Day 1 :
University of Manitoba, Canada
Time : 10:35-11:05
Naranjan S Dhalla is a distinguished Professor at the University of Manitoba and is the Director of Cardiovascular Developments at the St. Boniface Hospital Albrechtsen Research Centre. He has been investigating the pathophysiology and pharmacology of heart disease and has published 794 full length papers. His research work has been cited more than 22,600 times with h-factor of 71. He has given 350 symposia talks at various national and international conferences in addition to 340 talks at different institutions. He has received more than 178 honours and awards, including six honorary doctorate degrees and four honorary professorships from institutions all over the world.
Hypertension has been shown to be associated with an elevated level of intracellular Ca2+, which is determined by the functional status of both L-type Ca2+ channels and store-operated Ca2+channels in the vascular smooth muscle. Although L-type Ca2+ antagonists such as verapamil are known to exert anti-hypertensive actions, the effects of store-operated blockers such as SKF-36365 (SK) on blood pressure and cell proliferation have not been examined. In this study, SK was observed to reduce systolic and diastolic blood pressures in rats in a dose and time dependent manner. While SK showed no effect on basal [Ca2+]i in rat aortic smooth muscle cells, the increase in [Ca2+]i due to lysophosphatidic acid (LPA) or angiotensin II was depressed by this agent. On the other hand, norepinephrine- or the endothelin-induced increase in [Ca2+]i was not affected by SK. The cell proliferation, as determined by cell number as well as thymidine incorporation in the absence or presence of LPA, was reduced by SK. This agent was also observed to augment the verapamil-induced reduction in diastolic blood pressure without any effect on the verapamil-induced reduction in systolic blood pressure. In addition, verapamil was found to depress LPA-induced or ATP-induced increase in [Ca2+]I, these actions of verapamil were promoted by SK. The results suggest that store-operated Ca2+ channel blockers, which affect sites different from those for L-type Ca2+ channel antagonists, either alone or in combination, may be useful for the treatment of hypertension.
University of Montreal, Canada
Keynote: Geo-ethnic diversity, hypertension and renal impairment in diabetes: Therapeutic consequences
Time : 11:20-12:00
Pavel Hamet is the holder of the Canada Research Chair in Predictive Genomics. He is Professor of Medicine at Université de Montréal, Adjunct Professor of Experimental Medicine at McGill University, and Visiting Professor at the First Faculty of Medicine at Charles University, Prague, Czech Republic. He is currently chief of Gene Medicine Services, member of the Endocrinology Service, and Director of the Ecogenomic platform for complex diseases at the CHUM. He is also CEO and Chief Scientific Officer of Medpharmgene. Author or co-author of over 600 scientific publications, Dr. Hamet has received many honours, including the prestigious Wilder Penfield Award in 2001, was named Officer of the Ordre national du Québec in 2008 and received the Okamoto Award by the Japan Vascular Disease Research Foundation
Complications of type 2 diabetes (T2D) have been reported to be different between Asian and Caucasian populations with higher prevalence and severity of renal disease and stroke in Chinese, contrasting with lower myocardial infarction, that could not be fully explained by differences in hypertension prevalence or treatment. Our objective was to determine whether ethnic heterogeneity exists within the Caucasian population with respect to phenotypic and genomic determinants of vascular complications of T2D. We analyzed the two main features of renal impairment: increase of albuminuria as uACR and decline of estimated glomerular filtration rate as eGFR in Caucasian T2D patients followed during the 5 year period of the ADVANCE trial. Genetic ethnic origins of 5000 genotyped subjects were determined by principal component analysis with Eigenstrat software. The first principal component separated T2D individuals into two ethnic groups of Slavo-Baltic and Germano-Celtic origins. Phenotypic analyses and Genome Wide Association Studies (GWAS) for age of onset of T2D and changes in uACR and eGFR over the course of the study were performed in the two ethnic groups combined and separately. Patients of Slavo-Baltic origin had T2D at a significantly younger age and were more hypertensive in spite of higher number of antihypertensive drugs received. Baseline uACR was higher in individuals with a Slavo-Baltic genetic profile. The decline in eGFRCKD-EPI during the ADVANCE study was steeper among individuals with Germano-Celtic than with Slavo-Baltic genetic profile. Macrovascular events at baseline (myocardial infarction and stroke) were significantly higher in Slavo-Baltic subjects (p=1.3x10-2 and p=4.0x10-5) as was cardiovascular death (p=1.6x10-4) during the study. These characteristics persisted in Slavo-Baltic subjects living in Germano-Celtic environment suggesting a strong genetic contribution. A set of independent genetic variants (SNPs) were identified as markers of genes associated with early onset of T2D. They were used in a genetic risk score to predict age of death and response to therapy. Our studies revealed distinct genetic architectures of age of onset of T2D between two geo-ethnic groups within the Caucasian population that likely have clinical relevance.
- Tracks : Hypertension & Obesity | Hypertension Risk factors | Hypertension Diagnosis
Location: Toronto, Canada
Marshfield Clinic, USA
Calicut Medical College, India
Loma Linda University, USA
Time : 12:00-12:30
Hossein Tabriziani obtained his Medical degree with honor at the age of 25. He completed his Internal Medicine residency at St. Barnabas Hospital, Weill Cornell Medical College in New York. With the passion for Transplant, he accepted a clinical Nephrology and Hypertension fellowship at Georgetown University in Washington, DC and continued his education at University of California San Francisco (UCSF) with a Transplant Nephrology fellowship. He was appointed at the Medical director of Pancreas Transplantation at Westchester Medical Center, New York Medical college before moving to Loma Linda Univeristy in California to accept the position as an Assistant Professor of Medicine in Transplant Nephrology division. He is an active member of American Society of Nephrology (ASN) and American Society of Tranplantation (AST). He has multiple publications and has been involved in many clinical researches. His interests are in Hypertension and oxidative stress in patintes with chronic kidney disease and transplantaion.
One quarter of Americans will be older than 65 by 2030 and more than half of this popultaion will be older than 80 years old and hypertension in this group will be ubiquitous. Most studies of hypertension exclude octogenarians and are not able to be generalized because of differences in physiologic and social phenomena. This presentaion will review and evaluate the existing literature in an effort to identify unresolved issues and guide future areas of investigation. Hypertension has been well characterized in adults and the young elderly, and the focus is on optimizing treatment regimens. However, research specifically involving this rapidly growing minority is sparse. Most studies are still trying to characterize blood pressure goals, and only one major series has begun to evaluate treatment options. Based on available evidence, it appears that an appropriate blood pressure goal may be somewhat higher in octogenarians and that thiazide diuretics may be the initial treatment of choice.
Marshfield Clinic, USA
Time : 12:30-13:00
Abdou Elhendy is a cardiologist at Marshfield Clinic and Clinical Associate Professor of Medicine, University of WI, Madison WI. He has completed his PhD at Erasmus University, Rotterdam, NL in 1996. He has published 250 papers in peer review journals including 70 original studies as first author in the field of cardiovascular imaging. He has contributed to CME publications by the American College of Cardiology and Society of Nuclear Medicine. He served on the editorial board of Journal of American Society of Echocardiography and Euro Echo.
Hypertension is a major risk factor for coronary artery disease (CAD) and its complications. Accurate non-invasive diagnosis of CAD allows identification of patients in whom aggressive medical therapy and intervention may improve outcome. Challenges in the diagnosis of CAD in hypertensive patients include baseline EKG abnormalities which impair accuracy of exercise EKG interpretation. Left ventricular hypertrophy may be associated with demand ischemia in absence of obstructive CAD. Stress echocardiography using exercise or dobutamine was shown to have good accuracy. The technique is widely available and does not entail irradiation. In addition to ischemia, left ventricular mass index predicts cardiac events. Hypertensive response during stress has been related to false positive results. Stress myocardial perfusion imaging provides good sensitivity and specificity. Some studies showed reduced specificity in patients with left ventricular hypertrophy. However, many studies demonstrated similar accuracy in patients with and without hypertension. A normal stress echocardiogram or radionuclide study is associated with low risk of cardiac death and myocardial infarction during intermediate and long term follow up. Coronary CT angiography is increasingly used in patients with intermediate probability of CAD and in those with equivocal stress test. The test has high negative predictive value to rule out CAD. Disadvantages include artifacts, irradiation and risk of contrast nephropathy. Obesity is a significant comorbid condition that may impair imaging quality of different techniques. Proper selection of imaging modality depends on various clinical parameters, availability and expertise of the center with each type of imaging.
Sasidharan is Vice President of Hypertension Society of India, Formerly Professor of Medicine& Head, Department of Medicine Calicut Medical College. Research Guide University of Calicut, Scientific Advisory committee Member- National Institute of Immuno Hematology, Mumbai, Dean Faculty of Medicine, University of Calicut. Best outgoing student for MBBS, MD from Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh. Awards and fellowships- 7; Teaching experience of – 32 years, Papers Published 73, Published 4 books and authored chapters in textbooks of Medicine and Hematology. Two land mark studies on Vitamin D and SLE. Papers presented: More than 500 guest speaker/Paper presentations in National & International conferences.
Hypovitaminosis D is widely prevalent in the Indian populations despite good sunlight exposure. Our landmark study has proven this first in 2000 in patients with tuberculosis and in the apparently normal individuals (Ref1). The role of vitamin D in several diseases is now becoming clearer and its role in hypertension and cardiovascular disease has been proven and studied in some western populations. There are little data on Vitamin D status in hypertensive patients in the Indian context. Aims and Objectives: a) to assess the vitamin D status in patients with essential hypertension and to compare the vitamin D status, dietary intake of vitamin D, physical activity and sunlight exposure among hypertensives and age and gender matched normotensive controls. b) To correlate vitamin D levels with dietary intake, physical activity, BMI and daily sunlight exposure. Materials and Methods: 55 subjects and 32 controls were studied over a period of nine months from December 2011 to August 2012. Their 25 Hydroxy Vitamin D levels, daily sunlight exposure, dietary intake, physical activity were assessed and subjected to statistical analysis. Results: The mean 25(OH) D levels for hypertensives were found to be 17.07 ± 9.72 ng/ml while in the normotensive controls were 22 ± 10 ng/ml (p=0.027). Only 20 % of the total population ie cases and controls had sufficient levels above 30 ng/ml. Higher dietary intake ie >200 IU/day were found to have lesser incidence of hypertension.
University of California School of Medicine, USA
Title: Reduction of blood pressure by electroacupuncture in mild to moderate hypertensive patients: Randomized controlled trial
Time : 14:15-14:45
Stephanie Tjen-A-Looi completed her Ph.D from University of Wisconsin, Madison and is currently Project Scientist in University of California, Irvine. She has published over 47 peer reviewed articles and chapters and is currently serving as an editorial board member for American Journal of Physiology - Heart and Circulation, Evidence-Based Complementary and Alternative Medicine, and BioMed Central (BMC) - Complementary and Alternative Medicine.
There is a growing interest in integrative medical treatments such as acupuncture on hypertension although therapy to control high blood pressure (BP) is available. We have demonstrated in a series of experimental investigations the mechanisms and actions of acupuncture and electroacupuncture (EA) in models of elevated BP associated with reflex induced sympathoexcitation. These studies suggest that bilateral EA at select acupoints PC5-6 and ST36-37, in contrast to EA at LI6-7 and GB37-39, inhibits sympathetically-mediated reflex responses lowering BP through cardiovascular regions in the brain and specific neurotransmitter systems. The experimental findings provided guidance in designing the clinical study to proof the overall hypothesis that weekly EA at PC5-6+ST36-37 but not LI6-7+GB37-39 acupoints for 8 weeks decreases BP for a prolonged period of time in patients with mild to moderate hypertension. We have used 24-hr ambulatory blood pressure measurements to monitor EA-inhibition of peak and average systolic and diastolic BP (SBP and DBP) and to identify high and low responders to EA. In a cross-over and double blinded design, we have shown that EA application to acupoints PC5-6+ST36-37 for 8 weeks reduces peak and average SBP by 8 and 6 mmHg in the overall group. Of interest, in high responders EA decreases peak and average SBP by 16 and 11 mmHg. Following 8 weeks of EA treatment, sympathetic activity reduces and therefore ultimately norepinephrine, renin-aldosterone-system. In subgroup of patients, we observed a long-lasting blood pressure lowering acupuncture effect for at least an additional four weeks after the end of EA treatment.
Habibollah Saadat is a Professor of Cardiology at Shahid Beheshti University of Medical Sciences. He has Cardiology fellowship from Shahid Beheshti University of Medical Sciences and is in clinical and academic research activities for 25 years.
The most common cardiovascular diseases are systemic hypertension, ischemic heart disease and heart failure. The earliest pathophysiology in these disorders is left ventricular (LV) diastolic dysfunction. Left atrial (LA) enlargement is the first reaction in LV diastolic dysfunction. As witness to chronically elevated LV filling pressures, LA enlargement is a reliable marker of diastolic dysfunction. At least 50% of hypertensive patients are asymptomatic and 25% of myocardial infarction happens silently. Early recognition of LA enlargement would help physicians to detect primary silent disorders at earlier stages. Most practitioners consider the P wave on electrocardiogram (ECG) as a diagnostic clue for the presence or absence of arrhythmias. However, P wave on ECG is an indicator of ventricular diastolic function. This fact needs to be emphasized by the cardiology community. Next to ECG, LA size and volume measured by 2D echocardiography are excellent parameters to assess diastolic function in a long-term fashion. LA size has an important role in LV diastolic dysfunction similar to the role that glycosylated hemoglobin (HbA1c) plays in clinical assessment of diabetes mellitus. Sophisticated but error prone, momentary Doppler parameters are getting too much attention at the cost of simple, shrewd ECG and 2D echo.