An analysis of the immune and vascular systems in untreated hypertension

Background: Blood pressure regulation leads to hypertension through complex environmental and genetic interactions, mediated by cardiac, vascular, endocrine, and renal systems. The immune system interacts with all of these, and may have a role in hypertension and associated organ damage. Methods and Results: The Inflammatension study comprehensively assessed vascular function (endothelial function, arterial stiffness, intima-media thickness, and cardiovascular variability), the immune cell ‘signature’ (including B and T cell subsets, monocyte and dendritic cells, and intracellular stimulation studies), and circulating protein biomarkers, in an untreated hypertensive group compared to normotensive controls, and in consideration of phenotypic groups, as follows. Does cardiovascular function differ between incident hypertension versus healthy controls? Hypertensive disease progression involves early arterial stiffness. Carotid atherosclerosis and impairment in endothelial function were not detected. Measures of arterial stiffness strongly correlate with each other, with ambulatory and central BP, and with cardiovascular variability. Are phenotypic subgroups apparent in hypertension? White coat hypertension patients demonstrated arterial stiffening in excess of sustained hypertension; masked hypertension patients vascular characteristics were akin to normotension. Machine learning techniques generated three phenotypic groups of hypertension, ‘arterially stiffened’, ‘vaso-protected’, and ‘non-dipper’. Identifying immune cell ‘signature’ in patients: Flow cytometry demonstrated lower CD4+ naïve cells (CD45RA+CCR7+CD45RO+CD62L+) in hypertension. CD4+ T central memory cells were expanded in hypertension, along with CD62- T effector memory cells in an adjusted model. Hypertensive group had proportionally fewer CD28+ lymphocytes and CD8+ TEMRA cells, and T cells polarised towards Th1/Tc1 and Th17.1/Tc17.1. Intermediate monocytes demonstrated a differing pattern of CCR2 and CCR5 chemokine receptor expression, and alterations in STAT1 and STAT6 phosphorylation cascades. Increased NK cell CD56+Dim expression and reduced NKT and T lymphocytes CD122 expression was linked to hypertension. Nocturnal non-dipping was associated with similar immune cell signature changes as hypertension, and dendritic cell mannose receptor downregulation in addition. The circulating protein biomarker ‘signature’ of untreated hypertension and hypertensive phenotypes: Cytokines and chemokines dominated the 34 biomarkers differing between normotension and hypertension, though failed to meet Bonferroni-adjusted thresholds. Inflammatory biomarkers correlated with BP and arterial stiffness, but not endothelial function. Associations were concordant across systolic and diastolic BP; TPP1, CCL7, CCL11, and CCL21 positively correlating; IL18R1, and KYNU negatively. These relationships were more pronounced in the hypertensive subgroup, especially CD molecules and cytokines. HGF, AGE, and CCL21 showed greatest between-group differences and correlations across arterial parameters. Systolic nocturnal dipping demonstrated negative correlation with immune cell interaction and cellular adhesion biomarkers (CTRC, EPHA1, LGALS4, SIT1, SMOC, IL-18 and TNFSF11). Sixteen of the 85 correlating biomarkers also differed between the ‘arterially stiffened’, ‘vaso-protected’, and ‘non-dipper’ phenotypic groups. Conclusions: In untreated hypertension arterial stiffness is already detectable, and along with nocturnal dipping and estimates of central BP, categorise hypertensive phenotypes. The exploratory data support alterations of circulating immune biomarkers, and innate (monocytes) and adaptive (T cells) immune compartments. Nocturnal dipping and hypertension phenotypes especially demonstrate immune system variances

The acute (immediate) specific haemodynamic effects of reflexology

Reflexology is one of the top six complementary therapies used in the UK. Reflexologists claim that massage to specific points of the feet increases blood supply to referred or 'mapped' organs in the body. Empirical evidence to validate this claim is scarce. This three-phase RCT measured changes in haemodynamic parameters in subjects receiving reflexology treatment applied to specific areas of the foot which are thought to correspond to the heart (intervention) compared with reflexology applied to other areas on the foot which are not (control)

Medicīnas sekcija (2017.gada 24.februārī): tēžu krājums

Supported by: Faculty of Medicine, University of Latvia, Latvijas Inovatīvās medicīnas fonds, Latvijas Invazīvās kardioloģijas attīstības biedrība, AS “Sistēmu Inovācijas”, Doktorantūras skola “Translācijas izpētē medicīnā

Smoking and Second Hand Smoking in Adolescents with Chronic Kidney Disease: A Report from the Chronic Kidney Disease in Children (CKiD) Cohort Study

The goal of this study was to determine the prevalence of smoking and second hand smoking [SHS] in adolescents with CKD and their relationship to baseline parameters at enrollment in the CKiD, observational cohort study of 600 children (aged 1-16 yrs) with Schwartz estimated GFR of 30-90 ml/min/1.73m2. 239 adolescents had self-report survey data on smoking and SHS exposure: 21 [9%] subjects had “ever” smoked a cigarette. Among them, 4 were current and 17 were former smokers. Hypertension was more prevalent in those that had “ever” smoked a cigarette (42%) compared to non-smokers (9%), p\u3c0.01. Among 218 non-smokers, 130 (59%) were male, 142 (65%) were Caucasian; 60 (28%) reported SHS exposure compared to 158 (72%) with no exposure. Non-smoker adolescents with SHS exposure were compared to those without SHS exposure. There was no racial, age, or gender differences between both groups. Baseline creatinine, diastolic hypertension, C reactive protein, lipid profile, GFR and hemoglobin were not statistically different. Significantly higher protein to creatinine ratio (0.90 vs. 0.53, p\u3c0.01) was observed in those exposed to SHS compared to those not exposed. Exposed adolescents were heavier than non-exposed adolescents (85th percentile vs. 55th percentile for BMI, p\u3c 0.01). Uncontrolled casual systolic hypertension was twice as prevalent among those exposed to SHS (16%) compared to those not exposed to SHS (7%), though the difference was not statistically significant (p= 0.07). Adjusted multivariate regression analysis [OR (95% CI)] showed that increased protein to creatinine ratio [1.34 (1.03, 1.75)] and higher BMI [1.14 (1.02, 1.29)] were independently associated with exposure to SHS among non-smoker adolescents. These results reveal that among adolescents with CKD, cigarette use is low and SHS is highly prevalent. The association of smoking with hypertension and SHS with increased proteinuria suggests a possible role of these factors in CKD progression and cardiovascular outcomes

A Systematic Review and Meta-Analysis of the Incidence of Injury in Professional Female Soccer

The epidemiology of injury in male professional football is well documented and has been used as a basis to monitor injury trends and implement injury prevention strategies. There are no systematic reviews that have investigated injury incidence in women’s professional football. Therefore, the extent of injury burden in women’s professional football remains unknown. PURPOSE: The primary aim of this study was to calculate an overall incidence rate of injury in senior female professional soccer. The secondary aims were to provide an incidence rate for training and match play. METHODS: PubMed, Discover, EBSCO, Embase and ScienceDirect electronic databases were searched from inception to September 2018. Two reviewers independently assessed study quality using the Strengthening the Reporting of Observational Studies in Epidemiology statement using a 22-item STROBE checklist. Seven prospective studies (n=1137 professional players) were combined in a pooled analysis of injury incidence using a mixed effects model. Heterogeneity was evaluated using the Cochrane Q statistic and I2. RESULTS: The epidemiological incidence proportion over one season was 0.62 (95% CI 0.59 - 0.64). Mean total incidence of injury was 3.15 (95% CI 1.54 - 4.75) injuries per 1000 hours. The mean incidence of injury during match play was 10.72 (95% CI 9.11 - 12.33) and during training was 2.21 (95% CI 0.96 - 3.45). Data analysis found a significant level of heterogeneity (total Incidence, X2 = 16.57 P < 0.05; I2 = 63.8%) and during subsequent sub group analyses in those studies reviewed (match incidence, X2 = 76.4 (d.f. = 7), P <0.05; I2 = 90.8%, training incidence, X2 = 16.97 (d.f. = 7), P < 0.05; I2 = 58.8%). Appraisal of the study methodologies revealed inconsistency in the use of injury terminology, data collection procedures and calculation of exposure by researchers. Such inconsistencies likely contribute to the large variance in the incidence and prevalence of injury reported. CONCLUSIONS: The estimated risk of sustaining at least one injury over one football season is 62%. Continued reporting of heterogeneous results in population samples limits meaningful comparison of studies. Standardising the criteria used to attribute injury and activity coupled with more accurate methods of calculating exposure will overcome such limitations

Yoga for improving sleep quality and quality of life of older adults in a western cultural setting

Little research has been published (by early 2007) on yoga as an intervention for improving sleep quality and quality of life of older people in a western cultural setting. The aim of the present study was to fill a gap in existing research and evaluate whether a yoga intervention could improve sleep quality and quality of life of elderly people living in a western cultural setting. A mixed ‘waiting list control’ (WLC) study design (n =74) was used, with participants’ ages ranging from 60 to 87 (M = 74.4, SD = 7.1). The yoga intervention included two weekly classes incorporating physical and meditative yoga, and daily home practice of meditative yoga for 12 weeks. Subjective measures included the Pittsburgh Sleep Quality index (PSQI), Karolinska Sleepiness Scale (KSS), Epworth Sleepiness Scale (ESS), Multivariate Apnea Prediction Index (MAP), Profile of Mood States (POMS), Depression Anxiety and Stress Scale (DASS), Short Form Health Survey (SF36) and daily sleep and practice logs. Objective measures were derived from sleep studies conducted using portable monitoring in the participants’ home environments. Overall, the results indicate that yoga appears to be a safe, easy to implement, and well accepted, non-drug intervention for insomnia in the elderly in a western cultural setting. Practicing yoga for at least 25 minutes a day for twelve weeks improved most aspects of subjective sleep status and many aspects of psychological and emotional well being. Practice compliance was found to be an essential factor in the outcomes of the yoga intervention with high practice compliance being related to improvements in sleep quality measures and some quality of life measures. In comparison to the control group the treatment group showed significant improvements in a range of subjective factors including overall sleep quality (p=.011), sleep efficiency (p=.045), sleep latency (p=.004), sleep duration (p=.042), self assessed sleep quality (p=.002) and fatigue (p=.010). Improvements were also seen in general well being (p=.008), overall mental health (p=.009), depression (p=.019), anxiety (p=.011), stress (p=.022), tension (p=.044) anger (p=.005), vitality (p=.053) and daily function in physical (p=.035), emotional (p=.043), and social (p=.030) roles. Improvements were also seen in the duration of the deep sleep (SWS) stage (p=.042). However, no significant change was found in the use of sedative-hypnotic medications in the study population. It was also found that obstructive sleep apnea (OSA) appears to be present to varying degrees in the majority of elderly people presenting with insomnia symptoms. While the results suggest that yoga practice did not result in a significant change in OSA status, the presence of co-morbid OSA reduced the efficacy of yoga in improving overall sleep quality and sleep efficiency and some aspects of quality of life including carrying out daily roles and social function, but did not affect most other measures. Currently, recommended diagnostic procedures for patients presenting with insomnia symptoms appear inadequate to diagnose OSA reliably in elderly patients presenting with insomnia symptoms, suggesting they should be screened for OSA using objective sleep studies prior to prescribing sedative-hypnotics