We examined the relationship of hypertension and plasma renin activity to atherogenesis in 48 moderately hyperlipidemic (total serum cholesterol was about 200 mg/dl) baboons (Papio sp.). We used renal artery stenosis (two-kidney, one clip model) to produce hypertension associated with elevated plasma renin activity, and used cellophane wrapping of both kidneys (bilateral perinephritis model) to produce hypertension with normal renin activity. Renal artery stenosis and bilateral perinephritis increased both systolic and diastolic blood pressure by about 30 mm Hg. Renal artery stenosis approximately doubled, but bilateral perinephritis did not change plasma renin activity.Both hypertensive groups, to about the same degree, had significantly more extensive atherosclerosis than the control group in the abdominal aorta and brachial, iliacfemoral, and carotid arteries. The effect of hypertension was greatest in the carotid arteries where the extent of atherosclerosis was nearly tripled. Hypertension did not influence lesions in the thoracic aorta.By multiple regression analysis, very low plus low density lipoprotein cholesterol, high density lipoprotein cholesterol, and systolic blood pressure were consistently strong predictive variables for the extent of atherosclerotic lesions. Most of the effects of renal hypertension on atherosclerotic lesions appeared to be accounted for by the increase in blood pressure. In the carotid arteries, however, there was a suggestion of an effect above that due to increased blood pressure. Additional analyses indicated that these treatment effects were associated with serum potassium concentration, plasma renin activity, or other closely related variables. (Arteriosclerosis 5:481-493, September/October 1985)

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A 31-year-old male patient with severe, migratory arthralgias presented to our academic medical centre after being erroneously diagnosed and treated for rheumatoid arthritis for over 1 year. Multiple immunomodulatory therapies for rheumatoid arthritis were attempted with no relief of symptoms. Eventually, the pain was so bothersome that the patient became bedridden for 1 month prior to presenting to our facility. Our assessment revealed that the patient met the diagnostic criteria, known as the Yamaguchi criteria, needed to diagnose adult-onset Still’s disease. Yamaguchi criteria include migratory inflammatory arthritis, quotidian fevers, leucocytosis and a salmon-coloured maculopapular rash. These signs and symptoms may go unnoticed or overlooked if adult-onset Still’s disease is not considered. The patient was treated with anakinra (a recombinant human IL-1 receptor antagonist) and had rapid improvement in his symptoms, with the restoration of mobility.

BACKGROUND: Hypertension, hyperlipidemia, and obesity most commonly result from poor diet and lack of physical activity. Lifestyle measures for risk factor modification and cardiovascular disease (CVD) prevention include exercise and dietary changes but most people are not successful at initiating and/or maintaining meaningful changes. We propose that such changes can be initiated using a short-term, intensive “immersion” support approach. METHODS: Moderate to high atherosclerotic CVD (ASCVD) risk individuals completed a 1-week, lifestyle-based immersion program, including daily nutrition education, 100% plant-based food consumption, exercise, and stress management classes. Beginning and end anthropomorphic measurements such as blood pressure and lipid measurements were collected. A dietary survey (14-point Mediterranean diet survey), functional capacity survey (Duke Activity Status Index [DASI] survey), and quality of life (QOL) survey (Sf-36), were administered on Day 0 and 3 months post-immersion. RESULTS: Eighty participants completed the program; 64% women, mean age 47 years (range 21-71), mean weight 88.43 kg (range 45.4-131.3 kg) and mean body mass index (BMI) 30.47 kg/m2 (range 18.6-44.8 kg/m2). Of the participants, 71% had hypertension (HtN), 39% had HbA1c ≥ 5.7%, 35% were former smokers, and 7.5% were active smokers. Average ASCVD risk was 6.84% (range 0.3-39%). After 1 week of the immersion program, BMI decreased on average 0.5 ± 0.38 kg/m2, weight decreased on average 11.49±1.19 kg (both p<0.001). Systolic blood pressures (SBP) decreased on average 6.76±15.17 mmHg and diastolic blood pressure (DBP) decreased on average 5.00±9.82 mmHg (both p<0.001). total cholesterol decreased on average 20.40 ± 15.44 mg/dL, triglycerides decreased on average 31.78 ± 44.06 mg/dL, LDL decreased on average 11.71 ± 15.92 mg/dL (all p < 0.001). High-density lipoprotein (HDL) also decreased on average 3.13 ± 5.83 mg/dL (p < 0.001). Sixty participants with diagnosed HtN or prescribed antihypertensive medications saw decreases in both SBP and DBP. In the majority of participants, improvements in functional capacity, QOL, and dietary compliance were noted. CONCLUSIONS: Short-term, intensive lifestyle intervention is feasible, can lead to immediate improvements in risk profiles, and, importantly, can have longer-lasting effects on exercise capacity, dietary compliance, and QOL.