Effects of autoantibodies against AT1-receptor and angiotensin Ⅱ on refractory hypertension

Objective The study will explore effects of the autoantibodies against AT1 receptor and angiotensin Ⅱ on the refractory hypertension. Methods Seventy-seven patients (46 men and 31 women) with essential hypertension were divided into groups of refractory hypertension (RH) and hypertension (HT) according to the 1999 WHO-ISH Guidelines for the Management of Hypertension. Forty normotensives (22 men) were recruited as controls. The mean age was 54. 3±13 years old in RH group, 53. 5±9 years old in HT group and 51. 2±11. 9 years old in normotensives (NT) group. The mean blood pressure was 154. 2±9. 4/98. 4± 8. 2 mmHg in RH group and 130. 1±7. 6/80. 5±6. 7 mmHg in HT group after combination drug therapy of hypertension for 4 weeks. Blood pressure in NT group was 120. 8±11. 7/76. 4 ± 7. 2 mmHg. The epitope of the 2nd extracellular loops of AT1 receptor was synthesized and used as antigens to screen the autoantibodies by ELISA. Plasma angiotensin (Ang) II were examined by a radioimmunoassay. Results The autoantibodies against AT1 receptor were positive in 18 (46. 15 %) patients with RH, in 4 (10. 5 % ) hypertension and in 3 (7. 5 % ) normotensives, P < 0. 01. Ang Ⅱwas 57. 01±52. 63 pmol/L in patients with RH. Both the autoantibodies positive and the Ang Ⅱ increasing were 4 (10. 3 % ) cases, both normal were 7 (17. 9 % ) cases, the autoantibodies positive or Ang II increasing was all of 14 (35. 9 % ) cases (x2 = 0. 09, P>0. 05) . There was no relationship between the autoantibodies against AT1 receptor and the angiotensin Ⅱ in refractory hypertension. Conclusion The autoantibodies against AT1 receptor and Ang Ⅱ might be two independent factors in developing of refractory hypertension. The findings suggest that AT1 receptor an-tagnist used in the treatment of refractory hypertension might have an important value.

Research Progress on Refractory Hypertension in Traditional Chinese Medicine

At present,the mortality rate and disability rate caused by cardiovascular and cerebrovascular diseases are very high in China.Individuals with refractory hypertension are at a greater risk of developing chronic kidney disease,heart failure,stroke and myocardial infarction.Therefore,how to effectively control blood pressure and identify the cause of refractory hypertension is a problem that medical workers need to solve,and it is also the key to prevent cardiovascular disease.In recent years,the government actively supports the development of traditional Chinese medicine.Since the curative effect of traditional Chinese medicine is recognized by the public,the prospect of traditional Chinese medicine in the prevention and treatment of refractory hypertension is considerable,and it is expected to become the main key research direction in the future.

Decompressive craniectomy in herpes simplex encephalitis

Intracranial hypertension is a common cause of morbidity in herpes simplex encephalitis(HSE).HSE is the most common form of acute viral encephalitis.Hereby we report a case of HSE in which decompressive craniectomy was performed to treat refractory intracranial hypertension.A 32-year-old male presented with headache,vomiting,fever,and focal seizures involving the right upper limb.Cerebrospinal fluid-meningoencephalitic profile was positive for herpes simplex.Magnetic resonance image of the brain showed swollen and edematous right temporal lobe with increased signal in gray matter and subcortical white matter with loss of gray,white differentiation in T2-weighted sequences.Decompressive craniectomy was performed in view of refractory intracranial hypertension.Decompressive surgery for HSE with refractory hypertension can positively affect patient survival,with good outcomes in terms of cognitive functions.