The Evolving Clinical Management of Hypertension

Weber, Michael A.

doi:10.1111/jch.12444

Cited by 7 publications

(7 citation statements)

References 55 publications

(52 reference statements)

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“…; Piecha et al . ; Weber, ). For many years, the Goldblatt or two kidney‐one clip (2K1C) experimental model has been used to study renovascular hypertension (Goldblatt et al .…”

Section: Introductionmentioning

confidence: 98%

“…It usually involves the ostium and proximal third of the main renal artery and the peri-renal aorta (Safian & Textor, 2001;Lopez-Novoa et al 2011). Renovascular hypertension affects ß6% of the elderly population, regardless of race or sex (Hansen et al 2002;Piecha et al 2012;Weber, 2014). For many years, the Goldblatt or two kidney-one clip (2K1C) experimental model has been used to study renovascular hypertension (Goldblatt et al 1934) and has been adopted in the present study.…”

Section: Introductionmentioning

confidence: 99%

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Carotid sinus denervation ameliorates renovascular hypertension in adult Wistar rats

Pijacka

McBryde

Marvar

et al. 2016

The Journal of Physiology

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The peripheral chemoreflex is known to be hyper-responsive in both spontaneously hypertensive (SHR) and Goldblatt hypertensive (two kidney one clip; 2K1C) rats. We have previously shown that carotid sinus nerve denervation (CSD) reduces arterial blood pressure (ABP) in SHR. In the present study, we show that CSD ameliorates 2K1C hypertension and reveal the potential underlying mechanisms. Adult Wistar rats were instrumented to record ABP via telemetry, and then underwent CSD (n = 9) or sham CSD (n = 9) 5 weeks after renal artery clipping, in comparison with normal Wistar rats (n = 5). After 21 days, renal function was assessed, and tissue was collected to assess sympathetic postganglionic intracellular calcium transients ([Ca ] ) and immune cell infiltrates. Hypertensive 2K1C rats showed a profound elevation in ABP (Wistar: 98 ± 4 mmHg vs. 2K1C: 147 ± 8 mmHg; P < 0.001), coupled with impairments in renal function and baroreflex sensitivity, increased neuroinflammatory markers and enhanced [Ca ] in stellate neurons (P < 0.05). CSD reduced ABP in 2K1C+CSD rats and prevented the further progressive increase in ABP seen in 2K1C+sham CSD rats, with a between-group difference of 14 ± 2 mmHg by week 3 (P < 0.01), which was accompanied by improvements in both baroreflex control and spectral indicators of cardiac sympatho-vagal balance. Furthermore, CSD improved protein and albuminuria, decreased [Ca ] evoked responses from stellate neurons, and also reduced indicators of brainstem inflammation. In summary, CSD in 2K1C rats reduces the hypertensive burden and improves renal function. This may be mediated by improvements in autonomic balance, functional remodelling of post-ganglionic neurons and reduced inflammation. Our results suggest that the peripheral chemoreflex may be considered as a potential therapeutic target for controlling renovascular hypertension.

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“…; Piecha et al . ; Weber, ). For many years, the Goldblatt or two kidney‐one clip (2K1C) experimental model has been used to study renovascular hypertension (Goldblatt et al .…”

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Carotid sinus denervation ameliorates renovascular hypertension in adult Wistar rats

Pijacka

McBryde

Marvar

et al. 2016

The Journal of Physiology

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“…[15][16][17][18] Thus, research aimed at improving BP control needs to broaden its focus and efforts to include other aspects of hypertension treatment than adherence to medication. Moreover, recent research has shown that by engaging and empowering patients in their own care, eg, through self-measurements of BP, [19][20][21] substantial gains may be made in BP control. Hence, a fruitful path to follow may be to shift focus away from reactive measures to reduce patient nonadherence to proactive measures to support patients' self-management of their condition.…”

mentioning

confidence: 99%

Improved Blood Pressure Control Using an Interactive Mobile Phone Support System

Bengtsson

Kjellgren

Hallberg

et al. 2015

J of Clinical Hypertension

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This explorative, longitudinal study evaluated the effect of the daily use of a mobile phone‐based self‐management support system for hypertension in reducing blood pressure (BP) among 50 primary care patients with hypertension over 8 weeks. The self‐management system comprises modules for (1) self‐reports of BP, pulse, lifestyle, symptoms, and well‐being; (2) delivery of reminders and encouragements; and (3) graphical feedback of self‐reports. Daily use of the support system significantly reduced BP (systolic BP −7 mm Hg, diastolic BP −4.9 mm Hg) between baseline and week 8, with daily improvements leveling off as the study progressed. Three homogenous subsets of patients were identified who, despite different initial BP levels, showed similar decreases in BP during the study, indicating that patients benefited irrespective of baseline BP. In showing significant reductions in BP, our results suggest that the self‐management support system may be a useful tool in clinical practice to help patients self‐manage their hypertension.

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“…Thiazide diuretics are currently among the most prescribed anti‐hypertension drugs. They are often combined with other antihypertensive drugs (Weber, ). Next generation diuretics may block synergistically the Na + Cl − cotransporter (NCC) and ENaC, and possibly in addition the Cl − /HCO 3 − ‐exchanger pendrin in patients with fluid overloads such as congestive heart failure, nephrotic syndrome, diuretic resistance or generalized oedema.…”

Section: Amiloride‐sensitive Epithelial Sodium Channelmentioning

confidence: 99%

The function and regulation of acid‐sensing ion channels (ASICs) and the epithelial Na⁺ channel (ENaC): IUPHAR Review 19

Boscardin

Alijevic

Hummler

et al. 2016

British J Pharmacology

133

122

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*These authors contributed equally.Acid-sensing ion channels (ASICs) and the epithelial Na + channel (ENaC) are both members of the ENaC/degenerin family of amiloride-sensitive Na + channels. ASICs act as proton sensors in the nervous system where they contribute, besides other roles, to fear behaviour, learning and pain sensation. ENaC mediates Na + reabsorption across epithelia of the distal kidney and colon and of the airways. ENaC is a clinically used drug target in the context of hypertension and cystic fibrosis, while ASIC is an interesting potential target. Following a brief introduction, here we will review selected aspects of ASIC and ENaC function. We discuss the origin and nature of pH changes in the brain and the involvement of ASICs in synaptic signalling. We expose how in the peripheral nervous system, ASICs cover together with other ion channels a wide pH range as proton sensors. We introduce the mechanisms of aldosterone-dependent ENaC regulation and the evidence for an aldosterone-independent control of ENaC activity, such as regulation by dietary K + . We then provide an overview of the regulation of ENaC by proteases, a topic of increasing interest over the past few years. In spite of the profound differences in the physiological and pathological roles of ASICs and ENaC, these channels share many basic functional and structural properties. It is likely that further research will identify physiological contexts in which ASICs and ENaC have similar or overlapping roles. AbbreviationsAQP, aquaporin; ASDN, aldosterone-sensitive distal nephron; ASIC, acid-sensing ion channel; BASIC, bile acid-activated ion channel; BK, big calcium-activated K + channel; CA, carbonic anhydrase; CAP-1, -2, or-3, channel activating proteases; Ca v , voltage-gated Ca2 + channel; CCD, cortical collecting duct; CD, collecting duct; PHA-1, pseudohypoaldosteronism type 1; CFTR, cystic fibrosis transmembrane conductance regulator; CNT, connecting tubule; CF, cystic fibrosis; CLCN/Kb, voltage-sensitive chloride channel Kb; DCT, distal convoluted tubule; DRG, dorsal root ganglion; ENaC, amiloride-sensitive epithelial sodium channel; EPSP, excitatory post-synaptic potential; FaNaC, FMRFa-activated Na + channel; FMRFa, PheMet-Arg-Phe-amide; GMQ, 2-guanidine-4-methylquinazoline; GPI, glycosylphosphatidyl-inositol; HAI, hepatocyte growth factor activator inhibitor; HCN, hyperpolarization-activated cyclic nucleotide-gated channel; I A , A-type current of rapid inactivating K + channels; iGluR, ionotropic glutamate receptor; I K , K + current; I Na , Na + current; I h , current produced by HCN channels; I max , maximal current amplitude; Kir, inward rectifier K + channel; K v , voltage-gated K + channel; MR, mineralocorticoid receptor; Na v , voltage-gated Na + channel; NBC, Na + , -HCO 3 -cotransporter; NCC, Na +-Cl À cotransporter; NHE, Na +-H + exchanger; OSR1/SPAK, Ste20-related protein kinases; P2X, purinergic receptor; PcTx1, Psalmotoxin 1; pH 50 , pH of half-maximal activation; pHe, extracellular pH; pH 50 Inh./Act., pH of h...

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The Evolving Clinical Management of Hypertension

Cited by 7 publications

References 55 publications

Carotid sinus denervation ameliorates renovascular hypertension in adult Wistar rats

Carotid sinus denervation ameliorates renovascular hypertension in adult Wistar rats

Improved Blood Pressure Control Using an Interactive Mobile Phone Support System

The function and regulation of acid‐sensing ion channels (ASICs) and the epithelial Na⁺ channel (ENaC): IUPHAR Review 19

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The Evolving Clinical Management of Hypertension

Cited by 7 publications

References 55 publications

Carotid sinus denervation ameliorates renovascular hypertension in adult Wistar rats

Carotid sinus denervation ameliorates renovascular hypertension in adult Wistar rats

Improved Blood Pressure Control Using an Interactive Mobile Phone Support System

The function and regulation of acid‐sensing ion channels (ASICs) and the epithelial Na+ channel (ENaC): IUPHAR Review 19

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The function and regulation of acid‐sensing ion channels (ASICs) and the epithelial Na⁺ channel (ENaC): IUPHAR Review 19