Effects of telmisartan and ramipril on adiponectin and blood pressure in patients with type 2 diabetes

<b>Background:</b> Adiponectin is secreted by adipose tissue and may play a role in cardiovascular disease. We examined adiponectin levels in patients with type 2 diabetes who participated in the Telmisartan vs. Ramipril in Renal Endothelial Dysfunction (TRENDY) study. <b>Methods</b> A total of 87 patients were assessed at baseline and following 9 weeks treatment with the angiotensin-receptor blocker telmisartan (final dose, 80 mg; n = 45) or the angiotensin-converting enzyme inhibitor ramipril (final dose, 10 mg; n = 42). Adiponectin levels were measured in plasma by radioimmunoassay. <b>Results:</b> Adiponectin levels were inversely correlated with systolic (SBP; r = -0.240, P < 0.05) and diastolic (DBP; r = -0.227, P < 0.05) blood pressure at baseline and following treatment with telmisartan or ramipril (SBP: r = -0.228, P < 0.05; DBP: r = -0.286, P < 0.05). Changes in adiponectin levels were related to changes in SBP (r = -0.357, P < 0.01) and DBP (r = -0.286, P < 0.01). There was a significant increase in adiponectin levels in the telmisartan (0.68 (95% confidence interval (CI), 0.27 to 1.10) <sup>µ</sup>g/ml, P < 0.01) but not in the ramipril group (0.17 (95% CI, -0.56 to 0.90) <sup>µ</sup>g/ml, P = 0.67). Blood pressure reduction in the telmisartan group (DeltaSBP: -13.5 (95% CI, -17.0 to -10.0) mm Hg; ΔDBP: -7.6 (95% CI, -9.8 to -5.3) mm Hg, each P < 0.001) was significantly (P less than or equal to 0.01 for SBP and P < 0.01 for DBP) greater than in the ramipril group (ΔSBP: -6.1 (95% CI, -6.2 to -2.0) mm Hg; ΔDBP: -2.7 (95% CI, -5.0 to -0.5) mm Hg; P < 0.01 and P < 0.05, respectively). <b>Conclusion:</b> Adiponectin is correlated with blood pressure in patients with type 2 diabetes. Whether increased adiponectin contributes to the blood pressure–lowering effect of telmisartan needs further study

Can we identify response markers to antihypertensive drugs? First results from the Ideal Trial

Current antihypertensive strategies do not take into account that individual characteristics may influence the magnitude of blood pressure (BP) reduction. Guidelines promote trial-and-error approaches with many different drugs. We conducted the Identification of the Determinants of the Efficacy of Arterial blood pressure Lowering drugs (IDEAL) Trial to identify factors associated with BP responses to perindopril and indapamide. IDEAL was a cross-over, double-blind, placebo-controlled trial, involving four 4-week periods: indapamide, perindopril and two placebo. Eligible patients were untreated, hypertensive and aged 25-70 years. The main outcome was systolic BP (SBP) response to drugs. The 112 participants with good compliance had a mean age of 52. One in every three participants was a woman. In middle-aged women, the SBP reduction from drugs was -11.5 mm Hg (indapamide) and -8.3 mm Hg (perindopril). In men, the response was significantly smaller: -4.8 mm Hg (indapamide) and -4.3 (perindopril) (P for sex differences 0.001 and 0.015, respectively). SBP response to perindopril decreased by 2 mm Hg every 10 years of age in both sexes (P=0.01). The response to indapamide increased by 3 mm Hg every 10 years of age gradient in women (P=0.02). Age and sex were important determinants of BP response for antihypertensive drugs in the IDEAL population. This should be taken into account when choosing drugs a priori.Journal of Human Hypertension advance online publication, 17 April 2014; doi:10.1038/jhh.2014.29

Reciprocal Interaction between Macrophages and T cells Stimulates IFN-γ and MCP-1 Production in Ang II-induced Cardiac Inflammation and Fibrosis

Background: The inflammatory response plays a critical role in hypertension-induced cardiac remodeling. We aimed to study how interaction among inflammatory cells causes inflammatory responses in the process of hypertensive cardiac fibrosis. Methodology/Principal Findings: Infusion of angiotensin II (Ang II, 1500 ng/kg/min) in mice rapidly induced the expression of interferon c (IFN-c) and leukocytes infiltration into the heart. To determine the role of IFN-c on cardiac inflammation and remodeling, both wild-type (WT) and IFN-c-knockout (KO) mice were infused Ang II for 7 days, and were found an equal blood pressure increase. However, knockout of IFN-c prevented Ang II-induced: 1) infiltration of macrophages and T cells into cardiac tissue; 2) expression of tumor necrosis factor a and monocyte chemoattractant protein 1 (MCP-1), and 3) cardiac fibrosis, including the expression of a-smooth muscle actin and collagen I (all p,0.05). Cultured T cells or macrophages alone expressed very low level of IFN-c, however, co-culture of T cells and macrophages increased IFN-c expression by 19.860.95 folds (vs. WT macrophage, p,0.001) and 20.9 6 2.09 folds (vs. WT T cells, p,0.001). In vitro co-culture studies using T cells and macrophages from WT or IFN-c KO mice demonstrated that T cells were primary source for IFN-c production. Co-culture of WT macrophages with WT T cells, but not with IFN-c-knockout T cells, increased IFN-c production (p,0.01). Moreover, IFN-c produced by T cells amplified MCP-1 expression in macrophages and stimulated macrophag

Carbon-nitrogen interactions in European forests and semi-natural vegetation - Part 1: Fluxes and budgets of carbon, nitrogen and greenhouse gases from ecosystem monitoring and modelling

The impact of atmospheric reactive nitrogen (N$_{r}$) deposition on carbon (C) sequestration in soils and biomass of unfertilized, natural, semi-natural and forest ecosystems has been much debated. Many previous results of this dC/dN response were based on changes in carbon stocks from periodical soil and ecosystem inventories, associated with estimates of N$_{r}$ deposition obtained from large-scale chemical transport models. This study and a companion paper (Flechard et al., 2020) strive to reduce uncertainties of N effects on C sequestration by linking multi-annual gross and net ecosystem productivity estimates from 40 eddy covariance flux towers across Europe to local measurement-based estimates of dry and wet N$_{r}$ deposition from a dedicated collocated monitoring network. To identify possible ecological drivers and processes affecting the interplay between C and N$_{r}$ inputs and losses, these data were also combined with in situ flux measurements of NO, N$_{2}$O and CH$_{4}$ fluxes; soil NO$_{3}$̅ leaching sampling; and results of soil incubation experiments for N and greenhouse gas (GHG) emissions, as well as surveys of available data from online databases and from the literature, together with forest ecosystem (BASFOR) modelling. Multi-year averages of net ecosystem productivity (NEP) in forests ranged from -70 to 826 gCm$^{-2}$ yr$^{-1}$ at total wet+dry inorganic N$_{r}$ deposition rates (N$_{dep}$) of 0.3 to 4.3 gNm$^{-2}$ yr$^{-1}$ and from -4 to 361 g Cm$^{-2}$ yr$^{-1}$ at N$_{dep}$ rates of 0.1 to 3.1 gNm$^{-2}$ yr$^{-1}$ in short semi-natural vegetation (moorlands, wetlands and unfertilized extensively managed grasslands). The GHG budgets of the forests were strongly dominated by CO$_{2}$ exchange, while CH$_{4}$ and N$_{2}$O exchange comprised a larger proportion of the GHG balance in short semi-natural vegetation. Uncertainties in elemental budgets were much larger for nitrogen than carbon, especially at sites with elevated N$_{dep}$ where N$_{r}$ leaching losses were also very large, and compounded by the lack of reliable data on organic nitrogen and N$_{2}$ losses by denitrification. Nitrogen losses in the form of NO, N$_{2}$O and especially NO$_{3}$̅ were on average 27%(range 6 %–54 %) of N$_{dep}$ at sites with N$_{dep}$ 3 gNm$^{-2}$ yr$^{-1}$. Such large levels of N$_{r}$ loss likely indicate that different stages of N saturation occurred at a number of sites. The joint analysis of the C and N budgets provided further hints that N saturation could be detected in altered patterns of forest growth. Net ecosystem productivity increased with N$_{r}$ deposition up to 2–2.5 gNm$^{-2}$ yr$^{-1}$, with large scatter associated with a wide range in carbon sequestration efficiency (CSE, defined as the NEP = GPP ratio). At elevated N$_{dep}$ levels (> 2.5 gNm$^{-2}$ yr$^{-1}$), where inorganic N$_{r}$ losses were also increasingly large, NEP levelled off and then decreased. The apparent increase in NEP at low to intermediate N$_{dep}$ levels was partly the result of geographical cross-correlations between N$_{dep}$ and climate, indicating that the actual mean dC/dN response at individual sites was significantly lower than would be suggested by a simple, straightforward regression of NEP vs. N$_{dep}$

Postural Control during the Stroop Test in Dyslexic and Non Dyslexic Teenagers

Postural control in quiet stance although simple still requires some cognitive resources; dual cognitive tasks influence further postural control. The present study examines whether or not dyslexic teenagers experience postural instability when performing a Stroop dual task for which their performances are known to be poor. Fifteen dyslexics and twelve non-dyslexics (14 to 17 years old) were recruited from the same school. They were asked to perform three tasks: (1) fixate a target, (2) perform an interference Stroop test (naming the colour or the word rather than reading the word), (3) performing flexibility Stroop task: the subject performed the interference task as in (2) except when the word was in a box, in which case he had to read the word. Postural performances were measured with a force platform. The results showed a main task effect on the variance of speed of body sway only: such variance was higher in the flexibility task than for the other two tasks. No group effect was found for any of the parameters of posture (surface, mediolateral and anteroposterior sway, variance of speed). Further wavelet analysis in the time-frequency domain revealed an increase in the spectral power of the medium frequency range believed to be related to cerebellum control; an accompanying increase in the cancellation time of the high frequency band related to reflexive loops occurred for non-dyslexics only. These effects occurred for the flexibility task and could be due to its high cognitive difficulty. Dyslexics displayed shorter cancellation time for the medium frequency band for all tasks, suggesting less efficient cerebellar control, perhaps of eye fixation and attention influencing body sway. We conclude that there is no evidence for a primary posture deficit in 15 year old teenagers who come from the general population and who were recruited in schools