Sri Lankan Journal of Cardiology – Volume 1 Issue 1, June 2018
Resistant hypertension could be defined as blood pressure that remains elevated despite being treated with 3 anti-hypertensives of which one is a diuretic at maximum tolerable dose. It is an important global health issue associated with morbi dity and mortality. It is a relatively common clinical problem. It is commonly associated with old age, obesity, sleep apnoea, and ch ronic kidney disease.A number of pathophysiological mechanisms are involved in resistant hypertension. Imbalance in sympathetic nervous system and renin-angiotensin system, excess sodium intake, disturbances between vasoconstrictors and vasodilators and wall resistance are other mechanisms involved in the pathogenesis. In the management life style modification such as weight loss, exercise and salt restriction has to be strictly enforced. If underlying cause is found it has to be treated. The initial preferred multidrug regime includes a diuretic,angiotensin – converting enzyme inhibitor or angiotensin II receptor blockers and long-acting calcium channel blockers.
Sri Lankan Journal of Cardiology Volume 1: Issue 2 – January 2019
The importance of the microbiome in the pathogenesis of metabolic diseases such as diabetes, hypertension, dyslipidaemia, obesity and cardiovascular diseases are emerging. The gut microbiome, once thought to have a limited function of producing vitamins and in bile acid metabolism is now known to be important in regulation of the gut barrier function, development and regulation of the immune system, glucose and lipid metabolism, synthesis of neurotransmitters and even regulation of our circadian rhythms. The composition and relative abundance of different microbiota play a pivotal role in health and disease. Microbial dysbiosis, which is characterized by reduced diversity of the microbiome with overabundance of bacteria of the Proteobacteria phyla, is associated with development of metabolic disease, autoimmune diseases, neuropsychiatric diseases and allergies. Such dysbiosis leads to metabolic endotoxemia resulting in a chronic inflammatory state and also leads to altered lipid and glucose metabolism.