Pathophysiological roles of vascular 11beta-hydroxysteroid dehydrogenase and aldosterone

Mineralocorticoid receptor (MR) binding is tightly regulated by the enzyme 11β-hydroxysteroid dehydrogenase type 2 (11β-HSDII) which selectively metabolizes glucocorticoids to inactive metabolites, thus allowing for MR activation by aldosterone. To examine whether this enzyme is involved in the pathophysiology of salt-sensitive hypertension, 11β-HSDII activity and messenger RNA (mRNA) levels were determined in blood vessels of Dahl Iwai salt-sensitive (DS) and salt-resistant (DR) rats. Decreased 11β-HSDII activity and mRNA levels in mesenteric arteries were observed in 8-week-old DS rats on a high-salt diet, indicating that 11β-HSDII may play a significant role in salt sensitivity and hypertension. It has been suggested that mineralocorticoids act on blood vessels, leading to increased vasoreactivity and peripheral resistance. We present direct evidence that blood vessels are aldosteronogenic. The production of aldosterone in blood vessels was compared between stroke-prone spontaneously hypertensive rats (SHRSP) and Wistar-Kyoto (WKY) rats. Vascular aldosterone and CYP11B2 mRNA levels were significantly increased in 2-week-old SHRSP versus WKY rats. However, the vascular aldosterone levels in 4- and 9-week-old SHRSP and WKY rats were similar. High sodium intake further increased both blood pressure and vascular aldosterone synthesis in the SHRSPs. Both the local renin–angiotensin–aldosterone system (RAAS) and the vascular 11β-HSDII level are critically important in the pathophysiology of cardiovascular disorders.     

阿托伐他汀早期干预对2型糖尿病合并高血压患者血脂及炎症因子水平的影响

目的:探讨早期阿托伐他汀钙片干预对2型糖尿病合并高血压患者血脂水平和炎症指标的影响。方法:选择2014年5月-2015年5月我院收治的2型糖尿病合并高血压患者130例,根据治疗方法不同,将患者分为研究组和对照组,每组各65例。对照组采取常规降压及降糖药物治疗,研究组在此基础上应用阿托伐他汀钙片。观察两组患者治疗前后血脂水平、高敏C-反应蛋白(hs-CRP)、白介素-6(IL-6)及白介素-18(IL-18)的变化情况。结果:治疗后,两组患者胆固醇(TC)及低密度脂蛋白胆固醇(LDL-C)水平均较治疗前降低,且研究组显著低于对照组,差异具有统计学意义(P0.05);两组患者治疗前后的甘油三脂(TG)及高密度脂蛋白胆固醇(HDL-C)水平比较,差异无统计学意义(P0.05);治疗后,两组患者hs-CRP、IL-6及IL-18水平均较治疗前降低,且研究组显著低于对照组,差异具有统计学意义(P0.05);两组不良反应的发生率比较,差异无统计学意义(P0.05)。结论:阿托伐他汀钙片可以有效改善2型糖尿病合并高血压患者的血脂水症,降低血清炎症因子的表达,值得临床推广应用。     

自发性高血压大鼠肠系膜微静脉白细胞-内皮细胞相互作用和微淋巴管收缩特性的研究

目的:探讨自发性高血压大鼠(Spontaneously Hypertensive Rat,SHR)肠系膜微静脉白细胞-内皮细胞相互作用和微淋巴管收缩的特性。方法:取8周龄Wistar大鼠、8周龄SHR(SHR8W)和13周龄SHR(SHR13W),麻醉、固定并暴露肠系膜后,微循环显微镜下观察肠系膜微循环并录像;回放录像,计算微静脉白细胞滚动数和滚动的白细胞-内皮细胞接触时间(Rolling leukocyte-endothelial contact time,RLECT),用Vas Track自动测量系统对微淋巴管口径进行动态测量,并计算微淋巴管收缩特性指标。结果:SHR13W的白细胞滚动数显著低于Wistar;SHR8W和SHR13W的RLECT均显著低于Wistar,且SHR13W的RLECT显著低于SHR8W;进一步按照管径分级后,三组间白细胞滚动数在10~20μm管径级别下未见差异;各个管径级别下,SHR8W和SHR13W的RLECT均未见差异。SHR13W的淋巴管收缩分数显著低于Wistar和SHR8W;SHR8W及SHR13W的总收缩活性指数均显著低于Wistar;SHR13W的淋巴管动力指数显著低于Wistar。结论:SHR肠系膜微静脉白细胞滚动数及RLECT减少,其中白细胞滚动数在不同管径级别微静脉中的分布不均匀,而RLECT随SHR周龄降低,意味着SHR淋巴管收缩功能降低。     

硬膜外复合全麻对老年高血压患者腹部手术后并发症的影响

目的：探讨硬膜外复合全麻对老年高血压患者腹部手术后并发生的影响。方法：收集2013 年6 月-2015 年6 月在两家医院 接受腹部手术的老年高血压患者100 例,根据麻醉方法不同分为研究组和对照组。研究组患者给予硬膜外复合麻醉,对照组给予 全凭静脉麻醉。观察并比较两组患者的麻醉时间、药物用量以及术后并发症的发生率。结果：两组麻醉时间比较,差异无统计学意 义（P>0.05）;研究组麻醉药物用量低于对照组,差异具有统计学意义（P<0.05）;两组患者手术时间比较,差异无统计学意义（P>0. 05）;研究组患者术后苏醒时间、拔管时间以及住院时间均短于对照组,差异具有统计学意义（P<0.05）;研究组术后并发症的发生 率低于对照组,差异具有统计学意义（P<0.05）。结论：硬膜外复合全麻用于老年高血压患者腹部手术能够减少麻醉药物用量,降低 术后并发症的发生率,安全性较高。     

坎地沙坦联合贝那普利治疗糖尿病肾病并高血压患者的临床研究

目的:探索坎地沙坦联合贝那普利治疗糖尿病肾病(DN)并高血压患者的临床疗效。方法:选择2012年7月至2014年9月我院接收的DN合并高血压患者135例,按照随机数表法将患者分成坎地沙坦组(口服8 mg/d坎地沙坦)、贝那普利组(口服10mg/d贝那普利)和联合用药组(口服8 mg/d坎地沙坦和10 mg/d贝那普利)三组,每组45例,连续治疗12周。比较三组患者治疗前后收缩压(SBP)、舒张压(DBP)、24 h尿微量清蛋白排泄频率(24 h UAER)、尿素氮(BUN)、血钾水平(K+)、血清肌酐(Scr)、肌酐清除率(Ccr)、空腹血糖(FPG)指标变化及不良反应发生率。结果:与治疗前相比,治疗后各组患者的SBP、DBP、24 h UAER及BUN、Scr、Ccr、FPG均显著下降(均P0.05),且联合用药组患者的上述各指标水平明显低于坎地沙坦组和贝那普利组(均P0.05);联合用药组不良反应发生率低于其他两组,但是三组之间差异无统计学意义(P0.05)。结论:坎地沙坦联合贝那普利可以有效改善DN并高血压患者的血压情况及尿蛋白水平,改善患者的肾脏功能,且疗效优于单药治疗,对于临床用药有指导意义。     

心理干预联合氟哌噻吨美利曲辛片对老年高血压伴焦虑抑郁患者血压的影响

目的:研究心理干预联合氟哌噻吨美利曲辛片对老年高血压伴焦虑抑郁患者的血压影响。方法:选取2013年4月到2014年4月某院收治的老年高血压伴焦虑抑郁的患者110例,按照随机数字表法将患者分为研究组和对照组,每组55例,对照组给予常规降压治疗,研究组在对照组的基础上给予心理干预,同时服用氟哌噻吨美利曲辛片,治疗时间均为8周,应用抑郁自评量表(HAMD)和汉密尔顿焦虑自评量表(HAMA)的评分来评价患者的抑郁状态,比较两组降压疗效、HAMD评分、HAMA评分以及不良反应。结果:研究组降压总有效率94.5%(52/55),对照组降压总有效率为67.3%(37/55),两组比较差异具有统计学意义(x2=12.952,P=0.013);研究组治疗后HAMA评分和HAMD评分分别为(10.5±0.6)分、(11.9±1.1)分显著低于治疗前的(20.8±0.4)分、(31.2±0.7)分,与治疗前比较差异具有统计学意义(t=9.923,10.628,P=0.025,0.019),与对照组比较差异具有统计学意义(t=9.823,11.628,P=0.023,0.016);两组不良反应比较差异无统计学意义(x2=5.492,P=0.072)。结论:心理干预联合氟哌噻吨美利曲辛片治疗老年高血压伴焦虑抑郁者具有较好的降压效果,能改善患者焦虑抑郁状态,且无严重不良反应。     

The glucocorticoid receptor in the distal nephron is not necessary for the development or maintenance of dexamethasone-induced hypertension

Glucocorticoids are used as a treatment for a variety of conditions and hypertension is a well-recognized side effect of their use. The mechanism of glucocorticoid-induced hypertension is incompletely understood and has traditionally been attributed to promiscuous activation of the mineralocorticoid receptor by cortisol. Multiple lines of evidence, however, point to the glucocorticoid receptor as an important mediator as well. We have developed a mouse model of glucocorticoid-induced hypertension, which is dependent on the glucocorticoid receptor. To determine the site(s) of glucocorticoid receptor action relevant to the development of hypertension, we studied glucocorticoid-induced hypertension in a mouse with a tissue-specific knockout of the glucocorticoid receptor in the distal nephron. Although knockout mice had similar body weight, nephron number and renal histology compared to littermate controls, their baseline blood pressure was mildly elevated. Nevertheless, distal nephron glucocorticoid receptor knockout mice and controls had a similar hypertensive response to dexamethasone. Urinary excretion of electrolytes, both before and after administration of glucocorticoid was also indistinguishable between the two groups. We conclude that the glucocorticoid receptor in the distal nephron is not necessary for the development or maintenance of dexamethasone-induced hypertension in our model.     

Indoxyl sulfate, a uremic toxin, promotes cell senescence in aorta of hypertensive rats

We demonstrated that administration of indoxyl sulfate, a uremic toxin, promotes aortic calcification in hypertensive rats. This study aimed to clarify if indoxyl sulfate could contribute to cell senescence in the aorta of hypertensive rats. The rat groups consisted of (1) Dahl salt-resistant normotensive rats (DN), (2) Dahl salt-resistant normotensive indoxyl sulfate-administered rats (DN + IS), (3) Dahl salt-sensitive hypertensive rats (DH), and (4) Dahl salt-sensitive hypertensive indoxyl sulfate-administered rats (DH + IS). After 32 weeks, their arcuate aortas were excised for histological and immunohistochemical analysis. Cell senescence was evaluated by immunohistochemistry of senescence-associated β-galactosidase (SA-β-gal), and senescence-related proteins such as p16^INK4a, p21^WAF1/CIP1, p53 and retinoblastoma protein (Rb). Both DH and DH + IS rats showed significantly higher systolic blood pressure than DN and DN + IS rats, respectively. Serum indoxyl sulfate levels were significantly higher in DN + IS and DH + IS rats than in DN and DH rats, respectively. In aorta, DH rats showed significantly increased aortic calcification and wall thickness, and increased expression of SA-β-gal, p16^INK4a, p21^WAF1/CIP1, p53 and Rb in the calcification area of arcuate aorta as compared with DN rats. More notably, DH + IS rats showed significantly increased aortic calcification and wall thickness, and significantly increased expression of SA-β-gal, p16^INK4a, p21^WAF1/CIP1, p53 and Rb in the cells embedded in the calcification area as compared with DH rats. In conclusion, indoxyl sulfate promotes cell senescence with aortic calcification and expression of senescence-related proteins in hypertensive rats.     

Super CitriMax (HCA-SX) attenuates increases in oxidative stress, inflammation, insulin resistance, and body weight in developing obese Zucker rats

Super CitriMax (HCA-SX) is a novel calcium/potassium salt of (−)-hydroxycitric acid extracted from the dried fruit rind of the plant Garcinia cambogia, and commonly consumed as weight loss dietary supplement. In the present study, we investigated the effect of HCA-SX on inflammation, oxidative stress and insulin resistance in developing obese Zucker rats, an animal model of type II diabetes associated with inflammation and oxidative stress. Male Zucker rats (5-week old) were supplemented with vehicle (control) and HCA-SX in drinking water for 7 weeks. Oxidative stress markers, including malondialdehyde (MDA), protein carbonyl (DNPH), and protein tyrosine nitration (tyr-NO₂) were measured in the liver and kidney tissues using biochemical and immunoblotting techniques. Compared to controls, the levels of MDA, DNPH and tyr-NO₂ were lower in the liver and kidney of HCA-SX-treated animals. Furthermore, the levels of C-reactive protein and interleukin-6, markers of inflammation measured by ELISA, were lower in the plasma of HCA-SX-supplemented animals compared to controls, as were levels of fasting plasma insulin, glucose, and triglycerides. Interestingly, insulin resistance did not develop in HCA-SX-supplemented rats. Food-intake and body weight gain was also lower in rats supplemented with HCA-SX compared to their control counterparts. These results suggest that HCA-SX supplementation in obese Zucker rats reduces food-intake, body weight gain, and also attenuates the increases in inflammation, oxidative stress, and insulin resistance observed in untreated animals. Therefore, HCA-SX may be used as an intervention to overcome obesity-related complications, including inflammation, oxidative stress, and insulin resistance.     

Hepatic morphological alterations,glycogen content and cytochrome P450 activities in rats treated chronically with N<Superscript>ω</Superscript>-nitro-L-arginine methyl ester (L-NAME)

Chronic treatment of rats with N(omega)-nitro-L-arginine methyl ester (L-NAME), an inhibitor of nitric oxide (NO) biosynthesis, results in hypertension mediated partly by enhanced angiotensin-I-converting enzyme (ACE) activity. We examined the influence of L-NAME on rat liver morphology, on hepatic glycogen, cholesterol, and triglyceride content, and on the activities of the cytochrome P450 isoforms CYP1A1/2, CYP2B1/2, CYP2C11, and CYP2E1. Male Wistar rats were treated with L-NAME (20 mg/rat per day via drinking water) for 2, 4, and 8 weeks, and their livers were then removed for analysis. Enzymatic induction was produced by treating rats with phenobarbital (to induce CYP2B1/2), beta-naphthoflavone (to induce CYP1A1/2), or pyrazole (to induce CYP2E1). L-NAME significantly elevated blood pressure; this was reversed by concomitant treatment with enalapril (ACE inhibitor) or losartan (angiotensin II AT(1) receptor antagonist). L-NAME caused vascular hypertrophy in hepatic arteries, with perivascular and interstitial fibrosis involving collagen deposition. Hepatic glycogen content also significantly increased. L-NAME did not affect fasting glucose levels but significantly reduced insulin levels and increased the insulin sensitivity of rats, based on an intraperitoneal glucose tolerance test. Immunoblotting experiments indicated enhanced phosphorylation of protein kinase B and of glycogen synthase kinase 3. All these changes were reversed by concomitant treatment with enalapril or losartan. L-NAME had no effect on hepatic cholesterol or triglyceride content or on the basal or drug-induced activities and protein expression of the cytochrome P450 isoforms. Thus, the chronic inhibition of NO biosynthesis produced hepatic morphological alterations and changes in glycogen metabolism mediated by the renin-angiotensin system. The increase in hepatic glycogen content probably resulted from enhanced glycogen synthase activity following the inhibition of glycogen synthase kinase 3 by phosphorylation.