INTRODUCTIONIt has been reported that renin-angiotensin systemexists in tissue and aldosterone can be synthesizedin extra-adrenal tissue including heart,bloodvessels and brain.Recent studies have broughtrich evidences...INTRODUCTIONIt has been reported that renin-angiotensin systemexists in tissue and aldosterone can be synthesizedin extra-adrenal tissue including heart,bloodvessels and brain.Recent studies have broughtrich evidences in favour of aldosterone as a strongstimulator of fibrogenesis and mitogenesis.展开更多
Hypertension （HTN） develops very early in childhood chronic kidney disease （CKD）. It is linked with rapid progression of kidney disease, increased morbidity and mortality hence the imperative to start anti-hyperte...Hypertension （HTN） develops very early in childhood chronic kidney disease （CKD）. It is linked with rapid progression of kidney disease, increased morbidity and mortality hence the imperative to start anti-hypertensive medication when blood pressure （BP）is persistently 〉 90th percentile for age, gender, and height in non-dialyzing hypertensive children with CKD. HTN pathomechanism in CKD is multifactorial and complexly interwoven. The patient with CKD-associated HTN needs to be carefully evaluated for co-morbidities that frequently alter the course of the disease as successful treatment of HTN in CKD goes beyond life style modification and anti-hypertensive therapy alone. Chronic anaemia, volume overload, endothelial dysfunction, arterial media calcifcation, and metabolic derangements like secondary hyperparathyroidism, hyperphosphataemia, and calcitriol deficiency are a few co-morbidities that may cause or worsen HTN in CKD. It is important to know if the HTN is caused or made worse by the toxic effects of medications like erythropoietin, cyclosporine, tacrolimus, corticosteroids and non-steroidal anti-infammatory drugs. Poor treatment response may be due to any of these co-morbidities and medications. A satisfactory hypertensive CKD outcome, therefore, depends very much on identifying and managing these co-morbid conditions and HTN promoting medications promptly and appropriately. This review attempts to point attention to factors that may affect successful treatment of the hypertensive CKD child and how to attain the desired therapeutic BP target.展开更多
Epidemiological evidence suggests that patients with hypertension infected with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)are at increased risk of acute lung injury.However,it is still not clear wheth...Epidemiological evidence suggests that patients with hypertension infected with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)are at increased risk of acute lung injury.However,it is still not clear whether this increased risk is related to the usage of renin-angiotensin system(RAS)blockers.We collected medical records of coronavirus disease 2019(COVID-19)patients from the First Affiliated Hospital,Zhejiang University School of Medicine(Hangzhou,China),and evaluated the potential impact of an angiotensin II receptor blocker(ARB)on the clinical outcomes of COVID-19 patients with hypertension.A total of 30 hypertensive COVID-19 patients were enrolled,of which 17 were classified as non-ARB group and the remaining 13 as ARB group based on the antihypertensive therapies they received.Compared with the non-ARB group,patients in the ARB group had a lower proportion of severe cases and intensive care unit(ICU)admission as well as shortened length of hospital stay,and manifested favorable results in most of the laboratory testing.Viral loads in the ARB group were lower than those in the non-ARB group throughout the disease course.No significant difference in the time of seroconversion or antibody levels was observed between the two groups.The median levels of soluble angiotensin-converting enzyme 2(sACE2)in serum and urine samples were similar in both groups,and there were no significant correlations between serum sACE2 and biomarkers of disease severity.Transcriptional analysis showed 125 differentially expressed genes which mainly were enriched in oxygen transport,bicarbonate transport,and blood coagulation.Our results suggest that ARB usage is not associated with aggravation of COVID-19.These findings support the maintenance of ARB treatment in hypertensive patients diagnosed with COVID-19.展开更多
基金the National Natural Science Foundation of China,No.39870331.
文摘INTRODUCTIONIt has been reported that renin-angiotensin systemexists in tissue and aldosterone can be synthesizedin extra-adrenal tissue including heart,bloodvessels and brain.Recent studies have broughtrich evidences in favour of aldosterone as a strongstimulator of fibrogenesis and mitogenesis.
文摘Hypertension （HTN） develops very early in childhood chronic kidney disease （CKD）. It is linked with rapid progression of kidney disease, increased morbidity and mortality hence the imperative to start anti-hypertensive medication when blood pressure （BP）is persistently 〉 90th percentile for age, gender, and height in non-dialyzing hypertensive children with CKD. HTN pathomechanism in CKD is multifactorial and complexly interwoven. The patient with CKD-associated HTN needs to be carefully evaluated for co-morbidities that frequently alter the course of the disease as successful treatment of HTN in CKD goes beyond life style modification and anti-hypertensive therapy alone. Chronic anaemia, volume overload, endothelial dysfunction, arterial media calcifcation, and metabolic derangements like secondary hyperparathyroidism, hyperphosphataemia, and calcitriol deficiency are a few co-morbidities that may cause or worsen HTN in CKD. It is important to know if the HTN is caused or made worse by the toxic effects of medications like erythropoietin, cyclosporine, tacrolimus, corticosteroids and non-steroidal anti-infammatory drugs. Poor treatment response may be due to any of these co-morbidities and medications. A satisfactory hypertensive CKD outcome, therefore, depends very much on identifying and managing these co-morbid conditions and HTN promoting medications promptly and appropriately. This review attempts to point attention to factors that may affect successful treatment of the hypertensive CKD child and how to attain the desired therapeutic BP target.
基金supported by the Department of Education of Zhejiang Province(No.Y202043382)the National Natural Science Foundation of China(Nos.82072377 and 81971919)。
文摘Epidemiological evidence suggests that patients with hypertension infected with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)are at increased risk of acute lung injury.However,it is still not clear whether this increased risk is related to the usage of renin-angiotensin system(RAS)blockers.We collected medical records of coronavirus disease 2019(COVID-19)patients from the First Affiliated Hospital,Zhejiang University School of Medicine(Hangzhou,China),and evaluated the potential impact of an angiotensin II receptor blocker(ARB)on the clinical outcomes of COVID-19 patients with hypertension.A total of 30 hypertensive COVID-19 patients were enrolled,of which 17 were classified as non-ARB group and the remaining 13 as ARB group based on the antihypertensive therapies they received.Compared with the non-ARB group,patients in the ARB group had a lower proportion of severe cases and intensive care unit(ICU)admission as well as shortened length of hospital stay,and manifested favorable results in most of the laboratory testing.Viral loads in the ARB group were lower than those in the non-ARB group throughout the disease course.No significant difference in the time of seroconversion or antibody levels was observed between the two groups.The median levels of soluble angiotensin-converting enzyme 2(sACE2)in serum and urine samples were similar in both groups,and there were no significant correlations between serum sACE2 and biomarkers of disease severity.Transcriptional analysis showed 125 differentially expressed genes which mainly were enriched in oxygen transport,bicarbonate transport,and blood coagulation.Our results suggest that ARB usage is not associated with aggravation of COVID-19.These findings support the maintenance of ARB treatment in hypertensive patients diagnosed with COVID-19.
