Abstract: Cardiovascular diseases are the most common cause of mortality and morbidity in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) receiving hemodialysis and peritoneal dialysis. Beside traditional risk factors including hypertension, diabetes, dyslipidemia, advanced age novel risk factors such as endothelial dysfunction, hyperphosphatemia, hyperparathyroidism, vascular calcification, increased oxidative stress and inflammation are highly prevalent and seem to play a more important role for vascular disease in CKD and ESRD patients compared to general population. This review briefly discuss classical and recent epidemiologic, pathophysiologic and clinical aspects of coronary artery disease in ESRD patients.

Abstract: Background: Isolated systolic hypertension (ISH) is one of hypertension hemodynamic subtypes. Although the prevalence of hypertension has been reported in Hispanics, the prevalence of ISH has not been fully investigated. Design and Methods: 7,546 Hispanic adults aged ≥18 years, representative of the US civilian noninstitutionalized Hispanic population, were selected from the National Health and Nutrition Examination Survey (NHANES) through a stratified multistage probability clustered sampling design. The prevalence estimates of ISH and 95% confidence intervals in Hispanics (including Mexican Americans and other Hispanics) were estimated by conducting weighted frequency and logistic procedures. Results: The prevalence of ISH was 11.21% among Hispanics adults in 1999-2010. The prevalence of ISH did not differ significantly between Mexican Americans and other Hispanics. Women were more prevalent in ISH than men (12.98% vs 8.98%) in Hispanics. Adults with a lower education (high school or below) had higher prevalence of ISH than adults with a higher education (college or above) in either of Hispanics (12.10% vs 7.58%) and Mexican Americans (12.14% vs 6.99%). For Hispanics and Mexican Americans, the prevalence of ISH was higher in elderly women than in elderly men, and higher in elderly adults with a lower education than in those with a higher education. Among all Hispanics who received a lower education, women had higher prevalence of ISH than men (14.17% vs 9.80%). In Mexican women, those with a lower education were more prevalent in ISH than those with a higher education (13.48% vs 6.64%). Conclusion: ISH is more prevalent in adults with a lower education in Mexican Americans. Considering Mexican Americans accounted for the vast majority of the Hispanic population and 74.09% of them received a high school education or below, more efforts and investments for enhancing the education attainment in Mexican Americans may significantly improve ISH in the Hispanic population.

Abstract: The case of an Albanian patient is reported, with bilateral adrenal hyperplasia diagnosed after a condition of persistent hypokalemia, in spite of continuous and adequate potassium administration. The patient, a Caucasian male of middle age, was suffering from diabetes, hypertension and angina pectoris, and admitted in a University Hospital Facility due to an unexplained confusional state. U waves were registered in the electrocardiography, and abdominal imaging was suggestive of adrenal hyperplasia. His plasmatic levels of potassium started to improve and became normal only after a therapy with potassium sparing diuretic, in our case with spironolactone. The administration of this type of drug has been widely advocated even for diagnostic purposes, when an unexplained condition of hypokalemia persists. Our case suggests that in lack of obvious causes of hypokalemia, suspicions on the existence of a primary hyperaldosteronism should be formulated, and investigations or therapeutic interventions have to be purposefully shaped.

Abstract: A genetic association between single nucleotide polymorphisms (SNPs) and pulmonary hypertension syndrome (PHS) was established in a commercial population of broiler chickens. The associated SNPs were found in the NOS3 and HIF1α genes (LOD > 6; p < 0.001). The SNPs in the NOS3 gene interfere with its trans-activation and transcriptional activation activities under natural hypobaric hypoxia conditions and are located in a consensus sequence that is called the hypoxia response element (HRE). SNPs located in the HIF1α gene could act as alternative cryptic splicing sites in intron six, which may stimulate non-sense mediated early decay (NMD) of the primary transcript. A fragment of intron 3 of the EDN1 gene was also evaluated, but the polymorphisms found were not associated with PHS (lod < 6; p > 0.001). However, further studies on the regulatory transcription sequences of EDN1 are recommended. The findings of this study indicate that intronic sequences should be included when searching for polymorphisms that produce physiological changes. Introns have transcriptional regulatory sequences or post-transcriptional control signals, which are known as cis- and trans-activation regulatory elements and are able to alter the physiological processes of hypoxia adaptation when modified. Based on these findings, it can be concluded that the inheritance pattern of PHS is autosomal overdominant and has deleterious effects that are characterized by higher penetrance in heterozygous than in homozygous animals, which prevent broiler chickens from being able to adapt to high altitudes.

Abstract: Endothelial dysfunction is associated with vascular inflammation, reduced serum levels of nitric oxide, vasoconstriction and atherosclerosis.Soluble adhesion molecules (SAM) are considered markers of endothelial dysfunction and play a role in end organ damage in those patients. Prehypertensive patients suffer endothelial dysfunction. The aim of this study was to evaluate the serum levels of circulating soluble adhesion molecules and nitric oxide (evaluated as serum levels of nitrites) in prehypertensive non-diabetic patients. METHODS: Circulating levels of VCAM-1, ICAM-1 and e-selectine (ELISA RyDSystems Minneapolis USA), and serum nitrite levels (Griess method, Molecular Probes Inc. Oregon USA) were measured in 20 prehypertensive non-diabetic patients (as defined by JNC 7) and in 20 age matched normotensive controls. Statistical analysis was performed with ANOVA. RESULTS: Prehypertensive patients showed significantly higher levels of SAM, (VCAM-1; 530 ± 30.9 vs. 477 ± 22.5 ng/ml p<0.001), (ICAM-1; 285 ± 16.5 vs. 239 ± 14.9 ng/ml p<0.001), (E- selectin; 68 ± 6.9 vs. 52 ± 9.8 ng/ml p<0.01) and lower levels of nitrites (4.5 ± 0.8μmol/L vs. 6.2 ± 1.2 μmol/L p<0.01) than controls. CONCLUSION: Prehypertensive patients showed higher circulating levels of SAM and lower nitrites than normotensive subjects; which may explain why prehypertensive patients had more complications and coronary risk than normotensive patients.

Abstract: Background: Hypertension (HTN) has been reported as the most common cardiovascular (CV) disorder observed in competitive athletes. However, information on the prevalence of HTN and pre-HTN among adolescent male football players is not well documented. This study assessed the prevalence of point and sustained HTN and pre-HTN in male adolescent footballers in Lagos, Nigeria. The distribution of CV risk factors among players was also evaluated. Methods: A cohort of 706 male adolescent players of a youth football league in Lagos, Nigeria were studied. Their blood pressures and anthropometric indices were measured using standard protocols at a pre-participation screening. Players identified as hypertensive (i.e. point HTN – defined as HTN based on 1 assessment derived from the mean of two measurements) were invited for follow-up assessment a week after initial assessment to detect sustained HTN. Data were presented using descriptive statistics. Results: The mean age of players was 17.7 ± 1.1 years (range = 14 – 19 years). The prevalence of point HTN and pre-HTN was 24.8% and 47.3% respectively, while the prevalence of sustained HTN and pre-HTN was 13.9% and 51.7% respectively. Hypertension (24.8%) and family history of a CV disease (5.1%) were the most prevalent CV risk factors among players at the pre-participation screening. Conclusion: This study reveals that HTN and pre-HTN are prevalent among male adolescent Nigerian footballers. Urgent public health action is needed to address the situation in order to fore-stall or attenuate the implications of adolescent HTN in these competitive athletes.