Blood pressure targets in the elderly

No abstract available

Sex differences in hypertension and other cardiovascular diseases

No abstract available

Genomics and precision medicine for clinicians and scientists in hypertension

No abstract available

Vascular biomedicine in an era of chronic disease and multimorbidity

It is increasingly common that patients present with more than one disease and that diseases are chronic in nature. Cardiovascular conditions such as hypertension, heart failure and stroke, renal diseases and cardiometabolic conditions such as diabetes are prime examples of chronic diseases which pose major challenges in contemporary healthcare provision. The complex features of multimorbidity call for precision medicine approaches that take comorbidity and chronicity into account. The research basis of chronic disease and multimorbidity, however, is currently in its infancy. This applies to all domains including basic, translational and clinical science. In this article we call for development of new models, smarter use of existing models and better characterisation of vascular and cardiovascular phenotypes in studies not directly related to cardiovascular diseases. This has the potential to further improve the quality of translational research, papers in journals such as Clinical Science and ultimately translate into better patient care

Use of biomarkers in the evaluation and treatment of hypertensive patients

The current definition of hypertension is based on blood pressure values, and blood pressure also drives treatment decisions, is the most important treatment monitoring tool and helps estimating risk of hypertension related organ damage. In an era of precision medicine additional biomarkers are needed in the diagnosis and management of patients with hypertension. In this review we outline the areas in which functional, imaging and circulating biomarkers could help in a more individualised definition of hypertension and associated risk. We will cover biomarkers for diagnosis; of pathophysiology and prediction of hypertension; response to treatment, organ damage; and to monitor treatment. A clear focus is on the vasculature, the heart and the kidneys, whereas we see a need to further develop biomarkers of cerebral function in order to diagnose cognition deficits and monitor changes in cognition in the future to support addressing the growing burden of hypertension associated vascular dementia

The future of "omics" in hypertension

Despite decades of research and clinical practice the pathogenesis of hypertension remains incompletely understood and blood pressure is often suboptimally controlled. Omics technologies allow the description of a large number of molecular features and have the potential to identify new factors that contribute to blood pressure regulation and how they interact. In this review we will focus on the potential of genomics, transcriptomics, proteomics and metabolomics and explore their role in unravelling the pathophysiology and diagnosis of hypertension; prediction of organ damage and treatment response; and monitoring of treatment effect. Substantial progress has been made in the area of genomics where genome-wide association studies have identified more than 50 blood pressure-related single nucleotide polymorphisms and sequencing studies especially in secondary forms of hypertension have discovered novel regulatory pathways. In contrast, other omics technologies, despite their ability to provide detailed insights into the physiological state of an organism, have only more recently demonstrated their impact on hypertension research and clinical practice. The majority of current proteomic studies focuses on organ damage due to hypertension and may have the potential to understand the link between blood pressure and organ failure but also serve as biomarker for early detection of cerebrovascular or coronary disease. Examples include signatures for early detection of left ventricular dysfunction or albuminuria. Metabolomic studies have potential to integrate environmental and intrinsic factors and are particularly suited to monitor the response to treatment. We will discuss examples of omics studies in hypertension and explore the challenges related to these novel technologies

Is microRNA-376c a biomarker or mediator of preeclampsia?

No abstract available

Natural killer cells in placentation and cancer: Implications for hypertension during pregnancy

Hypertension during pregnancy is the most common medical condition encountered during gestation. Despite this, knowledge of the mechanisms that underlie the disease and the development of new therapies are limited. Hypertension during pregnancy and some forms of cancer confer an increased risk to the development of cardiovascular disease later in life; one mechanism which may link these conditions is the involvement of natural killer (NK) cells. Whilst immunology and immunotherapy are well-developed areas in oncology; the complex mechanisms of the immune system in health and disease at the maternal-fetal interface are less well-defined. Natural killer (NK) cells have emerged as key immune cells involved in physiology and pathology of pregnancy. These small lymphocytes are present in the decidua (the uterine-specific uNK cells) and are distinct from peripheral NK cells. The uNK cell population plays a vital role in mediating trophoblast invasion and affecting decidual vascular remodelling whereas the role of the peripheral NK cell population during pregnancy is less well-defined. This review will give an overview of NK cell biology followed by a discussion of the current evidence for the role of uterine and peripheral NK cells at the maternal-fetal interface in health and disease. Furthermore, examples of NK cell research from cancer biology will be employed to inform future directions of research. By combining this knowledge from oncology where the field of immunotherapy has now matured into clinical trials; it is hopeful that new mechanisms can be elucidated to generate targets for similar therapeutic strategies for women with hypertensive pregnancies where interventions are needed

Thyroid stimulating hormone (TSH) ≥2.5mU/l in early pregnancy: prevalence and subsequent outcomes

Objective: There remains controversy over how women with abnormal thyroid function tests in pregnancy should be classified. In this study we assessed the proportion of women with thyroid stimulating hormone (TSH) ≥ 2.5 mU/l in a large obstetric cohort, and examined how many have gone on to develop thyroid disease in the years since their pregnancy. Study design: 4643 women were recruited and samples taken in early pregnancy between 2007 and 2010. Thyroid function tests were analysed in 2014; in women with raised TSH computerised health records and prescription databases were used to identify thyroid disease detected since pregnancy. Results: 58 women (1.5%) had a TSH over 5 mU/l and 396 women (10.3%) had TSH between 2.5 and 5 mU/l. Women with TSH > 5mU/l delivered infants of lower birthweight than those with TSH < 2.5 mU/l; there were no other differences in obstetric outcomes between the groups. Of those who have had thyroid tests since their pregnancy, 78% of those with TSH > 5 mU/l and 19% of those with TSH between 2.5 and 5 mU/l have gone on to be diagnosed with thyroid disease. Conclusions: Using a TSH cut-off of 2.5 mU/l in keeping with European and US guidelines means that over 12% of women in this cohort would be classified as having subclinical hypothyroidism. Treatment and monitoring of these women would have major implications for planning of obstetric services

Is there a role for proteomics in diabetic renal disease?

No abstract available