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Background Aim of the study was to determine the presence of preclinical diastolic dysfunction in hypertensive children relative to normotensive children by Tissue Doppler Imaging (TDI). Methods We prospectively enrolled children with untreated essential hypertension in absence of any other disease and a matched healthy control group with normal blood pressure (BP); both groups confirmed by clinic BP and a 24 hour ambulatory BP monitoring. Echocardiographic diastolic parameters were determined using spectral transmitral inflow Doppler, flow propagation velocity, TDI, and systolic parameters were determined via midwall shortening fraction and ejection fraction. Results A total of 80 multiethnic children were prospectively enrolled for the study: 46 hypertensive (median age 13 years, 72% males) and 34 control (median age 14 years, 65% males). The only echocardiography parameters which had a statistically significant change compared to the control children, were regional mitral Ea, Aa and the E/Ea ratio by TDI. In comparison to controls, hypertensive children had lower Ea and Aa velocities of anterior and posterior walls and higher lateral wall E/Ea ratio. The decrease in posterior wall Ea and Aa remained significant after adjustment for gender, age, body mass index, ethnicity, and left ventricular hypertrophy on multivariate analysis. The lateral and septal wall E/Ea ratios correlated significantly with fasting serum insulin levels on similar multivariate analysis. Conclusions Decreased regional TDI velocities were seen with preserved left ventricular systolic function even when other measures of diastolic dysfunction remained unchanged in untreated hypertensive children. Hypertension and serum insulin levels had strong associations with preclinical diastolic alterations in children.

KKidney disease could result from hypertension and ischemia/hypoxia. Key mediators of cellular adaptation to hypoxia are oxygen-sensitive hypoxia inducible factor (HIF)s which are regulated by prolyl-4-hydroxylase domain (PHD)-containing dioxygenases. However, HIF activation can be protective as in ischemic death or promote renal fibrosis in chronic conditions. This study tested the hypothesis that increased HIF-1α consequent to reduced PHD expression contributes to the attendant hypertension and target organ damage in deoxycorticosterone acetate (DOCA)/salt hypertension and that PHD inhibition ameliorates this effect. In rats made hypertensive by DOCA/salt treatment (DOCA 50 mg/kg s/c; 1% NaCl orally), PHD inhibition with dimethyl oxallyl glycine (DMOG) markedly attenuated hypertension (P<0.05), proteinuria (P<0.05) and attendant tubular interstitial changes and glomerular damage (P<0.05). Accompanying these changes, DMOG blunted the increased expression of kidney injury molecule (KIM)-1 (P<0.05), a marker of tubular injury and reversed the decreased expression of nephrin (P<0.05), a marker of glomerular injury. DMOG also decreased collagen I staining (P<0.05), increased serum nitrite (P<0.05) and decreased serum 8-isopostane (P<0.05). However, the increased HIF-1α expression (P<0.01) and decreased PHD2 expression (P<0.05) in DOCA/salt hypertensive rats was not affected by DMOG. These data suggest that reduced PHD2 expression with consequent increase in HIF-1α expression probably results from hypoxia induced by DOCA/salt treatment with the continued hypoxia and reduced PHD2 expression evoking hypertensive renal injury and collagen deposition at later stages. Moreover, a PHD inhibitor exerted a protective effect in DOCA/salt hypertension by mechanisms involving increased nitric oxide production and reduced production of reactive oxygen species.

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Focus groups were conducted among 50 African American adults with HIV to investigate their perceived risks for cardiovascular disease and perceived benefits and barriers to living a heart healthy lifestyle. In addition, anthropometric measures were obtained (height, weight, blood pressure) and participants completed a written cardiovascular disease risk profile. Analysis of the cardiovascular risk profile data revealed that 48 percent of participants were current smokers 58 percent reported they had hypertension; 50 percent reported hypercholesterolemia; 30 percent that their mother or sister was diagnosed with a heart attack before age 65; and 16 percent as having diabetes. The computed body mass index of 80 percent of participants was categorized as overweight to obese. Participants were aware of cardiovascular risk factors, shared beliefs about the negative effects of HIV on cardiovascular health, and expressed barriers and facilitators to cardiovascular disease risk reduction. The findings suggest that some information has been disseminated about cardiovascular disease to HIV patients, but there is still a lack of information concerning the possible link between HIV disease, HIV medications, and cardiovascular disease. More cardiovascular disease risk reduction programs are needed for persons living with HIV. This research is supported by the National Heart, Lung, and Blood Institute.