Potential therapeutic effects and applications of Eucommiae Folium in secondary hypertension

Eucommiae Folium(EF),a traditional Chinese medicine,has been used to treat secondary hypertension,including renal hypertension and salt-sensitive hypertension,as well as hypertension caused by thoracic aortic endothelial dysfunction,a high-fat diet,and oxidized low-density lipoprotein.The antihypertensive components of EF are divided into four categories:flavonoids,iridoids,lignans,and phenylpropanoids,such as chlorogenic acid,geniposide acid and pinoresinol diglucoside.EF regulates the occurrence and development of hypertension by regulating biological processes,such as inhibiting inflammation,regulating the nitric oxide synthase pathway,reducing oxidative stress levels,regulating endothelial vasoactive factors,and lowering blood pressure.However,its molecular antihypertensive mechanisms are still unclear and require further investigation.In this review,by consulting the relevant literature on the antihypertensive effects of EF and using network pharmacology,we summarized the active ingredients and pharmacological mechanisms of EF in the treatment of hypertension to clarify how EF is associated with secondary hypertension,the related components,and underlying mechanisms.The results of the network pharmacology analysis indicated that EF treats hypertension through a multicomponent,multi-target and multi-pathway mechanism.In particular,we discussed the role of EF targets in the treatment of hypertension,including epithelial sodium channel,heat shock protein70,rhoassociated protein kinase 1,catalase,and superoxide dismutase.The relevant signal transduction pathways,the ras homolog family member A(RhoA)/Rho-associated protein kinase(ROCK)and nicotinamide adenine dinucleotide phosphate(NADPH)oxidase/eNOS/NO/Ca^(2+)pathways,are also discussed.

The clinical analysis of secondary hypertension patients

Objective To analyze the situation of secondary hypertension caused by different etiology and its treatment status so as to improve its treatment.Methods Totally 580 patients with secondary hypertension selected with strict criteria were divided into 4 groups in accordance with the etiology.The data were dealt with SPSS 13.0.We analyzed the sex,age,systolic pressure,diastolic pressure and positive incidence of family history of all the secondary hypertension patients in each group,and compared their usage of every unilateral preparation.Results The average age of renal parenchymal disease was more advanced than that of adrenal disease and other diseases.The administration of diuretics and angiotensin-converting enzyme inhibitor(ACEI)in renal parenchymal disease group,αβ receptor blocking agents and calcium antagonists in kidney-artery disease group,α antagonists in adrenal disease and compound antihypertensive agents in other diseases groups all affected advantage of the ratio.Conclusion Diuretics and ACEI are suitable for hypertension caused by renal parenchymal disease.αβ receptor blocking agents and calcium antagonists are suitable for that caused by kidney artery disease,but α receptor blocking agents are suitable for that caused by adrenal disease.

THE CIRCADIAN ALTERATIONS OF BLOOD PRESSURE IN PATIENTS WITH SECONDARY HYPERTENSION

Objective To study the pattern of circadian blood pressure changes in patients with se-condary hypertension. Methods The 24h ambulatory blood pressure monitoring was performed in 80 patients with secondary hypertension (SH) including primary aldosteronism in 44, pheochromocytoma in 11, renovas-cular hypertension in 10, renoparenchymal hypertension in 15 and compared with 80 patients with essential hy-pertension (EH) matched by age and sex. Results The diurnal rhythm in patients with SH was different from that of patients with EU. The diurnal curves in SU and EU was overlapped in daytime and separated from each other at nighttime. The nocturnal blood pressure fall was less and average blood pressure at nighttime was higher in patients with SH than those in patients with Eli (P <0. 01). The nighttime blood pressure loading and non-dipper phenomenon were much more frequently seen in patients with SH than those in patients with Eli (P <0. 01). The nighttime blood pressure/daytime blood pressure ratio was significantly higher in patients with SH than that in patients with Eli (P <0. 01). Conclusion The non-invasive 24h ambulatory blood pressure monitoring may be a useful method in screening for

Characteristics of pediatric inpatients with primary and secondary hypertension

Importance:Extensive population-based studies have explored the prevalence of primary hypertension(HTN)in children and adolescents.However,there is little published data on the characteristics of different types of pediatric HTN and the causes of secondary HTN.Objective:To investigate the characteristics of different types of pediatric HTN and the causes of secondary HTN in a hospital setting.Methods:The study cohort comprised pediatric inpatients(<18 years of age)discharged with a diagnosis of HTN from Beijing Children's Hospital during 2015-2020.Pediatric patients with HTN were allocated to secondary and primary HTN groups on the basis of comprehensive analyses of their diagnoses,family history of HTN,and findings on physical examination,as documented in their medical records.The Mann-Whitney U test,χ^(2) and Fisher's exact test were used to assess differences in characteristics of patients with different HTN types and causes of secondary HTN.Results:Data of 1470 inpatients with HTN from 18 clinical departments were included in the analysis.Among them,458(31.2%)had primary HTN,and 1012(68.8%)had secondary HTN.Compared with patients had primary HTN,children with secondary HTN were younger and had lower body mass indexes and longer lengths of stay.Moreover,children with primary HTN had mostly been managed by the Endocrinology and Cardiology Departments,75.8%of them having obesity-related comorbidities.In contrast,most patients with secondary HTN had been managed by the Nephrology Department,renal diseases being the leading cause of their HTN(46.3%).Interpretation:Secondary HTN is more common than primary HTN in pediatric clinical settings,renal diseases being the leading cause of secondary HTN.

Accessory renal arteries-a source of hypertension:A case report

BACKGROUND Secondary hypertension is a relatively rare condition most commonly caused by renovascular disease due to atherosclerotic vascular disease or fibromuscular dysplasia.Although accessory renal arteries are frequent,to date,only six cases of secondary hypertension determined by their existence have been reported.CASE SUMMARY We describe a case of a 39-year-old female who came to the emergency department with an urgent hypertensive crisis and hypertensive encephalopathy.Despite normal renal arteries,the computed tomography angiography revealed an inferior polar artery with 50%stenosis of its diameter.Conservative treatment with amlodipine,indapamide and perindopril was adopted,leading to blood pressure control within one month.CONCLUSION To the best of our knowledge,there are controversies regarding accessory renal arteries as a potential etiology for secondary hypertension,but the seven similar cases already described,along with the current case,could reinforce the necessity of more studies concerning this subject.

Treatment controversies in a rare case of a simultaneous branch retinal artery and vein occlusion secondary to hyperhomocysteinemia and hypertension

Dear Editor,Combined vascular occlusions involving retinal arteries and veins have been reported in the past. Combined occlusion of the central retinal vein （CRVO） and artery （CRAO）is well described;. Cilioretinal artery occlusion along with CRVO is frequently reported and is well characterized;.

Primary hypertension in a postoperative paraganglioma patient:A case report

BACKGROUND Primary hypertension is a common clinical disease.Pheochromocytoma and paraganglioma is a rare cause of secondary hypertension.The diagnosis of the latter is still difficult,and the relationship between the two is not clear.The successful diagnosis of this case confirmed that standardized etiological investigation of secondary hypertension is necessary,contributes to the accurate diagnosis of rare diseases,and is conducive to the formulation or optimization of treatment plans.It shows an example of the coexistence of primary hypertension and secondary hypertension.CASE SUMMARY The patient was a 54-year-old male and was hospitalized with high blood pressure for 4 years.The patient’s blood pressure was measured at 150/100 mmHg during physical examination 4 years ago and had no paroxysmal or persistent elevated blood pressure,no typical triad of headache,palpitation,and sweating,without postural hypotension.After taking nifedipine sustained release tablets intermittently,the blood pressure did not meet the standard.Physical examination revealed blood pressure of 180/120 mmHg.There was no abnormality in cardiopulmonary and abdominal examination.The results of blood and/or urinary catecholamines/metanephrine and normetanephrine before and after operation were normal.Fundus examination revealed retinal arteriosclerosis in both eyes.There was a history of paraganglioma diagnosed by pathology after retroperitoneal tumor resection,a family history of hypertension,and a history of passive smoking.The clinical diagnosis was subclinical paraganglioma,primary hypertension,and hypertensive fundus lesions.The patient’s blood pressure was regulated,blood lipid was reduced,and anti-inflammatory,and symptomatic support were given.After treatment,the blood pressure was stable and up to standard without discomfort symptoms.CONCLUSION Subclinical paraganglioma and primary hypertension can coexist.The holistic thinking in clinical practice is helpful to the early diagnosis of rare diseases.

Acute coronary syndrome: a rare case of multiple endocrine neoplasia syndromes with pheochromocytoma and medullary thyroid carcinoma

Pheochromocytoma is a tumor arising from neuroectodermal chromaffin tissues in the adrenal gland or extra-adrenal paraganglia(paragangliomas). The prevalence of the tumor is 0.1%-0.6% in the hypertensive population, of which 10%-20% are malignant. Pheochromocytoma produces, stores, and secretes catecholamines, as well as leads to hypertensive crisis, arrhythmia, angina, and acute myocardial infarction without coronary artery diseases. We report a case of acute coronary syndrome(ACS) with a final diagnosis of multiple endocrine neoplasia with pheochromocytoma and medullary thyroid carcinoma(MTC).

An Incidental Detection of Nutcracker Phenomenon in an Adolescent with Transient High Blood Pressure: A Case Report

Nutcracker phenomenon (NCP) is caused by a compression of left renal vein between aorta and superior mesenteric artery. The traditional clinical manifestations of nutcracker syndrome is usually accompanied with abdominal pain, hematuria, orthostatic proteinuria, and varicocele formation, however, hypertension is rarely reported as main clinical feature. We describe a male adolescent with manifestation of hypertension who was identified as NCP. Renal ultrasound and computed tomography angiography have provided evidences of left renal vein dilatation, probably due to the compression through the decreased angle between aorta and superior mesenteric artery. There were no other signs for secondary hypertension for the blood levels of renin and aldosterone being between normal limits and urinalysis being negative of hematuria and proteinuria. This patient was conservatively observed without any anti-hypertensive drugs and was asked for appropriately putting on weight. Three months later, the hypertension symptom was alleviated. In conclusion, although there were no established direct pathogenetic links between hypertension and NCP, no other definite etiology was shown to be the cause of this main manifestation. Thus we speculate that the NCP might be the main cause of hypertension in this patient.