Cilnidipine, An L-/N-Type Calcium Channel Blocker, Changes the Circulating Angiotensin?(1-7)/Angiotensin II Ratio

Angiotensin-converting enzyme (ACE) 2 is a newly recognized ACE homolog within the renin-angiotensin system (RAS) that is produced and secreted by a variety of cell types. Although ACE2 may act onseveral substrates, it exhibits high catalytic efficiency, specifically for the hydrolysis of angiotensin (Ang) II to the vasodilator and growth inhibitor heptapeptide Ang-(1-7). 

Previous reports have suggested that Ang-(1-7) exerts vasodilatory effects through a combination of ACE inhibition and angiotensin type 1 receptor (AT1R) blockade. Taken together, these studies suggest that the regulation of Ang-(1-7) production by ACE2 may be an important component of not only blood pressure control but also vascular remodeling because Ang-(1-7) opposes the actions of Ang II in both cases. According to this novel concept, the final functional effects of the RAS may reflect a balance between the ACE-Ang II-AT1R arm and the ACE2-Ang-(1-7)- Mas receptor arm. Read more>>>>>>>>>>>>>>

Lessons Learned from the TOPCAT Trial

Approximately half of patients with heart failure have a preserved left ventricular ejection fraction. In sharp contrast to treatment of heart failure with reduced leftventricular ejection fraction, evidence-based drug therapies for treatment of heart failure with preserved left ventricular ejection fraction are still lacking. 

The 3 major outcome trials performed in patients with heart failure and preserved left ventricular ejection fraction using inhibitors of the renin-angiotensin-aldosterone system did not meet their primary endpoints. The Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) trial was a randomized, double-blind, placebo-controlled trial which randomized 3,445 patients with symptomatic heart failure and a left ventricular ejection fraction of 45% or more to receive either spironolactone 15 mg to 45 mg daily or placebo. Of these patients, 1,767 patients were enrolled from the United States, Canada, Brazil, and Argentina, and 1,678 patients were enrolled from Russia and Georgia.  Read more>>>>>>>>>>>>>>>>

Who is the Patient with Suspected White Coat Hypertension?

White coat hypertension (WCH) is the situation in which an individual has high blood pressure (BP) in the medical office (BP >140/90) and normal BP outside the office (BP <135/85). Masked hypertension (MHT) is the opposite of WCH, i.e., a situation in which a person has normal BP in the office and high BP outside of it. 

 The overall prevalence of WCH is approximately 15%. However, in extreme situations, as in the case of suspected resistant hypertension, the prevalence of WCH reaches 40%. Among the many indications of Ambulatory Blood Pressure Monitoring (ABPM), the main one is to assess patients with suspected WCH , being also indicated to evaluate the white coat effect on hypertensive patients using antihypertensive drugs, whose BP levels measured in the office remain high despite anti-hypertensive therapy. As the white-coat effect is common among the elderly, this is a group where this assessment is often indicated. Read more>>>>>>>>>>>>>>

Anthropometric Study of the Pectoralis Minor Muscle as a Power Source to a Bio-pump in Terminal Insufficiency of the Heart Muscle

The first ideas concerning a possibility of artificial support of the cardiovascular system appeared as early as 200 years ago. In 1812 Le Gallois pointed to possibilities of temporary or permanent support of the failing heart However, many years had passed before the joined engineering and medical effort resulted in the first clinical use of mechanical support of circulation. 

The first reports of studies on the artificial heart (AH) were published in 1958 by Akutsu and Kolff . In 1961 Dennis was the first to use a roller pump to support the left ventricle (LVAD). In 1962 Moulopoulos, Topaz and Kolff pioneered in using the intra-aortic balloon pump (IABP) . In 1963 De Bakey and Liotta used successfully the pulsating ventricular assist device in patients in cardiogenic shock postcardiotomy. In 1969, Cooley and Liotta reported the first clinical case of implantation of the artificial heart. Since then many institutions worldwide had carried out intensive research, which led to the development of many devices used in clinical practice to support the insufficient circulatory system.   Read more>>>>>>>>>>>>

Determination of Ghrelin’s Role in the Pathogenesis of Pregnancy Induced Hypertension

Pregnancy induced hypertension (PIH) is a disease of an unclear etiology that complicates 2-3 % of pregnancies. PIH is a critical cause of perinatal mortality of pregnant women and neonates and a major cause of intrauterine growth retardation and of iatrogenic prematurity. 

PIH is a multiorgan complication; its main causes result from the interaction of the mother’s immunological system with trophoblast antigens. The ethiopathogenesis of pregnancy induced hypertension remains to be elucidated. A crucial risk factor of pregnancy induced hypertension is obesity. Relationships between hypertension and obesity are well documented, ultimately involving excessive retention of sodium by the kidneys, insulin resistance, and chronic stimulation of the sympathetic system, leading to vessel remodelling.  Read more>>>>>>>>>>>>>>