Blood pressure breakthrough holds real hope for treatment of pre-eclampsia

ScienceDaily (Oct. 7, 2010) — Scientists have discovered a mechanism which raises blood pressure in pre-eclampsia, a potentially deadly condition which occurs during pregnancy.

After 20 years of research, scientists from the University of Cambridge have now cracked the first step in the main process that controls blood pressure. Their findings, published in the journal Nature, are likely to have significant implications for the treatment of pre-eclampsia as well as high blood pressure (also known as hypertension).

Blood pressure is controlled by hormones called angiotensins, which cause the blood vessels to constrict. These hormones are released by the protein angiotensinogen. Until now, it was not understood how this occurred.

Dr Aiwu Zhou, a British Heart Foundation (BHF) Fellow at the University of Cambridge, who made the breakthrough, said: "Although we primarily focused on pre-eclampsia, the research also opens new leads for future research into the causes of hypertension in general."

To make the discovery, the researchers solved the structure of angiotensinogen with the help of an extremely intense X-ray beam produced by Diamond Light Source, the UK synchrotron. Their results revealed that the protein is oxidised and changes shape to permit ready access to angiotensinogen by an enzyme, renin. Renin cuts off the tail of the protein to release the hormone angiotensin, which then raises blood pressure.

Taking their lab results into the clinic at the University of Nottingham, the research team showed that the amount of oxidised, and hence more active, angiotensinogen was increased in women with pre-eclampsia.

Professor Robin Carrell at the University of Cambridge, who led the 20-year research project, explained: "During pregnancy oxidative changes can occur in the placenta. These changes, the very ones we have found stimulates the release of the hormone angiotensin and lead to increased blood pressure, can arise as the circulation in the placenta readjusts the oxygen requirements of the growing foetus with the delivery of oxygen to the placenta from the mother."

Drugs currently used to treat high blood pressure -- such as ACE inhibitors -- focus on the later stages of the mechanism that controls blood pressure. The latest findings, which give insight into the previously mysterious early stages of the regulation process, provide scientists with new opportunities to research novel treatments for hypertension.

Professor Peter Weissberg, Medical Director of the BHF, which largely funded the study, said: "Every year in the UK pre-eclampsia is responsible for the deaths of around six women and several hundred babies. This research is of the highest quality and offers real hope for developing strategies to prevent or treat this dangerous condition by targeting the process that these scientists have identified. And of course, although the researchers only looked at pre-eclampsia in this study, similar strategies may be useful for those people with high blood pressure that is not effectively controlled by current medicines."

High blood pressure frequently affects pregnancy. However, in 2-7 per cent of pregnancies this develops into pre-eclampsia, which threatens the health and survival of both the mother and child. In Britain, it affects about one in 20 women during pregnancy, and every year 50,000 women and 500,000 infants die globally as a result of pre-eclampsia. There is no treatment for pre-eclampsia and often the mother is either induced early or undergoes a Caesarean.

The research was largely funded by the British Heart Foundation, with additional funding provided by the Medical Research Council, the Wellcome Trust and the Isaac Newton Trust.

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The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Cambridge, via EurekAlert!, a service of AAAS.

Journal Reference:

Aiwu Zhou, Robin W. Carrell, Michael P. Murphy, Zhenquan Wei, Yahui Yan, Peter L. D. Stanley, Penelope E. Stein, Fiona Broughton Pipkin, Randy J. Read. A redox switch in angiotensinogen modulates angiotensin release. Nature, 2010; DOI: 10.1038/nature09505

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Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

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African-Americans with high blood pressure need treatment sooner, more aggressively, experts urge

ScienceDaily (Oct. 4, 2010) — According to a consensus statement by the International Society on Hypertension in Blacks (ISHIB), high blood pressure in African-Americans is such a serious health problem that treatment should start sooner and be more aggressive. The ISHIB statement is published in Hypertension: Journal of the American Heart Association.

Complications related to high blood pressure such as stroke, heart failure and kidney damage occur much more frequently in African-Americans compared with whites.

"Evidence from several recently completed studies converged to convince our committee that we were waiting a little bit too long to start treating hypertension in African-Americans," said John M. Flack, M.D., M.P.H., lead author and chairman of the Department of Internal Medicine at Wayne State University in Detroit.

The update to the ISHIB's 2003 consensus statement makes two major recommendations: First, the thresholds at which African-American patients begin treatment should be lowered. Second, doctors should move quickly from single-drug therapy to multi-drug therapy to keep a patient's blood pressure comfortably below the thresholds.

"We believe that these recommendations will lead to better blood pressure control, and a better outlook for African-Americans with high blood pressure," Flack said.

Blood pressure is reported as two numbers, measured in millimeters of mercury (mm Hg). The top number represents the pressure in the arteries when the heart beats and the lower number reflects the pressure when the heart relaxes between beats.

Blood pressure below 120/80 is considered normal for healthy U.S. adults. However, the ISHIB proposes that doctors recommend lifestyle changes to lower blood pressure in otherwise healthy African-Americans with blood pressure at or above 115/75. Those changes include reduced dietary sodium (salt) and increased potassium from eating more fruits and vegetables, as well as losing weight if necessary, getting regular aerobic exercise and drinking in moderation, Flack said.

"Epidemiological data shows that 115/75 is the critical blood pressure number for adults, and every time that figure goes up by 20/10 the risk of cardiovascular disease essentially doubles. We think it makes perfect sense to start lifestyle changes at that lower threshold," he said. "The natural history of blood pressure is that it continues to go up as a person ages. In fact, from the age of 50 and onward, Americans have a 90 percent chance of developing hypertension."

Doctors currently begin drug therapy to reduce blood pressure in patients without a history of cardiovascular disease, diabetes or high blood pressure-related organ-damage when blood pressure is at or above 140/90. This is referred to as primary prevention. The ISHIB recommends tightening the primary prevention threshold to 135/85 for African-Americans.

In addition, the ISHIB recommends starting treatment earlier for African-Americans who have cardiovascular disease, diabetes, kidney disease or damage to target organs (the heart, brain, kidneys). This treatment, known as secondary prevention, should start when blood pressure is at or above 130/80, according to the ISHIB statement.

The ISHIB also recommends that doctors move swiftly from single-drug therapy to multi-drug therapy if one agent doesn't lower the pressure.

"The majority of patients of any race, and certainly African-Americans, are going to need more than one drug to be consistently controlled below their goal," Flack said. "The debate in the medical community over which single drug is best overwhelms the most pressing question: Which drugs work best together?"

Based on a review of recently completed studies, the ISHIB document provides doctors with step-by-step guidance on the best second, third and fourth drugs to add based on individual patient characteristics. The ISHIB statement provides charts with alternate multi-drug combinations so physicians have several options for keeping patients' blood pressure under targets, Flack said.

Flack stressed that the ISHIB tried whenever possible to suggest cheaper generic drugs to keep cost from becoming a treatment barrier.

"These guidelines raise the question for addressing issues surrounding treatment strategies and goals for African-Americans with hypertension," said Sidney C. Smith Jr., M.D., an American Heart Association spokesman and professor of medicine at the University of North Carolina School of Medicine in Chapel Hill, N.C. "Studies continue to accumulate that address ethnic, age and gender differences, as well as optimal therapies."

A major comprehensive statement regarding hypertension is expected to be published by the National Institutes of Health (NIH) by late 2011, Smith said.

The American Heart Association participates as a member organization in the NIH Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) guidelines.

Co-authors of the ISHIB statement are: Domenic A. Sica, M.D.; George Bakris, M.D.; Angela L. Brown, M.D.; Keith C. Ferdinand, M.D.; Richard H. Grimm, Jr., M.D., Ph.D.; W. Dallas Hall, M.D.; Wendell E. Jones, M.D.; David S. Kountz, M.D.; Janice P. Lea, M.D.; Samar Nasser, P.A.-C., M.P.H.; Shawna D. Nesbitt, M.D.; Elijah Saunders, M.D.; Margaret Scisney-Matlock, R.N., Ph.D. and Kenneth A. Jamerson, M.D. Individual author disclosures are on the manuscript.

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The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by American Heart Association, via EurekAlert!, a service of AAAS.

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Holistic Treatment for High Blood Pressure - Proven Remedies for Hypertension

Most people treat it as a mere symptom or a condition, but unknown to them, a mere symptom or condition can pave the way for serious conditions, ranging from heart ailments to kidney failures. At times, it can even lead to a heart attack, and the person still would not know what caused it.

A trip to the doctor, such as undergoing a routine general check-up annually may help prevent this situation. However, what if the doctor tells us we are hypertensive? Normally, medications are prescribed, which can be quite costly since we will be taking this for a certain period. Thus, we might consider pursuing a holistic treatment for high blood pressure, meaning, we should consider the body in its entirety in tending to this illness.

Though it cannot totally cure a person of his hypertension, pursuing this kind of treatment will help control high systolic pressure, and at the same time reduce the probability of taking medications for a very long period of time. Again, this holistic treatment for high blood pressure only serves to supplement, meaning, the doctor's order is still very important.

Obesity is one of the factors which lead to hypertension. This would mean pursuing an exercise regimen or performing daily workouts, coupled with a balanced diet to tone down that body weight. It is also recommended that the diet be concentrated more on vegetables and foods rich in fiber, as statistics show that only a handful of vegetarians suffer high blood pressure. Naturally, people should likewise start toning down on eating fatty foods or even cut their alcohol-drinking and smoking habits. Even with a good diet and daily exercise regimen, if we do not do our part in cutting down the factors which contribute to hypertension, then the efforts would be put to naught.

We can also consider practicing meditation or yoga, or even just get a health massage in order tone down and relax those muscles so our body would feel at rest and we can get a good night's sleep. Others even resort to acupuncture to relieve those tense muscles. In this manner, stress, which is one of the factors which contribute to high blood pressure, is greatly reduced to a significant degree. In the end, a healthy lifestyle is what can prevent us from experiencing hypertension symptoms.

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Potential treatment for pulmonary hypertension discovered

ScienceDaily (Aug. 12, 2010) — Researchers in the Faculty of Medicine & Dentistry at the University of Alberta are one step closer to a treatment for pulmonary arterial hypertension, a potentially deadly disease.

Pulmonary arterial hypertension, which is high blood pressure in the lungs, currently has only a few treatment options, but most cases lead to premature death. It is caused by a cancer-like excessive growth of cells in the wall of the lung blood vessels. It causes the lumen, the path where blood travels, to constrict putting pressure on the right ventricle of the heart which eventually leads to heart failure.

Evangelos Michelakis, his graduate student Gopinath Sutendra and a group of collaborators have found that this excessive cell growth can be reversed by targeting the mitochondria of the cell, which control metabolism of the cell and initiate cell death.

By using dichloroacetate (DCA) or Trimetazidine (TMZ), mitochondria targeted drugs, the activity of the mitochondria increases which helps induce cell death and regresses pulmonary hypertension in an animal model, says Sutendra.

Current therapies only look at dilating the constricted vessels rather than regression, so this is a very exciting advancement for the lab.

"In the pulmonary hypertension field they're really looking for new therapies to regress the disease, it might be the wave of the future," said Sutendra. "The other thing that is really exciting is that TMZ and DCA have been used clinically in patients so it's something that can be used right away in these patients."

Clinical trials are expected to be the next step. Michelakis is currently working with a college in the United Kingdom to have patients with pulmonary hypertension take DCA.

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The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Alberta, via EurekAlert!, a service of AAAS.

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Heart attack sufferers delay seeking treatment

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Fewer die after treatment at stroke centers: study

- NEW YORK (Reuters Health) -- People treated for stroke at designated stroke centers appear to survive slightly longer than those treated at other hospitals, suggests a new study.

While the finding has important implications, it doesn't change the most important message about stroke, which is to get help as soon as possible, said study author Dr. Ying Xian of the Duke Clinical Research Institute in Durham, North Carolina, and formerly of the University of Rochester Medical Center in New York, where he did the research.

"The most important thing for the patient is when you have a stroke attack, or you see people stroke attack, call 911 immediately," he told Reuters Health. "Ideally, the EMS will transport people to the appropriate hospital."

Most strokes occur when a blocked blood vessel causes some of the blood flow going to the brain to be cut off, damaging brain tissue that depends on that blood to survive.

Stroke is the third leading cause of death in the U.S., only topped by heart disease and cancer. Each year, nearly 800,000 people in the U.S. have a stroke and more than 130,000 people die as a result.

Within the last decade, both national and state programs have begun designating hospitals as official stroke centers when they demonstrate certain staff, facilities, and services believed to improve a patient's outcome.

In addition, states such as New York require ambulances to take stroke patients straight to a designated center, as long as they can get care within two hours.

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