Background: Focal segmental glomerulosclerosis (FSGS) is a component of childhood nephrotic syndrome occurring in 10%-20% of all cases. Over time, 25%-50% of children with FSGS develop kidney failure disease. We followed a cohort of children with FSGS in order to delineate the risk profile of progression to kidney failure (KF). Methods: We evaluated patient data collected from 1977 to 2002 at a regional mid-Atlantic nephrology center in the United States. KF was defined primarily for those patients whose serum creatinine (SCr) value doubled compared with the SCr value from a previous visit. Patients who received dialysis or a kidney transplant were also defined as having KF. We analyzed patient data for those who had at least two visits with SCr values recorded. Various baseline characteristics of patients who had developed KF and those with no kidney failure (NKF) were compared. Hazard ratios and correlation were used to further investigate potential risk factors of the kidney failure. We also compared the inverse SCr trend for KF and NKF patients using weighted linear regression. Results: Thirty-four of 43 FSGS patients had adequate follow-up data. About 60% of the patients developed KF over the study period. The average age of the KF patients at diagnosis of FSGS was 9 years, and that of NKF patients 12 years (P=0.05). FSGS patients with KF had a significantly higher mean diastolic blood pressure (DBP) at baseline, compared to those with NKF (P<0.0001). Other baseline characteristics including race, body mass index (BMI), systolic blood pressure, total cholesterol, urinary protein/creatinine ratio and calculated glomerular filtration rate (cGFR) were not significantly different. Baseline DBP was a significant risk factor in progression to KF (HR: 1.03; 95%CI: 1.01-1.06). Inverse SCr values were significantly decreased over time in KF patients (P=0.01). Conclusions: The data of this study indicate that children diagnosed with FSGS who are younger than 10 years and have elevated baseline DBP are more likely to develop kidney failure. The non-significant hazard ratios for other baseline characteristics including gender, race, and BMI are not instrumental risk factors. These results may help understand what may affect progression towards kidney failure in children with FSGS.

Epidemiological studies have demonstrated a positive relationship between heavy alcohol use and hypertension, but few studies have directly addressed the role of drinking pattern. This study was designed to investigate the association of current alcohol consumption and aspects of drinking pattern with hypertension risk in a sample of 2609 white men and women from western New York, aged 35 to 80 years, and free from other cardiovascular diseases. Hypertension was defined by systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg or use of antihypertensive medication. Odds ratios (95% confidence intervals) were computed after adjustment for several covariates. Compared with lifetime abstainers, participants reporting drinking on a daily basis (1.75 [1.13 to 2.72]) or mostly without food (1.64 [1.08 to 2.51]) exhibited significantly higher risk of hypertension. When analyses were restricted to current drinkers, daily drinkers and participants consuming alcohol without food exhibited a significantly higher risk of hypertension compared with those drinking less than weekly (1.65 [1.18 to 2.30]) and those drinking mostly with food (1.49 [1.10 to 2.00]), respectively. After additional adjustment for the amount of alcohol consumed in the past 30 days, the results were follows: 0.90 (0.58 to 1.41) for daily drinkers and 1.41 (1.04 to 1.91) for drinkers without food. For predominant beverage preference, no consistent association with hypertension risk was found across the various types of beverages considered (beer, wine, and liquor). In conclusion, drinking outside meals appears to have a significant effect on hypertension risk independent of the amount of alcohol consumed.

Indiana University-Purdue University Indianapolis (IUPUI) / Recent genome-wide association studies (GWAS) have identified many common genetic variants that are associated with women’s reproductive timing characteristics including ages at menarche and at natural menopause. However, the associations of these variants with other human health related phenotypes such as blood pressure, cancer, diabetes, obesity, and body height growth have not been well studied. No published studies to our knowledge have directly assessed the genetic influence of reproductive timing related variants on the aforementioned common traits. A better understanding of pleiotropic effects of these variants is important because it will help elucidate the precise mechanisms of common traits/diseases such as hypertension which have not been fully understood so far, and give clues for developing better solutions for disease prevention and treatment. We, therefore, conducted three studies to explore genetic variant effects on blood pressure and body height growth. In the first study, we analyzed data from a local cohort of 601 healthy adolescents from Indianapolis schools. Mixed effect model analysis revealed that 11 reproductive related single nucleotide polymorphisms (SNPs) were significantly associated with blood pressure in the study subjects. In order to assess if these genetic effects extended to the adult blood pressure, we performed the second study to investigate the genetic effect on blood pressure in adults. We used the summary statistics obtained from the two large international GWAS consortia, the Blood Pressure Consortium and the ReproGen Consortium. Bivariate analyses showed that more than 100 SNPs were associated with both blood pressure and reproductive timing. As the blood pressure development is closely related to somatic growth, we conducted the third study to exam the genetic effect of reproductive-timing related variants on the linear growth from the aforementioned local cohort. We identified 8 genetic variants significantly associated with the catch-up of linear growth in the study subjects. In conclusion, these three studies collectively provided evidence in support of the pleiotropic effects of the reproductive timing variants, suggesting the common genetic basis underlying the correlated traits. Future research is needed to validate the findings. / 2 years

No description available.

No description available.

Summary: The effects of clonidine, a central alpha2 agonist, on changes in blood pressure caused by muscle afferent nerve (ergoreceptor) activation and baroreceptor manipulation were studied in cats. Prolonged isometric contractions (ergoreceptor activation) of the gastrocnemius and plantaris muscles increased mean arterial pressure by 53 mmHg. This pressor response was not altered by naloxone (0.5 μmol·litre-1) but was eliminated by clonidine (0.5-2.0 μg) when injected into the cerebral aqueduct. Brief occlusion of the carotid artery (15-30 s) caused mean arterial pressure to increase by 32-42 mmHg at rest. Neither naloxone nor clonidine altered the magnitude of the reflex pressor response to carotid occlusion. Similar increases in pressure were measured when occlusion was applied during fatiguing isometric contractions; thus baroreceptor induced increases in pressure were superimposed on the ergoreceptor induced blood pressure changes. Naloxone did not affect the changes in pressure caused by either reflex response. Clonidine continued to eliminate the pressor response to muscular contraction but did not affect the pressure increase when the carotid occlusion was applied during contractions. Electrical stimulation of the carotid sinus nerve caused blood pressure to decrease by 36 mmHg during rest and by 41 mmHg during fatiguing isometric contractions. Clonidine did not alter the depressor response to carotid sinus nerve stimulation. These data may indicate that separate pathways centrally mediate the changes in blood pressure caused by ergoreceptor and baroreceptor afferent activation. The integration of the ergoreceptor pathway may involve a catecholaminergic-opioidergic system but the present results do not suggest a similar interaction for the baroreceptor integration.

The purpose of this practice improvement project was to implement an interprofessional team process to increase hypertension control in African American men, aged 21 to 59 years, with newly diagnosed hypertension in a primary care setting. This collaborative interprofessional team-based approach included education, health coaching, and follow-up. The guidelines of the Eighth Joint National Committee guided treatment. Systolic and/or diastolic blood pressure improved after implementation. Culturally appropriate interprofessional practice models acknowledge African American men as full participants in their health care team.

Research shows Mexican Americans typically have better cardiovascular health than European Americans, despite being relatively economically disadvantaged. Given research indicating the importance of relationship quality on one's health, the present study examined whether certain relationship orientations (e.g. communal or exchange) were more prevalent in different ethnic groups and if these orientations could help explain this Hispanic Paradox. 582 adults were recruited from the community. Participants were primarily European American (40%) and foreign-born Mexican Americans (55%). A cross-sectional designed was used where participants wore 24-hour ambulatory blood pressure (ABP) monitors and completed self-report measures of relationship satisfaction and relationship orientation. Results indicated that, contrary to predictions, European Americans tended to have more of a communal relationship orientation compared to foreign-born Mexican Americans. As expected however, communal orientation was predictive of higher relationship satisfaction, β = .29, SE = .07, p < .001, 95% CI [.15, .43], and while higher relationship satisfaction predicted lower systolic blood pressure, R2 = .02, β = -.16, SE = .07, p < .05, 95% CI [-.31, -.01], when ethnicity was added into the model this relationship was eliminated and foreign-born Mexican Americans had higher ABP compared to European Americans, β = 4.72, SE = 2.25, p < .05, 95% CI [.29, 9.14]. While there were these important differences, communal and exchange orientations had minimal direct or indirect effects on ABP. Even though communal and exchange relationship orientation don't seem to give us any more information to unravel the Hispanic Paradox, there are important ethnic differences in how we engage in marriage relationships and future research may consider other approaches to examine the health effects of these differences.

Mindfulness has historically been cultivated via formal meditation practice and the majority of meditation research examines individuals with extensive training or participants in Mindfulness based stress reduction programs that require considerable expense, a trained facilitator, and take approximately 8 weeks to complete. However, current literature does not speak directly to those who do not have the time or ability for such commitments. Formal mindfulness meditation practice and interventions reduce stress in various populations; however, the outcomes of a one-time intervention are relatively unknown. This study aims to examine whether a one-time (20-min) mindfulness meditation intervention would improve cardiovascular variables during acute stressors in a meditation naïve sample when compared to a control group. Fifty-eight (58) normotensive undergraduate students (27 males, 31 females) with no prior meditation experience were randomly placed into either a treatment group that participated in one-time 15-minute audio training session on mindfulness meditation or a control group which listened to an audio health article. Following the training, participants participated in a psychosocial stressor modeled after the Trier Social Stress Test. Heart rate and blood pressure were assessed before and after the intervention and during the stress task. Results showed the mindfulness meditation condition group was effective in decreasing blood pressure response during the study, when compared to the control group. These results indicate that brief meditation training has beneficial effects on cardiovascular variables. These findings suggest that the benefits of a brief one-time mindfulness meditation intervention can be recognized immediately after a brief training treatment.

Blood pressure biofeedback at home was compared with relaxation training and a combination of the two procedures for the treatment of essential hypertension, Ten subjects were taught to monitor blood pressure (BP) at home with electronic sphygmomanometers designed for self-use. Although situational factors appeared to have rather potent effects on BP levels, results suggested that training to control BP did generalize across situations. Although pretreatment BP level seemed to be related to the amount of reduction obtained, there was some evidence to indicate that subjects trained in behavioral methods of control could maintain BP in the average range after medication was discontinued, even if no significant reductions were obtained during treatment . Home practice of BP biofeedback was found to be the most successful single treatment for reducing systolic BP in the practice setting.