5 Things We Now Know About Pulmonary Arterial Hypertension
About The Editors
Editor-in-ChiefMichael Stowasser, PhD, MBBS, FRACP, University of Queensland, Brisbane, Australia
Michael is currently Director of the Hypertension Units and Co-Director of the Endocrine Hypertension Research Centre within the University of Queensland School of Medicine at Greenslopes and Princess Alexandra Hospitals in Brisbane. He has over 25 years clinical research experience in pathogenesis and management of hypertension and especially of endocrine varieties including primary aldosteronism, renovascular hypertension, pheochromocytoma and familial hyperkalemic hypertension. Working with mentor Richard Gordon, he helped to demonstrate that primary aldosteronism is at least 10 times more common than previously thought, and is the commonest specifically treatable and potentially curable form of hypertension. Ongoing studies are aimed at determining genetic bases for primary aldosteronism, examining non-blood pressure dependent effects of aldosterone excess, improving methods of detection, diagnostic workup and management of primary aldosteronism and exploring the pathogenesis and genetics of other salt sensitive forms of hypertension, including familial hyperkalemic hypertension.
Anthony Bain, PhD, MSc, University of Windsor, Ontario, Canada
Dr. Anthony Bain is an Associate Professor in the Department of Kinesiology and adjunct Professor in Integrative Biology at the University of Windsor. He received his PhD at the University of British Columbia and post-doctoral training at the University of Colorado Boulder. Dr. Bain specializes in integrative cerebral vascular and endothelial physiology, with particular focus on the responses to hypoxia, exercise and hyperthermia. His most recent research involves understanding the endothelial mechanisms associated with the responses and adaptations to vascular wall shear stress. Dr. Bain is a member of the Physical Activity and Cardiovascular Research (PACR) group as well as the WESPARK Health Institute. His research program is primarily funded through the National Science and Engineering Research Council of Canada (NSERC).
J. Brian Byrd, MD, MS, FAHA, FACC, University of Michigan School of Medicine, Michigan, USA
Dr. J. Brian Byrd investigates human hypertension using laboratory investigation of novel biomarkers, clinical trials, and epidemiology. While training in Nancy J. Brown's laboratory, he worked on the mechanism of ACE inhibitor-associated angioedema in a rodent model, a case-control study, a GWAS, and a randomized clinical trial of a new drug. He later served as an investigator for the SYMPLICITY HTN-3 pivotal clinical trial of renal artery denervation. His current interest is resistant hypertension, especially endocrine forms of hypertension. Recently, his laboratory has pioneered sensitive and specific assays to detect mineralocorticoid receptor-regulated gene expression in the supernatant of human urine. In addition, Dr. Byrd worked together with a group dedicated to improving the quality of studies involving exosomes, nanoscale vesicles secreted into biofluids that provide a novel source of physiologically relevant biomarkers, the work having now been published in Nature Methods. Beyond these and other research contributions, in 2017 Dr. Byrd and Casey Greene created the Research Symbiont Awards, which recognize excellence in data sharing. He is a principal investigator at the University of Michigan School of Medicine, where he is Assistant Professor in the Department of Internal Medicine's Division of Cardiovascular Medicine. He is funded by several organizations, including the National Institutes of Health.
Fadi Charchar, PhD, FAHA, Federation University, Ballarat, Australia
Professor Fadi Charchar is the Robert HT Smith Chair in Cardiovascular Genomics and Dean, Graduate Research School at Federation University. Professorial Research Fellow at the University of Melbourne and Visiting Chair at University of Leicester, UK. Professor Charchar is the Vice-President of the International Society of Hypertension and President of the International Society of Heart Research. He previously completed a Wellcome Trust Fellowship and a British Heart Foundation Lectureship in the UK. He is an internationally recognized expert in understanding the genetic mechanisms of cardiovascular disease. His research includes findings that the human Y chromosome contributes to hypertension and CAD.
Jordana Cohen, MD, MSCE, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
Dr. Cohen is an Assistant Professor of Medicine and Epidemiology in the Renal-Electrolyte and Hypertension Division and Department of Biostatistics, Epidemiology, and Informatics at the University of Pennsylvania Perelman School of Medicine. She is a co-investigator in the Chronic Renal Insufficiency Cohort (CRIC) Scientific and Data Coordinating Center, and co-chair of the CRIC Blood Pressure Working Group. Her primary clinical responsibility is caring for a panel of patients with complex hypertension as a part of the American Society of Hypertension/American Heart Association Level 1 Hypertension Center at the University of Pennsylvania. She leads a portfolio of National Institutes of Health-funded research projects that 1) examine physiology-driven pharmacologic effects of antihypertensive medications in complex and high-risk disease states and 2) seek novel strategies to apply out-of-office blood pressure measurement, with a goal of improving the generalizability and reproducibility of hypertension research findings.
Christian Delles, MD, FRCP, FAHA, FBIHS, University of Glasgow, Glasgow, United Kingdom
Christian Delles is Professor of Cardiovascular Prevention and Deputy Director of the Institute for Cardiovascular and Medical Sciences, University of Glasgow; and Honorary Consultant Physician with NHS Greater Glasgow & Clyde. His research is in the area of vascular biology with oxidative stress and endothelial function as pathogenetic factors of hypertension and other cardiovascular disorders. As such he studies markers for early diagnosis of a wide range of conditions including diabetic nephropathy; the molecular basis of vascular and renal diseases; the pathogenesis and long-term consequences of hypertensive disorders of pregnancy and gestational diabetes; and differences in the pathophysiology of cardiovascular diseases between men and women. Christian serves as Treasurer of the British and Irish Hypertension Society and Honorary Secretary of the Association of Physicians of Great Britain and Ireland. He is a member of national and international grant panels, associate editor and member of the editorial board of leading cardiovascular journals and has published more than 230 peer reviewed papers.
Sunil Nadar, MD, FESC, Dudley group of hospitals NHS trust UK, Dudley, United Kingdom
Dr Sunil Nadar is a consultant interventional cardiologist at the Dudley group of hospitals NHS trust UK, having worked previously at Sultan Qaboos University Hospital, Muscat, Oman and the Heart of England NHS trust as a consultant cardiologist and an honorary senior lecturer with the University of Birmingham UK. During his time in Oman he was listed on google scholar as one of the top ten researchers in Oman in 2016.He had completed his postgraduate research with Professor Gregory Lip and Professor Gareth Beevers at the University of Birmingham UK, on hypertension and platelet function and has co-edited a book on Hypertension with Prof Lip.His main research interests are platelet activation, hypertension, coronary artery disease, and coronary intervention. He is a fellow of the Royal college of physicians London and a Fellow of the European Society of cardiology.
Pantelis Sarafidis, MD, MSc, PhD, Aristotle University of Thessaloniki, Thessaloniki, Greece
Dr Sarafidis, MD, MSc, PhD is an Associate Professor in Nephrology at Aristotle University of Thessaloniki, and Consultant in Nephrology in Hippokration Hospita. He is the Head of the ESH Hypertension Excellence Center in this hospital. He received his MD degree from Aristotle University of Thessaloniki and a MSc in Health Units Administration from Hellenic Open University. Dr Sarafidis completed his training in Nephrology in the 1st Department of Medicine, AHEPA Hospital, where he also completed his PhD thesis on the relationship of Metabolic Syndrome with Hypertension and Kidney Disease between 2001-2005. He completed two yearly post-doc fellowships in the Hypertension/Clinical Research Center, Rush University Medical Center, Chicago and the Department of Renal Medicine, King's College Hospital, London. In 2008 he received the title ESH Clinical Hypertension Specialist.During the past 18 years, the clinical and research activities of Dr Sarafidis have been focused on hypertension, diabetic and hypertensive nephropathy, acute kidney injury, anemia in CKD, polycystic kidney disease and CVD in ESRD patients. He has participated as principal or sub-investigator in numerous observational studies and clinical trials in the above fields. He has authored more than 240 articles in peer-reviewed international medical journals and book chapters in international textbooks, and performed more than 200 lectures in national and international meetings in the areas of Nephrology, Hypertension and related fields. He is currently a reviewer for more than 60 international medical journals and serves on the Editorial Board of five. Dr Sarafidis has received several awards and grants from national and international Medical Societies for his research activities.
James Sharman, PhD, Menzies Institute for Medical Research, Hobart, Australia
James is a medical researcher in the field of blood pressure and cardiovascular disease. He is Deputy Director and heads the Blood Pressure Research Group at the Menzies Institute for Medical Research, Hobart, Australia. He is also the Scientific Director of the Menzies Blood Pressure Clinic and former head of the Cardiometabolic Research Theme at Menzies. His research program has focused on the physiology and clinical relevance of central aortic blood pressure and exercise haemodynamics, as well as new methods to improve cardiovascular risk management. He currently co-leads an initiative to improve the global availability of blood pressure devices that have been clinically validated for accuracy.
Gloria Valdes, MD, Pontificia Universidad Catolica de Chile, Santiago, Chile
Gloria Valdes is now Professor Emeritus of the Faculty of Medicine of the Pontificia Universidad Católica de Chile and integrates the Chilean Academy of Medicine. After training in Nephrology in Chile and in Hypertension at the Cleveland Clinic she focused on hypertension in patient care and pre- and postgraduate teaching, acquiring a national and Latin American influence. Her laboratory research on the role of vasodilators in the systemic and local adaptations of pregnancy went from increased renal kallikrein excretion in normal pregnant women to the localization of kallikrein and the main bradykinin receptor (B2R), eNOS and vasodilators within the RAS in human and guinea-pig utero-placental interphase. From enhanced trophoblast migration by stimulating the B2R to impaired trophoblast invasion and blood pressure in guinea-pigs by inhibiting it. She took part in showing endothelial dysfunction after preeclampsia and recurrent abortion and increased coronary lesions in women far from hypertensive pregnancies. Her present interest is promoting prolonged follow-up of hypertensive pregnant women and of low birth weight/premature babies to reduce cardiovascular and renal diseases.
Yuichiro Yano, MD, Duke University School of Medicine, Durham, USA
Yuichiro Yano, MD, PhD, is Assistant Professor at the Duke University School of Medicine. As a physician scientist he has been conducting prospective observational and interventional studies using clinic, home, and 24-hour ambulatory blood pressure monitoring in Japan and the U.S. He has also been conducting research on the etiology and outcomes of abnormal blood pressure phenotypes, longitudinal modeling of cardiovascular risks, and cardiovascular disease risk prediction among young adults. He has authored or co-authored more than 100 publications in peer reviewed journals in the field, including Journal of the American Medical Association (JAMA). In 2016 he received the American Society of Hypertension's Young Scholar Award and the Sandra A. Daugherty Award from the American Heart Association. In 2017 he received the Hypertension Top Paper Award. He was recently recognized by the American Heart Association for authoring one of the most impactful publications of 2018, and received Japanese Society of Hypertension Academic Award 2019.
Dr Sarah Partridge, BN, MSc, PhD, University of Sussex, Brighton, UK
Social Media EditorCarlos Valencia-Hernández, MD, MPH, University College London, United Kingdom
1 Million Plastic Water Bottles Are Sold Every Minute — Study Explains How Earth Is Paying The Cost
More than one million plastic water bottles are sold every minute in the world, according to a report published by The British Medical Journal. This trend is projected to continue, with experts forecasting a substantial increase in consumption in the years ahead. However, the industry's enormous global success comes at huge environmental, climate and social costs. The rising demand of bottled water is largely driven by convenience, portability, perceived nutritional advantages, mistrust of tap water quality and personal taste preferences. The use of plastic bottles for the consumption of beverages poses an immense toll on human and planetary health, as per the report.
Up to two-thirds of the bottled water in the US is repackaged tap water. "This finding becomes more impactful when considering the rigorous standards that tap water in high-income countries must meet, which far outstrip those for BW, particularly regarding chemical leaching from plastic containers," the report said.
Toxic Leaching: Plastic bottles leach harmful substances like microplastics, BPA, and other endocrine disruptors, which can interfere with the normal functioning of reproductive hormones, thyroid hormones and glucocorticoid receptors. BPA's exposure has been tied to a range of later-life health issues like hypertension, cardiovascular disease, diabetes and obesity.
Environmental Degradation: Ranking as the second most prevalent ocean pollutant, plastic bottles make up 11.9% of all plastic waste, surpassed only by plastic bags.6 Globally, a mere 9% of these bottles undergo recycling, with notable disparities among countries. There are also changes to natural habitats such as soil and sediment contamination, marine accumulation and nutrient cycling.
Greenhouse Gas Emissions: The production of plastic bottles is energy-intensive, contributing to global greenhouse gas emissions and climate change.
Drivers of Demand: Increased consumption is fueled by convenience, portability, mistrust in tap water, and taste preferences, even in regions where tap water is safe and regulated. Research has suggested that many individuals cannot differentiate between tap water and bottled water in blind tests. Certain minerals like sulfur can give water a distinctive taste that many might find unpleasant, yet these minerals do not necessarily compromise water quality or safety, according to the report.
The study highlighted a need for low-income and middle-income countries to invest in making safe drinking water accessible. To achieve this, public awareness campaigns are essential. They can generate demand and push governments to make policy changes and can create governmental accountability for the provision of clean and potable water. "They should provide clear evidence-based information about tap water's advantages, correct false beliefs and respond to worries about health risks and the taste and smell of tap water," the report added.
Genetic Factors Should Be Considered
Secondary hypertension is rare. Nonetheless, it should also be considered preemptively when caring for patients with incidentally discovered adrenal masses, which are initially clinically inapparent, for instance, subclinical hyperaldosteronism, subclinical Cushing's syndrome, or subclinical pheochromocytoma. Blood pressure is often still in the so-called normal range, which however is not necessarily normal for the individual patient (1). For example, normotensive pheochromocytomas occur in about one-third of patients with a mutation in the von Hippel-Lindau gene, as well as in other patients (2). One can measure not only free plasma metanephrines but also urinary fractionated metanephrines. In patients with Cushing's syndrome, it is often helpful to determine a salivary diurnal cortisol profile, especially for patients taking medications (such as contraceptives) that may lead to a false-positive (or false-negative) result in dexamethasone suppression tests (3). Knowledge of the CYP450 3A4 system is important (https://drug-interactions.Medicine.Iu.Edu/Main-Table.Aspx). Rare genetic disorders with mineralocorticoid excess are often discovered in childhood, but may also be diagnosed later, for example in connection with hypertension in a phenotypically adolescent girl with amenorrhea (17-alpha-hydroxylase deficiency; see also [3, 4]).
DOI: 10.3238/arztebl.2019.0071b
Prof. Dr. Med. Christian A. Koch, FACP, MACE
Medicover GmbH, Carl von Ossietzky Universität, Oldenburg, Germany and
University of Tennessee Health Science Center Memphis, TN, USA
christian.Koch65@gmail.Com
Conflict of interest statement
The author declares that no conflict of interest exists.
Comments
Post a Comment