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Sample records for hypertensive patients inadequately

  1. Inadequate Blood Pressure Control in Hypertensive Patients Referred for Cardiac Stress Test.

    PubMed

    Mousa, Tarek M; Akinseye, Oluwaseun A; Kerwin, Todd C

    2015-09-01

    The current study examined the degree of blood pressure (BP) control and incidence of myocardial ischemia in hypertensive patients (n=2039) referred for cardiac stress test. Patients were categorized into well-controlled (<140/90 mm Hg), poorly controlled (140-160/90-100 mm Hg), and very poorly controlled (>160/100 mm Hg) groups according to their resting BP. The mean age[±standard error of the mean] of the patients was 68±13 years, and 885 (43.4%) were men. The prevalence of well-controlled hypertension (HTN) was 47.2%, poorly controlled HTN was 29.5%, and very poorly controlled HTN was 23.3%. Evidence of ischemia was seen in 19.8% and 19.3% of the well-controlled and poorly controlled groups, respectively. The very poorly controlled group had the lowest incidence of ischemia (14.3%) (P<.05) compared with the other two groups. Symptoms that mimic ischemic heart disease in hypertensive patients may be partly explained by poorly controlled BP. Quality of care might be improved by optimally controlling BP in patients with angina symptoms prior to ordering diagnostic testing associated with radiation exposure and cost. PMID:26011137

  2. Efficacy of fimasartan/hydrochlorothiazide combination in hypertensive patients inadequately controlled by fimasartan monotherapy

    PubMed Central

    Rhee, Moo-Yong; Baek, Sang Hong; Kim, Weon; Park, Chang Gyu; Park, Seung Woo; Oh, Byung-Hee; Kim, Sang-Hyun; Kim, Jae-Joong; Shin, Joon-Han; Yoo, Byung-Su; Rim, Se-Joong; Ha, Jong-Won; Doh, Joon Hyung; Ahn, Youngkeun; Chae, Jei Keon; Park, Jeong Bae; Kim, Soon-Kil; Kim, Cheol Ho

    2015-01-01

    Background The study reported here compared the blood pressure (BP)-lowering efficacy of fimasartan alone with that of fimasartan/hydrochlorothiazide (HCTZ) combination in patients whose BP goal was not achieved after 4 weeks of treatment with once-daily fimasartan 60 mg. Methods Patients with sitting diastolic blood pressure (siDBP) ≥90 mmHg with 4 weeks of once-daily fimasartan 60 mg were randomly assigned to receive either once-daily fimasartan 60 mg/HCTZ 12.5 mg or fimasartan 60 mg for 4 weeks. After 4 weeks, the dose was increased from fimasartan 60 mg/HCTZ 12.5 mg to fimasartan 120 mg/HCTZ 12.5 mg or from fimasartan 60 mg to fimasartan 120 mg if siDBP was ≥90 mmHg. Results Of the 263 randomized patients, 256 patients who had available efficacy data were analyzed. The fimasartan/HCTZ treatment group showed a greater reduction of siDBP compared to the fimasartan treatment group at Week 4 (6.88±8.10 mmHg vs 3.38±7.33, P=0.0008), and the effect persisted at Week 8 (8.67±9.39 mmHg vs 5.02±8.27 mmHg, P=0.0023). Reduction of sitting systolic BP in the fimasartan/HCTZ treatment group was also greater than that in the fimasartan treatment group (at Week 4, 10.50±13.76 mmHg vs 5.75±12.18 mmHg, P=0.0069 and, at Week 8, 13.45±15.15 mmHg vs 6.84±13.57 mmHg, P=0.0007). The proportion of patients who achieved a reduction of siDBP ≥10 mmHg from baseline and/or a mean siDBP <90 mmHg after 4 weeks of treatment was higher in the fimasartan/HCTZ treatment group than in the fimasartan treatment group (53.6% vs 39.8%, P=0.0359). The overall incidence of adverse drug reaction was 11.79% with no significant difference between the treatment groups. Conclusion The combination treatment of fimasartan and HCTZ achieved better BP control than fimasartan monotherapy, and had comparable safety and tolerance to fimasartan monotherapy. PMID:26082615

  3. Blood pressure telemonitoring is useful to achieve blood pressure control in inadequately treated patients with arterial hypertension.

    PubMed

    Neumann, C L; Menne, J; Rieken, E M; Fischer, N; Weber, M H; Haller, H; Schulz, E G

    2011-12-01

    Failing to reach blood pressure (BP) goals is one of the main problems in hypertension management. Especially in high-risk patients, intensive monitoring including frequently office visits or new techniques to monitor home BP is required. A total of 60 patients with uncontrolled hypertension were included and randomized into a group with telemetric BP monitoring (TBPM) (n=30) and a control group receiving standard care (n=30). During the 3-month study period, patients received in addition to their antihypertensive pre-treatment up to 2 × 300 mg irbesartan to achieve the required target BP. All patients were instructed to measure their BP once daily in the morning. In the TBPM group automatic alerts were generated by the central database server using pre-defined algorithms and patients were subsequently contacted by the physician. At baseline mean 24-h ambulant BP monitoring (ABPM) was 143.3±11.1/82.6±9.9 mm Hg in the TBPM group and 141.4±12.6/82.1±6.5 mm Hg in the standard care group. During treatment mean systolic BP showed a more intensive decrease in the TBPM vs control group (-17.0±11.1 mm Hg vs -9.8±13.7 mm Hg; P=0.032). Patients in the TBPM group had a more pronounced night dipping and a higher reduction of mean pulse pressure than controls (-8.1±5.9 mm Hg vs -2.8±7.4 mm Hg, P=0.004). After 3 months, TBPM-treated patients were given a higher mean daily dose of irbesartan (375±187 mg vs 222±147 mg in controls; P=<0.001). We demonstrated that with TBPM a more effective and faster titration of the antihypertensive agent is possible. The alarm criteria chosen were useful to improve BP control. PMID:21228822

  4. Valsartan 160 mg/Amlodipine 5 mg Combination Therapy versus Amlodipine 10 mg in Hypertensive Patients with Inadequate Response to Amlodipine 5 mg Monotherapy

    PubMed Central

    Sung, Jidong; Jeong, Jin-Ok; Kwon, Sung Uk; Won, Kyung Heon; Kim, Byung Jin; Cho, Byung Ryul; Kim, Myeong-Kon; Lee, Sahng; Kim, Hak Jin; Lim, Seong-Hoon; Park, Seung Woo

    2016-01-01

    Background and Objectives When monotherapy is inadequate for blood pressure control, the next step is either to continue monotherapy in increased doses or to add another antihypertensive agent. However, direct comparison of double-dose monotherapy versus combination therapy has rarely been done. The objective of this study is to compare 10 mg of amlodipine with an amlodipine/valsartan 5/160 mg combination in patients whose blood pressure control is inadequate with amlodipine 5 mg. Subjects and Methods This study was conducted as a multicenter, open-label, randomized controlled trial. Men and women aged 20-80 who were diagnosed as having hypertension, who had been on amlodipine 5 mg monotherapy for at least 4 weeks, and whose daytime mean systolic blood pressure (SBP) ≥135 mmHg or diastolic blood pressure (DBP) ≥85 mmHg on 24-hour ambulatory blood pressure monitoring (ABPM) were randomized to amlodipine (A) 10 mg or amlodipine/valsartan (AV) 5/160 mg group. Follow-up 24-hour ABPM was done at 8 weeks after randomization. Results Baseline clinical characteristics did not differ between the 2 groups. Ambulatory blood pressure reduction was significantly greater in the AV group compared with the A group (daytime mean SBP change: -14±11 vs. -9±9 mmHg, p<0.001, 24-hour mean SBP change: -13±10 vs. -8±8 mmHg, p<0.0001). Drug-related adverse events also did not differ significantly (A:AV, 6.5 vs. 4.5 %, p=0.56). Conclusion Amlodipine/valsartan 5/160 mg combination was more efficacious than amlodipine 10 mg in hypertensive patients in whom monotherapy of amlodipine 5 mg had failed. PMID:27014353

  5. Hypertension Subtypes among Hypertensive Patients in Ibadan

    PubMed Central

    Salako, Babatunde L.; Ogunniyi, Adesola; Cooper, Richard S.

    2014-01-01

    Background. Certain hypertension subtypes have been shown to increase the risk for cardiovascular morbidity and mortality and may be related to specific underlying genetic determinants. Inappropriate characterization of subtypes of hypertension makes efforts at elucidating the genetic contributions to the etiology of hypertension largely vapid. We report the hypertension subtypes among patients with hypertension from South-Western Nigeria. Methods. A total of 1858 subjects comprising 76% female, hypertensive, aged 18 and above were recruited into the study from two centers in Ibadan, Nigeria. Hypertension was identified using JNCVII definition and was further grouped into four subtypes: controlled hypertension (CH), isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic-diastolic hypertension (SDH). Results. Systolic-diastolic hypertension was the most prevalent. Whereas SDH (77.6% versus 73.5%) and IDH (4.9% versus 4.7%) were more prevalent among females, ISH (10.1% versus 6.2%) was higher among males (P = 0.048). Female subjects were more obese (P < 0.0001) and SDH was prevalent among the obese group. Conclusion. Gender and obesity significantly influenced the distribution of the hypertension subtypes. Characterization of hypertension by subtypes in genetic association studies could lead to identification of previously unknown genetic variants involved in the etiology of hypertension. Large-scale studies among various ethnic groups may be needed to confirm these observations. PMID:25389499

  6. An inadequate pulmonary vascular capacity and susceptibility to pulmonary arterial hypertension in broilers.

    PubMed

    Wideman, R F; Chapman, M E; Hamal, K R; Bowen, O T; Lorenzoni, A G; Erf, G F; Anthony, N B

    2007-05-01

    Broilers are susceptible to pulmonary hypertension syndrome (PHS; ascites syndrome) when their pulmonary vascular capacity is anatomically or functionally inadequate to accommodate the requisite cardiac output without an excessive elevation in pulmonary arterial pressure. The consequences of an inadequate pulmonary vascular capacity have been demonstrated experimentally and include elevated pulmonary vascular resistance (PVR) attributable to noncompliant, fully engorged vascular channels; sustained pulmonary arterial hypertension (PAH); systemic hypoxemia and hypercapnia; specific right ventricular hypertrophy, and right atrioventricular valve failure (regurgitation), leading to central venous hypertension and hepatic cirrhosis. Pulmonary vascular capacity is broadly defined to encompass anatomical constraints related to the compliance and effective volume of blood vessels, as well as functional limitations related to the tone (degree of constriction) maintained by the primary resistance vessels (arterioles) within the lungs. Surgical occlusion of 1 pulmonary artery halves the anatomical pulmonary vascular capacity, doubles the PVR, triggers PAH, eliminates PHS-susceptible broilers, and reveals PHS-resistant survivors whose lungs are innately capable of handling sustained increases in pulmonary arterial pressure and cardiac output. We currently are using i.v. microparticle injections to increase the PVR and trigger PAH sufficient in magnitude to eliminate PHS-susceptible individuals while allowing PHS-resistant individuals to survive as progenitors of robust broiler lines. The microparticles obstruct pulmonary arterioles and cause local tissues and responding leukocytes to release vasoactive substances, including the vasodilator NO and the highly effective vasoconstrictors thromboxane A(2) and serotonin [5-hydroxytryptamine (5-HT)]. Nitric oxide is the principal vasodilator responsible for modulating (attenuating) the PAH response and ensuing mortality triggered by

  7. Knowledge of disease condition and medications among hypertension patients in Lesotho.

    PubMed

    Mugomeri, Eltony; Ramathebane, Maseabata V; Maja, Lineo; Chatanga, Peter; Moletsane, Lipalesa

    2016-01-01

    This study evaluated the levels of knowledge of hypertension and the associated medications among hypertension patients in Lesotho and assessed the significance of these indicators on hypertension treatment outcomes. About 81% (n = 212) of the patients had hypertension monocondition while the remaining had multiple chronic conditions. Seventy-six percent of the patients had uncontrolled hypertension. Nearly 36% had inadequate knowledge about hypertension while 44% had inadequate knowledge about their medicines. In total, 52.4% of the patients defaulted appointment dates while 64.6% failed to take their medications as prescribed at least once. Inadequate knowledge of antihypertensive medicines was significantly associated (P = .028) with having uncontrolled hypertension. Inadequate knowledge of antihypertensive medicines is an important determinant of uncontrolled hypertension. Improving the knowledge of hypertension and the associated medications is an important intervention required in this population. PMID:26775548

  8. [Hypertensive crisis in kidney patients].

    PubMed

    Scrivano, Jacopo; Giuliani, Anna; Pettorini, Laura; Punzo, Giorgio; Mene', Paolo; Pirozzi, Nicola

    2011-01-01

    The classification and management of hypertensive crisis have been recently reviewed in the context of both European and American guidelines. The key points for proper blood pressure control in severe arterial hypertension are: 1 - Distinction between urgent intervention and emergencies 2 - Choice of the best drug(s) 3 - Choice of the correct route of administration. In patients with renal disease, beside the common causes of hypertension/ hypertensive crises, kidney-specific causes should be taken into account such as renal parenchymal hypertension, renovascular hypertension, sclerodermic crises, and preeclampsia. PMID:22028263

  9. Hypertension in Patients with Cancer

    PubMed Central

    de Souza, Vinicius Barbosa; Silva, Eduardo Nani; Ribeiro, Mario Luiz; Martins, Wolney de Andrade

    2015-01-01

    There is a known association between chemotherapy and radiotherapy for treatment of cancer patients and development or worsening of hypertension. The aim of this article is to review this association. A literature search was conducted for articles reporting this association on the databases PubMed, SciELO and LILACS between 1993 and 2013. There was a high coprevalence of hypertension and cancer, since both diseases share the same risk factors, such as sedentary lifestyle, obesity, smoking, unhealthy diet and alcohol abuse. The use of chemotherapy and adjuvant drugs effective in the treatment of cancer increased the survival rate of these patients and, consequently, increased the incidence of hypertension. We described the association between the use of angiogenesis inhibitors (bevacizumab, sorafenib and sunitinib), corticosteroids, erythropoietin and non-steroidal anti-inflammatory drugs with the development of hypertension. We also described the relationship between hypertension and carotid baroreceptor injury secondary to cervical radiotherapy. Morbidity and mortality increased in patients with cancer and hypertension without proper antihypertensive treatment. We concluded that there is need for early diagnosis, effective monitoring and treatment strategies for hypertension in cancer patients in order to reduce cardiovascular morbidity and mortality. PMID:25742420

  10. Knowledge, Awareness and Self-Care Practices of Hypertension among Cardiac Hypertensive Patients

    PubMed Central

    Bilal, Muhammad; Haseeb, Abdul; Lashkerwala, Sehan Siraj; Zahid, Ibrahim; Siddiq, Khadijah; Saad, Muhammad; Dar, Mudassir Iqbal; Arshad, Mohammad Hussham; Shahnawaz, Waqas; Ahmed, Bilal; Yaqub, Aimen

    2016-01-01

    Introduction: The most prevalent form of hypertension is systolic blood pressure (SBP) and it is considered to be predisposing risk factor for cardiovascular disease. The objective of the study was to assess self-care practices, knowledge and awareness of hypertension, especially related to SBP among cardiac hypertensive patients. Methodology: A Cross sectional study was conducted on 664 cardiac hypertensive patients, which were selected by non-probability convenience sampling from cardiology outpatient department of three tertiary care hospitals. Face to face interviews were conducted using a pre designed questionnaire. Data was entered and analyzed by SPSS (V17). Results: 81.8%, did not know that hypertension is defined as high blood pressure. 97.1% of the sample population did not know that top measurement of blood pressure was referred to as systolic and only 25.0% correctly recognized normal systolic blood pressure to be less than 140mmHg. 7.4% of the patients consulted their doctor for hypertension once or twice in a month. Risk factor for high blood pressure most commonly identified by the participants was too much salt intake Conclusions: The results state that there is an inadequate general knowledge of hypertension among cardiac patients and they do not recognise the significance of elevated SBP levels. There is a need to initiate programs that create community awareness regarding long term complications of uncontrolled hypertension, particularly elevated SBP levels so that there is an improvement in self-care practices of the cardiacpatients. PMID:26383212

  11. [Personality characteristics of hypertensive patients].

    PubMed

    Kubej, P; Korán, M

    1989-02-01

    Essential hypertension, as well-known specialists believe, is due both to genetic and external environment factors. Apart from the steadily growing complexity of social life and various important life events, high-risk factors may also be seen in a certain way of behaviour and man's psychophysiological reactivity. Recent literature on this topic informs about some common characteristics found in the behaviour of hypertensive persons, for example: anxiety in social contacts, suppressed hostility, manifestations of perfectionism, suppression of emotions, exaggerated behavioral adaptability and defensive attitudes to stress stimuli. In accordance with literary data, the control group of hypertensive patients (N = 89) gave evidence of some identical characteristics. Their knowledge permits to carry out more specific attempts at influencing hypertension in a non-pharmacological way. PMID:2720750

  12. Sexual function in hypertensive patients receiving treatment

    PubMed Central

    Reffelmann, Thorsten; Kloner, Robert A

    2006-01-01

    In many forms of erectile dysfunction (ED), cardiovascular risk factors, in particular arterial hypertension, seem to be extremely common. While causes for ED are related to a broad spectrum of diseases, a generalized vascular process seems to be the underlying mechanism in many patients, which in a large portion of clinical cases involves endothelial dysfunction, ie, inadequate vasodilation in response to endothelium-dependent stimuli, both in the systemic vasculature and the penile arteries. Due to this close association of cardiovascular disease and ED, patients with ED should be evaluated as to whether they may suffer from cardiovascular risk factors including hypertension, cardiovascular disease or silent myocardial ischemia. On the other hand, cardiovascular patients, seeking treatment of ED, must be evaluated in order to decide whether treatment of ED or sexual activity can be recommended without significantly increased cardiac risk. The guideline from the first and second Princeton Consensus Conference may be applied in this context. While consequent treatment of cardiovascular risk factors should be accomplished in these patients, many antihypertensive drugs may worsen sexual function as a drug specific side-effect. Importantly, effective treatment for arterial hypertension should not be discontinued as hypertension itself may contribute to altered sexual functioning; to the contrary, alternative antihypertensive regimes should be administered with individually tailored drug regimes with minimal side-effects on sexual function. When phosphodiesterase-5 inhibitors, such as sildenafil, tadalafil and vardenafil, are prescribed to hypertensive patients on antihypertensive drugs, these combinations of antihypertensive drugs and phosphodiesterase 5 are usually well tolerated, provided there is a baseline blood pressure of at least 90/60 mmHg. However, there are two exceptions: nitric oxide donors and α-adrenoceptor blockers. Any drug serving as a nitric oxide

  13. Hyperuricemia and uncontrolled hypertension in treated hypertensive patients

    PubMed Central

    Cho, Jaelim; Kim, Changsoo; Kang, Dae Ryong; Park, Jeong Bae

    2016-01-01

    Abstract Previous epidemiological studies have suggested that uric acid is an independent risk factor for incident hypertension, whereas few studies have evaluated the effect of hyperuricemia on blood pressure control in hypertensive patients. We investigated whether hyperuricemia predicts uncontrolled hypertension through a large-scale prospective cohort study with hypertensive patients treated with fimasartan in the Republic of Korea (the Kanarb–Metabolic Syndrome study). Of the 10,601 hypertensive patients who were recruited from 582 private clinics and 11 university hospitals at baseline, 7725 completed the follow-up after 3 months of fimasartan medication, and 6506 were included in the analysis after excluding those with missing values. We estimated the risk of uncontrolled hypertension after 3 months (≥130/80 mm Hg in those with diabetes or chronic renal failure and ≥140/90 mm Hg in the remaining patients) related with baseline hyperuricemia (serum uric acid ≥7 mg/dL in males ≥6 mg/dL in females) using multiple logistic regression models. Hyperuricemia increased the risk of uncontrolled hypertension after 3 months of fimasartan medication (odds ratio, 1.247; 95% confidence interval, 1.063–1.462). Males in the highest quartile of uric acid level were at a 1.322 (95% confidence interval, 1.053–1.660) times higher risk of uncontrolled hypertension in reference to the lowest quartile; the same analyses in females were not significant. Patients without metabolic syndrome had significantly higher odds of uncontrolled hypertension with hyperuricemia (odds ratio, 1.328; 95% confidence interval, 1.007–1.751). Hyperuricemia predicted uncontrolled hypertension even after 3 months of fimasartan treatment in hypertensive patients. PMID:27428212

  14. Exercise radionuclide ventriculographic responses in hypertensive patients with chest pain

    SciTech Connect

    Wasserman, A.G.; Katz, R.J.; Varghese, P.J.; Leiboff, R.H.; Bren, G.G.; Schlesselman, S.; Varma, V.M.; Reba, R.C.; Ross, A.M.

    1984-11-15

    The effectiveness of exercise-treadmill testing in diagnosing coronary-artery disease in hypertensive patients is limited by a high rate of false positivity. Exercise radionuclide ventriculography, however, relies on different criteria (ejection fraction and wall motion), and we have evaluated this procedure in 37 hypertensive and 109 normotensive patients with chest pain, using coronary arteriography as an indicator of coronary disease. In the hypertensive cohort there was no difference in the ejection fraction at rest between the 17 patients with coronary disease and the 20 without it. Neither group had a significant mean (+/- S.E.M.) change in ejection fraction from rest to exercise (-1.9 +/- 2 and 1.4 +/- 1%, respectively). A wall-motion abnormality developed during exercise in 5 of the 17 hypertensive patients with coronary disease (29%) and in 4 of the 20 without it (20%) (P = not significant). In the normotensive cohort, however, the peak-exercise ejection fractions were significantly different. The 71 patients with coronary disease had a mean decrease of 3.6 +/- 1%, in contrast to the patients without coronary disease, who had an increase of +/- 1% (P < 0.001). An exercise-induced wall-motion abnormality was seen in 35 of the 71 patients with coronary disease (48%), as compared with 3 of the 38 without it (8%) (P < 0.001). We conclude that exercise radionuclide ventriculography is inadequate as a screening test for coronary atherosclerosis in hypertensive patients with chest pain. 28 references, 2 figures, 3 tables.

  15. Hypertension in the military patient.

    PubMed

    Hunter, Alys; Holdsworth, D A; D'Arcy, J; Bailey, K; Casadei, B

    2015-09-01

    Hypertension and hypertension-related diseases are a leading cause of morbidity and mortality worldwide. A diagnosis of hypertension can have serious occupational implications for military personnel. This article examines the diagnosis and management of hypertension in military personnel, in the context of current international standards. We consider the consequences of hypertension in the military environment and potential military-specific issues relating to hypertension. PMID:26253125

  16. Suitability of antiplatelet therapy in hypertensive patients.

    PubMed

    Martínez-Orozco, M J; Perseguer-Torregrosa, Z; Gil-Guillén, V F; Palazón-Bru, A; Orozco-Beltran, D; Carratalá-Munuera, C

    2015-01-01

    Antiplatelet therapy (AT) is indicated in hypertensive patients with increased cardiovascular risk. The literature about the adequate or inadequate prescription of AT is scarce. We conducted a prospective descriptive study to quantify therapeutic inertia and non-guideline-recommended prescription (NGRP) of AT (aspirinor clopidogrel or both), and to assess associated factors, calculating the adjusted odds ratios (ORs) from multivariate models. In 2007-2009, 712 primary health-care hypertensive patients in a Spanish region were enrolled. Inertia was defined as the lack of an AT prescription, despite being indicated by guidelines, whereas NGRP was defined as AT prescription when there was no guideline recommendation. We also recorded cardiovascular variables. Inertia and NGRP were quantified for primary and secondary prevention. Of 108 patients in secondary prevention, 53 had inertia (49.1%, 95% confidence interval (CI): 39.6-58.5%). Associated profile: female (OR=0.460, P=0.091), no dyslipidemia (OR=0.393, P=0.048), no coronary heart disease (OR=0.215, P=0.001) and high diastolic blood pressure (OR=1.076, P=0.016). In primary prevention, NGRP was present in 69 of 595 patients (11.6%, 95% CI: 9.0-14.2%). Associated profile: male (OR=1.610, P=0.089), smoking (OR=2.055, P=0.045), dyslipidemia (OR=3.227, P<0.001) and diabetes (OR=2.795, P<0.001). Although certain factors were clearly associated with these phenomena much still remains to be learnt. PMID:24694801

  17. Assessment and Management of Hypertension in Transplant Patients

    PubMed Central

    Burgess, Ellen D.; Cooper, James E.; Fenves, Andrew Z.; Goldsmith, David; McKay, Dianne; Mehrotra, Anita; Mitsnefes, Mark M.; Sica, Domenic A.; Taler, Sandra J.

    2015-01-01

    Hypertension in renal transplant recipients is common and ranges from 50% to 80% in adult recipients and from 47% to 82% in pediatric recipients. Cardiovascular morbidity and mortality and shortened allograft survival are important consequences of inadequate control of hypertension. In this review, we examine the epidemiology, pathophysiology, and management considerations of post-transplant hypertension. Donor and recipient factors, acute and chronic allograft injury, and immunosuppressive medications may each explain some of the pathophysiology of post-transplant hypertension. As observed in other patient cohorts, renal artery stenosis and adrenal causes of hypertension may be important contributing factors. Notably, BP treatment goals for renal transplant recipients remain an enigma because there are no adequate randomized controlled trials to support a benefit from targeting lower BP levels on graft and patient survival. The potential for drug-drug interactions and altered pharmacokinetics and pharmacodynamics of the different antihypertensive medications need to be carefully considered. To date, no specific antihypertensive medications have been shown to be more effective than others at improving either patient or graft survival. Identifying the underlying pathophysiology and subsequent individualization of treatment goals are important for improving long-term patient and graft outcomes in these patients. PMID:25653099

  18. Antihypertensive efficacy and tolerability of aliskiren/amlodipine single- pill combinations in patients with an inadequate response to aliskiren monotherapy.

    PubMed

    Glorioso, Nicola; Thomas, Mathew; Troffa, Chiara; Argiolas, Giuseppe; Patel, Samir; Baek, Inyoung; Zhang, Jack

    2012-11-01

    Many patients with hypertension will require multiple antihypertensive drugs to achieve blood pressure (BP) control. This double-blind study evaluated the efficacy and safety of aliskiren/amlodipine single-pill combinations (SPCs) in patients with mild-to-moderate hypertension who were non-responsive to aliskiren monotherapy. After a 4-week run-in with aliskiren 300 mg, patients with mean sitting diastolic BP (msDBP) ≥ 90 and < 110 mmHg were randomized to oncedaily aliskiren/ amlodipine 300/10 mg or 300/5 mg, or aliskiren 300 mg for 8 weeks. Aliskiren/amlodipine SPCs provided significantly greater mean reductions in mean sitting systolic BP/msDBP (300/10 mg, 18.0/13.1 mmHg; 300/5 mg, 14.4/10.5 mmHg) than aliskiren 300 mg (6.4/5.8 mmHg) at week 8 endpoint. This represents additional mean reductions of 11.6/7.2 mmHg (300/10 mg) and 8.0/4.7 mmHg (300/5 mg) over aliskiren alone (both p < 0.0001). Significantly more patients achieved BP control ( < 140/90 mmHg) with aliskiren/amlodipine 300/10 mg (65.5%) and 300/5 mg (56.6%) than with aliskiren (31.5% both p < 0.0001). Aliskiren, alone and in combination with amlodipine, was well tolerated, with a slightly higher incidence of adverse events with SPCs (29.0-30.1%) than with monotherapy (22.7%). In conclusion, aliskiren/amlodipine SPCs offer an effective next step for patients who have an inadequate BP response to aliskiren alone. PMID:22303910

  19. Study of depression among a sample of hypertensive patients.

    PubMed

    Al Madany, Adel Mohammed; Hassan, Fawzy Hamed; Al-Nabawy, Ali Abdel Fattah; Ramadan, Mohammed Elsayed Mohammed; Ismail, Abd-Allah Ahmed Abd-Allah

    2015-04-01

    Hypertension is one of the commonest diseases worldwide. Hypertension (HTN) or high blood pressure, sometimes called arterial hypertension, is a chronic medical condition, which elevated blood pressure in the arteries. This forces the heart to work harder than normal to circulate blood via the blood vessels. Blood pressure is summarized by two measurements, systolic and diastolic, which depend on between beats (diastole). Normal blood pressure at rest is within the range of 100-140 mmHg systolic (top reading) high blood pressure is said to be present if it is persistently at or above 140/90 mmHg of cases are categorized as primary hypertension that means high blood pressure with no obvious underlying medical cause. Updated studies reported associations between depressive symptoms and hypertensive patients. Depression may be an independent diagnosis, it is also possible that depressive symptoms are secondary to chronic illnesses and their associated complex medication regimens, regardless of the diagnosis being primary or secondary, prior reports have demonstrated that depressive symptoms are associated with inadequate blood pressure control and complications of hypertension. PMID:26012236

  20. Usability of conversational agents by patients with inadequate health literacy: evidence from two clinical trials.

    PubMed

    Bickmore, Timothy W; Pfeifer, Laura M; Byron, Donna; Forsythe, Shaula; Henault, Lori E; Jack, Brian W; Silliman, Rebecca; Paasche-Orlow, Michael K

    2010-01-01

    Embodied Conversational Agents (ECA) are computer-animated characters that simulate face-to-face conversation with patients. These agents can be programmed with best practices in human-human health communication and used for automated health education and behavior change counseling interventions. Evidence is presented from two ongoing clinical trials demonstrating that patients at different levels of health literacy find these agents acceptable and easy to use for automated health communication interventions. Innovative computer interface systems can be used to ensure that inadequate health literacy not serve as a barrier to interventions using health information technology. PMID:20845204

  1. Dental management of patients with hypertension.

    PubMed

    Bavitz, J Bruce

    2006-10-01

    About 50 million people in the United States have hypertension. Many epidemiologists feels it is the number one public health problem in developed countries. Although asymptomatic early on, untreated hypertension leads to cardiovascular disease, strokes, renal failure, and blindness. Dentists no doubt treat patients with hypertension and its sequelae in their practice. This article summarizes the current thinking on the diagnosis and treatment of this condition, emphasizing dental implications. The article presents common oral and systemic side effects of antihypertensive medications, and discusses how dentists can help treat hypertension through the fabrication of devices useful in reducing obstructive sleep apnea. PMID:17000273

  2. Results of salvage radiotherapy after inadequate surgery in invasive cervical carcinoma patients: A retrospective analysis

    SciTech Connect

    Saibishkumar, Elantholi P. . E-mail: drsaibish@rediffmail.com; Patel, Firuza D.; Ghoshal, Sushmita; Kumar, Vinay; Karunanidhi, Gunaseelan; Sharma, Suresh C.

    2005-11-01

    Purpose: To evaluate the results of salvage radiotherapy (RT) after inadequate surgery in patients with invasive carcinoma of the cervix. Methods and Materials: Between 1996 and 2001, 105 invasive cervical carcinoma patients were treated at our center with external beam RT with or without intracavitary RT after having undergone total/subtotal hysterectomy at outside institutions. Results: The median follow-up was 34 months. The gap between surgery and RT was 23-198 days (median, 80). Clinically visible residual disease was present in 81 patients (77.1%). Total hysterectomy had been done in 82 patients (78%) and subtotal hysterectomy in 23 patients (22%). The 5-year overall survival, disease-free survival, and pelvic control rates of all patients were 55.2%, 53.3%, and 72.4%, respectively. On univariate analysis, older age, total hysterectomy, hemoglobin level >10 g% before RT, nonsquamous histologic type, use of intracavitary RT, a shorter gap between surgery and RT, and the absence of, or a small volume of, residual disease favorably affected the outcome. The 5-year actuarial rate of late toxicity (Radiation Therapy Oncology Group Criteria) was 19% in the rectum, 4.8% in the bladder, 24.8% in the skin, and 14.3% in the small intestine. Conclusions: Inadequate and inappropriate surgery in invasive cervical cancer with resulting gross residual disease is common in India. Factors such as the use of intracavitary RT, the correction of anemia, and a shorter gap between surgery and RT will enable postoperative RT to achieve acceptable results with minimal morbidity.

  3. [Hypertensive crises in patients with arterial hypertension in ambulatory treatment].

    PubMed

    Gomes Guedes, Nirla; Chaves Costa, Francisca Bertilia; Moreira, Rafaella Pessoa; Moreira, Tahissa Frota; Soares Chavess, Emilia; de Araújo, Thelma Leite

    2005-06-01

    This study assessed the sociodemographic characteristics and the characteristics of therapeutic adhesion of 27 bearers of arterial hypertension undergoing ambulatorial treatment who had hypertensive urgencies crises or emergencies in the city of Fortaleza in the period between October of 2002 and May of 2003. The majority were women, between 50 and 60-years old, with little formal education, treatment time shorter than 5 years and time of diagnosis varying from 5 to 10 years. The use of medicine was the treatment that was most mentioned, followed by the reduction of the consumption of salt and attendance to medical appointments. However, attending the appointments and receiving orientation did not seem to change their behavior, since most of the patients that were interviewed practiced no physical exercises and demonstrated little knowledge of the illness, for they attributed the rise of the arterial pressure to emotional factors. PMID:16060305

  4. An approach to the young hypertensive patient.

    PubMed

    Mangena, P; Saban, S; Hlabyago, K E; Rayner, B

    2016-01-01

    Hypertension is the leading cause of death worldwide. Globally and locally there has been an increase in hypertension in children, adolescents and young adults<40 years of age. In South Africa, the first decade of the millennium saw a doubling of the prevalence rate among adolescents and young adults aged 15-24 years. This increase suggests that an explosion of cerebrovascular disease, cardiovascular disease and chronic kidney disease can be expected in the forthcoming decades. A large part of the increased prevalence can be attributed to lifestyle factors such as diet and physical inactivity, which lead to overweight and obesity. The majority (>90%) of young patients will have essential or primary hypertension, while only a minority (<10%) will have secondary hypertension. We do not recommend an extensive workup for all newly diagnosed young hypertensives, as has been the practice in the past. We propose a rational approach that comprises a history to identify risk factors, an examination that establishes the presence of target-organ damage and identifies clues suggesting secondary hypertension, and a limited set of basic investigations. More specialised tests should be performed only where there is a clinical suspicion that a secondary cause for hypertension exists. There have been no randomised clinical trials on the treatment of hypertension in young patients. Expert opinion advises an initial emphasis on lifestyle modification. This can comprise a diet with reduced salt and refined carbohydrate intake, an exercise programme and management of substance abuse issues. Failure of lifestyle measures or the presence of target-organ damage should prompt the clinician to initiate pharmacotherapy. We recommend referral to a specialist practitioner in cases of resistant hypertension, where there is severe target-organ damage and when a secondary cause is suspected. PMID:26933708

  5. Inadequate Dietary Calcium and Vitamin D Intake in Patients with Osteoporotic Fracture

    PubMed Central

    Yoon, Dong Sik; Lee, Young-Kyun; Ha, Yong-Chan

    2016-01-01

    Background Inadequate calcium and vitamin D intake is a possible risk factor of osteoporosis. Our purposes were to estimate calcium and vitamin D intake in women with osteoporotic fractures, to determine associated factors for low calcium and vitamin D intake, and to evaluate the effects of calcium and vitamin D intake on bone mineral density (BMD). Methods This is a multicenter, hospital-based, and cross-sectional study involving 277 women with osteoporotic fractures. Dietary calcium and vitamin D intake were evaluated using the Korean Calcium Assessment Tool (KCAT) self-reported questionnaire. BMD was measured by dual energy X-ray absorptiometry (DXA) in the lumbar spine and femoral neck. Results Average daily calcium and vitamin D intake was 503.7±274.7 mg and 7.5±12.6 µg, respectively. Patients with low calcium intake had less family history of osteoporosis and were older. There was a negative correlation between age and calcium intake (r=-0.14; P=0.019). In multivariate analysis, calcium intake showed a positive correlation with BMD of femoral neck (β=0.0005, P=0.021). Conclusions About 80% of patients with osteoporotic fracture had calcium and vitamin D intake below the recommended dietary intake. Low calcium intake was associated with no family history of osteoporosis and older age. Dietary calcium intake showed positive effect on BMD. PMID:27294077

  6. Comparison of Vildagliptin and Pioglitazone in Korean Patients with Type 2 Diabetes Inadequately Controlled with Metformin

    PubMed Central

    Kim, Jong Ho; Kim, Sang Soo; Baek, Hong Sun; Lee, In Kyu; Chung, Dong Jin; Sohn, Ho Sang; Bae, Hak Yeon; Kim, Mi Kyung; Park, Jeong Hyun; Choi, Young Sik; Kim, Young Il; Hahm, Jong Ryeal; Lee, Chang Won; Jo, Sung Rae; Park, Mi Kyung; Lee, Kwang Jae

    2016-01-01

    Background We compared the efficacies of vildagliptin (50 mg twice daily) relative to pioglitazone (15 mg once daily) as an add-on treatment to metformin for reducing glycosylated hemoglobin (HbA1c) levels in Korean patients with type 2 diabetes. Methods The present study was a multicenter, randomized, active-controlled investigation comparing the effects of vildagliptin and pioglitazone in Korean patients receiving a stable dose of metformin but exhibiting inadequate glycemic control. Each patient underwent a 16-week treatment period with either vildagliptin or pioglitazone as an add-on treatment to metformin. Results The mean changes in HbA1c levels from baseline were –0.94% in the vildagliptin group and –0.6% in the pioglitazone group and the difference between the treatments was below the non-inferiority margin of 0.3%. The mean changes in postprandial plasma glucose (PPG) levels were –60.2 mg/dL in the vildagliptin group and –38.2 mg/dL in the pioglitazone group and these values significantly differed (P=0.040). There were significant decreases in the levels of total, low density lipoprotein, high density lipoprotein (HDL), and non-HDL cholesterol in the vildagliptin group but increases in the pioglitazone group. The mean change in body weight was –0.07 kg in the vildagliptin group and 0.69 kg in the pioglitazone group, which were also significantly different (P=0.002). Conclusion As an add-on to metformin, the efficacy of vildagliptin for the improvement of glycemic control is not inferior to that of pioglitazone in Korean patients with type 2 diabetes. In addition, add-on treatment with vildagliptin had beneficial effects on PPG levels, lipid profiles, and body weight compared to pioglitazone. PMID:27098505

  7. Radioisotopic splenoportography in patients with portal hypertension.

    PubMed

    Samejima, N; Ikeda, K; Yokoyama, Y; Hirata, S

    1989-05-01

    Radio-isotopic splenoportography was performed by injecting 99mTcO4- into the spleens of 46 patients with portal hypertension and 14 patients with various disorders not having portal hypertension. No collateral circulation was demonstrated in the 14 patients without portal hypertension whereas some RI-images of portosystemic collaterals were found in 40 (87.0 per cent) of the 46 patients with portal hypertension. Collaterals were divided into an ascending group and a descending group, the appearance rate of ascending collaterals being 80.4 per cent and that of descending collaterals, 41.3 per cent. There were 3 image patterns in the ascending group, namely, an AZ-pattern in which the azygos vein was demonstrated; a SC-pattern in which the RI-bolus ascended along the esophagus to the neck and the subclavian vein; and an EG-pattern which showed stagnation of the RI-bolus in the esophagogastric region. There were 4 patterns in the descending group, namely; a pattern of gastro-renal caval shunt (GR-pattern); reverse flow patterns into the umbilical or paraumbilical veins (UV-pattern); into the superior mesenteric vein (SMV-pattern); and into the inferior mesenteric vein (IMV-pattern). The appearance of the EG-pattern was seen most frequently (74.4 per cent). The usefulness of this method for surveying the collateral circulation in portal hypertension, estimating the risk of esophageal variceal bleeding and evaluating its treatments, was suggested by the results of this study. PMID:2674500

  8. Assessment and Management of Hypertension in Patients on Dialysis

    PubMed Central

    Flynn, Joseph; Pogue, Velvie; Rahman, Mahboob; Reisin, Efrain; Weir, Matthew R.

    2014-01-01

    Hypertension is common, difficult to diagnose, and poorly controlled among patients with ESRD. However, controversy surrounds the diagnosis and treatment of hypertension. Here, we describe the diagnosis, epidemiology, and management of hypertension in dialysis patients, and examine the data sparking debate over appropriate methods for diagnosing and treating hypertension. Furthermore, we consider the issues uniquely related to hypertension in pediatric dialysis patients. Future clinical trials designed to clarify the controversial results discussed here should lead to the implementation of diagnostic and therapeutic techniques that improve long-term cardiovascular outcomes in patients with ESRD. PMID:24700870

  9. Impact of Inadequate Empirical Therapy on the Mortality of Patients with Bloodstream Infections: a Propensity Score-Based Analysis

    PubMed Central

    Retamar, Pilar; Portillo, María M.; López-Prieto, María Dolores; Rodríguez-López, Fernando; de Cueto, Marina; García, María V.; Gómez, María J.; del Arco, Alfonso; Muñoz, Angel; Sánchez-Porto, Antonio; Torres-Tortosa, Manuel; Martín-Aspas, Andrés; Arroyo, Ascensión; García-Figueras, Carolina; Acosta, Federico; Corzo, Juan E.; León-Ruiz, Laura; Escobar-Lara, Trinidad

    2012-01-01

    The impact of the adequacy of empirical therapy on outcome for patients with bloodstream infections (BSI) is key for determining whether adequate empirical coverage should be prioritized over other, more conservative approaches. Recent systematic reviews outlined the need for new studies in the field, using improved methodologies. We assessed the impact of inadequate empirical treatment on the mortality of patients with BSI in the present-day context, incorporating recent methodological recommendations. A prospective multicenter cohort including all BSI episodes in adult patients was performed in 15 hospitals in Andalucía, Spain, over a 2-month period in 2006 to 2007. The main outcome variables were 14- and 30-day mortality. Adjusted analyses were performed by multivariate analysis and propensity score-based matching. Eight hundred one episodes were included. Inadequate empirical therapy was administered in 199 (24.8%) episodes; mortality at days 14 and 30 was 18.55% and 22.6%, respectively. After controlling for age, Charlson index, Pitt score, neutropenia, source, etiology, and presentation with severe sepsis or shock, inadequate empirical treatment was associated with increased mortality at days 14 and 30 (odds ratios [ORs], 2.12 and 1.56; 95% confidence intervals [95% CI], 1.34 to 3.34 and 1.01 to 2.40, respectively). The adjusted ORs after a propensity score-based matched analysis were 3.03 and 1.70 (95% CI, 1.60 to 5.74 and 0.98 to 2.98, respectively). In conclusion, inadequate empirical therapy is independently associated with increased mortality in patients with BSI. Programs to improve the quality of empirical therapy in patients with suspicion of BSI and optimization of definitive therapy should be implemented. PMID:22005999

  10. Potential Factors for Inadequate Voriconazole Plasma Concentrations in Intensive Care Unit Patients and Patients with Hematological Malignancies

    PubMed Central

    Duettmann, Wiebke; Raggam, Reinhard B.; Seeber, Katharina; Troppan, Katharina; Fruhwald, Sonja; Prueller, Florian; Wagner, Jasmin; Valentin, Thomas; Zollner-Schwetz, Ines; Wölfler, Albert

    2013-01-01

    Voriconazole plasma concentrations (VPCs) vary widely, and concentrations outside the therapeutic range are associated with either worse outcome in invasive aspergillosis (IA) or increased toxicity. The primary goal of this cohort study conducted in a real-life setting was to identify potential factors associated with inadequate VPCs in ICU patients and patients with hematological malignancies. Within a period of 12 months, trough VPCs were obtained and analyzed with high-performance liquid chromatography, and the adequate range was defined as 1.5 to 5.5 mg/liter. VPCs of <1.5 mg/liter were defined as low, whereas VPCs of >5.5 mg/liter were defined as potentially toxic. A total of 221 trough VPCs were obtained in 61 patients receiving voriconazole, and 124/221 VPCs (56%) were found to be low. Multivariate analysis revealed that low VPCs were significantly associated with clinical failure of voriconazole, prophylactic use, younger age, underlying hematological malignancy, concomitant proton pump inhibitor (PPI) (pantoprazole was used in 88% of the patients), and absence of side effects. Low VPCs remained an independent predictor of clinical failure of voriconazole. The defined adequate range was reached in 79/221 (36%) VPCs. In 18 samples (8%), potentially toxic levels were measured. Multivariate analysis revealed higher body mass index (BMI), absence of hematological malignancy, therapeutic application, and diarrhea as factors associated with potentially toxic VPCs. Neurotoxic adverse events occurred in six patients and were mostly associated with VPCs in the upper quartile of our defined adequate range. In conclusion, potential factors like younger age, prophylaxis, underlying hematological malignancy, BMI, and concomitant PPI should be considered within the algorithm of voriconazole treatment. PMID:23629724

  11. Hypertension.

    PubMed

    Oparil, S; Calhoun, D A

    1989-03-01

    An estimated 58 million Americans are at increased risk of morbidity and premature death due to high blood pressure (BP) and require some type of therapy or systematic monitoring. This article focuses on recent advances in our understanding of the pathogenesis of hypertension, new approaches to the diagnosis and treatment of secondary hypertension, and current views of the most appropriate nonpharmacologic and pharmacologic therapy for essential hypertension. In view of the extremely high prevalence of the disorder, emphasis is placed on efficient and cost-effective strategies for diagnosing and managing the hypertensive patient. Recent evidence indicates that nonpharmacologic therapy, including dietary potassium and calcium supplements, reduction of salt intake, weight loss for the obese patient, regular exercise, a diet high in fiber and low in cholesterol and saturated fats, smoking cessation, and moderation of alcohol consumption produces significant sustained reductions in BP while reducing overall cardiovascular risk. Accordingly, nonpharmacologic antihypertensive therapy should be included in the treatment of all hypertensive patients. In persons with mild hypertension, nonpharmacologic approaches may adequately reduce BP, thereby avoiding the expense and potential side effects of drug therapy. In patients with more severe hypertension, nonpharmacologic therapy, used in conjunction with pharmacologic therapy, can reduce the dosage of antihypertensive medications necessary for BP control. Patients treated with nonpharmacologic therapy only should be followed closely, and if BP control is not satisfactory, drug therapy should be added. The large number of drugs available for use in hypertension treatment, coupled with our rapidly expanding knowledge of the pathophysiology of hypertension and of the adverse effects of these drugs in individual patient groups, make it possible to individualize antihypertensive treatment. When used as monotherapy, most agents

  12. Microbiological changes after periodontal therapy in diabetic patients with inadequate metabolic control.

    PubMed

    Silva-Boghossian, Carina Maciel; Orrico, Silvana Regina Perez; Gonçalves, Daniela; Correa, Fernanda Oliveira Bello; Colombo, Ana Paula Vieira

    2014-01-01

    The present study investigated the effect of non-surgical periodontal treatment (SRP) on the composition of the subgingival microbiota of chronic periodontitis (CP) in individuals with type 2 diabetes (DM2) with inadequate metabolic control and in systemically healthy (SH) individuals. Forty individuals (20 DM2 and 20 SH) with CP underwent full-mouth periodontal examination. Subgingival plaque was sampled from 4 deep sites of each individual and tested for mean prevalence and counts of 45 bacterial taxa by the checkerboard method. Clinical and microbiological assessments were performed before and 3 months after SRP. At baseline, those in the DM2 group presented a significantly higher percentage of sites with visible plaque and bleeding on probing compared with those in the SH group (p<0.01). Those in the DM2 group presented significantly higher levels of C. rectus and P. gingivalis, and lower prevalence of P. micra and S. anginosus, compared with those in the SH group (p≤0.001). At the 3-month visit, both groups showed a significant improvement in all clinical parameters (p<0.01). Those in the DM2 group showed significantly higher prevalence and/or levels of A. gerencseriae, A. naeslundii I, A. oris, A. odontolyticus, C. sputigena, F. periodonticum, and G. morbillorum compared with those in the SH group (p≤0.001). However, those in the DM2 group showed a significant reduction in the levels of P. intermedia, P. gingivalis, T. forsythia, and T. denticola (p≤0.001) over time. Those in the SRP group showed improved periodontal status and reduced levels of putative periodontal pathogens at 3 months' evaluation compared with those in the DM2 group with inadequate metabolic control. PMID:24918369

  13. Exercise in Treating Hypertension: Tailoring Therapies for Active Patients.

    ERIC Educational Resources Information Center

    Chintanadilok, Jirayos

    2002-01-01

    Exercise can be definitive therapy for some, and adjunctive therapy for many, people with hypertension, though people with secondary hypertension may not derive as much benefit. Low-to- moderate-intensity aerobic exercise can help with mild hypertension and reduce drug dosages in more severe cases. For active patients requiring medication,…

  14. Towards a framework for better management of patients with hypertension.

    PubMed

    Mabotuwana, Thusitha; Warren, Jim

    2009-01-01

    Management of patients with hypertension is poor and novel tools are needed to identify patients whose clinical outcomes can be improved. We herein present a framework we have developed that can be used to identify patients who meet specific audit criteria related to poor management of hypertension. Identified patients would benefit from an immediate follow-up by a practice nurse. PMID:19745349

  15. Pregabalin for the treatment of patients with generalized anxiety disorder with inadequate treatment response to antidepressants and severe depressive symptoms.

    PubMed

    Olivares, José M; Álvarez, Enrique; Carrasco, José L; Pérez Páramo, María; López-Gómez, Vanessa

    2015-09-01

    To evaluate the effectiveness of pregabalin in patients with resistant generalized anxiety disorder (GAD) and severe depressive symptoms, we carried out a post-hoc analysis of a multicenter, prospective, and observational 6-month study. We included patients who were at least 18 years old, fulfilled the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria for GAD, showed inadequate responses to previous courses of antidepressant treatment, had Montgomery-Asberg Rating Scale scores of at least 35, had not received pregabalin previously, and were prescribed pregabalin upon entry into this study. We included 1815 patients fulfilling the DSM-IV criteria for GAD, and 133 (7.3%) fulfilled the selection criteria for these analyses. Ninety-seven percent of the patients received pregabalin (mean dose: 222 mg/day) in combination with other psychotropics. The Hamilton Anxiety Scale total score was reduced by a mean of 20.3 points (95% confidence interval, 22.1-18.4) (57.2% reduction) at month 6. Pregabalin also ameliorated comorbid depressive symptoms, with a reduction in the mean score of the Montgomery-Asberg Rating Scale of 22.3 points (95% confidence interval, 24.2-20.4) (56.6% reduction). Our results suggest that pregabalin, as part of a combination regimen with antidepressants and/or benzodiazepines, might be effective for the treatment of patients with GAD who have shown inadequate response to previous antidepressants and have severe depressive symptoms. PMID:26111356

  16. Blood Pressure Control in Hypertensive Patients in the "Hiperdia Program": A Territory-Based Study

    PubMed Central

    de Souza, Clarita Silva; Stein, Airton Tetelbom; Bastos, Gisele Alsina Nader; Pellanda, Lucia Campos

    2014-01-01

    Background Systemic hypertension is highly prevalent and an important risk factor for cardiovascular events. Blood pressure control in hypertensive patients enrolled in the Hiperdia Program, a program of the Single Health System for the follow-up and monitoring of hypertensive patients, is still far below the desired level. Objective To describe the epidemiological profile and to assess blood pressure control of patients enrolled in Hiperdia, in the city of Novo Hamburgo (State of Rio Grande do Sul, Brazil). Methods Cross-sectional study with a stratified cluster random sample, including 383 adults enrolled in the Hiperdia Program of the 15 Basic Health Units of the city of Porto Alegre, conducted between 2010 and 2011. Controlled blood pressure was defined as ≤140 mmHg × 90 mmHg. The hypertensive patients were interviewed and their blood pressure was measured using a calibrated aneroid device. Prevalence ratios (PR) with 95% confidence interval, Wald's χ2 test, and simple and multiple Poisson regression were used in the statistical analysis. Results The mean age was 63 ± 10 years, and most of the patients were females belonging to social class C, with a low level of education, a sedentary lifestyle, and family history positive for systemic hypertension. Diabetes mellitus (DM) was observed in 31%; adherence to the antihypertensive treatment in 54.3%; and 33.7% had their blood pressure controlled. DM was strongly associated with inadequate BP control, with only 15.7% of the diabetics showing BP considered as controlled. Conclusion Even for hypertensive patients enrolled in the Hiperdia Program, BP control is not satisfactorily reached or sustained. Diabetic hypertensive patients show the most inappropriate BP control. PMID:25004419

  17. Patient kidney disease knowledge remains inadequate with standard nephrology outpatient care

    PubMed Central

    Gray, Nicholas A.; Kapojos, Jola J.; Burke, Michael T.; Sammartino, Christine; Clark, Carolyn J.

    2016-01-01

    Background Chronic kidney disease (CKD) knowledge among patients newly referred to a nephrology clinic is limited. This study aimed to determine if CKD knowledge 1 year after initial consultation in a nephrology clinic improves with standard care. Methods Patients newly referred to a nephrology outpatient clinic received standard care from nephrologists, and had access to educational pamphlets, relevant internet sites and patient support groups. Those with estimated glomerular filtration rate <20 mL/min/1.73 m2 received individual education from a multi-disciplinary team. Knowledge was assessed by questionnaire at first visit and after 12 months. Results Of 210 patients at baseline, follow-up data were available at 12.7 (±1.7) months for 95. Median age was 70 [interquartile range (IQR) 60–76] years and 54% were male. Baseline median creatinine of the follow-up cohort was 137 (IQR 99–179) µmol/L. Eighty per cent had seen a nephrologist at least three times, 8% saw a CKD nurse, 50% reported collecting pamphlets and 16% reported searching the internet. At 12 months, fewer patients reported being uncertain why they had been referred (5 versus 20%, P = 0.002) and fewer reported being unsure of the meaning of CKD (37 versus 57%, P = 0.005). Unknown (44%) and alcohol (23%) remained the most common causes of CKD identified. Fewer patients responded ‘unsure’ regarding the treatment of CKD (38 versus 57%, P = 0.004). Conclusions After a year of standard care at nephrology outpatient clinics there were some minor improvements in patient knowledge; however, patient understanding of CKD remained poor. PMID:26798471

  18. Hypertension.

    PubMed

    Poulter, Neil R; Prabhakaran, Dorairaj; Caulfield, Mark

    2015-08-22

    Raised blood pressure is the biggest single contributor to the global burden of disease and to global mortality. The numbers of people affected and the prevalence of high blood pressure worldwide are expected to increase over the next decade. Preventive strategies are therefore urgently needed, especially in less developed countries, and management of hypertension must be optimised. Genetic advances in some rare causes of hypertension have been made lately, but the aggregate effect on blood pressure of all the genetic loci identified to date is small. Hence, intervention on key environmental determinants and effective implementation of trial-based therapies are needed. Three-drug combinations can control hypertension in about 90% of patients but only if resources allow identification of patients and drug delivery is affordable. Furthermore, assessment of optimal drug therapy for each ethnic group is needed. PMID:25832858

  19. Does this patient have hypertensive encephalopathy?

    PubMed

    Christopoulou, Foteini; Rizos, Evangelos C; Kosta, Paraskevi; Argyropoulou, Maria I; Elisaf, Moses

    2016-05-01

    A 63-year-old man was admitted to our hospital for further investigation and management of brain metastases. The patient was initially presented with a 4-day history of confusion. On the day of admission, the patient was confused, agitated, disorientated in place and time, and had visual disturbances. His blood pressure was repeatedly recorded high, with levels of systolic blood pressure between 170-210 mm Hg. A brain magnetic resonance imaging showed areas of high signal on T2 and fluid-attenuated inversion recovery images, located bilaterally in the white matter of the occipital regions and unilateral in the left frontal lobe, suggestive of posterior reversible encephalopathy syndrome. Aggressive treatment of hypertension resulted in complete resolution of the clinical and radiologic features of the syndrome. PMID:26896240

  20. New drugs and indications in 2010: inadequate assessment; patients at risk.

    PubMed

    2011-04-01

    In 2010, we rated 97 new drugs or new indications in our French edition la revue Prescrire, only 4 of which provided a therapeutic advantage. However, 19 others (1 in 5) were approved despite having more harms than benefits. More paediatric products were released in 2010 than in previous years, but few of them made any real difference and many had not been properly evaluated. Drug regulatory agencies can protect patients from exposure to dangerous drugs by refusing to grant market approval or by demanding their market withdrawal.Yet they are failing to fulfil this responsibility: so-called risk management plans and modifications to the wording in the SPC are only half-measures. Too often the authorities put companies' short-term financial interests above patients' well-being by granting premature marketing authorisation, by agreeing to high levels of reimbursement that fail to take added therapeutic value into account, and by allowing the development of "umbrella" ranges. The European authorities' questionable plans for pharmacovigilance and advertising of prescription-only drugs were restricted after public mobilisation, but they are still likely to undermine healthcare quality. Decision-makers must make patients' well-being their top priority. PMID:21648217

  1. [Determination of endoxin in hypertensive patients].

    PubMed

    Gorjão Clara, J; Breitenfeld, B; Bicho, M; Moreira, C; Carvalho, C; Boaventura, I; Manso, C; Nogueira da Costa, J

    1991-01-01

    Digoxin like immunoreactive factor (DLIF), has been implicated on the effect of sodium in essential hypertension. The different concentration of DLIF as a function of sodium intake was demonstrated in animal experience by some authors. In this work the urinary DLIF excretion is evaluated by RIA and its biological activity by Na+/K+ ATPase inhibition, in 5 urine samples at the end of a free sodium diet week and in 10 urine samples in the last day of a week with 250 mg sodium diet. The urinary DLIF excretion after the free sodium diet week was 0.3460 +/- 0.055 and at the end of sodium restriction diet week of 0.2910 +/- 0.061 nmol/l. Although the DLIF values in the sodium restriction week were smaller than the DLIF values of the free sodium diet week, there was no statistical difference (p = 0.113). In five patients the DLIF could be evaluated at the end of the first and second weeks without changes in the hypertensive therapeutics, with clonidine and nifedipine, along the two weeks. In these five patients at the end of the free sodium diet week and at end of the sodium restricted diet week were 0.3460 +/- 0.055 and 0.2780 +/- 0.060 nmol/l. The reduction of urinary DLIF excretion in the sodium restricted diet week, was significative (p = 0.020). The results of the Na/K ATPase inhibition in the same five patients were: 34.6 +/- 6.51% at the end of the free sodium diet week and 31.7 +/- 6.32% at the end of the sodium restricted diet week, the differences were not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1647807

  2. Pulmonary hypertension in patients with Martorell hypertensive leg ulcer: a case control study

    PubMed Central

    2012-01-01

    Background Martorell hypertensive ischemic leg ulcer (Martorell ulcer) is characterized by distinct alterations in the arteriolar wall of subcutaneous vessels, leading to progressive narrowing of the vascular lumen and increase of vascular resistance. These changes are similar to the alterations observed in pulmonary arterioles in patients with chronic pulmonary hypertension (PH). This study was aimed to assess an association between the two disorders. Methods In this case–control study, 14 patients with Martorell ulcer were clinically assessed for the presence of pulmonary hypertension using transthoracic Doppler echocardiography. Data from patients were compared to 28 matched hypertensive controls. Results Systolic pulmonary arterial pressure (sPAP) in patients with Martorell ulcer was significantly higher than in the control group (33.8 ± 16.9 vs 25.3 ± 6.5 mmHg, p = 0.023); the prevalence of pulmonary hypertension was 31% (5/14) in patients and 7% (2/28) in controls (p = 0.031). No differences were seen in left heart size and function between patients and controls. Conclusion This study provides first evidence that subcutaneous arteriolosclerosis, the hallmark of Martorell ulcer, is associated with PH. These findings suggest that patients with Martorell leg ulcer might be at significant risk to develop elevated pulmonary arterial pressure. Patients with leg ulcers who present with dyspnea should be evaluated by echocardiography for the presence of pulmonary hypertension. PMID:22686459

  3. The Effect of Inadequate Initial Empiric Antimicrobial Treatment on Mortality in Critically Ill Patients with Bloodstream Infections: A Multi-Centre Retrospective Cohort Study

    PubMed Central

    Savage, Rachel D.; Fowler, Robert A.; Rishu, Asgar H.; Bagshaw, Sean M.; Cook, Deborah; Dodek, Peter; Hall, Richard; Kumar, Anand; Lamontagne, François; Lauzier, François; Marshall, John; Martin, Claudio M.; McIntyre, Lauralyn; Muscedere, John; Reynolds, Steven; Stelfox, Henry T.; Daneman, Nick

    2016-01-01

    Hospital mortality rates are elevated in critically ill patients with bloodstream infections. Given that mortality may be even higher if appropriate treatment is delayed, we sought to determine the effect of inadequate initial empiric treatment on mortality in these patients. A retrospective cohort study was conducted across 13 intensive care units in Canada. We defined inadequate initial empiric treatment as not receiving at least one dose of an antimicrobial to which the causative pathogen(s) was susceptible within one day of initial blood culture. We evaluated the association between inadequate initial treatment and hospital mortality using a random effects multivariable logistic regression model. Among 1,190 patients (1,097 had bacteremia and 93 had candidemia), 476 (40%) died and 266 (22%) received inadequate initial treatment. Candidemic patients more often had inadequate initial empiric therapy (64.5% versus 18.8%), as well as longer delays to final culture results (4 vs 3 days) and appropriate therapy (2 vs 0 days). After adjustment, there was no detectable association between inadequate initial treatment and mortality among bacteremic patients (Odds Ratio (OR): 1.02, 95% Confidence Interval (CI) 0.70–1.48); however, candidemic patients receiving inadequate treatment had nearly three times the odds of death (OR: 2.89, 95% CI: 1.05–7.99). Inadequate initial empiric antimicrobial treatment was not associated with increased mortality in bacteremic patients, but was an important risk factor in the subgroup of candidemic patients. Further research is warranted to improve early diagnostic and risk prediction methods in candidemic patients. PMID:27152615

  4. Nerve conduction velocity in hypertensive patients.

    PubMed

    Halar, E M; Stewart, D T; Venkatesh, B; Chrissian, S A

    1978-01-01

    Due to conflicting reports in the literature regarding nerve conduction velocities (NCVs) in hypertensives, peroneal and sural NCVs and facial nerve conduction latencies were studied in 30 hypertensives and in 30 controls. An improved technique of NCV measurement was used. Twenty-one of the hypertensives were retested after five weeks, and five of them were tested for motor and sensory NCVs of the median nerve during a short period of partial occlusion of blood flow in the arm. No changes were found that could be related to blood pressure, duration of hypertension, eyeground changes, or partial restriction of blood flow. PMID:619818

  5. Chronic thromboembolic pulmonary hypertension: treat the patient not the haemodynamics.

    PubMed

    Dunne, Ben; van den Broek, Annika; Williams, Vaughan; Smith, Gregory; Revesz, Tamas; Edwards, Mark; Gabbay, Eli

    2012-01-01

    Chronic thromboembolic pulmonary hypertension (CTEPH) is a disabling condition that is being increasingly recognised. It is unique as a cause of pulmonary hypertension in that it is surgically curable. We wish to highlight the importance of recognition and early referral of any patient who may have CTEPH even in the absence of resting pulmonary hypertension as excellent results can be achieved by restoring pulmonary vascular anatomy, reducing exercise-induced pulmonary hypertension, and reducing dead-space ventilation. We present a case that illustrates these points and discuss our experience as a referral centre for CTEPH. PMID:23133777

  6. Chronic Thromboembolic Pulmonary Hypertension: Treat the Patient Not the Haemodynamics

    PubMed Central

    Dunne, Ben; van den Broek, Annika; Williams, Vaughan; Smith, Gregory; Revesz, Tamas; Edwards, Mark; Gabbay, Eli

    2012-01-01

    Chronic thromboembolic pulmonary hypertension (CTEPH) is a disabling condition that is being increasingly recognised. It is unique as a cause of pulmonary hypertension in that it is surgically curable. We wish to highlight the importance of recognition and early referral of any patient who may have CTEPH even in the absence of resting pulmonary hypertension as excellent results can be achieved by restoring pulmonary vascular anatomy, reducing exercise-induced pulmonary hypertension, and reducing dead-space ventilation. We present a case that illustrates these points and discuss our experience as a referral centre for CTEPH. PMID:23133777

  7. Assessment of Mean Platelet Volume in Patients with Resistant Hypertension, Controlled Hypertension and Normotensives

    PubMed Central

    Surgit, Ozgur; Pusuroglu, Hamdi; Erturk, Mehmet; Akgul, Ozgur; Buturak, Ali; Akkaya, Emre; Gul, Mehmet; Uygur, Begum; Yazan, Serkan; Eksik, Abdurrahman

    2015-01-01

    Objective: Patients with resistant hypertension are at increased risk for cardiovascular events. Mean platelet volume (MPV) is an accepted biomarker of platelet activation and considered as a risk factor for cardiovascular disease. The aim of this study was to determine whether MPV levels are higher in resistant hypertensive (RHTN) patients than in controlled hypertensive (CHTN) patients and healthy normotensive controls. Materials and Methods: 279 consecutive patients were included in this study. Patients were divided into three groups: Resistant hypertension patient group [n=78; mean age 56.8±9.8; 42 males (53.8%)]; controlled hypertension patient group [n=121; mean age 54.1±9.6; 49 males (40.5%)]; and normotensive control group [n=80; mean age 49.8±8.5; 34 males (42.5%)]. Physical examination, laboratory work-up, and 24-hour ambulatory blood pressure measurement (ABPM) were performed in all participants. Results: The mean platelet volume levels were significantly higher in RHTN group than in the CHTN and normotensive groups (p<0.001). In correlation analysis office systolic and diastolic blood pressure was positively correlated with MPV. Conclusion: Our study demonstrated that MPV, as an important indicator of platelet activation, was statistically higher in RHTN patients than in CHTN and in normotensive subjects. Elevated MPV levels may help to determine a high risk group for atherosclerosis in RHTN patients. PMID:26180490

  8. Supervised drug administration in patients with refractory hypertension unmasking noncompliance.

    PubMed Central

    Cronin, C. C.; Higgins, T. M.; Murphy, M. B.; Ferriss, J. B.

    1997-01-01

    Noncompliance with medication is common, particularly in asymptomatic conditions such as hypertension that require long-term treatment, and is often unsuspected. We describe two patients with refractory hypertension in whom noncompliance was confirmed by a precipitous fall in blood pressure when antihypertensive medications were given under direct supervision. PMID:9156129

  9. Efficacy and safety of naloxegol in patients with opioid-induced constipation and laxative-inadequate response

    PubMed Central

    Tack, Jan; Lappalainen, Jaakko; Diva, Ulysses; Tummala, Raj

    2015-01-01

    Background Treatment options for patients with opioid-induced constipation (OIC) and inadequate response to laxatives (LIR) are few. Objective Assess the efficacy and safety of orally administered naloxegol in patients with prospectively confirmed OIC and LIR Methods We analyzed pooled data from two identical randomized, double-blind, placebo-controlled, Phase 3 trials of naloxegol in patients with non-cancer pain, OIC and LIR in which naloxegol (12.5 mg, n = 240; 25 mg, n = 241) or placebo (n = 239) were administered daily. We assessed the response rates, time to first post-dose laxation, spontaneous bowel movements (SBMs), OIC symptoms and patient-reported outcomes over 12 weeks. Results OIC response rates for the naloxegol 25-mg (p < 0.001) and the 12.5-mg (p = 0.005) LIR dose groups were higher than placebo. Median times to first post-dose SBM were 7.6, 19.2 and 41.1 hours for the naloxegol 25 mg, naloxegol 12.5 mg and placebo groups, respectively. Other SBM measures, daily symptoms of OIC, and both the Patient Assessment of Constipation - Symptoms and Patient Assessment of Constipation-Quality of Life scores improved from baseline with naloxegol treatment. Changes from baseline in opioid dose, pain scores and opioid withdrawal scores were similar among treatment groups. Conclusions Naloxegol was efficacious, generally safe and well tolerated in the patients with OIC and LIR, while preserving opioid analgesia. ClinicalTrials.gov identifiers: NCT01309841; NCT01323790 PMID:26535126

  10. [Kinking of the endotracheal tube in a prone patient associated with the inadequate withdrawal maneuver of the Pentax-AWS Airway Scope].

    PubMed

    Ohata, Hiroto; Iida, Yuko; Kito, Kazuhiro; Kawamura, Michika; Yamashita, Mika; Ohta, Shuichiro; Ueda, Norio; Iida, Hiroki

    2013-06-01

    We report a case of intraoperative kinking of an endotracheal tube (ETT) in a prone patient during spine surgery. We postulate that one of the risk factors involved with kinking was the inadequate withdrawal maneuver of Pentax-AWS Airway Scope (AWS). Patient was a 69-year-old woman with hypertension, diabetes mellitus, and rheumatoid arthritis, undergoing C4-6 laminoplasty under general anesthesia in the prone position. A 7.0-mm polyvinyl endotracheal tube (Paker Flex-Tip Tube) was placed to 21 cm at the right angle of the mouse without difficulty using the AWS. Both peak inspiratory pressure (PIP) and partial pressure of end-tidal carbon dioxide began to rise gradually from 24 to 28 cmH2O and 38 to 44 mmHg, respectively. Although over 30 cmH2O in PIP repeatedly appeared after that, we did not find any remarkable change of ventilation except for weak breath sound. Thereafter, when we checked the tube with a flexible fiberoptic bronchoscope, it could not pass through the tube. At first, we asked the surgeon to release neck flexion as much as possible. This procedure could not correct the kink completely but allowed the passage of bronchoscope in the ETT. Then, we tried to reposition the ETT by inserting the bronchoscope beyond the point of kinking for maintaining luminal patency and adequate ventilation. The subsequent anesthetic course was uneventful. Kinking of the ETT in the oral cavity is an uncommon problem but we must keep in mind as one of the differential diagnoses. When using the AWS for endotracheal intubation, we recommend the confirmation of the position of the ETT to be normal in the oral cavity by direct laryngoscopy. PMID:23814989

  11. Patient and provider perceptions of hypertension treatment: do they agree?

    PubMed

    Kaboli, Peter J; Shivapour, Daniel M; Henderson, Michael S; Barnett, Mitchell J; Ishani, Areef; Carter, Barry L

    2007-06-01

    The objective of our study was to explore physician and patient attitudes regarding hypertension management. One hundred forty-five primary care providers and 189 patients with hypertension at 6 Veterans Administration clinics completed a hypertension survey. Fifty-one percent of patients were at their blood pressure goal, 58% were on guideline-concordant therapy, and 31% achieved both. Patients and providers agreed that physicians were a "very/extremely" useful source of information but differed in perceived value of pharmacists, educational material, advertising, and the Internet. They also agreed on the value of preventing cardiovascular events but differed in their perceptions of the importance of medication costs, side effects, and national guidelines. Blood pressure control and guideline-concordant therapy was higher than most prior reports, but with opportunity for improvement. Patients and providers differed in perceived value of various aspects of hypertension management; this information may help to determine trial design and quality improvement strategies in the future. PMID:17541326

  12. Intrathecal chemotherapy alone is inadequate central nervous system prophylaxis in patients with intermediate-grade non-Hodgkin's lymphoma.

    PubMed

    Chua, S L; Seymour, J F; Streater, J; Wolf, M M; Januszewicz, E H; Prince, H M

    2002-09-01

    Central nervous system (CNS) relapse of non-Hodgkin's lymphoma (NHL) is usually fatal despite therapy and effective prophylaxis is desirable. Patients at high-risk usually receive intrathecal (i.t.) prophylaxis, although its efficacy is unproven. We therefore analyzed the outcome of all patients with newly diagnosed "intermediate-grade" NHL receiving i.t. prophylaxis from 1991 to 1999. Twenty-six patients were identified and analyzed. All were free of CNS involvement at diagnosis with negative cerebrospinal fluid (CSF) cytology. Disease stage was IE in 7, and IV in 19, with a median of two extranodal sites involved. Serum lactate dehydrogenase was elevated in 65%, and the median International Prognostic Factors Index score was 3 (range 0-5). Anthracycline-based chemotherapy was used in all cases and included high-dose methotrexate +/- ara-C in six patients. The median number of i.t. treatments was 5 (range 1-12) and comprised methotrexate +/- steroid in 15, together with ara-C in 11. The actuarial 3-year CNS-relapse rate was 26 +/- 10%. Six CNS-relapses were observed and involved the spinal cord or brain parenchyma in two cases each, and the leptomeninges in four patients. Treatment-related variables associated with higher CNS-relapse rates (34-50%) were: delay of > or = 14 days from diagnosis to first i.t. injection, < 5 i.t. treatments, delay of i.t. prophylaxis until after attaining CR and systemic treatment lacking high-dose methotrexate +/- ara-C (each P < or = 0.17). I.t. CNS prophylaxis, as used here, was inadequate. Alternative approaches should be pursued. PMID:12685832

  13. Management of vascular risk factors in the hypertensive patient.

    PubMed

    Taylor, S H

    1990-10-01

    Understanding of the multiple risk factors for premature vascular degeneration is essential for the most effective management of the hypertensive patient. High blood pressure is the most important single predictor of coronary heart disease risk in general clinical practice in the UK. However, hypertension is only a marker of an apparent excess of other risk factors for coronary heart disease among hypertensive patients. The global management of the patient is further complicated for two reasons. First, many of the risk factors are complexly interrelated, either biologically or by lifestyle. Second, the attempted correction of one factor is fraught with the potential for aggravation of the others. The benefits to the coronary and vascular risk profile from lowering blood pressure may be offset, partially or completely, by the aggravation of other risk factors by the antihypertensive drug used. Optimum management of the hypertensive patient can only be achieved when all the risk factors for coronary heart disease in that individual are modified. PMID:2148191

  14. Effect of pasireotide on glucose- and growth hormone-related biomarkers in patients with inadequately controlled acromegaly.

    PubMed

    Schmid, Herbert A; Brue, Thierry; Colao, Annamaria; Gadelha, Mônica R; Shimon, Ilan; Kapur, Karen; Pedroncelli, Alberto M; Fleseriu, Maria

    2016-07-01

    The purpose of this study was to gain more insight into the mechanism of action of pasireotide in patients who completed the PAOLA study. PAOLA was a 24-week, Phase III, randomized, three-arm study of pasireotide LAR 40 and 60 mg versus octreotide LAR 30 mg or lanreotide Autogel 120 mg in patients with inadequately controlled acromegaly. The current work was a planned exploratory objective of the PAOLA study that evaluated changes in levels of growth hormone (GH), insulin-like growth factor 1 (IGF-1), IGF-binding proteins (IGFBP-2, IGFBP-3), glycated haemoglobin (HbA1c) and fasting plasma glucose (FPG) in each treatment arm. Responders to pasireotide LAR (mean GH levels <2.5 μg/L and normal IGF-1 levels at 24 weeks) had lower GH and IGF-1 levels at baseline (GH 5.1 ng/mL, IGF-1 519 ng/mL) than non-responders (GH 7.9 ng/mL, IGF-1 672 ng/mL). Frequency of hyperglycaemia after pasireotide treatment was similar in responders and non-responders and depended more on the baseline FPG level. 47 % of all patients treated with pasireotide LAR (40 or 60 mg) did not receive antidiabetic medication at any time during this study. This is the first study to evaluate the treatment effect of pasireotide on key hormonal and glycaemic biomarkers and to identify potential predictors of pasireotide-associated hyperglycaemia. Pre-treatment glucose status may be predictive of the development of pasireotide-associated hyperglycaemia. A large subset of patients with acromegaly does not experience major disturbances in glucose homeostasis while receiving pasireotide LAR. PMID:26906713

  15. Factors affecting medication adherence in patients with hypertension.

    PubMed

    Karakurt, Papatya; Kaşikçi, Mağfiret

    2012-12-01

    The aim of this study descriptive study was to evaluate concordance with medication and those factors that affect the use of medicine in patients with hypertension. Data were collected using a questionnaire completed by 750 patients with hypertension between December 25, 2003, and April 30, 2004, in an outpatient hypertension clinic in Erzincan, Turkey. It was found that 57.9% of the patients did not use their medicines as prescribed. Forgetfulness, aloneness, and negligence were ranked as the top three reasons for this non-concordance, accounting for almost half (49.3%) of all patients with hypertension studied; price (expensive medicines) accounted for another quarter (26.5%). A statistically significant relationship with non-concordance was found for age, education level and profession. Patients' lack of knowledge related to the complications of hypertension was also found to have a statistically significant relationship with not taking medicines as prescribed. Gender, location of residence and salary were not found to be statistically related to concordance. These results indicate the need to educate patients with hypertension on how to use their medicine regularly and indicate also the target populations for this. PMID:23127428

  16. Patient Cases 2. A Patient with Apparent Resistant Hypertension.

    PubMed

    Aguiar, Carlos

    2015-07-01

    True treatment-resistant hypertension (TRH) is defined by specific criteria and a failure to response to initial therapy options does not necessarily mean that a patient has TRH. In this case, a 44-year-old male was discharged on a fixed combination of valsartan/hydrochlorothiazide (HCTZ) 160/125 mg/day after presenting to the emergency room with paraesthesia of the upper left limb and recording a blood pressure (BP) of 190/110 mmHg. The patient had a number of other cardiovascular (CV) risk factors, and was determined to be at high risk of developing type 2 diabetes mellitus and of CV death. Carvedilol and atorvastatin were added, but 24-h ambulatory BP monitoring (ABPM) showed persistent hypertension. After specialist assessment, the patient's antihypertensive regimen was switched to a fixed-dose combination of olmesartan/HCTZ in the morning and a fixed-dose combination of olmesartan/amlodipine in the evening. Repeat ABPM 6 weeks later showed better BP control then previous ABPM. PMID:26072255

  17. High Prevalence of Insecure Attachment in Patients with Primary Hypertension.

    PubMed

    Balint, Elisabeth M; Gander, Manuela; Pokorny, Dan; Funk, Alexandra; Waller, Christiane; Buchheim, Anna

    2016-01-01

    Hypertension is a major cardiovascular (CV) risk factor and is predicted by heightened CV reactivity to stress in healthy individuals. Patients with hypertension also show an altered stress response, while insecure attachment is linked to a heightened stress reactivity as well. This is the first study aiming to assess attachment representations in patients with primary hypertension and to investigate their CV responses when their attachment system is activated. We studied 50 patients (38 men, 12 women) with primary hypertension. The Adult Attachment Projective Picture System (AAP), a widely used and validated interview, was performed to measure the patients' attachment representations, and to activate their attachment system. Blood pressure and heart rate were measured after 10 min at rest prior to and directly after the AAP interview. Mood and state anxiety were assessed using the Multidimensional Mood State Questionnaire (MDBF) and the State Trait Anxiety Inventory-State (STAI-S) before and after the experiment. The prevalence of insecure attachment (dismissing, preoccupied, unresolved) in hypertensive patients was predominant (88%), while in non-clinical populations, only about 50% of individuals had insecure attachment patterns. Blood pressure (p < 0.001), heart rate (p = 0.016), and rate pressure product (p < 0.001) significantly increased in response to the attachment interview. Secure attached patients showed the highest rise in systolic blood pressure (p = 0.020) and the lowest heart rate compared to the other attachment groups (p = 0.043). However, attachment representation showed no significant group or interaction effects on diastolic blood pressure (DBP) and rate pressure product. Insecure attachment was highly over-represented in our sample of patients with primary hypertension. Additionally, a robust CV response to the attachment-activating stimulus was observed. Our data suggest that insecure attachment is significantly linked to primary hypertension

  18. High Prevalence of Insecure Attachment in Patients with Primary Hypertension

    PubMed Central

    Balint, Elisabeth M.; Gander, Manuela; Pokorny, Dan; Funk, Alexandra; Waller, Christiane; Buchheim, Anna

    2016-01-01

    Hypertension is a major cardiovascular (CV) risk factor and is predicted by heightened CV reactivity to stress in healthy individuals. Patients with hypertension also show an altered stress response, while insecure attachment is linked to a heightened stress reactivity as well. This is the first study aiming to assess attachment representations in patients with primary hypertension and to investigate their CV responses when their attachment system is activated. We studied 50 patients (38 men, 12 women) with primary hypertension. The Adult Attachment Projective Picture System (AAP), a widely used and validated interview, was performed to measure the patients' attachment representations, and to activate their attachment system. Blood pressure and heart rate were measured after 10 min at rest prior to and directly after the AAP interview. Mood and state anxiety were assessed using the Multidimensional Mood State Questionnaire (MDBF) and the State Trait Anxiety Inventory-State (STAI-S) before and after the experiment. The prevalence of insecure attachment (dismissing, preoccupied, unresolved) in hypertensive patients was predominant (88%), while in non-clinical populations, only about 50% of individuals had insecure attachment patterns. Blood pressure (p < 0.001), heart rate (p = 0.016), and rate pressure product (p < 0.001) significantly increased in response to the attachment interview. Secure attached patients showed the highest rise in systolic blood pressure (p = 0.020) and the lowest heart rate compared to the other attachment groups (p = 0.043). However, attachment representation showed no significant group or interaction effects on diastolic blood pressure (DBP) and rate pressure product. Insecure attachment was highly over-represented in our sample of patients with primary hypertension. Additionally, a robust CV response to the attachment-activating stimulus was observed. Our data suggest that insecure attachment is significantly linked to primary hypertension

  19. Management of Hypertension among Patients with Coronary Heart Disease.

    PubMed

    Olafiranye, Oladipupo; Zizi, Ferdinand; Brimah, Perry; Jean-Louis, Girardin; Makaryus, Amgad N; McFarlane, Samy; Ogedegbe, Gbenga

    2011-01-01

    Evidence suggests that coronary heart disease (CHD) is the most common outcome of hypertension. Hypertension accelerates the development of atherosclerosis, and sustained elevation of blood pressure (BP) can destabilize vascular lesions and precipitate acute coronary events. Hypertension can cause myocardial ischemia in the absence of CHD. These cardiovascular risks attributed to hypertension can be reduced by optimal BP control. Although several antihypertensive agents exist, the choice of agent and the appropriate target BP for patients with CHD remain controversial. In this succinct paper, we examine the evidence and the mechanisms for the linkage between hypertension and CHD and we discuss the treatment options and the goals of therapy that are consistent with the report of the seventh Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) and American Heart Association scientific statement. We anticipate changes in the recommendations of the forthcoming JNC 8. PMID:21785704

  20. Pulmonary Hypertension in Hemodialysis Patients Following Repeated Endovascular Thrombectomy

    PubMed Central

    Hsieh, Mu-Yang; Lin, Lin; Chen, Tsung-Yan; Wang, Ren-Huei; Huang, Su-Chin; Liu, HsiuChiao; Lai, Chao-Lun; Pu, Shih-Yen; Tsai, Kuei-Chin; Wu, Chih-Cheng

    2016-01-01

    Background The prevalence of pulmonary hypertension is unusually high in Taiwanese patients with end-stage renal disease. Thrombosis of hemodialysis grafts is common and pulmonary embolism has been reported after endovascular thrombectomy. The aim of this study was to evaluate the relationship between pulmonary hypertension and endovascular thrombectomy of hemodialysis grafts. Methods One hundred and ten patients on hemodialysis via arteriovenous grafts were enrolled in our study. The mean pulmonary artery pressure (PAP) was measured by right heart catheterization. Clinical information was collected by review of medical records. Comorbid cardiopulmonary disease was evaluated by echocardiography and chest X-ray. The history of patient vascular access thrombosis was reviewed from database, hemodialysis records, and interviews with staff at hemodialysis centers. Results Fifty-two participants (47%) had pulmonary hypertension diagnosed by right heart catheterization. There was no difference in the number of thrombectomy procedures between patients with and without pulmonary hypertension. Based on multivariate analysis, the number of prior endovascular thrombectomy procedures did not correlate with mean PAP (F-value = 1.10, p = 0.30) nor was it associated with pulmonary hypertension (odds ratio = 0.92, p = 0.17). Conclusions Prior endovascular arteriovenous graft thrombectomies were not associated with pulmonary hypertension or increased mean PAP in end-stage renal disease patients on maintenance hemodialysis. PMID:27274170

  1. [The patient with intra-abdominal hypertension].

    PubMed

    Sakka, Samir G

    2016-01-01

    An intra-abdominal hypertension (IAH) defined as a pathological increase in intra-abdominal pressure (IAP) is commonly found on ICU admission or during the ICU stay. Several studies confirmed that an IAH is an independent predictor for mortality of critically ill patients. The abdominal compartment syndrome (ACS) which is defined as a sustained IAP>20 mmHg (with or without an abdominal perfusion pressure [APP]<60mmHg) that is associated with new organ dysfunction or failure has a mortality of up to 60%. In general, an IAH may be induced by several intra-abdominal as well as extra-abdominal conditions. Reduced abdominal wall compliance, intra-abdominal pathologies (either of the peritoneal space or parenchymateous organs) may lead to an IAH. Most commonly, intra-abdominal infections and/or sepsis and severe trauma or burns are predisposing for an IAH. An early sign may be a decrease in urinary output. The effects of an increased IAP on cardiovascular function are well recognized and include negative effects on preload, afterload and contractility. However, all other compartments of the body may be affected by an IAH. Thus, by an increase of the respective compartment pressure, e.g. intracranial pressure, a poly-compartment syndrome may result. Adequate prevention, a forward-looking strategy, and objective techniques for measurement of IAP are required to avoid or early detect an IAH or ACS. Finally, an immediate and consequent interdisciplinary management using conservative, interventional and operative options are necessary to solve an IAH or ACS. PMID:26863642

  2. [Low-flow xenon anesthesia in surgical patients with hypertension].

    PubMed

    Rashchupkin, A B; Burov, N E

    2011-01-01

    A comparative study of central hemodynamics in 60 patients with essential hypertension during low flow anesthesia with xenon and nitrous oxide is carried out. The main group consisted of 30 patients, 22 male and 8 female, in the median age of 45.9 +/- 23 years. 22 patients out of those had 2nd stage essential hypertension, while the other 8 had 3rd stage. The control group consisted of 30 patients, 20 male and 10 female, in the median age of 45.1 + 1.3 years. 4 patients had 3rd stage essential hypertension, 26 patients had 2nd stage. The both groups were clinically comparable by the character and severity of the main disease, the carried out surgery (open cholecystectomy) and the qualification of surgeons. Results of the research showed, that low flow monoanesthesia with xenon abruptly eradicated the unfavourable consequences of induction of anesthesia (3-5 mg/kg of sodium thiopental or 2-2.5 mg/kg of propofol) and had a positive effect on the parameters of central hemodynamics of patients with essential hypertension. Xenon anesthesia, compared to nitrous oxide, rapidly stabilized the parameters of blood pressure and heart rate and can be recommended as a method of choice in patients with essential hypertension and compromised myocarium. Nitrous oxide with bolus of regular fentanyl doses doesn't reliable anesthesiological protection during open cholecystectomy and shows signs of toxicity. PMID:21692217

  3. Management of patients with resistant hypertension: current treatment options

    PubMed Central

    Kumar, Nilay; Calhoun, David A; Dudenbostel, Tanja

    2013-01-01

    Resistant hypertension (RHTN) is an increasingly common clinical problem that is often heterogeneous in etiology, risk factors, and comorbidities. It is defined as uncontrolled blood pressure on optimal doses of three antihypertensive agents, ideally one being a diuretic. The definition also includes controlled hypertension with use of four or more antihypertensive agents. Recent observational studies have advanced the characterization of patients with RHTN. Patients with RHTN have higher rates of cardiovascular events and mortality compared with patients with more easily controlled hypertension. Secondary causes of hypertension, including obstructive sleep apnea, primary aldosteronism, renovascular disease, are common in patients with RHTN and often coexist in the same patient. In addition, RHTN is often complicated by metabolic abnormalities. Patients with RHTN require a thorough evaluation to confirm the diagnosis and optimize treatment, which typically includes a combination of lifestyle adjustments, and pharmacologic and interventional treatment. Combination therapy including a diuretic, a long-acting calcium channel blocker, an angiotensin-converting enzyme inhibitor, a beta blocker, and a mineralocorticoid receptor antagonist where warranted is the classic regimen for patients with treatment-resistant hypertension. Mineralocorticoid receptor antagonists like spironolactone or eplerenone have been shown to be efficacious in patients with RHTN, heart failure, chronic kidney disease, and primary aldosteronism. Novel interventional therapies, including baroreflex activation and renal denervation, have shown that both of these methods may be used to lower blood pressure safely, thereby providing exciting and promising new options to treat RHTN. PMID:24231917

  4. Prevalence and management of hypertensive patients in clinical practice: Cross-sectional registry in five countries outside the European Union.

    PubMed

    Ragot, Stéphanie; Beneteau, Mathieu; Guillou-Bonnici, Françoise; Herpin, Daniel

    2016-01-01

    Inadequate blood pressure (BP) control may be linked with poor adherence to guidelines by the treating physician. This study aimed at assessing the rates of controlled hypertension as per the 2009 Reappraisal of the 2007 European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines in 2185 hypertensive adults across five countries (Algeria, Pakistan, Ukraine, Egypt and Venezuela). The rates of controlled hypertension according to physician perception, type of therapy and risk factors were evaluated. Overall, 40% of patients had controlled hypertension according to the guidelines. A marked divergence in the rates of controlled hypertension as assessed by physicians and guidelines was observed (72% vs 40%). The presence of high/very high risks was linked to poor BP control. High salt intake [29%; odds ratio (OR) 9.94, 95% confidence interval (CI) 6.72;14.69], treatment non-adherence (27%; OR 7.32, 95% CI 4.82;11.13), lack of understanding of the treatment's importance (25%; OR 4.95, 95% CI 3.16;7.75), comorbidity (13%) and depression (9%; OR 10.50, 95% CI 5.37;20.54) were major reasons for not achieving hypertension control. Addition of another drug was the most frequent medication change prescribed. Poor rates of BP control warrant repeated promotion of guidelines while identifying potential contributing factors and implementing strategies that re-establish BP control. PMID:26873621

  5. Drug therapy for the patient with resistant hypertension.

    PubMed

    Donazzan, Luca; Ewen, Sebastian; Papademetriou, Vasilios; Linicus, Yvonne; Linz, Dominik; Böhm, Michael; Mahfoud, Felix

    2015-03-01

    Resistant hypertension is associated with high morbidity and mortality. Resistant hypertension is defined as blood pressure above targets despite treatment with at least three antihypertensive drugs in adequate dose and combination. Nonadherence is a frequent cause of uncontrolled hypertension and can be improved by providing fixed dose (of two or three agents) single pill combination. Triple combination of the most widely used antihypertensive agents (renin-angiotensin-aldosterone system antagonists, calcium channel blockers and diuretics) is a safe and effective therapy. Fourth line therapy is the use of an aldosterone antagonist. Renal denervation and baroreceptor stimulation can be considered in patients who remained uncontrolled despite optimal medical therapy. PMID:25760878

  6. Correlation between Microalbuminuria and Hypertension in Type 2 Diabetic Patients

    PubMed Central

    Ali, Alia; Taj, Azeem; Amin, Muhammad Joher; Iqbal, Farrukh; Iqbal, Zafar

    2014-01-01

    Background: Hypertension is commonly found in patients with Diabetic Kidney Disease (DKD). Microalbuminuria is the first clinical sign of involvement of kidneys in patients with type 2 diabetes. Uncontrolled hypertension induces a higher risk of cardiovascular events, including death, increasing proteinuria and progression to kidney disease. Objectives: To determine the correlation between microalbuminuria and hypertension and their association with other risk factors in type 2 diabetic patients. Methods: One hundred and thirteen type 2 diabetic patients attending the diabetic clinic of Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan were screened for microalbuminuria and raised blood pressure. The study was conducted from November 2012 to June 2013. Results: Patients were divided into two groups. Group 1, those with normoalbuminuria (n=63) and Group 2, those having microalbuminuria (n=50). Group 2 patients showed higher blood pressure values as compared to Group 1. The results were statistically significant and showed poor glycemic control as a contributing risk factor. Conclusion: The study concluded that there is high frequency of hypertension among type 2 diabetics but still much higher among those having microalbuminuria. So, early recognition of renal dysfunction through detection of microalbuminuria and to start treatment without any delay will confer future protection from end stage renal disease as well as hypertension and its complications in type 2 diabetic patients. PMID:24948969

  7. Managing the Patient with Pulmonary Hypertension: Specialty Care Centers, Coordinated Care, and Patient Support.

    PubMed

    Chakinala, Murali M; Duncan, Maribeth; Wirth, Joel

    2016-08-01

    Pulmonary hypertension remains a challenging condition to diagnose and manage. Decentralized care for pulmonary arterial hypertension (PAH) has led to shortcomings in the diagnosis and management of PAH. The Pulmonary Hypertension Association-sponsored Pulmonary Hypertension Care Center program is designed to recognize specialty centers capable of providing multidisciplinary and comprehensive care of PAH. Ideally, Pulmonary Hypertension Care Centers will comanage PAH patients with community-based practitioners and address the growing needs of this emerging population of long-term PAH patients. PMID:27443143

  8. Assessment of cognitive function in patients with essential hypertension treated with lercanidipine

    PubMed Central

    Tisaire-Sánchez, J; Roma, J; CamachoAzcargorta, Ignacio; Bueno-Gómez, J; Mora-Maciá, J; Navarro, Angel

    2006-01-01

    Objectives The aim of this longitudinal, open-label, comparative, multicenter study was to assess cognitive function in hypertensive patients receiving mid-term treatment with lercanidipine. Methods Hypertensive patients aged 40 years or older were treated with lercanidipine (10mg daily) after 7–10 days washout period. The duration of the study was 6 months. Blood pressure (BP) was measured every 4 weeks (JNC 6th report). In patients with inadequate BP control, doxazosin was added and up-titrated. At baseline and after 6 months of treatment, cognitive function was evaluated using the Spanish validated version of the Mini-Mental State Examination (MMSE) and the Trail Making Test (TMT). Results In the study population of 467 patients, BP decreased from 154.4/95.3 mmHg at baseline to 134.8/80.7 mmHg at 6 months. At the end of the study, 98% of patients were receiving lercanidipine, 20% an angiotensin-converting enzyme inhibitor, and 6% doxazosin. Adequate BP control was obtained in 68% of patients. The mean (standard deviation) MMSE scores improved from 32.35 (2.59) to 33.25 (2.36) (p<0.0001). Patients with good BP control scored significantly better than those with inadequate BP control (p<0.05), which was already observed at the first month. Conclusions The third-generation calcium channel antagonist, lercanidipine, improved cognitive function after 6 months of treatment especially in patients with good BP control, suggesting that improvements in cognitive function may be associated with a decrease in BP. PMID:17323604

  9. [Positive exercise test in hypertensive patients correlated with coronary angiography].

    PubMed

    Rosado, J; de los Santos, C; Iturralde, P; Pérez, G; Romero, L; Colín, L; González Hermosillo, A; Casanova, J M

    1991-01-01

    With the purpose of evaluate the state of the coronary arteries in hypertensive patients with positive exercise test, 82 patients were selected, 50 male and 32 female with mean age of 56.9 +/- 13.2 years. Angiography was normal in 25 patients thirteen patients had a single coronary arteries narrow of less than 50% and 44 cases with significant coronary arteries lesions of more than 50%. The parameters obtained in the exercise test are not significant for statistic purposes. Systolic hypertension or flat response was more frequent in the group with advanced coronary lesions with a predicted positive value in coronary obstructions of 66 and 75%. We conclude that 70% of hypertensive patients have obstructive coronary lesions of some degree. PMID:1929669

  10. Antidepressant medication can improve hypertension in elderly patients with depression.

    PubMed

    Fu, Wenjing; Ma, Lina; Zhao, Xiaoling; Li, Yun; Zhu, Hong; Yang, Wei; Liu, Chuan; Liu, Jia; Han, Rui; Liu, Huizhen

    2015-12-01

    We explored the influence of antidepressant therapy on blood pressure and quality of life in elderly patients with hypertension. Depression occurs at a higher rate in patients with hypertension than in the normal population. It has been reported that depressive symptoms lead to poorer hypertension control, resulting in the development of complications. We conducted a randomized, parallel group study. A total of 70 elderly patients with hypertension in the period of August 2008 to March 2011 were divided into two groups based on their antihypertensive therapy, a control group (amlodipine, 5 mg daily; n=35) and a therapy group (amlodipine, 5mg daily; citalopram, 20 mg daily; n=35). We compared 24 hour, daytime, and nighttime measurements of systolic and diastolic blood pressure, in addition to quality of life, assessed using the Hamilton rating scale for depression, and a 36 item Short Form quality of life questionnaire (SF-36). Both groups were followed for 3 months. At the end of 3 months, all blood pressure levels were significantly lower in the therapy group than in the control group. The other scores (with the exception of the physical function subcategory of the SF-36 quality of life scale) were significantly higher. Our study indicates that clinicians should be aware of depressive symptoms in elderly patients with hypertension, and should consider antidepressant therapy in these patients. PMID:26256065

  11. Management of Hypertension: Adapting New Guidelines for Active Patients.

    ERIC Educational Resources Information Center

    Tanji, Jeffrey L.; Batt, Mark E.

    1995-01-01

    Discusses recent guidelines on hypertension from the National Heart, Lung, and Blood Institute and details the latest management protocols for patients with high blood pressure. The article helps physicians interpret the guidelines for treating active patients, highlighting diagnosis, step care revision, pharmacology, and sports participation…

  12. Utilities of Patients with Hypertension in Northern Vietnam

    PubMed Central

    Nguyen, Thi-Phuong-Lan; Krabbe, Paul F. M.; Nguyen, Thi-Bach-Yen; Schuiling-Veninga, Catharina C. M.; Wright, E. Pamela; Postma, Maarten J.

    2015-01-01

    Objectives The study aims to inform potential cost-effectiveness analysis of hypertension management in Vietnam by providing utilities and predictors of utilities in patients with hypertension. Methods Hypertensive patients up to 80 years old visiting the hospital were invited to participate in a survey using Quality Metric’s Short-form 36v2TM translated into Vietnamese. Health-state utilities were estimated by applying a previously published algorithm. Results The mean utility of the 691 patients interviewed was 0.73. Controlling for age, sex, blood pressure (BP) stage, and history of stroke, the utilities in older patients were lower than those in younger ones, and statistically significantly different between the extremes of youngest and oldest groups (p = 0.03). Utility in males was higher than in females (p = 0.002). As expected, patients with a history of stroke appeared to exhibit lower utilities than patients without such history, but the difference was not statistically significant (p = 0.73). Patients with more than three comorbidities did have lower utilities than patients without comorbidity (p = 0.01). Conclusions Health-state utilities found among hypertensive patients in Vietnam were similar to those found in other international studies. It is suggested that lower of health-state utilities exist among those patients who were older, female or had more than three comorbidities in comparison with respective reference groups. However, further research for confirmation is required. The data from this study provide a potential reference on health-state utilities of hypertensive patients in Vietnam as an input for future cost-effectiveness analysis of interventions. Also, it may serve as a reference for other similar populations, especially in the context of similar environments in low income countries. PMID:26506444

  13. Novel treatment approaches in hypertensive type 2 diabetic patients

    PubMed Central

    Castro Torres, Yaniel; Katholi, Richard E

    2014-01-01

    Type 2 diabetes mellitus (T2DM) and hypertension represent two common conditions worldwide. Their frequent association with cardiovascular diseases makes management of hypertensive patients with T2DM an important clinical priority. Carvedilol and renal denervation are two promising choices to reduce plasma glucose levels and blood pressure in hypertensive patients with T2DM to reduce future complications and improve clinical outcomes and prognosis. Pathophysiological mechanisms of both options are under investigation, but one of the most accepted is an attenuation in sympathetic nervous system activity which lowers blood pressure and improves insulin sensitivity. Choice of these therapeutic approaches should be individualized based on specific characteristics of each patient. Further investigations are needed to determine when to consider their use in clinical practice. PMID:25126399

  14. Heart rate variability and renal organ damage in hypertensive patients.

    PubMed

    Melillo, Paolo; Izzo, Raffaele; De Luca, Nicola; Pecchia, Leandro

    2012-01-01

    Heart rate variability (HRV), a noninvasive measure of autonomic dysfunction and a risk factor for cardiovascular disease (CVD), has not been systematically studied in hypertensive patients in relation with renal involvement. A retrospective analysis on a cohort of hypertensive patients was performed to show differences in groups of patients categorized according to renal involvement, assessed by glomerular filtration rate (GFR). Patient with 24-h ECG Holter monitoring and other clinical information registered in the database of the Hypertension Clinic of the University of Naples Federico II were selected. Linear standard HRV measures were computed according to international guidelines on 24-h nominal ECG. A total of 200 patients were included in the present study. Decreased ratio of low to high frequency power (LF/HF) was associated with patient with moderate GFR, the highest grade of renal involvement considered in this study. These results were consistent with the findings of previous studies which concluded that depressed HRV was associated with higher risk of progression to end-stage renal disease and suggested that autonomic dysfunction may lead to kidney damage. Further research is needed to define the role of autonomic dysfunction in the development of renal disease and of HRV as a diagnostic or prognostic maker in hypertensive patients. PMID:23366762

  15. Laparoscopic Cholecystectomy in Patients with Bilharzial Portal Hypertension

    PubMed Central

    Ismail, Abu Azab; Mohamed, Ibnoaf; Suliman, Fedail S

    2000-01-01

    Objective: The purpose of this study was to evaluate the results of laparoscopic cholecystectomy in patients with bilharzial portal hypertension. Methods: Patients who had gallstones and bilharzia had ultrasonographic assessment of peri-portal fibrosis, endoscopy, hemagglutination and rectal snip. Operating time, blood loss, hospital stay, time of return to work and operative mortality were recorded. Follow-up was two weeks, six weeks and six months after discharge. Results: Twenty-five out of 450 patients, who had laparoscopic cholecystectomy, suffered from bilharzial portal hypertension. Ten patients had grade 1 varices, 10 had grade 2 varices, and 5 had grade 3 esophageal varices. All patients had varying degrees of peri-portal fibrosis as shown by ultrasound. Rectal snip showed schistosoma mansoni in 5 patients, and a hemagglutination test was positive in all. Two patients had conversion to open cholecystectomy. Mean operating time was 1 hour and 15 minutes. Average blood loss was 50 cc. Mean hospital stay for 23 patients was 48 hours. Average time of return to work was 2 weeks in 23 patients and 6 weeks in the 2 patients who had conversion. Twenty-two patients benefited from the operation. There was no mortality in this series. Conclusions: Laparoscopic cholecystectomy in patients with bilharzial portal hypertension is feasible and has low morbidity. PMID:10917123

  16. Pheochromocytoma and Neurofibromatosis Type 1 in a Patient with Hypertension

    PubMed Central

    Petrovska, Julijana; Kitanovska, Biljana Gerasimovska; Bogdanovska, Stevka; Kuzmanoska, Svetlana Pavleska

    2015-01-01

    BACKGROUND: Neurofibromatosis type 1 is an autosomal dominant condition that has a variety of clinical manifestations. Essential or secondary hypertension may be associated with neurofibromatosis. A rare finding is hypertension due to pheochromocytoma in patient with neurofibromatosis type 1. CASE REPORT: We present a case with a 7-year medical history of hypertension which was poorly controlled and with wide variations of blood pressure before the examination. Investigations did not reveal a secondary cause of hypertension. After the physical examination and establishing the diagnosis of neurofibromatosis, as well as the history of symptomes suggestive of catecholamine discharge, diagnostic procedures for pheochromocytoma were undertaken. Abdominal CT and MRI have proven the presence of a right adrenal tumor mass which was suspected to be a pheochromocytoma. Patient was preoperatively treated for two weeks with alpha and beta blokers and right adrenalectomy was performed. Perioperatively and on a longer term, blood pressure remained well controlled with less antihypertensive therapy. Diagnosis and management of pheochromocytoma in neurofibromatosis involves a dermatologist, endocrinologist, nephrologist and an urologist and requires a well-coordinated multidisciplinary approach. CONCLUSIONS: Pheochromocytoma, although a rare condition in patients with neurofibromatosis, may be a cause for uncontrolled hypertension, as well as other cardiovascular complications and the clinician should do all available clinical investigations to confirm it or exclude it on time. PMID:27275314

  17. Exercise and cardiovascular risk in patients with hypertension.

    PubMed

    Sharman, James E; La Gerche, Andre; Coombes, Jeff S

    2015-02-01

    Evidence for the benefits of regular exercise is irrefutable and increasing physical activity levels should be a major goal at all levels of health care. People with hypertension are less physically active than those without hypertension and there is strong evidence supporting the blood pressure-lowering ability of regular exercise, especially in hypertensive individuals. This narrative review discusses evidence relating to exercise and cardiovascular (CV) risk in people with hypertension. Comparisons between aerobic, dynamic resistance, and static resistance exercise have been made along with the merit of different exercise volumes. High-intensity interval training and isometric resistance training appear to have strong CV protective effects, but with limited data in hypertensive people, more work is needed in this area. Screening recommendations, exercise prescriptions, and special considerations are provided as a guide to decrease CV risk among hypertensive people who exercise or wish to begin. It is recommended that hypertensive individuals should aim to perform moderate intensity aerobic exercise activity for at least 30 minutes on most (preferably all) days of the week in addition to resistance exercises on 2-3 days/week. Professionals with expertise in exercise prescription may provide additional benefit to patients with high CV risk or in whom more intense exercise training is planned. Despite lay and media perceptions, CV events associated with exercise are rare and the benefits of regular exercise far outweigh the risks. In summary, current evidence supports the assertion of exercise being a cornerstone therapy in reducing CV risk and in the prevention, treatment, and control of hypertension. PMID:25305061

  18. Pulmonary hypertension in patients with hematological disorders following splenectomy.

    PubMed

    Ghosh, Kanjaksha; Meera, V; Jijina, Farah

    2009-06-01

    Prevalence of pulmonary arterial hypertension (PAH) was studied by echocardiography and Doppler in 43 splenectomized patients with various disorders 1-20 years after splenectomy. Pulmonary arterial hypertension was detected only in thalassemia major, intermedia, hereditary sphereocytosis and myelofibrosis groups comprising a total of 21 patients. Six patients out of 21 was found to have PAH with mean pulmonary arterial pressure of 46.28 ± 28.17 mm of Hg. Twenty-one controls having similar duration and type of disease also were assessed for PAH in this case control study 3/21 had pulmonary arterial hypertension in this control group. The difference in number of patients showing pulmonary hypertension between case and control was not statistically significant (Chi square test P=0.29) though the difference in pulmonary arterial pressure between case and control were significantly different (t test P<0.0029) with control group showing a mean pulmonary arterial pressure of 25 ± 19 mm Hg.Platelet count in the splenectomized group was significantly higher (P=0.0029) than the controls. Pulmonary thromboembolism was equally high in the PAH patients with and without splenectomy. Patients undergoing splenectomy due to trauma, immune thrombocytopenia, sideroblastic anemia, extrahepatic portal hypertension, autoimmune hemolytic anemia did not show PAH after splenectomy even years after the procedure PAH following splenectomy is common after certain disorders and control patients in these diseases have tendency to develop PAH even without splenectomy. Pulmonary thromboembolism may be an important pathophysiological mechanism leading to this condition. Patients having hemolytic anemia and myelofibrosis should have regular evaluation of pulmonary arterial pressure whether he/she has been splenectomized or not.This is particularly important as availability of phosphodiesterase inhibitors such as sildenafil allows one to manage these cases. PMID:23100974

  19. Hypertension and arterial stiffness in heart transplantation patients

    PubMed Central

    de Souza-Neto, João David; de Oliveira, Ítalo Martins; Lima-Rocha, Hermano Alexandre; Oliveira-Lima, José Wellington; Bacal, Fernando

    2016-01-01

    OBJECTIVES: Post-transplantation hypertension is prevalent and is associated with increased cardiovascular morbidity and subsequent graft dysfunction. The present study aimed to identify the factors associated with arterial stiffness as measured by the ambulatory arterial stiffness index. METHODS: The current study used a prospective, observational, analytical design to evaluate a group of adult heart transplantation patients. Arterial stiffness was obtained by monitoring ambulatory blood pressure and using the ambulatory arterial stiffness index as the surrogate outcome. Multivariate logistic regression analyses were performed to control confounding. RESULTS: In a group of 85 adult heart transplantation patients, hypertension was independently associated with arterial stiffness (OR 4.98, CI 95% 1.06-23.4) as well as systolic and diastolic blood pressure averages and nighttime descent. CONCLUSIONS: Measurement of ambulatory arterial stiffness index is a new, non-invasive method that is easy to perform, may contribute to better defining arterial stiffness prognosis and is associated with hypertension.

  20. Restless Legs Syndrome in Patients with Hypertension and Diabetes Mellitus

    PubMed Central

    Sabic, Adela; Sinanovic, Osman; Sabic, Dzevad; Galic, Gordan

    2016-01-01

    Aim: The aim of this study was to analyze frequency of restless legs syndrome (RLS) in patients with hypertension and diabetes mellitus. Patients and Methods: It was analyzed 120 subjects (from Health Center Živinice/Family Medicine Department) through a survey conducted in the period from March to June 2015, of which 30 (8 men/22 women). Subjects were 30 patients with longtime hypertension (HT)(18 men/12 women), 30 patients with diabetes mellitus (DM) type I or II (9 men/21 women), 30 patients with long standing DM type I or II and HT (12 men /18 women), and 30 control subjects (12 men/18 women). RLS were evaluated by questionnaire - International RLS Study Group Criteria. The average age of patients in the group with HT was 58.70 ± 9.07, in the group with DM 48.43 ± 15.37, and in the group of patients with HT and DM 63.90 ± 7.49 years. In the control group mean age was 52.76 ± 14.83 years. Statistical data were analyzed in Excel and SSPS statistical program. Results: RLS was identified in 10 (30%) of those with HT; 7 (21%) in patients with DM, and 10 (30%) in patients with HT+DM. In the control group RLS was verified in 4 (12%) patients. Comparing the results, it was observed significant difference between the HT and the control group (p=0.0012) and HT+ DM and control group (p=0.0012). The frequency of RLS between DM and the control group was not significantly significant (p=0.107). Conclusion: RLS is frequent in patients with hypertension (30%), hypertension+ diabetes mellitus (30%), and patients with DM (21%). PMID:27147785

  1. [Assessment of cardiovascular risk in hypertensive patients: comparison among scores].

    PubMed

    Del Colle, Sara; Rabbia, Franco; Mulatero, Paolo; Veglio, Franco

    2004-09-01

    At present, a correct and thorough risk evaluation represents the best prognostic and therapeutic approach for hypertensive patients. Recent European and American guidelines recommend a global stratification of the cardiovascular risk of hypertensive patients, based on the evaluation of risk factors, organ damage, and the clinical conditions associated with hypertension. A similar approach uses numerical risk scores that transform the percentage risk, calculated from large populations, into absolute values. These scores have been calculated by different research groups and scientific organizations with the aim of better defining the real risk of a given population over time. Many of these risk scores have been conceived by American and European scientific groups on the basis of the epidemiology of different risk variables in the respective populations; in general, north American hypertensives are exposed to a higher cardiovascular risk compared to Europeans and some European countries have a higher risk than others. The present review underlines the pivotal role of a correct risk evaluation of hypertension as reported in the guidelines. We briefly analyze the principal studies on risk scores: we compare the advantages and disadvantages of the different scores, as well as the similarities and differences, in order to demonstrate not only their utility, but also the possible equivalence of the different parameters considered. PMID:15568607

  2. Erythrocyte membrane properties in patients with essential hypertension.

    PubMed

    Kaczmarska, Magdalena; Fornal, Maria; Messerli, Franz H; Korecki, Jozef; Grodzicki, Tomasz; Burda, Kvetoslava

    2013-01-01

    In spite of the extensive research efforts that have been conducted over the last decades, it is still very difficult to point out genetic determinants or environmental conditions responsible for the development of essential hypertension. We searched for differences in the RBC membrane skeleton structure and O2 membrane permeability between RBCs from patients with both essential arterial hypertension and hypercholesterolemia, from patients having only hypercholesterolemia and from healthy donors. The topography of RBCs and the content of various hemoglobin forms were detected using atomic force microscopy and Mössbauer spectroscopy, respectively. We found that the membrane skeleton of RBCs from healthy donors displayed a well-known honeycomb pattern, whereas in patients with essential hypertension and/or hypercholesterolemia, who had never received anti-hypertensive therapy, it displayed a corncob pattern. Hypertensive RBCs had an oval shape and the average lateral to longitudinal diameter ratio for the changed cells (about 70%) did not exceed 0.80. We observed that after the incubation of RBCs under high nitrogen (low O2) pressure at room temperature and then their transfer into 85 K, a content of oxyHb (deoxyHbOH) already after 1 h reached a stable level of about 85 ± 3% (15 ± 3%) in hypertensives, whereas in healthy individuals it showed a decrease for deoxyHbOH and an increase for oxyHb, which stabilized at a level of about 81 ± 5% and 19 ± 5%, respectively, only after 9 h. Quantitative analysis of the Δ(oxyHb) change estimated as the difference between the oxyHb level measured after 9 and 2 h at 85 K under low N2 pressure (to slow down oxyHb formation) was significantly higher in normotensives than in hypertensive patients with or without hypercholesterolemia, 19.9 versus -4.2, p < 0.02. Our findings indicate an impaired oxygen release by Hb in RBCs of patients with hypertension under low oxygen pressure which if present in vivo may cause hypoxemia and

  3. Clinical and haemodynamic study of minoxidil in moderately hypertensive patients.

    PubMed

    Aerenlund Jensen, H; Rasmussen, K; Mosbaek, N

    1976-12-01

    1. We have evaluated the effectiveness and safety of minoxidil in moderately hypertensive out-patients. Eight patients were treated with hydrochlorothiazide and minoxidil for 5 months. The only female patient developed slight, reversible facial hair growth. In the other seven patients there was a moderate decrease in blood pressure. There were only minimal side-effects. Mild exertional tachycardia and a mean increase in body weight of 0-5 kg was found, but no oedema or signs of cardiac insufficiency were observed. No abnormalities were seen during routine blood tests. 2. This study shows that minoxidil combined with a diuretic may be successfully used in treating moderately hypertensive male patients. PMID:1071686

  4. Effects of dapagliflozin on blood pressure in hypertensive diabetic patients on renin-angiotensin system blockade.

    PubMed

    Weber, Michael A; Mansfield, Traci A; Alessi, Federica; Iqbal, Nayyar; Parikh, Shamik; Ptaszynska, Agata

    2016-04-01

    Hypertension and type 2 diabetes mellitus (T2DM) are risk factors for cardiovascular disease. Dapagliflozin improves glycemic control and systolic blood pressure (SBP) in T2DM patients. This double-blind phase III study evaluated the effects of dapagliflozin on glycemic control and blood pressure in patients with inadequately controlled T2DM and hypertension, despite ongoing therapy with a renin-angiotensin system blocker. Patients were randomized to receive dapagliflozin 10 mg (n = 302) or placebo (n = 311) once daily for 12 weeks. Endpoints were change from baseline to week 12 in seated SBP and glycosylated hemoglobin (HbA1c); longitudinal repeated-measures analysis was performed. Additional endpoints included other hemodynamic measures, serum uric acid, fasting plasma glucose, body weight, blood lipids and heart rate. After 12 weeks, dapagliflozin-treated versus placebo-treated patients showed significant reductions in HbA1c (-0.6% vs -0.1%, p < 0.0001), mean seated SBP (-10.4 vs -7.3 mmHg, p = 0.0010) and mean 24 h ambulatory SBP (-9.6 vs -6.7 mmHg, p = 0.0043). Dapagliflozin also reduced body weight compared with placebo (-1.0 vs -0.3 kg). Dapagliflozin was well tolerated, with adverse events consistent with previous studies. Dapagliflozin improved glycemic control, and reduced SBP as well as body weight in patients with poorly controlled T2DM and hypertension. PMID:26623980

  5. Evaluation of medication adherence in Lebanese hypertensive patients.

    PubMed

    Yassine, Mohammad; Al-Hajje, Amal; Awada, Sanaa; Rachidi, Samar; Zein, Salam; Bawab, Wafa; Bou Zeid, Mayssam; El Hajj, Maya; Salameh, Pascale

    2016-09-01

    Controlling hypertension is essential in cardiovascular diseases. Poor medication adherence is associated with poor disease outcomes, waste of healthcare resources, and contributes to reduced blood pressure control. This study evaluates treatment adherence to antihypertensive therapy in Lebanese hypertensive patients by estimating the proportion of adherent hypertensive patients using a validated tool and investigates what factors predict this behavior. A questionnaire-based cross-sectional study was conducted on a random sample of 210 hypertensive outpatients selected from clinics located in tertiary-care hospitals and from private cardiology clinics located in Beirut. Adherence level was measured using a validated 8-item Modified Morisky Medication Adherence Scale (MMMAS). Among 210 patients, 50.5% showed high adherence, 27.1% medium adherence, and 22.4% low adherence to medication. Mean MMMAS score was 6.59±2.0. In bivariate analyses, having controlled blood pressure (p=0.003) and taking a combination drug (p=0.023) were predictors of high adherence. Forgetfulness (p<0.01), complicated drug regimen (p=0.001), and side effects (p=0.006) were predictors of low adherence after multiple liner regression. Logistic regression results showed that calcium channel blockers (p=0.030) were associated with increased adherence levels. In conclusion, developing multidisciplinary intervention programs to address the factors identified, in addition to educational strategies targeting healthcare providers, are necessary to enhance patient adherence. PMID:26232704

  6. Self-Care Behaviors and Related Factors in Hypertensive Patients

    PubMed Central

    Zinat Motlagh, Sayed Fazel; Chaman, Reza; Sadeghi, Erfan; Eslami, Ahmad Ali

    2016-01-01

    Background An assessment of an individual’s hypertension self-care behavior may provide clinicians and practitioners with important information regarding how to better control hypertension. Objectives The objective of this study was to investigate the self-care behaviors of hypertensive patients. Patients and Methods This cross-sectional study was conducted in 2014 in a sample of 1836 patients of both genders who had been diagnosed with hypertension in urban and rural health centers in the Kohgiluyeh Boyerahmad Province in southern Iran. They were randomly selected and were invited to participate in the study. Self-care activities were measured using the H-hypertension self-care activity level effects. Results The mean age of the respondents was 63 (range: 30 - 92), and 36.1% reported adherence to the recommended levels of medication; 24.5% followed the physical activity level guidelines. Less than half (39.2%) met the criteria for practices related to weight management, and adherence to low-salt diet recommendations was also low (12.3%). Overall, 86.7% were nonsmokers, and 100% abstained from alcohol. The results of a logistic regression indicated that gender was significantly associated with adherence to physical activity (OR = 0.716) and non-smoking (OR = 1.503) recommendations; that is, women were more likely to take part in physical activity than men. There was also a significant association between age and adherence to both a low-salt diet (OR = 1.497) and medication (OR = 1.435). Conclusions Based on our findings, it is crucial to implement well-designed educational programs to improve hypertension self-care behaviors.

  7. Control of hypertension and survival in haemodialysis patients.

    PubMed

    Iseki, Kunitoshi

    2015-02-01

    Hypertension is common in approximately 80% to 90% of patients at the start of dialysis therapy and is an established risk factor for cardiovascular disease. Therefore, it should be controlled, even in the chronic dialysis population. Observational studies indicate a U-shaped phenomenon, as the mortality rate is high among those with hypertension as well as those with hypotension. Among chronic dialysis patients, randomized controlled trials on the effect of anti-hypertensive treatment are not conclusive, at least not as demonstrated by studies with a large sample size. Similar to other potentially effective drug therapies such as erythropoietin stimulating agent, statins, and uraemic toxin adsorbents, the benefit of anti-hypertensive treatment remains to be demonstrated in dialysis patients. The blood pressure target level, however, is difficult to determine as evidence for the level of appropriate target is lacking. Currently, it should be determined individually, as the priority is to perform haemodialysis as prescribed. The target levels of blood pressure for chronic haemodialysis patients are not stated except in the Guidelines in the Japanese Society for Dialysis Therapy. In this guideline, systolic blood pressure between 140 to 159 mmHg is preferable among elderly patients with comorbid conditions. Rapid ultrafiltration, such as >600 mL/h, is to be avoided. Intra-dialysis hypotension, muscle cramps, and other complaints during HD are preventable. Moreover, the nutritional status should be maintained within the normal range with adequate intake of protein and calories, but with salt restriction. Further studies are necessary for better management of hypertension in the dialysis population. PMID:25376271

  8. Treatment of patients with hypertension and arthritis pain: new concepts.

    PubMed

    Weber, Michael A

    2009-05-01

    Arthritis pain often occurs concurrently with hypertension and other cardiovascular risk factors. Treating patients with hypertension who have arthritis and other painful conditions can be a challenge because of potential risks associated with the agents commonly used to treat pain and inflammation. Hypertension is associated with endothelial dysfunction and decreased bioavailability of nitric oxide (NO). Naproxcinod, an investigational drug, is the first in a new class of agents called cyclooxygenase-inhibiting NO donators. They differ from traditional nonsteroidal anti-inflammatory drugs in their ability to donate NO, a signaling molecule known to have potentially beneficial effects on the vasculature and the gastrointestinal tract. Naproxcinod, by donating NO, offers a therapeutic option that might mitigate the negative blood pressure effects and adverse gastrointestinal effects associated with traditional arthritis therapies. This article reviews some preliminary preclinical and clinical studies of key safety data of an investigational new NO-donating anti-inflammatory agent. PMID:19393822

  9. Renal Doppler ultrasound in patients with hypertension and metabolic syndrom.

    PubMed

    Lubomirova, Mila; Djerassi, Regina; Kiperova, Boryana; Boyanov, Mihail; Christov, Vladimir

    2007-01-01

    Evaluation of the renal changes by conventional and Doppler ultrasound (US) was performed in patients with hypertension and obesity. 67 persons were examined and divided in 3 groups. Group I includes 27 patients--15 M and 12 F, average age 52+/-4.87 with well controlled diabetes mellitus type II and hypertension, Ccr.--139+/-1.31. Group II includes 20 patients--9 M and 11 F, average age 53+/-7 with well controlled hypertension without diabetes, with Ccr 128+/-7.8. Group III--20) pts. 8 F and 12 M, average age 54+/-5 with uncontrolled hypertension without diabetes, with Ccr 128+/-7.8. All examined pts. were with BMI>30 and hyperlipidemia--total cholesterol>6.5 mmol/l. Tests for microalbuminuria were negative in all 3 groups. In all three groups, using conventional US, the following parameters were detected by Aloca 4000 machine: renal (RV) and parenchyma (PV) volumes as well as Doppler parameters RI, PI, Vmax, Vmin, and Vmean. There were no significant differences between RV and PV of all examined groups: Group I--254+/-53, Group II--238+/-38, Group III--263+/-38, p=0.1. The strong correlation between renal volumes and BMI was found (Pearson's r 0.58). There were no significant differences between Vmax, Vmin, Vmean in all three groups. RI is normal <0.7 in all examined patients: Group I--0.63+/-0.06, Group II--0.61+/-0.02, Group III--0.66+/-0.03. RI in group III was significantly higher, p<0.05 compared to RI indices detected in other two groups but remains at normal levels. Intrarenal hemodynamics exhibited no difference in all examined groups. Analysis of the Doppler spectrum of the intrarenal arteries provides an accurate information about renal vascular changes but has no significant advantages in patients with hypertension and obesity with normal renal function and signs of hypertensive nephropathy "benign nephrosclerosis". Nevertheless Duplex Doppler Ultrasound is a noninvasive method which is an important part of the diagnostic algorithm in patients with

  10. Quality of life in patients with chronic thromboembolic pulmonary hypertension

    PubMed Central

    Ghofrani, Hossein-Ardeschir; Mayer, Eckhard; Pepke-Zaba, Joanna; Nikkho, Sylvia; Simonneau, Gérald

    2016-01-01

    Patients with chronic thromboembolic pulmonary hypertension (CTEPH) experience debilitating symptoms that have a negative impact on their quality of life (QoL) in terms of physical capability, psychological wellbeing and social relationships. The use of QoL measurement tools is important in the assessment of treatment efficacy and in guiding treatment decisions. However, despite the importance of QoL, particularly to the patient, it remains under-reported in clinical studies of CTEPH therapy. CTEPH is unique in pulmonary hypertension in that it is potentially curable by surgery; however, a proportion of patients either have residual PH following surgery or are not operable. Although some patients with CTEPH have been treated off-label with pulmonary arterial hypertension-specific therapies, there have been few randomised controlled trials of these therapies in patients with CTEPH. Moreover, in these trials QoL outcomes are variably assessed, and there is little consistency in the tools used. Here we review the assessment of QoL in patients with CTEPH and the tools that have been used. We also discuss the effect of surgical intervention and medical therapies on QoL. We conclude that further studies of QoL in patients with CTEPH are needed to further validate the optimal QoL tools. PMID:27076580

  11. Quality of life in patients with chronic thromboembolic pulmonary hypertension.

    PubMed

    Mathai, Stephen C; Ghofrani, Hossein-Ardeschir; Mayer, Eckhard; Pepke-Zaba, Joanna; Nikkho, Sylvia; Simonneau, Gérald

    2016-08-01

    Patients with chronic thromboembolic pulmonary hypertension (CTEPH) experience debilitating symptoms that have a negative impact on their quality of life (QoL) in terms of physical capability, psychological wellbeing and social relationships. The use of QoL measurement tools is important in the assessment of treatment efficacy and in guiding treatment decisions. However, despite the importance of QoL, particularly to the patient, it remains under-reported in clinical studies of CTEPH therapy. CTEPH is unique in pulmonary hypertension in that it is potentially curable by surgery; however, a proportion of patients either have residual PH following surgery or are not operable. Although some patients with CTEPH have been treated off-label with pulmonary arterial hypertension-specific therapies, there have been few randomised controlled trials of these therapies in patients with CTEPH. Moreover, in these trials QoL outcomes are variably assessed, and there is little consistency in the tools used. Here we review the assessment of QoL in patients with CTEPH and the tools that have been used. We also discuss the effect of surgical intervention and medical therapies on QoL. We conclude that further studies of QoL in patients with CTEPH are needed to further validate the optimal QoL tools. PMID:27076580

  12. [Non-pharmacologic treatment of arterial hypertension in hemodialysis patients].

    PubMed

    Chazot, C; Charra, B

    2007-10-01

    High blood pressure in dialysis patients is related to extracellular volume excess and the related increase of systemic vascular resistances. Scribner has early described the treatment of hypertension with ultrafiltration and low salt diet, without any drugs. The dry weight method relies on the progressive reduction of the postdialysis body weight until blood pressure is normalized. Additional measures are needed such as low salt diet, neutral sodium balance during dialysis treatment, stop of antihypertensive drugs, adequate length of the dialysis session, and patient education. It may exist a lag time between the normalization of the extracellular volume and blood pressure. It is related to the correction of the hemodynamic consequences of the extracellular volume overload. Moreover, the dry weight may potentially vary in patients undergoing catabolic intercurrent events. The complications of these changes (severe hypertension, pulmonary oedema) must be anticipated by the nephrologist and the staff to avoid additional morbidity to the patient. PMID:18340684

  13. Treatment strategies for osteoarthritis patients with pain and hypertension.

    PubMed

    Verdecchia, Paolo; Angeli, Fabio; Mazzotta, Giovanni; Martire, Paola; Garofoli, Marta; Gentile, Giorgio; Reboldi, Gianpaolo

    2010-08-01

    Out of 100 patients with osteoarthritis (OA), almost 40 have a concomitant diagnosis of hypertension. Nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2) inhibitors may trigger a rise in blood pressure (BP), which is more marked in patients with established hypertension. NSAIDs and COX-2 inhibitors attenuate the antihypertensive effect of several antihypertensive agents. Frequent BP controls are needed in treated hypertensive patients who are concomitantly receiving NSAIDs or COX-2 inhibitors because even a small increase in BP may be associated with an important rise in the risk of major cardiovascular complications. In meta-analyses, an increase in systolic BP of 5mmHg was associated with a 25% higher risk of cardiovascular events. These data have been confirmed in randomized studies with rofecoxib and celecoxib, where a modest increase in BP was associated with a significantly higher risk of cardiovascular disease. There is emerging evidence that the COX-inhibiting nitric oxide donator (CINOD) class is promising in the treatment of patients with OA. Naproxcinod, the first CINOD investigated in clinical trials, is composed of the traditional NSAID naproxen covalently bound to the nitric oxide (NO)-donating moiety butanediol mono-nitrate (BDMN). The molecule has the potential to provide a sustained release of NO. In clinical studies, naproxcinod prevented the BP rise in normotensive and hypertensive patients observed with naproxen. The BP benefit of naproxcinod over naproxen was greater in patients concomitantly receiving angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. These investigational data suggest that naproxcinod is a valuable alternative to NSAIDs and COX-2 inhibitors for treatment of OA patients. PMID:22870450

  14. Treatment Strategies for Osteoarthritis Patients with Pain and Hypertension

    PubMed Central

    Verdecchia, Paolo; Angeli, Fabio; Mazzotta, Giovanni; Martire, Paola; Garofoli, Marta; Gentile, Giorgio; Reboldi, Gianpaolo

    2010-01-01

    Out of 100 patients with osteoarthritis (OA), almost 40 have a concomitant diagnosis of hypertension. Nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2) inhibitors may trigger a rise in blood pressure (BP), which is more marked in patients with established hypertension. NSAIDs and COX-2 inhibitors attenuate the antihypertensive effect of several antihypertensive agents. Frequent BP controls are needed in treated hypertensive patients who are concomitantly receiving NSAIDs or COX-2 inhibitors because even a small increase in BP may be associated with an important rise in the risk of major cardiovascular complications. In meta-analyses, an increase in systolic BP of 5mmHg was associated with a 25% higher risk of cardiovascular events. These data have been confirmed in randomized studies with rofecoxib and celecoxib, where a modest increase in BP was associated with a significantly higher risk of cardiovascular disease. There is emerging evidence that the COX-inhibiting nitric oxide donator (CINOD) class is promising in the treatment of patients with OA. Naproxcinod, the first CINOD investigated in clinical trials, is composed of the traditional NSAID naproxen covalently bound to the nitric oxide (NO)-donating moiety butanediol mono-nitrate (BDMN). The molecule has the potential to provide a sustained release of NO. In clinical studies, naproxcinod prevented the BP rise in normotensive and hypertensive patients observed with naproxen. The BP benefit of naproxcinod over naproxen was greater in patients concomitantly receiving angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. These investigational data suggest that naproxcinod is a valuable alternative to NSAIDs and COX-2 inhibitors for treatment of OA patients. PMID:22870450

  15. Reported Sildenafil Side Effects in Pediatric Pulmonary Hypertension Patients

    PubMed Central

    Siehr, Stephanie L.; McCarthy, Elisa K.; Ogawa, Michelle T.; Feinstein, Jeffrey A.

    2015-01-01

    Background: Sildenafil, a phosphodiestase type 5 inhibitor, was approved in 2005 for the treatment of pulmonary arterial hypertension (PAH) in adults and is commonly used off-label for pediatric patients. Little is known, however, about sildenafil’s side effects in this population. Methods: Single institution, longitudinal survey-based study performed in an outpatient pediatric cardiology clinic. Pediatric patients on sildenafil [alone or in combination with other pulmonary hypertension (PH) therapies] completed questionnaires regarding frequency of vascular, gastrointestinal, neurologic, and hematologic side effects. Results: Between January 2011 and May 2014, 66 pediatric patients with PH on sildenafil filled out 214 surveys, 32 patients (96 surveys) on monotherapy, and 43 patients (118 surveys) on sildenafil plus an endothelin receptor antagonist (ERA) (bosentan or ambrisentan) and/or a prostacyclin (epoprostenol or treprostinil). Overall, 30% of respondents identified at least one side effect. For all patients on sildenafil, incidence of side effects by system was 37% gastrointestinal, 35% vascular, and 22% neurologic. For patients on sildenafil monotherapy, incidence of side effects by system was 24% gastrointestinal, 21% vascular, and 18% neurologic compared to patients on combination therapy who reported an incidence of 48% gastrointestinal, 45% vascular, and 25% neurologic. Conclusion: Incidence of vascular, gastrointestinal, and neurologic side effect in pediatric patients on sildenafil therapy for PAH was 30%. Side effects were more common in patients on combination therapy with an ERA and/or prostacyclin than in patients on sildenafil monotherapy. PMID:25806361

  16. Gastrointestinal Bleeding in Cirrhotic Patients with Portal Hypertension

    PubMed Central

    Biecker, Erwin

    2013-01-01

    Gastrointestinal bleeding related to portal hypertension is a serious complication in patients with liver cirrhosis. Most patients bleed from esophageal or gastric varices, but bleeding from ectopic varices or portal hypertensive gastropathy is also possible. The management of acute bleeding has changed over the last years. Patients are managed with a combination of endoscopic and pharmacologic treatment. The endoscopic treatment of choice for esophageal variceal bleeding is variceal band ligation. Bleeding from gastric varices is treated by injection with cyanoacrylate. Treatment with vasoactive drugs as well as antibiotic treatment is started before or at the time point of endoscopy. The first-line treatment for primary prophylaxis of esophageal variceal bleeding is nonselective beta blockers. Pharmacologic therapy is recommended for most patients; band ligation is an alternative in patients with contraindications for or intolerability of beta blockers. Treatment options for secondary prophylaxis include variceal band ligation, beta blockers, a combination of nitrates and beta blockers, and combination of band ligation and pharmacologic treatment. A clear superiority of one treatment over the other has not been shown. Bleeding from portal hypertensive gastropathy or ectopic varices is less common. Treatment options include beta blocker therapy, injection therapy, and interventional radiology. PMID:27335828

  17. Management of Acute Hypertensive Response in Patients With Ischemic Stroke.

    PubMed

    AlSibai, Ahmad; Qureshi, Adnan I

    2016-07-01

    High blood pressure (BP) >140/90 mm Hg is seen in 75% of patients with acute ischemic stroke and in 80% of patients with acute intracerebral hemorrhages and is independently associated with poor functional outcome. While BP reduction in patients with chronic hypertension remains one of the most important factors in primary and secondary stroke prevention, the proper management strategy for acute hypertensive response within the first 72 hours of acute ischemic stroke has been a matter of debate. Recent guidelines recommend clinical trials to ascertain whether antihypertensive therapy in the acute phase of stroke is beneficial. This review summarizes the current data on acute hypertensive response or elevated BP management during the first 72 hours after an acute ischemic stroke. Based on the potential deleterious effect of lowering BP observed in some clinical trials in patients with acute ischemic stroke and because of the lack of convincing evidence to support acute BP lowering in those situations, aggressive BP reduction in patients presenting with acute ischemic stroke is currently not recommended. While the early use of angiotensin receptor antagonists may help reduce cardiovascular events, this benefit is not necessarily related to BP reduction. PMID:27366297

  18. Quality of life among pulmonary hypertension patients in Finland

    PubMed Central

    Kukkonen, Merja; Puhakka, Airi; Halme, Maija

    2016-01-01

    Background The purpose of the study was to examine pulmonary hypertension (PH) patients’ quality of life (QOL) for the first time in Finland. Methods This was a non-interventional, cross-sectional study. The SF-36v2 questionnaire was sent to the PH patients who had been referred to or followed up on at the Helsinki University Central Hospital's pulmonary clinic for idiopathic pulmonary arterial hypertension, associated pulmonary arterial hypertension (APAH), or chronic thromboembolic PH (CTEPH). The patients were on pulmonary arterial hypertension (PAH) – specific drugs, were at least 18 years old, and had signed an informed consent. Results There were 62 patients who fulfilled the inclusion criteria, and 53% of respondents rated their health as moderate. Similarly, 55% of respondents rated their health status approximately the same compared to their situation 1 year ago. QOL was impaired in all other subscales, except for the mental health and mental component score. A majority of patients suffered from PH symptoms, which worsened their QOL. The greatest impact on their QOL was associated with a high World Health Organization (WHO) functional class (FC), poor performance in a 6-min walking test (6MWT), symptoms, oxygen therapy, elevated pro-brain natriuretic peptide, pericardial effusion, APAH etiology, and being retired from work. Conclusions The respondents had a reduced QOL, compared to the general population, in all other subscales, except for mental health. APAH patients had the worst QOL. Good results in functional capacity measures (WHO FC, 6MWT) were associated with a better QOL. Patients’ QOL can be improved by reducing the symptoms of PAH. PMID:26787306

  19. Utility of endoscopic ultrasound in patients with portal hypertension.

    PubMed

    Hammoud, Ghassan M; Ibdah, Jamal A

    2014-10-21

    Endoscopic ultrasound (EUS) has revolutionized the diagnostic and therapeutic approach to patients with gastrointestinal disorders. Its application in patients with liver disease and portal hypertension is increasing. Patients with chronic liver disease are at risk for development of portal hypertension sequale such as ascites, spontaneous bacterial peritonitis and gastroesophageal varices. Bleeding esophageal and gastric varices are among the most common causes of mortality in patients with cirrhosis. Thus, early detection and treatment improve the outcome in this population. EUS can improve the detection and diagnosis of gastroesophageal varices and collateral veins and can provide endoscopic therapy of gastroesophageal varices such as EUS-guided sclerotherapy of esophageal collateral vessels and EUS-guided cynoacrylate (Glue) injection of gastric varices. EUS can also provide knowledge on the efficacy of pharmacotherapy of portal hypertension. Furthermore, EUS can provide assessment and prediction of variceal recurrence after endoscopic therapy and assessment of portal hemodynamics such as E-Flow and Doppler study of the azygous and portal veins. Moreover, EUS-guided fine needle aspiration may provide cytologic diagnosis of focal hepatic tumors and analysis of free abdominal fluid. Using specialized EUS-guided needle biopsy, a sample of liver tissue can be obtained to diagnose and evaluate for chronic liver disease. EUS-guided fine needle injection can be used to study portal vein pressure and hemodynamics, and potentially could be used to assist in exact measurement of portal vein pressure and placement of intrahepatic portosystemic shunt. PMID:25339809

  20. Management of hypertension in the very elderly patient.

    PubMed

    Elliott, William J

    2004-12-01

    This Hypertension Grand Rounds discusses pharmacological treatment of hypertension in individuals who have survived 9 decades on earth. This rapidly growing group of relatively active and healthy elderly people is at high risk for hypertension, its treatment, and its adverse consequences, including stroke and heart failure. In this age group, the most common abnormality is elevated systolic blood pressure, which is much more predictive of stroke and heart disease death after 53 years of age. With the possible exception of the Antihypertensive and Lipid Lowering to prevent Heart Attack Trial (ALLHAT), recent clinical trials have emphasized the overriding importance of lowering blood pressure rather than the specific agent chosen to begin therapy. In 1999, a metaanalysis of 7 clinical trials that enrolled 1670 subjects >80 years of age indicated that active antihypertensive drug therapy significantly reduced stroke by 34% and heart failure by 39% but was associated with a nonsignificant 6% increase in mortality. The HYpertension in the Very Elderly Trial (HYVET) will enroll 2100 patients >80 years of age and will compare 2 groups randomized to indapamide+/-perindopril versus placebo+/-placebo for incident stroke during 5 years of follow-up. This study should answer lingering questions about whether active antihypertensive therapy is associated with a major and significant reduction in cardiovascular morbidity and mortality in this age group as it clearly does in younger hypertensives. Its choice of a diuretic as initial therapy is consistent with other trials, but chlorthalidone is the drug with the most compelling evidence in large US trials that included very elderly patients. PMID:15505119

  1. The efficacy of isradipine in uncontrolled hypertension in Ethiopian patients.

    PubMed

    Zewdu, W; Habte, B

    1995-04-01

    The efficacy of isradipine, a new antihypertensive dihydropyridine calcium antagonist, was prospectively studied in Ethiopian patients with uncontrolled severe hypertension on multiple antihypertensive agents. Enrolled were 13 patients based on inclusion and exclusion criteria and 12 patients completed the study. The study design included a three-week wash-out period followed by eight weeks of active treatment. Eleven patients (92%) took diuretics in addition to isradipine. Patients were started on 2.5mg of isradipine twice daily and the dose was increased to 5mg twice daily in eight (67%) patients since the diastolic blood pressure (DBP) remained above 90mmHg four weeks after the initiation of therapy. The treatment resulted in a mean decrease of 42mmHg in systolic blood pressure (SBP) (p < 0.0001) and 34mmHg in DBP (p < 0.0001). Seven patients (58%) achieved normalization of DBP and in the remaining 5 (42%) the DBP became less than 105mmHg. Almost all patients experienced mild and transient side effects resulting from vasodilation but all tolerated these except one who dropped out from the study. In conclusion, these results indicate that isradipine combined with a diuretic is a safe and effective antihypertensive agent in Ethiopian patients with uncontrolled hypertension. PMID:7601086

  2. Caudal anesthesia in a patient with severe pulmonary hypertension.

    PubMed

    Ly, Doanh T

    2010-06-01

    Delivery of anesthesia to patients with severe pulmonary hypertension can be extremely challenging. The profound hemodynamic alterations of the disease can often be exacerbated by alterations in circulatory function brought about by anesthetic and surgical interventions. High perioperative morbidity and mortality rates have been reported. Minimizing adverse outcomes in these patients requires careful perioperative evaluation and planning. Selection of an anesthetic technique suitable for the surgery without causing major hemodynamic alterations, which can lead to cardiac failure and death, is a unique consideration of the anesthesia provider. As shown in this case report, caudal anesthesia, when appropriate, can offer a safe anesthetic for these patients. PMID:20572406

  3. Pulmonary hypertension in patients with hematological disorders following splenectomy.

    PubMed

    Meera, V; Jijina, Farah; Ghosh, Kanjaksha

    2010-03-01

    Prevalence of pulmonary arterial hypertension (PAH) was studied by Echocardiography and Doppler in 43 splenectomised patients with various disorders 1-20 years after splenectomy. PAH was detected only in thalassemia major, intermedia, hereditary sphereocytosis and myelofibrosis groups comprising a total of 21 patients. Six patients out of 21 was found to have PAH with mean pulmonary arterial pressure of 46.28 ± 28.17 mmHg. Twenty one controls having similar duration and type of disease also were assessed for PAH in this case control study 3/21 had PAH in this control group. The difference in number of patients showing pulmonary hypertension between case and control was not statistically significant (chi-square test p = 0.29-though the difference in pulmonary arterial pressure between case and control were significantly different (t-test p<0.0029) with control group showing a mean pulmonary arterial pressure of 25 ± 19 mmHg.Platelet count in the splenectomised group was significantly higher (p = 0.0029) than the controls. Pulmonary thromboembolism was equally high in the PAH patients with and without splenectomy. Patients undergoing splenectomy due to trauma, immune thrombocytopenia, sideroblastic anemia, extra hepatic portal hypertension, autoimmune hemolytic anemia did not show PAH after splenectomy even years after the procedure PAH following splenectomy is common after certain disorders and control patients with these diseases have tendency to develop PAH even without splenectomy. Pulmonary thromboembolism may be an important pathophysiological mechanism leading to this condition. Patients having hemolytic anemia and myelofibrosis should have regular evaluation of pulmonary arterial pressure whether he/she has been splenectomised or not. This is particularly important as availability of phosphodiesterase inhibitors like sildenafil allows one to manage these cases. PMID:23100991

  4. Efficacy and safety of linagliptin monotherapy in Asian patients with inadequately controlled type 2 diabetes mellitus: A multinational, 24-week, randomized, clinical trial

    PubMed Central

    Chen, Yuhong; Ning, Guang; Wang, Changjiang; Gong, Yan; Patel, Sanjay; Zhang, Candice; Izumoto, Toshiyasu; Woerle, Hans-Juergen; Wang, Weiqing

    2015-01-01

    Aims/Introduction Asian patients represent a large portion of the global population with type 2 diabetes mellitus, but are underrepresented in trials of glucose-lowering therapies. The present randomized, phase III, placebo-controlled, double-blind, 24-week study evaluated the dipeptidyl peptidase-4 inhibitor, linagliptin, as monotherapy in Asian patients with inadequately controlled type 2 diabetes mellitus. Materials and Methods Patients who were treatment naïve or had been treated with one oral antidiabetes drug were randomized to either linagliptin 5 mg daily or a placebo after washout. The primary end-point was a change from baseline in glycated hemoglobin after 24 weeks. Results A total of 300 Asian (87% Chinese) patients with type 2 diabetes mellitus were randomized to linagliptin or placebo at a 2:1 ratio. After 24 weeks of treatment, adjusted mean (standard error) glycated hemoglobin decreased by a placebo-corrected −0.50 ± 0.11 (P < 0.0001). In patients with baseline glycated hemoglobin ≥8.5%, the placebo-corrected decrease in glycated hemoglobin was −0.91 ± 0.20% (P < 0.0001). Adverse events occurred in 28.0 and 28.3% of linagliptin and placebo patients, respectively, but few were drug-related (3.0 and 2.0%, respectively). Hypoglycemia was reported by one linagliptin patient and no placebo patients. Treatment with linagliptin was weight neutral. Conclusions In Asian patients with inadequately controlled type 2 diabetes mellitus, linagliptin 5 mg as monotherapy was efficacious and well tolerated over 24 weeks. PMID:26543544

  5. Pulmonary Hypertension in Patients with Chronic Fibrosing Idiopathic Interstitial Pneumonias

    PubMed Central

    Hoeper, Marius M.; Behr, Juergen; Held, Matthias; Grunig, Ekkehard; Vizza, C. Dario; Vonk-Noordegraaf, Anton; Lange, Tobias J.; Claussen, Martin; Grohé, Christian; Klose, Hans; Olsson, Karen M.; Zelniker, Thomas; Neurohr, Claus; Distler, Oliver; Wirtz, Hubert; Opitz, Christian; Huscher, Doerte; Pittrow, David; Gibbs, J. Simon R.

    2015-01-01

    Background Pulmonary hypertension (PH) is a common finding in patients with chronic fibrosing idiopathic interstitial pneumonias (IIP). Little is known about the response to pulmonary vasodilator therapy in this patient population. COMPERA is an international registry that prospectively captures data from patients with various forms of PH receiving pulmonary vasodilator therapies. Methods We retrieved data from COMPERA to compare patient characteristics, treatment patterns, response to therapy and survival in newly diagnosed patients with idiopathic pulmonary arterial hypertension (IPAH) and PH associated with IIP (PH-IIP). Results Compared to patients with IPAH (n = 798), patients with PH-IIP (n = 151) were older and predominantly males. Patients with PH-IIP were treated predominantly with phosphodiesterase-5 inhibitors (88% at entry, 87% after 1 year). From baseline to the first follow-up visit, the median improvement in 6MWD was 30 m in patients with IPAH and 24.5 m in patients with PH-IIP (p = 0.457 for the difference between both groups). Improvements in NYHA functional class were observed in 22.4% and 29.5% of these patients, respectively (p = 0.179 for the difference between both groups). Survival rates were significantly worse in PH-IIP than in IPAH (3-year survival 34.0 versus 68.6%; p<0.001). Total lung capacity, NYHA class IV, and mixed-venous oxygen saturation were independent predictors of survival in patients with PH-IIP. Conclusions Patients with PH-IIP have a dismal prognosis. Our results suggest that pulmonary vasodilator therapy may be associated with short-term functional improvement in some of these patients but it is unclear whether this treatment affects survival. Trial Registration clinicaltrials.gov NCT01347216 PMID:26630396

  6. The hypothalamic neuropeptide FF network is impaired in hypertensive patients

    PubMed Central

    Goncharuk, Valeri D; Buijs, Ruud M; Jhamandas, Jack H; Swaab, Dick F

    2014-01-01

    Background The human hypothalamus contains the neuropeptide FF (NPFF) neurochemical network. Animal experiments demonstrated that NPFF is implicated in the central cardiovascular regulation. We therefore studied expression of this peptide in the hypothalamus of individuals who suffered from essential hypertension (n = 8) and died suddenly due to acute myocardial infarction (AMI), and compared to that of healthy individuals (controls) (n = 6) who died abruptly due to mechanical trauma of the chest. Methods The frozen right part of the hypothalamus was cut coronally into serial sections of 20 μm thickness, and each tenth section was stained immunohistochemically using antibody against NPFF. The central section through each hypothalamic nucleus was characterized by the highest intensity of NPFF immunostaining and thus was chosen for quantitative densitometry. Results In hypertensive patients, the area occupied by NPFF immunostained neuronal elements in the central sections through the suprachiasmatic nucleus (SCh), paraventricular hypothalamic nucleus (Pa), bed nucleus of the stria terminalis (BST), perinuclear zone (PNZ) of the supraoptic nucleus (SON), dorso- (DMH), ventromedial (VMH) nuclei, and perifornical nucleus (PeF) was dramatically decreased compared to controls, ranging about six times less in the VMH to 15 times less in the central part of the BST (BSTC). The NPFF innervation of both nonstained neuronal profiles and microvasculature was extremely poor in hypertensive patients compared to control. Conclusions The decreased NPFF expression in the hypothalamus of hypertensive patients might be a cause of impairment of its interaction with other neurochemical systems, and thereby might be involved in the pathogenesis of the disease. PMID:25161813

  7. Effect of losartan therapy on endothelial function in hypertensive patients.

    PubMed

    Sosa-Canache, Beatriz; Hernández-Hernández, Rafael; Armas-Padilla, María Cristina; Armas-Hernández, María José; Cammarata-Segura, Rosalba; Pacheco, Beatriz; Guerrero, Jaime; Israili, Zafar H; Valasco, Manuel

    2007-01-01

    The aim of the study was to evaluate the effect of losartan therapy on endothelial function by measuring serum nitric oxide (NO) levels and urinary excretion of NO in patients with essential hypertension. A group of 30 untreated stage 2 hypertensive patients (15 males and 15 females; age, 51.3 +/- 1.5 years) were included in the study. Office systolic and diastolic blood pressure (BP) was measured by using a mercury sphygmomanometer according to phase I and V of Korotkoff sounds. NO levels in serum and 24-hour urine were determined at baseline and after 6 weeks of daily dosing with losartan (50-100 mg). Losartan therapy resulted in a significant fall in systolic/diastolic BP (from 169.7 +/- 4.1/105 +/- 1.8 mm Hg at baseline to 146 +/- 2.7/91 +/- 1.9 mm Hg at the end of losartan treatment; P < 0.001). The therapy also caused significant increases in both serum NO level (32.74 +/- 3.01 microM/L at baseline versus 79.04 +/- 5.17 microM/L; P < 0.001 after therapy) and urinary NO excretion (58.21 +/- 3.72 microM/L at baseline versus 113.21 +/- 8.63 microM/L; P < 0.001 after therapy). Losartan therapy also reduced serum malondialdehyde (MDA), which is a measure of oxidative stress, by 0.201 nM (15.3%; P = 0.009). Losartan at a dose of 50 to 100 mg per day was effective in reducing elevated BP. The increase in serum NO levels and urinary NO excretion and a decrease in serum MDA levels by losartan treatment indicate a reduction in oxidative stress and enhances NO availability, both of which improve endothelial function. Thus, losartan therapy improves endothelial function in hypertensive patients with essential hypertension. PMID:17414585

  8. Common Secondary Causes of Resistant Hypertension and Rational for Treatment

    PubMed Central

    Faselis, Charles; Doumas, Michael; Papademetriou, Vasilios

    2011-01-01

    Resistant hypertension is defined as uncontrolled blood pressure despite the use of three antihypertensive drugs, including a diuretic, in optimal doses. Treatment resistance can be attributed to poor adherence to antihypertensive drugs, excessive salt intake, physician inertia, inappropriate or inadequate medication, and secondary hypertension. Drug-induced hypertension, obstructive sleep apnoea, primary aldosteronism, and chronic kidney disease represent the most common secondary causes of resistant hypertension. Several drugs can induce or exacerbate pre-existing hypertension, with non-steroidal anti-inflammatory drugs being the most common due to their wide use. Obstructive sleep apnoea and primary aldosteronism are frequently encountered in patients with resistant hypertension and require expert management. Hypertension is commonly found in patients with chronic kidney disease and is frequently resistant to treatment, while the management of renovascular hypertension remains controversial. A step-by-step approach of patients with resistant hypertension is proposed at the end of this review paper. PMID:21423678

  9. [Should hypertensive patients adapt their antihypertensive drugs during high altitude exposure?].

    PubMed

    Wuerzner, G; Allemann, Y

    2015-09-01

    High altitude exposure during leisure time is becoming more and more frequent. Due to the high prevalence of hypertension in the general population, high altitude exposure in hypertensive patients may not be uncommon. The increase in blood pressure with altitude has been confirmed by ambulatory blood pressure measurement in normotensive as well as in hypertensive patients. Compared to a placebo, most hypertensive drugs keep their blood pressure lowering effect up to a certain altitude. It is recommended that hypertensive patients measure their blood pressure during high altitude, exposure and plan a possible adaptation of treatment with their physician before their sojourn. PMID:26540993

  10. Cervicoscopy and Microcolposcopy in the Evaluation of Squamo Columnar Junction and Cervical Canal in LSIL Patients with Inadequate or Negative Colposcopy

    PubMed Central

    Valli, Edoardo; Fabbri, Guido; Centonze, Chiara; Bompiani, Alessandro; Baiocco, Federico; Larciprete, Giovanni; Ghinassi, Alessio

    2013-01-01

    Objective: The present study evaluated indications’ validity of cervicoscopic and microcolposcopic examination in LSIL patients with unsatisfactory or negative colposcopy. Matherial and methods: In the cervico-vaginal pathology unit of the “San Giovanni Calibita Fatebenefratelli” University of Rome “Tor Vergata”, 119 patients with a positive cervical cytology (LSIL), were submitted to the exam for the following two indications: 1) unsatisfactory colposcopy 37 (31.1%); 2) negative colposcopy 82 (68.9%). Results: Cervicoscopy allowed the SCJ visualization in 115 (9.6%) patients. In 4 patients 3.4%, the SCJ visualization was not possible due to cervical stenosis. Cervicoscopy without staining, revealed endocervical squamous columnar junction in 33 (28.7%) patients. The blue dye in panoramic view detected endocervical SCJ in 41 (35.7%), out of 115 patients (>5 mm in 34 (29.6%) patients and >10 mm in 7 (6.1%)). Conclusions: Cervicoscopic examination revealed 7.8% of CIN2-3 in LSIL patients with inadequate or negative colposcopy. In patients with negative colposcopy the percentage of undiagnosed lesions inside the cervical canal was very low. The blue dye added sensitivity to the exam. PMID:24170989

  11. Efficacy and safety of alirocumab in high cardiovascular risk patients with inadequately controlled hypercholesterolaemia on maximally tolerated doses of statins: the ODYSSEY COMBO II randomized controlled trial

    PubMed Central

    Cannon, Christopher P.; Cariou, Bertrand; Blom, Dirk; McKenney, James M.; Lorenzato, Christelle; Pordy, Robert; Chaudhari, Umesh; Colhoun, Helen M.

    2015-01-01

    Aims To compare the efficacy [low-density lipoprotein cholesterol (LDL-C) lowering] and safety of alirocumab, a fully human monoclonal antibody to proprotein convertase subtilisin/kexin 9, compared with ezetimibe, as add-on therapy to maximally tolerated statin therapy in high cardiovascular risk patients with inadequately controlled hypercholesterolaemia. Methods and results COMBO II is a double-blind, double-dummy, active-controlled, parallel-group, 104-week study of alirocumab vs. ezetimibe. Patients (n = 720) with high cardiovascular risk and elevated LDL-C despite maximal doses of statins were enrolled (August 2012–May 2013). This pre-specified analysis was conducted after the last patient completed 52 weeks. Patients were randomized to subcutaneous alirocumab 75 mg every 2 weeks (plus oral placebo) or oral ezetimibe 10 mg daily (plus subcutaneous placebo) on a background of statin therapy. At Week 24, mean ± SE reductions in LDL-C from baseline were 50.6 ± 1.4% for alirocumab vs. 20.7 ± 1.9% for ezetimibe (difference 29.8 ± 2.3%; P < 0.0001); 77.0% of alirocumab and 45.6% of ezetimibe patients achieved LDL-C <1.8 mmol/L (P < 0.0001). Mean achieved LDL-C at Week 24 was 1.3 ± 0.04 mmol/L with alirocumab and 2.1 ± 0.05 mmol/L with ezetimibe, and were maintained to Week 52. Alirocumab was generally well tolerated, with no evidence of an excess of treatment-emergent adverse events. Conclusion In patients at high cardiovascular risk with inadequately controlled LDL-C, alirocumab achieved significantly greater reductions in LDL-C compared with ezetimibe, with a similar safety profile. Trial registration clinicaltrials.gov Identifier: NCT01644188. PMID:25687353

  12. [Endothelial dysfunction in patients with primary hypertension and hyperhomocysteinemia].

    PubMed

    Baszczuk, Aleksandra; Kopczyński, Zygmunt; Thielemann, Anna

    2014-01-01

    It is widely accepted that endothelial dysfunction is the basis of the development of cardiovascular diseases, including hypertension. With regard to hypertension, endothelial dysfunction is concerned mainly with impaired vascular expansion; however, it is also related to the intensity of the development of atherosclerosis and thrombosis. Among the factors that cause damage to the endothelium, along with classic risk factors, is hyperhomocysteinemia. Hyperhomocysteinemia promotes the formation of oxygen radicals, lowering the oxidation-reduction potential, adversely affects the biosynthesis and function of vasodilator factors in the vascular wall, contributes to the inhibition of endothelial cell division with intense myocyte proliferation and migration, and impairs production of extracellular matrix components in the vascular wall. In addition, high levels of homocysteine and its derivatives contribute to the modification of LDL and HDL particles, inflammation and disorders in coagulation and fibrinolysis. Biochemical effects of the impact of hyperhomocysteinemia on endothelium can lead to damage of endothelial cells, dysfunction of diastolic function of vessels and reduction of their flexibility through its influence on vascular wall remodeling. These changes lead to an increase in blood pressure, strengthening the development of hypertension and target organ damage in patients with this disease. PMID:24491900

  13. Diabetes screening: a pending issue in hypertense/obese patients.

    PubMed

    Sepehri, Armina; Palazón-Bru, Antonio; Gil-Guillén, Vicente Francisco; Ramírez-Prado, Dolores; Navarro-Cremades, Felipe; Cortés, Ernesto; Rizo-Baeza, María Mercedes

    2015-01-01

    The literature about possible cardiovascular consequences of diagnostic inertia in diabetes is scarce. We examined the influence of undetected high fasting blood glucose (FBG) levels on the cardiovascular risk and poor control of cardiovascular risk factors in hypertensive or obese patients, with no previous diagnosis of diabetes mellitus (i.e., diagnostic inertia). A cross-sectional study during a preventive program in a Spanish region was performed in 2003-2004. The participants were aged ≥40 years and did not have diabetes but were hypertensive (n = 5, 347) or obese (n = 7, 833). The outcomes were high cardiovascular risk (SCORE ≥5%), poor control of the blood pressure (≥140/90 mmHg) and class II obesity. The relationship was examined between FBG and the main parameters, calculating the adjusted odd ratios with multivariate models. Higher values of FBG were associated with all the outcomes. A more proactive attitude towards the diagnosis of diabetes mellitus in the hypertensive and obese population should be adopted. PMID:25922799

  14. Diabetes screening: a pending issue in hypertense/obese patients

    PubMed Central

    Sepehri, Armina; Gil-Guillén, Vicente Francisco; Ramírez-Prado, Dolores; Navarro-Cremades, Felipe; Cortés, Ernesto; Rizo-Baeza, María Mercedes

    2015-01-01

    The literature about possible cardiovascular consequences of diagnostic inertia in diabetes is scarce. We examined the influence of undetected high fasting blood glucose (FBG) levels on the cardiovascular risk and poor control of cardiovascular risk factors in hypertensive or obese patients, with no previous diagnosis of diabetes mellitus (i.e., diagnostic inertia). A cross-sectional study during a preventive program in a Spanish region was performed in 2003–2004. The participants were aged ≥40 years and did not have diabetes but were hypertensive (n = 5, 347) or obese (n = 7, 833). The outcomes were high cardiovascular risk (SCORE ≥5%), poor control of the blood pressure (≥140/90 mmHg) and class II obesity. The relationship was examined between FBG and the main parameters, calculating the adjusted odd ratios with multivariate models. Higher values of FBG were associated with all the outcomes. A more proactive attitude towards the diagnosis of diabetes mellitus in the hypertensive and obese population should be adopted. PMID:25922799

  15. Characteristics of the patients referred to a Hypertension Unit between 1989 and 2003.

    PubMed

    Leotta, G; Rabbia, F; Canadè, A; Testa, E; Papotti, G; Mulatero, P; Veglio, F

    2008-02-01

    The level of blood pressure, the type of antihypertensive treatment and the prevalence of resistant hypertension at the first examination were evaluated in 6254 patients referred to a hospital Hypertension Unit from 1989 to 2003. From 1989-1993 to 1999-2003, we observed a reduced prevalence of grade 2 and grade 3 hypertension, and an increase in the prevalence of grade 1 hypertension, the proportion of treated subjects, the average number of antihypertensive drugs per patient and the prevalence of resistant hypertension. PMID:17855800

  16. Portosystemic Shunt Surgery in Patients with Idiopathic Noncirrhotic Portal Hypertension.

    PubMed

    Karagul, Servet; Yagci, Mehmet Ali; Tardu, Ali; Ertugrul, Ismail; Kirmizi, Serdar; Sumer, Fatih; Isik, Burak; Kayaalp, Cuneyt; Yilmaz, Sezai

    2016-01-01

    BACKGROUND Idiopathic noncirrhotic portal hypertension (INCPH) is a rare disease characterized by increased portal venous pressure in the absence of cirrhosis and other causes of liver diseases. The aim of the present study was to present our results in using portosystemic shunt surgery in patients with INCPH. MATERIAL AND METHODS Patients who had been referred to our Liver Transplantation Institute for liver transplantation and who had undergone surgery from January 2010 to December 2015 were retrospectively analyzed. Patients with INCPH who had undergone portosystemic shunt procedure were included in the study. Age, sex, symptoms and findings, type of portosystemic shunt, and postoperative complications were assessed. RESULTS A total of 1307 patients underwent liver transplantation from January 2010 to December 2015. Eleven patients with INCPH who did not require liver transplantation were successfully operated on with a portosystemic shunt procedure. The mean follow-up was 30.1±19 months (range 7-69 months). There was no mortality in the perioperative period or during the follow-up. Two patients underwent surgery again due to intra-abdominal hemorrhage; one had bleeding from the surgical site except the portacaval anastomosis and the other had bleeding from the h-graft anastomosis. No patient developed encephalopathy and no patient presented with esophageal variceal bleeding after portosystemic shunt surgery. Shunt thrombosis occurred in 1 patient (9.9%). Only 1 patient developed ascites, which was controlled medically. CONCLUSIONS Portosystemic shunt surgery is a safe and effective procedure for the treatment of patients with INCPH. PMID:27194018

  17. Optimising the management of pulmonary arterial hypertension patients: emergency treatments.

    PubMed

    Delcroix, M; Naeije, R

    2010-09-01

    Pulmonary arterial hypertension (PAH) is a rare and potentially fatal disease whose management is usually restricted to a few specialised centres. As patients do not necessarily live in the neighbourhood of these centres, daily care and emergencies have to be delegated to first and second lines. Treatment guidelines do not usually provide recommendations for acute emergency situations as evidence is scarce. This short review provides a description of our therapeutic protocols based on available data. A model of transmural organisation of care for PAH patients, currently applied in Belgium, is described. Thereafter, based on an analysis of the reasons of death in the PAH population, a review of the main emergencies is provided. Cardiac arrest and resuscitation, decompensated right heart failure, respiratory failure, arrhythmia, pericardial effusion, haemoptysis, surgery and drug-related adverse events will be discussed successively. Case reports showing the precariousness of PAH patients will enforce our thesis of the need for optimal patient management organisation. PMID:20956193

  18. Randomized, Double-Blind, Dose-Ranging Study of TAK-875, a Novel GPR40 Agonist, in Japanese Patients With Inadequately Controlled Type 2 Diabetes

    PubMed Central

    Kaku, Kohei; Araki, Takahiro; Yoshinaka, Ryoji

    2013-01-01

    OBJECTIVE Assessment of the efficacy and safety of TAK-875 (a novel GPR40 agonist) in Japanese patients with type 2 diabetes inadequately controlled by diet/exercise. RESEARCH DESIGN AND METHODS This was a phase II, multicenter, randomized, double-blind, parallel-group, placebo-controlled, 12-week dose-ranging evaluation of TAK-875 (6.25–200 mg once daily) with the primary end point of change in A1C at week 12. A nonblinded group received 1 mg glimepiride once daily as an active control. RESULTS A total of 396 patients were randomized to receive TAK-875 (n = 299), placebo (n = 48), or glimepiride (n = 49). The least square mean changes in A1C at week 12 from baseline were as follows: 0.09% in the placebo group; −0.54, −0.67, −0.88, −1.27, −1.29, and −1.40% in the 6.25-, 12.5-, 25-, 50-, 100-, and 200-mg TAK-875 groups, respectively; and −1.32% in the 1-mg glimepiride group. All TAK-875 groups had statistically significant reductions in A1C compared with placebo (P < 0.0001), and those receiving ≥50 mg TAK-875 achieved reductions in A1C equivalent to those with glimepiride. Results for other glycemic parameters, including improvements during a meal tolerance test, mirrored these positive findings with TAK-875. There were no significant differences in incidence of adverse events among the groups and no dose-dependent changes in tolerability. Hypoglycemic episodes were reported in 0.7% of patients in the TAK-875 groups and in 4.1% of the glimepiride group. CONCLUSIONS TAK-875 produced clinically and statistically significant improvements in glycemic control in patients with type 2 diabetes inadequately controlled by diet and exercise, and it was well tolerated with a lower propensity to cause hypoglycemia. PMID:23086138

  19. Correlation between serum cystatin C level and elderly hypertensive patients combined coronary heart disease

    PubMed Central

    Wang, Ying; Su, Xianming; Zhang, Wei; Yang, Wei; Wang, Ying; He, Yajun

    2015-01-01

    Objectives: To explore the correlation between serum cystatin C level and elderly hypertension with coronary heart disease patients. Methods: 500 hypertensive patients combined coronary heart disease were selected by coronary angiography. 321 of them were elderly patients with hypertension (male 204, female 117), and 400 of them were elderly patients with coronary heart disease (male 257, female 143), The serum cystatin C level of all patients were detected by immunoturbidimetry, and analyzed the correlation between the serum cystatin C level and different degree of blood pressure and the degree of coronary artery stenosis in elderly patients. Results: The serum cystatin C level was closely related with the blood pressure and the degree of the coronary artery stenosis. The higher the blood pressure level and the more serious the coronary artery stenosis, the higher the serum cystatin C level; The serum cystatin C level of hypertensive patients with coronary heart disease patients (Group D) were markedly higher than the level of the patients without hypertension and coronary heart disease patients (Group A), and the level of the patients with coronary heart disease (Group B) and the hypertension group (Group C) (P < 0.05). Conclusion: The serum cystatin C level of elderly patients with hypertension and coronary heart disease were closely related with the degree of blood pressure and coronary arteries stenosis. The serum cystatin C maybe a predictor of disease severity in elderly hypertensive patients with coronary heart disease. PMID:26131241

  20. Left ventricular systolic response to exercise in patients with systemic hypertension without left ventricular hypertrophy.

    PubMed

    Christian, T F; Zinsmeister, A R; Miller, T D; Clements, I P; Gibbons, R J

    1990-05-15

    Supine exercise radionuclide angiography was performed in 367 men to assess left ventricular (LV) systolic response to exercise; 58 had systemic hypertension without LV hypertrophy on a resting electrocardiogram and 309 were normotensive. All patients met the following criteria defining a low pretest likelihood of coronary artery disease: age less than 50 years; normal electrocardiographic response to exercise; absence of typical or atypical chest pain; and exercise heart rate greater than 120 beats/min. Patients taking beta-receptor blockers were excluded. There were no significant differences between hypertensive and normotensive groups in peak exercise heart rate, workload or exercise duration. However, hypertensive patients had significantly higher peak exercise systolic blood pressures and peak exercise rate-pressure products. There were no differences between patients with and without hypertension in resting ejection fraction, peak exercise ejection fraction (hypertensive patients 0.71 +/- 0.01, normotensive patients 0.70 +/- 0.05) or change in ejection fraction at peak exercise (hypertensive patients 0.07 +/- 0.01, normotensive patients 0.07 +/- 0.04). Diastolic and systolic ventricular volumes tended to be smaller in the hypertensive patients, but the difference was not statistically significant. The change in systolic volume with exercise was similar in the 2 groups (hypertensive -10 +/- 3 ml/m2, normotensive -10 +/- 1 ml/m2). In the absence of electrocardiographic evidence of LV hypertrophy, systemic hypertension does not influence LV systolic response to exercise. PMID:2140008

  1. Potent antihypertensive action of dietary flaxseed in hypertensive patients.

    PubMed

    Rodriguez-Leyva, Delfin; Weighell, Wendy; Edel, Andrea L; LaVallee, Renee; Dibrov, Elena; Pinneker, Reinhold; Maddaford, Thane G; Ramjiawan, Bram; Aliani, Michel; Guzman, Randolph; Pierce, Grant N

    2013-12-01

    Flaxseed contains ω-3 fatty acids, lignans, and fiber that together may provide benefits to patients with cardiovascular disease. Animal work identified that patients with peripheral artery disease may particularly benefit from dietary supplementation with flaxseed. Hypertension is commonly associated with peripheral artery disease. The purpose of the study was to examine the effects of daily ingestion of flaxseed on systolic (SBP) and diastolic blood pressure (DBP) in peripheral artery disease patients. In this prospective, double-blinded, placebo-controlled, randomized trial, patients (110 in total) ingested a variety of foods that contained 30 g of milled flaxseed or placebo each day over 6 months. Plasma levels of the ω-3 fatty acid α-linolenic acid and enterolignans increased 2- to 50-fold in the flaxseed-fed group but did not increase significantly in the placebo group. Patient body weights were not significantly different between the 2 groups at any time. SBP was ≈ 10 mm Hg lower, and DBP was ≈ 7 mm Hg lower in the flaxseed group compared with placebo after 6 months. Patients who entered the trial with a SBP ≥ 140 mm Hg at baseline obtained a significant reduction of 15 mm Hg in SBP and 7 mm Hg in DBP from flaxseed ingestion. The antihypertensive effect was achieved selectively in hypertensive patients. Circulating α-linolenic acid levels correlated with SBP and DBP, and lignan levels correlated with changes in DBP. In summary, flaxseed induced one of the most potent antihypertensive effects achieved by a dietary intervention. PMID:24126178

  2. Efficacy and safety of vildagliptin in patients with type 2 diabetes mellitus inadequately controlled with dual combination of metformin and sulphonylurea

    PubMed Central

    Lukashevich, V; Del Prato, S; Araga, M; Kothny, W

    2014-01-01

    Aim The broadly used combination of metformin and sulphonylurea (SU) often fails to bring patients to glycaemic goal. This study assessed the efficacy and safety of vildagliptin as add-on therapy to metformin plus glimepiride combination in patients with type 2 diabetes mellitus (T2DM) who had inadequate glycaemic control. Methods A multicentre, double-blind, placebo-controlled study randomized patients to receive treatment with vildagliptin 50 mg bid (n = 158) or placebo (n = 160) for 24 weeks. Results After 24 weeks, the adjusted mean change in haemoglobin A1c (HbA1c) was −1.01% with vildagliptin (baseline 8.75%) and −0.25% with placebo (baseline 8.80%), with a between-treatment difference of −0.76% (p < 0.001). Significantly more patients on vildagliptin achieved the HbA1c target <7% (28.3% vs. 5.6%; p < 0.001). The difference in fasting plasma glucose reduction between vildagliptin and placebo was −1.13 mmol/l (p < 0.001). In subgroup of patients with baseline HbA1c ≤8%, vildagliptin reduced HbA1c by 0.74% from baseline 7.82% (between-treatment difference: –0.97%; p < 0.001) with significantly more patients achieving the HbA1c target <7% (38.6% vs. 13.9%; p = 0.014). Vildagliptin was well tolerated with low incidence of hypoglycaemia, slightly higher than with placebo (5.1% vs. 1.9%) and no clinically relevant weight gain. Conclusions Vildagliptin significantly improved glycaemic control in patients with T2DM inadequately controlled with metformin plus glimepiride combination. The addition of vildagliptin was well tolerated with low risk of hypoglycaemia and weight gain. This makes vildagliptin an attractive treatment option for patients failing on metformin plus SU particularly in patients with baseline HbA1c ≤8%. PMID:24199686

  3. Combined vitamin D and calcium supplementation in vitamin D inadequate patients with urolithiasis: Impact on hypercalciuria and de novo stone formation

    PubMed Central

    Hesswani, Charles; Noureldin, Yasser A.; Elkoushy, Mohamed A.; Andonian, Sero

    2015-01-01

    Introduction: We examined the effect of combined vitamin D and calcium supplementation (VDCS) on urinary calcium excretion and de novo stone formation in vitamin D inadequate (VDI) urolithiasis patients. Methods: We retrospectively reviewed the data of VDI patients (serum 25-hydroxyvitamin D <75 nmol/L) followed at a tertiary stone centre between September 2009 and December 2014. VDI patients with history of urolithiasis, who were placed on VDCS for abnormal bone mineral density or hyperoxaluria, were included. Hypercalciuric patients and patients on thiazide diuretics were excluded. Metabolic stone workup and two 24-hour urine collections were performed before and after VDCS. Results: In total, we included 34 patients, with a mean age of 54.8 years and a mean body mass index of 25.7 kg/m2. After VDCS, there was a significant increase in the mean serum 25-hydroxyvitamin D (52.0 vs. 66.4 nmol/L, p < 0.001) and the mean urinary calcium excretion (3.80 vs. 5.64 mmol/d, p < 0.001). Eight (23.5%) patients developed de novo hypercalciuria. After a median follow-up of 39 (range: 7–60) months, 50% of hypercalciuric patients developed stones compared with 11.5% of non-hypercalciuric patients (p = 0.038). Conclusion: This study showed a significant effect of combined VDCS on mean urinary calcium excretion, de novo hypercalciuria, and stone development in VDI patients with history of urolithiasis. Therefore, VDI urolithiasis patients receiving VDCS are advised to have monitoring with 24-hour urine collections and imaging studies. Although small, our sample size was good enough to validate the statistical outcomes. Prospective studies are needed to confirm these results. PMID:26788229

  4. [Blood glucose and insulin in arterial hypertension. The elderly hypertensive patient].

    PubMed

    Fonseca, T; Clara, J G; Bicho, M; Azevedo, M; Manso, C; da Costa, J N

    1993-11-01

    The clinical importance of relationship between insulin resistance, hyperinsulinemia and high blood pressure is not yet fully understood. The aim of this study was to evaluate the influence of age in the relation between hyperglycemia, hyperinsulinemia and hypertension (HT). Two groups of patients with moderate to severe essential hypertension, aged < 65 (n = 40) and > or = 65 (n = 55) were compared with two other groups of normotensive subjects (NT) matched for sex (n = 14) and age (n = 18). The radioimmunoassay method and glucose oxidase methods were used to evaluate plasma insulin and plasma glucose concentrations. The global analysis shows: The plasma glucose level was significantly lower (p < 0.02) in NT group (n = 32; glycemia: 67.52 +/- 44 mg/dl) than in the HT group (n = 95; glycemia: 86.25 +/- 34.7 mg/dl. Further more the plasma insulin level in NT (3.37 +/- 3.18 microU/ml) was also lower than in HT (4.29 +/- 3.08 microU/ml) although without statistical significance. The patients (HT) aged < 65 years old had higher glycemia (85.76 +/- 26.8 mg/dl) and insulinemia (4.92 +/- 3.56) than NT of same age (glycemia: 59.0 +/- 11.8 mg/dl, insulinemia: 2.86 +/- 1.86), respectively p < 0.001 and p < 0.05. In HT aged > or = 65 the glycemia (82.38 +/- (9.67 mg/dl) was higher than in the NT matched group (65.5 +/- 20.36 mg/dl), p < 0.01, but plasma insulin was not different in the two groups (3.88 +/- 2.63 and 3.80 +/- 2.27 microU/ml).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8305245

  5. Pleiotropic effects of sitagliptin versus voglibose in patients with type 2 diabetes inadequately controlled via diet and/or a single oral antihyperglycemic agent: a multicenter, randomized trial

    PubMed Central

    Matsushima, Yukiko; Takeshita, Yumie; Kita, Yuki; Otoda, Toshiki; Kato, Ken-ichiro; Toyama-Wakakuri, Hitomi; Akahori, Hiroshi; Shimizu, Akiko; Hamaguchi, Erika; Nishimura, Yasuyuki; Kanamori, Takehiro; Kaneko, Shuichi; Takamura, Toshinari

    2016-01-01

    Purpose A step-up strategy for diet therapy and/or single oral antihyperglycemic agent (OHA) regimens has not yet been established. The aim of this study was to evaluate hemoglobin A1c (HbA1c) as a primary end point, and the pleiotropic effects on metabolic and cardiovascular parameters as secondary end points, of sitagliptin versus voglibose in patients with type 2 diabetes with inadequate glycemic control while on diet therapy and/or treatment with a single OHA. Methods In this multicenter, randomized, open-label, parallel-group trial, a total of 260 patients with inadequately controlled type 2 diabetes (HbA1c levels >6.9%) were randomly assigned to receive either sitagliptin (50 mg, once daily) or voglibose (0.6 mg, thrice daily) for 12 weeks. The primary end point was HbA1c levels. Results Patients receiving sitagliptin showed a significantly greater decrease in HbA1c levels (−0.78±0.69%) compared with those receiving voglibose (−0.30±0.78%). Sitagliptin treatment also lowered serum alkaline phosphatase levels and increased serum creatinine, uric acid, cystatin-C and homeostasis model assessment-β values. Voglibose increased low-density lipoprotein-cholesterol levels and altered serum levels of several fatty acids, and increased Δ-5 desaturase activity. Both drugs increased serum adiponectin. The incidence of adverse events (AEs) was significantly lower in the sitagliptin group, due to the decreased incidence of gastrointestinal AEs. Conclusions Sitagliptin shows superior antihyperglycemic effects compared with voglibose as a first-line or second-line therapy. However, both agents possess unique pleiotropic effects that lead to reduced cardiovascular risk in Japanese people with type 2 diabetes. Trial registration number UMIN 000003503. PMID:27110370

  6. Efficacy and Safety of Avandamet or Uptitrated Metformin Treatment in Patients with Type 2 Diabetes Inadequately Controlled with Metformin Alone: A Multicenter, Randomized, Controlled Trial

    PubMed Central

    Cai, Xiao-Ling; Chen, Ying-Li; Zhao, Jia-Jun; Shan, Zhong-Yan; Qiu, Ming-Cai; Li, Cheng-Jiang; Gu, Wei; Tian, Hao-Ming; Yang, Hua-Zhang; Xue, Yao-Ming; Yang, Jin-Kui; Hong, Tian-Pei; Ji, Li-Nong

    2015-01-01

    Background: At present, China has listed the compound tablet containing a fixed dose of rosiglitazone and metformin, Avandamet, which may improve patient compliance. The aim of this study was to evaluate the efficacy and safety of Avandamet or uptitrated metformin treatment in patients with type 2 diabetes inadequately controlled with metformin alone. Methods: This study was a 48-week, multicenter, randomized, open-labeled, active-controlled trial. Patients with inadequate glycaemic control (glycated hemoglobin [HbA1c] 7.5–9.5%) receiving a stable dose of metformin (≥1500 mg) were recruited from 21 centers in China (from 19 November, 2009 to 15 March, 2011). The primary objective was to compare the proportion of patients who reached the target of HbA1c ≤7% between Avandamet and metformin treatment. Results: At week 48, 83.33% of patients reached the target of HbA1c ≤7% in Avandamet treatment and 70.00% in uptitrated metformin treatment, with significantly difference between groups. The target of HbA1c ≤6.5% was reached in 66.03% of patients in Avandamet treatment and 46.88% in uptitrated metformin treatment. The target of fasting plasma glucose (FPG) ≤6.1 mmol/L was reached in 26.97% of patients in Avandamet treatment and 19.33% in uptitrated metformin treatment. The target of FPG ≤7.0 mmol/L was reached in 63.16% of patients in Avandamet treatment and 43.33% in uptitrated metformin treatment. Fasting insulin decreased 3.24 ± 0.98 μU/ml from baseline in Avandamet treatment and 0.72 ± 1.10 μU/ml in uptitrated metformin treatment. Overall adverse event (AE) rates and serious AE rates were similar between groups. Hypoglycaemia occurred rarely in both groups. Conclusions: Compared with uptitrated metformin, Avandamet treatment provided significant improvements in key parameters of glycemic control and was generally well tolerated. Registration number: ChiCTR-TRC-13003776. PMID:25963345

  7. Effects of naltrexone on electrocutaneous pain in patients with hypertension compared to normotensive individuals.

    PubMed

    Ring, Christopher; France, Christopher R; al'Absi, Mustafa; Edwards, Louisa; McIntyre, David; Carroll, Douglas; Martin, Una

    2008-02-01

    An opioid mechanism may help explain hypertensive hypoalgesia. A double-blind placebo-controlled design compared the effects of opioid blockade (naltrexone) and placebo on electrocutaneous pain threshold, pain tolerance, and retrospective McGill Pain Questionnaire ratings in 35 unmedicated patients with essential hypertension and 28 normotensive individuals. The hypertensives experienced less pain than normotensives during the assessment of their pain tolerance; however, this manifestation of hypertensive hypoalgesia was not moderated by naltrexone. These findings fail to support the hypothesis that essential hypertension is characterised by relative opioid insensitivity. PMID:18031920

  8. Hypertension management in patients with vascular disease: An update.

    PubMed

    Kohlman-Trigoboff, Debra

    2016-09-01

    Hypertension (HTN) is a major risk factor for cardiovascular disease. About 80 million U.S. adults (33%) have HTN. Of these individuals, approximately 77% use antihypertensive medication, however, only 54% have controlled HTN. Studies have demonstrated that patients whose blood pressures are controlled achieve a minimum of 50% reduction in cardiovascular events compared to similar patients with poorly controlled blood pressure. This article will define HTN and its consequences. Diagnostic evaluation and evidence-based treatment guidelines for HTN to include lifestyle modifications and pharmacotherapy will be discussed. Finally, this article will examine why the treatment of HTN can prevent the development and reduce the progression of atherosclerosis in vascular disease. PMID:27568315

  9. [Global treatment of cardiovascular risk in the hypertensive patient].

    PubMed

    Mazón-Ramos, Pilar; Bertomeu-Martínez, Vicente; Palma-Gámiz, José L; Quiles-Granado, Juan; Guindo-Soldevilla, José; González-Juanatey, José R

    2007-02-01

    During 2006, new evidence supporting the need to adopt a global approach to the treatment of cardiovascular risk in hypertensive patients has been reported. It is increasingly clear that it is not sufficient to aim for optimum blood pressure control, which in any case is not easy to achieve, and that it is essential to treat all cardiovascular risk factors by using drugs with proven benefits, even when those benefits are supplementary to the drug's principal effects. In addition, drugs that could have a detrimental effect or that are, merely, less beneficial should be avoided or kept as a last resort. This appears to have happened with atenolol, and with beta-blockers in general, which have been withdrawn as first-line treatment in the recommendations of some professional societies. To lower cardiovascular risk, it is essential to prevent the development of conditions like diabetes, which are known to have drastic effect on the patient's prognosis. Recently, the results of the DREAM study, which are discussed in detail in this article, have been reported. They could lead to a change in therapeutic strategy in patients who are expected to develop diabetes. In addition, this year has seen the publication of substantial data on a new antihypertensive agent, aliskiren, the first oral renin inhibitor. It is awaiting approval by the international medicine agencies (i.e., the FDA and the EMEA), but should provide a very promising tool in the difficult area of high blood pressure management. Despite numerous advances in the pharmacologic treatment of high blood pressure, control is very difficult to achieve, principally in the elderly, in whom the prevalence of hypertension is high. In these patients, social factors and difficulties with treatment compliance also have an influence and must be dealt with by public health measures aimed at improving blood pressure control. PMID:17352858

  10. Tocilizumab in patients with active rheumatoid arthritis and inadequate responses to DMARDs and/or TNF inhibitors: a large, open-label study close to clinical practice

    PubMed Central

    Bykerk, Vivian P; Östör, Andrew J K; Alvaro-Gracia, José; Pavelka, Karel; Ivorra, José Andrés Román; Graninger, Winfried; Bensen, William; Nurmohamed, Michael T; Krause, Andreas; Bernasconi, Corrado; Stancati, Andrea; Sibilia, Jean

    2012-01-01

    Objective To evaluate the safety and efficacy of tocilizumab in clinical practice in patients with rheumatoid arthritis (RA) with inadequate responses (IR) to disease-modifying antirheumatic drugs (DMARDs) or both DMARDs and tumour necrosis factor α inhibitors (TNFis). Methods Patients—categorised as TNFi-naive, TNFi-previous (washout) or TNFi-recent (no washout) —received open-label tocilizumab (8 mg/kg) every 4 weeks ± DMARDs for 24 weeks. Adverse events (AEs) and treatment discontinuations were monitored. Efficacy end points included American College of Rheumatology (ACR) responses, 28-joint disease activity score (DAS28) and European League Against Rheumatism responses. Results Overall, 1681 (976 TNF-naive, 298 TNFi-previous and 407 TNFi-recent) patients were treated; 5.1% discontinued treatment because of AEs. The AE rate was numerically higher in TNFi-recent (652.6/100 patient-years (PY)) and TNFi-previous (653.6/100PY) than in TNFi-naive (551.1/100PY) patients. Serious AE rates were 18.0/100PY, 28.0/100PY and 18.6/100PY; serious infection rates were 6.0/100PY, 6.8/100PY and 4.2/100PY, respectively. At week 4, 36.5% of patients achieved ACR20 response and 14.9% DAS28 remission (<2.6); at week 24, 66.9%, 46.6%, 26.4% and 56.8% achieved ACR20/ACR50/ACR70 responses and DAS28 remission, respectively. Overall, 61.6% (TNFi-naive), 48.5% (TNFi-previous) and 50.4% (TNFi-recent) patients achieved DAS28 remission. Conclusions In patients with RA who were DMARD-IR/TNFi-IR, tocilizumab ± DMARDs provided rapid and sustained efficacy without unexpected safety concerns. PMID:22615456

  11. Effects of sex and hypertension subtype on haemodynamics and left ventricular diastolic function in older patients with stage 1 hypertension

    PubMed Central

    Fujimoto, Naoki; Okada, Yoshiyuki; Shibata, Shigeki; Best, Stuart A.; Bivens, Tiffany B.; Levine, Benjamin D.; Fu, Qi

    2013-01-01

    Background Hypertension is associated with cardiovascular stiffening and left ventricular diastolic dysfunction, leading to comorbidities such as heart failure with preserved ejection fraction (HFpEF). It is unknown whether sex and hypertension subtype affect haemodynamics and left ventricular function in older individuals. Methods Ninety-five older patients with Stage 1 hypertension (ambulatory awake SBP135–159 mmHg) and 56 normotensive controls were enrolled. Patients were stratified prospectively into isolated systolic hypertension (ISH, DBP <85 mmHg) or systolic-diastolic hypertension (SDH, DBP ≥85 mmHg). Haemodynamics and Doppler variables including early filling (E) and averaged mitral annular (E′mean) velocities were measured during supine rest. Results Ambulatory awake blood pressures (BPs) were the highest in SDH, whereas supine SBP was similar in both hypertensive groups. No sex difference was observed in supine or ambulatory awake BPs in all groups. Stroke volume was similar among groups within the same sex, but smaller in women. Women exhibited faster E, slower E′mean and greater E/E′mean, whereas no group difference was observed in E within the same sex. In women, E′mean was significantly slower in SDH (5.9 ± 1.6 vs. 7.4 ± 1.1 cm/s, P < 0.01) and ISH (6.6 ± 1.6 cm/s, P = 0.07) than controls, resulting in the highest E/E′mean in SDH. In men, E′mean and E/E′mean were similar among the three groups. Conclusion These results suggest that elderly hypertensive women may have left ventricular early diastolic dysfunction and higher estimated filling pressure, consistent with their susceptibility to HFpEF. Women with SDH seemed to have more left ventricular diastolic dysfunction, which might be explained by the greater cumulative afterload when ambulatory. PMID:24077248

  12. [Secondary hypertension].

    PubMed

    Yoshida, Yuichi; Shibata, Hirotaka

    2015-11-01

    Hypertension is a common disease and a crucial predisposing factor of cardiovascular diseases. Approximately 10% of hypertensive patients are secondary hypertension, a pathogenetic factor of which can be identified. Secondary hypertension consists of endocrine, renal, and other diseases. Primary aldosteronism, Cushing's syndrome, pheochromocytoma, hyperthyroidism, and hypothyroidism result in endocrine hypertension. Renal parenchymal hypertension and renovascular hypertension result in renal hypertension. Other diseases such as obstructive sleep apnea syndrome are also very prevalent in secondary hypertension. It is very crucial to find and treat secondary hypertension at earlier stages since most secondary hypertension is curable or can be dramatically improved by specific treatment. One should keep in mind that screening of secondary hypertension should be done at least once in a daily clinical practice. PMID:26619670

  13. High Frequency of Pulmonary Hypertension-Causing Gene Mutation in Chinese Patients with Chronic Thromboembolic Pulmonary Hypertension

    PubMed Central

    Xi, Qunying; Liu, Zhihong; Zhao, Zhihui; Luo, Qin; Huang, Zhiwei

    2016-01-01

    The pathogenesis of chronic thromboembolic pulmonary hypertension (CTEPH) is unknown. Histopathologic studies revealed that pulmonary vasculature lesions similar to idiopathic pulmonary arterial hypertension (PAH) existed in CTEPH patients as well. It’s well-known that genetic predisposition plays an important role in the mechanism of PAH. So we hypothesized that PAH-causing gene mutation might exist in some CTEPH patients and act as a background to facilitate the development of CTEPH. In this study, we analyzed 7 PAH-causing genes including BMPR2, ACVRL1, ENG, SMAD9, CAV1, KCNK3, and CBLN2 in 49 CTEPH patients and 17 patients recovered from pulmonary embolism (PE) but without pulmonary hypertension(PH). The results showed that the nonsynonymous mutation rate in CTEPH patients is significantly higher than that in PE without PH patients (25 out of 49 (51%) CTEPH patients vs. 3 out of 17 PE without PH patients (18%); p = 0.022). Four CTEPH patients had the same point mutation in ACVRL1 exon 10 (c.1450C>G), a mutation approved to be associated with PH in a previous study. In addition, we identified two CTEPH associated SNPs (rs3739817 and rs55805125). Our results suggest that PAH-causing gene mutation might play an important role in the development of CTEPH. PMID:26820968

  14. Analysis of various etiologies of hypertension in patients hospitalized in the endocrinology division.

    PubMed

    Ye, Dan; Dong, FengQin; Lu, XunLiang; Zhang, Zhe; Feng, YunFei; Li, ChengJiang

    2012-08-01

    This research aimed to analyze the clinical data of various etiologies of hypertension in patients hospitalized in the Endocrinology Division. The differences between essential and secondary hypertension were examined to provide a basis for clinical differential diagnosis. The data from all the inpatients with hypertension of unknown origin admitted in the Endocrinology Division of the First Affiliated Hospital of the Zhejiang University School of Medicine from January 2001 to May 2011 were reviewed. The patients were classified into either essential or secondary hypertensive groups. The differentiating parameters of these forms of hypertension were analyzed using the one-factor and multi-factor logistic regression analysis. A total of 1,001 cases were selected in which 346 cases (34.6%) were essential hypertensive and 655 cases (65.4%) were secondary hypertensive. Adrenal hypertension was the primary cause of secondary hypertension, followed by renal artery, central, psychogenic, and renal hypertension as well as others that have not been classified systematically. Using one-factor analysis, significant differences were found among duration of hypertension, age, the onset age, family history of hypertension, diastolic pressure on admission, Cushing syndrome, body mass index (BMI), urine protein, serum creatinine, orthostatic aldosterone, ratio of orthostatic aldosterone to renin activity, incidence of fatty liver displayed by type-B ultrasound, and computed tomography adrenal masses incidence (P < 0.05). Multi-factor regression analysis showed that family history of hypertension (OR = 7.196) and BMI above the normal range (OR = 15.124) were the independent factors that predicted essential hypertension, but failed to determine any other valid predictors of secondary causes except adrenal masses (OR = 10.114), orthostatic aldosterone value >200 pg/ml (OR = 9.742), and a ratio of orthostatic aldosterone and renin activity >40 (OR = 4.723). PMID:22212439

  15. What Is in a Name? How Biomedical Language May Derail Patient Understanding of Hypertension.

    PubMed

    Bokhour, Barbara G; Kressin, Nancy R

    2015-07-01

    Despite major advances in treating hypertension, >50% of all individuals diagnosed with the condition remain in poor control. A fundamental issue may be that patients may not fully understand the meaning of the term hypertension or its cause, leading to poor adherence to medications and limiting other effective self-management behaviors. We posit that the word hypertension itself may contribute to these misunderstandings, particularly in regards to the role of stress in causing hypertension, which thus suggests stress management as a primary strategy for control. The word hypertension is often interpreted by patients to mean too much tension. In conjunction with cultural framings of stress causing high blood pressure, many patients turn to stress management to control their hypertension. The word hypertension can thus cause patients to think of it as more of a psychological than physiological condition, thus discounting the value of antihypertensive medications and interfering with medication adherence. We therefore suggest that clinicians reconsider the use of the term hypertension and the ways in which they explain the condition to patients. Reorienting the language to the more patient-centered term of high blood pressure may help patients better understand the condition and to more readily embrace the available efficacious therapies. PMID:26152679

  16. Effects of bosentan on peripheral endothelial function in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension

    PubMed Central

    Adachi, Shiro; Nakano, Yoshihisa; Kamimura, Yoshihiro; Shimokata, Shigetake; Takeshita, Kyosuke; Murohara, Toyoaki; Kondo, Takahisa

    2016-01-01

    Abstract Endothelin receptor antagonists (ERAs) have been shown to improve the prognosis of patients with pulmonary arterial hypertension (PAH). However, the effect of the oral dual ERA bosentan on peripheral endothelial dysfunction (PED), as assessed by flow-mediated vasodilation (FMD), in patients with pulmonary hypertension is not well characterized. We investigated the effect of bosentan on PED in patients with PAH or inoperable chronic thromboembolic pulmonary hypertension (CTEPH). A total of 18 patients with PAH and 8 with CTEPH were treated with bosentan. All patients underwent FMD assessment before and after 3 months of bosentan treatment. Whereas FMD increased from 6.01% ± 2.42% at baseline to 8.07% ± 3.18% after 3 months (P < 0.0001) in patients with PAH, those with CTEPH showed no change in FMD after bosentan therapy. In addition, FMD at baseline showed no correlation with pulmonary vascular resistance (r = 0.09) or plasma brain natriuretic peptide levels (r = −0.23) in patients with PAH. Bosentan treatment ameliorated PED in patients with PAH but not in those with inoperable CTEPH. In addition, FMD did not correlate with PAH severity. PMID:27252842

  17. The Characteristics of Treated Pulmonary Arterial Hypertension Patients in Ontario.

    PubMed

    Vaid, Haris M; Camacho, Ximena; Granton, John T; Mamdani, Muhammad M; Yao, Zhan; Singh, Samantha; Juurlink, David N; Gomes, Tara

    2016-01-01

    Background. There are no Canadian prevalence studies on pulmonary arterial hypertension (PAH) to date. We described the characteristics of treated PAH patients and the healthcare utilization and costs associated with PAH in a population of public drug plan beneficiaries in Ontario, Canada. Methods. A retrospective cross-sectional analysis was conducted between April 2010 and March 2011 to identify treated PAH patients using population-based health administrative databases. We investigated demographic and clinical characteristics of treated PAH patients and conducted a cohort study to determine treatment patterns, healthcare utilization, and associated costs, over a one-year follow-up period (March 2012). Results. We identified 326 treated PAH cases in Ontario's publicly funded drug plan. Overall mean age was 59.4 years (±20.3 years) and over 77% of cases were women (n = 251). Combination therapy was used to treat 22.9% (n = 69) of cases, costing an average of $4,569 (SD $1,544) per month. Median monthly healthcare costs were $264 (IQR $96-$747) for those who survived and $2,021 (IQR $993-$6,399) for those who died over a one-year period, respectively (p < 0.01). Conclusions. PAH care in Ontario is complex and has high healthcare costs. This data may help guide towards improved patient management. PMID:27445555

  18. The Characteristics of Treated Pulmonary Arterial Hypertension Patients in Ontario

    PubMed Central

    Vaid, Haris M.; Camacho, Ximena; Granton, John T.; Mamdani, Muhammad M.; Yao, Zhan; Singh, Samantha; Juurlink, David N.; Gomes, Tara

    2016-01-01

    Background. There are no Canadian prevalence studies on pulmonary arterial hypertension (PAH) to date. We described the characteristics of treated PAH patients and the healthcare utilization and costs associated with PAH in a population of public drug plan beneficiaries in Ontario, Canada. Methods. A retrospective cross-sectional analysis was conducted between April 2010 and March 2011 to identify treated PAH patients using population-based health administrative databases. We investigated demographic and clinical characteristics of treated PAH patients and conducted a cohort study to determine treatment patterns, healthcare utilization, and associated costs, over a one-year follow-up period (March 2012). Results. We identified 326 treated PAH cases in Ontario's publicly funded drug plan. Overall mean age was 59.4 years (±20.3 years) and over 77% of cases were women (n = 251). Combination therapy was used to treat 22.9% (n = 69) of cases, costing an average of $4,569 (SD $1,544) per month. Median monthly healthcare costs were $264 (IQR $96–$747) for those who survived and $2,021 (IQR $993–$6,399) for those who died over a one-year period, respectively (p < 0.01). Conclusions. PAH care in Ontario is complex and has high healthcare costs. This data may help guide towards improved patient management. PMID:27445555

  19. Renal outcomes in hypertensive Black patients at high cardiovascular risk.

    PubMed

    Weir, Matthew R; Bakris, George L; Weber, Michael A; Dahlof, Bjorn; Devereux, Richard B; Kjeldsen, Sverre E; Pitt, Bertram; Wright, Jackson T; Kelly, Roxzana Y; Hua, Tsushung A; Hester, R Allen; Velazquez, Eric; Jamerson, Kenneth A

    2012-03-01

    The ACCOMPLISH trial (Avoiding Cardiovascular events through Combination therapy in Patients Living with Systolic Hypertension) was a 3-year multicenter, event-driven trial involving patients with high cardiovascular risk who were randomized in a double-blinded manner to benazepril plus either hydrochlorothiazide or amlodipine and titrated in parallel to reach recommended blood pressure goals. Of the 8125 participants in the United States, 1414 were of self-described Black ethnicity. The composite kidney disease end point, defined as a doubling in serum creatinine, end-stage renal disease, or death was not different between Black and non-Black patients, although the Blacks were significantly more likely to develop a greater than 50% increase in serum creatinine to a level above 2.6 mg/dl. We found important early differences in the estimated glomerular filtration rate (eGFR) due to acute hemodynamic effects, indicating that benazepril plus amlodipine was more effective in stabilizing eGFR compared to benazepril plus hydrochlorothiazide in non-Blacks. There was no difference in the mean eGFR loss in Blacks between therapies. Thus, benazepril coupled to amlodipine was a more effective antihypertensive treatment than when coupled to hydrochlorothiazide in non-Black patients to reduced kidney disease progression. Blacks have a modestly higher increased risk for more advanced increases in serum creatinine than non-Blacks. PMID:22189843

  20. Studies on blood rheology in patients with primary pulmonary hypertension.

    PubMed

    Persson, S U; Gustavsson, C G; Larsson, H; Persson, S

    1991-10-01

    The rheologic properties of blood were studied in 6 patients with primary pulmonary hypertension (PPH) and compared with those of a control group of 10 healthy subjects. Blood viscosity was studied with a rotational viscometer and blood cell deformability with a filtrometer giving values for clogging particles (CP) and red cell transit time (RCTT). Blood viscosity at varying shear rates was found to be increased both at natural (p less than 0.025-0.005) and standardized hematocrit, 45% (p less than 0.05 at 40 s-1) in patients with PPH. Red cell deformability was reduced as indicated by a significant increase of RCTT (p less than 0.01). Increased values for hematocrit (p less than 0.001), hemoglobin concentration (p less than 0.001), and erythrocyte count (p less than 0.005) were found and decreased values for mean corpuscular hemoglobin concentration (MCHC) (p less than 0.025) and HDL cholesterol (p less than 0.005). Plasma viscosity, white cell deformability, white cell count, mean corpuscular volume (MCV), and plasma fibrinogen concentration did not significantly differ from the values found in the control group. It is concluded that patients with PPH have impaired blood rheology. The hemorheologic abnormalities in these patients may be of hemodynamic significance. PMID:1952272

  1. Renal artery bilateral arteriosclerosis cause of resistant hypertension in hemodialysed patients.

    PubMed

    Niculae, Andrei; Peride, Ileana; Marinescu-Paninopol, Adriana; Vrabie, Camelia Doina; Ginghină, Octav; Jecan, Cristian Radu; Bratu, Ovidiu Gabriel

    2016-01-01

    We present the case of a 57-year-old hemodialysed male patient known with severe hypertension resistant to six classes of hypotensive medication, in maximal doses, correlated with increased ultrafiltration during the hemodialysis session. In this case, bilateral nephrectomy was performed as final treatment option for malignant hypertension, and histopathological examination of both kidneys emphasized arteriosclerosis lesions. The results consisted in better hypertension management, with a reduction in both the number and doses of antihypertensive drugs. PMID:27516040

  2. Association of Hypertension With Erectile Function in Chronic Peripheral Arterial Insufficiency Patients

    PubMed Central

    Spessoto, Luis Cesar Fava; Facio, Fernando Nestor; de Arruda, Jose Germano Ferraz; Arruda, Pedro Francisco F.; Gatti, Marcio; Antoniassi, Thiago Silveira; Facio, Maria Fernanda Warick; de Godoy, Jose Maria Pereira

    2016-01-01

    Background Risk factors may influence the improvement or worsening of erectile dysfunction (ED). The aim of the current study was to evaluate the effect of systemic hypertension on ED in patients with peripheral arterial disease. Methods The effect of hypertension on ED was assessed in 125 consecutive patients in a cross-sectional quantitative study. The ages of the patients ranged from 19 to 88 years old (mean: 59.82 ± 10.48 years). The only exclusion criterion was the amputation of one or both legs. The ankle-arm index was assessed and the international index of ED questionnaire was applied to all participants in the study. Results Of the 125 patients, 22 (17.6%) had mild (grade 1), 50 (40.0%) had moderate (grade 2) and 53 (42.4%) had severe (grade 3) ED. Hypertensive patients have more ED, with ED in hypertensive patients being associated to chronic arterial disease. However, in comparison with normotensive patients, hypertension exerts an immediate protective effect on erectile function. Conclusions In conclusion, although erectile function is initially protected by systemic arterial hypertension in patients with chronic arterial disease, both chronic arterial disease and ED deteriorate over the long term in hypertensive patients. PMID:27429678

  3. Efficacy and tolerability of flexibly-dosed adjunct TC-5214 (dexmecamylamine) in patients with major depressive disorder and inadequate response to prior antidepressant.

    PubMed

    Vieta, Eduard; Thase, Michael E; Naber, Dieter; D'Souza, Bernadette; Rancans, Elmars; Lepola, Ulla; Olausson, Bengt; Szamosi, Johan; Wilson, Ellis; Hosford, David; Dunbar, Geoffrey; Tummala, Raj; Eriksson, Hans

    2014-04-01

    This paper reports the efficacy and tolerability of the nicotinic channel modulator TC-5214 (dexmecamylamine) as adjunct therapy for patients with major depressive disorder who have an inadequate response to initial antidepressant treatment in 2 Phase III studies. These double-blind, placebo-controlled studies (NCT01157078, D4130C00002 [Study 002] conducted in the US and India; NCT01180400, D4130C00003 [Study 003] conducted in Europe) comprised 8 weeks of open-label antidepressant treatment followed by 8 weeks of active treatment during which patients were randomized to flexibly-dosed TC-5214 1-4 mg twice daily (BID) or placebo as an adjunct to ongoing therapy with SSRI/SNRI. The primary efficacy endpoint in both studies was change in Montgomery Åsberg Depression Rating Scale (MADRS) total score from randomization (week 8) to treatment end (week 16). Secondary endpoints included change in Sheehan Disability Scale and Hamilton Depression Rating Scale 17-item scores. Study 002 randomized 319 patients and Study 003 randomized 295 patients to TC-5214 or placebo. At treatment end, no significant differences were seen for change in MADRS total score with TC-5214 versus placebo. Furthermore, there were no significant differences in any of the secondary endpoints. The most commonly reported (≥ 10%) adverse events with TC-5214 in these studies were constipation and headache. In these 2 flexibly-dosed studies, no specific therapeutic effects were observed for TC-5214 (1-4 mg BID) adjunct to antidepressant in the primary endpoint or any secondary endpoint; however, TC-5214 was generally well tolerated. In conclusion, no antidepressant effect of TC-5214 was observed in these studies. PMID:24507016

  4. Diagnosing and Managing Primary Aldosteronism in Hypertensive Patients: a Case-Based Approach.

    PubMed

    Carey, Robert M

    2016-10-01

    Primary aldosteronism with a prevalence of 8 % of hypertension and 20 % of pharmacologically resistant hypertension is the most common secondary cause of hypertension. Yet, the diagnosis is missed in the vast majority of patients. Current clinical practice guidelines recommend screening for primary aldosteronism in patients with sustained elevation of blood pressure (BP) ≥150/100 mmHg if possible prior to initiation of antihypertensive therapy, and in patients with resistant hypertension, spontaneous or diuretic-induced hypokalemia, adrenal incidentaloma, obstructive sleep apnea, a family history of early onset of hypertension or cerebrovascular accident patients with primary aldosteronism. Clinical and laboratory methods of screening, confirmatory testing, subtype classification, and medical and surgical management are systematically reviewed and illustrated with a clinical case. PMID:27566330

  5. Stakeholder Perspectives on Changes in Hypertension Care Under the Patient-Centered Medical Home

    PubMed Central

    O’Donnell, Alison J.; Kellom, Katherine; Miller-Day, Michelle; McClintock, Heather F. de Vries; Kaye, Elise M.; Gabbay, Robert; Cronholm, Peter F.

    2016-01-01

    Introduction Hypertension is a major modifiable risk factor for cardiovascular and kidney disease, yet the proportion of adults whose hypertension is controlled is low. The patient-centered medical home (PCMH) is a model for care delivery that emphasizes patient-centered and team-based care and focuses on quality and safety. Our goal was to investigate changes in hypertension care under PCMH implementation in a large multipayer PCMH demonstration project that may have led to improvements in hypertension control. Methods The PCMH transformation initiative conducted 118 semistructured interviews at 17 primary care practices in southeastern Pennsylvania between January 2011 and January 2012. Clinicians (n = 47), medical assistants (n = 26), office administrators (n = 12), care managers (n = 11), front office staff (n = 7), patient educators (n = 4), nurses (n = 4), social workers (n = 4), and other administrators (n = 3) participated in interviews. Study personnel used thematic analysis to identify themes related to hypertension care. Results Clinicians described difficulties in expanding services under PCMH to meet the needs of the growing number of patients with hypertension as well as how perceptions of hypertension control differed from actual performance. Staff and office administrators discussed achieving patient-centered hypertension care through patient education and self-management support with personalized care plans. They indicated that patient report cards were helpful tools. Participants across all groups discussed a team- and systems-based approach to hypertension care. Conclusion Practices undergoing PCMH transformation may consider stakeholder perspectives about patient-centered, team-based, and systems-based approaches as they work to optimize hypertension care. PMID:26916899

  6. Echocardiographic abnormalities in the assessment of cardiac organ damage in never-treated hypertensive patients.

    PubMed

    Milan, Alberto; Avenatti, Eleonora; Puglisi, Elisabetta; Abram, Sara; Magnino, Corrado; Naso, Diego; Tosello, Francesco; Fabbri, Ambra; Vairo, Alessandro; Mulatero, Paolo; Rabbia, Franco; Veglio, Franco

    2012-01-01

    Hypertension-related cardiac organ damage, other than left ventricular (LV) hypertrophy (LVH), has been described: in particular, concentric remodeling, LV diastolic dysfunction (DD), and left atrial (LA) enlargement are significantly associated with cardiovascular morbility and mortality in different populations. This study evaluated the prevalence of these latter morphofunctional abnormalities, in never-treated essential hypertensive patients and the role of such a serial assessment of hypertensive cardiac damage in improving cardiovascular risk stratification in these patients. A total of 100 never-treated essential hypertensive subjects underwent a complete clinical and echocardiographic evaluation. Left ventricular morphology, systolic and diastolic function, and LA dimension (linear and volume) were evaluated by echocardiography. Left ventricular hypertrophy was present in 14% of the patients, whereas concentric remodeling was present in 25% of the subjects. Among patients free from LV morphology abnormalities, the most frequent abnormality was LA enlargement (global prevalence 57%); the percentage of patients with at least one parameter consistent with DD was 22% in the entire population, but DD was present as the only cardiac abnormality in 1% of our patient. Left atrial volume indexed for body surface area was the most sensitive parameter in identifying hypertension-related cardiac modification. The global prevalence of cardiac alteration reached 73% in never-treated hypertensive patients. Left ventricular remodeling and LA enlargement evaluation may grant a better assessment of cardiac organ damage and cardiovascular risk stratification of hypertensive patients without evidence of LVH after routine examination. PMID:22738434

  7. Blood pressure effects of naproxcinod in hypertensive patients.

    PubMed

    Townsend, Raymond; Bittar, Neville; Rosen, Jeffrey; Smith, William; Ramsay, Andrea; Chrysant, Steven G; Weiss, Robert; Pivodic, Aldina; Duquesroix, Brigitte; Djian, Jacques

    2011-05-01

    The blood pressure (BP) effects of naproxcinod and naproxen were assessed in an 8-week, double-blind, crossover study in 131 hypertensive patients aged 50 to 74 years. Patients received naproxcinod 750 mg twice daily or naproxen 500 mg twice daily, then the alternate treatment, each for 14 days, with placebo run-in/washout before each active treatment period and 24-hour ambulatory BP monitoring conducted before and after each active treatment period. Mean change from baseline in average 24-hour systolic BP (SBP) after 2 weeks of treatment numerically favored naproxcinod 750 mg twice daily (least-squares [LS] mean for naproxcinod minus naproxen: -1.6 mm Hg; P=.12). Post hoc analyses showed statistically significant SBP differences favoring naproxcinod for the 8 elapsed hours (LS mean: -4.4 mm Hg; P<.0001) and the 24 hours following morning dosing (LS mean: -2.4 mm Hg; P=.006). Naproxcinod may be a beneficial alternative for patients with osteoarthritis requiring nonsteroidal anti-inflammatory drugs. PMID:21545399

  8. Postmodernity and a hypertensive patient: rescuing value from nihilism.

    PubMed Central

    Smith, S

    1998-01-01

    Much of postmodern philosophy questions the assumptions of Modernity, that period in the history of the Western world since the Enlightment. These assumptions are that truth is discoverable through human reason; that certain knowledge is possible; and furthermore, that such knowledge will provide a basis for the ineluctable progress of Mankind. The Enlightenment project is underwritten by the conviction that knowledge gained through the scientific method is secure. In so far as biomedicine inherits these assumptions it becomes fair game for postmodern deconstruction. Today, perhaps more than ever, plural values compete, and contradictory approaches to health, for instance, garner support and acquire supremacy through consumer choice and media manipulation rather than evidence-based science. Many doctors feel a tension between meeting the needs of the patient face to face, and working towards the broader health needs of the public at large. But if the very foundations of medical science are questioned, by patients, or by doctors themselves, wherein lies the value of their work? This paper examines the issues that the anti-foundationalist thrust of postmodernism raises, in the light of a case of mild hypertension. The strict application of medical protocol, derived from a nomothetic, statistical perspective, seems unlikely to furnish value in the treatment of an individual. The anything goes, consumerist approach, however, fares no better. The author argues that whilst value cannot depend on any rationally predetermined parameters, it can be rescued, and emerges from the process of the meeting with the patient. PMID:9549679

  9. Noninvasive cardiac output measurements in patients with pulmonary hypertension.

    PubMed

    Rich, Jonathan D; Archer, Stephen L; Rich, Stuart

    2013-07-01

    Pulmonary hypertension (PH) is characterised by a progressive decline in cardiac output (CO) and right heart failure. NICOM® (noninvasive cardiac output monitor) is a bioreactance-based technology that has been broadly validated, but its specific application in right heart failure and PH is unknown. Cardiac catheterisation was performed in 50 consecutive patients with PH. CO measurements were performed using three different methods (thermodilution, Fick and NICOM) at baseline and after vasodilator challenge. We compared the precision (coefficient of variation) and accuracy of NICOM compared to thermodilution and Fick. The mean CO (L·min(-1)) at baseline as measured by the three methods was 4.73±1.15 (NICOM), 5.69±1.74 (thermodilution) and 4.84±1.39 (Fick). CO measured by NICOM was more precise than by thermodilution (3.5±0.3% versus 9.6±6.1%, p<0.001). Bland-Altman analyses comparing NICOM to thermodilution and Fick revealed bias and 95% limits of agreement that were comparable to those comparing Fick to thermodilution. All three CO methods detected an increase in CO in response to vasodilator challenge. CO measured via NICOM is precise and reliably measures CO at rest and changes in CO with vasodilator challenge in patients with PH. NICOM may allow for the noninvasive haemodynamic assessment of patients with PH and their response to therapy. PMID:23100501

  10. Indirect comparisons of the efficacy of subsequent biological agents in patients with psoriatic arthritis with an inadequate response to tumor necrosis factor inhibitors: a meta-analysis.

    PubMed

    Ungprasert, Patompong; Thongprayoon, Charat; Davis, John M

    2016-07-01

    Significant portion of patients with psoriatic arthritis (PsA) could not tolerate or do not have a satisfactory response to either non-steroidal anti-inflammatory drugs (NSAIDs), non-biologic disease-modifying anti-rheumatic drugs (DMARDs), or even TNF inhibitors. Non-TNF inhibitor biologic agents have emerged as second-line therapy in such situation. However, the comparative efficacy of these agents remains unknown as head-to-head randomized controlled trials (RCTs) are not available. RCTs examining the efficacy of non-TNF inhibitor biologic agents in patients with PsA who experienced inadequate response or intolerance of TNF inhibitors were identified. If more than one RCT was available for a given biologic agent, the pooled odds ratio (OR) and 95 % confidence interval (CI) of achieving 20 % improvement according to American College of Rheumatology criteria (ACR20) response across trials were calculated. The pooled OR for each biologic agent was then compared using the indirect comparison technique. Five RCTs of four non-TNF inhibitor biologic agents, including abatacept, secukinumab, ustekinumab, and apremilast, with 675 participants were identified and included in the data analyses. We found no significant difference in any comparisons, with the p values ranging from 0.14 to 0.98. Our study demonstrates that the likelihood of achieving the ACR20 response in patients with TNF inhibitor experience is not significantly different between the four non-TNF biologic agents. However, the interpretation of this analysis is limited by the small sample sizes. Head-to-head comparisons are still required to confirm the comparative efficacy. PMID:26852316

  11. Relevance of plasma malondialdehyde level and severity of portal hypertension in cirrhotic patients

    PubMed Central

    Wang, Sheng-Lan; Zhu, Xin-Yan; Zhang, Dong-Wei; Zhang, Zhao-Jie; Gao, Heng-Jun; Yang, Chang-Qing

    2015-01-01

    Background: Portal hypertension is one of the death reasons for the liver cirrhosis patients. The oxidative stress is related to the occurrence and development of portal hypertension in cirrhosis. Malondialdehyde (MDA), one of the lipid peroxides, increases substantially in cirrhotic patients. Aims: To evaluate the relevance between the MDA level and portal hypertension in cirrhotic patients. Methods: 60 liver cirrhotic patients and 30 healthy controls were enrolled. The plasma MDA level and general blood tests including ALT, AST, ALB, total bilirubin, and platelet were measured. All people enrolled accepted endoscopic examination and B-Ultrasound check to evaluate the severity of portal hypertension. Results: The MDA plasma level of cirrhotic patients was significantly higher than the controls (P<0.001) and increased significantly accompanied by the severity of liver fibrosis and portal hypertension (P<0.01). Further, the plasma MDA level of cirrhotic patients was significantly correlated with Child-Pugh classification of cirrhosis (r=0.820, P<0.001), the degree of esophageal varices (r=0.857, P<0.001) and the width of portal vein (r=0.652, P<0.001). The ROC curve analyses showed that the plasma MDA level is a strong predictor of liver cirrhosis and portal hypertension. Conclusions: Plasma MDA level may correlate with the severity of portal hypertension in cirrhotic patients. PMID:26379897

  12. Hypertension management in patients with renal cell cancer treated with anti-angiogenic agents

    PubMed Central

    Larochelle, P.; Kollmannsberger, C.; Feldman, R.D.; Schiffrin, E.L.; Poirier, L.; Patenaude, F.; Ruether, D.; Myers, M.; Bjarnason, G.

    2012-01-01

    Inhibitors of the vascular endothelial growth factor (vegf-is) signalling pathway have fundamentally changed the treatment of metastatic renal cell carcinoma (mrcc). Hypertension is one of the most common side effects of vegf-is and has been reported with almost every vegf-i used for treatment to date. The exact mechanism of vegf-i–induced hypertension appears complex and multifactorial, and it remains to be fully explained. No randomized clinical trials are available to guide the management of hypertension during vegf-i treatment in mrcc patients. The guiding principles suggested here summarize the consensus of opinions on the diagnosis and management of vegf-i–induced hypertension during treatment of mrcc obtained from an expert working group composed of 4 Canadian medical oncologists and 5 Canadian hypertension specialists. The Canadian Hypertension Education Program guidelines, available literature, and expert opinion were used to develop the guiding principles. PMID:22876146

  13. Use of Biomarkers in the Evaluation and Treatment of Hypertensive Patients.

    PubMed

    Currie, Gemma; Delles, Christian

    2016-07-01

    The current definition of hypertension is based on blood pressure values, and blood pressure also drives treatment decisions, is the most important treatment monitoring tool and helps estimating risk of hypertension-related organ damage. In an era of precision medicine, additional biomarkers are needed in the diagnosis and management of patients with hypertension. In this review, we outline the areas in which functional, imaging and circulating biomarkers could help in a more individualised definition of hypertension and associated risk. We will cover biomarkers for diagnosis; of pathophysiology and prediction of hypertension; response to treatment, organ damage; and to monitor treatment. A clear focus is on the vasculature, the heart and the kidneys, whereas we see a need to further develop biomarkers of cerebral function in order to diagnose cognition deficits and monitor changes in cognition in the future to support addressing the growing burden of hypertension-associated vascular dementia. PMID:27221728

  14. Computer-Based Education for Patients with Hypertension: A Systematic Review

    ERIC Educational Resources Information Center

    Saksena, Anuraag

    2010-01-01

    Objective: To evaluate the benefits of using computer-based interventions to provide patient education to individuals with hypertension. Methods: MEDLINE, Web of Knowledge, CINAHL, ERIC, EMBASE, and PsychINFO were searched from 1995 to April 2009 using keywords related to "computers," "hypertension," "education," and "clinical trial." Additional…

  15. The Effects of Health Education on Patients with Hypertension in China: A Meta-Analysis

    ERIC Educational Resources Information Center

    Xu, L. J.; Meng, Q.; He, S. W.; Yin, X. L.; Tang, Z. L.; Bo, H. Y.; Lan, X. Y.

    2014-01-01

    Objective: This study collected on from all research relating to health education and hypertension in China and, with the aid of meta-analysis tools, assessed the outcomes of such health education. The analysis provides a basis for the further development of health-education programmes for patients with hypertension. Methods: Literature searches…

  16. Effects of vildagliptin versus saxagliptin on daily acute glucose fluctuations in Chinese patients with T2DM inadequately controlled with a combination of metformin and sulfonylurea.

    PubMed

    Xiaoyan, Chen; Jing, Wang; Xiaochun, Huang; Yuyu, Tan; Shunyou, Deng; Yingyu, Fu

    2016-06-01

    Objective The present study aimed to compare the effects of the dipeptidyl peptidase-4 (DPP-4) inhibitors vildagliptin and saxagliptin on 24 hour acute glucose fluctuations in Chinese patients with type 2 diabetes mellitus (T2DM) inadequately controlled with a combination of metformin and sulfonylurea. Research design and methods This was a 24 week, prospective, randomized, open-label, active-controlled study. Patients (N = 73) with T2DM who had inadequate glycemic control (HbA1c 7.0%-10.0%) with a stable dosage of metformin plus gliclazide for more than 3 months were randomized to receive either vildagliptin 50 mg twice daily (BID, n = 37) or saxagliptin 5 mg once daily (QD, n = 36). Change in mean amplitude of glycemic excursions (MAGE) was assessed at the end of 24 weeks. Results At baseline, the mean (±SD) age was 62.9 ± 6.55 years, disease duration was 7.0 ± 2.33 years, and HbA1c was 8.4 ± 0.68%. After 24 weeks of treatment, the MAGE decreased from 5.81 ± 1.16 mmol/L to 4.06 ± 0.86 mmol/L (p<0.001) in the vildagliptin group and from 5.66 ± 1.14 mmol/L to 4.79 ± 1.25 mmol/L (p = 0.003) in the saxagliptin group. The mean change in MAGE in the vildagliptin group was significantly greater than that in the saxagliptin group (1.74 ± 0.48 mmol/L vs. 0.87 ± 0.40 mmol/L, p<0.001). The mean change in HbA1c, from baseline to the study endpoint, in the vildagliptin and saxagliptin groups, was 1.22 ± 0.40% and 1.07 ± 0.36%, respectively, with no significant difference between the groups (p = 0.091). The overall safety and tolerability of vildagliptin and saxagliptin were similar. The limitations of the study were a small number of patients and open-label administration of the study drug. Conclusion Vildagliptin produced a significantly greater reduction in acute glucose fluctuations compared with saxagliptin when added to a dual combination of metformin and sulfonylurea in Chinese

  17. Tofacitinib for acute rheumatoid arthritis patients who have had an inadequate response to disease-modifying antirheumatic drug (DMARD): a systematic review and meta-analysis.

    PubMed

    Zhang, Xingming; Liang, Fuxiang; Yin, Xiaoxue; Xiao, Xiaojuan; Shi, Peiyu; Wei, Dang; Yao, Liang; Wang, Qi; Chen, Yaolong

    2014-02-01

    The aim of this systematic review and meta-analysis is to assess the efficacy and safety of tofacitinib for the treatment of patients with acute rheumatoid arthritis (RA) who have had an inadequate response to disease-modifying antirheumatic drug (DMARD). Randomized controlled trials were searched in MEDLINE (1966-2013), Embase (1947-2013), the Cochrane Central Register of Controlled Trials (1948-2013), WHO International Clinical Trial Registration Platform (2004-2013), Clinical Trial.gov (1999-2013), and China Biology Medicine disc (1978-2013). The review included 10 studies involving 4,929 patients. A pooled analysis of six studies showed that tofacitinib had a superior effect over placebo (both with background therapy) at weeks 12 and 24. Also, the pooled results of three studies showed that tofacitinib monotherapy had a significantly greater effect over placebo. Compared to adalimumab, tofacitinib was found to be more efficacious as well. For safety, tofacitinib monotherapy had less serious adverse events (sAE) than placebo but not other adverse effects (oAE). In the comparison of tofacitinib and placebo both with background therapy, no difference in sAE and oAE were found. However, the quality of the evidence was quite low when evaluated using GRADE. Tofacitinib alone, or together with non-biologic DMARDs, was associated with more favorable remission in the signs and symptoms of RA than adalimumab or placebo. Also, tofacitinib monotherapy was safer than placebo with regards to reported sAE, but not oAE. However, the quality of evidence is exceedingly low; long-term, large-scale, and high-quality post-marketing research is suggested to further verify the conclusion. PMID:24389749

  18. Systemic hypertension in two patients with ASL deficiency: A result of nitric oxide deficiency?

    PubMed Central

    Brunetti-Pierri, Nicola; Erez, Ayelet; Shchelochkov, Oleg; Craigen, William; Lee, Brendan

    2009-01-01

    Argininosuccinic aciduria (ASA) is an inborn error of ureagenesis which if untreated leads to hyperammonemia, accumulation of argininosuccinic acid and arginine depletion. The presence of high blood pressure in patients with ASA has been reported so far as transient in one newborn. We describe the first two patients, one child and one young adult, with ASA and persistent systemic hypertension. Extensive evaluation of both patients excluded secondary causes of systemic hypertension. The intriguing link between nitric oxide (NO) production and hypertension lead us to hypothesize that endogenous synthesized arginine deficiency caused by ASL deficiency is responsible for the increased blood pressure. PMID:19592285

  19. Effect of 2 different anesthesia methods on stress response in neurosurgical patients with hypertension or normal

    PubMed Central

    Chen, Ying; Jiang, Shan; Wu, Yong

    2016-01-01

    Abstract Hypertensive patients in neurosurgery are becoming more common, which increased the risk of surgical stress response. Meanwhile, the relationship between hypertension and anesthesia methods is unclear on the stress response. The purpose of this study is to compare the effect of different anesthesia methods on high-sensitivity C-reactive protein (Hs-CRP), blood glucose, and leucocyte levels in neurosurgical patients with hypertension or normal. Eighty neurosurgical patients were randomly divided into 4 groups (n = 20): balanced anesthesia group (A), balanced anesthesia with hypertension group (B), total intravenous anesthesia group (C), total intravenous anesthesia with hypertension group (D). The levels of Hs-CRP, blood glucose, leucocyte count, and neutrophil percentage and were detected at before anesthesia (T0), during anesthesia (T1), 2 hours post anesthesia (T2), 24 hours post anesthesia (T3). Patients with hypertension had higher Hs-CRP expression, blood glucose, and neutrophil percentage at time T0 than those of normal, but not leucocyte count. At time T3, patients with hypertension in D group had lower Hs-CRP expression than those in B group (P < 0.01). Patients with normal in C group had lower Hs-CRP expression (P < 0.01), blood glucose (P < 0.05), and leukocyte count (P < 0.05) than those in A group. Both hypertension history and anesthesia method had significant effects on the Hs-CRP expression, blood glucose, and leukocyte count. Total intravenous anesthesia decreases Hs-CRP expressions more efficiently than balanced anesthesia in neurosurgical patients with hypertension or normal. Moreover, total intravenous anesthesia can availably reduce the perioperative stress response by attenuating the increase of blood glucose and leukocyte count in normal tensive patients. PMID:27583931

  20. Cost-effectiveness evaluation of a collaborative patient education hypertension intervention in Utah.

    PubMed

    Trogdon, Justin G; Larsen, Barbara; Larsen, David; Salas, Wendy; Snell, Matt

    2012-11-01

    This study analyzed the cost-effectiveness of a patient hypertension education intervention that provided patient education through interactive voice response technology and distribution of automated blood pressure monitors to high-risk plan members with uncontrolled hypertension. A total of 17,318 members were identified with hypertension in an administrative database. The study sample consisted of all 534 high-risk hypertensive plan members who received blood pressure monitors. Using data on activity-based program costs and changes in hypertension control, this study modeled the intervention's cost-effectiveness relative to no intervention. The intervention was estimated to have brought hypertension under control in 151 patients during the study year. Across all 534 participants in 1 year, 0.3 events (acute myocardial infarction, stroke, congestive heart failure, and renal failure) were avoided and 2.77 life-years were gained (LYG). The incremental cost-effectiveness ratio (ICER) for the intervention compared with no intervention was $767 per person brought under control or $41,927 per LYG. If the gains in hypertension control from 1 year's investment were assumed to last 10 years, the 10-year ICER relative to no intervention was $1857 per LYG. The intervention is a cost-effective strategy to address hypertension and can serve as a model for future innovations. PMID:23126347

  1. Traditional Chinese Medicine Syndromes for Essential Hypertension: A Literature Analysis of 13,272 Patients

    PubMed Central

    Wang, Jie; Xiong, Xingjiang; Liu, Wei

    2014-01-01

    Background. To simplify traditional Chinese medicine syndrome differentiation and allow researchers to master syndrome differentiation for hypertension, this paper retrospectively studied the literature and analyzed syndrome elements corresponding to hypertension syndromes. Methods. Six databases including PubMed, EMBASE, Chinese Bio-Medical Literature Database, Chinese National Knowledge Infrastructure, Chinese Scientific Journal Database, and Wan-fang Data were searched from 1/January/2003 to 30/October/2013. We included all clinical literature testing hypertension syndromes and retrospectively studied the hypertension literature published from 2003 to 2013. Descriptive statistics calculated frequencies and percentages. Results. 13,272 patients with essential hypertension were included. Clinical features of hypertension could be attributed to 11 kinds of syndrome factors. Among them, seven syndrome factors were excess, while four syndrome factors were deficient. Syndrome targets were mainly in the liver and related to the kidney and spleen. There were 33 combination syndromes. Frequency of single-factor syndromes was 31.77% and frequency of two-factor syndromes was 62.26%. Conclusions. Excess syndrome factors of hypertension patients include yang hyperactivity, blood stasis, phlegm turbidity, internal dampness, and internal fire. Deficient syndrome factors of hypertension patients are yin deficiency and yang deficiency. Yin deficiency with yang hyperactivity, phlegm-dampness retention, and deficiency of both yin and yang were the three most common syndromes in clinical combination. PMID:24660016

  2. Prevalence of undiagnosed and inadequately treated type 2 diabetes mellitus, hyperension, and dyslipidemia in morbidly obese patients who present for bariatric surgery

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Context: Pharmacotherapy is considered the primary treatment modality for metabolic diseases, such as diabetes mellitus (DM), hypertension (HTN), and dyslipidemia (DYS). Objective: We hypothesize that these metabolic diseases become exceedingly difficult to treat with pharmacotherapy in morbidly ob...

  3. Plasma endothelin-1 levels in patients with systemic sclerosis: influence of pulmonary or systemic arterial hypertension.

    PubMed Central

    Morelli, S; Ferri, C; Di Francesco, L; Baldoncini, R; Carlesimo, M; Bottoni, U; Properzi, G; Santucci, A

    1995-01-01

    OBJECTIVES--To investigate the behaviour of circulating endothelin-1 (ET-1) in patients affected by systemic sclerosis and to elucidate the relationship between systemic and pulmonary plasma peptide and arterial pressure levels. METHODS--Plasma ET-1 concentrations were determined in 48 patients affected by systemic sclerosis (41 women, seven men; mean age 47.2 (SD 5.5) years) with or without systemic or pulmonary hypertension (or both). A group of 18 normal volunteers served as controls (15 women, three men; mean age 45.0 (10.1) years). RESULTS--Plasma ET-1 levels were significantly greater in patients affected by systemic sclerosis (1.65 (0.29) pg/ml) than in controls (0.63 (0.19) pg/ml) (p < 0.0001). Pulmonary artery systolic hypertension alone was present in 14 patients with systemic sclerosis (50.5 (8.49) mm Hg, range 37-67 mm Hg), and systemic hypertension alone (160.7 (5.9)/100.6 (3.2) mm Hg) was present in 11 patients. Both conditions were present in 12 patients, while 11 patients had systemic hypertension. There were no significant differences in plasma ET-1 levels between patients with pulmonary hypertension alone (1.62 (0.21) pg/ml) and those with systemic hypertension alone (1.65 (0.43) pg/ml). In particular, patients with normal pulmonary artery and systemic pressures (n = 11) had plasma ET-1 concentrations identical to those found in patients (n = 12) with both pulmonary and systemic hypertension (1.70 (0.15) v 1.64 (0.35) pg/ml, respectively). No correlations were observed between plasma ET-1 and either pulmonary or systemic pressures. CONCLUSION--Systemic sclerosis is characterised by increased plasma ET-1 levels, but neither pulmonary nor systemic hypertension are accompanied by further increase in plasma peptide levels. PMID:7495344

  4. Traditional Herbal Medicine Use Among Hypertensive Patients in Sub-Saharan Africa: A Systematic Review

    PubMed Central

    Liwa, Anthony C.; Smart, Luke R.; Frumkin, Amara; Epstein, Helen-Ann B.; Fitzgerald, Daniel W.; Peck, Robert N.

    2014-01-01

    Background Hypertension is increasingly common in sub-Saharan Africa, and rates of hypertension control are low. Use of traditional herbal medicines (THM) is common among adults in sub-Saharan Africa and may affect hypertension therapy. Methods We searched Ovid MEDLINE, Ovid EMBASE, and Web of Knowledge in June 2013 to find studies about THM use among hypertensive patients living in sub-Saharan Africa. Two independent reviewers evaluated titles and abstracts. Qualifying references were reviewed in full text. Data were extracted using a standardized questionnaire. Results Four hundred eighty-one references were retrieved, and 4 articles from 2 countries met criteria for inclusion. The prevalence of THM use was 25-65% (average 38.6%). THM was the most common type of complementary and alternative medicines used by patients (86.7%-96.6%). Among THM users, 47.5% concomitantly used both allopathic medicine and THM. Increased age (p<0.001), male sex (RR 2.58), belief in a supernatural cause of hypertension (RR 2.11), and family history of hypertension (OR 1.78) were positively associated with THM use while belief that hypertension is preventable was negatively associated with THM use (OR 0.57). Conclusion More than a third of adults with hypertension in sub-Saharan Africa use THM. Half of these patients use THM concurrently with allopathic medicine. Healthcare workers in sub-Saharan Africa must discuss THM use with their hypertensive patients. More research is urgently needed to define the impact of THM use on hypertension control and outcomes in sub-Saharan Africa. PMID:24764197

  5. Traditional herbal medicine use among hypertensive patients in sub-Saharan Africa: a systematic review.

    PubMed

    Liwa, Anthony C; Smart, Luke R; Frumkin, Amara; Epstein, Helen-Ann B; Fitzgerald, Daniel W; Peck, Robert N

    2014-06-01

    Hypertension is increasingly common in sub-Saharan Africa, and rates of hypertension control are low. Use of traditional herbal medicines (THM) is common among adults in sub-Saharan Africa and may affect hypertension therapy. We searched Ovid MEDLINE, Ovid EMBASE, and Web of Knowledge in June 2013 to find studies about THM use among hypertensive patients living in sub-Saharan Africa. Two independent reviewers evaluated titles and abstracts. Qualifying references were reviewed in full text. Data were extracted using a standardized questionnaire. Four hundred and eighty-one references were retrieved, and four articles from two countries met criteria for inclusion. The prevalence of THM use was 25-65% (average 38.6%). THM was the most common type of complementary and alternative medicines used by patients (86.7-96.6%). Among THM users, 47.5% concomitantly used both allopathic medicine and THM. Increased age (p<0.001), male sex (RR 2.58), belief in a supernatural cause of hypertension (RR 2.11), and family history of hypertension (OR 1.78) were positively associated with THM use, while belief that hypertension is preventable was negatively associated with THM use (OR 0.57). More than one-third of adults with hypertension in sub-Saharan Africa use THM. Half of these patients use THM concurrently with allopathic medicine. Healthcare workers in sub-Saharan Africa must discuss THM use with their hypertensive patients. More research is urgently needed to define the impact of THM use on hypertension control and outcomes in sub-Saharan Africa. PMID:24764197

  6. Perceptions of Received Information, Social Support, and Coping in Patients with Pulmonary Arterial Hypertension or Chronic Thromboembolic Pulmonary Hypertension

    PubMed Central

    Ivarsson, Bodil; Ekmehag, Björn; Hesselstrand, Roger; Rådegran, Göran; Sjöberg, Trygve

    2014-01-01

    Patients with a life-limiting diagnosis of pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) need disease-specific information, ability to cope, and functioning social networks. This cohort study investigated the experiences of PAH and CTEPH patients who received information about their diagnosis, treatment, and management, in addition to coping and social support. Sixty-eight adult patients (mean ± SD, age 67 ± 14; 66% women) were included. A total of 54% of the patients wanted more information. Patients received information mostly in areas concerning medical test procedures, the diagnosis, disease severity, possible disease causes, and how to manage their disease. Coping ability was significantly better in patients who were satisfied with the received information (P = 0.0045). The information given to PAH or CTEPH patients and their communication with healthcare professionals can be greatly improved. Gaps in information and misunderstandings can be avoided by working in cooperation with the patients, their relatives, and within the PAH team. PMID:25374462

  7. Pulmonary Hypertension Among End-Stage Renal Failure Patients Following Hemodialysis Access Thrombectomy

    SciTech Connect

    Harp, Richard J.; Stavropoulos, S. William; Wasserstein, Alan G.; Clark, Timothy W.I.

    2005-01-15

    Purpose: Percutaneous hemodialysis thrombectomy causes subclinical pulmonary emboli without short-term clinical consequence; the long-term effects on the pulmonary arterial vasculature are unknown. We compared the prevalence of pulmonary hypertension between patients who underwent one or more hemodialysis access thrombectomy procedures with controls without prior thrombectomy.Methods: A retrospective case-control study was performed. Cases (n = 88) had undergone one or more hemodialysis graft thrombectomy procedures, with subsequent echocardiography during routine investigation of comorbid cardiovascular disease. Cases were compared with controls without end-stage renal disease (ESRD) (n = 100, group 1), and controls with ESRD but no prior thrombectomy procedures (n = 117, group 2). The presence and velocity of tricuspid regurgitation on echocardiography was used to determine the prevalence and grade of pulmonary hypertension; these were compared between cases and controls using the chi-square test and logistic regression.Results: The prevalence of pulmonary hypertension among cases was 52% (46/88), consisting of mild, moderate and severe in 26% (n = 23), 10% (n = 9) and 16% (n = 14), respectively. Prevalence of pulmonary hypertension among group 1 controls was 26% (26/100), consisting of mild, moderate and severe pulmonary hypertension in 14%, 5% and 7%, respectively. Cases had 2.7 times greater odds of having pulmonary hypertension than group 1 controls (p = 0.002). The prevalence of pulmonary hypertension among group 2 controls was 42% (49/117), consisting of mild, moderate and severe pulmonary arterial hypertension in 25% (n = 49), 10% (n = 12) and 4% (n = 5), respectively. Cases were slightly more likely to have pulmonary hypertension than group 2 controls (OR = 1.5), although this failed to reach statistical significance (p = 0.14).Conclusion: Prior hemodialysis access thrombectomy does not appear to be a risk factor for pulmonary arterial hypertension

  8. Comparison of Azelnidipine and Trichlormethiazide in Japanese Type 2 Diabetic Patients with Hypertension: The COAT Randomized Controlled Trial

    PubMed Central

    Takihata, Masahiro; Nakamura, Akinobu; Kondo, Yoshinobu; Kawasaki, Satsuki; Kimura, Mari; Terauchi, Yasuo

    2015-01-01

    Objective This study compared the efficacy and safety of azelnidipine with that of trichlormethiazide in Japanese type 2 diabetic patients with hypertension. Methods In a multicenter, open-label trial, 240 patients with adequately controlled diabetes (HbA1c ≤ 7.0%) under lifestyle modification and/or administration of hypoglycemic agents and inadequately controlled hypertension (systolic blood pressure [sBP] ≥ 130 mmHg or diastolic blood pressure [dBP] ≥ 80 mmHg) who were being treated with olmesartan were enrolled. Participants were randomly assigned to an azelnidipine group or a trichlormethiazide group and were followed up for 48 weeks. Main outcome measure was the difference in the change in HbA1c levels from the baseline values at 48 weeks between these two groups. Results Of the 240 subjects that were enrolled, 209 subjects (azelnidipine group: 103 patients, trichlormethiazide group: 106 patients) completed this trial. At 48 weeks, the following changes were observed in the azelnidipine and trichlormethiazide groups, respectively: HbA1c levels, 0.19 ± 0.52% and 0.19 ± 0.54%; sBP/dBP, -10.7 ± 9.6/-6.6 ± 6.6 mmHg and -7.1 ± 7.7/-3.3 ± 6.1 mmHg (P < 0.001 for both sBP and dBP). In both groups, dizziness (12 patients [11.7%] and 16 patients [15.1%]) and edema (16 patients [15.5%] and 7 patients [6.6%], P = 0.047) were observed during the 48-week follow-up period. Conclusions Azelnidipine was more effective for controlling blood pressure than trichlormethiazide in Japanese type 2 diabetes patients, whereas trichlormethiazide was more effective for reducing albuminuria than azelnidipine. Both of these agents, however, similarly exacerbated glycemic control in type 2 diabetic patients with hypertension. Trial Registration UMIN 000006081. PMID:25938807

  9. [Innovative instruction for assisting patients with arterial hypertension].

    PubMed

    Bontemps, S; Pechère-Bertschi, A

    2015-09-01

    The MOOC In The Heart of Hypertension is an innovative online training for students and health providers. Its aim is to strengthen skills for professionals caring people suffering from hypertension. A MOOC is a free online training aiming unlimited participation. It widely promotes a high quality education. Medical and paramedical training recently seized upon this powerful tool, for initial and continuing training. Indeed, MOOC responds to several pedagogic challenges, particularly through educational strategies focused on the learner's skills: mastery of pedagogy, retrieval practice and peer grading. This MOOC about hypertension aims at responding to the needs of caregivers to enhance their therapeutic support skills. PMID:26540996

  10. [Hypertensive crisis and sudden change of vision in young patients].

    PubMed

    Cortés Fernández, M S; Martín-Castillejos, C; Armario, P

    2016-01-01

    The sudden change in vision is a medical emergency that must be evaluated immediately to rule out important institutions as systemic vasculitis or ischemic stroke. Its association with hypertensive crisis makes it necessary to rule out accelerated-malignant hypertension, which is accompanied by other retinal disorders (exudates and hemorrhages) and adrenal involvement. Nonarteritic anterior ischemic optic neuropathy (AION) is another entity to consider, as is it not uncommon in the young (12.7% in a series of 848 cases). Its association with hypertension has been described in 32% of cases. PMID:26847495

  11. Hypertension in perspective

    PubMed Central

    Terpstra, W.F.; Zijlstra, F.

    2005-01-01

    Decisions about the management of hypertensive patients should not be based on the level of blood pressure alone, but also on the presence of other risk factors, target organ damage and cardiovascular and renal disease. The results of echocardiography and carotid ultrasonography aids in the stratification of absolute cardiovascular risk as recently advocated by the guidelines of the European Society of Hypertension 2003. Therefore, the detection of target organ damage by ultrasound techniques allows an accurate identification of high-risk patients. Cardiovascular risk stratification only based on a simple routine work-up can often underestimate overall risk, thus leading to a potentially inadequate therapeutic management especially of low-medium risk patients. PMID:25696486

  12. Plasma concentrations of adrenomedullin and natriuretic peptides in patients with essential hypertension

    PubMed Central

    HU, WEI; ZHOU, PANG-HU; ZHANG, XIAO-BIN; XU, CHANG-GENG; WANG, WEI

    2015-01-01

    This study was designed to assess any changes in the plasma concentrations of adrenomedullin (ADM) and atrial and brain natriuretic peptide (ANP and BNP, respectively), and to investigate their pathophysiological roles in patients with essential hypertension (EH). The plasma ADM, ANP and BNP concentrations were measured in 64 patients with untreated EH and 35 normotensive control subjects. After 4 weeks of effective antihypertensive therapy with oral drugs for the hypertensive patients, the plasma concentrations of ADM, ANP and BNP in the hypertensive patients were measured again. The plasma concentrations of ADM, ANP and BNP were significantly higher in the hypertensive patients than those in the control subjects, and the concentrations increased with the clinical stage. Furthermore, the hypertensive patients exhibited increased mean arterial pressure (MAP), blood urea nitrogen (BUN), serum creatinine (Scr) and decreased glomerular filtration rates (GFRs) compared with the control subjects. The plasma ADM concentration was not only correlated with BUN, Scr and the GFR, but was also associated with the MAP and the plasma levels of ANP and BNP. Following effective antihypertensive therapy with oral medication for 4 weeks, the plasma concentrations of ADM, ANP and BNP were significantly, but not sharply, decreased. In conclusion, ADM, along with ANP and BNP, may be involved in the mechanisms acting against a further increase in blood pressure and may be useful biomarkers for the diagnosis and treatment of hypertensive patients. PMID:26136912

  13. Subclinical LV Dysfunction Detection Using Speckle Tracking Echocardiography in Hypertensive Patients with Preserved LV Ejection Fraction

    PubMed Central

    Ayoub, Amal Mohamed; Keddeas, Viola William; Ali, Yasmin Abdelrazek; El Okl, Reham Atef

    2016-01-01

    BACKGROUND Early detection of subclinical left ventricular (LV) systolic dysfunction in hypertensive patients is important for the prevention of progression of hypertensive heart disease. METHODS We studied 60 hypertensive patients (age ranged from 21 to 49 years, the duration of hypertension ranged from 1 to 18 years) and 30 healthy controls, all had preserved left ventricular ejection fraction (LVEF), detected by two-dimensional speckle tracking echocardiography (2D-STE). RESULTS There was no significant difference between the two groups regarding ejection fraction (EF) by Simpson’s method. Systolic velocity was significantly higher in the control group, and global longitudinal strain was significantly higher in the control group compared with the hypertensive group. In the hypertensive group, 23 of 60 patients had less negative global longitudinal strain than −19.1, defined as reduced systolic function, which is detected by 2D-STE (subclinical systolic dysfunction), when compared with 3 of 30 control subjects. CONCLUSION 2D-STE detected substantial impairment of LV systolic function in hypertensive patients with preserved LVEF, which identifies higher risk subgroups for earlier medical intervention. PMID:27385916

  14. Inadequate analgesia in emergency medicine.

    PubMed

    Rupp, Timothy; Delaney, Kathleen A

    2004-04-01

    Review of emergency department pain management practices demonstrates pain treatment inconsistency and inadequacy that extends across all demographic groups. This inconsistency and inadequacy appears to stem from a multitude of potentially remediable practical and attitudinal barriers that include (1) a lack of educational emphasis on pain management practices in nursing and medical school curricula and postgraduate training programs; (2) inadequate or nonexistent clinical quality management programs that evaluate pain management; (3) a paucity of rigorous studies of populations with special needs that improve pain management in the emergency department, particularly in geriatric and pediatric patients; (4) clinicians' attitudes toward opioid analgesics that result in inappropriate diagnosis of drug-seeking behavior and inappropriate concern about addiction, even in patients who have obvious acutely painful conditions and request pain relief; (5) inappropriate concerns about the safety of opioids compared with nonsteroidal anti-inflammatory drugs that result in their underuse (opiophobia); (6) unappreciated cultural and sex differences in pain reporting by patients and interpretation of pain reporting by providers; and (7) bias and disbelief of pain reporting according to racial and ethnic stereotyping. This article reviews the literature that describes the prevalence and roots of oligoanalgesia in emergency medicine. It also discusses the regulatory efforts to address the problem and their effect on attitudes within the legal community. PMID:15039693

  15. High Prevalence of Isolated Nocturnal Hypertension in Chinese Patients With Chronic Kidney Disease

    PubMed Central

    Wang, Cheng; Deng, Wen-Jie; Gong, Wen-Yu; Zhang, Jun; Tang, Hua; Peng, Hui; Zhang, Qun-Zi; Ye, Zeng-Chun; Lou, Tanqi

    2015-01-01

    Background Isolated nocturnal hypertension (INH) has been studied among the general population and hypertensive patients. However, little insight is available on the prevalence of INH and its role in target-organ damage among patients with chronic kidney disease (CKD). Methods and Results We recruited 1282 CKD patients admitted to our hospital division. Patients were divided into 4 groups: INH; isolated daytime hypertension; day–night sustained; and ambulatory normotension. Multiple linear regression analyses were used to evaluate the correlation between INH and renal/cardiovascular parameters. A total of 262 (20.44%) CKD patients had isolated nocturnal hypertension and 651 (50.78%) had day–night sustained hypertension, whereas only 350 (27.30%) patients showed normotension and 19 (1.48%) had isolated daytime hypertension. Multivariate logistic regression analysis showed that INH was associated mainly with age, estimated glomerular filtration rate, clinic diastolic blood pressure, and that INH was determined only by age, estimated glomerular filtration rate, and clinic diastolic blood pressure. The prevalence of impaired renal function, left ventricular hypertrophy, and carotid intima-media thickness in patients with INH were higher than in normotensive patients (P<0.05), whereas impaired renal function and left ventricular hypertrophy in these patients were lower than patients in the day–night sustained hypertension group (P<0.05). INH was correlated with estimated glomerular filtration rate, left ventricular mass index, and carotid intima-media thickness according to multiple linear regression analyses. Conclusions The prevalence of INH in CKD patients was high, and INH was correlated with target-organ damage in CKD patients. PMID:26089178

  16. Effects of Commercial Air Travel on Patients With Pulmonary Hypertension

    PubMed Central

    Elliott, C. Gregory; Barnett, Christopher F.; Blanc, Paul D.; Chen, Joan; De Marco, Teresa; Chen, Hubert

    2012-01-01

    Background: Limited data are available on the effects of air travel in patients with pulmonary hypertension (PH), despite their risk of physiologic compromise. We sought to quantify the incidence and severity of hypoxemia experienced by people with PH during commercial air travel. Methods: We recruited 34 participants for a prospective observational study during which cabin pressure, oxygen saturation (Spo2), heart rate, and symptoms were documented serially at multiple predefined time points throughout commercial flights. Oxygen desaturation was defined as Spo2 < 85%. Results: Median flight duration was 3.6 h (range, 1.0-7.3 h). Mean ± SD cabin pressure at cruising altitude was equivalent to the pressure 1,968 ± 371 m (6,456 ± 1,218 ft) above sea level (ASL) (maximum altitude = 2,621 m [8,600 ft] ASL). Median change in Spo2 from sea level to cruising altitude was −4.9% (range, 2.0% to −15.8%). Nine subjects (26% [95% CI, 12%-38%]) experienced oxygen desaturation during flight (minimum Spo2 = 74%). Thirteen subjects (38%) reported symptoms during flight, of whom five also experienced desaturations. Oxygen desaturation was associated with cabin pressures equivalent to > 1,829 m (6,000 ft) ASL, ambulation, and flight duration (all P values < .05). Conclusions: Hypoxemia is common among people with PH traveling by air, occurring in one in four people studied. Hypoxemia was associated with lower cabin pressures, ambulation during flight, and longer flight duration. Patients with PH who will be traveling on flights of longer duration or who have a history of oxygen use, including nocturnal use only, should be evaluated for supplemental in-flight oxygen. PMID:22490871

  17. Phase 2, randomised placebo-controlled trial to evaluate the efficacy and safety of an anti-GM-CSF antibody (KB003) in patients with inadequately controlled asthma

    PubMed Central

    Molfino, Nestor A; Kuna, Piotr; Leff, Jonathan A; Oh, Chad K; Singh, Dave; Chernow, Marlene; Sutton, Brian; Yarranton, Geoffrey

    2016-01-01

    Objectives We wished to evaluate the effects of an antigranulocyte-macrophage colony-stimulating factor monoclonal antibody (KB003) on forced expiratory volume in 1 s (FEV1), asthma control and asthma exacerbations in adult asthmatics inadequately controlled by long-acting bronchodilators and inhaled/oral corticosteroids. Settings 47 ambulatory asthma care centres globally. Primary outcome measures Change in FEV1 at week 24. Participants 311 were screened, 160 were randomised and 129 completed the study. Interventions 7 intravenous infusions of either 400 mg KB003 or placebo at baseline and weeks 2, 4, 8, 12, 16 and 20. Primary and secondary outcome measures FEV1 at week 24, asthma control, exacerbation rates and safety in all participants as well as prespecified subgroups. Main results In the KB003 treated group, FEV1 at week 24 improved to 118 mL compared with 54 mL in the placebo group (p=0.224). However, FEV1 improved to 253 vs 26 mL at week 24 (p=0.02) in eosinophilic asthmatics (defined as >300 peripheral blood eosinophils/mL at baseline) and comparable improvements were seen at weeks 20 (p=0.034) and 24 (p=0.077) in patients with FEV1 reversibility ≥20% at baseline and at weeks 4 (p=0.029), 16 (p=0.018) and 20 (p=0.006) in patients with prebronchodilator FEV1 ≤50% predicted at baseline. There were no effects on asthma control or exacerbation rates. The most frequent adverse events in the KB003 group were rhinosinusitis and headache. There was no significant difference in antidrug antibody response between placebo and treated groups. There were no excess infections or changes in biomarkers known to be associated with the development of pulmonary alveolar proteinosis. Conclusions Higher doses and/or further asthma phenotyping may be required in future studies with KB003. Trial registration number NCT01603277; Results. PMID:26739717

  18. The efficacy of additive use of etizolam in patients with essential hypertension and unspecified complaints.

    PubMed

    Matsuo, H; Watanabe, S; Ishiguro, M; Arai, M; Sugiyama, A; Matsuno, Y; Hirano, T; Arakawa, M

    1992-02-01

    The relationship between hypertension and emotional depression or anxiety has been long-argued. We assessed the efficacy of etizolam (an antianxiety drug) in 18 patients with essential hypertension accompanied with unspecified complaints. In the assessment of overall improvement, 4 patients (22.2%) were rated as markedly improved, 4 patients (22.2%) as moderately improved, 7 patients (38.9%) as slightly improved, 3 patients (16.7%) as unchanged, and none as worsened. Systolic and diastolic pressure decreased significantly in 13 patients (72.2%) and 10 patients (55.5%), respectively. Many subjective symptoms such as anxiety, fatigue and depression improved. No significant adverse reaction from drug was observed. These results allow us to conclude that etizolam is effective and safe for the treatment of essential hypertension accompanied with unspecified complaints. PMID:1551746

  19. Patient classification of hypertension in Traditional Chinese Medicine using multi-label learning techniques

    PubMed Central

    2015-01-01

    Background Hypertension is one of the major risk factors for cardiovascular diseases. Research on the patient classification of hypertension has become an important topic because Traditional Chinese Medicine lies primarily in "treatment based on syndromes differentiation of the patients". Methods Clinical data of hypertension was collected with 12 syndromes and 129 symptoms including inspection, tongue, inquiry, and palpation symptoms. Syndromes differentiation was modeled as a patient classification problem in the field of data mining, and a new multi-label learning model BrSmoteSvm was built dealing with the class-imbalanced of the dataset. Results The experiments showed that the BrSmoteSvm had a better results comparing to other multi-label classifiers in the evaluation criteria of Average precision, Coverage, One-error, Ranking loss. Conclusions BrSmoteSvm can model the hypertension's syndromes differentiation better considering the imbalanced problem. PMID:26399893

  20. [Successful pregnancy in a patient with idiopathic pulmonary arterial hypertension. Case report].

    PubMed

    Szenczi, Orsolya; Karlócai, Kristóf; Bucsek, László; Rigó, János

    2016-04-10

    Idiopathic pulmonary arterial hypertension is characterized by progressive increase in pulmonary arterial pressure and pulmonary vascular resistance which lead to right ventricular failure and death. Pregnancy in patients with idiopathic pulmonary arterial hypertension is contraindicated because of the high maternal and fetal mortality. The authors present a case of successful pregnancy and delivery of a patient with idiopathic pulmonary arterial hypertension in Hungary for the first time. The aim of the report was to demonstrate that management and treatment of idiopathic pulmonary arterial hypertension in a pregnant woman is a complex and multidisciplinary task that should involve obstetrician, cardiologist and anesthesiologist. Those patients who become pregnant and do not wish to terminate the pregnancy must be referred to obstetric centers where a multidiciplinary approach is taken. PMID:27039998

  1. White coat hypertension: improving the patient-health care practitioner relationship.

    PubMed

    Cobos, Briana; Haskard-Zolnierek, Kelly; Howard, Krista

    2015-01-01

    White coat hypertension is characterized by the variability of a patient's blood pressure measurements between the physician's office and the patient's home environment. A patient with white coat hypertension has high blood pressure levels in the physician's office and normal blood pressure levels in their typical environment. This condition is likely caused by the patient's anxiety within the physician's office and in the presence of the physician. Research has shown that improving the relationship between a patient and their health care provider can decrease the patient's anxiety, with the implication of decreasing the patient's likelihood of demonstrating white coat hypertension. This review provides an overview of the previous literature regarding white coat hypertension, its prevalence, and the consequences for those who develop persistent hypertension. Furthermore, this review discusses the implications of improving patient and health care provider interactions through effective communication, empathy, and trust, as well as the implications for future research studies in improving the patient and health care provider's relationship. PMID:25999772

  2. [Chronopharmacokinetics of nadolol in patients with arterial hypertension].

    PubMed

    Rumiantsev, D O; Duda, S G; Poteshnykh, A V; Piotrovskiĭ, V K; Metelitsa, V I; Belolipetskaia, V G

    1997-01-01

    The pharmacokinetics of nadolol in blood serum and its excretion in the urine were studied in 6 male patients (aged from 35 to 59 years) with arterial hypertension for 48 h and, respectively, 72 h after a single per os administration of nadolol in a dose of 80 mg in the morning (9.00 a.m.), in daytime (15.00 p.m.) and in the evening (20.00 p.m.). The concentration of nadolol in the blood serum and urine was determined by high performance liquid chromatography with fluorescence detection. Analysis of the obtained data showed maximum blood serum nadolol concentration and the area under the concentration--time curve to be lower (93 ng/ml and 1786 ng h/ml) in the case of evening medication, and the peroral clearance and kinetic distribution volume to be higher (44.8 l/h and 940 l) than after morning medication (188 ng/ml, 2816 ng h/ml, and 28.4 l/h and 650 l, respectively). The corresponding parameters after daytime medication had intermediate values. The half-life period, mean retention time, and time of achievement of maximum blood serum nadolol concentration did not depend on the time of medication and were in the range of 15.2-15.8 h, 21.1-22.0 h, and 2.9-4.0 h, respectively. The pharmacokinetic parameters characterizing nadolol excretion with the urine were independent of the time of its intake. On the basis of the character of the detected circadian changes in the parameters of nadolol pharmacokinetics it is suggested that these changes reflect the circadian variations in the absorption of the drug in the gastrointestinal tract. PMID:9483406

  3. Do calcium channel blockers increase the diagnosis of heart failure in patients with hypertension?

    PubMed

    Shibata, Marcelo C; León, Hernando; Chatterley, Trish; Dorgan, Marlene; Vandermeer, Ben

    2010-07-15

    Calcium channel blockers (CCBs) are widely used to control hypertension. Previous work suggested that their use could increase heart failure (HF), which is 1 of the consequences of uncontrolled hypertension. Information about the effect of CCBs on incident HF in patients with hypertension is scarce. A systematic review was conducted to evaluate patients with hypertension treated with CCBs and incident HF. An electronic search of publications was conducted using 8 major databases. Studies were eligible if they (1) were randomized clinical trials, (2) performed comparisons of CCBs versus active control, (3) randomized >200 patients, (4) had follow-up periods >6 months, and (5) provided data regarding incident HF. Trials of renal transplantation patients, placebo-controlled trials, and HF trials were excluded. A total of 156,766 patients were randomized to CCBs or control, with a total of 5,049 events. The analysis indicated a significant increase in the diagnosis of HF in patients allocated to CCBs (odds ratio 1.18, 95% confidence interval 1.07 to 1.31). The effect observed was independent of incident myocardial infarction. Subgroup analyses indicated that patients with diabetes were at higher risk for developing HF (odds ratio 1.71, 95% confidence interval 1.21 to 2.41). In conclusion, the results suggest that patients with hypertension treated with CCBs have increased incident HF. PMID:20599008

  4. The pathophysiology of hypertension in patients with obesity

    PubMed Central

    DeMarco, Vincent G.; Aroor, Annayya R.; Sowers, James R.

    2015-01-01

    The combination of obesity and hypertension is associated with high morbidity and mortality because it leads to cardiovascular and kidney disease. Potential mechanisms linking obesity to hypertension include dietary factors, metabolic, endothelial and vascular dysfunction, neuroendocrine imbalances, sodium retention, glomerular hyperfiltration, proteinuria, and maladaptive immune and inflammatory responses. Visceral adipose tissue also becomes resistant to insulin and leptin and is the site of altered secretion of molecules and hormones such as adiponectin, leptin, resistin, TNF and IL-6, which exacerbate obesity-associated cardiovascular disease. Accumulating evidence also suggests that the gut microbiome is important for modulating these mechanisms. Uric acid and altered incretin or dipeptidyl peptidase 4 activity further contribute to the development of hypertension in obesity. The pathophysiology of obesity-related hypertension is especially relevant to premenopausal women with obesity and type 2 diabetes mellitus who are at high risk of developing arterial stiffness and endothelial dysfunction. In this Review we discuss the relationship between obesity and hypertension with special emphasis on potential mechanisms and therapeutic targeting that might be used in a clinical setting. PMID:24732974

  5. The pathophysiology of hypertension in patients with obesity.

    PubMed

    DeMarco, Vincent G; Aroor, Annayya R; Sowers, James R

    2014-06-01

    The combination of obesity and hypertension is associated with high morbidity and mortality because it leads to cardiovascular and kidney disease. Potential mechanisms linking obesity to hypertension include dietary factors, metabolic, endothelial and vascular dysfunction, neuroendocrine imbalances, sodium retention, glomerular hyperfiltration, proteinuria, and maladaptive immune and inflammatory responses. Visceral adipose tissue also becomes resistant to insulin and leptin and is the site of altered secretion of molecules and hormones such as adiponectin, leptin, resistin, TNF and IL-6, which exacerbate obesity-associated cardiovascular disease. Accumulating evidence also suggests that the gut microbiome is important for modulating these mechanisms. Uric acid and altered incretin or dipeptidyl peptidase 4 activity further contribute to the development of hypertension in obesity. The pathophysiology of obesity-related hypertension is especially relevant to premenopausal women with obesity and type 2 diabetes mellitus who are at high risk of developing arterial stiffness and endothelial dysfunction. In this Review we discuss the relationship between obesity and hypertension with special emphasis on potential mechanisms and therapeutic targeting that might be used in a clinical setting. PMID:24732974

  6. Serum soluble RAGE level inversely correlates with left ventricular hypertrophy in essential hypertension patients.

    PubMed

    Liu, Q; Chen, H B; Luo, M; Zheng, H

    2016-01-01

    Soluble receptor for advanced glycation end-products (sRAGE) acts as a decoy to prevent interaction between RAGE and its pro-inflammatory ligands. sRAGE levels have been found to decrease in chronic inflammatory diseases, including hypertension. However, few data have been reported concerning the association between serum sRAGE levels and hypertensive left ventricular hypertrophy (LVH). Fasting blood samples were obtained from 209 essential hypertensive patients, and sRAGE levels were measured using a commercially available double-sandwich enzyme-linked immunosorbent assay kit. All patients underwent complete transthoracic echocardiographic examination. LVH was defined as a left ventricular mass index >115 g/m(2) for men and >95 g/m(2) for women. Eighty-one hypertensive patients (38.76%) were categorized in the LVH(+) group. Age (P = 0.009), hypertension duration (P = 0.013), triglyceride levels (P = 0.028), and systolic blood pressure (P = 0.026) were higher, and sRAGE and high-density lipoprotein cholesterol levels were lower in the LVH(+) group compared with the LVH(-) group. Multivariate logistic regression analysis showed that sRAGE level [odds ratio (OR) = 0.916; 95% confidence interval (CI) = 0.864-0.984; P = 0.003], hypertension duration (OR = 1.024; 95%CI = 1.003-1.052; P = 0.027), and triglyceride level (OR = 1.017; 95%CI = 1.005-1.039; P = 0.018) were independent predictors of LVH in hypertensive patients. In conclusion, serum sRAGE level was inversely associated with LVH in hypertensive patients. PMID:27421025

  7. Prevalence of chronic obstructive pulmonary disease among patients with systemic arterial hypertension without respiratory symptoms

    PubMed Central

    Rabahi, Marcelo Fouad; Pereira, Sheila Alves; Silva Júnior, José Laerte Rodrigues; de Rezende, Aline Pacheco; Castro da Costa, Adeliane; de Sousa Corrêa, Krislainy; Conde, Marcus Barreto

    2015-01-01

    Background The diagnosis of chronic obstructive pulmonary disease (COPD) is often delayed until later stages of the disease. The purpose of the present study was to determine the prevalence of COPD among adults on treatment for systemic arterial hypertension independently of the presence of respiratory symptoms. Methods This cross-sectional study included adults aged ≥40 years with tobacco/occupational exposure and systemic arterial hypertension diagnosed at three Primary Health Care facilities in Goiania, Brazil. Patients were evaluated using a standardized respiratory questionnaire and spirometry. COPD prevalence was measured considering the value of forced vital capacity and/or forced expiratory volume in 1 second <0.70. Results Of a total of 570 subjects, 316 (55%) met inclusion criteria and were invited to participate. Two hundred and thirty-three (73.7%) patients with arterial hypertension reported at least one respiratory symptom, while 83 (26.3%) reported no respiratory symptoms; 41 (17.6%) patients with arterial hypertension and at least one respiratory symptom, and 10 (12%) patients with arterial hypertension but no respiratory symptoms were diagnosed with COPD (P=0.24). The prevalence of COPD in people with no previous COPD diagnosis was greater among those with no respiratory symptoms (100%) than among those with respiratory symptoms (56.1%) (P=0.01). Conclusion Our findings suggest that regardless of the presence of respiratory symptoms, individuals aged ≥40 years with tobacco/occupational exposure and arterial hypertension may benefit from spirometric evaluation. PMID:26257517

  8. Association between epistaxis and hypertension: a one year follow-up after an index episode of nose bleeding in hypertensive patients.

    PubMed

    Knopfholz, Jose; Lima-Junior, Emilton; Précoma-Neto, Daniel; Faria-Neto, Jose Rocha

    2009-05-29

    Association between epistaxis and hypertension is controversial. In this study, we evaluated in hypertensive patients the incidence of epistaxis according to stages of hypertension and compared blood pressure (BP) readings in these episodes to routine readings. Thirty-six patients admitted to the Emergency Department (ED) with epistaxis were enrolled and divided into 3 groups according to hypertension severity (JNC-VI criteria). BP readings were obtained weekly (routine BP) and in the setting of a new episode of epistaxis (epistaxis BP). No difference in the incidence of epistaxis was found: patients with hypertension stage 1 had 7.6+/-4.1 episodes/year, those in stage 2 had 8.0+/-4.0 and in stage 3 the incidence was 8.2+/-3.9 (p=ns). The average SBP for all 36 patients was 154+/-19 mmHg on routine readings and 157+/-22 mmHg on epistaxes episodes (p=ns). No difference was also observed regarding DBP: 104+/-18 mmHg vs. 105+/-18 mmHg (p=ns). In conclusion, epistaxis incidence in hypertensive patients is not associated to hypertension severity. Moreover, BP readings in the setting of epistaxis are similar to readings obtained in routine situations. PMID:18499285

  9. Hypertensive patients in primary health care: access, connection and care involved in spontaneous demands.

    PubMed

    Girão, Ana Lívia Araújo; Freitas, Consuelo Helena Aires de

    2016-06-01

    Objective To assess the impacts of inclusion of care for spontaneous demands in the treatment of hypertensive patients in primary health care. Methods Third generation qualitative assessment survey conducted with 16 workers in a Primary Care Health Unit (PHCU) of the city of Fortaleza, state of Ceara, in the period between July and September of 2015. To collect data, systematic field observation and semi-structured interviews were used, and the stages of thematic content analysis were adopted for data analysis. Results Participants revealed that access, connection and care are fundamental to the treatment of hypertension. However, they said that the introduction of free access for spontaneous demands compromised the flow of care in the hypertension programs. Conclusion A dichotomy between the practice of care recommended by health policies and the one existing in the reality of PHCUs was shown, causing evident losses to the care of hypertensive patients in primary care. PMID:27253602

  10. Survey of cancellation rate of hypertensive patients undergoing anaesthesia and elective surgery.

    PubMed

    Dix, P; Howell, S

    2001-06-01

    Hypertension is the commonest avoidable medical indication for postponing anaesthesia and surgery. There are no universally accepted guidelines stating the arterial pressure values at which anaesthesia should be postponed. The aim of this study was to determine the extent of variation across the South-West region of the UK in the anaesthetic management of patients presenting with stage 2 or stage 3 hypertension. Each anaesthetist in the region was sent a questionnaire with five imaginary case histories of patients with stage 2 or stage 3 hypertension. They were asked if they would be prepared to provide anaesthesia for each patient. The response rate was 58%. We found great variability between anaesthetists as to which patients would be cancelled. Departmental protocols may aid general practitioners and surgeons in the preparation of patients for surgery, but such protocols may be difficult to agree in the light of such a wide variation in practice. PMID:11573584

  11. Risk factors for pulmonary hypertension in patients receiving maintenance peritoneal dialysis

    PubMed Central

    Zeng, Y.; Yang, D.D.; Feng, S.; Shen, H.Y.; Wang, Z.; Jiang, S.; Shi, Y.B.; Fu, J.X.

    2016-01-01

    We investigated the risk factors for pulmonary hypertension (PH) in patients receiving maintenance peritoneal dialysis (MPD). A group of 180 end-stage renal disease patients (124 men and 56 women; mean age: 56.43±8.36) were enrolled in our study, which was conducted between January 2009 and June 2014. All of the patients received MPD treatment in the Dialysis Center of the Second Affiliated Hospital of Soochow University. Clinical data, laboratory indices, and echocardiographic data from these patients were collected, and follow-ups were scheduled bi-monthly. The incidence and relevant risk factors of PH were analyzed. The differences in measurement data were compared by t-test and enumeration data were compared with the χ2 test. Among the 180 patients receiving MPD, 60 were diagnosed with PH. The remaining 120 were regarded as the non-PH group. Significant differences were observed in the clinical data, laboratory indices, and echocardiographic data between the PH and non-PH patients (all P<0.05). Furthermore, hypertensive nephropathy patients on MPD showed a significantly higher incidence of PH compared with non-hypertensive nephropathy patients (P<0.05). Logistic regression analysis showed that the proportion of internal arteriovenous fistula, C-reactive protein levels, and ejection fraction were the highest risk factors for PH in patients receiving MPD. Our study shows that there is a high incidence of PH in patients receiving MPD and hypertensive nephropathy patients have an increased susceptibility to PH. PMID:26840710

  12. Achievement of cardiometabolic goals in aware hypertensive patients in Spain: a nationwide population-based study.

    PubMed

    Banegas, José R; Graciani, Auxiliadora; de la Cruz-Troca, Juan J; León-Muñoz, Luz M; Guallar-Castillón, Pilar; Coca, Antonio; Ruilope, Luis M; Rodríguez-Artalejo, Fernando

    2012-10-01

    Despite the importance of achieving cardiometabolic goals beyond blood pressure, in the health of hypertensives, no comprehensive assessment of these characteristics has been performed in whole countries. We studied in 2008-2010 a total of 11 957 individuals representative of the Spanish population aged≥18 years. Information on cardiometabolic characteristics was collected at the participants' homes, through structured questionnaires, physical examination, and fasting blood samples. A total of 3983 individuals (33.3%) had hypertension (≥140/90 mm Hg or current antihypertensive drug treatment), 59.4% were aware of their condition, 78.8% treated among those aware, and 48.5% controlled among those aware and treated (22.7% of all hypertensives). Of the aware hypertensives, 13.8% had a body mass index<25 kg/m2, 38.6% consumed <2.4 g/d of sodium, 19.3% were diabetic with 61% attaining goal hemoglobin A1c<6.5%, whereas 42.3% had hypercholesterolemia, with 38.1% reaching goal low-density lipoprotein<115 mg/dL. Only 30.7% of overweight patients received a prescription of specific method for weight loss, 17.4% of daily smokers were offered a smoking cessation strategy, and 15.8% of older patients were given a flu shot. Aware and unaware hypertensives showed a similar frequency of some lifestyle, such as adequate physical activity. In conclusion, in a European country with a well-developed, free-access healthcare system, achievement of many cardiometabolic goals among hypertensives is poor. Moreover, a serious deficiency in hypertension awareness and in the effectiveness of some lifestyle interventions among aware hypertensives is present. Greater effort is needed in the management of coexisting risk factors and on lifestyle medical advice to improve the cardiometabolic health of hypertensives. PMID:22949530

  13. Urinary Mitochondrial DNA Copy Number Identifies Chronic Renal Injury in Hypertensive Patients.

    PubMed

    Eirin, Alfonso; Saad, Ahmed; Tang, Hui; Herrmann, Sandra M; Woollard, John R; Lerman, Amir; Textor, Stephen C; Lerman, Lilach O

    2016-08-01

    Mitochondrial injury contributes to renal dysfunction in several models of renal disease, but its involvement in human hypertension remains unknown. Fragments of the mitochondrial genome released from dying cells are considered surrogate markers of mitochondrial injury. We hypothesized that hypertension would be associated with increased urine mitochondrial DNA (mtDNA) copy numbers. We prospectively measured systemic and urinary copy number of the mtDNA genes cytochrome-c oxidase-3 and NADH dehydrogenase subunit-1 by quantitative polymerase chain reaction in essential (n=25) and renovascular (RVH, n=34) hypertensive patients and compared them with healthy volunteers (n=22). Urinary kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin served as indices of renal injury. Renal blood flow and oxygenation were assessed by multidetector computed tomography and blood oxygen level-dependent magnetic resonance imaging. Blood pressure, urinary neutrophil gelatinase-associated lipocalin, and kidney injury molecule-1 were similarly elevated in essential hypertension and RVH, and estimated glomerular filtration rate was lower in RVH versus healthy volunteers and essential hypertension. Renal blood flow was lower in RVH compared with essential hypertension. Urinary mtDNA copy number was higher in hypertension compared with healthy volunteers, directly correlated with urinary neutrophil gelatinase-associated lipocalin and kidney injury molecule-1 and inversely with estimated glomerular filtration rate. In RVH, urinary mtDNA copy number correlated directly with intrarenal hypoxia. Furthermore, in an additional validation cohort, urinary mtDNA copy number was higher in RVH compared with healthy volunteers (n=10 each). The change in serum creatinine levels and estimated glomerular filtration rate 3 months after medical therapy without or with revascularization correlated with the change in urinary mtDNA. Therefore, elevated urinary mtDNA copy numbers in

  14. Correlation of serum parathormone with hypertension in chronic renal failure patients treated with hemodialysis.

    PubMed

    Baradaran, Azar; Nasri, Hamid

    2005-01-01

    To consider the correlation of serum parathormone on severity of hypertension in end-stage renal disesase (ESRD) patients on hemodialysis (HD). A cross-sectional study was done on patients with ESRD on treatment with maintenance HD. Levels of serum calcium, phosphorus, alkaline phosphatase, albumin and intact parathormone (iPTH) were measured. Stratification of hypertensive patients was done from stages one to three. The total number of patients studied was 73 (Females=28, Males=45), consisting of 58 non-diabetic (F=22 M=36) and 15 diabetic patients (F=6 M=9). The mean age of the study patients was 46.5 +/- 16 years.The mean duration on HD of the study patients was 21.5 +/- 23.5 months. The mean serum PTH of the study patients was 309 +/- 349 pg/ml and the mean serum alkaline phosphatase was 413 +/- 348 IU/L. There was a significant positive correlation between the stage of hypertension and serum PTH levels (r =0.200 p=0.045). Also, there was a significant positive correlation between stage of hypertension and calcium-phosphorus product (r = 0. 231 p=0.027).There was no significant correlation between stage of hypertension and serum ALP (r =0.135 p=0.128). Relationship between serum PTH and severity of hypertension in patients on HD needs to be studied in more detail. Hypertention and secondary hyperparathyroidism interact in the process of accelerated atherosclerosis in HD patients thus warranting appropriate measures to control hyperparathyroidism vigorously. PMID:17642794

  15. The 2014 hypertension guidelines: implications for patients and practitioners in Asia

    PubMed Central

    Angeli, Fabio; Reboldi, Gianpaolo; Verdecchia, Paolo

    2015-01-01

    Hypertension is a global public health issue and a major cause of morbidity and mortality. Because of population growth and ageing, the number of people with uncontrolled hypertension rose from 600 million in 1980 to nearly 1 billion in 2008. Furthermore, the number of adults with hypertension in 2025 has also been predicted to increase by about 60% to a total of 1.56 billion. The prevalence of hypertension in most Asian countries has increased over the last 30 years and more dramatically in the last 10 years. Several factors contributed to such changes in Asia, but acculturation to Western lifestyle, modernisation and urbanisation are considered key contributing factors. There are some unique features in regards to cardiovascular risk in Asia. Specifically, Asian regions have disproportionately higher mortality and morbidity from stroke compared with Western countries. Furthermore, the relationship between blood pressure level and risk of stroke is stronger in Asia than in Western regions. Although evidence-based and qualified guidelines for hypertension diagnosis and management have been released recently from Europe and North America, the unique features of Asian patients with hypertension raise concerns in regards to the real clinical applicability of Western guidelines in Asian populations. Specifically, it is not yet clear to what extent the new blood pressure target proposed by Western guidelines for high risk and elderly hypertensive individuals apply to Asian populations.

  16. Sodium-22 influx into erythrocytes from diabetic hypertensive patients on maintenance hemodialysis

    SciTech Connect

    Gambhir, K.K.; Mathews, J.; Parui, R.; Cruz, I.A.; Hosten, A.O.; Dillard, M.G. )

    1990-10-01

    We have studied the percentage of 22Na+ uptake in cell suspensions; 0.4 to 2.0 x 10(9) erythrocytes/mL from diabetic uremic patients with secondary hypertension and from normal subjects. Suspensions from diabetic uremic patients with secondary hypertension 0.42 +/- 0.06 to 2.05 +/- 0.28; normal subjects showed a percentage uptake of 22Na+ of 0.27 +/- 0.05 to 1.28 +/- 0.22. The uptake of 22Na+ in 2.0 x 10(9) cells/mL was 60% more (P less than .05) in diabetic uremic patients than in the controls. These studies indicate that 22Na+ influx determinations may be used to distinguish secondary hypertensive patients from normal subjects.

  17. Evaluation of Prothrombin Time and Activated Partial Thromboplastin Time in Hypertensive Patients Attending a Tertiary Hospital in Calabar, Nigeria

    PubMed Central

    Nnenna Adaeze, Nnamani; Uchenna Emeribe, Anthony; Abdullahi Nasiru, Idris; Babayo, Adamu; Uko, Emmanuel K.

    2014-01-01

    Introduction. Several biomedical findings have established the effects of hypertension on haemostasis and roles of blood coagulation products in the clinical course of hypertension. Methods. This cross-sectional study aimed at determining effects of hypertension on prothrombin time (PT) and activated partial thromboplastin time (APTT) in hypertensive patients in comparison with normotensive subjects attending a tertiary hospital in Calabar. Forty-two (42) hypertensive patients and thirty-nine (39) normotensive control subjects were investigated for PT and APTT using Quick one-stage methods. Results. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) correlated positively with APTT (r = 0.3072, r = 0.4988; P < 0.05) in hypertensive patients. DBP, SBP, PT, and APTT were significantly higher in hypertensive patients when compared to normotensive subjects (P < 0.05). DBP correlated negatively with duration of illness (r = −0.3097; P < 0.05) in hypertensive patients and positively with age of normotensive subjects (r = 0.3523; P < 0.05). Conclusion. The results obtained indicated that measurements of PT and APTT may serve as indices for evaluating hemostatic abnormalities in hypertensive patients and guide for antihypertensive therapy. However, to have better understanding of hemostatic activities in hypertension, it is recommended to conduct D-dimer, platelet factors, and protein assays. PMID:25477963

  18. [Analysis of a disturbance of trace element balance in patients with ischemic stroke with arterial hypertension].

    PubMed

    Kuramshina, D B; Novikova, L B; Nikonov, A A; Torshin, I Iu; Gromova, O A

    2012-01-01

    Disturbance of trace element balance increases the risk of cerebrovascular disease and, above all, ischemic stroke (IS). A comparative analysis of clinical and demographic parameters and trace element composition of hair was performed in the group of 30 ischemic stroke patients with arterial hypertension (AH) and 30 stroke patients without hypertension (mean age 55±7 years). The stroke patients with hypertension were characterized by the elevated body mass index (28.5±4.1 kg/m2, AI, 26.0±2.9 kg/m2, p=0.006), higher incidence of coronary heart disease (p=0.04). Alcohol consumption more than 3 drinks a week was associated with a 5-fold increase of the risk of stroke with hypertension (95% CI 1.0-27, p=0.035). The results revealed a number of statistically significant differences in trace element profile in the studied groups of patients: deficits of essential magnesium, manganese, cobalt, copper, zinc, a statistically significant increase in sodium levels, toxic and conditionally toxic trace elements (cadmium, mercury, bismuth, barium, etc.). One of the probable factors that lead to the accumulation of toxic trace elements in stroke patients is the increased consumption of alcohol including that of substandard quality. The data obtained also show the feasibility of implementing screening programs to assess micronutrient status (including trace elements) for early detection of pathological abnormalities in the elemental homeostasis that might lead to an increased risk of ischemic stroke and hypertension. PMID:22677769

  19. [Complex assessment of vasomotor function of vascular endothelium in patients with hypertension].

    PubMed

    Gel'tser, B I; Savchenko, S V; Kotel'nikov, V N; Plotnikova, I V

    2004-01-01

    Vasomotor function of vascular endothelium was studied in 62 patients with grade 1-2 hypertension with moderate and high added risk. Methods included study of brachial and middle cerebral artery endothelium dependent and independent vasodilation/vasoconstriction, measurement of plasma levels of nitric oxide metabolites (NO(n)-), endothelin-1, and antithrombin, as well as registration of their changes during vasomotor tests with calculation of integral indexes. Most patients with hypertension differed from controls by preponderance of vasoconstrictor over vasodilator reactions both in peripheral and cerebral vascular bed. At the same time patients with hypertension had pronounced dissociation between vasomotor responses of cerebral and peripheral vessels compared with subjects with normal blood pressure (p<0.05). Besides lowered basal level of NO(n)- and high concentration of endothelin-1 patients with hypertension were characterized by hyperreactivity of nitricoxidergic system, augmented lability of endothelin producing system, and impaired athrombogenecity of vascular endothelium. Complex assessment of vasomotor function of vascular endothelium by sequential vasoactive tests characterizes functional and metabolic activity of cerebral and peripheral vessels and can be used for improvement of risk stratification and monitoring of efficacy of treatment of patients with hypertension. PMID:15111971

  20. Intervention of Collective Exercise on the Mental Health of Elderly Hypertensive Patients

    PubMed Central

    XU, Wenxin; LI, Menglong; YAO, Jiwei

    2016-01-01

    Background: Anxiety, depression, and other adverse psychological reactions are often observed in elderly hypertensive patients. Appropriate exercise is a safe form of adjuvant therapy without causing side effects among these patients, with consistent effects on patients’ mental health. In this study, a collective exercise intervention experiment was conducted to evaluate the mental health of elderly hypertensive patients and to verify the effect of the psychological intervention of collective exercise. Method: A total of 115 elderly hypertensive patients aged 60–70 years old were selected as study subjects from May 2012 to January 2015 in Fuzhou City, Fujian Province, China. A total of 57 patients were included in the control group and 58 patients were assigned in the experimental group. Patients in the experimental group participated in a 12 weeks exercise intervention, while patients in the control group didn’t participate in any regular physical exercise. Results: After intervention, the Symptom Checklist-90 (SCL-90), total score, somatization, obsessive-compulsive symptom, interpersonal sensitivity, depression, anxiety, hostility, and paranoia scores of the experimental group were significantly lower than those of the control group (P < 0.05). The positive coping style score of the experimental group was significantly higher than that of the control group (P<0.05); by contrast, the negative coping style score of the experimental group was significantly lower than that of the control group (P < 0.05). Conclusion: The mental health level and coping ability of elderly hypertensive patients can be effectively improved with the proposed treatment. PMID:27141493

  1. Cortisol Level and Hemodynamic Changes During Tooth Extraction at Hypertensive and Normotensive Patients

    PubMed Central

    Agani, Zana Bajrami; Benedetti, Alberto; Krasniqi, Vjosa Hamiti; Ahmedi, Jehona; Sejfija, Zana; Loxha, Mergime Prekazi; Murtezani, Arben; Rexhepi, Aida Namani; Ibraimi, Zana

    2015-01-01

    Background: The patients that are subjects to oral-surgical interventions produce large amounts of steroids in comparison with healthy patients which are not a subject to any dental intervention. The aim of research was to determine the level of stress hormone cortisol in serum, arterial blood pressure and arterial pulse, and to compare the effectiveness of the usage of lidocaine with adrenalin in comparison with lidocaine without adrenalin during the tooth extraction. Patients and methods: This clinical research includes patients with indication of tooth extraction divided in hypertensive and normotensive patients. Results: There is no important statistical distinction between groups, for the cortisol levels before, during and after tooth extraction regardless of the type of anesthetic used, while we registered higher values of systolic and diastolic values at hypertensive patients, regardless of the type of anesthetic Conclusion: There is significant systolic and diastolic blood pressure rise in both groups of patients hypertensive and normotensive patients, (regardless of anesthetic used with or without vasoconstrictor), who underwent tooth extraction. The special emphasize is attributed to hypertensive patients where these changes are more significant. As per cortisol level and pulse rate, our results indicate no significant statistical difference in between groups. PMID:26005263

  2. Serum Concentrations of Endothelin-1 and Matrix Metalloproteinases-2, -9 in Pre-Hypertensive and Hypertensive Patients with Type 2 Diabetes

    PubMed Central

    Kostov, Krasimir; Blazhev, Alexander; Atanasova, Milena; Dimitrova, Anelia

    2016-01-01

    Endothelin-1 (ET-1) is one of the most potent vasoconstrictors known to date. While its plasma or serum concentrations are elevated in some forms of experimental and human hypertension, this is not a consistent finding in all forms of hypertension. Matrix metalloproteinases -2 and -9 (MMP-2 and MMP-9), which degrade collagen type IV of the vascular basement membrane, are responsible for vascular remodeling, inflammation, and atherosclerotic complications, including in type 2 diabetes (T2D). In our study, we compared concentrations of ET-1, MMP-2, and MMP-9 in pre-hypertensive (PHTN) and hypertensive (HTN) T2D patients with those of healthy normotensive controls (N). ET-1, MMP-2, and MMP-9 were measured by ELISA. Concentrations of ET-1 in PHTN and N were very similar, while those in HTN were significantly higher. Concentrations of MMP-2 and MMP-9 in PHTN and HTN were also significantly higher compared to N. An interesting result in our study is that concentrations of MMP-2 and MMP-9 in HTN were lower compared to PHTN. In conclusion, we showed that increased production of ET-1 in patients with T2D can lead to long-lasting increases in blood pressure (BP) and clinical manifestation of hypertension. We also demonstrated that increased levels of MMP-2 and MMP-9 in pre-hypertensive and hypertensive patients with T2D mainly reflect the early vascular changes in extracellular matrix (ECM) turnover. PMID:27490532

  3. Improvement of blood pressure control in hypertensive patients with renal diseases.

    PubMed

    Ohta, Yuko; Tsuruya, Kazuhiko; Fujii, Koji; Tokumoto, Masanori; Kanai, Hidetoshi; Matsumura, Kiyoshi; Tsuchihashi, Takuya; Hirakata, Hideki; Iida, Mitsuo

    2007-04-01

    For hypertensive patients with renal diseases (RD), strict blood pressure (BP) control has been recommended in recent hypertension guidelines, such as JNC VI, JNC 7, WHO/ISH 1999 and ESH-ESC 2003. We assessed the current status of BP control and the changes of BP control before and after the publication of these guidelines in 489 hypertensive patients with or without RD (age, 19-89 years, mean 59+/-13 years) who visited the hypertension and kidney outpatient clinic at Kyushu University Hospital. The clinical characteristics of RD and non-RD patients were assessed (RD patients: age, 20-89 years, mean 60+/-13 years, n=311; non-RD patients: age, 19-86 years, mean 58+/-13 years, n=178). In addition, we compared the BP control status in 2003 to that in 1996. In 2003, the BP in RD patients was 134+/-16/78+/-10 mmHg and that in non-RD patients was 138+/-12/83+/-9 mmHg. When strict BP control was defined as <130/80 mmHg, the frequency of strict BP control in RD patients was 28.9% in 2003. In addition, the BP levels of RD patients in 2003 were significantly lower than those in 1996 (134+/-16/78+/-10 mmHg vs. 141+/-17/85+/-10 mmHg, p<0.05 for both systolic blood pressure [SBP] and diastolic blood pressure [DBP]), and the frequency of strict BP control in RD patients was higher in 2003 than in 1996 (28.9% vs. 11.8%, p<0.01). The BP levels of non-RD patients in 2003 tended to be lower than those in 1996 (138+/-12/83+/-9 mmHg vs. 141+/-13/85+/-9 mmHg, n.s.). In 2003, angiotensin II receptor blockers (ARBs) were more frequently prescribed to RD patients than to non-RD patients. Furthermore, the use of ARBs was markedly increased in 2003 compared with 1996. In conclusion, in our outpatient clinic, BP levels in hypertensive patients with RD have improved in recent years, and were lower than those in hypertensive patients without RD, which may in part reflect the physicians' awareness of the importance of strict BP control in RD patients, as suggested by several recent hypertension

  4. Sex-specific differences in cardiovascular risk factors and blood pressure control in hypertensive patients.

    PubMed

    Tziomalos, Konstantinos; Giampatzis, Vasilios; Baltatzi, Maria; Efthymiou, Elias; Psianou, Konstantia; Papastergiou, Natalia; Magkou, Dimitra; Bougatsa, Vagia; Savopoulos, Christos; Hatzitolios, Apostolos I

    2014-04-01

    Cardiovascular disease (CVD) and cardiovascular risk factors are frequently undertreated in women. However, it is unclear whether the prevalence of additional cardiovascular risk factors and the total cardiovascular risk differ between hypertensive men and women. There are also limited data regarding rates of blood pressure control in the two sexes outside the United States. The authors aimed to compare the cardiovascular risk profile between sexes. A total of 1810 hypertensive patients (40.4% men, age 56.5±13.5 years) attending the hypertension outpatient clinic of our department were studied. Men were more frequently smokers than women and were more heavy smokers than the latter. Serum high-density lipoprotein cholesterol levels were lower and serum triglyceride levels were higher in men. On the other hand, abdominal obesity and chronic kidney disease were more prevalent in women. The estimated cardiovascular risk was higher in men than in women but the prevalence of established CVD did not differ between the sexes. The percentage of patients with controlled hypertension and the number of antihypertensive medications were similar in men and women. In conclusion, hypertensive men have more adverse cardiovascular risk factor profile and greater estimated cardiovascular risk than women. However, the prevalence of established CVD does not differ between sexes. These findings further reinforce current guidelines that recommend that management of hypertension and of other cardiovascular risk factors should be as aggressive in women as in men in order to prevent cardiovascular events. PMID:24621371

  5. The prevalence of silent myocardial ischaemia in patients with white-coat hypertension.

    PubMed

    Nalbantgil, I; Onder, R; Nalbantgil, S; Yilmaz, H; Boydak, B

    1998-05-01

    The aim of this study was to estimate the incidence of silent myocardial ischaemia in patients with mild to moderate hypertension, white-coat hypertension (WCH) and those with normal blood pressure. Ambulatory electrocardiographic (ECG) monitoring was carried out in 272 cases with normal blood pressure, 164 cases with mild to moderate hypertension (diastolic blood pressure >95 and <114 mm Hg), and 106 cases with white-coat hypertension who were diagnosed with ambulatory blood pressure monitoring. The ages of the patients of all groups were between 42-61 years. There were no differences between the groups according to age, gender and other parameters. There were no anginal symptoms, and resting ECGs were in normal limits in all cases. The diagnosis of silent ischaemia was considered to be present if there was ST depression >2 mm/at least 120 sec in ambulatory ECG examination without angina or its equivalent cardiac symptoms. The incidence of silent ischaemia was 6.4%, 18.8%, and 26.2% in cases with normal blood pressure, WCH, and hypertension, respectively. The differences between groups were significant. It was concluded that WCH is not a benign condition, but shares some characteristics with essential hypertension. PMID:9655656

  6. Pregnancy outcomes in patients with severe pulmonary hypertension and Eisenmenger syndrome treated with sildenafil monotherapy

    PubMed Central

    Alan, Pichy Ann; Benedicto, Jubert

    2014-01-01

    Pregnancy outcomes in patients with pulmonary arterial hypertension have not been documented in our local setting. In our institution, access to therapies like nitric oxide, inhaled prostacyclin and iloprost is limited. We describe two such women given sildenafil monotherapy between April and May 2011. Both had an atrial septal defect complicated by Eisenmenger syndrome. Both survived – one after elective Caesarean section for malpresentation (breech) under general anaesthesia, the other after an assisted vaginal delivery. In addition to oral sildenafil, both received oxygen supplementation. To date, there have been three reported cases of pulmonary arterial hypertension in pregnancy treated with sildenafil in combination with another drug. Our two cases demonstrate that treatment for pulmonary arterial hypertension using sildenafil as monotherapy may allow stabilization of the maternal condition and improve clinical outcomes for both mother and baby. However, pregnancy is still discouraged in women with pulmonary arterial hypertension.

  7. Drug related problems in type 2 diabetes patients with hypertension: a cross-sectional retrospective study

    PubMed Central

    2013-01-01

    Background Type 2 diabetes (T2DM) patients with hypertension are at increased risk for experiencing drug-related problems (DRPs) since they often receive multiple medications and have multiple comorbidities. To date, there is a lack of studies conducted in T2DM patients with hypertension. This study aims to analyze the DRPs and identify factors affecting the DRPs in this patient population. Method This retrospective study involved T2DM patients with hypertension and was conducted at a tertiary hospital in Malaysia from January 2009 to December 2011. The assessment of DRPs was based on the Pharmaceutical Network Care Europe (PCNE) tool version 5.01. Results Two hundred patients with a total of 387 DRPs were identified. Among these patients, 90.5% had at least one DRP, averaging 1.9 ± 1.2 problems per patient. The most common DRPs encountered were insufficient awareness of health and diseases (26%), drug choice problems (23%), dosing problems (16%) and drug interactions (16%). The most implicated drugs were aspirin, clopidogrel, simvastatin, amlodipine and metformin. The six domains of DRPs found to have statistically significant associations were renal impairment, polypharmacy, cardiovascular disease, elderly status, and duration of hospital stay. Conclusions Early identification of the types and patterns of DRPs and the factors associated to them may enhance the prevention and management of DRPs in T2DM patients with hypertension. PMID:23289895

  8. Electrocardiographic and Echocardiographic Imaging of the Heart of Athletes and Patients with Hypertension

    PubMed Central

    Kreso, Amir; Barakovic, Fahir; Medjedovic, Senad; Halilbasic, Amela; Klepic, Muhamed

    2015-01-01

    Introduction: “Athlete’s heart syndrome” is a condition characterized by structural, electrophysiologic and functional adaptation of the myocardium to physical activity (training), depending on the activity intensity, duration and type. In athletes left ventricular hypertrophy often resembles comorbid conditions (hypertension or hypertrophic cardiomyopathy) so the differential diagnosis of the disease is very important and crucial, especially in people who are in active training. In fact, if an athlete has finding which indicate thickening of the left ventricle walls, should be distinguished hypertrophy which occurred as a result of many years of training from accidental existence of hypertension or hypertrophic cardiomyopathy in the same person. Therefore, it is important to make a diagnostic difference between healthy and sick heart. Material and methods: The study involved male persons aged 20-45 which have increased muscle mass of the left ventricle due to different etiology. Definite sample included 80 respondents divided into two groups. All respondent underwent interview, clinical examination, ECG and echocardiography. Results: Average systolic blood pressure (SBP) for the athletes were 115.8±7.2 mmHg, and in patients, with hypertension 154.4±3.5 mmHg, average values of diastolic blood pressure (DBP) for the athletes were 74.2±8.1 mmHg in patients, hypertensive 96.2 ± 3.9 mmHg. Values of SBP and DBP were significantly lower in the group of athletes compared to patients with hypertension (p=0.001). The value of the SFO/min was significantly lower in the group of athletes compared to patients with hypertension (p <0.001). There was a statistically significant difference in the sum of SV2 RV5 and between groups of athletes and groups of patients with hypertension (p<0.05). There was no significant difference in the echocardiography parameters between two groups. There was a statistically significant difference in the sum of SV2 and RV5 between groups

  9. Serum Superoxide Dismutase Is Associated with Vascular Structure and Function in Hypertensive and Diabetic Patients

    PubMed Central

    Gómez-Marcos, Manuel A.; Blázquez-Medela, Ana M.; Gamella-Pozuelo, Luis; Recio-Rodriguez, José I.; García-Ortiz, Luis; Martínez-Salgado, Carlos

    2016-01-01

    Oxidative stress is associated with cardiac and vascular defects leading to hypertension and atherosclerosis, being superoxide dismutase (SOD) one of the main intracellular antioxidant defence mechanisms. Although several parameters of vascular function and structure have a predictive value for cardiovascular morbidity-mortality in hypertensive patients, there are no studies on the involvement of SOD serum levels with these vascular parameters. Thus, we assessed if SOD serum levels are correlated with parameters of vascular function and structure and with cardiovascular risk in hypertensive and type 2 diabetic patients. We enrolled 255 consecutive hypertensive and diabetic patients and 52 nondiabetic and nonhypertensive controls. SOD levels were measured with an enzyme-linked immunosorbent assay kit. Vascular function and structure were evaluated by pulse wave velocity, augmentation index, ambulatory arterial stiffness index, and carotid intima-media thickness. We detected negative correlations between SOD and pressure wave velocity, peripheral and central augmentation index and ambulatory arterial stiffness index, pulse pressure, and plasma HDL-cholesterol, as well as positive correlations between SOD and plasma uric acid and triglycerides. Our study shows that SOD is a marker of cardiovascular alterations in hypertensive and diabetic patients, since changes in its serum levels are correlated with alterations in vascular structure and function. PMID:26635913

  10. Occurrence and relevance of postprandial hypotension in patients with essential hypertension.

    PubMed

    Mitro, P; Feterik, K; Cvercková, A; Trejbal, D

    1999-04-23

    The aim of this study was to determine the occurrence of postprandial hypotension (PPH) in patients with arterial hypertension, identify its risk factors and evaluate the importance of postprandial blood pressure reduction in relation to the management of hypertension. Forty-nine patients (23 male; 26 female; mean age 65.6 +/- 12 years) with diagnosed hypertension underwent measurement of blood pressure and pulse rate before intake of a standardised breakfast (1821 kJ) and at 15-minute intervals until 1 hour thereafter. The orthostatic test for detection of orthostatic hypotension was performed before the ingestion of food. PPH was detected in 22 patients (45%) with arterial hypertension. Patients treated with diuretics had significantly greater postprandial reductions in blood pressure compared to those who received no diuretic treatment. Levels of premeal systolic blood pressure, age, orthostatic hypotension, history of syncope cardiovascular disease or stroke were not associated with a more severe decline in postprandial blood pressure. Maximal reductions in blood pressure were recorded approximately 33 +/- 15 minutes after ingestion of food. Therefore, recent intake of food should be taken into account in the evaluation of hypertension and the effect of antihypertensive drugs when blood pressure is measured within one hour after a meal. PMID:10378313

  11. Serum Superoxide Dismutase Is Associated with Vascular Structure and Function in Hypertensive and Diabetic Patients.

    PubMed

    Gómez-Marcos, Manuel A; Blázquez-Medela, Ana M; Gamella-Pozuelo, Luis; Recio-Rodriguez, José I; García-Ortiz, Luis; Martínez-Salgado, Carlos

    2016-01-01

    Oxidative stress is associated with cardiac and vascular defects leading to hypertension and atherosclerosis, being superoxide dismutase (SOD) one of the main intracellular antioxidant defence mechanisms. Although several parameters of vascular function and structure have a predictive value for cardiovascular morbidity-mortality in hypertensive patients, there are no studies on the involvement of SOD serum levels with these vascular parameters. Thus, we assessed if SOD serum levels are correlated with parameters of vascular function and structure and with cardiovascular risk in hypertensive and type 2 diabetic patients. We enrolled 255 consecutive hypertensive and diabetic patients and 52 nondiabetic and nonhypertensive controls. SOD levels were measured with an enzyme-linked immunosorbent assay kit. Vascular function and structure were evaluated by pulse wave velocity, augmentation index, ambulatory arterial stiffness index, and carotid intima-media thickness. We detected negative correlations between SOD and pressure wave velocity, peripheral and central augmentation index and ambulatory arterial stiffness index, pulse pressure, and plasma HDL-cholesterol, as well as positive correlations between SOD and plasma uric acid and triglycerides. Our study shows that SOD is a marker of cardiovascular alterations in hypertensive and diabetic patients, since changes in its serum levels are correlated with alterations in vascular structure and function. PMID:26635913

  12. [The influence of citoflavin on molecular mechanisms of hypertensive encephalopathy development in patients with systolic arterial hypertension].

    PubMed

    Kartashova, E A; Romantsov, M G; Sarvilina, I V

    2014-01-01

    The molecular pharmacological effects of cytoflavin in patients with hypertensive encephalopathy (HE) and isolated systolic arterial hypertension (ISAH) have been investigated using the following methods: assessment of complaints, 24-hour arterial pressure monitoring, ultrasound diagnostics including echocardiography, measurement of lipid profiles and coagulograms, and molecular phenotyping by MALDI-TOF/TOF-MS. A combination of cytoflavin administration with standard therapy of HE and ISAH led to the most expressed return development of clinical symptoms, restoration of the hemodynamic, structural, and geometrical parameters of cardiovascular system, and normalization of the indices of lipid profiles and coagulograms in comparison to patients with HE and ISAH, which accepted only standard therapy. Molecular mechanisms of cytoflavin action have been revealed, which include control of the activity of cellular signaling pathways by means of intermolecular interactions. The optimized therapy of HE and ISAH is recommended for clinical application, which assumes a combined use of standard therapy and cytoflavin and provides a geroprotective action upon the cardiovascular system. PMID:25102730

  13. Sequential cognitive-behavioral therapy for children with obsessive-compulsive disorder with an inadequate medication response: a case series of five patients.

    PubMed

    Storch, Eric A; Bagner, Daniel M; Geffken, Gary R; Adkins, Jennifer W; Murphy, Tanya K; Goodman, Wayne K

    2007-01-01

    Few data have been reported on the efficacy of cognitive-behavioral therapy (CBT) for youth with obsessive-compulsive disorder (OCD) who have not responded to prior treatment with medication. Given this, we report an open trial of CBT for children who have remained symptomatic following medication trials. Five children with OCD who had an inadequate response to psychotropic medications (e.g., limited response and/or unable to be titrated to a complete dose due to side effects) received treatment in a 3-week intensive CBT program. Assessments were conducted at baseline and after treatment. All participants were classified as treatment responders (much improved or very much improved) and the severity of clinician-rated OCD symptoms and impairment significantly decreased after the intervention. Although a number of limitations of this preliminary report exist, this study provides preliminary support for the utility of an intensive intervention for youth with OCD who have had an inadequate response and/or adverse side effects. PMID:17044015

  14. The multiple lifestyle modification for patients with prehypertension and hypertension patients: a systematic review protocol

    PubMed Central

    Li, Juan; Zheng, Hui; Du, Huai-bin; Tian, Xiao-ping; Jiang, Yi-jing; Zhang, Shao-lan; Kang, Yu; Li, Xiang; Chen, Jie; Lu, Chao; Lai, Zhen-hong; Liang, Fan-rong

    2014-01-01

    Introduction The objective of this systematic review is to investigate the effectiveness, efficacy and safety of multiple concomitant lifestyle modification therapies for patients with hypertension or prehypertension. Methods and analysis Electronic searches will be performed in the Cochrane Library, OVID, EMBASE, etc, along with manual searches in the reference lists of relevant papers found during electronic search. We will identify eligible randomised controlled trials utilising multiple lifestyle modifications to lower blood pressure. The control could be drug therapy, single lifestyle change or no intervention. Changes in systolic blood pressure and diastolic blood pressure constitute primary end points, and secondary end points include the number of patients meeting the office target blood pressure, the number of patients reporting microvascular or macrovascular complications, etc. We will extract descriptive, methodological and efficacy data from identified randomised controlled trials (RCTs). We will calculate the relative risk for proportion of patients with a normal blood pressure in the experimental group. Dichotomous data will be analysed using risk difference and continuous data using weighted mean differences, both with 95% CI. We will use the χ2 test and the I2 statistic to assess heterogeneity. We will use the fixed effects model to compute the efficacy unless there is evidence of heterogeneity. If heterogeneity of effect size persists with respect to blood pressure change, further metaregression will be performed within groups. We will examine the potential for publication bias by using a funnel plot. Dissemination We will synthesise results from RCTs which provide more precise and accurate information on the effect of multiple lifestyle changes on blood pressure. The results of this review will increase the understanding of multiple lifestyle modifications for patients with hypertension or prehypertension. Trail registration number Our protocol

  15. [Anesthetic Management for Non-cardiac Surgery in a Patient with Severe Pulmonary Arterial Hypertension].

    PubMed

    Ohno, Sho; Niiyama, Yukitoshi; Murouchi, Takeshi; Yamakage, Michiaki

    2016-05-01

    Severe pulmonary arterial hypertension is a significant risk factor for anesthetic management in patients undergoing even non-cardiac surgery. A 64-year-old female patient with severe pulmonary arterial hypertension was scheduled to undergo inguinal hernioplasty. Preoperative systolic pulmonary arterial pressure was 115 mmHg. We selected monitored anesthesia care with 0.2-0.5 μg x kg(-1) x hr(-1) dexmedetomidine and ultrasound-guided iliohypogastric block. Thereafter, LiDCOrapid was used to acquire the hemodynamic responses during surgery. Continuous iliohypogastric block produced postoperative pain relief and the supplemental analgesic was not needed. The monitored anesthesia care by dexmedetomidine and ultrasound guided continuous iliohypogastric block would be a safe procedure for patients with severe pulmonary arterial hypertension undergoing non-cardiac surgery. LiDCO rapid could be low invasive and useful as a hemodaynamic monitor in such a case. PMID:27319099

  16. Liver transplantation in a patient with pulmonary hypertension at high altitude.

    PubMed

    Dou, Kefeng; Wang, Desheng; Zhao, Qingchuan; Song, Zhenshun; Yue, Shuqiang; Tao, Kaishan; Chen, Shaoyang; He, Yong; Ti, Zhenyu

    2010-03-01

    Chronic hypoxia at high altitude stresses many of the body's homeostatic mechanisms. As a consequence, the body develops alveolar hypoxia, hypoxemia, and polycythemia, which in turn causes vasoconstriction, pulmonary hypertension, and an increased risk of atherothrombotic complications. We report a successful liver transplantation in a patient with pulmonary hypertension who lives 4500 m above sea level. Pulmonary hypertension and hypercoagulable state induced by chronic hypoxia at high altitude may increase the risk of cardiopulmonary complication and perioperative mortality. The patient was discharged in good condition with normal liver function at the 34th postoperative day. After 41 months of follow-up, the patient is alive and well with a continued normalization of hepatic function and is continuing to live at 4500 m above sea level. PMID:20591354

  17. [Hypertensive emergency and urgence].

    PubMed

    Gegenhuber, Alfons; Lenz, Kurt

    2003-12-01

    DEFINITION, PATHOPHYSIOLOGY, THERAPY: The hypertensive crisis is characterized by a massive, acute rise in blood pressure. Patients with underlying hypertensive disease usually have an increase in systolic blood pressure values > 220 mmHg and diastolic values > 120 mmHg. The severity of the condition, however, is not determined by the absolute blood pressure level but by the magnitude of the acute increase in blood pressure. Thus, in the presence of primarily normotensive baseline values (such as those in eclampsia), even a systolic blood pressure > 170 mmHg may lead to a life-threatening condition. The most important causes are non-compliance (reduction or interruption of therapy), inadequate therapy, endocrine disease, renal (vessel) disease, pregnancy and intoxication (drugs). The management of this condition greatly depends on whether the patient has a hypertensive crisis with organ manifestation (hypertensive emergency) or a crisis without organ manifestation (hypertensive urgency). By documenting the medical history, the medical status and by simple diagnostic procedures, the differential diagnosis can be established at the emergency site within a very short period of time. In the absence of organ manifestations (hypertensive urgency) the patient may have non-specific symptoms such as palpitations, headache, malaise and a general feeling of illness in addition to the increase in blood pressure. In a hypertensive urgency the patient's blood pressure should not be reduced within a few minutes but within a period of 24 to 48 hours. Such adjustment can be achieved on an out-patient basis, however, only if the patient can be followed up adequately for early detection of a renewed attack. In the absence of follow-up facilities, the patient's blood pressure should be reduced over a period of 4 to 6 hours, if necessary in an out-patient emergency service. While intravenous medication is given preference when a rapid effect is desired, oral medication may be used for

  18. Patients' illness schemata of hypertension: the role of beliefs for the choice of treatment.

    PubMed

    Figueiras, Maria; Marcelino, Dalia Silva; Claudino, Adelaide; Cortes, Maria Armanda; Maroco, Joao; Weinman, John

    2010-04-01

    The aims of this study were (1) to investigate what are the illness perceptions of hypertensive patients and their relationship with beliefs about specific medicines, and (2) to identify different illness schemata and how they relate to the choice of medication. This was a cross-sectional study in which 191 Portuguese patients (59% females), with a hypertension diagnosis, aged over 18 years old, were recruited from a hospital clinic in the Lisbon Metropolitan area. The questionnaire included measures of choice of medication, beliefs about specific medicines (BMQ-Specific), illness perception (Brief-IPQ), and socio-demographic information. The results indicated that the components of the illness perceptions were associated with patients' beliefs about necessity and concerns about medication. Patients seem to differ in their choice of medication (generic or brand names) according to the three illness schemata identified. Patients with more negative illness schemata were more likely to choose a brand medicine, whereas patients with a more positive perception of hypertension were more likely to choose a generic medicine. Our findings support the argument that illness perceptions and beliefs about medicines play a role in influencing patients' preferences of medicines for the treatment of hypertension. PMID:20204931

  19. Clinical Values of Studying Kidney Elasticity with Virtual Touch Quantification in Gestational Hypertension Patients.

    PubMed

    Wang, Yi; Feng, Yujin; Yang, Xiaoyun; Zhang, Liyan; Zhang, Tongdi; Wang, Wengang

    2016-01-01

    BACKGROUND The aim of this study was to investigate the differences in shear wave velocity (SWV) in renal cortex, renal medulla, and renal sinuses between gestational hypertension and normal pregnant women. MATERIAL AND METHODS Ninety patients with gestational hypertension and 30 women with normal pregnancy were enrolled in this study. Kidney biopsy was performed within 6 weeks to 3 months postpartum to determine the pathological nature of renal injury. According to the classification criteria for gestational hypertension, the patients were divided into 3 groups. Gestational hypertension only patients were classified as Group A; patients with mild preeclampsia as group B; patients with severe preeclampsia as group C; normal pregnant women as a control group. Virtual Touch Quantification technique was used to measure renal shear wave velocity; blood pressure, urine analysis, and renal function were also tested. RESULTS There was no difference in renal function between patients in group A and the control group (p>0.05), but there was a significant difference in renal function among patients in group A, B, and C, and there was a significant difference in renal function between patients in group B and C versus control (p<0.05 for all comparisons). There was also a significant difference in SWV values of the renal cortex, renal medulla, and renal sinus between patients in group A, B, and C versus control group (p<0.05). CONCLUSIONS The SWV values of the renal cortex, renal medulla, and renal sinus in patients with gestational hypertension were smaller than those of normal pregnant women, and the more severe the kidney injury, the smaller the SWV value. PMID:26851959

  20. Prolonged QT interval and reduced heart rate variability in patients with uncomplicated essential hypertension.

    PubMed

    Maule, Simona; Rabbia, Franco; Perni, Valentina; Tosello, Francesco; Bisbocci, Daniela; Mulatero, Paolo; Veglio, Franco

    2008-11-01

    A prolonged QT interval is a risk factor for ischemic heart disease in hypertensive subjects. Heart rate variability (HRV) is both an index of autonomic function and an important prognostic factor in several diseases. The aim of the present study was to evaluate the relation between a prolonged QT interval and autonomic nervous system function in patients with untreated uncomplicated essential hypertension. Two hundred and fifteen untreated patients with essential hypertension underwent a Holter ECG equipped with software dedicated to HRV and QT analyses. Nine percent of the patients showed a corrected QT (QTc) >or=440 ms. The HRV indexes in the time domain (SDNN, SDNN index, RMSSD, and pNN50) were significantly reduced in the patients with a prolonged QTc compared to those with a normal QTc (SDNN 24 h: 126.4+/-29.9 vs. 143.9+/-35.4 ms, p=0.02; SDNN index [nighttime]: 85.9+/-32.4 vs. 115.5+/-36.7 ms, p=0.0006; RMSSD 24 h: 22.2+/-7.7 vs. 31.2+/-13.0 ms, p=0.0007; pNN50 24 h: 4.4+/-4.9 vs. 9.7+/-8.4%, p=0.0006). The linear correlation analysis between QTc length and HRV parameters showed a significant negative correlation with all the time-domain indexes. Such a correlation was maintained for RMSSD 24 h, pNN50 24 h and SDNN index (nighttime) after correction for gender and age. The present study shows that, even prior to the development of cardiac hypertensive disease, a prolongation of the QTc and a reduced HRV, both markers of cardiovascular risk, coexist in a proportion of patients with untreated essential hypertension. Further studies are warranted to evaluate whether the combination of such markers can identify hypertensive patients at risk for life-threatening arrhythmias and sudden death. (Hypertens Res 2008; 31: 2003-2010). PMID:19098371

  1. Silent cerebrovascular damage and its early correlates in essential hypertensive patients.

    PubMed

    Paglieri, Cristina; Rabbia, Franco; Bergui, Mauro; Genesia, Maria Luisa; Canadè, Antonella; Berra, Elena; Fulcheri, Chiara; Covella, Michele; Di Stefano, Cristina; Cerrato, Paolo; Veglio, Franco

    2012-01-01

    This study tested the association between cognitive functions, cerebrovascular damage, and cerebrovascular reactivity in 71 essential young hypertensives (age matched) and 22 normotensives (age matched). They underwent ambulatory blood pressure monitoring, neurocognitive tests, cerebral magnetic resonance, and transcranial Doppler. Twenty-three percent of patients showed more than 10 white matter lesions and 8% showed none. No control subjects showed more than 10 white matter lesions and 90% of normal controls showed no lesions. Patients with more than 10 white matter alterations had longer hypertensive story and showed significant lower nocturnal blood pressure fall. Pulsatility index was correlated with the number of white matter lesions. PMID:22574940

  2. Hypertension associated with venous thromboembolism in patients with newly diagnosed lung cancer

    PubMed Central

    Zhang, Yuhui; Yang, Yuanhua; Chen, Wenhui; Liang, Lirong; Zhai, Zhenguo; Guo, Lijuan; Wang, Chen; Zhang, Li; Xu, Qixia; Jiang, Luning; Zhang, Xinhong

    2016-01-01

    The aim of this study was to evaluate associations between cardiovascular disease (CVD) risk factors and the occurrence of venous thromboembolism (VTE) in patients with lung cancer that might help estimate an individual’s risk for VTE. A total of 632 unselected patients with newly diagnosed lung cancer were investigated for VTE within the three months prior to recruitment, and their major CVD risk factors were assessed at the baseline examination. Eighty-six of the 632 (13.6%) developed a VTE event. Multivariate logistic regression analysis, including age, sex, smoking, body mass index, diabetes, dyslipidemia, hypertension and white blood cell count, found that hypertension (OR 1.8; 95% CI 1.0–3.3) and leukocytosis (OR 2.7; 95% CI 1.5–4.8) were significantly associated with VTE in different tumor histology models and that hypertension (OR 1.9; 95% CI 1.1–3.4) and leukocytosis (OR 2.7; 95% CI 1.5–4.7) were also significantly associated with VTE in different tumor stage models. Leukocytosis was linearly associated with hypertension and VTE (P for trend = 0.006), and the ORs for VTE increased with leukocytosis (all P for trend <0.05). In conclusion, hypertension increased the risk of VTE in patients with newly diagnosed lung cancer, which may be mediated by the presence of inflammation. PMID:26797411

  3. Hypertension associated with venous thromboembolism in patients with newly diagnosed lung cancer.

    PubMed

    Zhang, Yuhui; Yang, Yuanhua; Chen, Wenhui; Liang, Lirong; Zhai, Zhenguo; Guo, Lijuan; Wang, Chen

    2016-01-01

    The aim of this study was to evaluate associations between cardiovascular disease (CVD) risk factors and the occurrence of venous thromboembolism (VTE) in patients with lung cancer that might help estimate an individual's risk for VTE. A total of 632 unselected patients with newly diagnosed lung cancer were investigated for VTE within the three months prior to recruitment, and their major CVD risk factors were assessed at the baseline examination. Eighty-six of the 632 (13.6%) developed a VTE event. Multivariate logistic regression analysis, including age, sex, smoking, body mass index, diabetes, dyslipidemia, hypertension and white blood cell count, found that hypertension (OR 1.8; 95% CI 1.0-3.3) and leukocytosis (OR 2.7; 95% CI 1.5-4.8) were significantly associated with VTE in different tumor histology models and that hypertension (OR 1.9; 95% CI 1.1-3.4) and leukocytosis (OR 2.7; 95% CI 1.5-4.7) were also significantly associated with VTE in different tumor stage models. Leukocytosis was linearly associated with hypertension and VTE (P for trend = 0.006), and the ORs for VTE increased with leukocytosis (all P for trend <0.05). In conclusion, hypertension increased the risk of VTE in patients with newly diagnosed lung cancer, which may be mediated by the presence of inflammation. PMID:26797411

  4. Comorbidity Analysis According to Sex and Age in Hypertension Patients in China

    PubMed Central

    Liu, Jiaqi; Ma, James; Wang, Jiaojiao; Zeng, Daniel Dajun; Song, Hongbin; Wang, Ligui; Cao, Zhidong

    2016-01-01

    Background: Hypertension, an important risk factor for the health of human being, is often accompanied by various comorbidities. However, the incidence patterns of those comorbidities have not been widely studied. Aim: Applying big-data techniques on a large collection of electronic medical records, we investigated sex-specific and age-specific detection rates of some important comorbidities of hypertension, and sketched their relationships to reveal the risk for hypertension patients. Methods: We collected a total of 6,371,963 hypertension-related medical records from 106 hospitals in 72 cities throughout China. Those records were reported to a National Center for Disease Control in China between 2011 and 2013. Based on the comprehensive and geographically distributed data set, we identified the top 20 comorbidities of hypertension, and disclosed the sex-specific and age-specific patterns of those comorbidities. A comorbidities network was constructed based on the frequency of co-occurrence relationships among those comorbidities. Results: The top four comorbidities of hypertension were coronary heart disease, diabetes, hyperlipemia, and arteriosclerosis, whose detection rates were 21.71% (21.49% for men vs 21.95% for women), 16.00% (16.24% vs 15.74%), 13.81% (13.86% vs 13.76%), and 12.66% (12.25% vs 13.08%), respectively. The age-specific detection rates of comorbidities showed five unique patterns and also indicated that nephropathy, uremia, and anemia were significant risks for patients under 39 years of age. On the other hand, coronary heart disease, diabetes, arteriosclerosis, hyperlipemia, and cerebral infarction were more likely to occur in older patients. The comorbidity network that we constructed indicated that the top 20 comorbidities of hypertension had strong co-occurrence correlations. Conclusions: Hypertension patients can be aware of their risks of comorbidities based on our sex-specific results, age-specific patterns, and the comorbidity network

  5. Retinal vascular changes in hypertensive patients in Ibadan, Sub-Saharan Africa

    PubMed Central

    Oluleye, Sunday Tunji; Olusanya, Bolutife Ayokunu; Adeoye, Abiodun Moshood

    2016-01-01

    Background Earlier studies in Nigeria reported the rarity of retinal vascular changes in hypertensives. The aim of this study was to describe the various retinal vascular changes in the hypertensive patients of Nigeria. Patients and methods Nine hundred and three hypertensive patients were studied. This study was approved by the ethical and research committee of the University of Ibadan and University College Hospital, Ibadan, Nigeria. Blood pressure and anthropometric measurements were measured. Cardiac echocardiography was performed on 156 patients. All patients had dilated fundoscopy and fundus photography using the Kowa portable fundus camera and an Apple iPhone with 20 D lens. Statistical analysis was done with Statistical Packages for the Social Sciences (Version 21). Results The mean age of patients was 57 years with a male:female ratio of 1. No retinopathy was found in 556 (61.5%) patients. In all, 175 (19.4%) patients had features of hypertensive retinopathy. Retinal vascular occlusion was a significant finding in 121 patients (13.4%), of which branch retinal vein occlusion, 43 (4.7%), and central retinal vein occlusion, 30 (3.3%), were the most prominent ones in cases. Hemicentral retinal vein occlusion, 26 (2.9%), and central retinal artery occlusion, 17 (1.9%), were significant presentations. Other findings included nonarteritic anterior ischemic optic neuropathy in five (0.6%) patients, hypertensive choroidopathy in seven (0.8%) patients, and hemorrhagic choroidal detachment in five (0.6%) patients. Left ventricular (LV) geometry was abnormal in 85 (55.5%) patients. Concentric remodeling, eccentric hypertrophy, and concentric hypertrophy were observed in 43 (27.6%), 26 (17.2%), and 15 (9.7%) patients, respectively. LV hypertrophy was found in 42 (27%) patients, while 60 (39%) patients had increased relative wall thickness. In this study, bivariate analysis showed a correlation between LV relative wall thickness and severity of retinopathy in both eyes

  6. Ambulatory monitoring derived blood pressure variability and cardiovascular risk factors in elderly hypertensive patients.

    PubMed

    Magdás, Annamária; Szilágyi, László; Belényi, Boglárka; Incze, Alexandru

    2014-01-01

    Hypertension in the elderly is characterized by isolated systolic hypertension and high variability, but its clinical significance is not yet fully understood. The goal of this paper was to assess circadian blood pressure variability (BPV) in elderly hypertensives, and to determine its relationship to cardiovascular risk factors. To achieve this goal, a number of 75 inefficiently treated hypertensive patients were studied, 45 elderly, aged over 60 years, 30 middle-aged, younger than 60 years. After 24-hour ambulatory blood pressure monitoring (ABPM), blood pressure (BP) values, pulse pressure (PP), morning surge were compared between the groups. BPV was calculated using average real variability (ARV). The relationships between BPV, pulse pressure, left ventricular mass index (LVMI), and cardiovascular risk factors were assessed in both groups. As a result, it was found that left ventricular mass (p=0.01), PP, morning surge, 24-hour systolic ARV were significantly higher in the elderly group (p<0.05). In both groups, higher 24-hour BPV was associated with an increase in LVMI. In the elderly population 24-hour BPV was positively correlated to increased PP, total cholesterol and triglyceride levels (p<0.05). Moreover, it was concluded that ABPM-derived BP variability index could be an early predictive marker of end-organ damage in hypertension. Its reduction might be an important objective of hypertension management in elderly. PMID:25226958

  7. Endothelin receptor antagonists for pulmonary hypertension in adult patients with sickle cell disease.

    PubMed

    Minniti, Caterina P; Machado, Roberto F; Coles, Wynona A; Sachdev, Vandana; Gladwin, Mark T; Kato, Gregory J

    2009-12-01

    Pulmonary Hypertension is a serious complication of sickle cell disease (SCD), with high morbidity and mortality. Endothelin (ET)-1, a potent vasoconstrictor elevated in SCD, acts through the ET receptors (ETR), ETR-A and ETR-B. Bosentan and ambrisentan are ETR blockers used in primary pulmonary hypertension. We report on the use of ETR blocking agents in a cohort of 14 high-risk SCD adult patients with pulmonary hypertension. Patients underwent right heart catheterization, 6-min walk test, echocardiogram, physical examination and blood work-up before starting ETR blockers. Eight patients received ETR blockers as initial therapy; six patients were already taking sildenafil. Over more than 6 months of therapy, sequential measurements of 6-min walk distance increased significantly (baseline 357 +/- 22 to 398 +/- 18 m at 5-6 months, P < 0.05). Downward trends were observed for amino-terminal brain natriuretic peptide and tricuspid regurgitant velocity. Pulmonary artery mean pressures decreased in three patients that had repeat right heart catheterization (44-38 mmHg). Adverse events were: increased serum alanine aminotransferase (2), peripheral oedema (4), rash (1), headache (3), decreased haemoglobin (2). Therapy was stopped in two patients who were switched then to the other ETR blocker agent. These data suggest preliminary evidence for the benefit of bosentan and ambrisentan in pulmonary hypertension in SCD. PMID:19775299

  8. Drug attitude and adherence: a qualitative insight of patients with hypertension.

    PubMed

    Saleem, F; Hassali, Ma; Shafie, Aa; Atif, M

    2012-04-01

    The study is aimed to explore the perceptions and experiences of hypertensive patients toward medication use and adherence. The study was qualitative in nature conducted at Sandamen Provisional Hospital of Quetta city, Pakistan; a public hospital catering to the health needs of about 40% of the population. A qualitative approach was used to gain an in-depth knowledge of the issues. Sixteen patients were interviewed, and the saturation point was achieved after the 14(th) interview. All interviews were audio-taped, transcribed verbatim, and were then analyzed for thematic contents by the standard content analysis framework. Thematic content analysis yielded five major themes. (1) Perceived benefits and risks of medications, (2) physician's interaction with patients, (3) perception toward traditional remedies, (4) layman concept toward medications, and (5) beliefs toward hypertension and its control. The majority of the patients carried specific unrealistic beliefs regarding the long-term use of medication; yet these beliefs were heavily accepted and practiced by the society. The study indicated a number of key themes that can be used in changing the beliefs and experiences of hypertensive patients. Physician's attitude, patient's past experiences, and knowledge related to hypertension were noted as major contributing factors thus resulting in nonadherence to therapy prescribed. PMID:22754262

  9. Medication Adherence and the Occurrence of Complications in Patients with Newly Diagnosed Hypertension

    PubMed Central

    Kim, Hyun-Jin; Oh, In-Hwan; Lim, Jae Hee; Kim, Young Ae

    2016-01-01

    Background and Objectives In this retrospective cohort study, we sought to elucidate the relationship between medication adherence (MA) and the incidence of complications in patients with newly diagnosed hypertension. Subjects and Methods Using claims data from the National Health Insurance Service, we measured health outcomes based on levels of MA, analyzed the incidence of complications in patients with a good MA, and clarified factors that may affect or predict MA. Results In 2008, a total of 4294773 patients were diagnosed with hypertension and were subsequently prescribed anti-hypertensive medications. In the present study, we enrolled 564782 patients who met our inclusion/exclusion criteria. The 40-59% medication possession ratio (MPR) group had a 1.36 times higher risk of developing complications (95% confidence interval [CI]: 1.27-1.45) than did the MPR≥ 80% group, as revealed through Cox's proportional hazards analysis. Similarly, the <20% MPR group was 2.01 times more likely to develop complications than the good MA group (95% CI: 1.82-2.23). Overall, patients who had a lower level of MA had a higher risk of developing complications. Conclusion Our results demonstrate that MA is tightly correlated with hypertension health outcomes. Improving MA could be one strategy for reducing the risk of cerebrovascular disease complications and the loss of productivity in these patients. PMID:27275175

  10. Re-evaluation of Pre-pump Arterial Pressure to Avoid Inadequate Dialysis and Hemolysis: Importance of Prepump Arterial Pressure Monitoring in Hemodialysis Patients.

    PubMed

    Shibata, Eriko; Nagai, Kojiro; Takeuchi, Risa; Noda, Yasuhiro; Makino, Tomomi; Chikata, Yusuke; Hann, Michael; Yoshimoto, Sakiya; Ono, Hiroyuki; Ueda, Sayo; Tamaki, Masanori; Murakami, Taichi; Matsuura, Motokazu; Abe, Hideharu; Doi, Toshio

    2015-07-01

    Prepump arterial pressure (PreAP) is monitored to avoid generating excessive negative pressure. The National Kidney Foundation K/DOQI clinical practice guidelines for vascular access recommend that PreAP should not fall below -250 mm Hg because excessive negative PreAP can lead to a decrease in the delivery of blood flow, inadequate dialysis, and hemolysis. Nonetheless, these recommendations are consistently disregarded in clinical practice and pressure sensors are often removed from the dialysis circuit. Thus far, delivered blood flow has been reported to decrease at values more negative than -150 mm Hg of PreAP. These values have been analyzed by an ultrasonic flowmeter and not directly measured. Furthermore, no known group has evaluated whether PreAP-induced hemolysis occurs at a particular threshold. Therefore, the aim of this study was to clarify the importance of PreAP in the prediction of inadequate dialysis and hemolysis. By using different diameter needles, human blood samples from healthy volunteers were circulated in a closed dialysis circuit. The relationship between PreAP and delivered blood flow or PreAP and hemolysis was investigated. We also investigated the optimal value for PreAP using several empirical monitoring methods, such as a pressure pillow. Our investigation indicated that PreAP is a critical factor in the determination of delivered blood flow and hemolysis, both of which occured at pressure values more negative than -150 mm Hg. With the exception of direct pressure monitoring, commonly used monitoring methods for PreAP were determined to be ineffective. We propose that the use of a vacuum monitor would permit regular measurement of PreAP. PMID:25940509

  11. Association of Blood Lead level with Elevated Blood Pressure in Hypertensive Patients

    PubMed Central

    Alghasham, Abdullah A.; Meki, Abdel-Raheim M.A.; Ismail, Hisham A.S.

    2011-01-01

    Background: Lead is a metal with many important industrial uses. The relationship between lead exposure and the rise of blood pressure has received a great deal of attention as it was implicated that the mortality from cardiovascular diseases might be reduced by lowering lead levels in the environment. Objectives: The study was to investigate the correlation between the blood lead (B-Pb) levels and the values of blood pressure in hypertensive patients. Moreover, the plasma activities of angiotensin converting enzyme (ACE), plasma levels of nitric oxide (NO), total antioxidants (TAOX) and malondialdehyde (MDA) were estimated to investigate the correlations between the measured parameters and B-Pb levels in hypertensive patients. Methods: Fifty-five hypertensive patients were compared with fifty-three age and sex matched control group. The B-Pb levels were detected by flame atomic absorption spectrometry. The plasma levels of ACE activities, NO, TAOX and MDA were measured by colorimetric methods. Results: In the hypertensive patients, B-Pb levels were significantly higher than controls. Concomitantly, the plasma levels of ACE activities and MDA were significantly increased while the plasma levels of NO and TAOX were significantly reduced in the hypertensive patients in comparison with controls. There were significant positive correlations between B-Pb and each of MDA, and systolic as well as diastolic blood pressure. Conversely, a significant negative correlation was found between B-Pb and NO. Conclusions: Our study indicated that a positive relationship exists between blood pressure and B-Pb levels. The increased B-Pb levels were associated with oxidative stress. Moreover, The B-Pb level was negatively correlated with NO and this may clarify the implication of Pb as leading risk factor for the cardiovascular diseases and hypertension. These findings provide support for continued efforts to reduce lead concentration in the population at Qassim region. PMID:22489226

  12. Plasma Parathyroid Hormone Is Independently Related to Nocturnal Blood Pressure in Hypertensive Patients: The Styrian Hypertension Study.

    PubMed

    Verheyen, Nicolas D; Kienreich, Katharina; Gaksch, Martin; van Ballegooijen, Adriana J; Grübler, Martin R; Hartaigh, Briain Ó; Schmid, Johannes; Fahrleitner-Pammer, Astrid; Kraigher-Krainer, Elisabeth; Colantonio, Caterina; Belyavskiy, Evgeny; Treiber, Gerlies; Catena, Cristiana; Brussee, Helmut; Pieske, Burkert; März, Winfried; Tomaschitz, Andreas; Pilz, Stefan

    2016-06-01

    High parathyroid hormone (PTH) has been linked with high blood pressure (BP), but the relationship with 24-hour ambulatory blood pressure monitoring is largely unknown. The authors therefore analyzed cross-sectional data of 292 hypertensive patients participating in the Styrian Hypertension Study (mean age, 61±11 years; 53% women). Median plasma PTH (interquartile range) determined after an overnight fast was 49 pg/mL (39-61), mean daytime BP was 131/80±12/9 mm Hg, and mean nocturnal BP was 115/67±14/9 mm Hg. In multivariate regression analyses adjusted for BP and PTH-modifying parameters, PTH was significantly related to nocturnal systolic and diastolic BP (adjusted β-coefficient 0.140 [P=.03] and 0.175 [P<.01], respectively). PTH was not correlated with daytime BP readings. These data suggest a direct interrelationship between PTH and nocturnal BP regulation. Whether lowering high PTH concentrations reduces the burden of high nocturnal BP remains to be shown in future studies. PMID:26456544

  13. Pulmonary arterial hypertension in patients with sarcoidosis: the Pulsar single center experience.

    PubMed

    Pabst, Stefan; Hammerstingl, Christoph; Grau, Natalie; Kreuz, Jens; Grohe, Christian; Juergens, Uwe R; Nickenig, Georg; Skowasch, Dirk

    2013-01-01

    Sarcoidosis is a systemic granulomatous disease with unknown etiology. Lungs and lymph nodes are commonly affected. Also, cases of pulmonary hypertension (PH) and pulmonary arterial hypertension (PAH) are described. However, the exact prevalence of PAH in patients with sarcoidosis is unclear. A 111 patients with proven sarcoidosis were recruited from January 2010 to October 2010. All patients were studied prospectively by transthoracic echocardiography (TTE) for the presence of PH. In assumed PH, a right heart catheterization (RHC) followed if there were no other reasons for PH. In 23 of the 111 patients (21%) PH was assumed in TTE. Three patients presented with severe mitral insufficiency III° and IV°, in eight patients PH was supposed to be caused by chronic heart failure or relevant diastolic dysfunction > II°, two patients declined undergoing RHC. Of the ten patients investigated with RHC, four showed a precapillary pulmonary arterial hypertension and in one patient a postcapillary hypertension was diagnosed. All four patients with precapillary PH had a radiologic stage III and IV. In three of the four patients a significantly reduced transfer factor for carbon monoxide (TLCO) <50% was found. All patients with precapillary PH had a chronic course of sarcoidosis lasting ≥13 years. This is the first study which prospectively investigated a large cohort of patients with sarcoidosis for the prevalence of PH and PAH. The prevalence of precapillary PH was found to be at least 3.6% (4/111) and therefore exceeds the prevalence of PAH in the normal population by far. A chronic and progressive lung involvement due to sarcoidosis seems to be the most evident risk factor for developing a sarcoidosis PH. PMID:22826080

  14. Erythroid-Specific Transcriptional Changes in PBMCs from Pulmonary Hypertension Patients

    PubMed Central

    Cheadle, Chris; Berger, Alan E.; Mathai, Stephen C.; Grigoryev, Dmitry N.; Watkins, Tonya N.; Sugawara, Yumiko; Barkataki, Sangjucta; Fan, Jinshui; Boorgula, Meher; Hummers, Laura; Zaiman, Ari L.; Girgis, Reda; McDevitt, Michael A.; Johns, Roger A.; Wigley, Frederick; Barnes, Kathleen C.; Hassoun, Paul M.

    2012-01-01

    Background Gene expression profiling of peripheral blood mononuclear cells (PBMCs) is a powerful tool for the identification of surrogate markers involved in disease processes. The hypothesis tested in this study was that chronic exposure of PBMCs to a hypertensive environment in remodeled pulmonary vessels would be reflected by specific transcriptional changes in these cells. Methodology/Principal Findings The transcript profiles of PBMCs from 30 idiopathic pulmonary arterial hypertension patients (IPAH), 19 patients with systemic sclerosis without pulmonary hypertension (SSc), 42 scleroderma-associated pulmonary arterial hypertensio patients (SSc-PAH), and 8 patients with SSc complicated by interstitial lung disease and pulmonary hypertension (SSc-PH-ILD) were compared to the gene expression profiles of PBMCs from 41 healthy individuals. Multiple gene expression signatures were identified which could distinguish various disease groups from controls. One of these signatures, specific for erythrocyte maturation, is enriched specifically in patients with PH. This association was validated in multiple published datasets. The erythropoiesis signature was strongly correlated with hemodynamic measures of increasing disease severity in IPAH patients. No significant correlation of the same type was noted for SSc-PAH patients, this despite a clear signature enrichment within this group overall. These findings suggest an association of the erythropoiesis signature in PBMCs from patients with PH with a variable presentation among different subtypes of disease. Conclusions/Significance In PH, the expansion of immature red blood cell precursors may constitute a response to the increasingly hypoxic conditions prevalent in this syndrome. A correlation of this erythrocyte signature with more severe hypertension cases may provide an important biomarker of disease progression. PMID:22545094

  15. Management of older hypertensive patients: is there a difference in approach?

    PubMed

    Black, Henry R

    2003-01-01

    Hypertension is the most common reason Americans visit a physician. Recent analyses from the Framingham Heart Study and others have shown that there will be 70 million hypertensive Americans by the year 2020 and that the overwhelming majority of hypertensives will be 65 years of age or older (what we used to call elderly). The lifetime risk of Americans who live to age 85 years of becoming hypertensive is approximately 90% for both men and women. These individuals, even if they develop an elevated blood pressure late in life, are at significantly increased risk of the many medical complications attributable to hypertension (coronary artery disease, strokes, heart failure, chronic renal disease, and more). Older hypertensives are more likely to have an elevated systolic blood pressure and a low diastolic blood pressure, both of which are related to a loss of article compliance and have an increase in left ventricular mass and a decrease in peripheral resistance. We now have a substantial body of evidence from well done clinical trials that older hypertensives benefit as much or more than younger patients from antihypertensive therapy, so there is no longer any justification for withholding medication from any hypertensive patient whose competing risk or other medical problems are not a contraindication to treatment. These same studies, and practice-based analyses, have shown that the major barrier to reaching blood pressure goal is our failure to reduce systolic blood pressure to <140 mm Hg in most patients and to <130 mm Hg in diabetics and those with renal failure. The basis for all antihypertensive therapy, especially in older people, is thiazide diuretics with either angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta blockers, or calcium entry blockers as appropriate add-on treatment. The choice of the second agent depends on other factors, such as comorbidity, lifestyle, and affordability. We must be more aggressive in getting the

  16. Cost-Effectiveness of Therapeutic Drug Monitoring in Diagnosing Primary Aldosteronism in Patients With Resistant Hypertension.

    PubMed

    Velasco, Alejandro; Chung, Oliver; Raza, Fayez; Pandey, Ambarish; Brinker, Stephanie; Arbique, Debbie; Price, Angela; Lotan, Yair; Das, Sandeep R; Vongpatanasin, Wanpen

    2015-09-01

    Primary aldosteronism (PA) is present in up to 20% of patients with treatment-resistant hypertension (TRH). Investigation for PA in patients with TRH is recommended by current guidelines after medication nonadherence is excluded. Studies using therapeutic drug monitoring (TDM) have shown that >50% of patients with TRH are nonadherent to their prescribed antihypertensive medications. However, the relationship between the prevalence of PA and medication adherence as confirmed by TDM has not been previously assessed. A retrospective analysis from a hypertension referral clinic showed that prevalence of PA in adherent patients with TRH by TDM was significantly higher than in nonadherent patients (28% vs 8%, P<.05). Furthermore, cost analysis showed that TDM-guided PA screening was $590.69 less expensive per patient, with minimal impact on the diagnostic accuracy. These data support a TDM-guided PA screening approach as a cost-saving strategy compared with routine PA screening for TRH. PMID:25917401

  17. Treatment of hypertensive patients with diabetes: beyond blood pressure control and focus on manidipine.

    PubMed

    Saiz Satjes, Margarita; Martinez-Martin, Francisco J

    2016-07-01

    Renin-angiotensin system inhibitors should be considered as the first-line therapy in the treatment of patients with hypertension and diabetes. However, most of the diabetic subjects with hypertension require at least two drugs to achieve blood pressure targets. The ACCOMPLISH trial suggested that the best combination in the treatment of high-risk hypertensive patients should include a renin-angiotensin system inhibitor and a dihydropyridine. However, not all dihydropyridines block the same receptors. Those dihydropyridines that block T-type calcium channel blockers may provide additional advantages. A number of studies suggest that compared with amlodipine, manidipine have the same antihypertensive efficacy, but with a lesser risk of ankle edema. In addition, manidipine, but not amlodipine, significantly reduces urinary albumin excretion rates. PMID:27221471

  18. Microalbuminuria is related to marked end organ damage in previously untreated, elderly hypertensive patients.

    PubMed

    Terpstra, W F; May, J F; Smit, A J; de Graeff, P A; Crijns, H J G M

    2002-01-01

    We wondered whether, in an elderly hypertensive population in a primary prevention setting, free from diabetes mellitus and clinical atherosclerosis, differences between end organ damage and microalbuminuria (MA) could be found using a lower level of urinary albumin excretion than that of classically defined MA. From a population survey of 173 previously untreated hypertensive patients (4x blood pressure systolic > or = 160 and < or = 220 mmHg, and/or diastolic > or = 95 and < or = 115 mmHg), mean age 67 +/- 4 years, were screened for MA (defined as albumin excretion between 20 and 300 mg/24 h). End organ damage was determined by B-mode ultrasound scanning of carotid and femoral arteries and echocardiography. Out of 173 hypertensives, 14 showed MA (8%). These hypertensives had a significantly higher intima media thickness (IMT; 1.01 +/- 0.21 vs 0.88 +/- 0.6 mm, p < 0.05) and increased left ventricular mass index (118 +/- 31 vs 103 +/- 22 g/m2, p < 0.05) than hypertensives without MA. Linear regression analysis showed that MA, age, male gender and diastolic blood pressure were independently related to IMT, while systolic blood pressure, male gender and body mass index were independently related to left ventricular mass. Even using lower levels of urinary albumin excretion rate, patients with MA had significantly higher IMT and increased left ventricular mass. Moreover, MA was independently related to IMT in these elderly hypertensives. These results suggest that the threshold value for MA should be reconsidered in hypertension. PMID:12035876

  19. Influence of circadian blood pressure profile on endothelial function in patients with and without arterial hypertension.

    PubMed

    Rekhviashvili, A; Giorgobiani, T; Minashvili, A; Baganashvili, E

    2015-03-01

    Little is known about the relationship between the circadian BP rhythm and endothelial function in patients with essential hypertension. Consequently, we have hypothesized, that hypertensive patients with non-dipper circadian BP profile have more deteriorated endothelial function, than those with dipper BP profile. 57 untreated hypertensive patients and 17 normotensive controls were undergone to the anthropometrical measurements, physical examinations, review of their medical histories, 24-hour ABPM and vascular doppler-echography with high resolution ultrasound. Circadian BP profile was not independent from the BP level; namely, dipper profile was more frequent in normotensives. Independent from hypertension, dipper patients had significantly higher FMD%. In the whole study population, FMD showed strong negative correlation with 24-hour SBP, DBP and PP. Our study confirms the presence of disturbed endothelium-dependent vasodilatation in AH. Furthermore, our study showed that non-dipper circadian BP rhythm is associated with the significant impairment of endothelial function. Consequently, we can suggest that patients with non-dipper circadian BP profile could be assessed as a high risk group, which might need permanent supervising for avoiding of future cardiovascular and cerebrovascular complications. PMID:25879555

  20. Correlation between Left Ventricular Mass Index and Calcium Metabolism in Patients with Essential Hypertension

    PubMed Central

    Helvacı, Ayşen; Çopur, Besime; Adaş, Mine

    2013-01-01

    Objective: To determine the correlation between left ventricular mass index and calcium metabolism in patients with essential hypertension. Study Design: Cross sectional case-control study. Material and Methods: Twenty-seven patients with essential hypertension and 20 healthy individuals were compared with respect to calciotropic hormones, left ventricular mass index (LVMI), and urinary and serum biochemical parameters. The correlations between parathormone, vitamin D, and calcitonin levels and LVMI and blood pressure elevation were determined. Results: The parathormone level was significantly higher (p=0.006) and vitamin D level was significantly lower (p=0.01) in the patient group compared with the control group. However, the two groups were similar in terms of albumin-corrected calcium levels, which were within the normal range (p=0.988). The serum sodium (p=0.014) and urinary calcium (p=0.003) levels and LVMI (p<0.01) were also significantly higher in the patient group. No significant correlations were determined between ambulatory blood pressure and parathormone and vitamin D levels, but a significant correlation was found between LVMI and parathormone level (p=0.06) in hypertensive patients. Conclusion: Essential hypertension alters calcium metabolism, causing calciuresis by hypernatremia. Parathormone release increases to compensate for this, and leads to protein synthesis, which in turn provokes the development of myocardial hypertrophy. PMID:25207075

  1. Nocturnal oscillations in plasma renin activity during sleep in hypertensive patients: the influence of perindopril.

    PubMed

    Brandenberger, G; Imbs, J L; Libert, J P; Ehrhart, J; Simon, C; Santoni, J P; Follenius, M

    1990-01-01

    In previous studies, we established a strong concordance between nocturnal oscillations in plasma renin activity (PRA) and REM-NREM sleep cycles. To determine whether this relation persists in the case of moderate essential hypertension and if it is influenced by antihypertensive therapies affecting renin release, six normal subjects and six hypertensive patients were studied. The normal subjects underwent one control night. The hypertensive patients were studied during a first night when a placebo was given. Four of them underwent a second night following a single dose of an angiotensin-converting enzyme (ACE) inhibitor, perindopril; and a third night, 45 days later, with the antihypertensive treatment. In addition, two of the patients underwent two night-studies, after a single and repeated doses of a beta-blocker, atenolol, to see whether preventing renin release modified the sleep structure. The relationship between the nocturnal PRA oscillations and the sleep stage patterns persisted in hypertensive patients receiving placebo. In patients who had low PRA levels, the increases associated with NREM sleep were small. However, the mean relative amplitude of the oscillations, expressed as a percentage of the nocturnal mean, was about 60%, which was similar to that in normotensive subjects. Active renin and PRA oscillations were closely coupled. ACE activity profiles displayed damped fluctuations and no systematic relationship with sleep stages.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2172356

  2. Beta blocker effects on plasma homocysteine levels in patients with hypertension.

    PubMed

    Atar, Ilyas; Korkmaz, Mehmet Emin; Demircan, Senol; Atar, Inci Asli; Bozbaş, Hüseyin; Aydinalp, Alp; Ozin, Bülent; Yildirir, Aylin; Müderrisoğlu, Haldun

    2005-08-01

    Recent studies have shown that hyperhomocysteinemia might play a role in the pathogenesis of hypertension. The effects of antihypertensive agents on plasma homocysteine levels have not been tested extensively. We investigated the effects of beta-blocker therapy on homocysteine levels in patients with hypertension. In the study, 120 patients with newly diagnosed hypertension were enrolled. All patients received metoprolol succinate 100 mg/day initially. If blood pressure was above normal on the 15th day of follow-up, the metoprolol dosage was doubled. Before initiation of the antihypertensive medication and after the fourth month of treatment, homocysteine levels were measured. Of the 120 patients enrolled, 39 could not complete the study. Homocysteine levels decreased significantly by the end of the fourth month when compared with basal values (13.5+/-4.5 micromol/l versus 12.4+/-4.9 micromol/l; P = 0.001). There was no relation between homocysteine level and blood pressure control. There was a significant decrease in homocysteine levels in the women treated in this study (P = 0.001); however, this effect was absent in men (P = 0.185). We demonstrate that metoprolol succinate treatment significantly decreases plasma homocysteine levels in patients with hypertension, especially in women. PMID:16039296

  3. Perioperative management of patients with severe pulmonary hypertension in major orthopedic surgery: experience-based recommendations

    PubMed Central

    Seyfarth, Hans-Jürgen; Gille, Jochen; Sablotzki, Armin; Gerlach, Stefan; Malcharek, Michael; Gosse, Andreas; Gahr, Ralf H.; Czeslick, Elke

    2015-01-01

    Introduction: It is known that pulmonary hypertension is associated with worse outcome in both cardiac and non-cardiac surgery. The aims of our retrospective analysis were to evaluate the outcomes of our patients with pulmonary hypertension undergoing major orthopedic surgery and to give experience-based recommendations for the perioperative management. Material and methods: From 92 patients with pulmonary hypertension undergoing different kinds of surgical procedures from 2011–2014 in a tertiary academic hospital we evaluated 16 patients with major orthopedic surgery for perioperative morbidity and mortality. Results: Regarding the in-hospital morbidity and mortality, one patient died postoperatively due to pulmonary infection and right heart failure (6.25%) and 6 patients suffered significant postoperative complications (37.5%; bleeding = 1, infection = 1, wound healing deficits = 3; dysrhythmia = 1). Conclusion: Our data show that major orthopedic surgery is feasible with satisfactory outcome even in cases of severe pulmonary hypertension by an individualized, disease-adapted interdisciplinary treatment concept. PMID:26504732

  4. Early Vascular Aging in Normotensive Patients With Systemic Lupus Erythematosus: Comparison With Young Patients Having Hypertension.

    PubMed

    Morreale, Massimiliano; Mulè, Giuseppe; Ferrante, Angelo; D'ignoto, Francesco; Cottone, Santina

    2016-08-01

    Connective tissue diseases, like systemic lupus erythematosus (SLE), are associated with early and accelerated atherosclerosis. Recently, the concept of "early vascular aging" (EVA) has been more widely accepted. Aortic stiffness is one of the important markers of EVA. We evaluated EVA and subclinical atherosclerosis, by measuring aortic pulse wave velocity (aPWV) and carotid intima-media thickness (cIMT), in 50 normotensive patients with SLE (mean age: 39 ± 12 years). We compared these participants with 50 age- and sex-matched patients with essential hypertension (EH) and 20 healthy controls. Each participant underwent 24-hour ambulatory blood pressure monitoring (ABPM), aPWV, and cIMT measurements. Clinic and 24-hour ABPM values were significantly lower in patients with SLE and controls when compared with the participants having EH (all P < .0001), but aPWV and cIMT were significantly lower in the control group when compared with patients having SLE and EH (all P < .001). Overall, patients with SLE and EH had similar cIMT and aPWV values (P = .31 and P = .47, respectively). Our results suggest that SLE has a similar deleterious impact on EVA as EH. PMID:26535012

  5. Decreased pituitary response to insulin-induced hypoglycaemia in young lean male patients with essential hypertension.

    PubMed

    Radikova, Z; Penesova, A; Cizmarova, E; Huckova, M; Kvetnansky, R; Vigas, M; Koska, J

    2006-07-01

    Essential hypertension is associated with changes in central catecholaminergic pathways which might also be reflected in the pituitary response to stress stimuli. The aim of this study was to determine whether the response of pituitary hormones, cortisol, plasma renin activity, aldosterone and catecholamines to insulin-induced hypoglycaemia is changed in hypertension. We studied 22 young lean male patients with newly diagnosed untreated essential hypertension and 19 healthy normotensive, age- and body mass index (BMI)-matched controls. All subjects underwent an insulin tolerance test (0.1 IU insulin/kg body weight intravenously) with blood sampling before and 15, 30, 45, 60 and 90 min after insulin administration. Increased baseline levels of norepinephrine (P<0.05), increased response of norepinephrine (P<0.001) and decreased response of growth hormone (P<0.001), prolactin (P<0.001), adrenocorticotropic hormone (P<0.05) and cortisol (P<0.001) were found in hypertensive patients when compared to normotensive controls. Increased norepinephrine levels and a decreased pituitary response to metabolic stress stimuli may represent another manifestation of chronically increased sympathetic tone in early hypertension. PMID:16617309

  6. Utility of home blood pressure monitoring to evaluate postprandial blood pressure in treated hypertensive patients.

    PubMed

    Alfie, José

    2015-08-01

    Postprandial hypotension, defined as a fall in systolic blood pressure (SBP) of 20 mmHg or greater within 2 hours after a meal, is a risk factor for stroke, coronary events and mortality. The clinical suspicion is typically raised by episodes of postprandial syncope or falls, whereas asymptomatic postprandial hypotension is mostly neglected. The magnitude of the postprandial fall in SBP, as detected by 24-hour recording in apparently healthy middle-aged to elderly subjects, was proportional to the severity of the silent cerebrovascular damage. Postprandial hypotension can also be detected by self-measured blood pressure before and within 2 hours after meals using automatic devices. The review highlights the value of home blood pressure monitoring (HBPM) as a screening test for asymptomatic postprandial hypotension in hypertensive patients. Using a HBPM protocol that included duplicated blood pressure measurements before and after three consecutive lunches, we detected unsuspected postprandial hypotension in 27.4% of the 230 hypertensive patients screened. The prevalence of postprandial hypotension was 13.2% in controlled and 42.2% in uncontrolled hypertensive patients (p < 0.001), raising the dilemma of further lowering blood pressure in the setting of postprandial hypotension. The inclusion of preprandial and postprandial measurements in the protocol of HBPM is useful to identify hypertensive patients with postprandial hypotension and may guide adjustments in antihypertensive treatment according to postprandial blood pressure. PMID:26187907

  7. Five-Year Blood Pressure Control and Mortality Following Health Education for Hypertensive Patients.

    ERIC Educational Resources Information Center

    Morisky, Donald E.; And Others

    1983-01-01

    Three health education interventions for urban poor hypertensive patients were introduced in a randomized factorial design. Two-year data on compliance with therapy and five-year mortality data indicate the success of such educational programs in the long-term management and control of high blood pressure. (Author/GC)

  8. Catheter-based radiofrequency renal-nerve ablation in patients with resistant hypertension.

    PubMed

    Azizi, M; Steichen, O; Frank, M; Bobrie, G; Plouin, P-F; Sapoval, M

    2012-03-01

    This review aims to describe the role and the results of catheter-based renal nerve ablation for the treatment of resistant hypertension. Despite the availability of multiple classes of orally active antihypertensive treatments, resistant hypertension remains an important public health issue in 2012 due to its prevalence and association with target-organ damage and poor prognosis. The failure of purely pharmacological approaches to treat resistant hypertension has stimulated interest in invasive device-based treatments based on old concepts. In the absence of orally active antihypertensive agents, patients with severe and complicated hypertension were widely treated by surgical denervation of the kidney until the 1960s, but this approach was associated with a high incidence of severe adverse events and a high mortality rate. A new catheter system using radiofrequency energy has been developed, allowing an endovascular approach to renal denervation and providing patients with resistant hypertension with a new therapeutic option that is less invasive than surgery and can be performed rapidly under local anaesthesia. To date, this technique has been evaluated only in open-label trials including small numbers of highly selected resistant hypertensive patients with suitable renal artery anatomy. The available evidence suggests a favourable blood pressure-lowering effect in the short term (6 months) and a low incidence of immediate local and endovascular complications. This follow-up period is, however, too short for the detection of rare or late-onset adverse events. For the time being, the benefit/risk ratio of this technique remains to be evaluated, precluding its uncontrolled and widespread use in routine practice. PMID:22237510

  9. Clinical characteristics, treatment patterns and outcomes of Hispanic hypertensive patients.

    PubMed

    Campbell, Patrick T; Krim, Selim R; Lavie, Carl J; Ventura, Hector O

    2014-01-01

    Hispanics are the largest and fastest-growing minority population in the United States, currently comprising about 16.3% (52 million) of the total population. With an increased prevalence of metabolic risk factors in this population, the rate of uncontrolled hypertension (HTN) in Hispanics significantly exceeds the rates observed among non-Hispanic blacks and whites. Unfortunately, data on HTN in Hispanics remains limited due to the under-representation of Hispanics in clinical trials; with most of the data primarily restricted to observational and retrospective subgroup analyses. This article aims to review the available data on prevalence, awareness and control of HTN, risk factors and some of the challenges unique to the Hispanics population. We also discuss treatment strategies derived from large HTN trials that included Hispanics. PMID:25537632

  10. The platelet-to-lymphocyte ratio as an inflammation marker in non-dipper hypertensive patients

    PubMed Central

    Bayrakci, N; Ozkayar, N; Akyel, F; Ates, I; Akyel, S; Dede, F

    2015-01-01

    Background Non-dipper hypertensive patients have a higher risk of cardiovascular disease (CVD) than dipper hypertensive patients. Inflammation plays an important role in the pathogenesis and progression of CVD. This study aimed to determine the relationship between the platelet-to-lymphocyte ratio (PLR), and dipper and non-dipper hypertension. Materials and Methods This prospective study included 199 consecutive patients that were diagnosed with primary hypertension. According to ambulatory blood pressure monitoring measurements, non-dipper and dipper group were determined. PLR was determined based on the platelet count and lymphocyte count in the complete blood count. Results The non-dipper group included 103 patients (74 females and 29 males; mean age: 52.37 ± 10.7 years) and the dipper group included 96 patients (65 females and 31 males; mean age: 48.40 ± 11.1 years). Mean systolic blood pressure was significantly higher in the non-dipper group than in the dipper group (124 ± 15.1 mmHg versus 120 ± 11.2 mmHg, p =0.032) and the median PLR was significantly higher in the non-dipper group than in the dipper group [132.15 (range: 69.64-400) versus 117.0 (range: 53.52-192.26), p = 0.001], whereas the mean white blood cell count (6.86 ± 1.43 × 10³/ μL versus 7.24 ± 1.26 × 10³/μL, p =0.046) and median lymphocyte count [2.09 (range: 0.95-3.92)  × 10³/μL versus 2.24 (range: 0.97-3.98) × 10³/μL, p =0.001) were significantly lower in the non-dipper group. Conclusion Median PLR was significantly higher in the non-dipper hypertensive patients than in the dipper hypertensive patients. We think this finding further supports the role of an increase in inflammatory response in non-dipper hypertension. Hippokratia 2015; 19 (2):114-118.