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Middle Aortic Syndrome with Superior Mesenteric and Bilateral Renal Artery Involvement: Unusual Type of Aortic Coarctation.

Jongseon PARK

Journal of the Korean Society of Hypertension.2013;19(1):39-43. doi:10.5646/jksh.2013.19.1.39

Middle aortic syndrome (MAS) is very uncommon vascular pathology characterized by a long segmental narrowing or obstruction of the abdominal and/or distal thoracic aorta, commonly involving with the visceral and renal arteries. This syndrome may be presented with various physical signs of coarctation of the aorta, including resistant hypertension, renal insufficiency and/or mesenteric ischemia. Here, we report a case of a 64-year-old man with severe hypertension. He was diagnosed with MAS associated with stenosis of visceral and renal vessels by use of computed tomography and magnetic resonance angiography.
Aorta, Abdominal ; Aorta, Thoracic ; Aortic Coarctation ; Constriction, Pathologic ; Hypertension ; Hypertension, Renal ; Ischemia ; Magnetic Resonance Angiography ; Renal Artery

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Influence of PD 123319 (AT2-Receptor Antagonist) on Catecholamine Secretion in the Perfused Rat Adrenal Medulla.

Soon Pyo HONG ; Bhandary BIDUR ; Mee Sung CHOI ; Young Hwan SEO ; Dong Yoon LIM

Journal of the Korean Society of Hypertension.2013;19(1):23-38. doi:10.5646/jksh.2013.19.1.23

BACKGROUND: The aim of this study was to examine whether PD 123319 (an angiotensin II type 2 [AT2] receptor antagonist) can influence the release of catecholamines (CA) from the perfused model of the rat adrenal medulla. METHODS: The adrenal gland was isolated by the modification of Wakade method, and perfused with normal Krebs-bicarbonate solution. The content of CA was measured using the fluorospectrophotometer. RESULTS: During perfusion of PD 123319 (range, 5 to 50 nM) into an adrenal vein for 90 minutes the CA secretory responses evoked by acetylcholine (ACh), high K+, 1,1-dimethyl-4-phenylpiperazinium iodide (DMPP), and McN-A-343 was dose- and time-dependently inhibited. Furthermore, loading with PD 123319 for 90 minutes also markedly inhibited the CA secretory responses evoked by 4-dihydro-2,6-dimethyl-3-nitro-4-(2-trifluoro-methyl-phenyl)-pyridine-5-carboxylate (Bay-K-8644), cyclopiazonic acid, veratridine, and angiotensin II (Ang II). PD 123319 did not affect basal CA output. Simultaneous perfusion of PD 123319 and CGP 42112 perfused into an adrenal vein for 90 minutes rather more potently inhibited the CA seretory responses evoked by Ach, high K+, DMPP, Bay-K-8644, veratridine, and Ang II compared to the inhibitory effect by PD123319-treated alone. CONCLUSIONS: Taken together, these results show that PD 123319 inhibits the CA secretion evoked by both cholinergic and Ang II receptor stimulation from the perfused rat adrenal medulla. This inhibitory effect of PD 123319 seems to be exerted by blocking the influx of both Na+ and Ca2+ through their voltage-dependent channels into the rat adrenomedullary chromaffin cells as well as by reducing the Ca2+ release from its cytoplasmic calcium store, which may be relevant to AT2 receptor blockade. Based on these present data, it is thought that PD 123319 has different activity from previously known AT2 antagonist activity in the perfused adrenal medulla, and that AT2 receptors may be involved in the rat adrenomedullary CA secretion.
(4-(m-Chlorophenylcarbamoyloxy)-2-butynyl)trimethylammonium Chloride ; 3-Pyridinecarboxylic acid, 1,4-dihydro-2,6-dimethyl-5-nitro-4-(2-(trifluoromethyl)phenyl)-, Methyl ester ; Acetylcholine ; Adrenal Glands ; Adrenal Medulla ; Angiotensin II ; Angiotensin II Type 2 Receptor Blockers ; Animals ; Calcium ; Catecholamines ; Chromaffin Cells ; Cytoplasm ; Dimethylphenylpiperazinium Iodide ; Imidazoles ; Indoles ; Oligopeptides ; Perfusion ; Pyridines ; Rats ; Veins ; Veratridine

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Renal Sodium Transporters and Water Channels.

Hye Young KIM

Journal of the Korean Society of Hypertension.2013;19(1):17-22. doi:10.5646/jksh.2013.19.1.17

Hypertension is closely related to salt and water retention. The kidney plays an important role in the blood pressure regulation primarily to modulating tubular sodium and water reabsorption. The regulation of the salt and water balance depends upon an array of solute and water channels in the renal tubules. An altered regulation of sodium and water channels in the kidney may be related to various pathological conditions associated with altered salt and water retention. This review will discuss renal handling of sodium and water, with particular emphasis on aquaporins and renal sodium transporters and channels.
Aquaporins ; Blood Pressure ; Handling (Psychology) ; Hypertension ; Kidney ; Membrane Transport Proteins ; Retention (Psychology) ; Sodium ; Water

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MicroRNA in the Diseased Pulmonary Vasculature: Implications for the Basic Scientist and Clinician.

Richard C JIN ; Pil Ki MIN ; Stephen Y CHAN

Journal of the Korean Society of Hypertension.2013;19(1):1-16. doi:10.5646/jksh.2013.19.1.1

Since the first descriptions of their active functions more than ten years ago, small non-coding RNA species termed microRNA (miRNA) have emerged as essential regulators in a broad range of adaptive and maladaptive cellular processes. With an exceptionally rapid pace of discovery in this field, the dysregulation of many individual miRNAs has been implicated in the development and progression of various cardiovascular diseases. MiRNA are also expected to play crucial regulatory roles in the progression of pulmonary vascular diseases such as pulmonary hypertension (PH), yet direct insights in this field are only just emerging. This review will provide an overview of pulmonary hypertension and its molecular mechanisms, tailored for both basic scientists studying pulmonary vascular biology and physicians who manage PH in their clinical practice. We will describe the pathobiology of pulmonary hypertension and mechanisms of action of miRNA relevant to this disease. Moreover, we will summarize the potential roles of miRNA as biomarkers and therapeutic targets as well as future strategies for defining the cooperative actions of these powerful effectors in pulmonary vascular disease.
Anoxia ; Biomarkers ; Biology ; Cardiovascular Diseases ; Hydrogen-Ion Concentration ; Hypertension, Pulmonary ; MicroRNAs ; RNA, Small Untranslated ; Vascular Diseases

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Influences of Dry Weight Adjustment Based on Bioimpedance Analysis on Ambulatory Blood Pressure in Hemodialysis Patients.

Jung Ho SHIN ; Chae Rim KIM ; Moonki HONG ; Su Hyun KIM ; Suk Hee YU

Journal of the Korean Society of Hypertension.2012;18(4):166-175. doi:10.5646/jksh.2012.18.4.166

BACKGROUND: Hypertension is a common problem for hemodialysis patients and is associated with an increased cardiovascular mortality. We analyzed ambulatory blood pressure (ABP) in hemodialysis patients and investigated if an adjustment of dry weight can be used to control blood pressure. METHODS: ABP was measured for twenty-four hours after hemodialysis. A bioimpedance Analysis (BIA) was conducted. Patients were divided into two groups by the edema index. A normohydration (NH) group included patients with the edema index less than 0.40, and an overhydration (OH) group included patients with the edema index 0.40 or more. We accordingly adjusted the dry weight based on BIA results. RESULTS: Thirty-six patients were recruited, comprising twenty-two men and fourteen women. In regard to the ABP, 24-hour systolic and diastolic blood pressures were 140.2 +/- 19.7 mm Hg and 79.0 +/- 10.6 mm Hg, respectively. There was a significant association between 24-hour systolic blood pressure and the edema index (r = 0.501, p = 0.002). Twenty four-hour systolic blood pressure was significantly different between the NH and OH groups (median value, 132.0 vs. 150.5 mm Hg; p = 0.008). In OH group, after adjustment of the dry weight, the edema index was decreased from 0.411 +/- 0.009 to 0.389 +/- 0.047 and office systolic blood pressure was also decreased from 144.7 +/- 32.7 mm Hg to 125.3 +/- 15.4 mm Hg in OH group (p = 0.028 and p = 0.018, respectively). CONCLUSIONS: The edema index obtained by the bioimpedance analysis is significantly correlated with 24-hour systolic blood pressure in hemodialysis patients. Also, an adjustment of dry weight can be used to control blood pressure in hemodialysis patients.
Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Edema ; Female ; Humans ; Hypertension ; Male ; Renal Dialysis

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Determinants of Follow-up Changes of Brachial Ankle Pulse Wave Velocity in Korean Women.

Dae Young KIM ; Sung Yeol KONG ; Sung Ja LEE ; Ha Do SONG ; Eun Jin HAN ; Ji Hoon YANG ; Ji Yeon KIM ; Dong Hyun LEE ; Hyun Ho SHIN

Journal of the Korean Society of Hypertension.2012;18(4):154-165. doi:10.5646/jksh.2012.18.4.154

BACKGROUND: Pulse Wave Velocity (PWV) correlates well with arterial distensibility and stiffness and is a useful approach for evaluating the severity of systemic arteriosclerosis in adults. In addition, measurement of brachial-ankle PWV (baPWV) has been commonly reported as a simple, noninvasive, and practicable method. Arterial stiffness assessed by PWV could predict cardiovascular morbidity and mortality. In this study, we investigated the association between the changes of baPWV and cardiovascular risk factors in Korean women using data from follow-up evaluations. METHODS: The subjects were 626 women (age, 47.2 +/- 8.2) in whom we measured baPWV and cardiovascular risk factors at baseline and about one year later. Arterial stiffness was evaluated by baPWV and biological parameters were evaluated on the same day. We retrospectively analyzed the relationships between changes of baPWV and those other factors. All analyses were performed with SPSS ver. 20.0 and p-values < 0.05 were considered significant. RESULTS: In correlation analysis, changes of baPWV were affected by changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure, total cholesterol, high density lipoprotein-cholesterol, and low density lipoprotein-cholesterol. Multiple regression analysis of relationship between changes of baPWV and other associated variables shows that improvement of baPWV was significantly positively associated with changes of SBP and hemoglobin A1c (HbA1c), and worsening of baPWV was significantly negatively associated with changes of DBP, age, and SBP in sequence. CONCLUSIONS: In improvement of baPWV, decreases of SBP and HbA1c and in worsening of baPWV, increases of DBP, age, and SBP were significant factors in Korean women.
Adult ; Animals ; Ankle ; Arteriosclerosis ; Blood Pressure ; Cholesterol ; Female ; Follow-Up Studies ; Hemoglobins ; Humans ; Pulse Wave Analysis ; Retrospective Studies ; Risk Factors ; Vascular Stiffness

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Altered Regulation of Endothelin, Atrial Natriuretic Peptide, and Nitric Oxide Systems in Angiotensin II-induced Hypertension.

Eun Hui BAE ; Chang Seong KIM ; Joon Seok CHOI ; Seong Kwon MA ; Jong Un LEE ; Soo Wan KIM

Journal of the Korean Society of Hypertension.2012;18(4):146-153. doi:10.5646/jksh.2012.18.4.146

BACKGROUND: The present study aimed to determine the changes of endothelin (ET), nitric oxide, and atrial natriuretic peptide (ANP) systems in the kidney and aorta in angiotensin (Ang) II-induced hypertension. METHODS: Male Sprague-Dawley rats were used. Ang II (100 ng.min-1.kg-1) was infused through entire time course. Fourteen days after beginning the regimen, aorta and kidney were taken. The protein expression of nitroc oxide synthase (NOS) was determined by semiquantitative immunoblotting. The mRNA expression of components of ET, NOS, ANP system was determined by real-time polymerase chain reaction. RESULTS: Hypertension was developed in the experimental group. mRNA expression of ET-1 in the aorta and kidney was increased. The protein expression of endothelial NOS (eNOS) was decreased in the aorta, while that of inducible NOS and neuronal NOS remained unaltered. mRNA expression of ANP, natriuretic peptide type (NPR)-A, and NPR-C was not changed in the aorta. CONCLUSIONS: Based on these results, it seems that in Ang II-induced hypertensive rats, increased expression of ET-1 in the aorta and kidney, and decreased eNOS expression in the aorta contribute to the pathogenesis of hypertension.
Angiotensin II ; Angiotensins ; Animals ; Aorta ; Atrial Natriuretic Factor ; Endothelins ; Humans ; Hypertension ; Immunoblotting ; Kidney ; Male ; Neurons ; Nitric Oxide ; Rats ; Rats, Sprague-Dawley ; RNA, Messenger

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Changing Concept of Hypertensive Heart Disease.

Joong Wha CHUNG

Journal of the Korean Society of Hypertension.2012;18(4):137-145. doi:10.5646/jksh.2012.18.4.137

Arterial hypertension leads to both structural and functional changes of the heart. Hypertensive heart disease (HHD) is characterized by complex changes in myocardial structure (e.g., enhanced cardiomyocyte growth, excessive cardiomyocyte apoptosis, accumulation of interstitial and perivascular collagen fibers, disruption of endomysial and perimysial collagen network) that cause the remodeling of the myocardium. In the 1970s, hypertrophic growth of cardiomyocytes is compensatory to reduce wall stress on the ventricular wall imposed by pressure overload. Recent data from animal studies suggest that inhibition of ventricular hypertrophy was not associated with ventricular dilatation or reduced wall motion despite elevated wall stress. The genetic complexity (gene-gene and/or gene-environment interactions) may modulate left ventricular mass and transcriptional regulators are participated in pathologic myocardial growth. Many hormones and cytokines lead to a profibrotic and inflammatory environment. Excess of ventricular collagen in hypertensive patients is the result of both increased collagen synthesis by fibroblasts and stimulated myofibroblasts, and unchanged or decreased collagen degradation by matrix metalloproteinase. Several biochemical markers of myocardial remodeling will prove to be useful. The development of noninvasive methods like echoreflectivity, cardiac magnetic resonance imaging, speckle tracking echocardiography, and cardiac molecular imaging would enable broader application. Meta-analysis showed that there was a significant difference among medication classes in decreasing left ventricular mass.
Animals ; Apoptosis ; Biomarkers ; Collagen ; Cytokines ; Dilatation ; Echocardiography ; Fibroblasts ; Heart ; Heart Diseases ; Humans ; Hypertension ; Hypertrophy ; Magnetic Resonance Imaging ; Molecular Imaging ; Myocardium ; Myocytes, Cardiac ; Myofibroblasts ; Track and Field ; Ventricular Remodeling

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Obesity Increases Blood Pressure Variability during the Night.

Hong Ju AN ; Wan KIM ; Chung KANG ; Dong In NAM ; Il Hyung JUNG ; Hoon KANG ; Sang Sun LEE ; Ho Yeong SONG ; Sang Cheol CHO ; Won Yu KANG ; Sun Ho HWANG

Journal of the Korean Society of Hypertension.2014;20(1):1-7. doi:10.5646/jksh.2014.20.1.1

BACKGROUND: Previous studies have reported that obesity increases heart rate variability. Body mass index (BMI) has been reported to affect blood pressure variability (BPV) over 24 hours. However, the diurnal variation in the effect of BMI on BPV has not been evaluated. This study aimed to clarify the diurnal variation in the effect of BMI on BPV. METHODS: A total of 2,044 patients were consecutively enrolled in this study, and the data were analyzed retrospectively. All patients underwent 24-hour ambulatory blood pressure monitoring. We divided patients into two groups according to BMI (non-obese group: n = 1,145, BMI < 25; obese group: n = 899, BMI > or = 25). We compared BPV during daytime and nighttime between the non-obese and obese groups. We also evaluated the impact of BMI on BPV by multivariate regression analysis. RESULTS: On univariate regression analysis, there was no significant difference in BPV during daytime (systolic BP [SBP] variability: 20.7 vs. 21.7, p = 0.511; diastolic BP [DBP] variability: 16.8 vs. 17.5, p = 0.539). However, both SBP variability (13.8 vs. 17.6, p = 0.009) and DBP variability (11.7 vs. 14.3, p = 0.042) during nighttime were affected significantly by BMI. After adjusting other compounding variables (age > 60 years, current smoking habit, hypertension, diabetes mellitus, and use of calcium channel blockers and renin-angiotensin-aldosterone system blockers), multivariate analysis showed that BMI was an independent factor associated with increase in BPV during the night (SBP variability: p = 0.039; DBP variability: p = 0.034). CONCLUSIONS: Obesity increased BPV during nighttime.
Blood Pressure Monitoring, Ambulatory ; Blood Pressure* ; Body Mass Index ; Calcium Channel Blockers ; Diabetes Mellitus ; Heart Rate ; Humans ; Hypertension ; Multivariate Analysis ; Obesity* ; Renin-Angiotensin System ; Retrospective Studies ; Smoke ; Smoking

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A Successful Delivery of a Woman with Pulmonary Arterial Hypertension: Under Close Observation and without Medications.

Ji Hoon YANG ; Ji Yeon KIM ; Dong Hyun LEE ; Dong Jin SONG ; Cheol Yoon JEONG ; Hyun Ho SHIN

Journal of the Korean Society of Hypertension.2013;19(3):90-97. doi:10.5646/jksh.2013.19.3.90

Pregnant women with severe pulmonary arterial hypertension (PAH) have a high maternal mortality risk. Regardless of the PAH severity, the possibility of maternal death increases before and after childbirth. In general principle, if pregnancy happens, termination is the recommendation. Several case reports noted successful deliveries of pregnant women with PAH while using the drugs of anticoagulants, calcium channel blockers, prostaglandins, and phosphodiesterase V inhibitors. However, choices of treatment are generally achieved by clinical experiences because of no established guidelines of treatments for PAH in pregnancy. We describe a case of a 31-year-old pregnant woman with mild PAH who successfully delivered a viable newborn under close observation and without any medications. In the state of no consensus of the management for PAH in pregnancy, prior to termination or empirical drug treatments, close observation without medications could be considered in mild PAH.
Adult ; Female ; Humans ; Hypertension, Pulmonary ; Infant, Newborn ; Parturition* ; Pregnancy ; Pregnant Women

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