Diretrizes Brasileiras de Hipertensão Arterial – 2020

Arquivos Brasileiros de Cardiologia, Journal Year: 2021, Volume and Issue: 116(3), P. 516 - 658

Published: March 1, 2021

Content 1. Definition, Epidemiology, and Primary Prevention 528 1.1 Definition of Hypertension […] Brazilian Guidelines – 2020

Language: Английский

---

Hypertension-induced cognitive impairment: from pathophysiology to public health

Nature Reviews Nephrology, Journal Year: 2021, Volume and Issue: 17(10), P. 639 - 654

Published: June 14, 2021

Language: Английский

---

Alzheimer’s Disease and Vascular Aging

Journal of the American College of Cardiology, Journal Year: 2020, Volume and Issue: 75(8), P. 942 - 951

Published: Feb. 24, 2020

Alzheimer's disease, the leading cause of dementia in elderly, is a neurodegenerative condition characterized by accumulation amyloid plaques and neurofibrillary tangles brain. However, age-related vascular changes accompany or even precede development pathology, raising possibility that they may have pathogenic role. This review provides an appraisal alterations cerebral systemic vasculature, heart, hemostasis occur disease their relationships to cognitive impairment. Although molecular pathogenesis these remains be defined, amyloid-β likely contributor brain as heart. Collectively, evidence suggests pathology dementia, including inextricably linked onset progression. Consequently, contribution factors should considered preventive, diagnostic, therapeutic approaches address one major health challenges our time.

Language: Английский

---

Cerebral blood flow decrease as an early pathological mechanism in Alzheimer's disease

Acta Neuropathologica, Journal Year: 2020, Volume and Issue: 140(6), P. 793 - 810

Published: Aug. 31, 2020

Abstract Therapies targeting late events in Alzheimer’s disease (AD), including aggregation of amyloid beta (Aβ) and hyperphosphorylated tau, have largely failed, probably because they are given after significant neuronal damage has occurred. Biomarkers suggest that the earliest event AD is a decrease cerebral blood flow (CBF). This caused by constriction capillaries contractile pericytes, evoked oligomeric Aβ. CBF also reduced neutrophil trapping clot formation, perhaps secondary to capillary constriction. The fall potentiates neurodegeneration upregulating BACE1 enzyme makes Aβ promoting tau hyperphosphorylation. Surprisingly, therefore, reduction may play crucial role driving cognitive decline initiating cascade itself, or being amplifying production. Here, we review developments this area neglected current approaches AD, with aim novel mechanism-based therapeutic approaches.

Language: Английский

---

Vascular contributions to cognitive impairment and dementia (VCID): A report from the 2018 National Heart, Lung, and Blood Institute and National Institute of Neurological Disorders and Stroke Workshop

Alzheimer s & Dementia, Journal Year: 2020, Volume and Issue: 16(12), P. 1714 - 1733

Published: Oct. 8, 2020

Abstract Vascular contributions to cognitive impairment and dementia (VCID) are characterized by the aging neurovascular unit being confronted with failing cope biological insults due systemic cerebral vascular disease, proteinopathy including Alzheimer's biology, metabolic or immune response, resulting in decline. This report summarizes discussion recommendations from a working group convened National Heart, Lung, Blood Institute of Neurological Disorders Stroke evaluate state field VCID research, identify research priorities, foster collaborations. As discussed this report, advances understanding mechanisms across wide spectrum pathologies, chronic comorbidities, other risk factors may lead potential prevention new treatment strategies decrease burden dementia. Better social determinants health that affect risks for both disease could provide insight into reduce racial ethnic disparities VCID.

Language: Английский

---

Endothelium-Macrophage Crosstalk Mediates Blood-Brain Barrier Dysfunction in Hypertension

Hypertension, Journal Year: 2020, Volume and Issue: 76(3), P. 795 - 807

Published: July 13, 2020

Hypertension is a leading cause of stroke and dementia, effects attributed to disrupting delivery blood flow the brain. also alters blood-brain barrier (BBB), critical component brain health. Although endothelial cells are ultimately responsible for BBB, development maintenance properties depend on interaction with other vascular-associated cells. However, it remains unclear if BBB disruption in hypertension requires cooperative Perivascular macrophages (PVM), innate immune closely associated cerebral microvessels, have emerged as major contributors neurovascular dysfunction. Using 2-photon microscopy vivo electron mouse model Ang II (angiotensin II) hypertension, we found that vascular segments most susceptible increased permeability arterioles venules >10 µm not capillaries. Brain macrophage depletion clodronate attenuates, but does abolish, these where PVM located. Deletion AT1R (Ang type-1 receptors) using bone marrow chimeras partially attenuated dysfunction through free radical-producing enzyme Nox2. In contrast, downregulation viral gene transfer-based approach prevented completely. The results indicate while AT1R, mainly venules, initiate required full expression findings unveil previously unappreciated contribution resident identify putative therapeutic target diseases

Language: Английский

---

Hypertension, Neurovascular Dysfunction, and Cognitive Impairment

Hypertension, Journal Year: 2022, Volume and Issue: 80(1), P. 22 - 34

Published: Oct. 5, 2022

Hypertension affects a significant proportion of the adult and aging population represents an important risk factor for vascular cognitive impairment late-life dementia. Chronic high blood pressure continuously challenges structural functional integrity cerebral vasculature, leading to microvascular rarefaction dysfunction, neurovascular uncoupling that typically impairs supply. disrupts blood-brain barrier integrity, promotes neuroinflammation, may contribute amyloid deposition Alzheimer pathology. The mechanisms underlying these harmful effects are still focus investigation, but studies in animal models have provided molecular cellular mechanistic insights. Remaining questions relate whether adequate treatment hypertension prevent deterioration function, threshold treatment, most effective antihypertensive drugs. Recent advances biology, advanced brain imaging, detection subtle behavioral phenotypes begun provide insights into critical issues. Importantly, parallel analysis parameters humans is feasible, making it possible foster translational advancements. In this review, we evaluation evidence available experimental examine progress made identify remaining gaps knowledge.

Language: Английский

---

Understanding the Connection Between Common Stroke Comorbidities, Their Associated Inflammation, and the Course of the Cerebral Ischemia/Reperfusion Cascade

Frontiers in Immunology, Journal Year: 2021, Volume and Issue: 12

Published: Nov. 15, 2021

Despite the enormous progress in understanding of course ischemic stroke over last few decades, a therapy that effectively protects neurovascular units (NVUs) and significantly improves neurological functions patients has still not been achieved. The reasons for this state are unclear, but it is obvious cerebral ischemia reperfusion cascade highly complex phenomenon, which includes intense neuroinflammatory processes, comorbid risk factors strongly worsen outcomes likely make substantial contribution to pathophysiology ischemia/reperfusion, enhancing difficulties searching successful treatment. Common concomitant (arterial hypertension, diabetes mellitus hyperlipidemia) drive inflammatory processes during ischemia/reperfusion; because these often present long time before stroke, causing low-grade background inflammation brain, already initially disrupting proper NVUs. Broad consideration situation basic research may prove be crucial success future clinical trials neuroprotection, vasculoprotection immunomodulation stroke. This review focuses on mechanism by coexisting common intertwine ischemic/reperfusion dysfunction disintegration NVUs through principally activation pattern recognition receptors, alterations expression adhesion molecules subsequent pathophysiological consequences.

Language: Английский

---

Hypertension management in patients with cardiovascular comorbidities

European Heart Journal, Journal Year: 2022, Volume and Issue: 44(23), P. 2066 - 2077

Published: Nov. 7, 2022

Abstract Arterial hypertension is a leading cause of death globally. Due to ageing, the rising incidence obesity, and socioeconomic environmental changes, its increases worldwide. Hypertension commonly coexists with Type 2 diabetes, dyslipidaemia, sedentary lifestyle, smoking risk amplification. Blood pressure lowering by lifestyle modifications antihypertensive drugs reduce cardiovascular (CV) morbidity mortality. Guidelines recommend dual- triple-combination therapies using renin–angiotensin system blockers, calcium channel and/or diuretic. Comorbidities often complicate management. New such as angiotensin receptor-neprilysin inhibitors, sodium–glucose cotransporter glucagon-like peptide-1 receptor agonists, non-steroidal mineralocorticoid antagonists improve CV renal outcomes. Catheter-based denervation could offer an alternative treatment option in comorbid associated increased sympathetic nerve activity. This review summarises latest clinical evidence for managing comorbidities.

Language: Английский

---

Molecular biomarkers for vascular cognitive impairment and dementia

Nature Reviews Neurology, Journal Year: 2023, Volume and Issue: 19(12), P. 737 - 753

Published: Nov. 13, 2023

Language: Английский

---