مختصر البحث:
Abstract
Background
Hypertension is a complicated condition in which many mechanisms collaborate, causing cardiovascular and cerebrovascular implications that are now among the most common causes of death globally. Currently, 1.13 billion individu…
Abstract
Background
Hypertension is a complicated condition in which many mechanisms collaborate, causing cardiovascular and cerebrovascular implications that are now among the most common causes of death globally. Currently, 1.13 billion individuals are suffering from hypertension, as reported by the World Health Association. The level of incidence of hypertension rises substantially with age, and due to the continuing aging of the population around the world, both the overall incidence of hypertension and the adverse outcomes continue to keep growing. Serum magnesium plays a role in controlling blood pressure by its vasodilatory effect through competition for binds site of calcium. Some clinical trials and reports suggest that hypertensive individuals possess deficient serum magnesium levels that connect to adverse consequences on blood pressure levels. However, magnesium deficiency is linked to a higher risk of heart failure, strokes, and cardiovascular disease, as well as a worsening of their other medical conditions.
Aim of the study
1- To study the relation between serum magnesium level and severity of hypertension.
2- To study the impact of serum magnesium level on the prevalence of coronary artery disease and stroke in hypertensive patients.
3- To assess the effect of serum magnesium level on the lipid level.
Patients and Methods
This study is a cross-sectional study that included 150 hypertensive patients, 102 females and 48 males, aged 25-75 years with mean ± SD (59.53 ± 10.4). All the patients were screened for evidence of coronary artery diseases and stroke. Measurements of serum magnesium levels were done for each participant by the xylidyl blue technique (magnesium liquicolor-human reagent), lipid profile, blood urea, and creatinine level measurements by the chemical biochemistry analyzer Mindray.
Results
There was a significant inverse relationship between the number of antihypertensive drugs and mean serum magnesium level. The study demonstrates that serum magnesium level is significantly reduced in patients who were administered beta blockers.
There was no significant effect of age, sex, and smoking on mean serum magnesium level. However, mean serum magnesium level was significantly less in obese patients (p < 0.05). Although the result shows a significant difference in serum magnesium level between controlled and uncontrolled hypertensive patients, there was no significant relation between mean serum magnesium level and associated comorbid conditions, including DM, IHD, and CVA (p > 0.05).
Moreover, the statin therapy (lipid-lowering agents) shows no significant effect on mean serum magnesium level. In addition, there was no significant association between serum lipid profile (cholesterol, triglyceride, HDL, and LDL) and mean serum magnesium level (p > 0.05).
Conclusion
This study demonstrates that in hypertensive patients, serum magnesium levels were significantly low in patients with multiple antihypertensive drugs and those on beta-blockers; serum magnesium levels were significantly low in uncontrolled hypertensive patients compared to controlled hypertensive patients; and serum magnesium levels were significantly reduced in obese hypertensive patients.
List of Contents
Content Page
Abstract (in English) I-III
List of contents IV-VII
List of tables VII
List of figures VIII
List of abbreviations IX-XII
CHAPTER ONE: INTRODUCTION 1-5
1.1. Hypertension 1
1.2. Aims of the study. 5
CHAPTER TWO: REVIEW OF LITERATURE 6-22
2.1 Blood pressure physiology 6
2.2 Hypertension 6
2.2.1 Hypertension epidemiology 7
2.2.2 Hypertension pathophysiology 8
2.2.3 Hypertension diagnosis 9
2.2.4 Hypertension comorbidities and complication 10
2.2.5 Hypertension management 13
2.3 Magnesium 14
2.3.1 Magnesium homeostasis 15
2.3.2 Magnesium cardiovascular mechanisms 15
2.3.3 Cardiovascular complication associated with magnesium deficiency 19
CHAPTER THREE: PATIENTS AND MATERIALS 23-30
3.1. patients 23
3.1.1 Research papulation 23
3.1.2 Apparatuses and equipment 24
3.2 Methods 25
3.2.1 Full medical history 25
3.2.2 Clinical examination 26
3.2.2.1 Blood pressure assessment 26
3.2.2.2 The determination of the body mass index 27
3.2.3 Collection of blood sample 27
3.2.4 Biochemical analysis 27
3.2.4.1 Magnesium measurement 27
3.2.4.2 Analyses of lipid profile, serum creatinine, and blood urea 28
3.2.5 Study design 29
3.2.6 Evaluation of statistics 30
CHAPTER FOUR: RESULTS 31-38
4.1 Demographic data 31
4.2 The effect of age, sex, BMI, and smoking on mean serum magnesium level. 32
4.3 The relation between mean serum magnesium level and number of antihypertensive drugs. 33
4.4 The relation between mean serum magnesium level and the type of antihypertensive drugs 34
4.5 The relation between mean serum magnesium level and statin therapy 35
4.6 The association between lipid profile and mean serum magnesium level 35
4.7 The relation between mean serum magnesium level and associated comorbid condition 36
4.8 The effect of mean serum magnesium level on the control of hypertension. 38
CHAPTER FIVE: DISCUSSION 39-51
5.1. The effect of age, sex, BMI, and smoking on mean serum magnesium level. 39
5.2. The relation between mean serum magnesium level and number of antihypertensive drugs. 41
5.3. The relation between mean serum magnesium level and the type of antihypertensive drugs 43
5.4. The relation between mean serum magnesium level and statin therapy 44
5.5. The association between lipid profile and mean serum magnesium level 45
5.6. The relation between mean serum magnesium level and associated comorbid condition 46
5.7. The effect of mean serum magnesium level on the control of hypertension. 50
CONCLUSIONS AND RECOMMENDATIONS 52-53
LIMITATIONS 54
CHAPTER SIX : REFERANCES 55-67
APPENDICES 68-74
Abstract (in Arabic) 75
Thesis title (in Arabic) 77
List of Tables
Table no. Table Title Page
Table 2-1 Categorization of hypertension based on office blood pressure measurement 10
Table 3.1 Equipment, chemical, and instruments. 25
Table 3.2 Blood pressure categorizations 26
Table 4.1 Demographic and clinical characteristics of the patients 31
Table 4.2 The effect of age, sex, BMI, and smoking on mean serum magnesium level. 32
Table 4.3 The relation between mean serum magnesium level and the type of antihypertensive drugs 34
Table 4.4 The association between lipid profile and mean serum magnesium level 36
Table 4.5 Comparison between mean serum magnesium level and associated comorbid condition 37
List of Figures
Figure no. Figure Title Page
Figure 2.1 Complication of atherosclerosis in coronary artery diseases 12
Figure 2.2 Magnesium antihypertensive function 18
Figure 2.3 Insulin resistance lowers the DCT's capacity to reabsorb Mg2+ through the prourine in type 2 diabetes 20
Figure 3.1 Spectrophotometer V-1000 (AOELAB-China) analyzer for magnesium assessment. 28
Figure 3.2 Chemical biochemistry analyzer Mindray (BS-230-Korea) for lipid profile assessment. 29
Figure 4.1 The relation between mean serum magnesium level and number of antihypertensive drugs. 33
Figure 4.2 The relation between mean serum magnesium level and statin therapy 35
Figure 4.3 The relation between mean serum magnesium level and number of co-morbidities (DM , CVA , IHD) 37
Figure 4.4 The effect of mean serum magnesium level on the control of hypertension. 38
List of abbreviations
Abbreviations Meaning
ABPM Ambulatory blood pressure monitoring
ACC/AHA American College of Cardiology/ American Heart Association
ACEi Angiotensin-converting enzyme inhibitors
AF Atrial fibrillation
AMI Acute myocardial infarction
ARBs Angiotensin receptor blockers
ATP Adenosine triphosphate
AT-2 Angiotensin 2 receptor
B.U Blood urea
BBB Blood-brain barrier
BMI Body mass index
BP Blood pressure
Ca2+ Calcium
CAD Coronary artery disease
CCDs Calcium channel blockers
CHD Coronary heart diseases
CKD Chronic kidney disease
CVA Cerebrovascular accident
CVD Cardio vascular disease
DBP Diastolic blood pressure
DCT Distal convoluted tubules
DM Diabetes mellitus
DNA Deoxyribonucleic acid
ECG Electrocardiogram
eGFR Estimated glomerular filtration rate
eNOS Endothelial NO synthase
ESRD End-stage renal disease
HDL High density lipoprotein
HF Heart failure
HDL-C High density lipoprotein cholesterol
HMG-CoA 3-Hydroxy-3-Methylglutaryl-Coenzyme A
IHD Ischemic heart diseases
IL-6 Interleukin-6
IL-8 Interleukin-8
IP3 inositol-1,4,5-trisphosphate
K+ Potassium
LCAT lecithin–cholesterol acyl transferase
LDL Low density lipoprotein
L-Glu L-glutamate
LMICs Low- and middle-income countries
LVH Left ventricular hypertrophy
Mg+ Magnesium
MI Myocardial infarction
Na+ Sodium
NaCl Sodium chloride
NCDs Non-communicable diseases
NMDA N-methyl-D-aspartate
NO Nitric oxide
PAD Peripheral artery diseases
PCT Proximal convoluted tubules
PVN hypothalamic paraventricular nucleus
RAAS Renin-angiotensin-aldosterone system
RAS Renin-angiotensin system
RDA Recommended dietary allowance
RNA Ribonucleic acid
ROS Reactive oxygen species
RVLM rostral ventrolateral medulla
SBP Systolic blood pressure
SD Standard deviation
SGLT2is Sodium-glucose cotransporter 2 inhibitors
SNS Sympathetic neural system
TG Triglyceride
TGF-β Transforming growth factor β
TNF-α Tumor necrosis factor- α
VSMCs vascular smooth muscle cells
WHO World health organization
