISH 2016 Abstract Book:e40.
PMID: 27753883

Primary aldosteronism (PA) is the most common type of secondary hypertension occurring in ∼10% of hypertensive patients. Up to 50% of PA is caused by aldosterone-producing adenomas (APA). This study is to identify the potential biological processes and canonical pathways involved with aldosterone regulation, APA formation, or APA and ZG cell functions.

Matched MeSH terms: Hypertension
Fulltext Clinical Practice Guidelines: Management of Hypertension. 5th edition

Citation: Clinical Practice Guidelines: Management of Hypertension, 5th Edition. Putrajaya: Ministry of Health, Malaysia; 2018

Training Manual: http://www.acadmed.org.my/view_file.cfm?fileid=944

Older versions
Clinical Practice Guidelines: Management of Hypertension, 4th Edition. Putrajaya: Ministry of Health, Malaysia; 2013
http://www.acadmed.org.my/view_file.cfm?fileid=634
Clinical Practice Guidelines: Management of Hypertension, 3rd Edition. Kuala Lumpur: Ministry of Health, Malaysia; 2008
Clinical Practice Guidelines: Management of Hypertension, 2nd Edition. Kuala Lumpur: Ministry of Health, Malaysia; 2002
Keywords: CPG

Matched MeSH terms: Hypertension
COVID-19 and Hypertension: The What, the Why, and the How

Muhamad SA, Ugusman A, Kumar J, Skiba D, Hamid AA, Aminuddin A

Front Physiol, 2021;12:665064.
PMID: 34012410 DOI: 10.3389/fphys.2021.665064

It has been a year since the coronavirus disease 2019 (COVID-19) was declared pandemic and wreak havoc worldwide. Despite meticulous research has been done in this period, there are still much to be learn from this novel coronavirus. Globally, observational studies have seen that majority of the patients with COVID-19 have preexisting hypertension. This raises the question about the possible relationship between COVID-19 and hypertension. This review summarizes the current understanding of the link between hypertension and COVID-19 and its underlying mechanisms.

Matched MeSH terms: Hypertension
Fulltext Apolipoprotein E gene polymorphisms in essential hypertension: a preliminary study with meta-analysis

Wisam, Nabil lbrahim, Norsidah KZ, Samsul D, Zamzila A, Rafidah HM

International Medical Journal Malaysia, 2015;14(2):45-52.
MyJurnal

Essential hypertension is a multifactorial disease. Many experimental studies have elucidated
the role of oxidative stress and atherosclerosis in the pathogenesis of essential hypertension. Apolipoprotein
E is a plasma protein that is found to have antioxidant properties, and it also protects against atherosclerosis.
Interestingly, the biological function of apolipoprotein E is strongly affected by polymorphisms in its gene.
Based on this evidence, our aim was to investigate the association of apolipoprotein E gene polymorphisms with
essential hypertension.

Matched MeSH terms: Hypertension
Fulltext Primary arteritis of aorta causing renal artery stenosis and hypertension

Danaraj TJ, Wong HO, Thomas MA

Br Heart J, 1963 Mar;25(2):153-65.
PMID: 14024854

The evidence presented by the nine cases described in this paper indicates that primary arteritis of the aorta is a single clinico-pathological entity of which Takayashu's syndrome is a part. Different segments of the aorta may be affected resulting in a variety of symptom complexes. In this series, the mode of presentation was hypertension consequent on renal artery stenosis. Early diagnosis is important and surgical treatment is indicated to relieve the hypertension which carries an immediately serious prognosis.

Matched MeSH terms: Hypertension*; Hypertension, Renal*
Fulltext Orthogonal Stimulus-Response as a Tool to Formulate Traditional Chinese Medicinal Herbal Combination: - New Scientific-Based TCM Herbal Formulating Method

Loh YC, Tan CS, Yam MF, Oo CW, Omar WMW

J Pharmacopuncture, 2018 Sep;21(3):203-206.
PMID: 30283708 DOI: 10.3831/KPI.2018.21.024

Objectives: There is an increasing number of complex diseases that are progressively more difficult to be controlled using the conventional "single compound, single target" approach as demonstrated in our current modern drug development. TCM might be the new cornerstone of treatment alternative when the current treatment option is no longer as effective or that we have exhausted it as an option. Orthogonal stimulus-response compatibility group study is one of the most frequently employed formulas to produce optimal herbal combination for treatment of multi-syndromic diseases. This approach could solve the relatively low efficacy single drug therapy usage and chronic adverse effects caused by long terms administration of drugs that has been reported in the field of pharmacology and medicine.
Methods: The present review was based on the Science Direct database search for those related to the TCM and the development of antihypertensive TCM herbal combination using orthogonal stimulus-response compatibility group studies approach.
Results: Recent studies have demonstrated that the orthogonal stimulus-response compatibility group study approach was most frequently used to formulate TCM herbal combination based on the TCM principles upon the selection of herbs, and the resulting formulated TCM formula exhibited desired outcomes in treating one of global concerned complex multi-syndromic diseases, the hypertension. These promising therapeutic effects were claimed to have been attributed by the holistic signaling mechanism pathways employed by the crude combination of herbs.
Conclusion: The present review could serve as a guide and prove the feasibility of TCM principles to be used for future pharmacological drug research development.

Matched MeSH terms: Hypertension
A review of blood pressure profile and hypertension studies in Malaysia

Liew YM, Tan H, Khoo KL

Family Physician, 1994;6:36-45.

This paper reviews the literature on blood pressure profile and hypertension studies carried out in Peninsular Malaysia from 1952 to 1988. From these studies, the following key information is summarised: 1. Blood pressure profiles of Malaysians, irrespective of sex and the three major ethnic groups viz., Malay, Chinese and Indian followed a similar rising trend with age. 2. The mean systolic and diastolic pressures were 134 mmHg and 84 mmHg respectively across the major ethnic groups. 3. The prevalence of hypertension for Malaysians was 16.0%, 4.2% and 3.4% when 140/90 mmHg, 150/90 mmHg or a diastolic pressure of 100 mmHg or greater were taken as cut-off values respectively. Males generally showed a higher prevalence of hypertension than females. 4. Orang Asli living in the deep jungle had relatively low blood pressures (Mean: 109/70 mmHg) and their blood pressure did not rise with increasing age. 5. There was generally no difference in the prevalence of hypertension amongst the major ethnic groups. However, there was a tendency for the Malays to have a higher prevalence of hypertension than the Chinese or the Indians. 6. There was an increased prevalence of hypertension among subjects who smoked heavily or who did very little or no physical exercise. Differences in prevalence of hypertension among subjects living in changing environment and lifestyle, such as urban versus rural, alcohol versus non-alcohol consumers and low income versus moderate income groups were not evident in the studies reviewed. 7. Percent unawareness of hypertension in hypertension subjects was generally high i.e. 57 % - 69% except in one sample which recorded a moderately value (33%).

Matched MeSH terms: Hypertension
The general practitioner and the diagnosis of hypertension

Catterall RA

Family Practitioner, 1976;2:13-17.

Matched MeSH terms: Hypertension
Paediatric middle aortic syndrome with endovascular treatment in East Malaysia

Hong Ong G, Benjamin Leong DK

Med J Malaysia, 2018 02;73(1):57-59.
PMID: 29531207 MyJurnal

Middle-aortic syndrome is a surgically curable cause of childhood hypertension. Open surgery is traditionally offered but with the advance of medical technology, endovascular approached is available in many country. Failure to control BP in open surgery is as low as 4.1% compares to 13% in endovascular approaches. However, mortality is 4% in open surgery almost 2 times higher than 2.3% in endovascular approach. This article presents a case of 10 years old child treated successfully without complication with endovascular balloon dilatation, as a first case of such disease in East Malaysia.

Matched MeSH terms: Hypertension
Fulltext BNT162b2 COVID-19 Vaccination and Its Effect on Blood Pressure

Tan TL, Salleh SA, Che Man Z, Tan MHP, Kader R, Jarmin R

Medicina (Kaunas), 2022 Dec 05;58(12).
PMID: 36556993 DOI: 10.3390/medicina58121789

Background and Objectives: The objective of this study is to examine the effect of the BNT162b2 vaccine on systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP) before and 15 min after two doses that were given 21 days apart. Materials and Methods: This active surveillance study of vaccine safety was conducted on 15 and 16 March (for the first dose) and 5 and 6 April (for the second dose) 2021 in an academic hospital. For both doses, SBP, DBP, MAP, and PP levels were measured before and 15 min after both doses were given to healthcare workers over the age of 18. The results of the study were based on measurements of the mean blood pressure (BP), the mean changes in BP, and the BP trends. Results: In total, 287 individuals received the vaccine. After the first dose, 25% (n = 72) of individuals had a decrease in DBP of at least 10 mmHg (mean DBP decrease: 15 mmHg, 95% CI: 14-17 mmHg), and after the second dose it was 12.5% (mean DBP decrease: 13 mmHg, 95% CI: 12-15 mmHg). After the first dose, 28.6% (n = 82) had a PP that was wider than 40 mmHg. After the first dose, 5.2% and 4.9% of the individuals experienced an increase or decrease in SBP, respectively, of more than 20 mmHg. After the second dose, the SBP of 11% (n = 32) decreased by at least 20 mmHg. Conclusions: Improved understanding of vaccine effects on BP may help address vaccine hesitancy in healthcare workers.

Matched MeSH terms: Hypertension
Management of Patient Care in Hemodialysis While Focusing on Cardiovascular Disease Events and the Atypical Role of Hyper- and/or Hypotension: A Systematic Review

Khan A, Khan AH, Adnan AS, Syed Sulaiman SA, Gan SH, Khan I

Biomed Res Int, 2016;2016:9710965.
PMID: 27833921

Background. Hemodialysis related hemodynamic instability is a major but an underestimated issue. Moreover, cardiovascular events are the leading cause of morbidity and mortality associated with blood pressure in hemodialysis patients. However, there have been many controversies regarding the role and management of hyper- and/or hypotension during hemodialysis that needs to be addressed. Objective. To critically review the available published data on the atypical role of hyper- and/or hypotension in cardiovascular associated morbidity and mortality in patients on hemodialysis and to understand the discrepancies in this context. Methods. A comprehensive search of literature employing electronic as well as manual sources and screening 2783 papers published between Jan 1980 and Oct 2015 was conducted to collect, identify, and analyze relevant information through peer-reviewed research articles, systematic reviews, and other published works. The cardiovascular events, including accelerated atherosclerotic cardiovascular disease (ASCVD), stroke, heart failure, myocardial infarction, myocardial ischemia, and stress induced myocardial dysfunction, leading to death were considered relevant. Results. A total of 23 published articles met the inclusion criteria and were included for in-depth review and analysis to finalize a comprehensive systematic review article. All the studies showed a significant association between the blood pressure and cardiovascular disease events in hemodialysis patients. Conclusions. Both intradialytic hypertension/hypotension episodes are major risk factors for cardiovascular mortality with a high percentage of probable causality; however, clinicians are faced with a dilemma on how to evaluate blood pressure and treat this condition.

Matched MeSH terms: Hypertension/etiology; Hypertension/mortality; Hypertension/physiopathology*
Fulltext The impact of cranioplasty on cerebral blood flow and its correlation with clinical outcome in patients underwent decompressive craniectomy

Mah JK, Kass RA

Asian J Neurosurg, 2016 Jan-Mar;11(1):15-21.
PMID: 26889273 DOI: 10.4103/1793-5482.172593

Decompressive craniectomy is commonly use as the treatment for medically refractory intracranial hypertension. Unexpected improvement in patient's neurological status has been observed among patients that underwent cranioplasty. Restoration of cerebral blood flow (CBF) hemodynamics is one of the contributing factors. This study was conducted to determine the impact of cranioplasty on CBF and its correlation with clinical outcome.

Matched MeSH terms: Intracranial Hypertension
Fulltext Effects of Curcuma xanthorrhiza Extracts and Their Constituents on Phase II Drug-metabolizing Enzymes Activity

Salleh NA, Ismail S, Ab Halim MR

Pharmacognosy Res, 2016 Oct-Dec;8(4):309-315.
PMID: 27695274 DOI: 10.4103/0974-8490.188873

BACKGROUND: Curcuma xanthorrhiza is a native Indonesian plant and traditionally utilized for a range of illness including liver damage, hypertension, diabetes, and cancer.
OBJECTIVE: The study determined the effects of C. xanthorrhiza extracts (ethanol and aqueous) and their constituents (curcumene and xanthorrhizol) on UDP-glucuronosyltransferase (UGT) and glutathione transferase (GST) activities.
MATERIALS AND METHODS: The inhibition studies were evaluated both in rat liver microsomes and in human recombinant UGT1A1 and UGT2B7 enzymes. p-nitrophenol and beetle luciferin were used as the probe substrates for UGT assay while 1-chloro-2,4-dinitrobenzene as the probe for GST assay. The concentrations of extracts studied ranged from 0.1 to 1000 μg/mL while for constituents ranged from 0.01 to 500 μM.
RESULTS: In rat liver microsomes, UGT activity was inhibited by the ethanol extract (IC50 =279.74 ± 16.33 μg/mL). Both UGT1A1 and UGT2B7 were inhibited by the ethanol and aqueous extracts with IC50 values ranging between 9.59-22.76 μg/mL and 110.71-526.65 μg/Ml, respectively. Rat liver GST and human GST Pi-1 were inhibited by ethanol and aqueous extracts, respectively (IC50 =255.00 ± 13.06 μg/mL and 580.80 ± 18.56 μg/mL). Xanthorrhizol was the better inhibitor of UGT1A1 (IC50 11.30 ± 0.27 μM) as compared to UGT2B7 while curcumene did not show any inhibition. For GST, both constituents did not show any inhibition.
CONCLUSION: These findings suggest that C. xanthorrhiza have the potential to cause herb-drug interaction with drugs that are primarily metabolized by UGT and GST enzymes.
SUMMARY: Findings from this study would suggest which of Curcuma xanthorrhiza extracts and constituents that would have potential interactions with drugs which are highly metabolized by UGT and GST enzymes. Further clinical studies can then be designed if needed to evaluate the in vivo pharmacokinetic relevance of these interactions Abbreviations Used: BSA: Bovine serum albumin, CAM: Complementary and alternative medicine, cDNA: Complementary deoxyribonucleic acid, CDNB: 1-Chloro-2,4-dinitrobenzene, CuSO4.5H2O: Copper(II) sulfate pentahydrate, CXEE: Curcuma xanthorrhiza ethanol extract, CXAE: Curcuma xanthorrhiza aqueous extract, GC-MS: Gas chromatography-mass spectroscopy, GSH: Glutathione, GST: Glutathione S-transferase, KCl: Potassium chloride, min: Minutes, MgCl2: Magnesium chloride, mg/mL: Concentration (weight of test substance in milligrams per volume of test concentration), mM: Milimolar, Na2CO3: Sodium carbonate, NaOH: Sodium hydroxide, nmol: nanomol, NSAIDs: Non-steroidal antiinflammatory drug, p-NP: para-nitrophenol, RLU: Relative light unit, SEM: Standard error of mean, UDPGA: UDP-glucuronic acid, UGT: UDP-glucuronosyltransferase.
KEYWORDS: Curcuma xanthorrhiza; UDP-glucuronosyltransferase; glutathione transferase; xanthorrhizol

Matched MeSH terms: Hypertension
Preliminary studies of left ventricular wall thickness and mass of normotensive and hypertensive subjects using m-mode echocardiography

Jaafar MS, Hamid O, Khor CS, Yuvaraj RM

Malays J Med Sci, 2002 Jan;9(1):28-33.
PMID: 22969315 MyJurnal

The relationship between left ventricular mass (LVM) and the mean arterial blood pressure (MAP) was investigated, using M-Mode echocardiography. MAP was higher in hypertensive patients (p<0.05, n=9) compared to that of controlled subjects. The results showed that LVM index for hypertensive patients was significantly higher (p<0.05, n=9) than that for the normal group. LVM index correlates fairly (r=0.6) with MAP for hypertensive patients. The results also show that the increase of intraventricular septal wall thickness (IVST) was due to hypertension. The LVM (r =0.9) and IVST (r=0.75) of the normal subjects were linearly dependent on the body surface area (BSA). The hypertensive group revealed a non-linear relationship to the BSA.

Matched MeSH terms: Hypertension
Therapeutic Implications of Nitrite in Hypertension

Ling WC, Mustafa MR, Murugan DD

J Cardiovasc Pharmacol, 2020 02;75(2):123-134.
PMID: 31651673 DOI: 10.1097/FJC.0000000000000771

Nitrite, an anion produced from the oxidative breakdown of nitric oxide (NO), has traditionally been viewed as an inert molecule. However, this dogma has been challenged with the findings that nitrite can be readily reduced to NO under pathological conditions, hence representing a physiologically relevant storage reservoir of NO either in the blood or tissues. Nitrite administration has been demonstrated to improve myocardial function in subjects with heart failure and to lower the blood pressure in hypertensive subjects. Thus, extensive amount of work has since been carried out to investigate the therapeutic potential of nitrite in treating cardiovascular diseases, especially hypertension. Studies done on several animal models of hypertension have demonstrated the efficacy of nitrite in preventing and ameliorating the pathological changes associated with the disease. This brief review of the current findings aims to re-evaluate the use of nitrite for the treatment of hypertension and in particular to highlight its role in improving endothelial function.

Matched MeSH terms: Hypertension/diagnosis; Hypertension/drug therapy*; Hypertension/metabolism; Hypertension/physiopathology

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