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Sample records for adult hypertensive patients

  1. Secondary hypertension in adults

    PubMed Central

    Puar, Troy Hai Kiat; Mok, Yingjuan; Debajyoti, Roy; Khoo, Joan; How, Choon How; Ng, Alvin Kok Heong

    2016-01-01

    Secondary hypertension occurs in a significant proportion of adult patients (~10%). In young patients, renal causes (glomerulonephritis) and coarctation of the aorta should be considered. In older patients, primary aldosteronism, obstructive sleep apnoea and renal artery stenosis are more prevalent than previously thought. Primary aldosteronism can be screened by taking morning aldosterone and renin levels, and should be considered in patients with severe, resistant or hypokalaemia-associated hypertension. Symptoms of obstructive sleep apnoea should be sought. Worsening of renal function after starting an angiotensin-converting enzyme inhibitor suggests the possibility of renal artery stenosis. Recognition, diagnosis and treatment of secondary causes of hypertension lead to good clinical outcomes and the possible reversal of end-organ damage, in addition to blood pressure control. As most patients with hypertension are managed at the primary care level, it is important for primary care physicians to recognise these conditions and refer patients appropriately. PMID:27211205

  2. 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

  3. 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

  4. Hemodynamic Follow-Up in Adult Patients with Pulmonary Hypertension Associated with Atrial Septal Defect after Partial Closure

    PubMed Central

    Song, Jinyoung; Lee, Sang-Yun; Kang, I-Seok; Lee, Chang Ha; Lee, Cheul; Yang, Ji-Hyuk; Jun, Tae-Gook

    2016-01-01

    Purpose We evaluated the hemodynamic statuses of patients after partial closure of atrial septal defects with fenestration due to pulmonary hypertension. Materials and Methods Seventeen adult patients underwent partial atrial septal defect closure and follow-up cardiac catheterization. We analyzed hemodynamic data and clinical parameters before and after closure. Results The median age at closure was 29 years old. The baseline Qp/Qs was 1.9±0.6. The median interval from the operation to the cardiac catheterization was 27 months. The CT ratio decreased from 0.55±0.07 to 0.48±0.06 (p<0.05). The mean pulmonary arterial pressure decreased from 50.0±11.5 mm Hg to 32.5±14.4 mm Hg (p<0.05), and the pulmonary resistance index decreased from 9.2±3.6 Wood units*m2 to 6.3±3.8 Wood units*m2 (p<0.05). Eleven patients (64.7%) continued to exhibit high pulmonary resistance (over 3.0 Wood units*m2) after closure. These patients had significantly higher pulmonary resistance indices and mean pulmonary arterial pressures based on oxygen testing before the partial closures (p<0.05). However, no significant predictors of post-closure pulmonary hypertension were identified. Conclusion Despite improvement in symptoms and hemodynamics after partial closure of an atrial septal defect, pulmonary hypertension should be monitored carefully. PMID:26847280

  5. Gender Differences in Hypertension and Hypertension Awareness Among Young Adults

    PubMed Central

    EVERETT, BETHANY; ZAJACOVA, ANNA

    2016-01-01

    Previous research has shown that men have higher levels of hypertension and lower levels of hypertension awareness than women, but it remains unclear if these differences emerge among young adults. Using the National Longitudinal Study of Adolescent to Adult Health (Add Health), this study examines gender differences in hypertension and hypertension awareness among U.S. young adults, with special focus on factors that may contribute to observed disparities (N = 14,497). Our results show that the gender disparities in hypertension status were already evident among men and women in their twenties: women were far less likely to be hypertensive compared to men (12% vs. 27%). The results also reveal very low levels of hypertension awareness among young women (32% of hypertensive women were aware of their status) and even lower levels among men (25%). Finally, this study identifies key factors that contribute to these observed gender disparities. In particular, health care use, while not related to the actual hypertension status, fully explains the gender differences in hypertension awareness. The findings thus suggest that regular medical visits are critical for improving hypertension awareness among young adults and reducing gender disparities in cardiovascular health. PMID:25879259

  6. QT dispersion in adult hypertensives.

    PubMed Central

    Sani, Isa Muhammad; Solomon, Danbauchi Sulei; Imhogene, Oyati Albert; Ahmad, Alhassan Muhammad; Bala, Garko Sani

    2006-01-01

    Increased QT dispersion is associated with sudden cardiac death in congestive cardiac failure, hypertrophic cardiomyopathy and following myocardial infarction. Patients with hypertension--in particular, those with left ventricular hypertrophy (LVH)--are also at greater risk of sudden cardiac death. We examined whether QT dispersion, which is easily obtained from a routine ECG, correlates with LVH. One-hundred untreated patients with systemic hypertension and 78 normotensives had QT dispersion measured manually from a surface 12-lead electrocardiogram and two-dimensional echocardiography performed to measure interventricular septal thickness, posterior wall thickness and left ventricular internal diameter. Office blood pressure was also recorded. Multivariate analysis demonstrated significant relationships between QT dispersion and office systolic blood pressure, and left ventricular mass index. Manual measurement of QT dispersion might be a simple, noninvasive screening procedure to identify those hypertensives at greatest risk of sudden cardiac death in a third-world country. PMID:16623077

  7. [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

  8. 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

  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. Impact of Health Insurance Expansions on Nonelderly Adults With Hypertension

    PubMed Central

    Bruen, Brian K.; Lantz, Paula M.; Mendez, David

    2015-01-01

    Introduction Hypertension is a risk factor for cardiovascular disease (CVD), the leading cause of death in the United States. The treatment and control of hypertension is inadequate, especially among patients without health insurance coverage. The Affordable Care Act offered an opportunity to improve hypertension management by increasing the number of people covered by insurance. This study predicts the long-term effects of improved hypertension treatment rates due to insurance expansions on the prevalence and mortality rates of CVD of nonelderly Americans with hypertension. Methods We developed a state-transition model to simulate the lifetime health events of the population aged 25 to 64 years. We modeled the effects of insurance coverage expansions on the basis of published findings on the relationship between insurance coverage, use of antihypertensive medications, and CVD-related events and deaths. Results The model projected that currently anticipated health insurance expansions would lead to a 5.1% increase in treatment rate among hypertensive patients. Such an increase in treatment rate is estimated to lead to 111,000 fewer new coronary heart disease events, 63,000 fewer stroke events, and 95,000 fewer CVD-related deaths by 2050. The estimated benefits were slightly greater for men than for women and were greater among nonwhite populations. Conclusion Federal and state efforts to expand insurance coverage among nonelderly adults could yield significant health benefits in terms of CVD prevalence and mortality rates and narrow the racial/ethnic disparities in health outcomes for patients with hypertension. PMID:26133648

  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. 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

  13. Vesicoureteral Reflux, a Scarred kidney, and Minimal Proteinuria: An Unusual Cause of Adult Secondary Hypertension

    PubMed Central

    Sandal, Shaifali; Khanna, Apurv

    2011-01-01

    Hypertension affects about 65 million individuals in the United States. In adult patients, primary aldosteronism and renovascular causes are described as most prevalent. Vesicoureteral reflux as a cause of hypertension, while commonly described in pediatric populations, is less prevalent in the adult population especially in the absence of proteinuria. We present the case of a 31-year-old female presenting with early onset hypertension. Workup for renovascular hypertension was unrevealing. She was found to have right-sided vesicoureteral reflux with a unilateral scarred kidney. Patient underwent a nephrectomy with marked improvement in blood pressure control. PMID:22110521

  14. 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

  15. Risk factors for intra-abdominal hypertension and abdominal compartment syndrome among adult intensive care unit patients: a systematic review and meta-analysis

    PubMed Central

    2013-01-01

    Introduction Although intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are associated with substantial morbidity and mortality among critically ill adults, it remains unknown if prevention or treatment of these conditions improves patient outcomes. We sought to identify evidence-based risk factors for IAH and ACS in order to guide identification of the source population for future IAH/ACS treatment trials and to stratify patients into risk groups based on prognosis. Methods We searched electronic bibliographic databases (MEDLINE, EMBASE, PubMed, and the Cochrane Database from 1950 until January 21, 2013) and reference lists of included articles for observational studies reporting risk factors for IAH or ACS among adult ICU patients. Identified risk factors were summarized using formal narrative synthesis techniques alongside a random effects meta-analysis. Results Among 1,224 citations identified, 14 studies enrolling 2,500 patients were included. The 38 identified risk factors for IAH and 24 for ACS could be clustered into three themes and eight subthemes. Large volume crystalloid resuscitation, the respiratory status of the patient, and shock/hypotension were common risk factors for IAH and ACS that transcended across presenting patient populations. Risk factors with pooled evidence supporting an increased risk for IAH among mixed ICU patients included obesity (four studies; odds ratio (OR) 5.10; 95% confidence interval (CI), 1.92 to 13.58), sepsis (two studies; OR 2.38; 95% CI, 1.34 to 4.23), abdominal surgery (four studies; OR 1.93; 95% CI, 1.30 to 2.85), ileus (two studies; OR 2.05; 95% CI, 1.40 to 2.98), and large volume fluid resuscitation (two studies; OR 2.17; 95% CI, 1.30 to 3.63). Among trauma and surgical patients, large volume crystalloid resuscitation and markers of shock/hypotension and metabolic derangement/organ failure were risk factors for IAH and ACS while increased disease severity scores and elevated creatinine were

  16. Prevalence, Awareness, Treatment, and Control of Hypertension among Saudi Adult Population: A National Survey

    PubMed Central

    Saeed, Abdalla A.; Al-Hamdan, Nasser A.; Bahnassy, Ahmed A.; Abdalla, Abdelshakour M.; Abbas, Mostafa A. F.; Abuzaid, Lamiaa Z.

    2011-01-01

    This cross-sectional study aimed at estimating prevalence, awareness, treatment, control, and predictors of hypertension among Saudi adult population. Multistage stratified sampling was used to select 4758 adult participants. Three blood pressure measurements using an automatic sphygmomanometer, sociodemographics, and antihypertensive modalities were obtained. The overall prevalence of hypertension was 25.5%. Only 44.7% of hypertensives were aware, 71.8% of them received pharmacotherapy, and only 37.0% were controlled. Awareness was significantly associated with gender, age, geographical location, occupation, and comorbidity. Applying drug treatment was significantly more among older patients, but control was significantly higher among younger patients and patients with higher level of physical activity. Significant predictors of hypertension included male gender, urbanization, low education, low physical activity, obesity, diabetes, and hypercholesterolemia. In conclusion prevalence is high, but awareness, treatment, and control levels are low indicating a need to develop a national program for prevention, early detection, and control of hypertension. PMID:21912737

  17. HIV, antiretroviral treatment, hypertension, and stroke in Malawian adults

    PubMed Central

    Corbett, Elizabeth L.; Connor, Myles D.; Mzinganjira, Henry; Kampondeni, Sam; Choko, Augustine; Hopkins, Mark; Emsley, Hedley C.A.; Bryer, Alan; Faragher, Brian; Heyderman, Robert S.; Allain, Theresa J.; Solomon, Tom

    2016-01-01

    Objective: To investigate HIV, its treatment, and hypertension as stroke risk factors in Malawian adults. Methods: We performed a case-control study of 222 adults with acute stroke, confirmed by MRI in 86%, and 503 population controls, frequency-matched for age, sex, and place of residence, using Global Positioning System for random selection. Multivariate logistic regression models were used for case-control comparisons. Results: HIV infection (population attributable fraction [PAF] 15%) and hypertension (PAF 46%) were strongly linked to stroke. HIV was the predominant risk factor for young stroke (≤45 years), with a prevalence of 67% and an adjusted odds ratio (aOR) (95% confidence interval) of 5.57 (2.43–12.8) (PAF 42%). There was an increased risk of a stroke in patients with untreated HIV infection (aOR 4.48 [2.44–8.24], p < 0.001), but the highest risk was in the first 6 months after starting antiretroviral therapy (ART) (aOR 15.6 [4.21–46.6], p < 0.001); this group had a lower median CD4+ T-lymphocyte count (92 vs 375 cells/mm3, p = 0.004). In older participants (HIV prevalence 17%), HIV was associated with stroke, but with a lower PAF than hypertension (5% vs 68%). There was no interaction between HIV and hypertension on stroke risk. Conclusions: In a population with high HIV prevalence, where stroke incidence is increasing, we have shown that HIV is an important risk factor. Early ART use in immunosuppressed patients poses an additional and potentially treatable stroke risk. Immune reconstitution inflammatory syndrome may be contributing to the disease mechanisms. PMID:26683649

  18. 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.

  19. [Hypertension and primary glomerulonephritis in adults. A study of 302 cases].

    PubMed

    Seba, A; Rayane, T; Kaci, L; Haddoum, F; Benabadji, M

    1997-08-01

    The purpose of the present work was to show the place of hypertension in primary glomerulonephritis in adults. Hypertension was defined as diastolic blood pressure above 90 mmHg and renal insufficiency as serum creatinine above 135 mc mol/L. Secondary glomerulonephritis was excluded. The study was performed in 302 patients with primary glomerulonephritis biopsied between March 1994 and March 1996. They were 183 males and 119 females, aged from 16 to 63 years (mean: 29.8 years). The incidence of hypertension at the time of admission was 46.6%: 141/302 cases. The only consideration of prolonged hypertension (excluded transient hypertension of acute nephritic syndrome) shows an incidence of 31.4%: 95/302 cases (table). Frequency of hypertension (HT) in different types of primary glomerulonephritis (GN): [table: see text] The histological types observed in these cases of hypertension were represented essentially by the proliferative lesions: 73% (72/95 cases) who were grouped mainly in proliferative glomerulonephritis postinfectious and IgA nephropathy. No proliferative lesions: 24% (23/95 cases) were especially represented by focal segmental sclerosis. Renal insufficiency noted in 69 cases on 95 hypertensions was probably the result of the parallel evolution of hypertension renal lesions and those belonging to these histologic types. In conclusion, this study shows a narrow correlation between the hypertension and proliferative glomerulonephritis in our young adults population. PMID:9404432

  20. 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

  1. 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

  2. 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

  3. Adult congenital heart disease and pulmonary arterial hypertension: the Texas Adult Congenital Heart Program experience.

    PubMed

    Franklin, Wayne J; Parekh, Dhaval R; Safdar, Zeenat

    2011-11-01

    Congenital heart disease (CHD) is a common structural defect of the heart or major blood vessels. Patients with adult congenital heart disease (ACHD) have medical needs that are distinct from those of pediatric patients with CHD, and the transition into adult health care is important for management of the patient with ACHD. A large proportion of patients with CHD develop diseases and complications associated with the long-term stress of intracardiac shunts. Pulmonary arterial hypertension (PAH) is a significant complication of some CHD lesions. The treatment of these patients remains challenging due to their combined heart and lung disease, and multidisciplinary care is ofen necessitated for a variety of secondary conditions. A number of treatment options are available for the management of PAH associated with CHD, including prostanoids, phosphodiesterase type-5 inhibitors, and endothelin receptor antagonists. This article discusses the diagnosis and management of such ACHD patients with PAH. PMID:22104452

  4. [Vitamin D supply in adults with hypertension].

    PubMed

    Franczyk, Agata; Sadurska, Angelika; Stolarz-Skrzypek, Katarzyna; Czarnecka, Danuta

    2016-01-01

    The discovery of a receptor for vitamin D in most cells suggested a role in other body systems, not only the impact on the body's calcium economy. Epidemiological studies found that lower levels of cholecalciferol coexists with cardiovascular diseases. The aim of the study was to evaluate the factors influencing the serum concentration of vitamin in the population of the region of Cracow and to assess and compare the rate of consumption of food products rich in vitamin D in patients with hypertension and with normal blood pressure. In the studied population, the higher the age of the subjects, and the later the month of the year the sample was taken, the lower the vitamin D serum concentrations. Low body mass index and body fat were associated with higher levels of cholecalciferol. Additionally, deficiency of vitamin D was caused by insufficient supply of food products rich in cholecalciferol. PMID:27526422

  5. 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

  6. Review of isolated systolic hypertension in older adults.

    PubMed

    Kamath, Neetha; Cappuzzo, Kimberly A

    2010-06-01

    A 75-year-old patient comes to a community pharmacy to refill her blood pressure (BP) medications. She approached the pharmacist complaining of a headache and an unusually high BP reading that she had gotten from the automated machine. The patient was unaware of her usual BP, but knew that the reading was unusually high for her. Following evaluation of the patient and after obtaining several high systolic BP readings, the pharmacist appropriately calls for an ambulance. At the hospital, the patient is told she is in need of triple-bypass surgery. After her hospital stay, the patient is now diligent about refilling her BP medications on time and consistently monitors and records her BP at home. Isolated systolic hypertension is a growing concern in older adults, and a large percentage of adults are not appropriately managed. Pharmacists play an active role in educating patients on the importance of high BP monitoring and adherence to minimize the risk of cardiovascular events. PMID:20534408

  7. Patient Eye Examinations - Adults

    MedlinePlus

    ... Examinations, Adults Patient Eye Examinations, Children Refractive Errors Scientists in the Laboratory Visual Acuity Testing Patient Eye Examinations, Adults × Warning message Automatic fallback to the cURL connection method kicked in to handle the request. Result code ...

  8. [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

  9. Pediatric and adult vision restoration after optic nerve sheath decompression for idiopathic intracranial hypertension.

    PubMed

    Bersani, Thomas A; Meeker, Austin R; Sismanis, Dimitrios N; Carruth, Bryant P

    2016-06-01

    To compare presentations of idiopathic intracranial hypertension and efficacy of optic nerve sheath decompression between adult and pediatric patients, a retrospective cohort study was completed All idiopathic intracranial hypertension patients undergoing optic nerve sheath decompression by one surgeon between 1991 and 2012 were included. Pre-operative and post-operative visual fields, visual acuity, color vision, and optic nerve appearance were compared between adult and pediatric (<18 years) populations. Outcome measures included percentage of patients with complications or requiring subsequent interventions. Thirty-one adults (46 eyes) and eleven pediatric patients (18 eyes) underwent optic nerve sheath decompression for vision loss from idiopathic intracranial hypertension. Mean deviation on visual field, visual acuity, color vision, and optic nerve appearance significantly improved across all subjects. Pre-operative mean deviation was significantly worse in children compared to adults (p=0.043); there was no difference in mean deviation post-operatively (p=0.838). Significantly more pediatric eyes (6) presented with light perception only or no light perception than adult eyes (0) (p=0.001). Pre-operative color vision performance in children (19%) was significantly worse than in adults (46%) (p=0.026). Percentage of patients with complications or requiring subsequent interventions did not differ between groups. The consistent improvement after surgery and low rate of complications suggest optic nerve sheath decompression is safe and effective in managing vision loss due to adult and pediatric idiopathic intracranial hypertension. Given the advanced pre-operative visual deficits seen in children, one might consider a higher index of suspicion in diagnosing, and earlier surgical intervention in treating pediatric idiopathic intracranial hypertension. PMID:27163674

  10. [Hypertensive emergencies in adults: a practical review].

    PubMed

    Sosner, Philippe; Plouin, Pierre-François; Herpin, Daniel

    2010-10-01

    Hypertensive emergencies must be distinguished from severe blood pressure elevations without acute target organ damage. Clinical examination (chest pain, dyspnoea, neurological disorders, ECG, retinal examination) and laboratory tests (blood and urine tests, cerebral imaging in case of neurological disorders) have to be immediately performed. Immediate referral to an intensive care unit is indicated, and an intravenous antihypertensive therapy has to be implemented. Blood pressure objectives depend on the associated acute pathology (myocardial infarction, pulmonary oedema, aortic dissection, severe pre-eclampsia and eclampsia of pregnancy, hypertensive encephalopathy, retinopathy, subarachnoid hemorrhage, cerebral hemorrhage, ischemic stroke treated or not with thrombolysis). PMID:20547034

  11. Pulmonary arterial hypertension: a comparison between children and adults

    PubMed Central

    Barst, R.J.; Ertel, S.I.; Beghetti, M.; Ivy, D.D.

    2011-01-01

    The characteristics of pulmonary arterial hypertension (PAH), including pathology, symptoms, diagnosis and treatment are reviewed in children and adults. The histopathology seen in adults is also observed in children, although children have more medial hypertrophy at presentation. Both populations have vascular and endothelial dysfunction. Several unique disease states are present in children, as lung growth abnormalities contribute to pulmonary hypertension. Although both children and adults present at diagnosis with elevations in pulmonary vascular resistance and pulmonary artery pressure, children have less heart failure. Dyspnoea on exertion is the most frequent symptom in children and adults with PAH, but heart failure with oedema occurs more frequently in adults. However, in idiopathic PAH, syncope is more common in children. Haemodynamic assessment remains the gold standard for diagnosis, but the definition of vasoreactivity in adults may not apply to young children. Targeted PAH therapies approved for adults are associated with clinically meaningful effects in paediatric observational studies; children now survive as long as adults with current treatment guidelines. In conclusion, there are more similarities than differences in the characteristics of PAH in children and adults, resulting in guidelines recommending similar diagnostic and therapeutic algorithms in children (based on expert opinion) and adults (evidence-based). PMID:21357924

  12. 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

  13. 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

  14. Pharmacologic Therapy for Pulmonary Arterial Hypertension in Adults

    PubMed Central

    Taichman, Darren B.; Chung, Lorinda; Klinger, James R.; Lewis, Sandra; Mandel, Jess; Palevsky, Harold I.; Rich, Stuart; Sood, Namita; Rosenzweig, Erika B.; Trow, Terence K.; Yung, Rex; Elliott, C. Gregory; Badesch, David B.

    2014-01-01

    OBJECTIVE: Choices of pharmacologic therapies for pulmonary arterial hypertension (PAH) are ideally guided by high-level evidence. The objective of this guideline is to provide clinicians advice regarding pharmacologic therapy for adult patients with PAH as informed by available evidence. METHODS: This guideline was based on systematic reviews of English language evidence published between 1990 and November 2013, identified using the MEDLINE and Cochrane Library databases. The strength of available evidence was graded using the Grades of Recommendations, Assessment, Development, and Evaluation methodology. Guideline recommendations, or consensus statements when available evidence was insufficient to support recommendations, were developed using a modified Delphi technique to achieve consensus. RESULTS: Available evidence is limited in its ability to support high-level recommendations. Therefore, we drafted consensus statements to address many clinical questions regarding pharmacotherapy for patients with PAH. A total of 79 recommendations or consensus statements were adopted and graded. CONCLUSIONS: Clinical decisions regarding pharmacotherapy for PAH should be guided by high-level recommendations when sufficient evidence is available. Absent higher level evidence, consensus statements based upon available information must be used. Further studies are needed to address the gaps in available knowledge regarding optimal pharmacotherapy for PAH. PMID:24937180

  15. 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

  16. 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

  17. Discordance in National Estimates of Hypertension Among Young Adults

    PubMed Central

    Nguyen, Quynh C.; Tabor, Joyce W.; Entzel, Pamela P.; Lau, Yan; Suchindran, Chirayath; Hussey, Jon M.; Halpern, Carolyn T.; Harris, Kathleen Mullan; Whitsel, Eric A.

    2011-01-01

    Background In the U.S., where coronary heart disease (CHD) is the leading cause of mortality, CHD risk assessment is a priority and accurate blood pressure (BP) measurement is essential. Methods Hypertension estimates in the National Longitudinal Study of Adolescent Health (Add Health), Wave IV (2008)—a nationally-representative field study of 15,701 participants aged 24–32—was referenced against NHANES (2007–2008) participants of the same age. We examined discordances in hypertension, and estimated the accuracy and reliability of blood pressure in the Add Health study. Results Hypertension rates (BP ≥ 140/90 mm Hg) were higher in Add Health compared with NHANES (19% versus 4%), but self-reported history was similar (11% versus 9%) among adults aged 24–32. Survey weights and adjustments for differences in participant characteristics, examination time, use of anti-hypertensive medications, and consumption of food/caffeine/cigarettes before blood pressure measurement had little effect on between-study differences in hypertension estimates. Among Add Health participants interviewed and examined twice (full and abbreviated interviews), blood pressure was similar, as was blood pressure at the in-home and in-clinic exams conducted by NHANES III (1988–1994). In Add Health, there was minimal digit preference in blood pressure measurements; mean bias never exceeded 2 mm Hg; and reliability (estimated as intra-class correlation coefficients) was 0.81 and 0.68 for systolic and diastolic BPs, respectively. Conclusions The proportion of young adults in NHANES reporting a history of hypertension was twice that with measured hypertension, whereas the reverse was found in Add Health. Between-survey differences were not explained by digit preference, low validity, or reliability of Add Health blood pressure data, or by salient differences in participant selection, measurement context, or interview content. The prevalence of hypertension among Add Health Wave IV

  18. Association between fried food consumption and hypertension in Korean adults.

    PubMed

    Kang, Yunjin; Kim, Jihye

    2016-01-14

    The present study explored the relationships between fried food consumption and metabolic risk factors and hypertension in Korean adults. The study was based on the fifth Korean National Health and Nutrition Examination Survey between 2010 and 2011. A total of 9221 Korean adults aged ≥19 years were studied. Fried food consumption was assessed using a validated FFQ. Metabolic risk factors such as waist circumference, fasting plasma glucose (FPG), TAG, HDL-cholesterol and systolic and diastolic blood pressure (SBP and DBP) were measured. Hypertension was defined as SBP≥140 mmHg, DBP≥90 mmHg or current use of antihypertensive medication. Adjusted OR for elevated blood pressure significantly increased in men (OR 1·62; 95% CI 1·11, 2·37; P(trend)=0·0447) and women (OR 2·20; 95% CI 1·21, 4·00; P(trend)=0·0403) with a greater than twice a week consumption of fried food compared with those who rarely consumed fried food. However, fried food consumption was not associated with other metabolic risk factors (abdominal obesity, high FPG, hypertriacylglycerolaemia, low HDL-cholesterol and the metabolic syndrome). The adjusted OR for hypertension increased by 2·4-fold in women (OR 2·37; 95% CI 1·19, 4·72; P(trend)=0·0272) with a greater than twice a week fried food consumption compared with those who rarely consumed it. No significant association was found between fried food consumption and hypertension in men. This study suggests that frequent fried food consumption is associated with hypertension in Korean women. Further studies are needed to investigate the effect of different types of fried foods on hypertension. PMID:26449129

  19. Perinatal Resveratrol Supplementation to Spontaneously Hypertensive Rat Dams Mitigates the Development of Hypertension in Adult Offspring.

    PubMed

    Care, Alison S; Sung, Miranda M; Panahi, Sareh; Gragasin, Ferrante S; Dyck, Jason R B; Davidge, Sandra T; Bourque, Stephane L

    2016-05-01

    This study was undertaken to determine whether perinatal maternal resveratrol (Resv)-a phytoalexin known to confer cardiovascular protection-could prevent the development of hypertension and improve vascular function in adult spontaneously hypertensive rat offspring. Dams were fed either a control or Resv-supplemented diet (4 g/kg diet) from gestational day 0.5 until postnatal day 21. Indwelling catheters were used to assess blood pressure and vascular function in vivo; wire myography was used to assess vascular reactivity ex vivo. Perinatal Resv supplementation in dams had no effect on fetal body weights, albeit continued maternal treatment postnatally resulted in growth restriction in offspring by postnatal day 21; growth restriction was no longer evident after 5 weeks of age. Maternal perinatal Resv supplementation prevented the onset of hypertension in adult offspring (-18 mm Hg;P=0.007), and nitric oxide synthase inhibition (withl-NG-nitroarginine methyl ester) normalized these blood pressure differences, suggesting improved nitric oxide bioavailability underlies the hemodynamic alterations in the Resv-treated offspring. In vivo and ex vivo, vascular responses to methylcholine were not different between treatment groups, but prior treatment withl-NG-nitroarginine methyl ester attenuated the vasodilation in untreated, but not Resv-treated adult offspring, suggesting a shift toward nitric oxide-independent vascular control mechanisms in the treated group. Finally, bioconversion of the inactive precursor big endothelin-1 to active endothelin-1 in isolated mesenteric arteries was reduced in Resv-treated offspring (-28%;P<0.05), and this difference could be normalized byl-NG-nitroarginine methyl ester treatment. In conclusion, perinatal maternal Resv supplementation mitigated the development of hypertension and causes persistent alterations in vascular responsiveness in spontaneously hypertensive rats. PMID:26928803

  20. Prevalence and predictors of adult hypertension in Kabul, Afghanistan

    PubMed Central

    2014-01-01

    Background The prevalence of hypertension is rising worldwide with an estimated one billion people now affected globally and is of near epidemic proportions in many parts of South Asia. Recent turmoil has until recently precluded estimates in Afghanistan so we sought, therefore, to establish both prevalence predictors in our population. Methods We conducted a cross-sectional study of adults ≥40 years of age in Kabul from December 2011-March 2012 using a multistage sampling method. Additional data on socioeconomic and lifestyle factors were collected as well as an estimate of glycaemic control. Bivariate and multivariable analyses were undertaken to explore the association between hypertension and potential predictors. Results A total of 1183 adults (men 396, women 787) of ≥ 40years of age were assessed. The prevalence of hypertension was 46.2% (95% CI 43.5 – 49.3). Independent predictors of hypertension were found to be: age ≥50 (OR = 3.86, 95% CI: 2.86 – 5.21); illiteracy (OR = 1.90, 1.05 – 1.90); the consumption of rice >3 times per week (OR = 1.43, 1.07 – 1.91); family history of diabetes (OR = 2.20, 1.30 – 3.75); central obesity (OR = 1.67, 1.23 – 2.27); BMI ≥ 30 Kg/meter squared (OR = 2.08, 1.50 – 2.89). The consumption of chicken and fruit more than three times per week were protective with ORs respectively of 0.73 (0.55-0.97) and 0.64 (0.47 – 0.86). Conclusions Hypertension is a major public health problem in Afghan adults. We have identified a number of predictors which have potential for guiding interventions. PMID:24754870

  1. 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

  2. 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

  3. 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,…

  4. 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

  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. 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

  7. 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

  8. Correlation between hypertension and hyperglycemia among young adults in India

    PubMed Central

    Midha, Tanu; Krishna, Vinay; Shukla, Rishi; Katiyar, Praveen; Kaur, Samarjeet; Martolia, Dinesh Singh; Pandey, Umeshwar; Rao, Yashwant Kumar

    2015-01-01

    AIM: To assess the correlation between blood pressure levels and fasting plasma glucose levels among young adults attending Chatrapati Shahuji Maharaj University, Kanpur, India. METHODS: The present study was cross-sectional in nature, conducted among students in the Institute of Paramedical Sciences, Chatrapati Shahuji Maharaj University, Kanpur. Study subjects included 185 young adults. Among them, 94 were males and 91 were females, in the age group 17 to 19 years. RESULTS: Mean age among males was 18.5 ± 1.5 years and among females was 17.9 ± 1.8 years. Of the total 185 study subjects, 61 (32.9%) were classified as pre-diabetic and 20 (10.8%) as pre-hypertensive. Mean waist circumference, systolic blood pressure and serum high density lipoprotein did not vary significantly between normoglycemic and pre-diabetic subjects. However, the mean diastolic blood pressure of pre-diabetics (82 ± 5 mmHg) was significantly higher than normoglycemics (79 ± 6 mmHg). Mean serum cholesterol, serum triglycerides, serum low density lipoprotein (LDL) and serum very low density lipoprotein was also higher among pre-diabetic subjects in comparison to normoglycemic subjects and the difference was statistically significant. Upon multiple linear regression analysis, it was observed that body mass index (BMI) (β = 0.149), diastolic blood pressure (β = 0.375) and serum LDL (β = 0.483) were significantly associated with fasting plasma glucose. Multiple linear regression with diastolic blood pressure as the outcome variable showed that BMI (β = 0.219), fasting blood glucose (β = 0.247) and systolic blood pressure (β = 0.510) were significantly associated. CONCLUSION: A significant prevalence of pre-diabetes and pre-hypertension in young adults is a matter of concern therefore all young adults need to be targeted for screening of diabetes and hypertension and lifestyle modification. PMID:25685764

  9. 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

  10. 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

  11. 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

  12. Hyperhomocysteinemia predicts renal function decline: a prospective study in hypertensive adults.

    PubMed

    Xie, Di; Yuan, Yan; Guo, Jiangnan; Yang, Shenglin; Xu, Xin; Wang, Qin; Li, Youbao; Qin, Xianhui; Tang, Genfu; Huo, Yong; Deng, Guangpu; Wu, Shengjie; Wang, Binyan; Zhang, Qin; Wang, Xiaobin; Fang, Pu; Wang, Hong; Xu, Xiping; Hou, Fanfan

    2015-01-01

    Hyper-homocysteinemia (HHcy) is associated with microalbuminuria and glomerular injury in general and diabetic populations. However, HHcy's role in hypertensive patients was not studied. We investigated whether HHcy is an independent risk factor for renal function decline and development of chronic kidney disease (CKD) in hypertensive men and women. This was a community-based prospective cohort study of 2,387 hypertensive adults without CKD at baseline, with a mean follow-up of 4.4 years. Baseline and follow-up levels of plasma Hcy, folate, vitamin B12, blood pressure and other pertinent covariables were obtained. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/per 1.73 m(2) and an eGFR decline rate >1 ml/min/per 1.73 m(2)/year. There was a graded association between Hcy tertiles and eGFR decline. Subjects in the 3(rd) tertile of Hcy levels had an accelerated rate of eGFR decline and an increased risk of incident CKD, as compared with those in the 1st tertile, after adjusting for age, gender, baseline diabetes, SBP, BMI, smoking, dyslipidemia, eGFR, folate and vitamin B12 levels. In conclusion, in this prospective cohort of Chinese hypertensive adults, elevated baseline plasma Hcy can serve as an independent biomarker to predict renal function decline and incident CKD. PMID:26553372

  13. 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

  14. 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

  15. 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

  16. Prevalence of Hypertension in Adults with Intellectual Disability in the Netherlands

    ERIC Educational Resources Information Center

    van de Louw, Joyce; Vorstenbosch, R.; Vinck, L.; Penning, C.; Evenhuis, H.

    2009-01-01

    Background: Literature on the prevalence of hypertension in people with intellectual disability (ID) is mostly based on file studies or on measurements limited to the age group below 50 years. We measured and calculated the prevalence of hypertension in adults with ID and studied the distribution of hypertension in relation to age, gender,…

  17. Beta Testing of a Network-Based Health Literacy Program Tailored for Older Adults With Hypertension

    PubMed Central

    NEAFSEY, PATRICIA J.; ANDERSON, ELIZABETH; PEABODY, SHERI; LIN, CAROLYN A.; STRICKLER, ZOE; VAUGHN, KATHLEA

    2013-01-01

    A touch screen–enabled “Personal Education Program” was modified to the “next generation” to capture self-medication behaviors of older adults with hypertension and assess related knowledge and self-efficacy. The program analyzes patient-entered information and delivers interactive educational content tailored to the reported behaviors. Summaries of self-reported symptoms, medication use (including frequency/time), drug interactions, and corrective strategies with an illustration of the drug interaction are printed to inform the provider before the primary care visit and for the patient to take home for self-study. After formative research during development and formal diagnostic and verification usability studies with advanced practice nurses and older adults, a beta test was conducted with older adults with hypertension over a 3-month period. Findings from the beta test suggest that older adult user satisfaction was high. Blood pressure declined over the four visits for 82% of the participants. The next generation of the Personal Education Program had a large effect size in increasing knowledge and self-efficacy for avoiding adverse self-medication behaviors. Behavior risk score did not change significantly but was significantly correlated with systolic blood pressure on the fourth visit. The positive results found in this small sample suggest that the next generation of the Personal Education Program could play a central role in facilitating patient-provider communication and medication adherence. PMID:19047879

  18. Beta testing of a network-based health literacy program tailored for older adults with hypertension.

    PubMed

    Neafsey, Patricia J; Anderson, Elizabeth; Peabody, Sheri; Lin, Carolyn A; Strickler, Zoe; Vaughn, Kathlea

    2008-01-01

    A touch screen-enabled "Personal Education Program" was modified to the "next generation" to capture self-medication behaviors of older adults with hypertension and assess related knowledge and self-efficacy. The program analyzes patient-entered information and delivers interactive educational content tailored to the reported behaviors. Summaries of self-reported symptoms, medication use (including frequency/time), drug interactions, and corrective strategies with an illustration of the drug interaction are printed to inform the provider before the primary care visit and for the patient to take home for self-study. After formative research during development and formal diagnostic and verification usability studies with advanced practice nurses and older adults, a beta test was conducted with older adults with hypertension over a 3-month period. Findings from the beta test suggest that older adult user satisfaction was high. Blood pressure declined over the four visits for 82% of the participants. The next generation of the Personal Education Program had a large effect size in increasing knowledge and self-efficacy for avoiding adverse self-medication behaviors. Behavior risk score did not change significantly but was significantly correlated with systolic blood pressure on the fourth visit. The positive results found in this small sample suggest that the next generation of the Personal Education Program could play a central role in facilitating patient-provider communication and medication adherence. PMID:19047879

  19. Evaluation of a pilot hypertension management programme for Guatemalan adults.

    PubMed

    Mendoza Montano, Carlos; Fort, Meredith; deRamirez, Miriam; Cruz, Judith; Ramirez-Zea, Manuel

    2016-06-01

    Corazón Sano y Feliz is a hypertension management intervention developed to address deficiencies in the management of hypertensive patients in Guatemala. From 2007 to 2009, Corazón Sano y Feliz was pilot-tested in the community of Mixco. Corazón Sano y Feliz comprises a clinical risk assessment and treatment component implemented primarily by nurses, and a health education component implemented by community health workers. To accomplish our secondary objective of determining Corazon Sano y Feliz's potential for change at the patient level, we implemented a one-group pretest-posttest study design to examine changes in clinical measures, knowledge and practices between baseline and the end of the 6-month intervention. Two nurses and one physician set up a hypertension clinic to manage patients according to risk level. Twenty-nine community health workers were trained in CVD risk reduction and health promotion and in turn led six educational sessions for patients. Comparing baseline and 6-month measures, the intervention achieved significant improvements in mean knowledge and behaviour (increase from 54.6 to 59.1 out of a possible 70 points) and significant reductions of mean systolic and diastolic blood pressure (27.2 and 7.7 mmHg), body mass index (from 26.5 to 26.2 kg/m(2)) and waist circumference (89.6-88.9 cm). In this pilot study we obtained preliminary evidence that this community-oriented hypertension management and health promotion intervention model was feasible and achieved significant reduction in risk factors. If scaled up, this intervention has the potential to substantially reduce CVD burden. PMID:25595280

  20. [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

  1. Glucocorticoid-induced fetal origins of adult hypertension: Association with epigenetic events.

    PubMed

    Anwar, M Akhtar; Saleh, Alaaeldin I; Al Olabi, Reem; Al Shehabi, Tuqa S; Eid, Ali H

    2016-07-01

    Hypertension is a predominant risk factor for cardiovascular diseases and a major health care burden. Accumulating epidemiological and experimental evidence suggest that adult-onset hypertension may have its origins during early development. Upon exposure to glucocorticoids, the fetus develops hypertension, and the offspring may be programmed to continue the hypertensive trajectory into adulthood. Elevated oxidative stress and deranged nitric oxide system are not only hallmarks of adult hypertension but are also observed earlier in life. Endothelial dysfunction and remodeling of the vasculature, which are robustly associated with increased incidence of hypertension, are likely to have been pre-programmed during fetal life. Apparently, genomic, non-genomic, and epigenomic factors play a significant role in the development of hypertension, including glucocorticoid-driven effects on blood pressure. In this review, we discuss the involvement of the aforementioned participants in the pathophysiology of hypertension and suggest therapeutic opportunities for targeting epigenome modifiers, potentially for personalized medicine. PMID:26903240

  2. Correlates of Hypertension Among Adult Men and Women in Kosovo

    PubMed Central

    Hashani, Valdet; Roshi, Enver; Burazeri, Genc

    2014-01-01

    Aim: We aimed to assess the independent socioeconomic, behavioral and psychosocial correlates of hypertension among the adult population of Kosovo. Methods: This was a cross-sectional study carried out in Pristina in 2012-2013 which included a large representative sample of 1793 consecutive primary health care users aged ≥35 years (mean age: 51.2±6.7 years; 52.5% women; overall response: 95%). Systolic and diastolic blood pressure was measured, whereas demographic and socioeconomic characteristics (age, sex, marital status, place of residence, education, employment status and income), lifestyle factors (smoking, alcohol intake, physical exercise and dietary fat intake) and psychosocial factors (hostility and reaction to transition) were assessed through a structured questionnaire. Multivariable-adjusted binary logistic regression was used to assess the independent “predictors” of hypertension. Results: Upon simultaneous adjustment in a backward stepwise elimination procedure for all socioeconomic characteristics, lifestyle factors and psychosocial factors, significant positive correlates of hypertension were older age (OR=1.03, 95%CI=1.01-1.05), male gender (OR=1.41, 95%CI=1.19-1.58), a lower educational attainment (OR=1.36, 95%CI=1.08-1.67), smoking (OR=1.53, 95%CI=1.28-2.16), physical inactivity (OR=1.98, 95%CI=1.46-2.74) and hostility (OR=1.42, 95%CI=1.17-2.08). Conclusions: Findings from this study conducted in transitional Kosovo are generally in line with previous reports from the Western Balkan countries and beyond. Decision-makers and policymakers should be aware of the rising trend and socioeconomic, behavioral and psychosocial determinants of hypertension in post-war Kosovo. PMID:25126020

  3. 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

  4. Adherence to Antihypertensive Medication in Older Adults With Hypertension

    PubMed Central

    Lo, Suzanne H. S.; Chau, Janita P. C.; Woo, Jean; Thompson, David R.; Choi, Kai Chow

    2016-01-01

    Background/Objectives: Effective prevention of cardiovascular events in people with hypertension requires optimal control of blood pressure. Despite advances in management, poor adherence to antihypertensive medications is often reported as the major reason attenuating treatment efficacy. Research has provided limited evidence of associations between illness perceptions, satisfaction with consultations, and medication adherence. The aim of this study is to identify factors significantly associated with medication adherence in a group of Chinese older adults with essential hypertension. Design/Setting/Participants: A cross-sectional correlational study was conducted. Data were collected from 195 older adults (mean [SD] age, 76 [6.6] years) recruited from 12 community centers. Measurements: The Illness Perception Questionnaire–Revised was used to measure illness perceptions, and the Medical Interview Satisfaction Scale was used to measure satisfaction with individual consultations. The Morisky Medication Adherence Scale was used to measure the extent of adherence to antihypertensive medications. Multivariate logistic regression analysis was performed to examine factors, including illness perceptions, consultation satisfaction, and demographic and clinical characteristics, that were significantly associated with medication adherence. Results: More than half of the respondents (55.9%) acknowledged some degree of medication nonadherence. Older age, living alone, and perception related to treatment control were independently associated with increased odds of medication adherence, with odds ratios ranging from 1.14 to 1.92 (P < .05). Conclusion: The results highlight the importance of cultivating positive beliefs that hypertension is amenable to control by treatment. Furthermore, the adherence behavior of those of younger individuals and living with family should be closely monitored. PMID:25774846

  5. The Utility of Ambulatory Blood Pressure Monitoring for Diagnosing White Coat Hypertension in Older Adults.

    PubMed

    Reynolds, Kristi; Bowling, C Barrett; Sim, John J; Sridharan, Lakshmi; Harrison, Teresa N; Shimbo, Daichi

    2015-11-01

    The beneficial effect of antihypertensive medication on reducing the risk of cardiovascular disease (CVD) events is supported by data from randomized controlled trials of older adults with hypertension. However, in clinical practice, overtreatment of hypertension in older adults may lead to side effects and an increased risk of falls. The diagnosis and treatment of hypertension is primarily based on blood pressure measurements obtained in the clinic setting. Ambulatory blood pressure monitoring (ABPM) complements clinic blood pressure by measuring blood pressure in the out-of-clinic setting. ABPM can be used to identify white coat hypertension, defined as elevated clinic blood pressure and non-elevated ambulatory blood pressure. White coat hypertension is common in older adults but does not appear to be associated with an increased risk of CVD events among this population. Herein, we review the current literature on ABPM in the diagnoses of white coat hypertension in older adults, including its potential role in preventing overtreatment. PMID:26400076

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. Precursors of Hypertensive Heart Phenotype Develop in Healthy Adults

    PubMed Central

    de Marvao, Antonio; Dawes, Timothy J.W.; Shi, Wenzhe; Durighel, Giuliana; Rueckert, Daniel; Cook, Stuart A.; O’Regan, Declan P.

    2015-01-01

    Objectives This study used high-resolution 3-dimensional cardiac magnetic resonance to define the anatomical and functional left ventricular (LV) properties associated with increasing systolic blood pressure (SBP) in a drug-naïve cohort. Background LV hypertrophy and remodeling occur in response to hemodynamic stress but little is known about how these phenotypic changes are initiated in the general population. Methods In this study, 1,258 volunteers (54% women, mean age 40.6 ± 12.8 years) without self-reported cardiovascular disease underwent 3-dimensional cardiac magnetic resonance combined with computational modeling. The relationship between SBP and wall thickness (WT), relative WT, end-systolic wall stress (WS), and fractional wall thickening were analyzed using 3-dimensional regression models adjusted for body surface area, sex, race, age, and multiple testing. Significantly associated points in the LV model (p < 0.05) were identified and the relationship with SBP reported as mean β coefficients. Results There was a continuous relationship between SBP and asymmetric concentric hypertrophic adaptation of the septum and anterior wall that was associated with normalization of wall stress. In the lateral wall an increase in wall stress with rising SBP was not balanced by a commensurate hypertrophic relationship. In normotensives, SBP was positively associated with WT (β = 0.09) and relative WT (β = 0.07) in the septal and anterior walls, and this regional hypertrophic relationship was progressively stronger among pre-hypertensives (β = 0.10) and hypertensives (β = 0.30). Conclusions These findings show that the precursors of the hypertensive heart phenotype can be traced to healthy normotensive adults and that an independent and continuous relationship exists between adverse LV remodeling and SBP in a low-risk population. These adaptations show distinct regional variations with concentric hypertrophy of the septum and eccentric hypertrophy of the

  12. 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

  13. Relationship Between Dyslipidemia and Albuminuria in Hypertensive Adults

    PubMed Central

    Lee, Sung-Ho; Kim, Do Hoon; Kim, Yang-Hyun; Roh, Yong Kyun; Ju, Sang Yhun; Nam, Hyo-Yun; Nam, Ga-Eun; Choi, Jun-Seok; Lee, Jong-Eun; Sang, Jung-Eun; Han, Kyungdo; Park, Yong-Gyu

    2016-01-01

    Abstract This study aimed to estimate the relationship between various lipid abnormalities and albuminuria in hypertensive Korean adults. Data obtained from the Korea National Health and Nutrition Examination Survey in 2011 to 2012 were analyzed. The study included 2330 hypertensive participants. Total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels were measured. Dyslipidemia parameters were defined as high TG ≥200 mg/dL, low HDL-C as HDL-C <40 mg/dL, high TC/HDL-C as TC/HDL-C ratio ≥4, high TG/HDL-C as TG/HDL-C ratio ≥3.8, and high LDL-C/HDL-C as LDL-C/HDL-C ratio ≥2.5. Albuminuria was defined as a urine albumin to creatinine ratio (ACR) ≥30 mg/g. Women with albuminuria showed significantly higher levels of TG, TC/HDL-C, and TG/HDL-C and a lower level of HDL-C than women without albuminuria (all P < 0.05). LogTG, TC/HDL-C, and logTG/HDL-C were positively correlated with ACR in both men and women; however, HDL-C was negatively correlated with ACR in women and non-HDL-C was positively correlated with ACR in men. In men, there was no association between ACR and lipid parameters. However, in women, higher values for logTG, TC/HDL-C, and logTG/HDL-C were associated with an increased odds ratio (OR) for albuminuria (OR [95% confidence interval]: 1.53 [1.06–2.21], 1.21 [1.02–1.45], and 1.78 [1.21–2.63], respectively) and HDL-C with a decreased OR for albuminuria (0.78 [0.67–0.92]) after adjusting for all covariates. LogTG, TC/HDL-C, and logTG/HDL-C were associated with an increased prevalence of albuminuria in hypertensive women. Screening and treatment for dyslipidemia may be necessary for hypertensive women to address potential albuminuria. PMID:27100412

  14. Pulmonary Hypertension in Congenital Heart Disease: Beyond Eisenmenger Syndrome.

    PubMed

    Krieger, Eric V; Leary, Peter J; Opotowsky, Alexander R

    2015-11-01

    Patients with adult congenital heart disease have an increased risk of developing pulmonary hypertension. There are several mechanisms of pulmonary hypertension in patients with adult congenital heart disease, and understanding them requires a systematic approach to define the patient's hemodynamics and physiology. This article reviews the updated classification of pulmonary hypertension in patients with adult congenital heart disease with a focus on pathophysiology, diagnostics, and the evaluation of pulmonary hypertension in special adult congenital heart disease populations. PMID:26471823

  15. 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

  16. 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.

  17. 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

  18. 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

  19. Use of a telehealth system by older adults with hypertension

    PubMed Central

    Czaja, Sara J; Lee, Chin Chin; Arana, Neysari; Nair, Sankaran N; Sharit, Joseph

    2016-01-01

    We conducted a feasibility study of a home telehealth system that monitored blood pressure and bodyweight. A total of 34 participants with hypertension (10 males and 24 females) had the telemedicine system installed in their homes. Their mean age was 72 years and 94% of them self-identified as Hispanic. The telehealth system transmitted blood pressure and bodyweight data to a server. There was also a messaging function that was used to send a daily reminder to the participants. Participants used the telehealth system for six months. Ten participants were lost to follow up and 24 participants completed the entire study. Participants had strong positive perceptions regarding the usability and usefulness of the telemedicine system. Most of them (92%) found the device easy to use and 96% felt that the training they received prepared them to use the device. The providers indicated that use of the system improved their ability to manage their patients. The results of the study suggest that use of the telehealth system for home monitoring in Hispanic patients with hypertension is feasible. PMID:24803275

  20. 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

  1. 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

  2. Prevalence, Awareness, Treatment, Control and Risk Factors Associated with Hypertension among Adults in Southern China, 2013.

    PubMed

    Yang, Li; Yan, Jing; Tang, Xinhua; Xu, Xiaoling; Yu, Wei; Wu, Haibin

    2016-01-01

    To investigate the prevalence, awareness, treatment, control of hypertension and their associated factors in southern China. A cross-sectional survey was conducted in 5 cities of urban areas and 5 counties of rural areas in Southern China in 2013, a stratified multistage random sampling method was used to select a representative sample. Recruitment included a total of 19254 participants aged 15 or older. Socio-demographic profiles, examinations were administrated on each subject. Multilevel logistic regression models were used to identify the risk factors of hypertension, awareness, treatment, and control. Overall, the prevalence of hypertension and pre-hypertension are 24.59% and 32.11%, respectively in southern China. Among all the hypertensive patients, 67.43% were aware of their condition, 55.76% took anti-hypertension medication recent two weeks, and 30.79% had their blood pressure controlled. Compared with male, female hypertensive patients had higher rates of hypertension awareness, treatment and control. Age, gender, marital status, living areas, education, BMI, waist circumference, visceral adipose index (VAI), high body fat percentage (BFP) and family hypertension history correlated with the prevalence of hypertension. SBP/DBP increased with VAI and BFP increasing. There is an increasing prevalence of hypertension and high pre-hypertension in the general population in southern China, but levels of awareness, treatment, and control remain relatively low, especially for young and middle-aged population. Innovative strategies including of adopting appropriate anti-hypertensive medication therapy and healthy lifestyles should be taken. PMID:26784948

  3. Prevalence, Awareness, Treatment, Control and Risk Factors Associated with Hypertension among Adults in Southern China, 2013

    PubMed Central

    Tang, Xinhua; Xu, Xiaoling; Yu, Wei; Wu, Haibin

    2016-01-01

    To investigate the prevalence, awareness, treatment, control of hypertension and their associated factors in southern China. A cross-sectional survey was conducted in 5 cities of urban areas and 5 counties of rural areas in Southern China in 2013, a stratified multistage random sampling method was used to select a representative sample. Recruitment included a total of 19254 participants aged 15 or older. Socio-demographic profiles, examinations were administrated on each subject. Multilevel logistic regression models were used to identify the risk factors of hypertension, awareness, treatment, and control. Overall, the prevalence of hypertension and pre-hypertension are 24.59% and 32.11%, respectively in southern China. Among all the hypertensive patients, 67.43% were aware of their condition, 55.76% took anti-hypertension medication recent two weeks, and 30.79% had their blood pressure controlled. Compared with male, female hypertensive patients had higher rates of hypertension awareness, treatment and control. Age, gender, marital status, living areas, education, BMI, waist circumference, visceral adipose index (VAI), high body fat percentage (BFP) and family hypertension history correlated with the prevalence of hypertension. SBP/DBP increased with VAI and BFP increasing. There is an increasing prevalence of hypertension and high pre-hypertension in the general population in southern China, but levels of awareness, treatment, and control remain relatively low, especially for young and middle-aged population. Innovative strategies including of adopting appropriate anti-hypertensive medication therapy and healthy lifestyles should be taken. PMID:26784948

  4. 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

  5. The relationships between lifestyle factors and hypertension in community-dwelling Korean adults

    PubMed Central

    Kim, Ill-Gwang; So, Wi-Young; Sung, Dong Jun

    2015-01-01

    [Purpose] This study was performed to determine whether certain lifestyle factors are associated with hypertension in community-dwelling Korean adults. [Subjects and Methods] The subjects were 586 males and 1,135 females > 20 years old who had visited a public health promotion center in Seoul, Republic of Korea to take a survey related to lifestyle factors. Hypertension status was defined according to the criteria of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure VII report. [Results] The relationships between lifestyle factors and hypertension status were assessed using multivariate logistic regression analysis after adjusting for age and gender. Only mental stress and economic status significantly predicted hypertension status. [Conclusion] We conclude that sleep duration, education level, frequency of drinking and smoking status were not associated with hypertension status. However, economic status and mental stress were significantly associated with hypertension in community-dwelling Korean adults, regardless of age or gender. PMID:26834333

  6. The relationships between lifestyle factors and hypertension in community-dwelling Korean adults.

    PubMed

    Kim, Ill-Gwang; So, Wi-Young; Sung, Dong Jun

    2015-12-01

    [Purpose] This study was performed to determine whether certain lifestyle factors are associated with hypertension in community-dwelling Korean adults. [Subjects and Methods] The subjects were 586 males and 1,135 females > 20 years old who had visited a public health promotion center in Seoul, Republic of Korea to take a survey related to lifestyle factors. Hypertension status was defined according to the criteria of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure VII report. [Results] The relationships between lifestyle factors and hypertension status were assessed using multivariate logistic regression analysis after adjusting for age and gender. Only mental stress and economic status significantly predicted hypertension status. [Conclusion] We conclude that sleep duration, education level, frequency of drinking and smoking status were not associated with hypertension status. However, economic status and mental stress were significantly associated with hypertension in community-dwelling Korean adults, regardless of age or gender. PMID:26834333

  7. 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

  8. [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

  9. Prevalence and predictors of adult hypertension in an urban eastern Indian population

    PubMed Central

    Prasad, D S; Kabir, Zubair; Dash, Ashok K; Das, B C

    2012-01-01

    Objective To determine the prevalence of hypertension and to identify predictors of adult hypertension specifically in an underdeveloped urban region of eastern India. Study design Population-based cross-sectional study, with multi-stage random sampling technique. Settings A main urban city located in South Orissa in eastern India. Participants 1178 adults 20–80 years of age randomly selected from 37 electoral wards of an urban locale. Statistical methods Descriptive and multivariable logistic regression analyses. Results The prevalence of hypertension was 36%. Significant predictors of hypertension were age, central obesity, inadequate fruit intake, diabetes, low high-density lipoprotein level and physical inactivity. Conclusions One-third of the adults in this urban population of eastern India are reported to be hypertensive and the classical risk factors have been found to contribute to the increased burden, which reinforces the importance of preventive cardiovascular interventions in tackling this burden.

  10. [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

  11. 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

  12. 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.

  13. Trends in Hypertension Prevalence, Awareness, Treatment and Control in an Adult Type 2 Diabetes Spanish Population between 2003 and 2009

    PubMed Central

    de Burgos-Lunar, Carmen; Jiménez-García, Rodrigo; Salinero-Fort, Miguel A.; Gómez-Campelo, Paloma; Gil, Ángel; Abánades-Herranz, Juan C.; Cárdenas-Valladolid, Juan; del Cura-González, Isabel

    2014-01-01

    In patients with type 2 diabetes, the prevalence of hypertension is higher than in non-diabetic subjects. Despite the high cardiovascular risk involving hypertension in these patients, its prevalence and control are not well known. The aims of this study were: to estimate the hypertension prevalence, awareness, treatment and control in Spanish adults with type 2 diabetes attended in Primary Care; and to analyse its time trend from 2003 to 2009. A serial cross-sectional study from 2003 to 2009 was performed in 21 Primary Care Centres in Madrid. The study population comprised all patients with diagnosed type 2 diabetes in their computerised medical history. Overall annual prevalence during the period 2003–2009 was calculated from and according to sex and age groups. Linear trend tests, regression lines and coefficients of determination were used. In 2003 89.78% (CI 87.92–91.64) of patients with type 2 diabetes suffered hypertension and 94.76% (CI: 92.85–96.67) in 2009. This percentage was greater for women and for patients over 65 years old. 30% of patients suffered previously undiagnosed hypertension in 2003 and 23.1% in 2009. 97% of diagnosed patients received pharmacological treatment and 28.79% reached the blood pressure objective in 2009. The average number of antihypertensive drugs taken was 2.72 in 2003 and 3.27 in 2009. Only 5.2% of patients with type 2 diabetes show blood pressure levels below 130/80 mmHg. Although significant improvements have been achieved in the diagnosis and control of hypertension in people with type 2 diabetes, these continue to remain far from optimum. PMID:24475171

  14. Hypertension in Adult Survivors of Child Abuse: Observations from the Nurses’ Health Study II

    PubMed Central

    Riley, EH; Wright, RJ; Jun, HJ; Hibert, EN; Rich-Edwards, JW

    2013-01-01

    Background Limited research has shown a possible association between exposure to physical or sexual abuse prior to age 18 and the risk of developing hypertension as an adult. The factors mediating this relationship are unknown. Methods We analyzed questionnaire data from 68 505 female participants in the Nurses’ Health Study II regarding exposure to physical and sexual abuse prior to age 18. Cox proportional hazards regression was used to assess the relationship between abuse exposure and hypertension. Results Sixty-four percent of the participants (n = 41 792) reported physical and/or sexual abuse prior to age 18; 17% reported hypertension. All forms of abuse had a dose-response relationship with hypertension. Adjustments for smoking, alcohol, family history of hypertension, exercise, and oral contraceptives did not alter risk estimates. Adjustment for body mass index (BMI) significantly attenuated the associations between abuse and risk of hypertension and accounted for approximately 50% of the observed association between abuse exposure and hypertension. Women experiencing forced sexual activity as a child and as an adolescent had a 20% increased risk for developing hypertension (95% CI 8–32%) that was independent of BMI. Similarly, women reporting severe physical abuse in childhood and/or adolescence had risk estimates ranging from 14% (95% CI 5–24%) to 22% (95% CI 11–33%). Conclusion Early interpersonal violence may be a widespread risk factor for the development of hypertension in women. BMI is a significant mediator in the relationship between early abuse and adult hypertension. PMID:20445210

  15. 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

  16. 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

  17. 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

  18. [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

  19. Percentage of Adults with High Blood Pressure Whose Hypertension Is Adequately Controlled

    MedlinePlus

    ... is Adequately Controlled Percentage of Adults with High Blood Pressure Whose Hypertension is Adequately Controlled Heart disease ... Survey. Age Group Percentage of People with High Blood Pressure that is Controlled by Age Group f94q- ...

  20. An Analysis of Adult Obesity and Hypertension in Appalachia

    PubMed Central

    Herath, Janaranjana; Brown, Cheryl

    2013-01-01

    Obesity is a major health problem in the United States, and the burden associated is high. Hypertension seems to be the most common obesity-related health problem. Studies show that hypertension is approximately twice as prevalent among the obese as in the non-obese population. This study has two main objectives. First, to examine the association between obesity and hypertension within the context of economic growth in Appalachia, and second to estimate the cost of hypertension linked to obesity in Appalachia. The study uses simultaneous equations and Logit analysis for estimations. Data are from Behavior Risk Factor Surveillance Systems (BRFSS) surveys of 2001 and 2009. Results for simultaneous analysis show that hypertension decreases with decreasing obesity, increasing employment growth, and increasing income. Logit analysis highlights the importance of controlling obesity, income growth, employment growth, education, and exercises in mitigating hypertension in Appalachia. Ageing indicates a high potential of getting hypertension. Total economic cost of hypertension linked to obesity is $9.35 billion, significantly a high cost to Appalachia. Overall, results reveal the impacts of obesity on hypertension and some possible ways of mitigation. Thus, results suggest a comprehensive set of policies to Appalachia which sufficiently improve employment opportunities, educational facilities, and healthcare facilities with adequately addressed to obesity and hypertension. PMID:23618482

  1. Ambulatory Blood Pressure Monitoring (ABPM) as the reference standard for diagnosis of hypertension and assessment of vascular risk in adults.

    PubMed

    Hermida, Ramón C; Smolensky, Michael H; Ayala, Diana E; Portaluppi, Francesco

    2015-01-01

    New information has become available since the ISC, AAMCC, and SECAC released their first extensive guidedelines to improve the diagnosis and treatment of adult arterial hypertension. A critical assessment of evidence and a comparison of what international guidelines now propose are the basis for the following statements, which update the recommendations first issued in 2013. Office blood pressure (BP) measurements should no longer be considered to be the "gold standard" for the diagnosis of hypertension and assessment of cardiovascular risk. Relying on office BP, even when supplemented with at-home wake-time self-measurements, to identify high-risk individuals, disregarding circadian BP patterning and asleep BP level, leads to potential misclassification of 50% of all evaluated persons. Accordingly, ambulatory BP monitoring is the recommended reference standard for the diagnosis of true hypertension and accurate assessment of cardiovascular risk in all adults ≥18 yrs of age, regardless of whether office BP is normal or elevated. Asleep systolic BP mean is the most significant independent predictor of cardiovascular events. The sleep-time relative SBP decline adds prognostic value to the statistical model that already includes the asleep systolic BP mean and corrected for relevant confounding variables. Accordingly, the asleep systolic BP mean is the recommended protocol to diagnose hypertension, assess cardiovascular risk, and predict cardiovascular event-free interval. In men, and in the absence of compelling clinical conditions, reference thresholds for diagnosing hypertension are 120/70 mmHg for the asleep systolic/diastolic BP means derived from ambulatory BP monitoring. However, in women, in the absence of complicating co-morbidities, the same thresholds are lower by 10/5 mmHg, i.e., 110/65 mmHg for the asleep means. In high-risk patients, including those diagnosed with diabetes or chronic kidney disease, and/or those having experienced past

  2. Guideline for the diagnosis and management of hypertension in adults - 2016.

    PubMed

    Gabb, Genevieve M; Mangoni, Arduino A; Anderson, Craig S; Cowley, Diane; Dowden, John S; Golledge, Jonathan; Hankey, Graeme J; Howes, Faline S; Leckie, Les; Perkovic, Vlado; Schlaich, Markus; Zwar, Nicholas A; Medley, Tanya L; Arnolda, Leonard

    2016-07-18

    The National Heart Foundation of Australia has updated the Guide to management of hypertension 2008: assessing and managing raised blood pressure in adults (updated December 2010). Main recommendations For patients at low absolute cardiovascular disease risk with persistent blood pressure (BP) ≥ 160/100 mmHg, start antihypertensive therapy. The decision to treat at lower BP levels should consider absolute cardiovascular disease risk and/or evidence of end-organ damage, together with accurate BP assessment. For patients at moderate absolute cardiovascular disease risk with persistent systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg, start antihypertensive therapy. Treat patients with uncomplicated hypertension to a target BP of < 140/90 mmHg or lower if tolerated. Changes in management as a result of the guideline Ambulatory and/or home BP monitoring should be offered if clinic BP is ≥ 140/90 mmHg, as out-of-clinic BP is a stronger predictor of outcome. In selected high cardiovascular risk populations, aiming for a target of < 120 mmHg systolic can improve cardiovascular outcomes. If targeting < 120 mmHg, close follow-up is recommended to identify treatment-related adverse effects including hypotension, syncope, electrolyte abnormalities and acute kidney injury. Why the changes have been made A 2015 meta-analysis of patients with uncomplicated mild hypertension (systolic BP range, 140-169 mmHg) demonstrated that BP-lowering therapy is beneficial (reduced stroke, cardiovascular death and all-cause mortality). A 2015 trial comparing lower with higher blood pressure targets in selected high cardiovascular risk populations found improved cardiovascular outcomes and reduced mortality, with an increase in some treatment-related adverse events. PMID:27456450

  3. 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

  4. Arterial Hypertension and other risk factors associated with cardiovascular diseases among adults1

    PubMed Central

    Radovanovic, Cremilde Aparecida Trindade; dos Santos, Lucimary Afonso; Carvalho, Maria Dalva de Barros; Marcon, Sonia Silva

    2014-01-01

    OBJECTIVE: to identify the prevalence of arterial hypertension and its association with cardiovascular risk factors among adults. METHOD: cross-sectional, population-based, descriptive study conducted with 408 adult individuals. Data were collected through a questionnaire and measurements of weight, height and waist circumference. Person's Chi-square and multiple logistic regression were used in the data analysis. RESULTS: 23.03% of the individuals reported hypertension with a higher prevalence among women. Odds Ratio indicated that smoking, body mass index, waist circumference, diabetes mellitus and dyslipidemia were positively associated with arterial hypertension. CONCLUSION: high self-reported hypertension and its association with other cardiovascular risk factors such as diabetes, obesity and dyslipidemia show the need for specific nursing interventions and the implementation of protocols focused on minimizing complications arising from hypertension, as well as to prevent the emergence of other cardiovascular diseases. PMID:25296137

  5. The audiological profile of adults with and without hypertension

    PubMed Central

    Soares, Mariana Aparecida; Sanches, Seisse Gabriela Gandolfi; Matas, Carla Gentile; Samelli, Alessandra Giannella

    2016-01-01

    OBJECTIVE: To determine whether there is any influence of systemic arterial hypertension on the peripheral auditory system. METHODS: This was a cross-sectional study that investigated 40 individuals between 30 and 50 years old, who were divided into groups with and without systemic arterial hypertension, using data from high-frequency audiometry, transient-evoked otoacoustic emissions and distortion-product otoacoustic emissions. The results were compared with those from groups of normal-hearing individuals, with and without systemic arterial hypertension, who underwent the pure-tone audiometry test. All individuals also underwent the following procedures: otoscopy, acoustic immittance measures, pure-tone audiometry at frequencies from 250 to 16000 Hz, transient-evoked otoacoustic emissions test and distortion-product otoacoustic emissions test. RESULTS: No statistically significant difference was observed between the groups with and without systemic arterial hypertension in either conventional or high-frequency audiometry. Regarding transient-evoked otoacoustic emissions, there was a trend toward statistical significance whereby the systemic arterial hypertension group showed lower results. Regarding distortion-product otoacoustic emissions, the systemic arterial hypertension group showed significantly lower results at the following frequencies: 1501, 2002, and 3003 Hz. A discriminant analysis indicated that the distortion-product otoacoustic emissions variables best distinguished individuals with and without systemic arterial hypertension. CONCLUSION: Data from this study suggest cochlear dysfunction in individuals with systemic arterial hypertension because their otoacoustic emission results were lower than those in the systemic arterial hypertension group. PMID:27166767

  6. Rapid onset pressor and sympathetic responses to static handgrip in older hypertensive adults.

    PubMed

    Greaney, J L; Edwards, D G; Fadel, P J; Farquhar, W B

    2015-07-01

    Exaggerated pressor and muscle sympathetic nerve activity (MSNA) responses have been reported during static handgrip in hypertensive (HTN) adults. Recent work suggests that such responses may occur much more rapidly in HTN patients; however, this has not been extensively studied. Thus, we examined the blood pressure (BP) and MSNA responses at the immediate onset of muscle contraction and tested the hypothesis that older HTN adults would exhibit rapid onset pressor and sympathetic responses compared with normotensive (NTN) adults. Heart rate (HR), BP (Finometer) and MSNA (peroneal microneurography) were retrospectively analyzed in 15 HTN (62 ± 1 years; resting BP 153 ± 3/91 ± 5 mm Hg) and 23 age-matched NTN (60 ± 1 years; resting BP 112 ± 1/67 ± 2 mm Hg) subjects during the first 30 s of static handgrip at 30 and 40% of maximal voluntary contraction (MVC). HTN adults demonstrated exaggerated increases in mean BP during the first 10 s of both 30% (NTN: Δ1 ± 1 vs HTN: Δ7 ± 2 mm Hg; P < 0.05) and 40% (NTN: Δ2 ± 1 vs HTN: Δ8 ± 2 mm Hg; P < 0.05) intensity handgrip. Likewise, HTN adults exhibited atypical increases in MSNA within 10 s. Increases in HR were also greater in HTN adults at 10 s of 30% MVC handgrip, although not at 40% MVC. There were no group differences in 10 s pressor or sympathetic responses to a cold pressor test, suggesting no differences in generalized sympathetic responsiveness. Thus, static handgrip evokes rapid onset pressor and sympathetic responses in older HTN adults. These findings suggest that older HTN adults likely have greater cardiovascular risk even during short duration activities of daily living that contain an isometric component. PMID:25471615

  7. 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…

  8. Pulmonary Arterial Hypertension in Adults: Novel Drugs and Catheter Ablation Techniques Show Promise? Systematic Review on Pharmacotherapy and Interventional Strategies

    PubMed Central

    Gaudio, Carlo; Greco, Cesare; Keylani, Abdul M.; D'Agostino, Darrin C.

    2014-01-01

    This systematic review aims to provide an update on pharmacological and interventional strategies for the treatment of pulmonary arterial hypertension in adults. Currently US Food and Drug Administration approved drugs including prostanoids, endothelin-receptor antagonists, phosphodiesterase type-5 inhibitors, and soluble guanylate-cyclase stimulators. These agents have transformed the prognosis for pulmonary arterial hypertension patients from symptomatic improvements in exercise tolerance ten years ago to delayed disease progression today. On the other hand, percutaneous balloon atrioseptostomy by using radiofrequency perforation, cutting balloon dilatation, or insertion of butterfly stents and pulmonary artery catheter-based denervation, both associated with very low rate of major complications and death, should be considered in combination with specific drugs at an earlier stage rather than late in the progression of pulmonary arterial hypertension and before the occurrence of overt right-sided heart failure. PMID:25013799

  9. Spontaneous rupture of the kidney in the patients with synchronous renal hemangioma and nephrogenic hypertension

    PubMed Central

    Memmedoğlu, Akif; Musayev, Jamal

    2015-01-01

    Most renal neoplasms in adults are epithelial in origin and mesenchymal tumors are rarely encountered. Vascular tumors and tumor-like lesions account for a very small subset. Hemangioma of the kidney is a rarely seen benign vascular neoplasm that probably arises from angioblastic cells. Its general sign is macroscopic hematuria with or without pain. Preoperative diagnosis is difficult or impossible. Previously, spontaneous rupture of the kidney caused by renal hemangioma was not reported in the English literature. In this study, two cases with a history of nephrogenic hypertension who presented with spontaneous renal rupture are presented. There wasn’t any trauma history in the background of our patients. A long-standing nephrogenic hypertension was present in both patients. Patients underwent radical nephrectomy due to rupture of the renal tumor. In histopathological examination, capillary hemangioma was detected in the renal medulla in both cases. Patients didn’t need antihypertensive therapy during the postoperative period. PMID:26623154

  10. 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

  11. 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

  12. 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

  13. Anemia rather than hypertension contributes to cerebral hyperperfusion in young adults undergoing hemodialysis: A phase contrast MRI study

    PubMed Central

    Zheng, Gang; Wen, Jiqiu; Yu, Wenkui; Li, Xue; Zhang, Zhe; Chen, Huijuan; Kong, Xiang; Luo, Song; Jiang, Xiaolu; Liu, Ya; Zhang, Zongjun; Zhang, Long Jiang; Lu, Guang Ming

    2016-01-01

    Cerebral hyperperfusion, anemia and hypertension are common in patients with end-stage renal disease (ESRD). Young ESRD adults might afford a better hemodynamic tolerance; however, their cerebral vascular disorders are often overlooked. This phase-contrast MRI study investigated relationships between cerebral blood flow (CBF), anemia and hypertension in young adults undergoing hemodialysis (HD). Blood flows, velocities, and cross-sectional areas of bilateral internal carotid arteries and vertebral arteries were quantified on phase maps in 33 patients and 27 healthy controls. Cerebral oxygen delivery (COD) and vascular resistance were (CVR) were computed based on CBF, hemoglobin and mean arterial pressure (MAP). We found strong correlations among hemoglobin, MAP and CBF. Hemoglobin rather than MAP was directly related to CBF. COD was negatively related to MAP, while CVR was positively related to hemoglobin. The cross-sectional areas of arteries were increased which were directly associated with hemoglobin rather than MAP. HD patients were of elevated CBF, decreased COD and unchanged CVR. Although elevated CBF compensated anemia-induced hypoxia, COD of these patients was still lower. Anemia directly contributed to elevated CBF and hypertension affected CBF through anemia. Unaffected CVR of young patients probably indicated that they could maintain basic functions of cerebral circulation under multiple risk factors. PMID:26923866

  14. Anemia rather than hypertension contributes to cerebral hyperperfusion in young adults undergoing hemodialysis: A phase contrast MRI study.

    PubMed

    Zheng, Gang; Wen, Jiqiu; Yu, Wenkui; Li, Xue; Zhang, Zhe; Chen, Huijuan; Kong, Xiang; Luo, Song; Jiang, Xiaolu; Liu, Ya; Zhang, Zongjun; Zhang, Long Jiang; Lu, Guang Ming

    2016-01-01

    Cerebral hyperperfusion, anemia and hypertension are common in patients with end-stage renal disease (ESRD). Young ESRD adults might afford a better hemodynamic tolerance; however, their cerebral vascular disorders are often overlooked. This phase-contrast MRI study investigated relationships between cerebral blood flow (CBF), anemia and hypertension in young adults undergoing hemodialysis (HD). Blood flows, velocities, and cross-sectional areas of bilateral internal carotid arteries and vertebral arteries were quantified on phase maps in 33 patients and 27 healthy controls. Cerebral oxygen delivery (COD) and vascular resistance were (CVR) were computed based on CBF, hemoglobin and mean arterial pressure (MAP). We found strong correlations among hemoglobin, MAP and CBF. Hemoglobin rather than MAP was directly related to CBF. COD was negatively related to MAP, while CVR was positively related to hemoglobin. The cross-sectional areas of arteries were increased which were directly associated with hemoglobin rather than MAP. HD patients were of elevated CBF, decreased COD and unchanged CVR. Although elevated CBF compensated anemia-induced hypoxia, COD of these patients was still lower. Anemia directly contributed to elevated CBF and hypertension affected CBF through anemia. Unaffected CVR of young patients probably indicated that they could maintain basic functions of cerebral circulation under multiple risk factors. PMID:26923866

  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. Associations between Traffic Noise, Particulate Air Pollution, Hypertension, and Isolated Systolic Hypertension in Adults: The KORA Study

    PubMed Central

    Wolf, Kathrin; Petz, Markus; Heinrich, Joachim; Cyrys, Josef; Peters, Annette

    2014-01-01

    Background: Studies on the association between traffic noise and cardiovascular diseases have rarely considered air pollution as a covariate in the analyses. Isolated systolic hypertension has not yet been in the focus of epidemiological noise research. Methods: The association between traffic noise (road and rail) and the prevalence of hypertension was assessed in two study populations with a total of 4,166 participants 25–74 years of age. Traffic noise (weighted day–night average noise level; LDN) at the facade of the dwellings was derived from noise maps. Annual average PM2.5 mass concentrations at residential addresses were estimated by land-use regression. Hypertension was assessed by blood pressure readings, self-reported doctor-diagnosed hypertension, and antihypertensive drug intake. Results: In the Greater Augsburg, Germany, study population, traffic noise and air pollution were not associated with hypertension. In the City of Augsburg population (n = 1,893), where the exposure assessment was more detailed, the adjusted odds ratio (OR) for a 10-dB(A) increase in noise was 1.16 (95% CI: 1.00, 1.35), and 1.11 (95% CI: 0.94, 1.30) after additional adjustment for PM2.5. The adjusted OR for a 1-μg/m3 increase in PM2.5 was 1.15 (95% CI: 1.02, 1.30), and 1.11 (95% CI: 0.98, 1.27) after additional adjustment for noise. For isolated systolic hypertension, the fully adjusted OR for noise was 1.43 (95% CI: 1.10, 1.86) and for PM2.5 was 1.08 (95% CI: 0.87, 1.34). Conclusions: Traffic noise and PM2.5 were both associated with a higher prevalence of hypertension. Mutually adjusted associations with hypertension were positive but no longer statistically significant. Citation: Babisch W, Wolf K, Petz M, Heinrich J, Cyrys J, Peters A. 2014. Associations between traffic noise, particulate air pollution, hypertension, and isolated systolic hypertension in adults: the KORA Study. Environ Health Perspect 122:492–498; http://dx.doi.org/10.1289/ehp.1306981 PMID:24602804

  17. 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

  18. 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

  19. Knowledge, Treatment, Control, and Risk Factors for Hypertension among Adults in Southern Iran

    PubMed Central

    Zinat Motlagh, Sayed Fazel; Chaman, Reza; Ghafari, Sayed Rashid; Parisay, Zafar; Golabi, Mohamad Reza; Eslami, Ahmad Ali; Babouei, Amin

    2015-01-01

    Hypertension is the first and the most common risk factor to diseases such as cardiovascular, stroke, and renal diseases. The aim of this study was to determine the factors relevant to hypertension knowledge, treatment, and control in southern Iran. In this cross-sectional study, conducted in Kohgiluye Boyer-Ahmad province, south of Iran, a total of 1836 hypertension patients were randomly selected to participate voluntarily in the study. Hypertension treatment and its control were defined during study. In addition, knowledge about hypertension was measured by hypertension knowledge level scale (HK-LS). Treatment rates were 75.5 and 37.7 percent for female and male, respectively. Habitat, education, income, family history with hypertension, smoking, and time of diagnosis to the disease were found to be related to the treatment of the disease. Control rates were 30.7 and 31.4 for males and females, respectively. Habitat, education, and time of diagnosis to the disease were related to control. Over 50 percent of patients had average knowledge on hypertension. Considering the low rate of control and knowledge on hypertension among patients, health care providers should reinforce their services to improve appropriate knowledge level among elders and, also, plan comprehensive programs to promote health in order to encourage patients change and reform their life style. PMID:26783454

  20. 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

  1. Cut-off of body mass index and waist circumference to predict hypertension in Indian adults

    PubMed Central

    Midha, Tanu; Krishna, Vinay; Nath, Bhola; Kumari, Ranjeeta; Rao, Yashwant Kumar; Pandey, Umeshwar; Kaur, Samarjeet

    2014-01-01

    AIM: To determine the cut-off values of body mass index (BMI) and waist circumference to predict hypertension in adults in north India. METHODS: A community based cross-sectional study was conducted in 801 subjects in Kanpur, aged 20 years and above, using multistage stratified random sampling technique. A pre-tested structured questionnaire was used to elicit the required information from the study participants and the diagnostic criteria for hypertension were taken according to the Seventh Joint National Committee Report on Hypertension (JNC-7). Receiver operating characteristic (ROC) analysis was used to estimate the cut-off values of BMI and waist circumference to predict hypertension. RESULTS: The ROC analysis revealed that BMI is a good predictor of hypertension for both men (area under the ROC curve 0.714) and women (area under the ROC curve 0.821). The cut-off values of BMI for predicting hypertension were identified as ≥ 24.5 kg/m2 in men and ≥ 24.9 kg/m2 in women. Similarly, the ROC analysis for waist circumference showed that it is a good predictor of hypertension both for men (area under the ROC curve 0.784) and women (area under the ROC curve 0.815). The cut-offs for waist circumference for predicting hypertension were estimated as ≥ 83 cm for men and ≥ 78 cm for women. Adults with high BMI or high waist circumference had a higher prevalence of hypertension, respectively. CONCLUSION: Simple anthropometric measurements such as BMI and waist circumference can be used for screening people at increased risk of hypertension in order to refer them for more careful and early diagnostic evaluation. Policies and programs are required for primary and secondary prevention of hypertension. PMID:25032202

  2. 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

  3. The prevalence of and risk factors for hypertension in adults living in Istanbul.

    PubMed

    Onal, A E; Erbil, S; Ozel, S; Aciksari, K; Tumerdem, Y

    2004-01-01

    The prevalence of and risk factors for hypertension were determined among habitants in the European side of Istanbul who are 25 years and older. Eight administrative districts were selected with the method of simple random sampling. The participants were selected through systematic calling from address lists. Between 17 and 22 June 2002, the questionnaires were applied to the participants in a face-to-face interview; then arterial blood pressures, body weights and heights of the participants were measured. Of 423 adults participating in the study, 35.5% were hypertensive; 35.9% were obese, 27.9% were overweight and 2.1% were underweight. Risk factors for hypertension such as age, gender, educational status, social security, family history of hypertension and cardiovascular disease, medical history of diabetes and congestive heart failure, smoking and alcohol use, and body mass index in the hypertensive and non-hypertensive groups were investigated by means of logistic regression analysis. Age [odds ratio (OR): 5.20, 95% confidence interval (CI): 2.18-12.40], body mass index (OR: 2.22, 95% CI: 1.57-3.16) and smoking (OR: 0.72, 95% CI: 0.55-0.95) were found to be correlated with hypertension. The results showed that the prevalence of hypertension was high in Istanbul, and obesity, being overweight and advanced age were the risk factors for hypertension. PMID:15083638

  4. Portal Hypertension

    MedlinePlus

    ... Chronic Hepatitis C Additional Content Medical News Portal Hypertension By Steven K. Herrine, MD NOTE: This is ... Hepatic Encephalopathy Jaundice in Adults Liver Failure Portal Hypertension Portal hypertension is abnormally high blood pressure in ...

  5. 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

  6. [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

  7. Polypharmacy in Older Adults With Hypertension: A Comprehensive Review.

    PubMed

    Mukete, Bertrand N; Ferdinand, Keith C

    2016-01-01

    Older adults are more likely to take more than two medications for medical conditions, and polypharmacy is associated with increased risk of adverse events (fall injury, hyperkalemia and hypokalemia, heart failure, and blood pressure exacerbation), polypharmacy mismanagement, drug-drug interaction, and increased costs. Knowledge of drugs that interact with known antihypertensive agents is paramount to avoiding or reducing adverse events, hospitalizations, and health care dollars. Innovative approaches such as use of a fixed-dose combination pill, ingestible sensor system, electronic reminder system, medical audits, and the integration of a pharmacist in the care of patients should be implemented to avoid polypharmacy mismanagement. PMID:26215211

  8. Frequency and predictors of non-compliance to dietary recommendations among hypertensive patients.

    PubMed

    Khan, Muhammad Shahzeb; Bawany, Faizan Imran; Mirza, Arslan; Hussain, Mehwish; Khan, Asadullah; Lashari, Muhammad Nawaz

    2014-08-01

    Compliance to dietary recommendations among hypertensive people is a major health care issue. Non-compliance can nullify the effects of even the most scientific and optimum treatment plan. The main aim of this study was to determine the frequency and predictors of non-adherence in our region. We also investigated the possible factors based on patient opinions that could increase compliance. A sample of 400 adult patients, diagnosed with hypertension for at least 3 years, who visited Civil Hospital during the time period April-June 2013 were included in this cross sectional study. Patient data and opinions were collected by two trained interviewers using a pre-coded questionnaire. Compliance was assessed based on patients self report. More than three quarters (n = 310, 77.5%) of the hypertensive patients were non-compliant. More than one social gathering in a week, peer-influence, no friends to follow the recommended diet plan and lack of believe regarding diet as an effective measure to control blood pressure were found to be the significant predictors of non-compliance (P values <0.0001). Counseling was thought to be the most effective way by the patients to increase adherence. Non-compliance to dietary recommendations is a major problem prevalent especially in Pakistan. There is an urgent need for doctors and nurses to counsel their patients effectively to prevent future morbidities and mortalities because of non-compliance. PMID:24452406

  9. Prevalence and Associated Factors of Hypertension among Adults in Rural Nepal: A Community Based Study.

    PubMed

    Chataut, J; Khanal, K; Manandhar, K

    2015-01-01

    Background Hypertension is a major health problem throughout the world and is one of the major risk factors for cardiovascular mortality. It is important to detect and manage prehypertension and hypertension to reduce the risk of correlated complications especially cardiovascular diseases. Objective The objective of the study was to find the prevalence and risk factors of hypertension among the adults in rural Nepal. Method A community based cross-sectional study was conducted among 648 respondents. The information was obtained using pre-tested questionnaire which included demographic information of individuals and other risk factors like alcohol and tobacco use, physical activity and diet preference. Height, weight and blood pressure were recorded and hypertension was defined as per Joint National Committee (JNC) VII guidelines. Result The overall prevalence of hypertension was 20.5 % and pre-hypertension was 46.6%. The males had higher prevalence of hypertension (30.6%) compared to females (13.8%). Bivariate analysis showed male gender, smoking and non vegetarian diet have association with hypertension. Male gender [OR 2.50 (1.68 - 3.74)] and non vegetarian diet [OR 0.11 (0.01 - 0.85)] were found to be significantly associated with hypertension in multivariate analysis. Conclusion The prevalence of hypertension and prehypertension was high in the study population. In absence of life style modification and risk reduction the individuals categorized as prehypertension have great risk of developing hypertension in the future which may pose a great challenge in the future. Hence, there is a big scope for screening and primary prevention strategies to curb the epidemic of hypertension. PMID:27423286

  10. 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

  11. 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

  12. 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

  13. 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.

  14. Blood pressure levels, left ventricular mass and function are correlated with left atrial volume in mild to moderate hypertensive patients.

    PubMed

    Milan, A; Caserta, M A; Dematteis, A; Naso, D; Pertusio, A; Magnino, C; Puglisi, E; Rabbia, F; Pandian, N G; Mulatero, P; Veglio, F

    2009-11-01

    Arterial hypertension is associated with an increased risk of atrial fibrillation (AF), and leads to a pronounced increase in morbidity and mortality. Left atrial volume (LAV) is an important prognostic marker in the older populations. The aim of our study was to identify the clinical and echocardiographic determinants of LAV in middle-aged (<70 years old) essential hypertensive patients.We evaluated cardiac structure and function in 458 patients, 394 treated and untreated mild to moderate essential hypertensives patients (mean+/-s.d. age 48.4+/-11.1 years) with no associated clinical condition and 64 normotensive control participants (age 45.7+/-12.8 years; P=0.12). A multivariate analysis was performed to calculate the relative weight of each of the variables considered able to predict LAV. The LAV index (LAVi) was significantly increased in the essential hypertensive group vs the control group and was significantly dependent on blood pressure levels (SBP and DBP, P<0.05 for both) and body mass index (BMI) (P<0.0001). Considering the left ventricular (LV) variables, the LV mass index (LVMI) (R(2)=0.19, P<0.001) and LAV were increased in essential hypertensive patients with left ventricular hypertrophy (LVH), and patients with enlarged LAV showed lower systolic and diastolic function and an increased LVMI. The LAVi is dependent on blood pressure levels and anthropometric variables (age and BMI). Further structural (LVMI) and functional (systolic and diastolic) variables are related to the LAVi; LVMI is the most important variable associated with LAV in mild to moderate essential hypertensive adult patients. These findings highlight the importance of left atrium evaluation in adult, relatively young, essential hypertensive patients. PMID:19262581

  15. 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

  16. Elevation of cadmium, lead, and zinc in the hair of adult black female hypertensives

    SciTech Connect

    Medeiros, D.M.; Pellum, L.K.

    1984-05-01

    The southern portion of the United States has the highest mortality due to cardiovascular disease of any region of the country. The prevalence of hypertension in the South is also higher. Dietary intake of sodium, an overweight condition, and genetic factors may contribute to the problem. The role of trace elements is also a factor in producing hypertension. The objective of the present study was to explore the relationship of selected trace elements with tensive status using hair as a biopsy material. The study examined the differences in hair elemental concentrations between adult black female hypertensives and normotensives from low socioeconomic backgrounds.

  17. Prevalence and correlation of hypertension among adult population in Bahir Dar city, northwest Ethiopia: a community based cross-sectional study

    PubMed Central

    Anteneh, Zelalem Alamrew; Yalew, Worku Awoke; Abitew, Dereje Birhanu

    2015-01-01

    Background Hypertension is one of the most common causes of premature death and morbidity and has a major impact on health care costs. It is an important public health challenge to both developed and developing countries. The aim of this study was to determine the magnitude and correlates of hypertension. Methods A community-based cross-sectional study was conducted in June 2014 among 681 adult residents of Bahir Dar city using multistage sampling techniques. An interview-administrated questionnaire and physical measurements such as blood pressure (BP), weight, height, and waist and hip circumferences were employed to collect the data. The data were coded, entered, and analyzed with SPSS version 16 software package. Results A total of 678 responses were included in the analysis resulting in a response rate of 99.6%. The findings declared that 17.6%, 19.8%, and 2.2% of respondents were prehypertension, hypertension stage I, and hypertension stage II, respectively, on screening test. The overall prevalence of hypertension (systolic BP ≥140 mmHg, or diastolic BP ≥90 mmHg, or known hypertensive patient taking medications) was 25.1%. According to the multivariate logistic regression analysis, age; having ever smoked cigarette; number of hours spent walking/cycling per day; number of hours spent watching TV per day; history of diabetes; adding salt to food in addition to the normal amount that is added to the food during cooking; and body mass index were statistically significant predictors of hypertension. Conclusion One out of every four respondents of the study had hypertension, and more than one out of three cases of hypertension (38.8%) did not know that they had the hypertension; 17.6% of the respondents were in prehypertension stage, which adds to overall future risk of hypertension. Therefore, mass screening for hypertension, health education to prevent substance use, regular exercise, reducing salt consumption, and life style modifications are recommended

  18. 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

  19. 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

  20. 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

  1. 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

  2. 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

  3. [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

  4. Calcium intake and hypertension among obese adults in United States: associations and implications explored.

    PubMed

    Chen, Y; Strasser, S; Cao, Y; Wang, K-S; Zheng, S

    2015-09-01

    The relationship between calcium intake and hypertension is receiving increased research attention. The prevalence of hypertension is high among the obese populations. Calcium is a mineral that influences blood pressure. The aim of the study was to examine the association between calcium intake and hypertension in a large nationally representative sample of obese American adults. A total of 14,408 obese adults aged 20 years or older were obtained from the 1999-2010 National Health and Nutrition Examination Survey. Analysis of variance and linear regression models were used to examine relationships between calcium intake and systolic blood pressure (SBP) as well as diastolic blood pressure (DBP). Multiple logistic regression models were used to examine the association between calcium intake and hypertension after adjusting for potential confounders and interactions, including: age, race, education level, alcohol use, smoking, diabetes status, sodium intake and potassium intake. Calcium intake was significantly lower for the hypertensive group compared with the normotensive group (P<0.0001), especially among those obese female young adults aged 20-44 years and among non-diabetic obese adults. Based on ordinary linear regression analysis, a significant inverse relationship was detected, SBP and DBP decreased if calcium intake increased (SBP: regression coefficient estimate=-0.015, P<0.0001; DBP: regression coefficient estimate=-0.028, P<0.0001). Multiple logistic regression showed that calcium intake was negatively associated with the probability of hypertension (odds ratio (OR)=0.81, 95% confidence interval (CI): 0.74-0.87, P<0.0001). In stratified analysis, calcium intake in youngest adults (age 20-44 years) had the lowest likelihood of hypertension (OR=0.77, 95% CI: 0.64-0.93, P<0.0001), the inverse relationship between calcium intake and probability of hypertension was stronger among females (OR: 0.68, 95% CI: 0.55-0.84, P<0.0001), when compared with the whole

  5. Prevalence of hypertension in a sample of Black American adults using JNC 7 classifications.

    PubMed

    Brown, Debra J; Metiko, Esther B

    2005-12-01

    High blood pressure is a major health problem, particularly among Black Americans, and many Black Americans are unaware that they have the disease. In 2003, new guidelines (JNC 7) were created for classifying blood pressure including a category designated as "pre-hypertension." We examined the prevalence of hypertension based on JNC 7 guidelines in Black Americans from the study of Everyday Life for Black American Adults: Stress, Emotional and Cardiovascular Responses. In this study, 211 (N = 211) participants had no history of hypertension and were not taking anti-hypertensive medications. Demographic factors were also explored in relationship to the JNC 7 classifications. Using JNC 7, only 28.9% of the participants had normal blood pressures. Of those with abnormal blood pressures, 37.8% were pre-hypertensive. Surprisingly, there was a high prevalence of hypertension, which might be explained by a lack of awareness of their disease status, lack of desire to acknowledge it, or fear of having a disease. The pre-hypertension category allows for earlier identification of those at risk for developing hypertension so that early interventions can deter its debilitating effects. PMID:16570640

  6. 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

  7. 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

  8. 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

  9. 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

  10. Effect of sodium restriction on blood pressure of unstable or uncontrolled hypertensive patients in primary care

    PubMed Central

    Tilleman, Katrien; Ampe, Jan; De Henauw, Stefaan; Huybrechts, Inge

    2015-01-01

    BACKGROUND/OBJECTIVES The aims of the present study are: 1) to quantify sodium consumption of patients with unstable or uncontrolled hypertension, 2) to investigate if reduced sodium intake can lower BP in these patients, and 3), to assess the acceptability and feasibility of this approach. SUBJECTS/METHODS This study included 25 adults (age: 50+ years) with frequently elevated BP or patients with uncontrolled, uncomplicated hypertension despite drug treatment in a general practice setting. BP and salt intake (24h urinary excretion and food records) were measured at baseline and after a sodium reduced diet. RESULTS Mean (± SD) systolic (SBP) over diastolic (DBP) blood pressure (mmHg) at baseline was 150.7 (± 9.5)/84.149 (± 5.6). Mean urinary sodium excretion was 146 mmol/24h. A reduction of 28 mmol sodium excretion decreased SBP/DBP to 135.5 (± 13.0)/82.5 (± 12.8) (P < 0.001). After one month of no dietary advice, only in 48%, SBP was still ≤140 mmHg. CONCLUSION Assessment of sodium intake using food records, 24h urine collections and probing questions to identify use of sodium containing supplements or drugs are essential for tailored advice targeted at sodium intake reduction. The results of the present study indicate that reduced sodium intake can lower BP after 4 weeks in unstable or uncontrolled hypertensive patients. PMID:25861425

  11. 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

  12. 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

  13. 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

  14. 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

  15. Hypertension Impact on Health-Related Quality of Life: A Cross-Sectional Survey among Middle-Aged Adults in Chongqing, China

    PubMed Central

    Liu, Lingli

    2016-01-01

    Hypertension is a major risk factor of cardiovascular disease in China, and yet little is known about health-related quality of life (HRQOL) and its associations with demographic and social-economic characteristics in middle-aged patients with hypertension. A cross-sectional survey was undertaken in Chongqing, China, using a multistage stratified random sampling methodology. Data was collected on 1,224 eligible adults, aged between 45 and 53 years, including the Medical Outcomes Survey Short Form-36 to measure HRQOL. Hypertension was associated with poor state of physical functioning, role-physical, bodily pain, general health, vitality, and social function (p < 0.05 for all). In multivariable analyses, education level, job conditions, average monthly income, smoking status, sleep quality, perception of relationship with family, childhood breastfeeding history, and body mass index were associated with domains of SF36 among those with hypertension (p < 0.05 for all). Hypertensive respondents with high education, marital status, breastfeeding, higher incomes, good quality of sleep, positive relationship with family, and higher body mass index have better HRQOL in middle-aged people with hypertension. Those unemployed had a better state of general health and had a poorer state of social function. Nonsmokers had a poorer state of bodily pain than smokers. This study provides detailed information of the implications for health care providers to gain a more complete picture of their hypertension patients' health.

  16. Hypertension and Obesity as Cardiovascular Risk Factors among HIV Seropositive Patients in Western Kenya

    PubMed Central

    Bloomfield, Gerald S.; Hogan, Joseph W.; Keter, Alfred; Sang, Edwin; Carter, E. Jane; Velazquez, Eric J.; Kimaiyo, Sylvester

    2011-01-01

    Background There is increased risk of cardiovascular disease among HIV seropositive individuals. The prevalence of HIV is highest in sub-Saharan Africa; however, HIV-related cardiovascular risk research is largely derived from developed country settings. Herein, we describe the prevalence of hypertension and obesity in a large HIV treatment program in Kenya. Methods We performed a retrospective analysis of the electronic medical records of a large HIV treatment program in Western Kenya between 2006 and 2009. We calculated the prevalence of hypertension and obesity among HIV+ adults as well as utilized multiple logistic regression analyses to examine the relationship between clinical characteristics, HIV-related characteristics, and hypertension. Results Our final sample size was 12,194. The median systolic/diastolic blood pressures were similar for both sexes (male: 110/70 mmHg, female: 110/70 mmHg). The prevalence of hypertension among men and women were 11.2% and 7.4%, respectively. Eleven percent of men and 22.6% of women were overweight/obese (body mass index ≥25 kg/m2). Ordinal logistic regression analyses showed that overweight/obesity was more strongly associated with hypertension among HIV+ men (OR 2.41, 95% CI 1.88–3.09) than a higher successive age category (OR 1.62, 95% CI 1.40–1.87 comparing 16–35, 36–45 and >45 years categories). Among women, higher age category and overweight/obesity were most strongly associated with hypertension (age category: OR 2.21, 95% CI 1.95–2.50, overweight/obesity: OR 1.80, 95% CI 1.50–2.16). Length of time on protease inhibitors was not found to be related to hypertension for men (OR 1.62, 95% CI 0.42–6.20) or women (OR 1.17, 95% CI 0.37–2.65) after adjustment for CD4 count, age and BMI. Conclusion In Western Kenya, there is a high prevalence of hypertension and overweight/obesity among HIV+ patients with differences observed between men and women. The care of HIV+ patients in sub-Saharan Africa should

  17. 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

  18. 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

  19. 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

  20. 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

  1. Structural and Functional Vascular Alterations and Incident Hypertension in Normotensive Adults

    PubMed Central

    Peralta, Carmen A.; Adeney, Kathryn L.; Shlipak, Michael G.; Jacobs, David; Duprez, Daniel; Bluemke, David; Polak, Joseph; Psaty, Bruce; Kestenbaum, Bryan R.

    2010-01-01

    Vascular abnormalities may exist before clinical hypertension. Using Poisson regression, the authors studied the association of coronary artery calcium (CAC), common carotid intima-media thickness (CIMT), aortic distensibility, and large and small arterial elasticity with incident hypertension among 2,512 normotensive US adults free of cardiovascular disease. Incidence rate ratios for incident hypertension (blood pressure ≥140/90 mm Hg or new antihypertensive medication) were calculated. Increased CAC was associated with incident hypertension in demographics-adjusted models (incidence rate ratio (IRR) = 1.35, 95% confidence interval (CI): 1.04, 1.75; IRR = 1.35, 95% CI: 1.02, 1.78; and IRR = 1.59, 95% CI: 1.12, 2.25 for CAC scores of 30–99, 100–399, and ≥400, respectively) but was attenuated after further adjustment. Increased common CIMT was associated with incident hypertension (IRR = 1.77, 95% CI: 1.28, 2.46 for quintile 4; IRR = 1.80, 95% CI: 1.28, 2.53 for quintile 5). Participants with the lowest, compared with the highest, aortic distensibility had an increased risk of hypertension (IRR = 1.75, 95% CI: 1.10, 2.79), as did those with the lowest large arterial elasticity (IRR = 1.49, 95% CI: 1.11, 1.99). Lower small arterial elasticity was incrementally associated with incident hypertension starting at quintile 2 (IRR = 2.01, 95% CI: 1.39, 2.91; IRR = 2.47, 95% CI: 1.71, 3.57; IRR = 2.73, 95% CI: 1.88, 3.95; and IRR = 2.85, 95% CI: 1.95, 4.16). Structural and functional vascular abnormalities are independent predictors of incident hypertension. These findings are important for understanding the pathogenesis of hypertension. PMID:19951938

  2. Interaction of Sleep Duration and Sleep Quality on Hypertension Prevalence in Adult Chinese Males

    PubMed Central

    Lu, Kai; Chen, Jia; Wu, Shouling; Chen, Ji; Hu, Dayi

    2015-01-01

    Background Previous studies demonstrated conflicting results about the association of sleep duration and hypertension. Given the potential relationship between sleep quality and hypertension, this study aimed to investigate the interaction of self-reported sleep duration and sleep quality on hypertension prevalence in adult Chinese males. Methods We undertook a cross-sectional analysis of 4144 male subjects. Sleep duration were measured by self-reported average sleep time during the past month. Sleep quality was evaluated using the standard Pittsburgh Sleep Quality Index. Hypertension was defined as blood pressure level ≥140/90 mm Hg or current antihypertensive treatment. The association between hypertension prevalence, sleep duration, and sleep quality was analyzed using logistic regression after adjusting for basic cardiovascular characteristics. Results Sleep duration shorter than 8 hours was found to be associated with increased hypertension, with odds ratios and 95% confidence intervals (CIs) of 1.25 (95% CI, 1.03–1.52) for 7 hours, 1.41 (95% CI, 1.14–1.73) for 6 hours, and 2.38 (95% CI, 1.81–3.11) for <6 hours. Using very good sleep quality as the reference, good, poor, and very poor sleep quality were associated with hypertension, with odds ratios of 1.20 (95% CI, 1.01–1.42), 1.67 (95% CI, 1.32–2.11), and 2.32 (95% CI, 1.67–3.21), respectively. More importantly, further investigation of the association of different combinations of sleep duration and quality in relation to hypertension indicated an additive interaction. Conclusions There is an additive interaction of poor sleep quality and short sleep duration on hypertension prevalence. More comprehensive measurement of sleep should be performed in future studies. PMID:25912096

  3. Defining Older Adults' Perceived Causes of Hypertension in the Brief Illness Perception Questionnaire

    ERIC Educational Resources Information Center

    Duwe, Elise A. G.; Koerner, Kari M.; Madison, Anna M.; Falk, Nikki A.; Insel, Kathleen C.; Morrow, Daniel G.

    2014-01-01

    Objectives: This study sought to make the Brief Illness Perception Questionnaire (BIPQ) to be more informative about illness representation among older adults with hypertension. The authors developed categories for coding the open-ended question regarding cause of illness in the BIPQ--a pervasive quantitative measure for illness representation.…

  4. Hypertension among adults in a deprived urban area of Peru – Undiagnosed and uncontrolled?

    PubMed Central

    Davies, Alisha R; Miranda, J Jaime; Gilman, Robert H; Smeeth, Liam

    2008-01-01

    Background In Peru, cardiovascular disease was the second most common cause of death in those aged 65 years or more in 2000. Hypertension is a major modifiable risk factor for cardiovascular disease, and if treated can significantly reduce cardiovascular disease risk. The objectives of this study were to investigate the prevalence of hypertension and levels of awareness, treatment and control in a deprived urban area of Peru. Methods A cross-sectional study was completed. Blood pressure measurements were recorded in triplicate. Hypertension was defined as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, or self report of receiving antihypertensive medication at the time of interview. Results The study sample was 584 adults (29.1% male, mean age 35.3 years). Age standardized prevalence of hypertension was 19.5% (95% CI 9.9%, 29.1%) in men, 11.4% (95% CI 3.7%, 19.1%) in women, and 13.2% (95% CI 5.0%, 21.5%) overall. Among those with hypertension 38.3% (95% CI 22.7%, 53.9%, n = 18/47) were aware of their condition with greater awareness among women than men. Of those aware, 61.1% (n = 11/18) were treated, equating to 23.4% (95% CI 10.1%, 36.7%, n = 11/47) of all adults with hypertension. Of those treated 63.6% (n = 7/11) had controlled hypertension, equating to 14.9% (95% CI 3.0%, 26.8%, n = 7/47) of all adults with hypertension. Conclusion Levels of awareness and control in this population were low. Lack of control is likely to be due to both a failure to diagnose hypertension, especially among men, and initiate or comply with treatment, especially among women. These results suggest a considerable burden of undiagnosed hypertension, and poor levels of control in those treated, in a deprived urban area of Lima, Peru. PMID:18710540

  5. 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

  6. 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

  7. [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

  8. Independent and Joint Effect of Brachial-Ankle Pulse Wave Velocity and Blood Pressure Control on Incident Stroke in Hypertensive Adults.

    PubMed

    Song, Yun; Xu, Benjamin; Xu, Richard; Tung, Renee; Frank, Eric; Tromble, Wayne; Fu, Tong; Zhang, Weiyi; Yu, Tao; Zhang, Chunyan; Fan, Fangfang; Zhang, Yan; Li, Jianping; Bao, Huihui; Cheng, Xiaoshu; Qin, Xianhui; Tang, Genfu; Chen, Yundai; Yang, Tianlun; Sun, Ningling; Li, Xiaoying; Zhao, Lianyou; Hou, Fan Fan; Ge, Junbo; Dong, Qiang; Wang, Binyan; Xu, Xiping; Huo, Yong

    2016-07-01

    Pulse wave velocity (PWV) has been shown to influence the effects of antihypertensive drugs in the prevention of cardiovascular diseases. Data are limited on whether PWV is an independent predictor of stroke above and beyond hypertension control. This longitudinal analysis examined the independent and joint effect of brachial-ankle PWV (baPWV) with hypertension control on the risk of first stroke. This report included 3310 hypertensive adults, a subset of the China Stroke Primary Prevention Trial (CSPPT) with baseline measurements for baPWV. During a median follow-up of 4.5 years, 111 participants developed first stroke. The risk of stroke was higher among participants with baPWV in the highest quartile than among those in the lower quartiles (6.3% versus 2.4%; hazard ratio, 1.66; 95% confidence interval, 1.06-2.60). Similarly, the participants with inadequate hypertension control had a higher risk of stroke than those with adequate control (5.1% versus 1.8%; hazard ratio, 2.32; 95% confidence interval, 1.49-3.61). When baPWV and hypertension control were examined jointly, participants in the highest baPWV quartile and with inadequate hypertension control had the highest risk of stroke compared with their counterparts (7.5% versus 1.3%; hazard ratio, 3.57; 95% confidence interval, 1.88-6.77). There was a significant and independent effect of high baPWV on stroke as shown among participants with adequate hypertension control (4.2% versus 1.3%; hazard ratio, 2.29, 95% confidence interval, 1.09-4.81). In summary, among hypertensive patients, baPWV and hypertension control were found to independently and jointly affect the risk of first stroke. Participants with high baPWV and inadequate hypertension control had the highest risk of stroke compared with other groups. PMID:27217412

  9. Drug treatment of hypertension in pregnancy: a critical review of adult guideline recommendations.

    PubMed

    Al Khaja, Khalid A J; Sequeira, Reginald P; Alkhaja, Alwaleed K; Damanhori, Awatif H H

    2014-03-01

    This review evaluates the guideline recommendations for the management of hypertension in pregnancy as presented by 25 national/international guidelines developed for the management of arterial hypertension in adults. There is a general consensus that oral α-methyldopa and parenteral labetalol are the drugs of choice for nonsevere and severe hypertension in pregnancy, respectively. Long-acting nifedipine is recommended by various guidelines as an alternative for first-line and second-line therapy in nonsevere and severe hypertension. The safety of β-blockers, atenolol in particular, in early and late stages of pregnancy is unresolved; their use is contraindicated according to several guidelines. Diuretic-associated harmful effects on maternal and fetal outcomes are controversial: their use is discouraged in pregnancy. It is important to develop specific guidelines for treating hypertension in special groups such as adult females of childbearing age and sexually active female adolescents to minimize the risk of adverse effects of drugs on the fetus. In several guidelines, the antihypertensive classes, recommended drug(s), intended drug formulation, and route of administration are not explicit. These omissions should be addressed in future guideline revisions in order to enhance the guidelines' utility and credibility in clinical practice. PMID:24384846

  10. Combined effect of hyperuricemia and overweight/obesity on the prevalence of hypertension among US adults: result from the National Health and Nutrition Examination Survey.

    PubMed

    Han, G-M; Gonzalez, S; DeVries, D

    2014-10-01

    Hypertension is a large and growing public health problem worldwide. Hyperuricemia and overweight/obesity are two of the most important risk factors for hypertension. However, their combined effect on the risk of hypertension is not known. Participants aged 20 years and older from the National Health and Nutrition Examination Survey from 1999-2012 were used to evaluate the separate and combined effects of hyperuricemia and overweight/obesity on the risk of prevalent hypertension among different race, gender and age groups. Participants (31,473) were used to estimate separate and combined effects on the prevalence of hypertension. The overall prevalence of hypertension among adults with a combination of hyperuricemia and overweight/obesity (50.2%, 95% confidence interval (CI) 48.3-52.1%) was significantly higher than separate hyperuricemia (41.7%, 95% CI 37.2-46.2%) and overweight/obesity (30.6%, 95% CI 29.5-31.8%). The magnitude of odds ratio (OR) from the combination of hyperuricemia and overweight/obesity (OR=4.53, 95% CI 4.05-5.07) was significantly higher than both hyperuricemia (OR=2.62, 95% CI 2.07-3.32) and overweight/obesity (OR=2.08, 95% CI 1.89-2.30). Combined effect of hyperuricemia and overweight/obesity on the risk of hypertension is much stronger than any separate one. These data can provide important information for identification of target populations for future intervention and patient management. PMID:24785975

  11. Urinary Bisphenol A and Hypertension in a Multiethnic Sample of US Adults

    PubMed Central

    Shankar, Anoop; Teppala, Srinivas

    2012-01-01

    Background. Bisphenol A (BPA) is a common chemical used in the manufacture of polycarbonate plastics and epoxy resins, with >93% of US adults having detectable BPA levels in urine. Recent animal studies have suggested that BPA exposure may have a role in several mechanisms involved in the development of hypertension, including weight gain, insulin resistance, thyroid dysfunction, endothelial dysfunction, and oxidative stress. However, no previous human study has examined the association between markers of BPA exposure and hypertension. Methods. We examined urinary BPA levels in 1380 subjects from the National Health and Nutritional Examination Survey 2003-2004. Main outcome-of-interest was hypertension, defined as blood pressure-reducing medication use and/or blood pressures >140/90 mm of Hg (n = 580). Results. We observed a positive association between increasing levels of urinary BPA and hypertension independent of confounding factors such as age, gender, race/ethnicity, smoking, body mass index (BMI), diabetes mellitus and total serum cholesterol levels. Compared to tertile 1 (referent), the multivariate-adjusted odds ratio (95% confidence interval) of hypertension associated with tertile 3 was 1.50 (1.12−2.00); P-trend = 0.007. The association was consistently present in subgroup analyses by race/ethnicity, smoking status, BMI, and diabetes mellitus. Conclusions. Urinary BPA levels are associated with hypertension, independent of traditional risk factors. PMID:22363351

  12. New Cardiovascular Risk Factors and Their Use for an Accurate Cardiovascular Risk Assessment in Hypertensive Patients

    PubMed Central

    TAUTU, Oana-Florentina; DARABONT, Roxana; ONCIUL, Sebastian; DEACONU, Alexandru; COMANESCU, Ioana; ANDREI, Radu Dan; DRAGOESCU, Bogdan; CINTEZA, Mircea; DOROBANTU, Maria

    2014-01-01

    Objectives: To analyze the predictive value of new cardiovascular (CV) risk factors for CV risk assessment in the adult Romanian hypertensive (HT) population. Methods: Hypertensive adults aged between 40-65 years of age, identified in national representative SEPHAR II survey were evaluated by anthropometric, BP and arterial stiffness measurements: aortic pulse wave velocity (PWVao), aortic augmentation index (AIXao), revers time (RT) and central systolic blood pressure (SBPao), 12 lead ECGs and laboratory workup. Values above the 4th quartile of mean SBP' standard deviation (s.d.) defined increased BP variability. Log(TG/HDL-cholesterol) defined atherogenic index of plasma (AIP). Serum uric acid levels above 5.70 mg/dl for women and 7.0 mg/dl for males defined hyperuricemia (HUA). CV risk was assessed based on SCORE chart for high CV risk countries. Binary logistic regression using a stepwise likelihood ratio method (adjustments for major confounders and colliniarity analysis) was used in order to validate predictors of high and very high CV risk class. Results: The mean SBP value of the study group was 148.46±19.61 mmHg. Over forty percent of hypertensives had a high and very high CV risk. Predictors of high/very high CV risk category validated by regression analysis were: increased visit-to-visit BP variability (OR: 2.49; 95%CI: 1.67-3.73), PWVao (OR: 1.12; 95%CI: 1.02-1.22), RT (OR: 0.95; 95% CI: 0.93-0.98), SBPao (OR: 1.01; 95%CI: 1.01-1.03) and AIP (OR: 7.08; 95%CI: 3.91-12.82). Conclusion: The results of our study suggests that the new CV risk factors such as increased BP variability, arterial stiffness indices and AIP are useful tools for a more accurate identification of hypertensives patients at high and very high CV risk. PMID:25705267

  13. [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

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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

  19. Evolving evidence in adult idiopathic intracranial hypertension: pathophysiology and management

    PubMed Central

    Mollan, Susan P; Ali, Fizzah; Hassan-Smith, Ghaniah; Botfield, Hannah; Friedman, Deborah I; Sinclair, Alexandra J

    2016-01-01

    Idiopathic intracranial hypertension (IIH) is a rare but important disease associated with significant morbidity. There is an expected rise in prevalence in line with the escalating global burden of obesity. Modern revisions in the terminology and diagnostic criteria for IIH help guide clinicians in investigations and researchers in standardising recruitment criteria for clinical trials. The pathophysiology of IIH is incompletely characterised; suggested underpinning mechanisms include the role of cerebrospinal fluid regulation as well as metabolic and endocrinological perspectives. Recent treatment trials are providing insights into the management but debate still surrounds key areas in treatment. This review will provide an up-to-date discussion on the potential pathogenic mechanisms and management of IIH. PMID:26888960

  20. Transesophageal echocardiography guided patent ductus arteriosus occlusion in adults with severe pulmonary hypertension through a parasternal approach

    PubMed Central

    Dai, Xiao-Fu; Chen, Liang-Wan; Chen, Dong-Zhong; Chen, Qiang; Zhen, Guo-Zhong; Zhang, Gui-Can

    2015-01-01

    Between April 2010 and April 2014, 39 consective adult patients (> 18 years) with PDA associated severe pulmonary hypertension underwent transesophageal echocardiography guided patent ductus arteriosus occlusion through a parasternal minimally invasive approach. Among 39 patients, the procedure was successful in 32 cases (82.1%) and failed in 7 cases (17.9%). In the failed cases, 3 cases had a large residual shunt and 4 cases had persistent pulmonary hypertension. The mean minimum miameter of the successfully closed PDAs was 15.2 ± 2.1 mm (range 9 to 24), and the mean diameter of the mushroom-shaped occluder was 17.5 ± 2.5 mm (range 11 to 26). The pulmonary artery pressure decreased significantly after occlusion (P < 0.05), but there were no significant differences in the aortic pressure and blood oxygen saturation before and after occlusion (P > 0.05). Echocardiography performed on the first postoperative day showed decreased volume within the left atrium, left ventricle, and pulmonary artery in 23 cases, decreased volume within the left atrium and left ventricle in 4 cases, and no change in the volume of the atrium and ventricle in 3 cases. A minor residual shunt was observed in 6 cases. The posteroanterior chest X-ray showed improved pulmonary congestion in all cases and significantly reduced cardiothoracic ratio in 25 cases. Patients were followed-up at least for 1 year. No symptoms including palpitation, dyspnoea, or chest tightness were observed. The heart function ranged from NYHA class I to II. A minor residual shunt was observed only in one case. There were varying degrees of decrease in volume within the atrium and ventricle. In conclusion, transesophageal echocardiography guided patent ductus arteriosus occlusion through a parasternal minimally invasive approach is a feasible and effective method for the treatment of PDA in adults with severe pulmonary hypertension. PMID:26722416

  1. Prevalence of isolated diastolic hypertension and associated risk factors among adults in Kanpur, India

    PubMed Central

    Midha, Tanu; Lalchandani, Arati; Nath, Bhola; Kumari, Ranjeeta; Pandey, Umeshwar

    2012-01-01

    Background Isolated diastolic hypertension (IDH) is a largely unrecognized subtype of hypertension, more commonly seen in the younger age group. Aims (1) To determine the prevalence of IDH in the adult population of Kanpur district. (2) To study the associated risk factors of IDH. Methods A community-based cross-sectional study was conducted in 801 subjects, aged 20 years and above, using multistage stratified random sampling technique. Results The prevalence of IDH was 4.5%, which was 6.2% in men and 3.1% in women. A significant proportion of IDH was seen in the 40–49 years age group. Multivariate logistic regression analysis of the associated risk factors showed that gender, physical activity and BMI were significantly associated with IDH. Conclusion Isolated diastolic hypertension is an emerging problem in developing countries. IDH is more common among men, sedentary individuals and those with a higher BMI. PMID:22929820

  2. 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

  3. Urban residential road traffic noise and hypertension: a cross-sectional study of adult population.

    PubMed

    Banerjee, Dibyendu; Das, Partha P; Fouzdar, Anjan

    2014-12-01

    Results from studies involving exposure to road traffic noise and risk of hypertension are diverse and have seldom reached statistical significance. This study was designed with the aim of investigating whether there is any association between road traffic noise and prevalence of hypertension in an urban adult population. Similar studies have never been reported from India. A cross-sectional study was performed on 909 adults (533 female and 376 male) aged 18-80 years residing in close proximity to roadways in Asansol City. Time-weighted equivalent noise level (L den) was estimated using a standard modeling platform. Odds for hypertension in relation to traffic noise exposure were estimated by univariate and multifactorial logistic regression. The adjusted odds ratio (OR) for self-reported hypertension was 1.99 (95 % confidence interval (CI) 1.66-2.39) per 5 dB(A) increase of L den (range 55.1-77.9). A gender-related risk difference was observed among the male (OR 1.81 (1.42-2.31)) and female (OR 2.18 (1.66-2.88)) respondents. For increase in 9 years of age, the odds of hypertension risk increased by 60 % (OR 1.66 (1.43-1.91) among those exposed above L den 60 dB(A). Vulnerable subgroups were female aged 35-54 years and male aged 45-54 years. The study suggests that a threshold exposure to road traffic noise at L den > 65 dB(A) for men and L den > 60 dB(A) in women may be associated with the occurrence of hypertension. PMID:25354710

  4. 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

  5. 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

  6. [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

  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. Digital Interventions to Promote Self-Management in Adults With Hypertension: Protocol for Systematic Review and Meta-Analysis

    PubMed Central

    Band, Rebecca; Saunderson, Kathryn; Hanlon, Peter; Little, Paul; McManus, Richard J; Yardley, Lucy; Mair, Frances S

    2015-01-01

    Background Digital interventions, defined as any intervention accessed and taking input from patients in the form of a computer/Web-based program or mobile phoned-based app, can potentially help empower patients to self-manage long-term conditions such as hypertension. Importantly, digital interventions have the potential to provide patients with personalized information and support for active involvement in treatment as well as cost saving. Objective The purpose of this systematic review is to synthesize the evidence for using digital interventions to support patient self-management of hypertension, and determine their impact on control and reduction of blood pressure, other clinical outcomes, quality of life, medication adherence, health service utilization, and economic benefits. Methods A systematic search of bibliographic databases including Medline, Embase, CINAHL, and PsycINFO will be undertaken. Abstracts and citations will be independently screened by 2 researchers against predetermined inclusion criteria. Any disagreements will be resolved by discussion and further consideration of the inclusion criteria. Only randomized controlled trials which have been published in peer peer-reviewed journals with a diagnosis of hypertension will be considered. Inclusion criteria will be (1) adults (age ≥ 18 years) with hypertension (as defined by the primary authors); (2) an interactive digital intervention compared with usual care; and (3) outcomes of objectively measured change in blood pressure. Data extraction from identified articles will be undertaken by 2 independent reviewers using a uniform template. The main outcomes are systolic blood pressure (SBP) and diastolic blood pressure (DBP), and quality of life indicators. Secondary outcomes include cost- effectiveness, medication adherence, emotional well-being, and physical activity. Risk of bias of included studies will be assessed using the Cochrane tool. Results Our research is currently ongoing. Data will

  9. Diurnal blood pressure pattern and development of prehypertension or hypertension in young adults: the CARDIA study

    PubMed Central

    Viera, Anthony J.; Zhu, Sha; Hinderliter, Alan L.; Shimbo, Daichi; Person, Sharina D.; Jacobs, David R.

    2011-01-01

    Nondippers (people whose sleep systolic blood pressure (SBP) fails to decrease >10% from daytime SBP) have increased risk of cardiovascular disease. The prevalence of nondipping in younger adults has not been well-studied, nor has its value for predicting hypertension. We examined the prevalence of nondipping in a sub-study of the Coronary Artery Risk Development in Young Adults (CARDIA) Study. We used Cox regression to estimate the hazard ratio (HR) conferred by nondipping for incident prehypertension or hypertension (preHTN/HTN) over 15 years. Of the 264 non-hypertensive participants at baseline, 118 (45%) were nondippers. Blacks were more likely than Whites to be nondippers (52% vs 33%, p=0.004). The incidence rate of preHTN/HTN was 29.2/1000 person-years among dippers and 36.2/1000 person-years among nondippers. Compared to those in the lowest quartile of nighttime to daytime SBP, those in the highest quartile were more likely to develop preHTN/HTN (HR 1.61; p =0.06), but this relationship was attenuated after adjustment (HR 1.34; p =0.27). Our results demonstrate that nondipping is common in young, nonhypertensive adults, and is more common in Blacks than Whites. Nondipping might predate a meaningful clinically detected increase in BP in some people, but more research in larger study samples is needed. PMID:21269909

  10. Validation of an Interaction Model of Health Behavior Among Adults With Hypertension.

    PubMed

    Hickman, Ronald L; Clochesy, John M; Alaamri, Marym

    2016-07-01

    The purpose of this study was to test the Interaction Model of Client Health Behavior among adults with hypertension. The predictive associations among health literacy, quality of the provider interaction, perceived communication skills, and behavioral activation on blood pressure control were examined. Participants were 109 adults with hypertension recruited from community settings. A path analysis using maximum likelihood estimation was conducted in Analysis of Moment Structures for Windows (AMOS). The model fit to these data was excellent (χ(2) = 1.1, p = .76, Tucker-Lewis index [TLI] = 1.1, comparative fit index [CFI] = 1.0, root mean square error of approximation [RMSEA] = .00, standardized root mean residual [SRMR] = .03). As hypothesized, health literacy, quality of the provider interaction, and perceived communication skills directly affected behavioral action. The quality of the provider interaction, perceived communication skills, and behavioral activation had direct effects on systolic blood pressure control. The study results support health literacy screening and communication skill building, and improving the quality of provider interactions to enhance blood pressure control among adults with hypertension. PMID:26879829

  11. Determinants of concentric left ventricular hypertrophy in patients with resistant hypertension: RESIST-POL study.

    PubMed

    Dobrowolski, Piotr; Prejbisz, Aleksander; Klisiewicz, Anna; Florczak, Elżbieta; Rybicka, Justyna; Januszewicz, Andrzej; Hoffman, Piotr

    2015-08-01

    Left ventricular hypertrophy, especially concentric hypertrophy, has been shown to be an independent factor of cardiovascular diseases in patients with hypertension. Obstructive sleep apnea (OSA) and/or metabolic syndrome (MS) are common in patients with resistant hypertension (RHTN). The aim of this study was to evaluate factors associated with concentric hypertrophy in patients with RHTN. Data from 155 patients (92M, 63F) was analyzed. All patients underwent a thorough examination including: biochemical evaluations, ambulatory blood pressure monitoring, polysomnography and echocardiography. MS was defined by The Adult Treatment Panel III. Clinically significant OSA was defined as apnea/hypopnea index (AHI)>15 events per hour. Left ventricular mass index (LVMI) and relative wall thickness (RWT) were calculated. Four types of LV geometry were distinguished based on the LVMI and RWT. Patients were divided into four groups based on the LV geometric patterns: group 1 (normal geometry) (n=38, 24.4%); group 2 (concentric remodeling) (n=40, 25.8%); group 3 (eccentric hypertrophy) (n=26, 16.8%); and group 4 (concentric hypertrophy) (n=51, 33%). MS was found in 64% and OSA (AHI>15) in 43.2% of patients. Factors independently associated with concentric hypertrophy were: age (OR-1.51; 95% CI-1.00-2.27; P<0.04), OSA>15 events per hour (OR-2.73; 95% CI-1.26-5.93; P=0.01) and nighttime systolic blood pressure (SBP) (OR-1.69; 95% CI-1.32-2.17; P=0.0001). Concentric hypertrophy was the most common type of left ventricular disorder in patients with RHTN. Nighttime SBP and clinically significant OSA were independently associated with concentric hypertrophy in patients with RHTN. PMID:25787038

  12. Relationship between Duration of Sleep and Hypertension in Adults: A Meta-Analysis

    PubMed Central

    Wang, Yan; Mei, Hao; Jiang, Yan-Rui; Sun, Wan-Qi; Song, Yuan-Jin; Liu, Shi-Jian; Jiang, Fan

    2015-01-01

    Objectives: Epidemiologic studies have shown that chronic short sleep may be associated with the development of hypertension; however, the results are controversial. This meta-analysis was conducted to determine whether the duration of sleep is associated with hypertension. Methods: Reference databases (PubMed, EmBase, the Cochrane Library, Chinese Biological Medicine database) were searched for studies related to sleep duration and hypertension. Sleep duration categories (≤ 5 h, 6 h, 7 h, 8 h, ≥ 9 h) and prevalence or incidence of hypertension in each sleep category were extracted. A general analysis and subgroup analyses stratified by gender, age, study design, and different definitions of sleep duration were conducted to evaluate the relationship between sleep duration and hypertension. Results: Thirteen articles out of a total of 1,628 articles involving 347,759 participants met the inclusion criteria. A U-shaped change in pooled odds ratios (ORs) for hypertension due to the change of sleep duration was observed. The unadjusted OR for hypertension of individuals who slept ≤ 5 h vs 7 h was 1.61, 95% CI = 1.28–2.02; those who slept ≥ 9 h vs 7 h was 1.29, 95% CI = 0.97–1.71. The pooled ORs were still significant after adjusted by age and gender. Women deprived of sleep (sleep time ≤ 5 h vs 7 h, OR = 1.68, 95% CI = 1.39–2.03) had a higher risk of hypertension than men (OR = 1.30, 95% CI = 0.93–1.83). Conclusion: Excessively longer and shorter periods of sleep may both be risk factors for high blood pressure; these associations are stronger in women than men. Citation: Wang Y, Mei H, Jiang YR, Sun WQ, Song YJ, Liu SJ, Jiang F. Relationship between duration of sleep and hypertension in adults: a meta-analysis. J Clin Sleep Med 2015;11(9):1047–1056. PMID:25902823

  13. Pattern of blood pressure distribution and prevalence of hypertension and prehypertension among adults in Northern Ethiopia: disclosing the hidden burden

    PubMed Central

    2014-01-01

    Background Hypertension is the 3rd cause of death accounting for one in eight deaths worldwide. Hypertension was thought to be rare in Africa, but it is now recognized as one of the most important cerebrovascular diseases contributing to about 40% of these diseases in the continent. The aims of this study were to describe the pattern of blood pressure distribution among adults, and determine prevalence of prehypertension and hypertension among adults in Northern Ethiopia. Method The study was done on a community-based sample of 1183 adults of 697 (58.8%) urban and 486 (41.1%) rural residents using statistical multistage sampling procedures. The study was based on the recent WHO and JNC-7 classification of blood pressure. Multi-item structured questionnaires were also developed to elicit additional information on the subjects. Results The overall prevalence of hypertension and prehypertension in the study population was 18.1% and 37.2%, respectively. The prevalence of hypertension positively correlated with body mass index and age in both urban and rural residents (P = 0.001). Sex and age adjusted mean systolic blood pressure (SBP) was statistically higher in urban than in rural population (P = 0.001). Conclusion Hypertension was found to have high prevalence in the study region. However, people’s awareness and control of hypertension was found to be very poor. Lack of a clear hypertension prevention guidelines and strategies nationwide can aggravate the impact of cardiovascular diseases. PMID:24592854

  14. [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

  15. Early Life Environmental Exposures and Height, Hypertension, and Cardiovascular Risk Factors Among Older Adults in India

    PubMed Central

    Ho, Jessica Y.

    2015-01-01

    Environmental exposures like rainfall and temperature influence infectious disease exposure and nutrition, two key early life conditions linked to later life health. However, few tests of whether early life environmental exposures impact adult health have been performed, particularly in developing countries. This study examines the effects of experiencing rainfall and temperature shocks during gestation and up through the first four years after birth on measured height, hypertension, and other cardiovascular risk factors using data on adults aged 50 and above (N=1,036) from the 2007–2008 World Health Organization Study on Global Ageing and Adult Health (SAGE) and district-level meteorological data from India. Results from multivariate logistic regressions show that negative rainfall shocks during gestation and positive rainfall shocks during the post-birth period increase the risk of having adult hypertension and CVD risk factors. Exposure to negative rainfall shocks and positive temperature shocks in the post-birth period increases the likelihood of falling within the lowest height decile. Prenatal shocks may influence nutrition in utero, while postnatal shocks may increase exposure to infectious diseases and malnutrition. The results suggest that gestation and the first two years after birth are critical periods when rainfall and temperature shocks take on increased importance for adult health. PMID:26266969

  16. Relationship between blood pressure reverse dipping and type 2 diabetes in hypertensive patients

    PubMed Central

    Sun, Lu; Yan, Bin; Gao, Ya; Su, Dan; Peng, Liyuan; Jiao, Yang; Wang, Yuhuan; Han, Donggang; Wang, Gang

    2016-01-01

    Recent studies suggested that nocturnal variations of blood pressure (BP) were closely related to type 2 diabetes. However, little information has been revealed about the relationship between reverse-dipper pattern of BP and type 2 diabetes. In this cross-sectional study, BP variations of 531 hypertensive patients were evaluated with ambulatory BP monitoring (ABPM). Diagnosis of diabetes in Chinese adults was made according to diabetes diagnostic criteria of 2015. Multivariate logistic regression was used to examine the relationships between type 2 diabetes and ABPM results. In the study, patients with reverse-dipper pattern (32.3%) had the highest prevalence of type 2 diabetes compared with dippers (21.4%) and nondippers (23.3%). After multivariate logistic regression, reverse-dipper BP pattern (OR 2.067, P = 0.024) and nondipper BP pattern (OR 1.637, P = 0.039) were found to be correlated with type 2 diabetes compared with dipper pattern. The results of our study also suggested that type 2 diabetes might contribute to the reverse-dipper pattern of BP (OR 1.691, P = 0.023). In addition, fasting glucose was negatively correlated with the decline rate of nocturnal SBP (r = -0.095, P = 0.029). Reverse-dipper pattern of BP in ABPM may be independently associated with type 2 diabetes in patients with hypertension. PMID:27109832

  17. [Regional characteristics of arterial hypertension in adult population of Croatia].

    PubMed

    Erceg, Marijan; Hrabak-Zerjavić, Vlasta; Ivicević Uhernik, Ana

    2007-06-01

    between the east and south, west and City of Zagreb should be investigated. In the high blood pressure group, 76.5% of subjects had a body mass index greater than 25 and 48% ofthose with inadequate physical activity, both exceeding the rates recorded in persons with normal blood pressure. Whereas 58.6% of the subjects knew they had elevated blood pressure, 48.4% of them were taking their therapy, and only 14.8% kept their blood pressure under control (systolic <140 mm Hg and diastolic <90 mm Hg). Arterial hypertension is a major public health problem in all regions of Croatia. The available literature data suggest that the Croatia's share of individuals with high blood pressure is comparable to that in industrialized countries of continental Europe. The prevention of excessive body weight, also through increased physical activity of the population and changes in poor dietary habits, remains the essential element in planning primary prevention programs for high blood pressure. Raising the population's awareness of the problem, early detection of high blood pressure and encouraging the population to take regular therapy for high blood pressure, along with the adoption of healthy lifestyle are important factors in achieving effective control and alleviating the consequences of hypertension. PMID:17629105

  18. 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

  19. Consistency with the Dietary Approaches to Stop Hypertension Diet among Adults with Diabetes

    PubMed Central

    Morton, Suzanne; Saydah, Sharon; Cleary, Sean D.

    2015-01-01

    Few studies have documented whether the dietary patterns of adults with diabetes are similar to the Dietary Approaches to Stop Hypertension (DASH) diet. Our objective was to determine differences in the degree of consistency with the DASH diet among adults with self-reported diabetes (with and without self-reported high blood pressure) compared with those without either disease. It was a cross-sectional study using data from 5,867 nonpregnant, noninstitutionalized adults aged ≥20 years with two reliable 24-hour recall dietary interviews in the National Health and Nutrition Examination Survey during 2003–2004 and 2005–2006. Diabetes and hypertension status were obtained from a questionnaire, and degree of consistency with the DASH diet was calculated based on nine nutrient targets (0- to 9-point DASH score). Multiple linear regression (adjusting for age, energy intake, and other covariates such as education, race, and body mass index) was performed to compare mean DASH scores and mean nutrient intakes among adults with diabetes, with and without high blood pressure, to those without either disease. No statistically significant differences were seen in mean DASH score among the three groups in the unadjusted or fully adjusted multivariable models. Compared with adults without either disease, those with only diabetes had higher intakes of fiber (8.1 g/1,000 kcal vs 7.6 g/1,000 kcal; P=0.02) and total fat as a percentage of total energy (35.3% vs 34.1%; P=0.006), and those with both diabetes and hypertension had higher sodium intake (153.0% of DASH target vs 146.6%; P=0.04). This information about individual nutrients could help guide the development of education programs. PMID:23102178

  20. Effects of exposure to violence with a weapon during adolescence on adult hypertension

    PubMed Central

    Browning, Christopher R.

    2014-01-01

    Objectives Examine the longitudinal associations between exposure to violence with a weapon during the past year among adolescents and hypertension during adulthood, including the extent to which adult cardiovascular risk factors mediated the association. Methods Secondary analysis of the National Longitudinal Study of Adolescent Health, 1994–2008. The sample included 3555 male and 4416 female adults who were aged 11 to 17 years at wave 1 (1994–1995). Participants were categorized as hypertensive if they had a mean systolic blood pressure ≥ 140 mmHg or a mean diastolic pressure ≥ 90 mmHg at wave 4 (2008). Witnessed violence with a weapon was defined as having seen a shooting or stabbing during the year prior to wave 1 while victim of violence with a weapon was defined as having been shot, cut or stabbed, or had a gun or knife drawn on them during the year prior to wave 1. Potential mediators of adult cardiovascular risk (wave-4) included body mass index, daily smoking, alcohol abuse, and depression. Results Males who witnessed violence and females who were victims of violence in the year prior to wave 1 had an increased odds of hypertension at wave 4 compared to their unexposed peers (AOR=1.45, 95% CI=1.003, 2.10; AOR=1.72, 95% CI=1.04, 2.84, respectively). The hypothesized adult cardiovascular risk mediators did not significantly attenuate the associations for either the male or female samples. Conclusions Interventions addressing prior violence exposure are needed to promote adult cardiovascular health. PMID:24530410

  1. Sex-specific effects of social networks on the prevalence, awareness, and control of hypertension among older Korean adults

    PubMed Central

    Baek, Jiwon; Hur, Nam Wook; Kim, Hyeon Chang; Youm, Yoosik

    2016-01-01

    Background Hypertension is a common chronic disease among older adults, and is associated with medical complications and mortality. This study aimed to examine the effects of social network characteristics on the prevalence, awareness, and control of hypertension among older adults. Methods The Korean Social Life, Health, and Aging Project (KSHAP) interviewed 814 ≥ 60-year-old residents and their spouses from a rural township between December 2011 and March 2012 (response rate: 95%). We evaluated the data from 595 participants. Multivariate logistic regression models were used to assess the effects of network characteristics on hypertension. Results We observed strong sex-specific network effects on the prevalence, awareness, and control of hypertension. Among older women, network density was associated with hypertension awareness [odds ratio (OR): 2.63, 95% confidence interval (CI): 1.03–5.37] and control (OR: 1.72; 95% CI: 0.94–3.13). Among older men, large networks were associated with a lower prevalence of hypertension (OR: 0.75; 95% CI: 0.58–0.96). Compared to older women, older men with coarse networks exhibited better hypertension awareness (OR: 0.37; 95% CI: 0.14–0.95) and control (OR: 0.42; 95% CI: 0.19–0.91). Network size interacted with density for hypertension control (P = 0.051), with controlled hypertension being associated with large and course networks. Conclusions A large network was associated with a lower risk for hypertension, and a coarse network was associated with hypertension awareness and control among older men. Older women with dense networks were most likely to exhibit hypertension awareness and control. PMID:27605938

  2. [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

  3. [Clinical and tomographic aspects of hemorrhagic cerebrovascular disease associated with hypertensive crisis in adults under 50 years of age].

    PubMed

    Arismendi-Morillo, G J; Fernández-Abreu, M; Añez-Moreno, R E

    2000-09-01

    The purpose of this study was to analyze both the clinical and tomographic aspects of the hemorrhagic cerebrovascular disease (HCd), associated with hypertensive crisis in adults under 50 years of age. Forty six patients, who were not under anticoagulant therapy, were not using illegal drugs, who had not a cerebral tumor disease, and who had neither arteriovenous malformations nor past traumatic episodes, were studied. Seventy eight percent of the patients had preexisted arterial hypertension, 30% of them had at least a previous emergency for a hypertensive crisis. Mortality for intracerebral hematoma (ICH) and for subarachnoid hemorrhage (SAH) was 21% and 23% respectively. In 68% of the cases, ICH was located in the deep structures of the brain. Asymmetric ventricular system, compression or the absence of mesencephalic cisterna were significantly associated (p > 0.01; p > 0.001 respectively) with higher mortality. There was not a significant difference between the deceased and the survivors in relation with their systolic and diastolic arterial pressure on admission to the emergency unit. A significant positive relation was found between the severity of the injury (percentage of patients with an Scale Coma Glasgow < or = 8 points) and the mortality percentage for the type of HCd (r = 0.81 for ICH; p < 0.001, r = 0.98 for SAH; p < 0.001). Age and a low Scale Coma Glasgow score on the admission, represent unfavorable prognostic factors. Due to the different criteria used to evaluate the tomographic characteristics of intracerebral hematomas, comparisons of the present results with other findings can be difficult. PMID:11029832

  4. Prevalence of taking actions to control blood pressure among adults with self-reported hypertension in 18 states and the District of Columbia, 2009.

    PubMed

    Ayala, Carma; Fang, Jing; Yuan, Keming

    2015-03-01

    The authors used 2009 Behavioral Risk Factor Surveillance System data to assess the prevalence of taking actions to control hypertension among adults with self-reported hypertension. Differences by descriptive characteristics (sex, age, race/ethnicity, access to health care, medication adherence), presence of other health risk factors (overweight/obesity, smoking, heavy drinking, inadequate fruit/vegetable intake, and physical inactivity), and comorbidities (diabetes, high cholesterol, coronary heart disease, and stroke) were compared. The prevalence of hypertension was 29.6%, and 75.0% of these patients reported taking antihypertensive medications, 73.1% changed eating habits, 72.8% decreased the use of salt, 78.8% reduced alcohol consumption, and 69.9% increased their physical activity. Overall, 87.2% reported taking two or more actions to reduce blood pressure. Patients taking antihypertensive medications were more likely to take two or more actions than their counterparts (90.6% vs 79.4%, P<.01). Those with at least one other health risk factor were 1.85 times as likely to take two or more actions as their counterparts (95% confidence interval, 1.18-2.92 times). More than 80% of hypertensive adults reported taking two or more actions to control blood pressure. The prevalence of taking actions differed significantly by descriptive characteristics, the presence health risk factors, and comorbidities. PMID:25644363

  5. Prevalence of Hypertension among Adults in Remote Rural Areas of Xinjiang, China

    PubMed Central

    Wang, Yulin; Zhang, Jingyu; Ding, Yusong; Zhang, Mei; Liu, Jiaming; Ma, Jiaolong; Guo, Heng; Yan, Yizhong; He, Jia; Wang, Kui; Li, Shugang; Ma, Rulin; Murat, Bek; Guo, Shuxia

    2016-01-01

    Objective: The present study aimed to estimate prevalence of hypertension among adults in rural remote areas of Xinjiang, China and evaluate the associated factors of hypertension. Methods: The survey was based on questionnaire interviews and clinical measurements of 11,340 individuals (≥18 years old), and was conducted during 2009–2010 via a stratified cluster random sampling method in the remote rural areas of Xinjiang, about 4407 km away from the capital Beijing. Hypertension was defined according to WHO/ISH criteria. Results: Systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the population were (126.3 ± 21.4) and (80.9 ± 13.4) mmHg. Compared with Han nationality subjects, SBP and DBP of Kazakh nationality subjects were significantly high (p < 0.05), while the SBP and DBP of Uyghur subjects were significantly low (Kazakh: (128.7 ± 23.9) and (83.0 ± 14.6) mmHg, Uyghur: (123.6 ± 19.3) and (77.4 ± 12.7) mmHg, Han: (126.5 ± 20.5) and (82.6 ± 11.9) mmHg, p < 0.05). Prevalence of hypertension of the population was 32.1%, and was greater among Kazakhs and lower among Uyghur than Han (Kazakh: 36.9%, Uyghur: 26.1%, Han: 33.7%, p < 0.05). The age-standardized prevalence of hypertension was 30.2%, and was greater among Kazakhs while lower among Uyghurs than Han subjects (Kazakh: 37.0%, Uyghur: 26.0%, Han: 33.8%, p < 0.05, p < 0.05). Multivariate logistic regression analyses showed Gender (OR = 1.324), age (OR = 2.098, 3.681, 6.794, 9.473, 14.646), nationality (OR = 1.541), occupation (OR = 1.659, 1.576), education (OR = 1.260), BMI (OR = 1.842), WC (OR = 1.585), WHR (OR = 1.188), WHR (OR = 1.188), diabetes (OR = 1.879), hypertriglyceridemia (OR = 1.361), hypercholesterolemia (OR = 1.131) and high blood low density lipoprotein cholesterol (LDL-C) (OR = 1.956) were all positively correlated with hypertension, while low blood high density lipoprotein cholesterol (HDL-C) (OR = 0.765) was negatively correlated with hypertension. Conclusions

  6. Evidence for exercise training in the management of hypertension in adults

    PubMed Central

    Ghadieh, Alexandra S.; Saab, Basem

    2015-01-01

    Abstract Objective To provide recommendations on exercise training as part of the management of hypertension in adults. Quality of evidence Evidence was found through a systematic search of PubMed, MEDLINE, EMBASE, Agency for Healthcare Research and Quality evidence-based reports, Bandolier, Clinical Evidence, the Institute for Clinical Systems Improvement guidelines, the National Guideline Clearinghouse database, UpToDate, and the Cochrane Database of Systematic Reviews (part of Ovid Evidence Based Medicine Reviews) for articles published from January 1973 to September 2013. Study types were limited to meta-analyses, randomized controlled trials, clinical trials, and reviews. Main message Exercise exerts an anti-inflammatory action through the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis, and has direct effects on blood pressure. The resulting physiologic effects are classified as acute, postexercise, and chronic. Current treatment guidelines emphasize the role of nonpharmacologic interventions, including physical activity, in the management of mild to moderate hypertension. Conclusion Moderate intensity aerobic exercise has been proven to prevent hypertension and to help in the management of stage 1 hypertension. Dynamic resistance exercises, if done properly, contribute to lowering both systolic and diastolic blood pressures. There is insufficient evidence about the safety and efficacy of isometric resistance training to recommend it. PMID:25927108

  7. 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

  8. 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

  9. 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

  10. Midterm results of “treat and repair” for adults with non-restrictive ventricular septal defect and severe pulmonary hypertension

    PubMed Central

    Hu, Zhenlei; Xie, Bo; Zhai, Xinming; Liu, Jidong; Gu, Jianmin; Wang, Xudong; Zheng, Hui

    2015-01-01

    Background A non-restrictive ventricular septal defect (VSD) can cause intracardiac left to right shunt, which leads to increased pulmonary vascular resistance (PVR) and pulmonary hypertension causes bi-directional or even right-left shunt, namely the Eisenmenger’s syndrome. For patients with non-restrictive VSD with severe pulmonary hypertension at stage of near or to be Eisenmenger’s syndrome, traditional VSD repair carries high mortality and poor prognosis. Recently, targeted drug therapy was used to decrease pulmonary circulation resistance in these patients before they receive defect repair surgery, namely “treat and repair” strategy, however, there is few reports about the midterm result of this strategy in adults with non-restrictive VSD with severe pulmonary hypertension at stage of near or to be Eisenmenger’s syndrome. Methods In this study, we used this strategy to treat 41 adult VSD patients who received bosentan as the targeted therapy to decrease their PVR before and after repair surgery. Results A total of 39 patients were followed up for an average of 37 months. None of the patients died during follow-up. Among them, 36 cases continued targeted drug therapy, whose mean pulmonary artery pressure (mPAP) was significantly reduced, including 31 cases with mPAP <50 mmHg, and the valve of tap hole was closed. Besides, the SpO2 was significantly elevated. Conclusions These results demonstrated that “treat-and-repair” strategy may be a viable approach for the adults with non-restrictive VSD with severe pulmonary hypertension at stage of near or to be Eisenmenger’s syndrome. PMID:26380732

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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

  19. Hypertension among HIV-Infected Adults Receiving Highly Active Antiretroviral Therapy (HAART) in Malaysia

    PubMed Central

    Hejazi, Nazisa; MSL, Huang; Lin, Khor Geok; Choong, Lee Christopher Kwok

    2014-01-01

    There are increasing researches about non-communicable disease such as elevated blood pressure among people living with HIV before and after initiation of highly active antiretroviral therapy (HAART). This cross-sectional study was designed to determine the prevalence of hypertension and associated risk factors among 340 HIV-infected patients on antiretroviral therapy at a Malaysian public hospital providing HIV-related treatment. Data on socioeconomic background, anthropometry, medical history and dietary intake of the patients were collected. Hypertension is defined as blood pressure ≥130/85 (mm Hg). Prevalence of hypertension was 45.60% (n=155) of which 86.5% of the hypertensive group were male (n=134). The results showed that increase in age (OR 1.051, 95% confidence interval (CI) 1.024-1.078), higher body mass index (OR 1.18, 95% CI 1.106-2.71), bigger waist circumference (OR 1.18, 95%CI 1.106-2.71), higher waist-hip ratio (OR 1.070, 95%CI 1.034-1.106), higher fasting plasma glucose (OR 1.332, 95% CI 0.845-2.100) and percentage energy intake from protein >15 (OR 2.519, 95%CI 1.391-4.561) were significant risk factors for hypertension (p<0.001). After adjusting for other variables, increasing age (adjusted odds ratio (aOR) 1.069 95%CI 1.016-1.124, p=0.010), being male (aOR 3.026, 95%CI 1.175-7.794, p=0.022) and higher body mass index (aOR 1.26, 95%CI 1.032-1.551, p=0.024) were independently associated with hypertension. None of the antiretroviral therapy and immunologic factors was linked to hypertension. In conclusion hypertension among PLHIV was linked to the well-known risk factors such as age, gender and body mass index. With HAART, people can live longer by making monitoring and control of some reversible factors, especially excessive weight gain for maintaining quality of life. PMID:24576366

  20. Exercise Blood Pressure and the Risk for Future Hypertension Among Normotensive Middle‐Aged Adults

    PubMed Central

    Berger, Assaf; Grossman, Ehud; Katz, Moshe; Kivity, Shaye; Klempfner, Robert; Segev, Shlomo; Goldenberg, Ilan; Sidi, Yehezkel; Maor, Elad

    2015-01-01

    Background The aim of the present study was to examine whether exercise blood pressure can be used to predict the development of hypertension in normotensive middle‐aged adults. Methods and Results We investigated 7082 normotensive subjects who were annually screened in a tertiary medical center and completed maximal treadmill exercise tests at each visit. After the initial 3 years, subjects were divided into approximate quartiles according to their average exercise systolic and diastolic blood pressure responses (≤158; 158 to 170; 170 to 183; ≥183 mm Hg for systolic blood pressure and ≤73; 73 to 77; 77 to 82; ≥82 mm Hg for diastolic blood pressure). Mean age of the study population was 48±9 years and 73% were men. Average baseline resting blood pressure was 120/77±12/7 mm Hg. During a follow‐up of 5±3 years, 1036 (14.6%) subjects developed hypertension. The cumulative probability of new‐onset hypertension at 5 years was significantly increased with increasing quartiles of exercise systolic blood pressure (5%, 9%, 17%, and 35%, respectively; P<0.001), with a similar association shown for diastolic blood pressure. After adjustment for baseline resting blood pressure and clinical parameters, each 5‐mm Hg increments in exercise either systolic or diastolic blood pressures were independently associated with respective 11% (P<0.001) and 30% (P<0.001) increased risk for the development of hypertension. Conclusions In normotensive middle‐aged individuals, blood pressure response to exercise is associated with future development of hypertension. PMID:25904593

  1. An Update on Inpatient Hypertension Management.

    PubMed

    Axon, R Neal; Turner, Mason; Buckley, Ryan

    2015-11-01

    Hypertension is highly prevalent affecting nearly one third of the US adult population. Though generally approached as an outpatient disorder, elevated blood pressure is observed in a majority of hospitalized patients. The spectrum of hypertensive disease ranges from patients with hypertensive emergency including markedly elevated blood pressure and associated end-organ damage to asymptomatic patients with minimally elevated pressures of unclear significance. It is important to note that current evidence-based hypertension guidelines do not specifically address inpatient hypertension. This narrative review focuses primarily on best practices for diagnosing and managing nonemergent hypertension in the inpatient setting. We describe examples of common hypertensive syndromes, provide suggestions for optimal post-acute management, and point to evidence-based or consensus guidelines where available. In addition, we describe a practical approach to managing asymptomatic elevated blood pressure observed in the inpatient setting. Finally, arranging effective care transitions to ensure optimal ongoing hypertension management is appropriate in all cases. PMID:26362300

  2. Hypertension impairs hippocampus-related adult neurogenesis, CA1 neuron dendritic arborization and long-term memory.

    PubMed

    Shih, Y-H; Tsai, S-F; Huang, S-H; Chiang, Y-T; Hughes, M W; Wu, S-Y; Lee, C-W; Yang, T-T; Kuo, Y-M

    2016-05-13

    Hypertension is associated with neurodegenerative diseases and cognitive impairment. Several studies using spontaneous hypertensive rats to study the effect of hypertension on memory performance and adult hippocampal neurogenesis have reached inconsistent conclusions. The contradictory findings may be related to the genetic variability of spontaneous hypertensive rats due to the conventional breeding practices. The objective of this study is to examine the effect of hypertension on hippocampal structure and function in isogenic mice. Hypertension was induced by the '2 kidneys, 1 clip' method (2K1C) which constricted one of the two renal arteries. The blood pressures of 2K1C mice were higher than the sham group on post-operation day 7 and remained high up to day 28. Mice with 2K1C-induced hypertension had impaired long-term, but not short-term, memory. Dendritic complexity of CA1 neurons and hippocampal neurogenesis were reduced by 2K1C-induced hypertension on post-operation day 28. Furthermore, 2K1C decreased the levels of hippocampal brain-derived neurotrophic factor, while blood vessel density and activation status of astrocytes and microglia were not affected. In conclusion, hypertension impairs hippocampus-associated long-term memory, dendritic arborization and neurogenesis, which may be caused by down-regulation of brain-derived neurotrophic factor signaling pathways. PMID:26921651

  3. 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

  4. Community-Based Mind-Body Meditative Tai Chi Program and Its Effects on Improvement of Blood Pressure, Weight, Renal Function, Serum Lipoprotein, and Quality of Life in Chinese Adults With Hypertension.

    PubMed

    Sun, Jing; Buys, Nicholas

    2015-10-01

    Obesity, metabolic syndrome, dyslipidemia, and poor quality of life are common conditions associated with hypertension, and incidence of hypertension is age dependent. However, an effective program to prevent hypertension and to improve biomedical factors and quality of life has not been adequately examined or evaluated in Chinese older adults. This study aims to examine the effectiveness of a Tai Chi program to improve health status in participants with hypertension and its related risk factors such as dyslipidemia, hyperglycemia, and quality of life in older adults in China. A randomized study design was used. At the conclusion of the intervention, 266 patients remained in the study. Blood pressure and biomedical factors were measured according to the World Diabetes Association standard 2002. A standardized quality-of-life measure was used to measure health-related quality of life. It was found that a Tai Chi program to improve hypertension in older adults is effective in reducing blood pressure and body mass index, maintaining normal renal function, and improving physical health of health-related quality of life. It did not improve existing metabolic syndrome levels, lipid level (dyslipidemia) or fasting glucose level (hyperglycemia), to prevent further deterioration of the biomedical risk factors. In conclusion, Tai Chi is effective in managing a number of risk factors associated with hypertension in Chinese older adults. Future research should examine a combination of Tai Chi and nutritional intervention to further reduce the level of biomedical risks. PMID:26251005

  5. Hypertension among older adults in low- and middle-income countries: prevalence, awareness and control

    PubMed Central

    Lloyd-Sherlock, Peter; Beard, John; Minicuci, Nadia; Ebrahim, Shah; Chatterji, Somnath

    2014-01-01

    Background This study uses data from the World Health Organization’s Study on Global Ageing and Adult Health (SAGE) to examine patterns of hypertension prevalence, awareness, treatment and control for people aged 50 years and over in China, Ghana, India, Mexico, the Russian Federation and South Africa. Methods The SAGE sample comprises of 35 125 people aged 50 years and older, selected randomly. Hypertension was defined as ≥140 mmHg (systolic blood pressure) or ≥90 mmHg (diastolic blood pressure) or by currently taking antihypertensives. Control of hypertension was defined as blood pressure below 140/90 mmHg on treatment. A person was defined as aware if he/she was hypertensive and self-reported the condition. Results Prevalence rates in all countries are broadly comparable to those of developed countries (52.9%; range 32.3% in India to 77.9% in South Africa). Hypertension was associated with overweight/obesity and was more common in women, those in the lowest wealth quintile and in heavy alcohol consumers. Awareness was found to be low for all countries, albeit with substantial national variations (48.3%; range 23.3% in Ghana to 72.1% in the Russian Federation). This was also the case for control (10.2%; range 4.1% in Ghana to 14.1% India) and treatment efficacy (26.3%; range 17.4% in the Russian Federation to 55.2% in India). Awareness was associated with increasing age, being female and being overweight or obese. Effective control of hypertension was more likely in older people, women and in the richest quintile. Obesity was associated with poorer control. Conclusions The high rates of hypertension in low- and middle-income countries are striking. Levels of treatment and control are inadequate despite half those sampled being aware of their condition. Since cardiovascular disease is by far the largest cause of years of life lost in these settings, these findings emphasize the need for new approaches towards control of this major risk factor. PMID:24505082

  6. 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

  7. 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

  8. 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

  9. Understanding Perceptions and Practices for Zambian Adults in Western Province at Risk for Hypertension: An Exploratory Descriptive Study

    PubMed Central

    Oelke, Nelly D.; Rush, Kathy L.; Goma, Fastone M.; Barker, Jessica; Marck, Patricia; Pedersen, Chloe

    2016-01-01

    Hypertension is an important public health issue in Zambia. Despite the need for early detection, treatment, and ongoing monitoring, there is little documented research on hypertension in Zambia. The study aims were to: 1) better understand risk factors for hypertension in urban and rural communities in Mongu and Limulunga Districts, Western Province; 2) identify current health practices for hypertension and prevention in these communities; and 3) explore intersections between culture and hypertension perceptions and practices for study participants. A mixed methods approach was used; 203 adults completed surveys including demographics, anthropometric measures, blood pressure (BP), physicial activity, diet, and salt intake at five health check stations. Two focus groups were conducted with rural and urban community members to better understand their perspectives on hypertension. The prevalence of hypertension was 32.8% for survey participants. A further 24.6% had pre-hypertension. The mean total weight of salt added to food was nearly double the WHO recommendation with women adding significantly more salt to food than men. Significant differences in waist circumference were observed between men and women with men at low risk and women at substantialy high risk. In focus groups, participants cited westernized diets, lack of physical activity, stress, psychological factors, and urbanization as causative factors for hypertension. Participants lacked understanding of BP medications, healthy lifestyles, adherence to treatment, and ongoing monitoring. Focus group participants mentioned challenges in obtaining treatment for hypertension and desired to be active contributors in creating solutions. They recommended that government priorize hypertension initiatives that increase access to health education to reduce risk, enhance early detection, and support lifestyle changes and medication adherence. Our findings suggest that policy-makers need to engage communities more

  10. Antenatal Antioxidant Prevents Nicotine-Mediated Hypertensive Response in Rat Adult Offspring.

    PubMed

    Xiao, DaLiao; Huang, Xiaohui; Li, Yong; Dasgupta, Chiranjib; Wang, Lei; Zhang, Lubo

    2015-09-01

    Previous studies have demonstrated that perinatal nicotine exposure increased blood pressure (BP) in adult offspring. However, the underlying mechanisms were unclear. The present study tested the hypothesis that perinatal nicotine-induced programming of hypertensive response is mediated by enhanced reactive oxygen species (ROS) in the vasculature. Nicotine was administered to pregnant rats via subcutaneous osmotic mini-pumps from Day 4 of gestation to Day 10 after birth, in the absence or presence of the ROS inhibitor N-acetyl-cysteine (NAC) in the drinking water. Experiments were conducted in 8-mo-old male offspring. Perinatal nicotine treatment resulted in a significant increase in arterial ROS production in offspring, which was abrogated by NAC. Angiotensin II (Ang II)-induced BP responses were significantly higher in nicotine-treated group than in saline-treated control group, and NAC treatment blocked the nicotine-induced increase in BP response. Consistent with that, the nicotine treatment significantly increased both Ang II-induced and phorbol [12, 13]-dibutyrate (PDBu, a Prkc activator)-induced arterial contractions in adult offspring, which were blocked by NAC treatment. In addition, perinatal nicotine treatment significantly attenuated acetylcholine-induced arterial relaxation in offspring, which was also inhibited by NAC treatment. Results demonstrate that inhibition of ROS blocks the nicotine-induced increase in arterial reactivity and BP response to vasoconstrictors in adult offspring, suggesting a key role for increased oxidative stress in nicotine-induced developmental programming of hypertensive phenotype in male offspring. PMID:26224008

  11. TIPS treatment in a patient with severe lower gastrointestinal bleeding with a misdiagnosis of cirrhotic portal hypertension.

    PubMed

    Laborda, Alicia; Guirola, José Andrés; Medrano, Joaquín; Simón, Miguel Ángel; Ioakeim, Ignatios; de-Gregorio, Miguel Ángel

    2015-12-01

    Abernethy malformation is a rare abnormal embryological development of splanchnic venous system characterised by the presence of a congenital extrahepatic portosystemic shunt. We present a rare case of an adult male patient that was admitted with severe lower gastrointestinal bleeding, requiring multiple blood transfusions. The patient's medical history and the laboratory tests performed led to the misdiagnosis of a congenital Abernethy malformation. We present a rare case, discussing the reasons for the misdiagnosis and we conclude that management of clinical data and imaging are highly important to discard these types of congenital malformations that can mimic a portal hypertension condition. PMID:26671592

  12. 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

  13. 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

  14. 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

  15. 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…

  16. 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…

  17. Incorporating Hypertensive Patient Education on Salt Intake Into an Introductory Pharmacy Practice Experience

    PubMed Central

    Westrick, Salisa C.; Teeter, Benjamin S.; Stevenson, T. Lynn

    2013-01-01

    Objective. To evaluate the impact of the Salt Education Program for hypertensive adults on student pharmacists' knowledge, behaviors, and attitudes regarding sodium consumption. Design. As part of the introductory pharmacy practice experience program in community pharmacies, student pharmacists assessed patients' sodium intake knowledge and behaviors, taught them how to read nutrition labels, and obtained information about their hypertensive conditions. Students completed pre-and post-intervention questionnaires in April and August 2012, respectively. Assessment. One hundred thirty student pharmacists (70% female, 78% white) completed pre- and post-intervention questionnaires. Students demonstrated significant improvements in knowledge scores (p<0.001) and perceived benefit of a low-salt diet (p=0.004). Further, there were significant improvements in the self-reported frequency of looking at sodium content of foods when shopping (p<0.001) and purchasing low-salt foods (p=0.004). Conclusion. Changes in students' knowledge, behaviors, and attitudes after participating in the Salt Education program suggested that the program was effective in improving student knowledge, behaviors, and attitudes. PMID:24249861

  18. 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

  19. [Rare forms of hypertension : From pheochromocytoma to vasculitis].

    PubMed

    Haller, H; Limbourg, F; Schmidt, B M; Menne, J

    2015-03-01

    Secondary hypertension affects only 5-10 % of hypertensive patients. Screening is expensive and time-consuming and should be performed only in patients for whom there is a high clinical suspicion of secondary hypertension. Clinical signs of secondary forms of hypertension are new-onset hypertension in patients without other risk factors (i.e., family history, obesity, etc.), sudden increase of blood pressure (BP) in a previously stable patient, increased BP in prepubertal children, resistant hypertension, and severe hypertension or hypertensive emergencies. In adults, renal parenchymal and vascular diseases as well as obstructive sleep apnea are the most common causes of secondary hypertension. Medication-induced hypertension and non-adherence to medication have to be ruled out. Of the endocrine causes associated with hypertension, primary aldosteronism is the most common. Other endocrine causes of hypertension such as thyroid disease (hypo- or hyperthyroidism), hypercortisolism (Cushing's syndrome), hyperparathyroidism, and pheochromocytoma are rare. Monogenetic forms of hypertension are mostly of tubular origin and associated with alterations in mineralocorticoid handling or signaling. Rare causes of hypertension also include inflammatory vascular disease. Acute forms of vasculitis may present as "malignant" hypertension with associated thrombotic microangiopathy and organ damage/failure. It is important to diagnose these rare forms of hypertension in order to prevent acute organ damage in these patients or unnecessary invasive treatment strategies. PMID:25700646

  20. Design considerations for adult patient education.

    PubMed

    Walsh, P L

    1982-01-01

    A variety of factors require attention in the design of patient education programs for adults. Andragogy, the art and science of helping adults learn, describes certain conditions of learning that are more conducive to growth and development for adults and prescribes practices in the learning-teaching transaction to meet them. Stigma, a special discrepancy between virtual and actual social identity, reduces a patient's self-esteem and fosters a feeling of dependence on others for care. Anxiety related to diagnosis and illness creates a situation in which patients cannot productively learn. The stages in acceptance of diagnosis provide a roadmap for understanding a patient's feelings/psychological processes and insight into opportunities to intervene with patient education. The specific disease a patient has effects his ability to learn. Each of these factors is considered with implications described for designing and implementing patient education activities for adults. PMID:10258421

  1. 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

  2. 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

  3. Adherence To JNC-VII and WHO-ISH guidelines of antihypertensive medications prescribed to hypertensive patients with co-morbid conditions.

    PubMed

    Kothari, Nitin; Ganguly, Barna

    2015-01-01

    The present study aims at comparing the prescribing pattern of antihypertensive drugs in essential hypertension with specific co-morbid conditions with JNC-VII and WHO-ISH guidelines. Adult patients of both sex, who were attending medicine OPD of Shri Krishna Hospital, Karamsad, Gujarat since last 6 months and being prescribed antihypertensive drug/s for hypertension, were selected for the study. Hypertensive patients with co-morbities diabetes mellitus, ischemic heart diseases, congestive heart failure, and chronic renal diseases were included in the study. Adherence to JNC-VII guideline and WHO-ISH guidelines with respect to prescribing antihypertensive drugs in patients with diabetes mellitus were found to be 97% and 40.81% respectively, while it was found to be 72.27% to both the guidelines in patients with IHD. Similarly in cases of hypertension with CHF, adherence to prescribing antihypertensive were found to be 93.62% and 38.30% respectively, whereas for CKD patients, adherence to both guidelines was found to be same i.e. 33.33%. There is need of following such authentic guidelines in managing hypertension like chronic disease since these guidelines are based on various clinical trials and successful attainment of target BP in patients will be much easier by implementing them. PMID:26571984

  4. 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

  5. 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

  6. [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

  7. [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

  8. 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

  9. 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

  10. 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

  11. The HYPERFlax trial for determining the anti-HYPERtensive effects of dietary flaxseed in newly diagnosed stage 1 hypertensive patients: study protocol for a randomized, double-blinded, controlled clinical trial

    PubMed Central

    2014-01-01

    Background In 2013 the World Health Organization deemed hypertension as a global crisis as it is the leading risk factor attributed to global mortality. Therefore, there is a great need for effective alternative treatment strategies to combat a condition that affects 40% of adults worldwide. Recently, the FlaxPAD Trial observed a significant reduction in systolic and diastolic blood pressure in hypertensive patients with peripheral arterial disease that consumed 30 g of milled flaxseed per day for one year. However, these patients were already on anti-hypertensive medication. Therefore, there is a need to assess if dietary flaxseed can effectively reduce blood pressure in the absence of peripheral arterial disease and anti-hypertensive medication in newly diagnosed hypertensive patients. Methods/Design The HYPERFlax Trial is a parallel, superiority, phase II/III, randomized, double-blinded, controlled clinical trial. St. Boniface Hospital and the Health Sciences Centre of Winnipeg, Canada, will recruit 100 participants newly diagnosed with stage 1 hypertension who have yet to be administered anti-hypertensive medication. Participants will be randomly allocated with a 1:1 ratio into a flaxseed or control group and provided food products to consume daily for six months. At baseline, two, four, and six months, participant assessments will include the primary outcome measure, averaged automated blood pressure, and secondary measures: 24-hour food recall, international physical activity questionnaire, anthropometrics, and blood and urine sampling for biochemical analysis. Plasma will be assessed for lipids, metabolomics profiling, and molecules that regulate vascular tone. Urine will be collected for metabolomics profiling. With an estimated dropout rate of 20%, the trial will have a power of 0.80 to detect differences between groups and across time, out of an effect size of 0.7 (SD) at an α level of 0.05. Discussion This trial will determine if dietary flaxseed is

  12. 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

  13. Anatomical considerations for the development of a new transcatheter aortopulmonary shunt device in patients with severe pulmonary arterial hypertension

    PubMed Central

    2013-01-01

    Abstract Morbidity from pulmonary arterial hypertension (PAH) ensues when the pulmonary pressure reaches suprasystemic levels. A transcatheter alternative to the Potts shunt would allow decompression of the right heart without the surgical risks. To aid development of a transcatheter aortopulmonary shunt (TAPS) device, we described the anatomic relationship between the left pulmonary artery (LPA) and the descending aorta (dAO) in adults with severe pulmonary hypertension. Adults with severe PAH (peak systolic pulmonary arterial pressure [PASP] ≥80 mmHg) who had computed tomography of the chest were enrolled. Measurements were taken on the axial plane at the level of the pulmonary artery bifurcation. Forty patients (male sex, 9 patients; median age ± standard deviation [SD], years; median PASP ± SD, mmHg) were identified. The mean distance (±SD) between the LPA and dAO was mm. The mean luminal dAO and LPA diameters (±SD) were mm and mm, respectively. The LPA and dAO approximated in 93% of patients, with 38% having aortic calcification at the contact site. The mean “landing zone” width and height (defining an area with distance <4 mm between the outer borders) of the two arteries were mm and mm, respectively, at a mean distance of mm from the main pulmonary artery bifurcation. This study shows that the landing zone is able to accommodate a TAPS device of up to 15 mm in diameter in the majority of patients with severe PAH. PMID:24618548

  14. Post-operative acute kidney injury in non-suprainguinal vascular surgery patients with a pre-operative history of hypertension

    PubMed Central

    Moodley, Yoshan; Biccard, Bruce M.

    2015-01-01

    Hypertension is an independent predictor of acute kidney injury (AKI) in non-cardiac surgery patients. There are a few published studies which report AKI following non-suprainguinal vascular procedures, but these studies have not investigated predictors of AKI, including anti-hypertensive medications and other comorbidities, in the hypertensive population alone. We sought to identify independent predictors of post-operative AKI in non-suprainguinal vascular surgery patients with a pre-operative history of hypertension. We performed univariate (chi-squared, or Fisher's exact testing) and multivariate (binary logistic regression) statistical analysis of prospectively collected data from 243 adult hypertensive patients who underwent non-suprainguinal vascular surgery (lower limb amputation or peripheral artery bypass surgery) at a tertiary hospital between 2008 and 2011 in an attempt to identify possible associations between comorbidity, acute pre-operative antihypertensive medication administration, and post-operative AKI (a post-operative increase in serum creatinine of ≥ 25 % above the pre-operative measurement) in these patients. The incidence of post-operative AKI in this study was 5.3 % (95 % Confidence Interval: 3.2-8.9 %). Acute pre-operative β-blocker administration was independently associated with post-operative AKI in non-suprainguinal vascular surgery patients with a pre-operative history of hypertension (Odds Ratio: 3.24; 95 % Confidence Interval: 1.03-10.25). The acute pre-operative administration of β-blockers should be carefully considered in non-suprainguinal vascular surgery patients with a pre-operative history of hypertension, in lieu of an increased risk of potentially poor post-operative renal outcomes. PMID:26966428

  15. Recommandations pour le dépistage de l’hypertension chez les adultes canadiens

    PubMed Central

    Lindsay, Patrice; Gorber, Sarah Connor; Joffres, Michel; Birtwhistle, Richard; McKay, Donald; Cloutier, Lyne

    2013-01-01

    Résumé Objectif Présenter des recommandations concernant le dépistage de l’hypertension chez les adultes de 18 ans et plus qui n’ont pas reçu antérieurement de diagnostic d’hypertension. Qualité des données Les données probantes sont tirées d’une recension systématique dans MEDLINE, EMBASE et la base de données des synthèses systématiques de la Collaboration Cochrane (EBM Reviews), de janvier 1985 à septembre 2011. Les types d’études retenues se limitaient aux études randomisées contrôlées, aux synthèses systématiques et aux études observationnelles avec groupes témoins. Message principal Trois fortes recommandations se sont dégagées de données probantes de qualité modérée. Il est recommandé de mesurer la pression artérielle à toutes les consultations appropriées en soins primaires, conformément aux techniques actuelles décrites dans les recommandations du Programme éducatif canadien sur l’hypertension pour la mesure de la pression artérielle en cabinet et en soins ambulatoires. Les critères du Programme éducatif canadien sur l’hypertension pour l’évaluation et le diagnostic de l’hypertension devraient s’appliquer aux personnes chez qui on observe une pression artérielle élevée. Conclusion À la suite d’un examen des plus récentes données probantes, le Groupe d’étude canadien sur les soins de santé préventifs continue de recommander la mesure de la pression artérielle lors des consultations périodiques auprès du médecin.

  16. Temporal Relationship Between Childhood Body Mass Index and Insulin and Its Impact on Adult Hypertension: The Bogalusa Heart Study.

    PubMed

    Zhang, Tao; Zhang, Huijie; Li, Ying; Sun, Dianjianyi; Li, Shengxu; Fernandez, Camilo; Qi, Lu; Harville, Emily; Bazzano, Lydia; He, Jiang; Xue, Fuzhong; Chen, Wei

    2016-09-01

    Although obesity and insulin resistance are closely correlated, their temporal sequences in early life and influence on adult hypertension are largely unknown. This study aims to delineate the temporal relationship patterns between body mass index (BMI) and insulin in childhood and their impact on adult hypertension. The longitudinal cohort consisted of 990 adults (630 whites and 360 blacks) who had BMI and fasting insulin measured twice 5.4 years apart in childhood (mean age, 10.5 years at baseline and 15.9 years at follow-up) and blood pressure measured 14.7 years later in adulthood (mean age, 30.5 years). Cross-lagged panel and mediation analysis models were used to examine the temporal relationship between childhood BMI and insulin and its impact on adult hypertension. After adjusting for age, race, sex, and follow-up years, the cross-lagged path coefficient (β=0.33; P<0.001) from baseline BMI to follow-up insulin was significantly greater than the path coefficient (β=-0.02; P>0.05) from baseline insulin to follow-up BMI in childhood with P<0.001 for the difference in βs. Blacks and whites showed similar patterns of the temporal relationship. The path coefficient (β=0.59; P<0.001) from BMI to insulin in the hypertensive group was significantly greater than that (β=0.24; P<0.001) in normotensive group, with P<0.001 for the difference in βs between these 2 groups. The mediation effect of childhood insulin on the childhood BMI-adult hypertension association was estimated at 21.1% (P<0.001). These findings provide evidence that higher BMI levels precede hyperinsulinemia during childhood, and this 1-directional relation plays a role in the development of hypertension. PMID:27432860

  17. 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

  18. Prevalence and Correlates of Prehypertension and Hypertension among Adults in Northeastern China: A Cross-Sectional Study

    PubMed Central

    Yang, Guang; Ma, Yue; Wang, Shibin; Su, Yingying; Rao, Wenwang; Fu, Yingli; Yu, Yaqin; Kou, Changgui

    2015-01-01

    Background: Prehypertension is a category between normotension and hypertension that is becoming increasingly common in China. However, limited data are available on the prevalence and correlates of prehypertension in northeastern China. Methods: A cross-sectional study using stratified, clustered multistage, and random sampling methods was performed on 17,584 participants. Results: The prevalence of prehypertension and hypertension was 36.0% and 30.8% in northeastern China, respectively. As age increased, the prevalence of prehypertension in males declined (p-trend < 0.001), in parallel to an increase in the prevalence of hypertension (p-trend < 0.001). The prevalence of hypertension for females increased as age increased (p-trend < 0.001). Logistic regression analysis showed that age, gender, location, drinking, Body Mass Index (BMI), abdominal obesity, hypertriglyceridemia, and hypercholesterolemia correlated with prehypertension and hypertension (p-trend < 0.05). Conclusions: This study revealed a high prevalence of prehypertension and hypertension in an adult population of northeastern China and some correlates of prehypertension and hypertension. PMID:26712776

  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. Impact of Adiposity on Incident Hypertension Is Modified by Insulin Resistance in Adults: Longitudinal Observation From the Bogalusa Heart Study.

    PubMed

    Zhang, Tao; Zhang, Huijie; Li, Shengxu; Li, Ying; Liu, Yaozhong; Fernandez, Camilo; Harville, Emily; Bazzano, Lydia; He, Jiang; Chen, Wei

    2016-01-01

    Adiposity and insulin resistance are closely associated with hypertension. This study aims to investigate whether the association between adiposity and hypertension is modified by insulin resistance. The cohort consisted of 1624 middle-aged normotensive black and white adults aged 18 to 43 years at baseline who followed for 16 years on average. Overweight/obesity at baseline was defined as body mass index (BMI) ≥25, and insulin resistance was measured using homeostasis model assessment of insulin resistance. Prevalence of incident hypertension was compared between the insulin-sensitive adiposity and insulin-resistant adiposity groups. The prevalence of incident hypertension was higher in the insulin-resistant adiposity than in the insulin-sensitive adiposity group (32.1% versus 22.1%, P<0.001). In multivariable logistic analyses, adjusted for baseline age, race, sex, follow-up years, and smoking, baseline insulin-resistant obesity was associated with incident hypertension (odds ratio, 1.9; P=0.008). Odds ratios did not differ between blacks and whites (P=0.238). Of note, the odds ratios of BMI associated with hypertension significantly increased with increasing quartiles of baseline homeostasis model assessment (odds ratio, 1.3, 1.1, 1.5, and 2.5 in quartiles I, II, III, and IV, respectively; P=0.006 for trend). Slopes of increasing follow-up blood pressure with baseline BMI, measured as regression coefficients (β), were significantly greater in insulin-resistant than in insulin-sensitive individuals (β=0.74 versus β=0.35 for systolic blood pressure, P=0.004 for difference; β=0.51 versus β=0.23 for diastolic blood pressure, P=0.001 for difference). These findings suggest that insulin resistance has a synergistic effect on the obesity-hypertension association in young adults, indicating that the role of adiposity in the development of hypertension is modified by insulin resistance. PMID:26573703

  3. Relationship between systemic hypertension, perfusion pressure and glaucoma: A comparative study in an adult Indian population

    PubMed Central

    Deb, Amit K; Kaliaperumal, Subashini; Rao, Vasudev A; Sengupta, Sabyasachi

    2014-01-01

    Aims: To study the relationship between blood pressure (BP), intraocular pressure (IOP), mean ocular perfusion pressure (MOPP) and primary open angle glaucoma (POAG) in patients with hypertension and compare it to a control group of normotensives. Design: Cross-sectional observational study. Materials and Methods: A total of 108 subjects with primary hypertension and 100 age-matched controls without hypertension were enrolled for the study. IOP measurement using Noncontact Tonometer and dilated fundus evaluation using + 90 D lens were done for all cases. Single recording of BP was taken. Gonioscopy, Humphrey's central visual fields, optical coherence tomography and pachymetry were done for all subjects with IOP > 21 mm Hg or C: D ratio ≥ 0.5 or asymmetry of > 0.2. Statistical Analysis: Univariate and multivariate multinomial regression models were used to determine the association between covariates and risk of glaucoma or glaucoma suspect. Results: There was no difference in the glaucoma status between subjects with and without hypertension. Subjects on antihypertensive medications were 1½ times more likely to have suspicious glaucoma (odds ratio [OR] =1.56] and nearly twice as likely to have POAG (OR = 1.85). In addition, we found a 31% and 12% reduction in risk of having POAG (95% confidence interval [CI] =13–45%, P = 0.001) and glaucoma suspect (95% CI = 2–21%, P = 0.03) respectively with every 1 mm Hg increment in MOPP. Conclusion: Subjects on antihypertensive medications are more likely to have either glaucoma or glaucoma suspect, and higher ocular perfusion pressure offers relative protection from glaucomatous damage. PMID:25370392

  4. Efficacy and tolerability of fixed dose combination of metoprolol and amlodipine in Indian patients with essential hypertension

    PubMed Central

    Rao, N. Srinivasa; Oomman, Abraham; Bindumathi, P. L.; Sharma, Vikram; Rao, Satish; Moodahadu, Latha Subramanya; Patnaik, Ashis; Kumar, B. R. Naveen

    2013-01-01

    Background: This open-labeled, post-marketing study was conducted to assess the efficacy and tolerability of fixed dose combination of amlodipine and metoprolol extended release capsules in mild to moderate hypertension in adult Indian patients. Materials and Methods: Of 101 enrolled patients, 64 drug naïve patients were treated with regimen A (amlodipine 5 mg + metoprolol 25 mg) and those with prior history of hypertension (n = 37) were treated with regimen B (amlodipine 5 mg + metoprolol 50 mg) for 8 weeks. Treatment response was assessed at week 4 and 8. Dose up titration to regimen B was carried out for those who failed to achieve the target blood pressure (BP) at week 4 in regimen A and additional antihypertensives were added to those in regimen B. Safety laboratory tests were performed at baseline and end of study. Results: Mean age (±SD) of patients was 53.36 (±11.26) years and body weight (±SD) 63.40 (10.03) kg. Ninety five patients (94.06%) were only hypertensive and 6 (5.94%) had hypertension with history of coronary artery disease; mean duration (±SD) of hypertension was 42.50 (48.07) months. At baseline, patients had a mean (±SD) systolic blood pressure (SBP) and diastolic blood pressure (DBP) of 154.98 (±7.76) mmHg and 95.55 (±5.70) mmHg respectively. There was a statistically significant (P < 0.001) reduction of 12.16% and 14.69% in SBP, 11.49% and 14.65% in DBP at week 4 and week 8 respectively, compared to baseline. Normalization of overall BP was achieved in 49.49% and 70.71% patients at week 4 and 8, respectively. Peripheral edema was reported in 2.97% (3/101) patients. Conclusion: This combination was safe, efficacious, and well-tolerated in study population. PMID:24672188

  5. [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

  6. Hypertension and cognitive function.

    PubMed

    Paglieri, Cristina; Bisbocci, Daniela; Caserta, Mimma; Rabbia, Franco; Bertello, Chiara; Canadè, Antonella; Veglio, Franco

    2008-11-01

    Arterial hypertension, cerebrovascular disease, and dementia are related pathologies. This paper has reviewed comparatively the incidence of arterial hypertension and adult-onset dementia disorders. Hypertension is associated with cerebrovascular disease, which is in turn associated with dementia. It is the most important modifiable risk factor for stroke, which is a recognized cause of vascular dementia. In terms of pathophysiology of hypertensive brain damage, several hypotheses were developed, such as that vascular alterations induced by hypertension can induce lacunar or cortical infarcts and leucoaraiosis, that hypertension is responsible for cerebrovascular disease and acts into the contest of a pre-existing subclinic Alzheimer's disease (AD), that hypertension determines neurobiologic alterations (such as beta-amyloid accumulation) resulting in neuropathologic damage, and that aging and cerebrovascular risk factors act together to cause cerebral capillary degeneration, mitochondrial disruption, reduced glucose oxidation, and reduced ATP synthesis. The consequence of these alterations are neuronal death and dementia. Macroscopic results of these mechanisms are the so-called white matter lesions (WML), the significance of which is analyzed. Increasing clinical evidence suggests a close relationship between the reduction of elevated blood pressure and countering of both vascular dementia and AD. Antihypertensive treatment probably influences cognitive performances and prevents cognitive function alterations and the development of dementia. It is therefore important to evaluate as soon as possible cognitive functions of hypertensive patients. PMID:19021021

  7. 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

  8. Hospital Patients Are Adult Learners.

    ERIC Educational Resources Information Center

    Caffarella, Rosemary S.

    Patient education is recognized by health care providers and patients themselves as an important component of adequate health care for hospital patients. Through this informational process, patients receive information about specific health problems, learn the necessary competencies to deal with them, and develop accepting attitudes toward the…

  9. 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

  10. 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

  11. Structural and functional vascular alterations and incident hypertension in normotensive adults: the Multi-Ethnic Study of Atherosclerosis.

    PubMed

    Peralta, Carmen A; Adeney, Kathryn L; Shlipak, Michael G; Jacobs, David; Duprez, Daniel; Bluemke, David; Polak, Joseph; Psaty, Bruce; Kestenbaum, Bryan R

    2010-01-01

    Vascular abnormalities may exist before clinical hypertension. Using Poisson regression, the authors studied the association of coronary artery calcium (CAC), common carotid intima-media thickness (CIMT), aortic distensibility, and large and small arterial elasticity with incident hypertension among 2,512 normotensive US adults free of cardiovascular disease. Incidence rate ratios for incident hypertension (blood pressure > or =140/90 mm Hg or new antihypertensive medication) were calculated. Increased CAC was associated with incident hypertension in demographics-adjusted models (incidence rate ratio (IRR) = 1.35, 95% confidence interval (CI): 1.04, 1.75; IRR = 1.35, 95% CI: 1.02, 1.78; and IRR = 1.59, 95% CI: 1.12, 2.25 for CAC scores of 30-99, 100-399, and > or =400, respectively) but was attenuated after further adjustment. Increased common CIMT was associated with incident hypertension (IRR = 1.77, 95% CI: 1.28, 2.46 for quintile 4; IRR = 1.80, 95% CI: 1.28, 2.53 for quintile 5). Participants with the lowest, compared with the highest, aortic distensibility had an increased risk of hypertension (IRR = 1.75, 95% CI: 1.10, 2.79), as did those with the lowest large arterial elasticity (IRR = 1.49, 95% CI: 1.11, 1.99). Lower small arterial elasticity was incrementally associated with incident hypertension starting at quintile 2 (IRR = 2.01, 95% CI: 1.39, 2.91; IRR = 2.47, 95% CI: 1.71, 3.57; IRR = 2.73, 95% CI: 1.88, 3.95; and IRR = 2.85, 95% CI: 1.95, 4.16). Structural and functional vascular abnormalities are independent predictors of incident hypertension. These findings are important for understanding the pathogenesis of hypertension. PMID:19951938

  12. State Socioeconomic Indicators and Self-Reported Hypertension Among US Adults, 2011 Behavioral Risk Factor Surveillance System

    PubMed Central

    Strasser, Sheryl M.; Zhang, Xingyou; Fang, Jing; Crawford, Carol G.

    2015-01-01

    Introduction Hypertension is the leading cause of chronic disease and premature death in the United States. To date, most risk factors for hypertension have been identified at the individual (micro) level. The association of macro-level (area) socioeconomic factors and hypertension prevalence rates in the population has not been studied extensively. Methods We used the 2011 Behavioral Risk Factor Surveillance System to examine whether state socioeconomic status (SES) indicators predict the prevalence of self-reported hypertension. Quintiles of state median household income, unemployment rate among the population aged 16 to 64 years, and the proportion of the population under the national poverty line were used as the proxy for state SES. Hypertension status was determined by the question “Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?” Logistic regression was used to assess the relationship between state SES and hypertension with adjustment for individual covariates (demographic and socioeconomic factors and lifestyle behaviors). Results States with a median household income of $43,225 or less (odds ratio [95% confidence interval] = 1.16 [1.08–1.25]) and states with 18.7% or more of residents living below the poverty line (odds ratio [95% confidence interval] = 1.14 [1.04–1.24]) had a higher prevalence of hypertension than states with the most residents in the most advantageous quintile of the indicators. Conclusion The observed state SES–hypertension association indicates that area SES may contribute to the burden of hypertension in community-dwelling adults. PMID:25719217

  13. Prevalence and Trends of Isolated Systolic Hypertension among Korean Adults: the Korea National Health and Nutrition Examination Survey, 1998-2012

    PubMed Central

    Kim, Na Rae

    2015-01-01

    Background and Objectives Systolic and diastolic blood pressure may have different effects on cardiovascular disease, but limited data is available for hypertension subtypes in the Korean population. Thus, the prevalence, and absolute number of hypertension subtypes among Korean adults was estimated. Subjects and Methods The Korea National Health and Nutrition Examination Survey 1998-2012 was used to estimate the prevalence and absolute number of each hypertension subtype among Korean adults aged ≥20 years. Hypertension was classified into four subtypes: treated hypertension (TH), isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and combined systolic and diastolic hypertension (SDH). Results In 2012, approximately 9.5 million adults were estimated to have hypertension, which consists of 5675671 TH (60.0%), 954253 ISH (10.1%), 1649486 IDH (17.4%), and 1175506 SDH (12.4%). Between 2010 and 2012, the proportion of IDH steadily decreased with age, but ISH increased especially in older ages (≥40). Between 1998 and 2012, TH markedly increased from 1.4 million to 5.7 million while the number of untreated hypertension remained relatively constant. During the same time, the number of hypertensive elderlies increased from 507000 to 2822000 along with rapid ageing of the Korean population. Despite of significant improvement in treatment rate, there are still around 583000 elderlies with untreated hypertension (423000 ISH; 42000 IDH; 118000 SDH) as of 2012. Conclusion Although the prevalence of hypertension has been constant over the last decades, absolute number of people with hypertension has been increasing. Along with the rapid population ageing, the number of elderly hypertension is increasing and the ISH is also becoming more prevalent. PMID:26617652

  14. 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

  15. Five-year cumulative incidence of hypertension in adult Croatian population: the CroHort study.

    PubMed

    Erceg, Marijan; Ivicević-Uhernik, Ana; Kern, Josipa; Vuletić, Silvije

    2012-01-01

    The aim of this study was to establish a five-year cumulative incidence of arterial hypertension (hereinafter 5-CIAH) and its dependence on initial prehypertension, body weight, age and gender "Croatian Adult Health Cohort Study (CroHort)" data collected during 2003 and 2008 for the 1383 subjects aged 18 + with initially normal blood pressure (systolic < 140 mmHg and diastolic < 90 mmHg, and not taking medication) was analised. Methods of descriptive statistics, Student's t-test, chi2-test and logistic regression were used. The recorded 5-CIAH in male cohort was 36.9% [32.1 to 41.6] and 33.0% [30.1 to 36.0] in women and was higher in subjects with initial prehypertension (men 43.3% [37.5 to 49.0] versus 9.6% [12.1 to 27.2]; women (42 3% [38.1 to 46.6] versus 22.3% [18.5 to 26.1]). The development of arterial hypertension was affected by age (OR = 2.2168), initial prehypertension (OR = 2.1987) and overweight (OR = 1.9399). PMID:22338752

  16. Diagnosis of Adult Patients with Cystic Fibrosis.

    PubMed

    Nick, Jerry A; Nichols, David P

    2016-03-01

    The diagnosis of cystic fibrosis (CF) is being made with increasing frequency in adults. Patients with CF diagnosed in adulthood typically present with respiratory complaints, and often have recurrent or chronic airway infection. At the time of initial presentation individuals may appear to have clinical manifestation limited to a single organ, but with subclinical involvement of the respiratory tract. Adult-diagnosed patients have a good response to CF center care, and newly available cystic fibrosis transmembrane receptor-modulating therapies are promising for the treatment of residual function mutation, thus increasing the importance of the diagnosis in adults with unexplained bronchiectasis. PMID:26857767

  17. 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

  18. Basal and postprandial serum levels of gastrin in normotensive and hypertensive adults.

    PubMed

    Jiang, Xiaoliang; Wang, Wenjie; Ning, Bin; Liu, Xing; Gong, Jian; Gan, Fusheng; Gao, Xuezhong; Zhang, Lianfeng; Jose, Pedro A; Qin, Chuan; Yang, Zhiwei

    2013-01-01

    Gastrin is a peptide hormone, which acts not only to regulate gastric acid secretion, but also to exert physiological actions such as the regulation of sodium balance. From a case (n = 95)-control (n = 82) study in Fuyang People's Hospital, Anhui Province, China, we found that the fasting serum gastrin levels are similar in normotensive and hypertensive adults but increased to higher levels in the latter group than in the former group after a mixed meal. We suggest that gastrin is involved in the regulation of blood pressure, possibly via the regulation of sodium and water metabolism and/or renin-angiotensin-aldosterone system. However, the mechanism remains to be determined. PMID:22680232

  19. 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

  20. 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

  1. Relationship Between Dyslipidemia and Albuminuria in Hypertensive Adults: A Nationwide Population-Based Study.

    PubMed

    Lee, Sung-Ho; Kim, Do Hoon; Kim, Yang-Hyun; Roh, Yong Kyun; Ju, Sang Yhun; Nam, Hyo-Yun; Nam, Ga-Eun; Choi, Jun-Seok; Lee, Jong-Eun; Sang, Jung-Eun; Han, Kyungdo; Park, Yong-Gyu

    2016-04-01

    This study aimed to estimate the relationship between various lipid abnormalities and albuminuria in hypertensive Korean adults. Data obtained from the Korea National Health and Nutrition Examination Survey in 2011 to 2012 were analyzed. The study included 2330 hypertensive participants. Total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels were measured. Dyslipidemia parameters were defined as high TG ≥200 mg/dL, low HDL-C as HDL-C <40 mg/dL, high TC/HDL-C as TC/HDL-C ratio ≥4, high TG/HDL-C as TG/HDL-C ratio ≥3.8, and high LDL-C/HDL-C as LDL-C/HDL-C ratio ≥2.5. Albuminuria was defined as a urine albumin to creatinine ratio (ACR) ≥30 mg/g. Women with albuminuria showed significantly higher levels of TG, TC/HDL-C, and TG/HDL-C and a lower level of HDL-C than women without albuminuria (all P < 0.05). LogTG, TC/HDL-C, and logTG/HDL-C were positively correlated with ACR in both men and women; however, HDL-C was negatively correlated with ACR in women and non-HDL-C was positively correlated with ACR in men. In men, there was no association between ACR and lipid parameters. However, in women, higher values for logTG, TC/HDL-C, and logTG/HDL-C were associated with an increased odds ratio (OR) for albuminuria (OR [95% confidence interval]: 1.53 [1.06-2.21], 1.21 [1.02-1.45], and 1.78 [1.21-2.63], respectively) and HDL-C with a decreased OR for albuminuria (0.78 [0.67-0.92]) after adjusting for all covariates. LogTG, TC/HDL-C, and logTG/HDL-C were associated with an increased prevalence of albuminuria in hypertensive women. Screening and treatment for dyslipidemia may be necessary for hypertensive women to address potential albuminuria. PMID:27100412

  2. 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

  3. 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

  4. 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

  5. Confocal microscopy for automatic measurement of the density and distance between elastin fibers of histologic preparations of normotensive and hypertensive patients

    NASA Astrophysics Data System (ADS)

    Vieira, G.; Ferro, D. P.; Adam, R. L.; de Thomaz, A. A.; Cesar, C. L.; Metze, K.

    2010-02-01

    Elastic fibers are essential components of the human aorta, and there is an association between elastin fibers remodeling and several diseases. Hypertension is one such example of a disease leading to elastin fibers remodeling. These fibers can be easily seen in eosin-hematoxilin (HE) stained histologic sections when observed by UV-excited fluorescence microscopy or by a much more precise Laser Scanning Confocal Microscope (LSCM). In order to study the effect of the hypertension on the elastin fibers pattern we developed an automatic system (software and hardware) to count the number of elastin fibers and to measure the distance between them in a LSCM and used it compare the statistical distribution of the distance between these fibers in normotensive and hypertensive patients. The full image of the whole sample (2 or 3mm long) was composed by several 220×220μm frames with 512×512 pixels. The software counters fiber and distance between fibers. We compared the elastic fiber texture in routinely HE-stained histologic slides of the aorta ascendens in 24 normotensive and 30 hypertensive adult patients of both sexes and of similar age from our autopsy files. Our results show that the average number of fibers is the same for both cases but the distance between the fibers are larger for hypertensive patients than for normotensive ones.

  6. 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

  7. Determining the effects and challenges of incorporating genetic testing into primary care management of hypertensive patients with African ancestry.

    PubMed

    Horowitz, C R; Abul-Husn, N S; Ellis, S; Ramos, M A; Negron, R; Suprun, M; Zinberg, R E; Sabin, T; Hauser, D; Calman, N; Bagiella, E; Bottinger, E P

    2016-03-01

    People of African ancestry (Blacks) have increased risk of kidney failure due to numerous socioeconomic, environmental, and clinical factors. Two variants in the APOL1 gene are now thought to account for much of the racial disparity associated with hypertensive kidney failure in Blacks. However, this knowledge has not been translated into clinical care to help improve patient outcomes and address disparities. GUARDD is a randomized trial to evaluate the effects and challenges of incorporating genetic risk information into primary care. Hypertensive, non-diabetic, adults with self-reported African ancestry, without kidney dysfunction, are recruited from diverse clinical settings and randomized to undergo APOL1 genetic testing at baseline (intervention) or at one year (waitlist control). Providers are educated about genomics and APOL1. Guided by a genetic counselor, trained staff return APOL1 results to patients and provide low-literacy educational materials. Real-time clinical decision support tools alert clinicians of their patients' APOL1 results and associated risk status at the point of care. Our academic-community-clinical partnership designed a study to generate information about the impact of genetic risk information on patient care (blood pressure and renal surveillance) and on patient and provider knowledge, attitudes, beliefs, and behaviors. GUARDD will help establish the effective implementation of APOL1 risk-informed management of hypertensive patients at high risk of CKD, and will provide a robust framework for future endeavors to implement genomic medicine in diverse clinical practices. It will also add to the important dialog about factors that contribute to and may help eliminate racial disparities in kidney disease. PMID:26747051

  8. Sleep Disorders in Adult Sickle Cell Patients

    PubMed Central

    Sharma, Sunil; Efird, Jimmy T.; Knupp, Charles; Kadali, Renuka; Liles, Darla; Shiue, Kristin; Boettger, Peter; Quan, Stuart F.

    2015-01-01

    Study Objectives: While sleep apnea has been studied in children with sickle cell disease (SCD), little is known about sleep disorders in adult sickle cell patients. The objective of this study was to evaluate sleep disordered breathing and its polysomnographic characteristics in adult patients with sickle cell disease. Methods: The analysis cohort included 32 consecutive adult SCD patients who underwent a comprehensive sleep evaluation and overnight polysomnography in an accredited sleep center after reporting symptoms suggesting disordered sleep or an Epworth Sleepiness Scale score ≥ 10. Epworth score, sleep parameters, comorbid conditions, and narcotic use were reviewed and compared in patients with and without sleep disordered breathing. SCD complication rates in the two groups also were compared. Results: In adult SCD patients who underwent overnight polysomnography, we report a high prevalence (44%) of sleep disordered breathing. Disease severity was mild to moderate (mean apnea-hypopnea index = 17/h (95% CI: 10–24/h). Concomitant sleep disorders, including insomnia complaints (57%) and delayed sleep-phase syndrome (57%), also were common in this population. In this limited cohort, we did not find increased SCD complications associated with sleep disordered breathing in adult patients with sickle cell disease. Conclusions: A high burden of sleep disordered breathing and other sleep-related complaints were identified in the adult sickle cell population. Our results provide important information on this unique population. Citation: Sharma S, Efird JT, Knupp C, Kadali R, Liles D, Shiue K, Boettger P, Quan SF. Sleep disorders in adult sickle cell patients. J Clin Sleep Med 2015;11(3):219–223. PMID:25515282

  9. Digital interventions to promote self-management in adults with hypertension systematic review and meta-analysis

    PubMed Central

    McLean, Gary; Band, Rebecca; Saunderson, Kathryn; Hanlon, Peter; Murray, Elizabeth; Little, Paul; McManus, Richard J.; Yardley, Lucy; Mair, Frances S.

    2016-01-01

    Objective: To synthesize the evidence for using interactive digital interventions (IDIs) to support patient self-management of hypertension, and to determine their impact on control and reduction of blood pressure. Method: Systematic review with meta-analysis was undertaken with a search performed in MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Cochrane Library, DoPHER, TROPHI, Social Science Citation Index and Science Citation Index. The population was adults (>18 years) with hypertension, intervention was an IDI and the comparator was usual care. Primary outcomes were change in SBP and DBP. Only randomized controlled trials and studies published in journals and in English were eligible. Eligible IDIs included interventions accessed through a computer, smartphone or other hand-held device. Results: Four out of seven studies showed a significantly greater reduction for intervention compared to usual care for SBP, with no difference found for three. Overall, IDIs significantly reduced SBP, with the weighted mean difference being −3.74 mmHg [95% confidence interval (CI) −2.19 to −2.58] with no heterogeneity observed (I-squared = 0.0%, P = 0.990). For DBP, four out of six studies indicated a greater reduction for intervention compared to controls, with no difference found for two. For DBP, a significant reduction of −2.37 mmHg (95% CI −0.40 to −4.35) was found, but considerable heterogeneity was noted (I-squared = 80.1%, P = <0.001). Conclusion: IDIs lower both SBP and DBP compared to usual care. Results suggest these findings can be applied to a wide range of healthcare systems and populations. However, sustainability and long-term clinical effectiveness of these interventions remain uncertain. PMID:26845284

  10. Association of alcohol consumption pattern with risk of hypertension in Korean adults based on the 2010-2012 KNHANES.

    PubMed

    Hong, S W; Linton, J A; Shim, J Y; Lee, H R; Kang, H T

    2016-08-01

    We examined the association between alcohol-drinking pattern and hypertension in Korean adults. This cross-sectional study included 15,052 participants (7054 men and 7998 women) who were included in the 2010-2012 Korean National Health and Nutrition Examination Survey (KNHANES). We categorized alcohol-drinking patterns into three groups based on the Alcohol Use Disorders Identification Test (AUDIT) score: low-risk (score: 0-7), intermediate-risk (score: 8-14), and high-risk (score: ≥15). Hypertension was defined as systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or current use of anti-hypertensive medications. In the study population, 25.2% of men and 4.6% of women were high-risk drinkers. Hypertension prevalence was 30.8% in men and 20.6% in women. Of the total population, 13.8% of men and 13.6% of women were using anti-hypertensive drugs. Age-adjusted hypertension prevalence was 30.8, 40.9, and 45.3% in men, and 24.6, 27.0, and 32.3% in women in the low-, intermediate-, and high-risk drinking group, respectively. Compared to the low-risk drinking group, the prevalence ratio (95% confidence interval [CI]) for hypertension was 1.664 (1.4331.933) and 2.070 (1.772-2.418) for men and 1.012 (0.774-1.323) and 1.650 (1.080-2.522) for women in the intermediate- and high-risk drinking group, respectively, after adjusting for age and other confounding factors. In conclusion, our study suggests high-risk drinking appears to be associated with a higher risk of hypertension in men and women. PMID:27565751

  11. 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.

  12. 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

  13. [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

  14. [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

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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.

  20. 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

  1. 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

  2. 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

  3. 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

  4. WIN OVER study: Efficacy and safety of olmesartan in Indian hypertensive patients: Results of an open label, non-comparative, multi-centric, post marketing observational study

    PubMed Central

    Kumbla, D.K.; Kumar, S.; Reddy, Y.V.; Trailokya, A.; Naik, M.

    2014-01-01

    Background Hypertension is a global health problem. Multiple classes of drugs including angiotensin receptor blockers (ARBs) are available for the treatment of hypertension. Olmesartan is a relatively newer ARB used in hypertension management. Objective To assess the efficacy and safety of WIN-BP (Olmesartan 20 mg/40 mg) tablet in Indian patients with hypertension. Material and methods An open label, non-comparative, multi-centric, real world post marketing observational study included Indian adult hypertensive patients who were treated with olmesartan 20 mg/40 mg tablet once daily for six months. The primary outcome was reduction of systolic blood pressure (SBP) to <140 mmHg and diastolic BP (DBP) to <90 mmHg at 3 and 6 months after initiation of treatment with olmesartan. All reported adverse events were recorded. Results A total of 8940 patients were enrolled in this study. Baseline SBP of 164 mmHg was reduced to 153, 145, 134 and 130 mmHg at the end of 15 days, 1, 3 and 6 months respectively. Similarly, baseline DBP of 100 mmHg was reduced to 93, 89, 84 and 82 mmHg at the end of 15 days, 1, 3 and 6 months respectively. The reduction in both systolic and diastolic blood pressure from day 15 to month 6 was statistically significant (p < 0.0001) with olmesartan treatment. The percentage of responders for both systolic and diastolic blood pressure increased consistently from day 15 to month 6. Only 0.08% patients reported the adverse events. No serious adverse event was reported in the study. Conclusion Olmesartan 20 mg/40 mg is effective and well tolerated without any serious adverse events in patients with hypertension. PMID:24973841

  5. A Practical Approach to Hypertension

    PubMed Central

    Dodek, Arthur; Wilkins, Graeme

    1976-01-01

    At least ten percent of the adult population has hypertension. Detection and effective treatment of hypertension are imperative in order to prevent the cardiovascular consequences. Effective antihypertensive treatment reduces morbidity and mortality. Weight reduction and sodium restriction are important fundamentals, and diuretics are the cornerstone of drug therapy. In order to increase patient compliance, treatment should be simple and drugs given twice daily wherever possible. PMID:20469276

  6. 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

  7. 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

  8. 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

  9. [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

  10. 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

  11. Functional evidence of α1D-adrenoceptors in the vasculature of young and adult spontaneously hypertensive rats

    PubMed Central

    Villalobos-Molina, Rafael; López-Guerrero, J Javier; Ibarra, Maximiliano

    1999-01-01

    The role of α1D-adrenoceptors in the vasculature of spontaneously hypertensive (SHR) and normotensive Wistar Kyoto rats (WKY), of different ages was assessed in pithed rats by the use of the selective α1D-adrenoceptor antagonist BMY 7378 (8-[2-[4-(2-methoxyphenyl)-1-piperazinyl]-ethyl]-8-azaspiro [4.5]decane-7,9-dione dihydrochloride). BMY 7378 displaced the pressor effect of phenylephrine in young pre-hypertensive pithed SHR rats, but produced no effect in young WKY rats (dose ratio of 3.4 and 1.6, respectively), while in adult rats BMY 7378 produced a greater shift in the phenylephrine response curve than in younger animals (dose ratio of 3.2 and 6.2 in WKY and SHR, respectively). The presence of α1D-adrenoceptors in the vasculature of pre-hypertensive rats, suggests its role in the pathogenesis/maintenance of increased blood pressure. PMID:10323583

  12. Functional evidence of alpha1D-adrenoceptors in the vasculature of young and adult spontaneously hypertensive rats.

    PubMed

    Villalobos-Molina, R; López-Guerrero, J J; Ibarra, M

    1999-04-01

    The role of alpha1D-adrenoceptors in the vasculature of spontaneously hypertensive (SHR) and normotensive Wistar Kyoto rats (WKY), of different ages was assessed in pithed rats by the use of the selective alpha1D-adrenoceptor antagonist BMY 7378 (8-[2-[4-(2-methoxyphenyl)-1-piperazinyl]-ethyl]-8-azaspiro [4.5]decane-7,9-dione dihydrochloride). BMY 7378 displaced the pressor effect of phenylephrine in young pre-hypertensive pithed SHR rats, but produced no effect in young WKY rats (dose ratio of 3.4 and 1.6, respectively), while in adult rats BMY 7378 produced a greater shift in the phenylephrine response curve than in younger animals (dose ratio of 3.2 and 6.2 in WKY and SHR, respectively). The presence of alpha1D-adrenoceptors in the vasculature of pre-hypertensive rats, suggests its role in the pathogenesis/maintenance of increased blood pressure. PMID:10323583

  13. 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

  14. [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

  15. Lean Body Mass as a Predictive Value of Hypertension in Young Adults, in Ankara, Turkey

    PubMed Central

    VAZIRI, Yashar; BULDUK, Sidika; SHADMAN, Zhaleh; BULDUK, Emre Ozgur; HEDAYATI, Mehdi; KOC, Haluk; ER, Fatmanur; ERDOGAN, Ceren Suveren

    2015-01-01

    Background: The aim of this study was to assess the predictive capacity of body composition estimated by bioelectrical impedance analysis (BIA) to identify abnormal blood pressure in physical education and sport teaching students in the city of Ankara. Methods: Data for this cross-sectional study were obtained in the city of Ankara in 2014. A total of 133 students aged 20–35 yr participated in this study. Anthropometric measurements were measured. Body composition was assessed by BIA. Physical activity level (PAL) and usual dietary intake were assessed. Pre-hypertension and hypertension were defined, respectively, as BP ≥120 and/or 80, and ≥140 and /or 90 mmHg. Results: More overweight students showed abnormal BP especially SBP (P=0.005 and 0.002, respectively). Age adjusted regression showed significant association between arm circumference (β= 0.176, P 0.044), mid arm muscle circumference (MAMC) (β= 0.235, P 0.007), lean body mass (LBM) (β= 0.238, P 0.006), basal metabolism rate (BMR) (β= 0.219, P 0.012) and SBP and, also, MAMC (β= 0.201, P 0.022), LBM (β= 0.203, P 0.021), BMR (β= 0.189, P 0.030) and DBP. Fat intake was associated with DBP (β= 0.14, P =0.040). Multivariate regression models adjusted for age, BMI, WC and fat intake/kg body weight showed positive association of SBP with MAMC, BMR and LBM (P<0.05). Conclusion: The relationship between blood pressure and body composition in young adults may be associated to LBM and MAMC. LBM or MAMC in this population may be indirect indicators of heart muscle mass and heart pumping power. PMID:26811815

  16. 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

  17. 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

  18. Association between Self-Reported Global Sleep Status and Prevalence of Hypertension in Chinese Adults: Data from the Kailuan Community

    PubMed Central

    Lu, Kai; Ding, Rongjing; Tang, Qin; Chen, Jia; Wang, Li; Wang, Changying; Wu, Shouling; Hu, Dayi

    2015-01-01

    Background: Assessment of sleep only by sleep duration is not sufficient. This cross-sectional study aimed to investigate the potential association of self-reported global sleep status, which contained both qualitative and quantitative aspects, with hypertension prevalence in Chinese adults. Methods: A total of 5461 subjects (4076 of them were male) were enrolled in the current study and were divided into two groups with the age of 45 years as the cut-off value. Sleep status of all subjects was assessed using the standard Pittsburgh Sleep Quality Index (PSQI). Hypertension was defined as blood pressure ≥140/90 mmHg in the current study. Results: After adjusting for basic cardiovascular characteristics, the results of multivariate logistic regression indicated that sleep status, which was defined as the additive measurement of sleep duration and sleep quality, was associated with hypertension prevalence in males of both age groups (odds ratio (OR) = 1.11, 95% confidence interval (CI), 1.07–1.15, p < 0.05; OR = 1.12, 95% CI, 1.08–1.15, p < 0.05) and in females aged ≤45years (OR = 1.10, 95% CI, 1.02–1.18, p < 0.05). As one component of PSQI, short sleep duration was associated with hypertension prevalence only in Chinese male subjects, but this association disappeared after the further adjustment of the other components of PSQI that measured the qualitative aspect of sleep. Conclusion: Association between sleep status and hypertension prevalence in Chinese adults varied by age and sex. Sleep should be measured qualitatively and quantitatively when investigating its association with hypertension. PMID:25575370

  19. Trends in self-reported prevalence and management of hypertension, hypercholesterolemia and diabetes in Swiss adults, 1997-2007

    PubMed Central

    2011-01-01

    Background Switzerland has a low mortality rate from cardiovascular diseases, but little is known regarding prevalence and management of cardiovascular risk factors (CV RFs: hypertension, hypercholesterolemia and diabetes) in the general population. In this study, we assessed 10-year trends in self-reported prevalence and management of cardiovascular risk factors in Switzerland. Methods data from three national health interview surveys conducted between 1997 and 2007 in representative samples of the Swiss adult population (49,261 subjects overall). Self-reported CV RFs prevalence, treatment and control levels were computed. The sample was weighted to match the sex - and age distribution, geographical location and nationality of the entire adult population of Switzerland. Results self-reported prevalence of hypertension, hypercholesterolemia and diabetes increased from 22.1%, 11.9% and 3.3% in 1997 to 24.1%, 17.4% and 4.8% in 2007, respectively. Prevalence of self-reported treatment among subjects with CV RFs also increased from 52.1%, 18.5% and 50.0% in 1997 to 60.4%, 38.8% and 53.3% in 2007 for hypertension, hypercholesterolemia and diabetes, respectively. Self-reported control levels increased from 56.4%, 52.9% and 50.0% in 1997 to 80.6%, 75.1% and 53.3% in 2007 for hypertension, hypercholesterolemia and diabetes, respectively. Finally, screening during the last 12 months increased from 84.5%, 86.5% and 87.4% in 1997 to 94.0%, 94.6% and 94.1% in 2007 for hypertension, hypercholesterolemia and diabetes, respectively. Conclusion in Switzerland, the prevalences of self-reported hypertension, hypercholesterolemia and diabetes have increased between 1997 and 2007. Management and screening have improved, but further improvements can still be achieved as over one third of subjects with reported CV RFs are not treated. PMID:21332996

  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. Interventions to Improve Medication Adherence in Hypertensive Patients: Systematic Review and Meta-analysis.

    PubMed

    Conn, Vicki S; Ruppar, Todd M; Chase, Jo-Ana D; Enriquez, Maithe; Cooper, Pamela S

    2015-12-01

    This systematic review applied meta-analytic procedures to synthesize medication adherence interventions that focus on adults with hypertension. Comprehensive searching located trials with medication adherence behavior outcomes. Study sample, design, intervention characteristics, and outcomes were coded. Random-effects models were used in calculating standardized mean difference effect sizes. Moderator analyses were conducted using meta-analytic analogues of ANOVA and regression to explore associations between effect sizes and sample, design, and intervention characteristics. Effect sizes were calculated for 112 eligible treatment-vs.-control group outcome comparisons of 34,272 subjects. The overall standardized mean difference effect size between treatment and control subjects was 0.300. Exploratory moderator analyses revealed interventions were most effective among female, older, and moderate- or high-income participants. The most promising intervention components were those linking adherence behavior with habits, giving adherence feedback to patients, self-monitoring of blood pressure, using pill boxes and other special packaging, and motivational interviewing. The most effective interventions employed multiple components and were delivered over many days. Future research should strive for minimizing risks of bias common in this literature, especially avoiding self-report adherence measures. PMID:26560139

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  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. Urine albumin excretion, within normal range, reflects increasing prevalence of metabolic syndrome in patients with essential hypertension.

    PubMed

    Vyssoulis, Gregory; Karpanou, Eva; Spanos, Pangiotis; Kyvelou, Stella-Maria; Adamopoulos, Dionysios; Stefanadis, Christodoulos

    2010-08-01

    Microalbuminuria is a prognostic marker of cardiovascular disease and is related to metabolic syndrome (MetS). For this purpose, the authors examined the relationship of low grade albuminuria to MetS, using 4 current definitions and a MetS score. They studied 6650 consecutive, nondiabetic, hypertensive patients with normal microalbumin excretion. MetS was defined by Adult Treatment Panel III, American Heart Association, World Heart Organization, International Diabetes Federation criteria, and MetS Gruppo Italiano per lo Studio della Streptochinasi nell'Infarcto Miocardico (GISSI) score. Urine microalbumin concentration was measured after a 24-hour urine collection by immunonephelometry. By all definitions, hypertensive patients with MetS had higher microalbumin levels. Significantly higher microalbumin levels were observed as the number of metabolic components rose. After adjustment for systolic blood pressure, the strength of this association was reduced to a nonsignificant level. Microalbumin levels, within normal range, are increased in patients with MetS, irrespective of the definition criteria. PMID:20695936

  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. 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

  20. 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

  1. 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

  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. 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

  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. Isolated Systolic Hypertension in Young and Middle-Aged Adults and 31-Year Risk for Cardiovascular Mortality

    PubMed Central

    Yano, Yuichiro; Stamler, Jeremiah; Garside, Daniel B.; Daviglus, Martha L.; Franklin, Stanley S.; Carnethon, Mercedes R.; Liu, Kiang; Greenland, Philip; Lloyd-Jones, Donald M.

    2016-01-01

    BACKGROUND Isolated systolic hypertension (ISH), defined as systolic blood pressure (SBP) ≥140 mm Hg and diastolic blood pressure (DBP) <90 mm Hg, in younger and middle-aged adults is increasing in prevalence. OBJECTIVE The aim of this study was to assess the risk for cardiovascular disease (CVD) with ISH in younger and middle-aged adults. METHODS CVD risks were explored in 15,868 men and 11,213 women 18 to 49 years of age (mean age 34 years) at baseline, 85% non-Hispanic white, free of coronary heart disease (CHD) and antihypertensive therapy, from the Chicago Heart Association Detection Project in Industry study. Participant classifications were as follows: 1) optimal-normal blood pressure (BP) (SBP <130 mm Hg and DBP <85 mm Hg); 2) high-normal BP (130 to 139/85 to 89 mm Hg); 3) ISH; 4) isolated diastolic hypertension (SBP <140 mm Hg and DBP ≥90 mm Hg); and 5) systolic diastolic hypertension (SBP ≥140 mm Hg and DBP ≥90 mm Hg). RESULTS During a 31-year average follow-up period (842,600 person-years), there were 1,728 deaths from CVD, 1,168 from CHD, and 223 from stroke. Cox proportional hazards models were adjusted for age, race, education, body mass index, current smoking, total cholesterol, and diabetes. In men, with optimal-normal BP as the reference stratum, hazard ratios for CVD and CHD mortality risk for those with ISH were 1.23 (95% confidence interval [CI]: 1.03 to 1.46) and 1.28 (95% CI: 1.04 to 1.58), respectively. ISH risks were similar to those with high-normal BP and less than those associated with isolated diastolic hypertension and systolic diastolic hypertension. In women with ISH, hazard ratios for CVD and CHD mortality risk were 1.55 (95% CI: 1.18 to 2.05) and 2.12 (95% CI: 1.49 to 3.01), respectively. ISH risks were higher than in those with high-normal BP or isolated diastolic hypertension and less than those associated with systolic diastolic hypertension. CONCLUSIONS Over long-term follow-up, younger and middle-aged adults with ISH

  6. 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

  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. 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

  9. 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

  10. Reporting of Adherence to Healthy Lifestyle Behaviors among Hypertensive Adults in the 50 States and the District of Columbia, 2013

    PubMed Central

    Fang, Jing; Moore, Latetia; Loustalot, Fleetwood; Yang, Quanhe; Ayala, Carma

    2016-01-01

    Achieving and maintaining a healthy lifestyle is an important part of hypertension management. The purpose of this study was to assess US state-level prevalence of adherence to healthy lifestyle behaviors among those with self-reported hypertension. Using 2013 data from the Behavioral Risk Factor Surveillance System, a state-based telephone survey, we examined the adherence to 5 healthy lifestyle behaviors related to hypertension management: having a “normal” weight, not smoking, avoiding or limiting alcohol intake, consuming the recommended amount of fruits and vegetables, and engaging in the recommended amount of physical activity. We estimated age-standardized percentages of each healthy lifestyle behavior overall and by state, as well as prevalence of all 5 healthy lifestyle behaviors. Overall, the prevalence of healthy lifestyle behaviors varied widely among those with self-reported hypertension: 20.5% had a normal weight, 82.3% did not smoke, 94.1% reported no or limited alcohol intake, 14.1% consumed the recommended amounts of fruits or vegetables, and 46.6% engaged in the recommended amount of physical activity. Overall, only 1.7% of adults with self-reported hypertension reported all 5 healthy lifestyle behaviors, with significant variation by state. Age-standardized prevalence of individuals reporting all 5 healthy lifestyle behaviors ranged from 0.3% in Louisiana to 3.8% in the District of Columbia. In conclusion, adherence to healthy lifestyle behaviors varied among those with hypertension; fewer than 2% reported meeting current recommendations and standards when assessed collectively. Disparities were observed by demographic and descriptive characteristics, including geography. PMID:26851000

  11. 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

  12. 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.

  13. Posterior reversible encephalopathy syndrome in a hypertensive patient with renal failure.

    PubMed

    Aatif, T; El Farouki, M R; Benyahia, M

    2016-03-01

    Posterior reversible encephalopathy syndrome (PRES) is a clinical and neuroimaging entity characterized by headache, visual field deficits, changes in mentation and seizures, and by typical neuro-imaging features such as areas of sub-cortical edema, occasionally cortical, involving predominantly the occipital and parietal lobes of both hemispheres. Hypertension, uremia, immunosuppressive drugs neurotoxicity, preeclampsia or eclampsia, renal disease, and sepsis are the most common etiologies of PRES. Less common, it has been described in the setting of autoimmune disease. We report a case of PRES which was associated with hypertensive crisis in a patient with renal failure. Antihypertensive therapy and hemodialysis resulted in complete recovery. PMID:26997402

  14. Acute hypertension during ramucirumab infusion in two patients with advanced oesophagogastric cancer.

    PubMed

    van der Woude, Stephanie O; van Laarhoven, Hanneke W M

    2016-01-01

    Ramucirumab, a monoclonal antibody targeting the vascular endothelial growth factor (VEGF) pathway, in combination with paclitaxel is becoming part of standard second-line systemic therapy for advanced oesophagogastric cancer, based on the results of the REGARD and RAINBOW trials. Common well-known side effects of VEGF pathway inhibitors are hypertension and infusion-related reactions. Here, we describe hypertension as the predominant feature of an infusion-related reaction in 2 patients with metastasised oesophagogastric carcinoma treated with ramucirumab and paclitaxel as second-line treatment and propose possible explanations of this side effect previously undescribed for ramucirumab. PMID:27539134

  15. Resistant Hypertension.

    PubMed

    Doroszko, Adrian; Janus, Agnieszka; Szahidewicz-Krupska, Ewa; Mazur, Grzegorz; Derkacz, Arkadiusz

    2016-01-01

    Resistant hypertension is a severe medical condition which is estimated to appear in 9-18% of hypertensive patients. Due to higher cardiovascular risk, this disorder requires special diagnosis and treatment. The heterogeneous etiology, risk factors and comorbidities of resistant hypertension stand in need of sophisticated evaluation to confirm the diagnosis and select the best therapeutic options, which should consider lifestyle modifications as well as pharmacological and interventional treatment. After having excluded pseudohypertension, inappropriate blood pressure measurement and control as well as the white coat effect, suspicion of resistant hypertension requires an analysis of drugs which the hypertensive patient is treated with. According to one definition - ineffective treatment with 3 or more antihypertensive drugs including diuretics makes it possible to diagnose resistant hypertension. A multidrug therapy including angiotensin - converting enzyme inhibitors, angiotensin II receptor blockers, beta blockers, diuretics, long-acting calcium channel blockers and mineralocorticoid receptor antagonists has been demonstrated to be effective in resistant hypertension treatment. Nevertheless, optional, innovative therapies, e.g. a renal denervation or baroreflex activation, may create a novel pathway of blood pressure lowering procedures. The right diagnosis of this disease needs to eliminate the secondary causes of resistant hypertension e.g. obstructive sleep apnea, atherosclerosis and renal or hormonal disorders. This paper briefly summarizes the identification of the causes of resistant hypertension and therapeutic strategies, which may contribute to the proper diagnosis and an improvement of the long term management of resistant hypertension. PMID:26935512

  16. Plasma endothelin 1/2 levels in healthy blood donors and in hypertensive patients: clinical application.

    PubMed

    Baldys-Waligórska, A; Szybinski, Z

    1993-06-01

    Normal endothelin 1/2 levels and their correlation with age were evaluated and compared with endothelin 1/2 levels in hypertensive patients. Plasma endothelin 1/2 (ET) levels were measured in healthy blood donors, mostly males, of mean age 36 +/- 8 years (36 subjects), subdivided into three groups: 17-30, 31-40 and above 40 years of age (41-59 yrs). Hypertensive patients (15 subjects) were subdivided into two groups: essential and nephrogenic hypertension. The normal ET levels in the three age groups (means +/- S.D.) were: 0.58 +/- 0.19, 0.62 +/- 0.31, and 0.80 +/- 0.28 fmol/ml, respectively. The average ET level for the whole normal population was 0.66 +/- 0.28 fmol/ml. Only the differences between the mean ET levels in the first and last group were significant (P < 0.05). The difference between the mean ET levels in smokers 0.71 +/- 0.28 fmol/ml (53% of total population) and non-smokers 0.65 +/- 0.28 fmol/ml, women and men, irrespective of age, was not found to be significant. The average ET level in all patients with hypertension (0.91 +/- 0.37 fmol/ml) was significantly higher than the average ET level in blood donors of the same age group (P < 0.05). Although patients with essential hypertension had elevated ET levels compared with control, the difference between the mean ET level in these patients (0.77 +/- 0.24 fmol/ml) and in the corresponsding control group (0.62 +/- 0.31 fmol/ml) was not significant.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8003715

  17. Comparison of Clinical Outcomes Following Acute Myocardial Infarctions in Hypertensive Patients With or Without Diabetes

    PubMed Central

    Lee, Min Goo; Ahn, Youngkeun; Chae, Shung Chull; Hur, Seung Ho; Hong, Taek Jong; Kim, Young Jo; Seong, In Whan; Chae, Jei Keon; Rhew, Jay Young; Chae, In Ho; Cho, Myeong Chan; Bae, Jang Ho; Rha, Seung Woon; Kim, Chong Jim; Choi, Donghoon; Jang, Yang Soo; Yoon, Junghan; Chung, Wook Sung; Cho, Jeong Gwan; Seung, Ki Bae; Park, Seung Jung

    2009-01-01

    Background and Objectives It is thought that patients with diabetes mellitus (DM) have a poor prognosis after an acute myocardial infarction (AMI), but the effect of diabetes on the outcomes of hypertensive patients with AMIs has not been elucidated in the Korean population. The aim of this study was to investigate the effects of diabetes on long-term clinical outcomes following AMIs in patients with hypertension. Subjects and Methods Using data from the Korea Acute Myocardial Infarction Registry (November 2005 to December 2006), 2,233 hypertensive patients with AMIs were grouped as follows based on the presence of DM: group I, diabetic hypertension (n=892, 544 men, mean age=66.2±10.9 years); and group II, non-diabetic hypertension (n=1341, 938 men, mean age=63.9±12.8 years). The primary study outcomes included in-hospital death and major adverse cardiac events (MACE; cardiac death, myocardial infarction (MI), repeat percutaneous coronary intervention, and coronary artery bypass surgery) at the 1 year follow-up. Results Hypertensive patients with DM were older and more likely to be women. The diabetic group had lower blood pressure (p<0.001), a lower left ventricular ejection fraction (p<0.001), a more severe degree of heart failure (p<0.001), a longer duration of coronary care unit admission (p<0.001), and a higher incidence of hyperlipidemia (p=0.007). The N-terminal pro-brain natriuretic peptide level (4602.5±8710.6 pg/mL vs. 2320.8±5837.9 pg/mL, p<0.001) was higher and the creatinine clearance (62.4±29.9 mL/min vs. 73.0±40.8 mL/min, p<0.001) was lower in the diabetic group than the non-diabetic group. Coronary angiographic findings revealed more frequent involvement of the left main stem (p=0.002) and multiple vessels (p<0.001) in the diabetic group. The rate of in-hospital death was higher in the diabetic group (p<0.001). During follow-up, the rates of composite MACE at 1 month, 6 months, and 12 months were higher in the diabetic group (p<0

  18. Managing hypertension in high-risk patients: lessons and promises from the STRATHE and ADVANCE trials.

    PubMed

    Waeber, Bernard

    2006-05-01

    Pharmacological treatment of hypertension represents a cost-effective way of preventing cardiovascular and renal complications. To benefit maximally from antihypertensive treatment, blood pressure should be brought to below 140/90 mmHg in every hypertensive patient, and even lower (< 130/80 mmHg) if diabetes or renal disease co-exists. Such targets cannot usually be reached using monotherapies. This is especially true in patients who present with a high cardiovascular risk. The co-administration of two agents acting by different mechanisms considerably increases the blood pressure control rate. Such combinations are not only efficacious, but are also well tolerated, and some fixed low-dose combinations even have a placebo-like tolerability. This is the case for the preparation containing the angiotensin-converting enzyme inhibitor perindopril (2 mg) and the diuretic indapamide (0.625 mg), a fixed low-dose combination that has been shown in controlled trials to be more effective than monotherapies in reducing albuminuria, regressing cardiac hypertrophy and improving the stiffness of large arteries. Using this combination to initiate antihypertensive therapy has been shown in a double-blind trial (Strategies of Treatment in Hypertension: Evaluation; STRATHE) to normalize blood pressure (< 140/90 mmHg) in significantly more patients (62%) than a sequential monotherapy approach based on atenolol, losartan and amlodipine (49%) and a stepped-care strategy based on valsartan and hydrochlorothiazide (47%), with no difference between the three arm groups in terms of tolerability. An ongoing randomized trial (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation; ADVANCE) is a study with a 2 x 2 factorial design assessing the effects of the fixed-dose perindopril-indapamide combination and of the intensive gliclazide modified release-based glucose control regimen in type 2 diabetic patients, with or without hypertension. A

  19. Baseline Antihypertensive Drug Count and Patient Response to Hypertension Medication Management.

    PubMed

    Crowley, Matthew J; Olsen, Maren K; Woolson, Sandra L; King, Heather A; Oddone, Eugene Z; Bosworth, Hayden B

    2016-04-01

    Telemedicine-based medication management improves hypertension control, but has been evaluated primarily in patients with low antihypertensive drug counts. Its impact on patients taking three or more antihypertensive agents is not well-established. To address this evidence gap, the authors conducted an exploratory analysis of an 18-month, 591-patient trial of telemedicine-based hypertension medication management. Using general linear models, the effect of medication management on blood pressure for patients taking two or fewer antihypertensive agents at study baseline vs those taking three or more was compared. While patients taking two or fewer antihypertensive agents had a significant reduction in systolic blood pressure with medication management, those taking three or more had no such response. The between-subgroup effect difference was statistically significant at 6 months (-6.4 mm Hg [95% confidence interval, -12.2 to -0.6]) and near significant at 18 months (-6.0 mm Hg [95% confidence interval, -12.2 to 0.2]). These findings suggest that baseline antihypertensive drug count may impact how patients respond to hypertension medication management and emphasize the need to study management strategies specifically in patients taking three or more antihypertensive medications. PMID:26370918

  20. [Difficult situations in radiotherapy: agitated adult patients].

    PubMed

    Noël, S; Noël, G

    2013-10-01

    The causes of agitation in adult patients are numerous. Agitation may cause difficulty or impossibility to initiate the radiotherapy technique but also can lead to accidents harmful to patients. However, the decision to not irradiate agitated patients may lead to a loss of curability chance or chance to palliate symptoms. Before taking such a decision, thinking about the possibilities available to calm the patient should be undertaken with the patient and the referring practitioners to attempt to make this therapy if it is considered major in the management of cancer. In all cases, current adaptations of radiotherapy should be used to deliver an effective radiation of a suitable time and safely. It is notable that the medical literature is extremely rare on this subject. PMID:23932645

  1. [Adult patients with congenital heart disease].

    PubMed

    Grabitz, R G; Kaemmerer, H; Mohr, F-W

    2013-01-01

    Unlike a few decades ago, today most patients with congenital heart disease reach adulthood after intervention or reparative surgery. As complete correction is generally not possible, a patient population with great complexity and a particular challenge to medical management is rising and a regular follow-up is mandatory. The aim of care is the timely recognition of residual or associated problems. Frequency and intensity of follow-up examinations depend on type and complexity of the lesion. The standard repertoire at follow-up consists of a specific history, clinical examination, ECG, Holter-monitoring, exercise tests, and echocardiography. Depending on the indication, cardio-MRI, CT scan, and sophisticated cardiac catheterization may become necessary. Long-term complications like rhythm disturbances, pulmonary hypertension, or heart failure are frequent, despite optimal care. Acute complications like arrhythmias, infective endocarditis, cerebral events, cerebral abscesses, aortic dissection, pulmonary embolism, and bleeding have to be recognized early and treated appropriately. Additional focus has to be placed on counseling and management of noncardiac disease and surgery, pregnancy and delivery, exercise at work and in private life, driving, and insurance issues. Training and certification of physicians as well as the establishment of specialized centers will help to ensure high quality health care for the affected patient population. PMID:23318541

  2. [Cardiovascular responses during laryngeal mask airway insertion in normotensive, hypertensive and chronic renal failure patients].

    PubMed

    Yamauchi, M; Igarashi, M; Tsunoda, K; Edanaga, M; Suzuki, H; Tohdoh, Y; Namiki, A

    1999-08-01

    The hemodynamic response to the insertion of the laryngeal mask airway (LM) following induction with propofol 2 mg.kg-1 was assessed and compared in normotensive (Normal), hypertensive (HT) and chronic renal failure (CRF) patients (n = 23 in each group). Before induction, in HT and CRF groups blood pressure and rate pressure products (RPP) were higher than in Normal group (P < 0.05). Although blood pressure and RPP were decreased in every patient by induction with propofol, no patients needed vasopressor drugs. The decreases of blood pressure and RPP were larger in HT and CRF groups than in Normal group (P < 0.05). There were no differences between groups in heart rate and rate of successful LM insertion. We concluded that LM insertion with propofol 2 mg.kg-1 was an effective induction method preventing the adverse circulatory responses in normotensive, hypertensive and chronic renal failure patients. PMID:10481421

  3. Interaction between essential elements selenium and zinc with cadmium and mercury in samples from hypertensive patients.

    PubMed

    Afridi, Hassan Imran; Kazi, Tasneem Gul; Talpur, Farah Naz; Kazi, Atif; Arain, Sadaf Sadia; Arain, Salma Aslam; Brahman, Kapil Dev; Panhwar, Abdul Haleem; Naeemullah; Shezadi, Mariam; Ali, Jamshed

    2014-08-01

    The abnormal metabolism of metal ions plays an important role in health and disease conditions; hence, the studies about them have received much interest. The objective of this study was to evaluate the association between trace and toxic elements zinc (Zn), cadmium (Cd), selenium (Se), and mercury (Hg) in biological samples (scalp hair, blood, and urine) of hypertensive patients (n = 257), residents of Hyderabad, Pakistan. For comparison purpose, the biological samples of age-matched healthy controls were selected as referents. The concentrations of trace and toxic elements were measured by atomic absorption spectrophotometer prior to microwave-assisted acid digestion. The validity and accuracy of the methodology was checked using certified reference materials and by the conventional wet acid digestion method. The recovery of all studied elements was found in the range of 96.4-99.1 % in certified reference materials. The results of this study showed that the mean values of Cd and Hg were significantly higher in scalp hair, blood, and urine samples of hypertensive patients than in referents (P < 0.001), whilst the concentrations of Zn and Se were lower in the scalp hair and blood, but higher in the urine samples of hypertensive patients. The deficiency of Zn and Se and the high exposure of toxic metals may be synergistic with risk factors associated with hypertension. PMID:24962640

  4. Relation of vitamin D deficiency and new-onset atrial fibrillation among hypertensive patients.

    PubMed

    Ozcan, Ozgur Ulas; Gurlek, Adalet; Gursoy, Eren; Gerede, Demet Menekse; Erol, Cetin

    2015-04-01

    Vitamin D deficiency is associated with various cardiovascular disorders including hypertension, coronary artery disease, and heart failure. The renin-angiotensin-aldosterone system (RAS) axis is activated in vitamin D deficiency. The RAS axis also plays a role in the pathophysiology of atrial fibrillation (AF). We aimed to investigate whether vitamin D deficiency is a risk factor for the development of new-onset AF in hypertension. A total of 227 hypertensive patients were enrolled, of whom 137 had new-onset AF; 90 patients without AF were included in the control group. The age of the patient, left atrial diameter, and vitamin D deficiency increased the probability of new-onset AF independent from confounding factors (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01-1.08; P = .03 for age; OR, 1.88; 95% CI, 1.15-3.45; P = .03 for left atrial diameter; OR, 1.68; 95% CI, 1.18-2.64; P = .03 for vitamin D deficiency). Vitamin D deficiency is associated with new-onset AF in hypertension. PMID:25753298

  5. Oral beraprost sodium improves exercise capacity and ventilatory efficiency in patients with primary or thromboembolic pulmonary hypertension

    PubMed Central

    Nagaya, N; Shimizu, Y; Satoh, T; Oya, H; Uematsu, M; Kyotani, S; Sakamaki, F; Sato, N; Nakanishi, N; Miyatake, K

    2002-01-01

    Objective: To investigate the effect of beraprost sodium, an orally active prostacyclin analogue, on exercise capacity and ventilatory efficiency in patients with primary pulmonary hypertension and chronic thromboembolic pulmonary hypertension. Patients and design: Symptom limited cardiopulmonary exercise testing was performed before and 3 (1) months (mean (SEM)) after beraprost treatment in 30 patients with precapillary pulmonary hypertension (14 with primary pulmonary hypertension and 16 with chronic thromboembolic pulmonary hypertension). Results: Long term treatment with beraprost resulted in significant increases (mean (SEM)) in peak workload (87 (4) W to 97 (5) W, p < 0.001) and peak oxygen consumption (peak V̇o2, 14.9 (0.7) ml/kg/min to 16.8 (0.7) ml/kg/min, p < 0.001). Beraprost decreased the ventilatory response to carbon dioxide production during exercise (V̇e–V̇co2 slope, 42 (2) to 37 (1), p < 0.001). No significant difference in the responses of these variables to beraprost treatment was observed between patients with primary pulmonary hypertension and chronic thromboembolic pulmonary hypertension. Conclusions: Oral administration of beraprost sodium may improve exercise capacity and ventilatory efficiency in patients with both primary and chronic thromboembolic pulmonary hypertension. PMID:11907007

  6. Improving the Blood Pressure Control With the ProActive Attitude of Hypertensive Patients Seeking Follow-up Services

    PubMed Central

    Tang, Shangfeng; Bishwajit, Ghose; Ji, Lu; Feng, Da; Fang, Haiqing; Fu, Hang; Shao, Tian; Shao, Piaopiao; Liu, Chunyan; Feng, Zhanchun; Luba, Tegene R.

    2016-01-01

    Abstract Proactive attitude of hypertensive patients seeking follow-up services (FUS) lies at the core of self-efficacy. However, few evidence have shown the activeness of seeking FUS in the context of blood pressure control among hypertensive patients. Improvements in follow-up visits may not just by services itself cause better control of blood pressure among hypertensive patients, rather due to the patient's pro-active attitude of the patient in seeking FUS. A cross-sectional study was carried out in selected rural regions of China to explore the association between blood pressure control and sociodemographic and economic variables and activeness of hypertensive patients in seeking FUS. The primary clinical outcome for this study was blood pressure control (systolic blood pressure <140 mmHg or diastolic blood pressure <90 mmHg) Out of the total 2321 participants with hypertension aged 35 years or older participated in this survey. Number of proactive FUS seekers were 3.17 times greater than those of passive seekers (odds ratio [OR] = 3.17, 95% confidence interval [CI] = 2.56–3.93, P < 0.001). In all subgroups, hypertensive patients who were seeking FUS actively were more likely to control blood pressure better than those seeking FUS passively. Proactive attitude of seeking follow-up services can improve blood pressure control among hypertensive patients. PMID:27057859

  7. Comparing the probability of stroke by the Framingham risk score in hypertensive Korean patients visiting private clinics and tertiary hospitals

    PubMed Central

    2010-01-01

    Background The purpose of this study was to investigate the pattern of distribution of risk factors for stroke and the 10-year probability of stroke by the Framingham risk score in hypertensive patients visiting private clinics vs. tertiary hospitals. Methods A total of 2,490 hypertensive patients who attended 61 private clinics (1088 patients) and 37 tertiary hospitals (1402 patients) were enrolled. The risk factors for stroke were evaluated using a series of laboratory tests and physical examinations, and the 10-year probability of stroke was determined by applying the Framingham stroke risk equation. Results The proportion of patients who had uncontrolled hypertension despite the use of antihypertensive agents was 49% (66 and 36% of patients cared for at private clinics and tertiary hospitals, respectively; p < 0.001). The average 10-year probability of stroke by the Framingham risk score in hypertensive patients was 21% (approximately 2.2 times higher than of the risk of stroke in the Korean Cancer Prevention Study [KCPS] cohort) and was higher in patients attending tertiary hospitals compared to private clinics (16 and 24% of patients attending private clinics and tertiary hospitals, respectively; p < 0.001). Conclusions Since the 10-year probability of stroke by the Framingham risk score in hypertensive patients attending tertiary hospitals was higher than the risk for patients attending private clinics. We suggest that the more aggressive interventions are needed to prevent and early detect an attack of stroke in hypertensive patients attending tertiary hospitals. PMID:20822544

  8. Pathophysiology and treatment of pulmonary hypertension in sickle cell disease.

    PubMed

    Gordeuk, Victor R; Castro, Oswaldo L; Machado, Roberto F

    2016-02-18

    Pulmonary hypertension affects ∼10% of adult patients with sickle cell disease (SCD), particularly those with the homozygous genotype. An increase in pulmonary artery systolic pressure, estimated noninvasively by echocardiography, helps identify SCD patients at risk for pulmonary hypertension, but definitive diagnosis requires right-heart catheterization. About half of SCD-related pulmonary hypertension patients have precapillary pulmonary hypertension with potential etiologies of (1) a nitric oxide deficiency state and vasculopathy consequent to intravascular hemolysis, (2) chronic pulmonary thromboembolism, or (3) upregulated hypoxic responses secondary to anemia, low O2 saturation, and microvascular obstruction. The remainder have postcapillary pulmonary hypertension secondary to left ventricular dysfunction. Although the pulmonary artery pressure in SCD patients with pulmonary hypertension is only moderately elevated, they have a markedly higher risk of death than patients without pulmonary hypertension. Guidelines for diagnosis and management of SCD-related pulmonary hypertension were published recently by the American Thoracic Society. Management of adults with sickle-related pulmonary hypertension is based on anticoagulation for those with thromboembolism; oxygen therapy for those with low oxygen saturation; treatment of left ventricular failure in those with postcapillary pulmonary hypertension; and hydroxyurea or transfusions to raise the hemoglobin concentration, reduce hemolysis, and prevent vaso-occlusive events that cause additional increases in pulmonary pressure. Randomized trials have not identified drugs to lower pulmonary pressure in SCD patients with precapillary pulmonary hypertension. Patients with hemodynamics of pulmonary arterial hypertension should be referred to specialized centers and considered for treatments known to be effective in other forms of pulmonary arterial hypertension. There have been reports that some of these treatments

  9. Differences in Hypertension by Sexual Orientation Among U.S. Young Adults

    PubMed Central

    Mollborn, Stefanie

    2013-01-01

    Using a nationally representative data set, this study provides the first estimates of differences in hypertension by sexual orientation using objective measures of systolic and diastolic blood pressure. Logistic regressions showed that there were no differences in hypertensive risk between mostly heterosexual/bisexual identified-respondents and heterosexual-identified respondents among both men and women. Gay men, however, are almost twice as likely (odds ratio = 1.92, p <.01) to be hypertensive compared to heterosexual men. The elevated risk is not explained by measures of minority stress, nor by cardiovascular disease risk factors such as smoking, alcohol use, drug use, BMI, or physical activity. No differences in hypertension risk by sexual orientation were detected among female respondents. The results suggest that gay men face an excess risk for hypertension compared to heterosexual men that is not explained by differences in measured health behaviors. PMID:23397511

  10. Coherence: A Novel Nonpharmacological Modality for Lowering Blood Pressure in Hypertensive Patients

    PubMed Central

    2012-01-01

    This study examined the efficacy of teaching emotional self-regulation techniques supported by heart rhythm coherence training (emWave Personal Stress Reliever) as a means to quickly lower blood pressure (BP) in patients diagnosed with hypertension. Previous studies have demonstrated systemic reductions in BP in both high stress populations and patients diagnosed with hypertension using this approach, but to the best of our knowledge, an investigation of their ability to produce immediate reductions in BP had not been published in the medical literature. The study was a randomized controlled design with 62 hypertensive participants who were divided into three groups. Group 1 was taking hypertensive medication, was taught self-regulation technique, and used heart rate variability coherence (HRVC) training devices. Group 2 was not yet taking medication and was trained in the same intervention. Group 3 was taking hypertensive medication but did not receive the intervention and was instructed to relax between the BP assessments. An analysis of covariates was conducted to compare the effectiveness of three different interventions on reducing the participants' BP. The use of the self-regulation technique and the HRVC-monitoring device was associated with a significantly greater reduction in mean arterial pressure in the two groups who used the intervention as compared with the relaxation-plus-medication group. Additionally, the group not taking medication that used the intervention also had a significantly greater reduction in systolic BP than the relaxation- plus-medication group. These results suggest that self-regulation techniques that incorporate the intentional generation of positive emotions to facilitate a shift into the psychophysiological coherence state are an effective approach to lowering BP. This approach to reducing BP should be considered a simple and effective approach that can easily be taught to patients to quickly lower their BP in stressful

  11. Serum uric acid in new and recent onset primary hypertension

    PubMed Central

    Anand, N. N.; Padma, V.; Prasad, Arun; Alam, Krishna Chaitanya; Javid, M. S. A. Syed Mohammed

    2015-01-01

    Introduction: Hyperuricemia is common among adults with prehypertension, especially when the microalbuminuria is present. Hyperuricemia precedes the development of hypertension. Aim: (1) To find the association of hyperuricemia in new-onset hypertensive patients. (2) To find the association of hyperuricemia in hypertensive patients with regard to gender and risk factors such as smoking and central obesity. Material and Methods: A total of 50 adults aged between 20 and 50 years who had mild early hypertension were selected for the study. Fifty controls without hypertension were enrolled and investigated. Results: The association between uric acid (UA) and hypertension was analyzed using Student's t-test and statistical difference were assessed using Pearson coefficient. The study showed a significant difference in UA between the hypertensive subjects and the normotensive controls. There was not a significant difference between waist abnormality, smoking and UA in cases. Males have a higher degree of hyperuricemia than females in hypertensive patients. Conclusion: Serum UA is strongly associated with blood pressure (BP) in new and recent onset primary hypertension. The remarkable association of UA with BP in adults is consistent with recent animal model data and the hypothesis that the UA might have a pathogenic role in the development of hypertension. PMID:26015744

  12. Multi-modal intervention to reduce cardiovascular risk among hypertensive older adults: Design of a randomized clinical trial.

    PubMed

    Buford, Thomas W; Anton, Stephen D; Bavry, Anthony A; Carter, Christy S; Daniels, Michael J; Pahor, Marco

    2015-07-01

    Persons aged over 65 years account for over 75% of healthcare expenditures and deaths attributable to cardiovascular disease (CVD). Accordingly, reducing CVD risk among older adults is an important public health priority. Functional status, determined by measures of physical performance, is an important predictor of cardiovascular outcomes in older adults and declines more rapidly in seniors with hypertension. To date, physical exercise is the primary strategy for attenuating declines in functional status. Yet despite the general benefits of training, exercise alone appears to be insufficient for preventing this decline. Thus, alternative or adjuvant strategies are needed to preserve functional status among seniors with hypertension. Prior data suggest that angiotensin converting enzyme inhibitors (ACEi) may be efficacious in enhancing exercise-derived improvements in functional status yet this hypothesis has not been tested in a randomized controlled trial. The objective of this randomized, double-masked pilot trial is to gather preliminary efficacy and safety data necessary for conducting a full-scale trial to test this hypothesis. Sedentary men and women ≥ 65 years of age with functional limitations and hypertension are being recruited into this 24 week intervention study. Participants are randomly assigned to one of three conditions: (1) ACEi plus exercise training, (2) thiazide diuretic plus exercise training, or (3) AT1 receptor antagonist plus exercise training. The primary outcome is change in walking speed and secondary outcomes consist of other indices of CV risk including exercise capacity, body composition, as well as circulating indices of metabolism, inflammation and oxidative stress. PMID:26115878

  13. Multi-modal intervention to reduce cardiovascular risk among hypertensive older adults: Design of a randomized clinical trial

    PubMed Central

    Buford, Thomas W.; Anton, Stephen D.; Bavry, Anthony; Carter, Christy S.; Daniels, Michael J.; Pahor, Marco

    2015-01-01

    Persons aged over 65 years account for over 75% of healthcare expenditures and deaths attributable to cardiovascular disease (CVD). Accordingly, reducing CVD risk among older adults is an important public health priority. Functional status, determined by measures of physical performance, is an important predictor of cardiovascular outcomes in older adults and declines more rapidly in seniors with hypertension. To date, physical exercise is the primary strategy for attenuating declines in functional status. Yet despite the general benefits of training, exercise alone appears to be insufficient for preventing this decline. Thus, alternative or adjuvant strategies are needed to preserve functional status among seniors with hypertension. Prior data suggest that angiotensin converting enzyme inhibitors (ACEi) may be efficacious in enhancing exercise-derived improvements in functional status yet this hypothesis has not been tested in a randomized controlled trial. The objective of this randomized, double-masked pilot trial is to gather preliminary efficacy and safety data necessary for conducting a full-scale trial to test this hypothesis. Sedentary men and women ≥ 65 years of age with functional limitations and hypertension are being recruited into this 24 week intervention study. Participants are randomly assigned to one of three conditions: (1) ACEi plus exercise training, (2) thiazide diuretic plus exercise training, or (3) AT1 receptor antagonist plus exercise training. The primary outcome is change in walking speed and secondary outcomes consist of other indices of CV risk including exercise capacity, body composition, as well as circulating indices of metabolism, inflammation and oxidative stress. PMID:26115878

  14. [Ambulatory 24-hour blood pressure monitoring in patients with resistant hypertension].

    PubMed

    Sznajderman, M; Popławska, W; Cybulska, I; Niegowska, J; Makowiecka-Cieśla, M; Baranowski, R

    1990-01-01

    The aim of the study was to assess the usefulness of 24-hour blood pressure (BP) and heart rate (HR) monitoring in patients with "resistant" hypertension. 30 patients (44.1 +/- 9.9 years) with diastolic BP 100 mm Hg or more in spite of treatment with three or more antihypertensive drugs were studied. Ambulatory recording of BP and HR was performed by means of Del Mar Avionics monitoring system 9000. Mean recording time was 21.5 hours and mean number of measurements during one recording--56.7. Mean ambulatory systolic and diastolic BP values were significantly lower than mean value of three casual measurements (146.0 +/- 24.6 vs 171.5 +/- 21.2 mm Hg for systolic and 97.2 +/- 11.3 vs 110.4 +/- 7.5 mm Hg for diastolic BP p less than 0.01) In 14 (46.6%) systolic BP and in 10 patients (33.3%) diastolic BP were normal. The patients with normal and abnormal ambulatory BP recordings did not differ in regard to age and mean clinic BP levels. However, patients with abnormal ambulatory BP recordings were more often overweight and showed a greater frequency of left ventricular hypertrophy and family history of hypertension and its complications. The results of the study show that ambulatory BP monitoring may be of value in assessing the response to antihypertensive treatment in patients with so called resistant hypertension as judged on the basis of clinic pressure. PMID:2074634

  15. Prevalence, Awareness, and Treatment of Hypertension in Patients with Type 1 Diabetes: A Nationwide Multicenter Study in Brazil

    PubMed Central

    Gomes, Marilia B.; Tannus, Lucianne Righeti Monteiro; Matheus, Alessandra Saldanha de Mattos; Cobas, Roberta Arnoldi; Palma, Catia C. Sousa; Silva, Aline Tiemi Kano; Negrato, Carlos Antonio; Dib, Sergio Atala; Rodacki, Melanie; Felício, João Soares; Canani, Luis Henrique

    2013-01-01

    Objective. This study evaluated the prevalence, awareness, and type of treatment for hypertension in Brazil in patients with type 1 diabetes (T1D). Methods. This was a cross-sectional, multicenter study that was conducted from December 2008 to December 2010 in 28 public clinics located in 20 Brazilian cities. Results. A total of 3,591 patients were studied, 56% female, average age 21.2 ± 11.7 years, with a median duration of diabetes 9.6 ± 8.1 years. Blood pressure levels were available for a total of 3,323 patients and 689 (19.2%) patients were hypertensive. Hypertensive patients were older, exhibited longer duration of diabetes, and had higher body mass index (BMI), total cholesterol, triglycerides, and LDL-C values (P < 0.001, for all comparisons), but only 370 (53.7%) received treatment. Patient awareness of hypertension was documented in 453 (65.5%) patients. However, only 76 (22.9%) of the treated patients attained the target systolic (sBP) and diastolic blood pressures (dBP). Conclusions. Our results demonstrate that a large number of T1D patients with hypertension do not receive appropriate treatment; few of the treated T1D patients achieved the target sBP and dBP values. Greater attention should be paid to blood pressure evaluation, hypertension diagnosis, and treatment of T1D patients in Brazil. PMID:23533714

  16. Right Ventricular Hemodynamics in Patients with Pulmonary Hypertension

    NASA Astrophysics Data System (ADS)

    Browning, James; Fenster, Brett; Hertzberg, Jean; Schroeder, Joyce

    2012-11-01

    Recent advances in cardiac magnetic resonance imaging (CMR) have allowed for characterization of blood flow in the right ventricle (RV), including calculation of vorticity and circulation, and qualitative visual assessment of coherent flow patterns. In this study, we investigate qualitative and quantitative differences in right ventricular hemodynamics between subjects with pulmonary hypertension (PH) and normal controls. Fifteen (15) PH subjects and 10 age-matched controls underwent same day 3D time resolved CMR and echocardiography. Echocardiography was used to determine right ventricular diastolic function as well as pulmonary artery systolic pressure (PASP). Velocity vectors, vorticity vectors, and streamlines in the RV were visualized in Paraview and total RV Early (E) and Atrial (A) wave diastolic vorticity was quantified. Visualizations of blood flow in the RV are presented for PH and normal subjects. The hypothesis that PH subjects exhibit different RV vorticity levels than normals during diastole is tested and the relationship between RV vorticity and PASP is explored. The mechanics of RV vortex formation are discussed within the context of pulmonary arterial pressure and right ventricular diastolic function coincident with PH.

  17. Cognitive evolution in hypertensive patients: a six-year follow-up

    PubMed Central

    Vicario, Augusto; del Sueldo, Mildren A; Zilberman, Judith M; Cerezo, Gustavo H

    2011-01-01

    Background: Several studies have examined the links between hypertension, vascular damage, and cognitive impairment. The functions most commonly involved seem to be those associated with memory and executive function. Aims: 1) to report the cognitive evolution in a cohort of hypertensive patients, 2) to identify the affected domains, and 3) to correlate the results obtained with blood pressure measurements. Materials and Methods: Observational 6-year follow-up cohort study including both males and females aged ≥65 and ≤80 years, and hypertensive patients under treatment. Patients with a history of any of the following conditions were excluded: stroke, transient ischemic attack, diabetes mellitus, atrial fibrillation, cardiac surgery, dementia, or depression. Four neurocognitive evaluations were performed (at baseline and every 2 years). The tests used evaluated memory and executive function domain. Blood pressure was measured on every cognitive evaluation. Results: Sixty patients were followed for 76.4 ± 2.8 months. The average age at baseline was 72.5 ± 4.2 and 77.9 ± 4.6 at 6 years (65% were women). Two patients were lost to follow up (3.3%) and 8 patients died (13.3%).The density incidence for dementia was 0.6% patients per year (pt/y) (n = 3) and for depression was 1.6% pt/y (n = 12). No changes were observed in either memory impairment or the Mini Mental State Examination (MMSE) results (p = ns) during follow-up. A progressive impairment of the executive function was shown regardless of the blood pressure measurements. Conclusion: 1) the incidence of dementia doubled to general population, 2) the initial memory impairment did not change during the evaluation period, 3) cognitive impairment worsened in the areas related to executive function (prefrontal cortex) regardless of the adequacy of anti-hypertensive treatment and blood pressure values. PMID:21603597

  18. Impact of Light Salt Substitution for Regular Salt on Blood Pressure of Hypertensive Patients

    PubMed Central

    Barros, Carolina Lôbo de Almeida; Sousa, Ana Luiza Lima; Chinem, Brunella Mendonça; Rodrigues, Rafaela Bernardes; Jardim, Thiago Souza Veiga; Carneiro, Sérgio Baiocchi; de Souza, Weimar Kunz Sebba Barroso; Jardim, Paulo César Brandão Veiga

    2015-01-01

    Background Studies have shown sodium restriction to have a beneficial effect on blood pressure (BP) of hypertensive patients. Objective To evaluate the impact of light salt substitution for regular salt on BP of hypertensive patients. Methods Uncontrolled hypertensive patients of both sexes, 20 to 65 years-old, on stable doses of antihypertensive drugs were randomized into Intervention Group (IG - receiving light salt) and Control Group (CG - receiving regular salt). Systolic BP (SBP) and diastolic BP (DBP) were analyzed by using casual BP measurements and Home Blood Pressure Monitoring (HBPM), and sodium and potassium excretion was assessed on 24-hour urine samples. The patients received 3 g of salt for daily consumption for 4 weeks. Results The study evaluated 35 patients (65.7% women), 19 allocated to the IG and 16 to the CG. The mean age was 55.5 ± 7.4 years. Most participants had completed the Brazilian middle school (up to the 8th grade; n = 28; 80.0%), had a family income of up to US$ 600 (n = 17; 48.6%) and practiced regular physical activity (n = 19; 54.3%). Two patients (5.7%) were smokers and 40.0% consumed alcohol regularly (n = 14). The IG showed a significant reduction in both SBP and DBP on the casual measurements and HBPM (p < 0.05) and in sodium excretion (p = 0.016). The CG showed a significant reduction only in casual SBP (p = 0.032). Conclusions The light salt substitution for regular salt significantly reduced BP of hypertensive patients. PMID:25409877

  19. Left Main Ostial Compression in a Patient with Pulmonary Hypertension: Dynamic Findings by IVUS

    PubMed Central

    Seabra, Luciana F.; Ribeiro, Henrique B.; de Barros e Silva, Pedro Gabriel Melo; Rodrigues, Marcelo J.; Spadaro, André G.; Conejo, Fábio; Godinho, Roger R.; Faig, Sandro M. M.; de Macedo, Thiago Andrade; de P. S. Baptista, Luciana; de Resende, Marcos Valerio C.; Furlan, Valter; Ribeiro, Expedito E.

    2015-01-01

    Patient: Female, 39 Final Diagnosis: Idiopathic pulmonary arterial hypertension Symptoms: Chest pain Medication: — Clinical Procedure: Percutaneous coronary intervention Specialty: Cardiology and Pulmonology Objective: Rare co-existance of disease or pathology Background: Pulmonary artery dilatation is a common feature among patients with severe pulmonary hypertension. Left main coronary artery extrinsic compression by an enlarged pulmonary artery is a rare complication and a potential cause for chest pain and sudden cardiac death in patients with pulmonary hypertension. This situation is very rare and few reports have described it. Currently, the appropriate management of these patients remains unknown. Case Report: In the present report we describe the case of a 39-year-old woman who presented with a 2-year history of cardiac symptoms related to exercise. The patient underwent a 64-slice multidetector computed tomography (MDCT) coronary angiography, which showed left main coronary artery (LMCA) compression by a markedly enlarged pulmonary artery trunk (44 mm), without intraluminal stenosis or coronary artery calcium, as determined by the Agatston score. This compression was considered to be the cause of the cardiac symptoms. To confirm and plan the treatment, the patient underwent cardiac catheterization that confirmed the diagnosis of pulmonary hypertension and LMCA critical obstruction. Taking into account the paucity of information regarding the best management in these cases, the treatment decision was shared among a “heart team” that chose percutaneous coronary intervention with stent placement. An intra-vascular ultrasound was performed during the procedure, which showed a dynamic compression of the left main coronary artery. The intervention was successfully executed without any adverse events. Conclusions: This case illustrates dynamic compression of the LMCA by IVUS, visually demonstrating the mechanism of the intermittent symptoms of myocardial

  20. [Effects of surgical treatment on circadian variations of arterial pressure in patients with primary aldosteronism and renovascular hypertension].

    PubMed

    Kosmacheva, E D; Minkin, S E; Chikhladze, N M; Arabidze, G G; At'kov, O Iu

    1990-05-01

    Noninvasive recording of blood pressure (BP) with a portable Del Mar Avionics monitor (USA) revealed its abnormal circadian rhythm in patients with renovascular hypertension or arterial hypertension caused by adrenal aldosteroma. Surgical treatment was shown to result in a significant decrease in blood pressures and normalization of its circadian rhythm in the early postoperative period. PMID:2391803

  1. Circulating renalase, catecholamines, and vascular adhesion protein 1 in hypertensive patients.

    PubMed

    Maciorkowska, Dominika; Zbroch, Edyta; Malyszko, Jolanta

    2015-11-01

    The aim of the study was to estimate and correlate circulating levels of renalase, vascular adhesion protein-1 (VAP-1), catecholamines in patients with primary hypertension. The renalase, VAP-1, and catecholamines concentration was estimated in 121 hypertensive patients. The correlation between renalase, VAP-1 levels and catecholamine concentration in blood, blood pressure control, pharmacological therapy, and medical history were taken in to consideration. The median office blood pressure was 145.5/86 mm Hg and was significantly higher than the median home blood pressure measurement value, which was 135/80 mm Hg, P < .05. Circulating renalase and VAP-1 (Me 9.57 μg/mL and Me = 326.7 ng/mL) levels were significantly higher in patients with hypertension comparing to healthy individuals (3.83 μg/mL and 248.37 ng/mL, P < .05). The correlation between renalase and noradrenalin concentration in blood was observed (r = 0.549; P < .05), also the correlation between VAP-1 and noradrenaline was noticed (r = 0.21, P = .029). Renalase level was higher in patients with coronary artery disease and correlated with decreased ejection fraction. VAP-1 concentration correlated also with left ventricular ejection fraction (r = -0.23, P = .013). Hypertensive patients with diabetes mellitus had almost statistically significant higher VAP-1 concentration compared with hypertensive patients without diabetes mellitus (Me = 403.22 ng/mL vs. Me = 326,68 ng/mL, P = .064). In multiple regression analysis, renalase was predicted by plasma dopamine and norepinephrine as also diastolic office blood pressure and left ventricle ejection fraction. Circulating renalase and VAP-1 levels are elevated in patients with poor blood pressure control. Its correlation with noradrenalin concentration need further studies to find out the role of renalase as also VAP-1 in pathogenesis and treatment of hypertension. PMID:26403854

  2. Management of erectile dysfunction in hypertension: Tips and tricks

    PubMed Central

    Viigimaa, Margus; Vlachopoulos, Charalambos; Lazaridis, Antonios; Doumas, Michael

    2014-01-01

    Arterial hypertension is a major risk factor for cardiovascular disease and affects approximately one third of the adult population worldwide. The vascular origin of erectile dysfunction is now widely accepted in the vast majority of cases. Erectile dysfunction is frequently encountered in patients with arterial hypertension and greatly affects their quality of life of hypertensive patients and their sexual partners. Therefore, the management of erectile dysfunction in hypertensive patients is of paramount importance. Unfortunately, erectile dysfunction remains under-reported, under-recognized, and under-treated in hypertensive patients, mainly due to the lack of familiarity with this clinical entity by treating physicians. This review aims to discuss the more frequent problems in the management of hypertensive patients with erectile dysfunction and propose ways to overcome these problems in everyday clinical practice. PMID:25276292

  3. Association of Serum Uric Acid with Cardiovascular Disease in Taiwanese Patients with Primary Hypertension

    PubMed Central

    Yang, Tsung-Yuan; Fang, Chih-Yuan; Chen, Jung-Sheng; Po, Helen L.; Chou, Li-Ping; Chiang, Chih-Yeng; Ueng, Kwo-Chang

    2015-01-01

    Background Hyperuricemia is closely linked to hypertension and may be a marker of susceptibility or an intermediate step in the development of metabolic syndrome. However, recently, there have been conflicting conclusions regarding the independent role of uric acid as a risk factor of cardiovascular disease (CVD). The specific role of serum uric acid (SUA) in relation to CVD remains controversial, and there are limited reports utilizing Asian data available on this issue. Therefore, this study investigated the association between SUA and cardiovascular disease in Taiwanese patients with essential hypertension. Methods There were 3472 participants from 55-80 years of age (1763 males, 1709 females) from 38 sites across Taiwan in this hospital-based cross-sectional study, covering the period November 2005 to December 2006. The CVD included diagnosed angina pectoris, myocardial infarction, congestive heart failure, and stroke. Results Hyperuricemia is positively associated with CVD in both sexes when a unified cut-off SUA level of 7 mg/dl was used. However, the odds ratios (ORs) for all CVD were greater in magnitude in hypertensive women than in men when there was co-morbidity of diabetes. The ORs of all CVD in the diabetes subgroup were statistically significantly (p = 0.01 for women, p = 0.07 for men). By multivariate analysis, hyperuricemia did not confer an increased risk of CVD. Conclusions Hyperuricemia may be associated with increased risk of CVD, but is not an independent risk factor of CVD in essential hypertensive Taiwanese patients. PMID:27122845

  4. [Efficiency of high-volume hemofiltration in patients with severe sepsis and intracranial hypertension].

    PubMed

    Musaeva, T S; Berdnikov, A P; Goncharenko, S I; Denisova, E A

    2014-01-01

    We performed a retrospective study in 68 patients (144 procedures) with severe sepsis and intracranial hypertension measured by the pressure in the central retinal vein. The patients underwent high-volume hemofiltration (HV-HF) for extrarenal indications. Increased pressure in the central retinal vein was accompanied by critical points of cerebral perfusion pressure and the growth of neurological deficit with inhibition level of consciousness to coma 1. In this case, IHV-HF may be associated with the formation of the critical points of cerebral perfihsion and severe disorders of microcirculation and the lack of resolution of tissue hypoperfusion. In case of intracranial hypertension IHV-HF is not effective in the category of patients where there is a combination ΔpCO2 > 5.9 mm Hg level and GCS <10 points. PMID:25831703

  5. Evaluation of splenic embolization in patients with portal hypertension and hypersplenism.

    PubMed Central

    Alwmark, A; Bengmark, S; Gullstrand, P; Joelsson, B; Lunderquist, A; Owman, T

    1982-01-01

    Twenty-five patients with hypersplenism caused by portal hypertension were treated by repeated partial splenic embolization. Fourteen surviving patients were followed for up to six years showing a good response on peripheral blood count and bleeding tendency. Three patients died in connection with the treatment and another eight died within half a year because of the underlying liver disease. The discomfort and complications of fever, pain, pleural effusion, and abscess formation and the possibility to avoid these by repeated partial embolization under antibiotic cover are discussed. The results are compared with reports in the reviewed actual literature and the splenic embolization is given a place among the means of a successful selective symptomatic treatment of partial hypertension. PMID:7125739

  6. Dose response to chlorthalidone in patients with mild hypertension. Efficacy of a lower dose.

    PubMed

    Materson, B J; Oster, J R; Michael, U F; Bolton, S M; Burton, Z C; Stambaugh, J E; Morledge, J

    1978-08-01

    A multicenter study of chlorthalidone was performed to determine the relative antihypertensive efficacy and side effects of doses lower than those usually recommended for therapy. After a 4-wk placebo control period 100 patients with mild hypertension were randomly assigned doubleblind to 12.5-, 25-, 50-, or 75-mg regimens of chlorthalidone or to placebo for 12 wk. The groups of patients taking 25, 50, and 75 mg had declines in blood pressure which were not significantly different from each other. Serum potassium decreased in the 50- and 75-mg groups but not significantly in the 25-mg group. We conclude that chlorthalidone, 25 mg daily, was at least as effective for hypertension as 50 and 75 mg with less perturbation of potassium. Use of smaller initial diuretic doses may provide equal efficacy with fewer side effects for many patients. PMID:354839

  7. Prevalence and associated risk factors of hypertension amongst adults in a rural community of Limpopo Province, South Africa

    PubMed Central

    Maimela, Eric; Alberts, Mariannes; Choma, Solly; Dikotope, Sekgothe

    2015-01-01

    Background Hypertension is problem already faced by urban populations of South Africa, but little is known about its prevalence and risk factors in rural areas. Aim To assess the prevalence of and risk factors associated with hypertension amongst adults in a rural community in South Africa. Setting Dikgale Health and Demographic Surveillance Site, Limpopo Province, South Africa. Methods A community-based cross-sectional survey was carried out at this site where individuals aged 15 years and older were screened using a locally adapted version of the World Health Organization STEPwise questionnaire. Demographics, anthropometry and three independent blood pressure (BP) readings were taken. The average of the three BP measurements was used in analysis, and hypertension taken as systolic and diastolic BP of ≥ 140 or ≥ 90 mmHg respectively, or at least a two-week history of antihypertensive treatment. Analysis included the Chi-square test and statistical significance was set at p ≤ 0.05. Results A total of 1407 individuals were interviewed, of whom 1281 had complete BP, weight and height measurements taken. The mean age of participants was 44.2 ± 20.9 years(range 15–98 years), 63% were female, 55% were single and 90% were unemployed, whilst 13% were tobacco smokers and 20% reported drinking alcohol. Overall prevalence of hypertension was 41% and this was significantly associated with age and marital status. Conclusion The prevalence of hypertension was found to be high. Prevention strategies are urgently needed to address this life-threatening and important risk factor for cardiovascular disease in rural Limpopo Province. PMID:26842512

  8. Health and Nutrition Literacy and Adherence to Treatment in Children, Adolescents, and Young Adults With Chronic Kidney Disease and Hypertension, North Carolina, 2015

    PubMed Central

    Ferris, Maria; Rak, Eniko

    2016-01-01

    Introduction Adherence to treatment and dietary restrictions is important for health outcomes of patients with chronic/end-stage kidney disease and hypertension. The relationship of adherence with nutritional and health literacy in children, adolescents, and young adults is not well understood. The current study examined the relationship of health literacy, nutrition knowledge, nutrition knowledge–behavior concordance, and medication adherence in a sample of children and young people with chronic/end-stage kidney disease and hypertension. Methods We enrolled 74 patients (aged 7–29 y) with a diagnosis of chronic/end-stage kidney disease and hypertension from the University of North Carolina Kidney Center. Participants completed instruments of nutrition literacy (Disease-Specific Nutrition Knowledge Test), health literacy (Newest Vital Sign), nutrition behavior (Nutrition Knowledge–Behavior Concordance Scale), and medication adherence (Morisky Medication Adherence Scale). Linear and binary logistic regressions were used to test the associations. Results In univariate comparisons, nutrition knowledge was significantly higher in people with adequate health literacy. Medication adherence was related to nutrition knowledge and nutrition knowledge–behavior concordance. Multivariate regression models demonstrated that knowledge of disease-specific nutrition restrictions did not significantly predict nutrition knowledge–behavior concordance scores. In logistic regression, knowledge of nutrition restrictions did not significantly predict medication adherence. Lastly, health literacy and nutrition knowledge–behavior concordance were significant predictors of medication adherence. Conclusion Nutrition knowledge and health literacy skills are positively associated. Nutrition knowledge, health literacy, and nutrition knowledge–behavior concordance are positively related to medication adherence. Future research should focus on additional factors that may predict

  9. 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

  10. The CXCR2 Gene Polymorphism Is Associated with Stroke in Patients with Essential Hypertension

    PubMed Central

    Timasheva, Yanina R.; Nasibullin, Timur R.; Mustafina, Olga E.

    2015-01-01

    Hypertension is the major risk factor for stroke, and genetic factors contribute to its development. Inflammation has been hypothesized to be the key link between blood pressure elevation and stroke. We performed an analysis of the association between inflammatory mediator gene polymorphisms and the incidence of stroke in patients with essential hypertension (EH). The study group consisted of 625 individuals (296 patients with noncomplicated EH, 71 hypertensive patients with ischemic stroke, and 258 control subjects). Both patients and controls were ethnic Tatars originating from the Republic of Bashkortostan (Russian Federation). The analysis has shown that the risk of ischemic stroke was associated with the CXCR2 rs1126579 polymorphism. Our results indicate that among patients with EH, the heterozygous genotype carriers had a higher risk of stroke (OR = 1.72, 95% CI 1.01-2.92), whereas the CXCR2*C/C genotype was protective against stroke (OR = 0.32, 95% CI 0.12-0.83). As shown by the gene-gene interaction analysis, the CXCR2 rs1126579 polymorphism was also present in all genotype/allele combinations associated with the risk of stroke. Genetic patterns associated with stroke also included polymorphisms in the CCL2, CCL18, CX3CR1, CCR5, and CXCL8 (IL8) genes, although no association between these loci and stroke was detected by individual analysis. PMID:26648969

  11. Clinical analysis of endometrial cancer patients with obesity, diabetes, and hypertension

    PubMed Central

    Yin, Xiang-Hua; Jia, Hong-Yan; Xue, Xiao-Rui; Yang, Shi-Zhang; Wang, Zhong-Qin

    2014-01-01

    The purpose of our study was to study the postoperation outcome and incidence of deep vein thrombosis (DVT) in endometrial cancer (EC) patients with or without hypertension, diabetes, and obesity. This analysis included 219 patients with endometrial carcinoma who were treated between 2002 and 2012 at the Department of Obstetrics and Gynecology, Yangzhou University Hospital. Patients were divided into five groups based on the comorbidities. Group 1 EC & Diabetes, Group 2 EC & Hypertension, Group 3 EC & Obesity, Group 4 EC Combined two, Group 5 no combined. Then the five groups were analyzed in postoperation outcomes and DVT incidence using one-way analysis of variance or Pearson χ2 tests. we found that there was no significant difference in pelvic lymph node metastasis (P=0.102), aortic lymph node metastasis (P=0.221), and operative time (P=0.503). But there was significant difference in blood loss (P<0.01), hospital stay (P<0.01). No significant difference (P>0.05) in treatment outcome between surgical operation, surgical operation+ radiotherapy and radiotherapy. Deep vein thrombosis and pulmonary embolism have some significantly (P<0.01) (P<0.01), respectively. Compared to patients who simply suffer from endometrial cancer, diabetes make patients easy bleeding in surgery and increase hospitalization time in corresponding. VTE is a common complication of EC surgery with comorbidities, such as diabetes and hypertension, and it’s a remarkable proportion of events occurring late after surgery. PMID:24753771

  12. Effect of vitamin C on inflammation and metabolic markers in hypertensive and/or diabetic obese adults: a randomized controlled trial

    PubMed Central

    Ellulu, Mohammed S; Rahmat, Asmah; Patimah, Ismail; Khaza’ai, Huzwah; Abed, Yehia

    2015-01-01

    Background Obesity is well associated as being an interfering factor in metabolic diseases such as hypertension and diabetes by increasing the secretion of proinflammatory markers from adipose tissue. Having healthy effects, vitamin C could work as an anti-inflammatory agent through its antioxidant capacity. Registration Registration number: FPSK_Mac [13]04. Objective The aim of the study reported here was to identify the effect of vitamin C on reducing the levels of inflammatory markers in hypertensive and/or diabetic obese adults. Subjects and methods Sixty-four obese patients, who were hypertensive and/or diabetic and had high levels of inflammatory markers, from primary health care centers in Gaza City, Palestine, were enrolled into one of two groups in an open-label, parallel, randomized controlled trial. A total of 33 patients were randomized into a control group and 31 patients were randomized into an experimental group. The experimental group was treated with 500 mg vitamin C twice a day. Results In the experimental group, vitamin C significantly reduced the levels of high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), fasting blood glucose (FBG), and triglyceride (TG) after 8 weeks of treatment (overall: P<0.001); no changes appeared in total cholesterol (TC). In the control group, there were significant reductions in FBG and TG (P=0.001 and P=0.026, respectively), and no changes in hs-CRP, IL-6, or TC. On comparing the changes in the experimental group with those in the control group at the endpoint, vitamin C was found to have achieved clinical significance in treating effectiveness for reducing hs-CRP, IL-6, and FBG levels (P=0.01, P=0.001, and P<0.001, respectively), but no significant changes in TC or TG were found. Conclusion Vitamin C (500 mg twice daily) has potential effects in alleviating inflammatory status by reducing hs-CRP, IL-6, and FBG in hypertensive and/or diabetic obese patients. PMID:26170625

  13. Cardiac oxygen supply is compromised during the night in hypertensive patients.

    PubMed

    Westerhof, Berend E; van Lieshout, Johannes J; Parati, Gianfranco; van Montfrans, Gert A; Guelen, Ilja; Spaan, Jos A E; Westerhof, Nico; Karemaker, John M; Bos, Willem Jan W

    2011-09-01

    The enhanced heart rate and blood pressure soon after awaking increases cardiac oxygen demand, and has been associated with the high incidence of acute myocardial infarction in the morning. The behavior of cardiac oxygen supply is unknown. We hypothesized that oxygen supply decreases in the morning and to that purpose investigated cardiac oxygen demand and oxygen supply at night and after awaking. We compared hypertensive to normotensive subjects and furthermore assessed whether pressures measured non-invasively and intra-arterially give similar results. Aortic pressure was reconstructed from 24-h intra-brachial and simultaneously obtained non-invasive finger pressure in 14 hypertensives and 8 normotensives. Supply was assessed by Diastolic Time Fraction (DTF, ratio of diastolic and heart period), demand by Rate-Pressure Product (RPP, systolic pressure times heart rate, HR) and supply/demand ratio by A(dia)/A(sys), with A(dia) and A(sys) diastolic and systolic areas under the aortic pressure curve. Hypertensives had lower supply by DTF and higher demand by RPP than normotensives during the night. DTF decreased and RPP increased in both groups after awaking. The DTF of hypertensives decreased less becoming similar to the DTF of normotensives in the morning; the RPP remained higher. A(dia)/A(sys) followed the pattern of DTF. Findings from invasively and non-invasively determined pressure were similar. The cardiac oxygen supply/demand ratio in hypertensive patients is lower than in normotensives at night. With a smaller night-day differences, the hypertensives' risk for cardiovascular events may be more evenly spread over the 24 h. This information can be obtained noninvasively. PMID:21786015

  14. Determinants of Adherence to Treatment in Hypertensive Patients of African Descent and the Role of Culturally Appropriate Education

    PubMed Central

    Meinema, Jennita G.; van Dijk, Nynke; Beune, Erik J. A. J.; Jaarsma, Debbie A. D. C.; van Weert, Henk C. P. M.; Haafkens, Joke A.

    2015-01-01

    Background In Western countries, better knowledge about patient-related determinants of treatment adherence (medication and lifestyle) is needed to improve treatment adherence and outcomes among hypertensive ethnic minority patients of African descent. Objective To identify patient-related determinants of adherence to lifestyle and medication recommendations among hypertensive African Surinamese and Ghanaian patients with suboptimal treatment results (SBP≥140) living in the Netherlands and how culturally appropriate hypertension education (CAHE) influenced those determinants. Methods This study analysed data of 139 patients who participated in the CAHE trial. Univariate logistic regression analysis was used to measure the association between patient-related determinants (medication self-efficacy, beliefs about medication and hypertension, social support, and satisfaction with care) and treatment adherence. We also tested whether CAHE influenced the determinants. Results Medication self-efficacy and social support were associated with medication adherence at baseline. At six months, more medication self-efficacy and fewer concerns about medication use were associated with improved medication adherence. Self-efficacy was also associated with adherence to lifestyle recommendations at baseline. CAHE influenced patients’ illness perceptions by creating more understanding of hypertension, its chronic character, and more concerns about the associated risks. Conclusion In this high-risk population, health care providers can support medication adherence by paying attention to patients’ medication self-efficacy, the concerns they may have about medication use and patients’ perceptions on hypertension. The CAHE intervention improved patients’ perception on hypertension. PMID:26267453

  15. Association of Elevated Serum Lipoprotein(a), Inflammation, Oxidative Stress and Chronic Kidney Disease with Hypertension in Non-diabetes Hypertensive Patients.

    PubMed

    Tangvarasittichai, Surapon; Pingmuanglaew, Patcharin; Tangvarasittichai, Orathai

    2016-10-01

    Hypertension is the most common cardiovascular risk factor. Lipoprotein(a) [Lp(a)], inflammation, oxidative stress and chronic kidney disease (CKD) exacerbate the response to tissue injury and acts as markers of the vascular disease, especially in glomerulosclerosis. We compared the clinical characteristics of 138 non-diabetes hypertensive women (ndHT) patients with 417 non-diabetes normotensive subjects and tested the association of hypertension with Lp(a), inflammation, CKD and oxidative stress by using multiple logistic regression. BP, BMI, waist circumference, creatinine, Lp(a), inflammation and malondialdehyde levels were significantly higher and CKD state in the ndHT patients (p < 0.05). Multiple logistic regression showed hypertension associated with increased Lp(a), inflammation, ORs and 95 % CIs were 2.52 (1.33, 4.80), 2.75 (1.44, 5.27) after adjusting for their covariates. Elevated serum Lp(a) and inflammation levels concomitants with increased oxidative stress and CKD were the major risk factors associated with hypertension and implications for the increased risk of HT and vascular disease. PMID:27605742

  16. Effect of Gender on the Total Abdominal Fat, Intra-Abdominal Adipose Tissue and Abdominal Sub-Cutaneous Adipose Tissue among Indian Hypertensive Patients

    PubMed Central

    Kumari, Savita; Jain, Sanjay

    2016-01-01

    Introduction Abdominal obesity is a better marker of adverse metabolic profile than generalized obesity in hypertensive subjects. Further, gender has effect on adiposity and its distribution. Aim Effect of gender on obesity and the distribution of fat in different sub-compartments of abdomen among Indian hypertensive subjects. Materials and Methods This observational study included 278 adult subjects (Males-149 & Females-129) with essential hypertension from a tertiary care centre in north India over one year. A detailed history taking and physical examination including anthropometry were performed in all patients. Total Abdominal Fat (TAF) and abdominal adipose tissue sub-compartments like Intra-Abdominal Adipose Tissue (IAAT) and Sub-Cutaneous Adipose Tissue (SCAT) were measured using the predictive equations developed for Asian Indians. Results Female hypertensive subjects had higher Body Mass Index (BMI) with more overweight (BMI ≥ 23kg/m2), and obesity (BMI≥ 25 kg/m2). Additionally, they had higher prevalence of central obesity based on both Waist Circumference (WC) criteria (WC≥ 90 cm in males and WC≥ 80 cm in females) and TAF criteria {≥245.6 cm2 (males) and ≥203.46 cm2 (females)} than male patients. But there was no difference in the prevalence of central obesity based on Waist Hip Ratio (WHR) criteria (WHR ≥0.90 in males and WHR ≥ 0.85 in females) between two genders. High TAF & IAAT were present in more females although there was no difference in the distribution of high SCAT between two genders. Conclusion Female hypertensive subjects were more obese with higher abnormal TAF & IAAT compared to male patients. However, there was no difference in the distribution of high SCAT among them. PMID:27190876

  17. Oral vasodilator therapy in patients with moderate to severe portopulmonary hypertension as a bridge to liver transplantation.

    PubMed

    Raevens, Sarah; De Pauw, Michel; Reyntjens, Koen; Geerts, Anja; Verhelst, Xavier; Berrevoet, Frederik; Rogiers, Xavier; Troisi, Roberto I; Van Vlierberghe, Hans; Colle, Isabelle

    2013-04-01

    Portopulmonary hypertension (POPH) is a part of group 1 pulmonary hypertension (pulmonary hypertension associated with portal hypertension). Liver transplantation (LTx) may be curative, but is usually restricted to patients with mild-to-moderate POPH. The presence of severe POPH may be a contraindication to transplantation because of the elevated risk of peritransplantation and post-transplantation morbidity and mortality. This report describes a series of seven patients with onset of moderate (two patients) or severe (five patients) POPH before LTx, of whom six were treated with oral vasodilator therapy for POPH. Although previous studies recommend aggressive parenteral prostacyclin therapy (epoprostenol), we describe the opportunity to treat cases of severe POPH with an oral phosphodiesterase type 5 inhibitor (sildenafil) and/or an endothelin receptor antagonist (bosentan/ambrisentan) as a bridge to successful LTx in selected patients. PMID:23242127

  18. Hibiscus sabdariffa L. tea (Tisane) lowers blood pressure in prehypertensive and mildly hypertensive adults

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Introduction: In vitro studies have shown Hibiscus sabdariffa L., an ingredient of many herbal tea blends and other beverages, has antioxidant properties. In animal models, extracts of hibiscus calyces possess hypocholesterolemic and anti-hypertensive properties. Hypothesis: We hypothesized that...

  19. Changes in left ventricular structure and function in patients with white coat hypertension: cross sectional survey

    PubMed Central

    Muscholl, Michael W; Hense, Hans-W; Bröckel, Ulrich; Döring, Angela; Riegger, Günter A J; Schunkert, Heribert

    1998-01-01

    Objectives: To assess the relation between white coat hypertension and alterations of left ventricular structure and function. Design: Cross sectional survey. Setting: Augsburg, Germany. Subjects: 1677 subjects, aged 25 to 74 years, who participated in an echocardiographic substudy of the monitoring of trends and determinants in cardiovascular disease Augsburg study during 1994-5. Outcome measures: Blood pressure measurements and M mode, two dimensional, and Doppler echocardiography. After at least 30 minutes’ rest blood pressure was measured three times by a technician, and once by a physician after echocardiography. Subjects were classified as normotensive (technician <140/90 mm Hg, physician <160/95 mm Hg; n=849), white coat hypertensive (technician <140/90 mm Hg, physician ⩾160/95 mm Hg; n=160), mildly hypertensive (technician ⩾140/90 mm Hg, physician <160/95 mm Hg; n=129), and sustained hypertensive (taking antihypertensive drugs or blood pressure measured by a technican ⩾140/90 mm Hg, and physician ⩾160/95 mm Hg; n=538). Results: White coat hypertension was more common in men than women (10.9% versus 8.2% respectively) and positively related to age and body mass index. After adjustment for these variables, white coat hypertension was associated with an increase in left ventricular mass and an increased prevalence of left ventricular hypertrophy (odds ratio 1.9, 95% confidence interval 1.2 to 3.2; P=0.009) compared with normotensive patients. The increase in left ventricular mass was secondary to significantly increased septal and posterior wall thicknesses whereas end diastolic diameters were similar in both groups with white coat hypertension or normotension. Additionally, the systolic white coat effect (difference between blood pressures recorded by a technician and physician) was associated with increased left ventricular mass and increased prevalence of left ventricular hypertrophy (P<0.05 each). Values for systolic left

  20. Association of aortic valve sclerosis with thrombin generation in hypertensive patients.

    PubMed

    Iida, M; Yamamoto, M; Yamazaki, M; Sawaguchi, M; Honjo, H; Kodama, I; Kamiya, K

    2008-11-01

    Aortic valve sclerosis (AVS) may predispose to a prothrombotic state, as AVS is predictor of cardiovascular events in hypertensive populations. Thrombin exerts non-thrombotic effects such as vessel tone regulation, progression of atherosclerosis and stimulation of atrial natriuretic peptide (ANP) secretion. We hypothesized that hypertensive patients with AVS may have a persistently activated thrombin generation. We studied 234 asymptomatic never-treated hypertensive patients (73 of them with AVS). Prothrombin F1+2 (F1+2), as a marker of thrombin generation and fibrin D-dimer, as a marker of thrombus formation, ANP and brain natriuretic peptide (BNP) were measured. Presence of AVS, aortic jet velocity and left ventricular diameter at diastole were determined by echocardiography. Glomerular filtration rate was estimated using the Modification of Diet in Renal Disease formula. F1+2 (median and interquartile range (IQR) = 1.05, 0.87-1.38 nM vs. 0.93, 0.72-1.16) and ANP (22, 14-37 pg ml(-1) vs. 17, 11-25) levels were greater, and glomerular filtration rate values (65+/-9 ml min(-1)/1.73 m2 vs. 68+/-11) were lower in hypertensive patients with AVS than in those without AVS. F1+2 (odds ratio, 95% CI = 2.94, 1.07-8.6) was independently associated with AVS after being adjusted for age, gender and the variables of cardiorenal functions measured. After 6 months of treatment using valsartan, F1+2 levels remained elevated in hypertensive patients with AVS (1.14, 0.83-1.42 nM vs. 1.07, 0.84-1.5, n=19), but decreased in those without AVS (1.01, 0.85-1.31 vs. 0.8, 0.84-1.78, n=27). Thrombin generation was associated with AVS in untreated hypertensive patients, and this association was persistent after blood-pressure-lowering treatment using valsartan. PMID:18633427

  1. Blood pressure control in treated hypertensive patients: clinical performance of general practitioners.

    PubMed Central

    Frijling, B D; Spies, T H; Lobo, C M; Hulscher, M E; van Drenth, B B; Braspenning, J C; Prins, A; van der Wouden, J C; Grol, R P

    2001-01-01

    BACKGROUND: The blood pressure of many treated hypertensive patients remains above recommended target levels. This discrepancy may be related to general practitioners' (GPs') actions. AIM: To assess clinical performance of GPs in blood pressure control in treated hypertensive patients and to explore the influence of patient and GP characteristics on clinical performance. DESIGN OF STUDY: Cross-sectional study conducted on 195 GPs with invitations to participate made via bulletins and by letter. SETTING: One hundred and thirty-two practices in the southern half of The Netherlands from November 1996 to April 1997. METHOD: Performance criteria were selected from Dutch national hypertension guidelines for general practice. GPs completed self-report forms immediately after follow-up visits of hypertensive patients treated with antihypertensive medication. RESULTS: The GPs recorded 3526 follow-up visits. In 63% of these consultations the diastolic blood pressure (DBP) was 90 mmHg or above. The median performance rates of the GPs were less than 51% for most of the recommended actions, even at a DBP of > or = 100 mmHg. Performance of non-pharmacological actions increased gradually with increasing DBP; prescribing an increase in antihypertensive medication and making a follow-up appointment scheduled within six weeks rose steeply at a DBP of > or = 100 mmHg. Patient and GP characteristics contributed little to clinical performance. Action performance rates varied considerably between GPs. CONCLUSION: GPs seem to target their actions at a DBP of below 100 mmHg, whereas guidelines recommend targeting at a DBP of below 90 mmHg. PMID:11271892

  2. Clinical implication of VEGF serum levels in cirrhotic patients with or without portal hypertension

    PubMed Central

    Nimer, Assy; M, Paizi; D, Gaitini; Y, Baruch; G, Spira

    1999-01-01

    AIM: To determine whether serum vascular endothelial growth factor (VEGF) levels correlates with the severity of liver cirrhosis and whether portal hypertension impacts on the expression of serum VEGF protein. METHODS: Fifty-three patients (mean age 56 ± 2 years) with HCV (n = 26), HBV (n = 13), and cryptogenic liver cirrhosis (n = 14) (Child-Pugh-s class A: 24, B: 19 and C: 12) and normal renal function constitute the patient population, who were all diagnosed by clinical, histological and radiological findings. Six healthy people and six patients with acute hepatitis served as controls. Severity of liver disease was evaluated by the CP score. Serum levels of IGF-1 and VEGF were measured by radioimmunoassay and ELISA, respectively. Portal hypertension was assessed using pulsed Doppler ultrasound. RESULTS: The mean serum VEGF levels in all cirrhotic patients (73 ± 58) were significantly lower than those of healthy controls (360 ± 217, P < 0.01) and acute hepatitis (1123 ± 1261, P < 0.01) respectively. No significant difference in median serum VEGF levels were noted among the different Child-Pugh-s classes (class A: median, 49.4 ng/L, range, 21-260 ng/L, Class B: median 59.9 ng/L; range 21-92, and Class C: median 69; range 20-247 ng/L). A significant correlation was noted between serum VEGF and two accurate parameters of portal hypertension: portal blood flow velocity (r = 06) and spleen size (r = 0.55). No correlation was found between VEGF serum levels and serum albumin, IGF-1, platelets count and aminotrasnferases (r = 0.2, r = 0.1, r = 0.2 and r = 0.2, respectively). CONCLUSION: Circulating VEGF level in patients with liver cirrhosis could not serve as an indicator of the progression of chronic liver disease but rather, they may reflect increased portal hypertension or decreased hepatic regenerative activity or the combination of both. PMID:11819451

  3. Low Response of Renin-Angiotensin System to Sodium Intake Intervention in Chinese Hypertensive Patients.

    PubMed

    Feng, Weijing; Cai, Qingqing; Yuan, Woliang; Liu, Yu; Bardeesi, Adham Sameer A; Wang, Jingfeng; Chen, Jie; Huang, Hui

    2016-02-01

    The interactions of sodium balance and response of renin-angiotensin-aldosterone system are important for maintaining the hemodynamic stability in physiological conditions. However, the influence of short-term sodium intake intervention in the response of renin-angiotensin system (RAS) on hypertensive patients is still unclear. Thus, we conducted a clinical trial to investigate the effects of short-term sodium intake intervention on the response of RAS in hypertensive patients.One hundred twenty-five primary Chinese hypertensive patients were divided into high, moderate, and low sodium groups by 24-hour urinary sodium excretion (UNa). All the patients received a 10-day dietary sodium intake intervention with standardized sodium (173.91mmol/day) and potassium (61.53mmol/day). Blood pressure, urinary sodium, urinary potassium, plasma sodium, potassium, creatinine, the levels of plasma renin activity, plasma angiotensin II concentrations (AT-II), and plasma aldosterone concentrations were detected before and after the intervention.Before the intervention, no differences were found in blood pressure and RAS among 3 groups. After standardized dietary sodium intake intervention, both UNa excretion and systolic pressure decreased in high-sodium group, while they increased in moderate and low-sodium groups. Intriguingly, there were no changes in the levels of plasma renin activity, AT-II, and plasma aldosterone concentrations among 3 groups during the intervention.The present study demonstrated that the influenced sodium excretion and blood pressure by short-term sodium intake intervention were independent of RAS quick response in Chinese hypertensive patients. PMID:26871780

  4. Long-term vardenafil therapy improves hemodynamics in patients with pulmonary hypertension.

    PubMed

    Aizawa, Kazunori; Hanaoka, Takeshi; Kasai, Hiroki; Kogashi, Kaoru; Kumazaki, Setsuo; Koyama, Jun; Tsutsui, Hiroshi; Yazaki, Yoshikazu; Watanabe, Noboru; Kinoshita, Osamu; Ikeda, Uichi

    2006-02-01

    The phosphodiesterase-5 (PDE-5) inhibitor, sildenafil, has been reported to produce sustained pulmonary vasodilatation in patients with pulmonary hypertension (PH). Recently, vardenafil, a more potent and selective PDE-5 inhibitor than sildenafil, has been approved for the treatment of erectile dysfunction. However, the long-term effects of oral vardenafil in patients with PH are unknown. We studied five consecutive patients with PH; one with primary pulmonary hypertension, two with chronic pulmonary thromboembolism, one with Eisenmenger syndrome (ventricular septal defect) and one with secondary pulmonary hypertension after a ventricular septal defect closure operation. In an acute hemodynamic trial, vardenafil (5 mg) significantly decreased both the pulmonary vascular resistance (PVR) and systemic vascular resistance (SVR) with an increase in cardiac output. In a chronic hemodynamic trial, the maintenance dose of vardenafil (10 to 15 mg) for 3 months significantly decreased the PVR, but not the SVR, with a 20.7% reduction of the PVR/ SVR ratio. Plasma brain natriuretic peptide (BNP) levels were also significantly decreased after 3 months. This pilot study demonstrates that long-term oral vardenafil therapy may be a safe and effective treatment for patients with PH. PMID:16755146

  5. Comparison of the Mindfulness Skills, Metacognitive Beliefs and Perceived Stress in Hypertension Patients and Control Group.

    PubMed

    Haji-Mirsaeidi, Zohreh; Kazemi-Zahrani, Hamid; Sadeghi, Masoumeh

    2016-01-01

    The aim of this study was to compare the skills of mindfulness, metacognitive beliefs and perceived stress in hypertension patients and control group. The study was a causal-comparative one. The population included all patients with high blood pressure who were admitted in Isfahan Cardiovascular Research Institute in 2014, 90 of which were selected by purposive sampling. Research instruments include: Kentucky's mindfulness skills (Baer, Smith, & Allen, 2004), metacognitive beliefs questionnaire (Welles, 1997) and questionnaire perceived stress (Cohen & Kamarck, 1983). Of all the questionnaires returned, 80 were fully completed and therefore analyzed. Data were analyzed using a t-test and multivariate analysis of variance. Results showed that there is a difference between mindfulness skills and beliefs of people with hypertension and control group. Moreover, the results showed that there isn't any meaningful difference between the perceived stress in patients with hypertension and control group. It can be said that mindfulness skills, metacognitive beliefs and perceived stress can help us to understand the psychological issues of patients with high blood pressure better. PMID:27530578

  6. NON-INVASIVE PREDICTORS OF PORTAL HYPERTENSION IN PATIENTS WITH HEPATITIS C VIRUS RELATED HEPATOCELLULAR CARCINOMA.

    PubMed

    Mohran, Zakaria; Sakr, Mohamed; Barakat, Eman; Elbaz, Ahmed; Al-Hamid, Mohamed Abd; Abou-Elmaaty, Mohamed

    2015-12-01

    The reference standard for portal venous pressure measurement which is clinically important for estimating the. feasibility of resection of hepatocellular carcinoma is the hepatic venous pressure gradient, which is, invasive and expqnsive. The present study evaluated the noninvasive parameters for assessment of portal hypertension in Child A patients with hepatocellular carcinoma on top of hepatitis C virus. A total of 112 patients were subjected to clinical assessment, biochemical assay, ultrasonographic Doppler study, triphasic spiral abdominal computed tomography, upper gastrointestinal endoscopy and hepatic venous pressure gradient measurement. According to hepatic venous pressure gradient measurement, they were classified into groups: GI: 58 patients with hepatic venous pressure gradient <10 mmHg and GII: 54 patients with hepatic venous pressure gradient > or = 10 mmHg. Significant variables in univariate analysis were included in a multivariate analysis to establish a model for prediction of clinically significant portal hypertension. Results showed that portal vein diameter > or = 1.3 cm, mono or biphasic pattern of flow in hepatic veins and Giannini index < or = 909 were independent risk factors for the clinically significant portal hypertension as indicated by HVPG > or = 10 mmHg. A model with highest likelihood ratio and good fitness was created. This prediction model was displayed by the receiver operating characteristic curve and under the curve area was 0.969 (0.938-1). PMID:26939231

  7. Management of the hypertensive patient with elevated heart rate: Statement of the Second Consensus Conference endorsed by the European Society of Hypertension.

    PubMed

    Palatini, Paolo; Rosei, Enrico Agabiti; Casiglia, Edoardo; Chalmers, John; Ferrari, Roberto; Grassi, Guido; Inoue, Teruo; Jelakovic, Bojan; Jensen, Magnus T; Julius, Stevo; Kjeldsen, Sverre E; Mancia, Giuseppe; Parati, Gianfranco; Pauletto, Paolo; Stella, Andrea; Zanchetti, Alberto

    2016-05-01

    In June 2015, a panel of experts gathered in a consensus conference to plan updating recommendations on the management of the hypertensive patient with elevated heart rate (HR), previously released in 2006. The issues examined during that meeting and further discussed by the participants during the following months involved the assessment of HR, the relevance of HR as a cardiovascular risk factor, the definition of tachycardia and the treatment of the hypertensive patient with high HR. For the measurement of resting HR the panel experts recommended that scientific investigations focusing on HR should report information on length of resting period before measurement, information about temperature and environment, method of measurement, duration of measurement, number of readings, time interval between measurements, body position and type of observer. According to the panellists there is convincing evidence that HR is an important risk factor for cardiovascular disease and they suggest to routinely include HR measurement in the assessment of the hypertensive patient. Regarding the definition of tachycardia, the panellists acknowledged that in the absence of convincing data any threshold used to define tachycardia is arbitrary. Similarly, as there are no outcome studies of HR lowering in tachycardia hypertension, the panellists could not make practical therapeutic suggestions for the management of such patients. However, the experts remarked that absence of evidence does not mean evidence against the importance of tachycardia as a risk factor for cardiovascular disease and that long-term exposure to a potentially important risk factor may impair the patient's prognosis. The main aims of the present document are to alert researchers and physicians about the importance of measuring HR in hypertensive patients, and to stimulate research to clarify unresolved issues. PMID:26982382

  8. Clinical features of patients with Philadelphia-negative myeloproliferative neoplasms complicated by portal hypertension

    PubMed Central

    Yan, Matthew; Geyer, Holly; Mesa, Ruben; Atallah, Ehab; Callum, Jeannie; Bartoszko, Justyna; Yee, Karen; Maganti, Manjula; Wong, Florence; Gupta, Vikas

    2015-01-01

    Backgroud Portal hypertension (PHTN) has been reported to afflict 7-18% of patients with Philadelphia-negative myeloproliferative neoplasms (MPNs), with complications of variceal bleeding and ascites. The clinical features and outcomes of these patients are unclear. Patients and Methods In this multi-centre retrospective study, we evaluated the clinical features of 51 patients with MPNs complicated by PHTN. Results The diagnosis of underlying MPN was most frequently polycythemia vera (PV) (39%) and primary myelofibrosis (MF) (35%), followed by post-PV myelofibrosis (18%), essential thrombocythemia (ET) (4%) and post-ET myelofibrosis (4%). Frequency of JAK2 V617F mutation appears as expected in the underlying MPN. Thrombosis within the splanchnic circulation was prevalent in patients with polycythemia compared to other MPNs (76% vs. 26%, p=0.0007). Conclusions PV and MF patients have a higher incidence of PHTN in our population, with thrombosis contributing to PHTN development in PV patients. Patients with splanchnic circulation thrombosis are potential candidates for screening for portal hypertension. These data may be useful for developing screening strategies for early detection of PHTN in patients with MPN. PMID:25027569

  9. Hypertension guidelines: Evidence-based treatments for maintaining blood pressure control.

    PubMed

    Davis, Leslie Louise

    2015-06-11

    Approximately one in three adults in the United States has hypertension. This article provides an update on the latest JNC-8 guideline for treating hypertension in adults. Emphasis is placed on new and updated information and implications for primary care clinicians to help patients achieve and maintain better blood pressure control. PMID:25922904

  10. Bone morphogenetic protein receptor 2 in patients with idiopathic portal hypertension

    PubMed Central

    De Gottardi, Andrea; Seijo, Susana; Milá, Montserrat; Alvarez, M Isabel; Bruguera, Miquel; Abraldes, Juan G; Bosch, Jaime; García-Pagán, Juan-Carlos

    2012-01-01

    In idiopathic portal hypertension (IPH) typical vascular lesions are present in the branches of the portal vein or in the perisinusoidal area of the liver. Similar histological alterations have been reported in the pulmonary vasculature of patients with idiopathic pulmonary artery hypertension (IPAH). As IPAH is associated with mutations of the bone morphogenetic protein receptor 2 (BMPR2) gene, the aim of this study was to investigate whether this association might also be found in patients with IPH. Twenty-three samples belonging to 21 unrelated caucasian patients with IPH followed in the hepatic haemodynamic laboratory of the Hospital Clinic in Barcelona were included in the study. All patients were studied for the entire open reading frame and splice site of the BMPR2 gene by direct sequencing and multiple ligation probe amplification (MLPA) in order to detect large deletions/duplications. None of the 23 patients had pulmonary artery hypertension. Four patients presented one single nucleotide polymorphism (SNP) in intron 5, four patients had a SNP in exon 12 and a SNP in exon 1 was found in two cases. Two patients had both intron 5 and exon 12 polymorphisms. All SNPs were previously described. Except for these three SNPs, neither mutations nor rearrangements have been identified in the BMPR2 gene in this population. We did not detect mutations or rearrangements in the coding region of the BMPR2 gene in our patients with IPH. These findings suggest that, in contrast to IPAH, mutations in BMPR2 are not involved in the pathogenesis of IPH. PMID:22129439

  11. Effects of valsartan versus amlodipine in diabetic hypertensive patients with or without previous cardiovascular disease.

    PubMed

    Yamashita, Kentaro; Kondo, Takahisa; Muramatsu, Takashi; Matsushita, Kunihiro; Nagahiro, Takanori; Maeda, Kengo; Shintani, Satoshi; Murohara, Toyoaki

    2013-12-01

    Recently, we reported that angiotensin II receptor blocker (ARB), valsartan, and calcium channel blocker (CCB), amlodipine, had similar effects on the prevention of cardiovascular disease (CVD) events in diabetic hypertensive patients. We assessed the difference of cardiovascular protective effects between ARB and CCB in patients with and without previous CVD, respectively. A total of 1,150 Japanese diabetic hypertensive patients were randomized to either valsartan or amlodipine treatment arms, which were additionally divided into 2 groups according to the presence of previous CVD at baseline (without CVD, n = 818; with CVD, n = 332). The primary composite outcomes were sudden cardiac death, acute myocardial infarction, stroke, coronary revascularization, or hospitalization for heart failure. The incidence of primary end point events in patients with previous CVD was 3.5-times greater than that in patients without previous CVD (64.1 vs 17.9/1,000 person-years). The ARB- and the CCB-based treatment arms showed similar incidence of composite CVD events in both patients without previous CVD (hazard ratio [HR] 1.35, 95% confidence interval [CI] 0.76 to 2.40) and those with previous CVD (HR 0.79, 95% CI 0.48 to 1.31). The ARB-treatment arm showed less incidence of stroke compared with the CCB-based treatment arm in patients with previous CVD (HR 0.24, 95% CI 0.05 to 1.11, p = 0.068), whereas the 2 treatment arms showed similar incidence of stroke in patients without previous CVD (HR 1.52, 95% CI 0.59 to 3.91). In conclusion, the ARB- and the CCB-based treatments exerted similar protective effects of CVD events regardless of the presence of previous CVD. For stroke events, the ARB may have more protective effects than the CCB in diabetic hypertensive patients with previous CVD. PMID:24035165

  12. Pulmonary hypertension

    MedlinePlus

    Pulmonary arterial hypertension; Sporadic primary pulmonary hypertension; Familial primary pulmonary hypertension; Idiopathic pulmonary arterial hypertension; Primary pulmonary hypertension; PPH; Secondary pulmonary ...

  13. The effect of physician personality on laboratory test ordering for hypertensive patients.

    PubMed

    Ornstein, S M; Markert, G P; Johnson, A H; Rust, P F; Afrin, L B

    1988-06-01

    Laboratory tests are responsible for a large percentage of health care expenses in the United States. In a retrospective study of the outpatient test ordering by residents for hypertensive patients between the years 1980 and 1986 at the Department of Family Medicine at the Medical University of South Carolina, we found great variability in laboratory test ordering as well as an association between personality as measured by the Myers-Briggs Type Indicator (MBTI) and test ordering. Introverts ordered more than extroverts, and intuitives ordered more than sensors. This association was confirmed by a multiple regression analysis controlling for potential confounders of test ordering, such as severity of disease, the presence of coexisting diabetes mellitus, the demographic characteristics of the patient population, and the number of initial evaluations for hypertension. Elucidation of a relationship between resident personality and laboratory test ordering has important implications for planning intervention strategies to reduce excessive laboratory test ordering in ambulatory care. PMID:3379985

  14. Pulmonary hypertension in patients with heart failure and preserved ejection fraction: differential diagnosis and management

    PubMed Central

    Charalampopoulos, Athanasios; Ramjug, Sheila; Condliffe, Robin; Elliot, Charlie A.; O’Toole, Laurence; Swift, Andrew; Kiely, David G

    2016-01-01

    Abstract The most common cause of pulmonary hypertension (PH) due to left heart disease (LHD) was previously rheumatic mitral valve disease. However, with the disappearance of rheumatic fever and an aging population, nonvalvular LHD is now the most common cause of group 2 PH in the developed world. In this review, we examine the challenge of investigating patients who have PH and heart failure with preserved ejection fraction (HF-pEF), where differentiating between pulmonary arterial hypertension (PAH) and PH-LHD can be difficult, and also discuss the entity of combined precapillary and postcapillary PH. Given the proven efficacy of targeted therapy for the treatment of PAH, there is increasing interest in whether these treatments may benefit selected patients with PH associated with HF-pEF, and we review current trial data. PMID:27162611

  15. Overview of clinical use and side effect profile of valsartan in Chinese hypertensive patients.

    PubMed

    Huang, Qi-Fang; Li, Yan; Wang, Ji-Guang

    2014-01-01

    We reviewed the Chinese and English literature for the efficacy and safety data of valsartan monotherapy or combination therapy in Chinese hypertensive patients. According to the data of ten randomized controlled trials, valsartan monotherapy was as efficacious as another angiotensin receptor blocker or other classes of antihypertensive drugs, excepting the slightly inferior diastolic blood pressure-lowering effect in comparison with calcium channel blockers. According to the data of six randomized controlled trials, valsartan combination, with hydrochlorothiazide, amlodipine, or nifedipine gastrointestinal therapeutic system, was more efficacious than monotherapy of valsartan, amlodipine, or nifedipine gastrointestinal therapeutic system. According to these trials, valsartan had an acceptable tolerability, regardless of whether it was used as monotherapy or in combination therapy. Nonetheless, several rare side effects have been reported, indicating that it should still be used with caution. This is of particular importance given that there are millions of hypertensive patients, worldwide, currently exposed to the drug. PMID:24403822

  16. Pulmonary hypertension in patient with elevated homocystein level and blast injuries.

    PubMed

    Zuljević, Ervin; Redzepi, Gzim; Plestina, Sanja; Vidjak, Vinko; Loncarić, Vlasta; Jakopović, Marko; Samarzija, Miroslav

    2009-03-01

    38-year-old man had chronic deep venous thrombosis (DVT) as a result of multiple injuries caused by an explosion of grenade 12 years ago, with recurrent pulmonary thromboembolisms and pulmonary hypertension which was unrecognized for a decade. Patient was admitted with a progressive dyspnea and exercise intolerance (NYHA II). The diagnosis was established according to clinical symptoms, transthoracic echocardiography, phlebography, lung scintigraphy and pulmonary angiography. Oral anticoagulant therapy was introduced and cava filter indicated to implant. During phlebography a floating thrombus was found in the inferior cava vein underneath renal vein. Implantation was delayed and patient received systemic fibrinolytic therapy with streptokinase (7500 000 UI within 4 days), followed by heparin infusion and warfarin. Post-fibrinolytic phlebography showed clear lumen of inferior vena cava. Fibrinolysis had also affected pulmonary hypertension-systolic pressure in the right ventricle measured by Doppler echocardiography decreased from 90 to 65 mmHg. Permanent intravenous cava filter was implanted. PMID:19408648

  17. Successful treatment of aortic root abscess in a patient with pulmonary arterial hypertension

    PubMed Central

    Duarte, Alexander G.

    2015-01-01

    Abstract Continuous prostanoid infusion is an established treatment for pulmonary arterial hypertension that has led to improvements in symptoms, exercise tolerance, and survival. Patients with pulmonary arterial hypertension (PAH) who develop sepsis frequently experience clinical and hemodynamic deterioration associated with poor outcomes. Successful management of sepsis involves identification of the source of infection, early antimicrobial administration, judicious fluid resuscitation, and continuation of specific PAH therapies. We describe successful management of a patient with idiopathic PAH receiving chronic intravenous prostacyclin therapy who developed an aortic root abscess due to Clostridium perfringens requiring emergent aortic root repair. Management involved imaging studies, removal of potential sources with administration of intravenous antibiotics, and cautious fluid administration with hemodynamic monitoring. A multidisciplinary group led by a PAH specialist worked cohesively before, during, and after surgical intervention and achieved a successful outcome. PMID:26697181

  18. Portal Hypertension in Patients with Liver Cirrhosis: Diagnostic Accuracy of Spleen Stiffness.

    PubMed

    Takuma, Yoshitaka; Nouso, Kazuhiro; Morimoto, Youichi; Tomokuni, Junko; Sahara, Akiko; Takabatake, Hiroyuki; Matsueda, Kazuhiro; Yamamoto, Hiroshi

    2016-05-01

    Purpose To evaluate the accuracy of spleen stiffness (SS) and liver stiffness (LS) measured by using acoustic radiation force impulse imaging in the diagnosis of portal hypertension in patients with liver cirrhosis, with the hepatic venous pressure gradient (HVPG) as a reference standard. Materials and Methods Institutional review board approval and informed consent were obtained for this prospective single-center study. From February 2012 to August 2013, 60 patients with liver cirrhosis (mean age, 70.8 years; age range, 34-88 years; 34 men, 26 women) with HVPG, LS, and SS measurements and gastrointestinal endoscopy and laboratory data were included if they met the following criteria: no recent episodes of gastrointestinal bleeding, no history of splenectomy, no history of partial splenic embolization, no history of β-blocker therapy, and absence of portal thrombosis. The efficacy of the parameters for the evaluation of portal hypertension was analyzed by using the Spearman rank-order correlation coefficient and receiver operating characteristic (ROC) curve analysis. Results The correlation coefficient between SS and HVPG (r = 0.876) was significantly better than that between LS and HVPG (r = 0.609, P < .0001). The areas under the ROC curve of SS for the identification of clinically important portal hypertension (HVPG ≥ 10 mm Hg), severe portal hypertension (HVPG ≥ 12 mm Hg), esophageal varices (EVs), and high-risk EVs were significantly higher (0.943, 0.963, 0.937, and 0.955, respectively) than those of LS, spleen diameter, platelet count, and platelet count to spleen diameter ratio (P < .05 for all). SS could be used to accurately rule out the presence of clinically important portal hypertension, severe portal hypertension, EVs, and high-risk EVs (negative likelihood ratios, 0.051, 0.056, 0.054, and 0.074, respectively). Conclusion SS is reliable and has better diagnostic performance than LS for identifying portal hypertension in liver cirrhosis. (©) RSNA

  19. Hypertension and aging.

    PubMed

    Buford, Thomas W

    2016-03-01

    Hypertension is a highly prevalent condition with numerous health risks, and the incidence of hypertension is greatest among older adults. Traditional discussions of hypertension have largely focused on the risks for cardiovascular disease and associated events. However, there are a number of collateral effects, including risks for dementia, physical disability, and falls/fractures which are increasingly garnering attention in the hypertension literature. Several key mechanisms - including inflammation, oxidative stress, and endothelial dysfunction - are common to biologic aging and hypertension development and appear to have key mechanistic roles in the development of the cardiovascular and collateral risks of late-life hypertension. The objective of the present review is to highlight the multi-dimensional risks of hypertension among older adults and discuss potential strategies for treatment and future areas of research for improving overall care for older adults with hypertension. PMID:26835847

  20. Prevalence, awareness, treatment, and control of hypertension and associated risk factors among adults in Xi'an, China: A cross-sectional study.

    PubMed

    Hu, Meiqin; Wan, Yi; Yu, Lifen; Yuan, Jing; Ma, Yonghong; Hou, Bin; Jiang, Xun; Shang, Lei

    2016-08-01

    To investigate the prevalence, awareness, treatment, and control of hypertension, and the associated risk factors among adults in Xi'an, China.From October to December 2013, participants in Xi'an, China were recruited for the study by using a multiple-stage sampling method. A self-developed questionnaire with an additional health examination was used to collect data on the history of hypertension diagnosis and antihypertensive medication. The status on prevalence, awareness, treatment, and control of hypertension were analyzed and related risk factors were identified by using logistic regression analysis.A total of 8193 participants were included with an overall prevalence of hypertension of 20.4%. Among the hypertensive participants, 63.7% were aware of their conditions, 47.3% took antihypertensive medication, and 17.8% had their blood pressure (BP) controlled within 140/90 mm Hg. More complications and less frequent BP measurements were associated with hypertension. Older participants, non-drinkers, and those with more complications and more frequent BP measurements were more aware of their hypertension. Being older, living in an urban area, and having more frequent BP measurements were all factors for better treatment. Participants who were women, living in an urban area, with a higher educational level and who were not obese were more likely to have their hypertension controlled.The prevalence of hypertension among adults in Xi'an is high with suboptimal low awareness, treatment, and control rates. Further comprehensive integrated strategies based on these risk factors should be taken into account in order to improve the prevention, awareness, treatment, and control of hypertension. PMID:27559980

  1. Idiopathic Intracranial Hypertension in a Prepubertal Pediatric Japanese Patient Complicated by Severe Papilledema

    PubMed Central

    Oka, Akiko; Ikesugi, Kengo; Kondo, Mineo

    2016-01-01

    Purpose To report a rare case of idiopathic intracranial hypertension (IIH) in a prepubertal pediatric patient. Case Report The patient was an 11-year-old Japanese boy. Initially, an ophthalmologist found severe papilledema, and the patient was diagnosed with IIH. He was unresponsive to conservative therapy, and a ventriculoperitoneal shunt was inserted in the Neurosurgery Department because the visual impairment was severe. Twelve months after the shunt, the improvement in vision was limited due to optic disc atrophy. Conclusion Ophthalmologists need to be more aware of II, especially in cases with severe papilledema that can lead to permanent reduction of vision. PMID:27065853

  2. ARB-based single-pill platform to guide a practical therapeutic approach to hypertensive patients.

    PubMed

    Volpe, Massimo; de la Sierra, Alejandro; Kreutz, Reinhold; Laurent, Stéphane; Manolis, Athanasios J

    2014-06-01

    Hypertension is a major modifiable risk for the development of cardiovascular, cerebrovascular and renal diseases. Thus, effective treatment of high blood pressure is an important strategy for reducing disease burden; however, in spite of the availability of numerous effective therapies only 30-40 % of patients with hypertension achieve the recommended blood pressure goals of <140/90 mmHg. Lack of adherence to therapy and reluctance to intensify therapy are cited frequently to explain the discrepancy between potential and attained outcomes. Adherence is closely related to the tolerability, effectiveness and complexity of therapy. Therapeutic inertia may be influenced by concerns over tolerability, as well as the lack of clear preferences for therapies when managing patients with risk factors and comorbidities. Effective and well-tolerated single pill combination therapies are now available that improve adherence and simplify treatment. The combination of a renin-angiotensin system blocker with a calcium channel blocker and a diuretic improves adherence to therapy. We have devised a practical tool for orienting the application of well-tolerated single pill 2/3 drug fixed dose combination therapies in clinical situations commonly encountered when treating hypertensive patients. This approach employs the angiotensin receptor blocker olmesartan alone or in combinations with amlodipine and/or hydrochlorothiazide. This platform is based on clinical evidence, guidelines, best practice, and clinical experience where none of these is available. We believe it will increase the percentage of hypertensive patients who achieve blood pressure control when applied as part of an integrative approach that includes regular follow-up and instruction on lifestyle changes. PMID:24532183

  3. Intramural Reentrant Ventricular Tachycardia in a Patient with Severe Hypertensive Left Ventricular Hypertrophy

    PubMed Central

    Lin, Chin-Yu; Chung, Fa-Po; Lin, Yenn-Jiang

    2015-01-01

    We describe the case of a patient with severe hypertensive left ventricular hypertrophy and sustained hemodynamically unstable ventricular tachycardia (VT). Entrainment was demonstrated in the electrophysiological study. Activation mapping and pacemapping identified the location of the intramural reentrant VT with the exit site close to the epicardium. However, VT persisted after ablation at the epicardial exit site. Successful ablation was performed endocardially at the corresponding position. PMID:26617657

  4. Red cell distribution width and end-organ damage in patients with systo-diastolic hypertension

    PubMed Central

    Akgul, Ozgur; Erturk, Mehmet; Surgit, Ozgur; Tasbulak, Omer; Akkaya, Emre; Yazan, Serkan; Gül, Mehmet; Türen, Selahattin

    2016-01-01

    Introduction Both end-organ damage and high red cell distribution width (RDW) values are associated with adverse cardiovascular events, inflammatory status, and neurohumoral activation in hypertensive disease and in the general population. In this study, we investigated the relationship between RDW and end-organ damage in hypertensive patients. Material and methods The 446 systo-diastolic hypertensive patients included in the study received 24-hour ambulatory blood pressure monitoring. Left ventricular mass index, glomerular filtration rate, and microalbuminuria were measured to identify end-organ damage. High-sensitivity C-reactive protein (hs-CRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels of all patients were also examined. Results The mean age of the participants was 49.96 ±11.04 years. The mean RDW was 13.06 ±1.05%. Red cell distribution width was positively correlated with left ventricular myocardial index (LVMI), urinary albumin, hs-CRP, and NT-proBNP (r = 0.298, p < 0.001; r = 0.228, p < 0.001; r = 0.337, p < 0.001; r = 0.277, p < 0.001, respectively), while RDW was negatively correlated with eGFR (r = –0.153, p < 0.001). Additionally, while there was a positive correlation between RDW and 24-h systolic blood pressure, no correlation was found between RDW and 24-h diastolic blood pressure (r = 0.132, p = 0.006 and r = 0.017, p = 0.725, respectively). Multiple linear regression analysis revealed that RDW levels were independently associated with eGFR, LVMI, and severity of albuminuria (β = 0.126, p = 0.010; β = –0.149, p = 0.002; β = 0.114, p = 0.035). Conclusions High RDW levels in systo-diastolic hypertensive patients were found to be an independent predictor of end-organ damage. PMID:27186175

  5. Heart-Carotid Pulse Wave Velocity a Useful Index of Atherosclerosis in Chinese Hypertensive Patients.

    PubMed

    Li, Chunyue; Xiong, Huahua; Pirbhulal, Sandeep; Wu, Dan; Li, Zhenzhou; Huang, Wenhua; Zhang, Heye; Wu, Wanqing

    2015-12-01

    This study was designed to investigate the relationship between heart-carotid pulse wave velocity (hcPWV) and carotid intima-media thickness (CIMT) in hypertensive patients, and also to examine the effect of pre-ejection period (PEP) on it. Doppler ultrasound device was used to measure CIMT in left common carotid artery. Hypertensive patients were divided into normal (n = 36, CIMT ≤0.8 mm) and thickened (n = 31, CIMT > 0.8 mm) group. Electrocardiogram R-wave-based carotid pulse wave velocity (rcPWV) and aortic valve-carotid pulse wave velocity (acPWV) were calculated as the ratio of the travel length to the pulse transit time with or without PEP, respectively. CIMT has significant relations with rcPWV (r = 0.611, P < 0.0001) and acPWV (r = 0.384, P = 0.033) in thickened group. Moreover, CIMT showed stronger correlation with rcPWV than with acPWV in thickened group. Furthermore, both acPWV and rcPWV were determinant factors of CIMT in thickened group, independent of clinical confounders including age, gender, smoking behavior, systolic blood pressure, diastolic blood pressure, fasting blood glucose, total cholesterol, high-density lipoprotein cholesterol, antihypertensive medication, and plaque occurrence. However, similar results were not found in normal group. Since CIMT has been considered as an index of atherosclerosis, our results suggested that both rcPWV and acPWV could be useful indexes of atherosclerosis in thickened CIMT hypertensive patients. Additionally, if hcPWV is computed with heart-carotid pulse transit time, including PEP could improve the accuracy of atherosclerosis assessment in hypertensive patients. PMID:26705228

  6. Pulmonary artery denervation for treatment of a patient with pulmonary hypertension secondary to left heart disease

    PubMed Central

    2016-01-01

    Abstract Pulmonary hypertension (PH) predicts poor outcome in patients with left heart disease. A 62-year-old man was referred for heart failure associated with ischemic cardiomyopathy. He received a diagnosis of combined postcapillary and precapillary PH secondary to left heart disease on the basis of hemodynamic parameters. After the pulmonary artery denervation procedure was performed, hemodynamic parameters were markedly improved, which resulted in a significant increase in functional capacity. PMID:27252851

  7. Pathophysiologic assessment of left ventricular hypertrophy and strain in asymptomatic patients with essential hypertension

    SciTech Connect

    Pringle, S.D.; Macfarlane, P.W.; McKillop, J.H.; Lorimer, A.R.; Dunn, F.G.

    1989-05-01

    To investigate the significance of the electrocardiographic (ECG) pattern of left ventricular hypertrophy and strain, two groups of asymptomatic patients with essential hypertension were compared. The patients were similar in terms of age, smoking habit, serum cholesterol and blood pressure levels, but differed in the presence (Group I, n = 23) or absence (Group II, n = 23) of the ECG pattern of left ventricular hypertrophy and strain. Group I patients had significantly more episodes of exercise-induced ST segment depression (14 versus 4, p less than 0.05) and reversible thallium perfusion abnormalities (11 of 23 versus 3 of 23, p less than 0.05) despite similar exercise capacity and absence of chest pain. Nonsustained ventricular tachycardia was detected on 24 h ambulatory ECG monitoring in two patients in Group I, but no patient in Group II. Coronary arteriography performed in 20 Group I patients demonstrated significant coronary artery disease in 8 patients. This study has shown that there is a subgroup of hypertensive patients with ECG left ventricular hypertrophy and strain who have covert coronary artery disease. This can be detected by thallium perfusion scintigraphy, and may contribute to the increased risk known to be associated with this ECG abnormality.

  8. Mineralocorticoid hypertension

    PubMed Central

    Gupta, Vishal

    2011-01-01

    Hypertension affects about 10 – 25% of the population and is an important risk factor for cardiovascular and renal disease. The renin-angiotensin system is frequently implicated in the pathophysiology of hypertension, be it primary or secondary. The prevalence of primary aldosteronism increases with the severity of hypertension, from 2% in patients with grade 1 hypertension to 20% among resistant hypertensives. Mineralcorticoid hypertension includes a spectrum of disorders ranging from renin-producing pathologies (renin-secreting tumors, malignant hypertension, coarctation of aorta), aldosterone-producing pathologies (primary aldosteronism – Conns syndrome, familial hyperaldosteronism 1, 2, and 3), non-aldosterone mineralocorticoid producing pathologies (apparent mineralocorticoid excess syndrome, Liddle syndrome, deoxycorticosterone-secreting tumors, ectopic adrenocorticotropic hormones (ACTH) syndrome, congenitalvadrenal hyperplasia), and drugs with mineraocorticoid activity (locorice, carbenoxole therapy) to glucocorticoid receptor resistance syndromes. Clinical presentation includes hypertension with varying severity, hypokalemia, and alkalosis. Ratio of plasma aldosterone concentraion to plasma renin activity remains the best screening tool. Bilateral adrenal venous sampling is the best diagnostic test coupled with a CT scan. Treatment is either surgical (adrenelectomy) for unilateral adrenal disease versus medical therapy for idiopathic, ambiguous, or bilateral disease. Medical therapy focuses on blood pressure control and correction of hypokalemia using a combination of anti-hypertensives (calcium channel blockers, angiotensin converting enzyme inhibitors, or angiotensin receptor blockers) and potassium-raising therapies (mineralcorticoid receptor antagonist or potassium sparing diuretics). Direct aldosterone synthetase antagonists represent a promising future therapy. PMID:22145132

  9. The Comparison of Dietary Behaviors among Rural Controlled and Uncontrolled Hypertensive Patients.

    PubMed

    Kamran, Aziz; Shekarchi, Ali Akbar; Sharifian, Elham; Heydari, Heshmatolah

    2016-01-01

    Nutrition is a dominant peripheral factor in increasing blood pressure; however, little information is available about the nutritional status of hypertensive patients in Iran. This study aimed to compare nutritional behaviors of the rural controlled and uncontrolled hypertensive patients and to determine the predictive power of nutritional behaviors from blood pressure. This cross-sectional study was conducted on 671 rural hypertensive patients, using multistage random sampling method in Ardabil city in 2013. Data were collected by a 3-day food record questionnaire. Nutritional data were extracted by Nutritionist 4 software and analyzed by the SPSS 18 software using Pearson correlation, multiple linear regression, ANOVA, and independent t-test. A significant difference was observed in the means of fat intake, cholesterol, saturated fat, sodium, energy, calcium, vitamin C, fiber, and nutritional knowledge between controlled and uncontrolled groups. In the controlled group, sodium, saturated fats, vitamin C, calcium, and energy intake explained 30.6% of the variations in blood pressure and, in the uncontrolled group, sodium, carbohydrate, fiber intake, and nutritional knowledge explained 83% of the variations in blood pressure. There was a significant difference in the nutritional behavior between the two groups and changes in blood pressure could be explained significantly by nutritional behaviors. PMID:27516908

  10. The Comparison of Dietary Behaviors among Rural Controlled and Uncontrolled Hypertensive Patients

    PubMed Central

    Shekarchi, Ali Akbar; Sharifian, Elham

    2016-01-01

    Nutrition is a dominant peripheral factor in increasing blood pressure; however, little information is available about the nutritional status of hypertensive patients in Iran. This study aimed to compare nutritional behaviors of the rural controlled and uncontrolled hypertensive patients and to determine the predictive power of nutritional behaviors from blood pressure. This cross-sectional study was conducted on 671 rural hypertensive patients, using multistage random sampling method in Ardabil city in 2013. Data were collected by a 3-day food record questionnaire. Nutritional data were extracted by Nutritionist 4 software and analyzed by the SPSS 18 software using Pearson correlation, multiple linear regression, ANOVA, and independent t-test. A significant difference was observed in the means of fat intake, cholesterol, saturated fat, sodium, energy, calcium, vitamin C, fiber, and nutritional knowledge between controlled and uncontrolled groups. In the controlled group, sodium, saturated fats, vitamin C, calcium, and energy intake explained 30.6% of the variations in blood pressure and, in the uncontrolled group, sodium, carbohydrate, fiber intake, and nutritional knowledge explained 83% of the variations in blood pressure. There was a significant difference in the nutritional behavior between the two groups and changes in blood pressure could be explained significantly by nutritional behaviors. PMID:27516908

  11. Uncontrolled hypertension secondary to leukemic cell infiltration of kidneys in a hemodialysis patient.

    PubMed

    Turkmen, Kultigin; Altintepe, Lutfullah; Guney, Ibrahim; Aydogdu, Ismet; Koc, Osman; Erkut, Mehmet Ali; Tonbul, Halil Zeki

    2010-01-01

    Leukemic infiltration of the kidney is usually silent, and the admission of the patients with renal dysfunction or acute kidney injury is uncommon. We present a 34-year old hemodialysis patient with new onset of uncontrolled hypertension, erythropoietin-resistant anemia, thrombocytopenia, and Bell's palsy. On admission, his blood pressure (BP) was 210/110 mmHg and he had petechiae and purpura at upper and lower extremities. Renal ultrasonography (USG) showed bilaterally enlarged kidneys without hydronephrosis, unlike his previous USG, which determined bilaterally atrophic kidneys. Acute lymphoblastic leukemia, hypertensive crisis due to bilateral leukemic cell infiltration of kidneys, tumor lysis syndrome, and leukemic involvement of the facial nerve were diagnosed. Despite intense antihypertensive management, his BP was not controlled. After prednisolone, daunorubicine, and vincristine therapy, the size of kidneys diminished and his BP dropped under normal range. In conclusion, pathological findings such as uncontrolled hypertension, flank pain, skin rashes, and abnormal blood count should be considered carefully, even in patients with end-stage renal disease receiving renal replacement therapy. PMID:21694931

  12. Why in 2016 are patients with hypertension not 100% controlled? A call to action.

    PubMed

    Redon, Josep; Mourad, Jean-Jacques; Schmieder, Roland E; Volpe, Massimo; Weiss, Thomas W

    2016-08-01

    The objective is to consider the problem of high blood pressure (BP), a leading global risk factor, associated with substantial morbidity and mortality. Despite the availability of treatment guidelines and a wide range of therapies, BP control is suboptimal in many countries. Recent data indicate that only around 40% of patients manage to achieve an adequate level of BP control. A group of international experts in the field of hypertension met in 2008 to consider this problem. The resulting white paper delivered an urgent call to action and identified six key issues for improving BP control. In 2015, a working group of investigators spontaneously undertook an action with the primary aim of considering the current hypertension management situation in Europe, to discuss whether the situation had changed since 2008 and to determine what can be learnt from the projects in other continents, such as the Canadian Hypertension Education Program, which has shown that higher levels of BP control can be achieved across a general population. The working group identified the main challenges affecting the improvement of BP control today and suggests five key actions: identify the BP treatment target of less than 140/90 mmHg for the majority of patients, simplify treatment strategies and encourage pill reduction, decrease therapeutic inertia, improve patient empowerment, and involve healthcare systems and reduce the prevailing focus on drug costs in many healthcare systems. Implementing key actions identified by the working group may help to improve achievement of better BP control across Europe. PMID:27270186

  13. Renovascular effects of nonprescription ibuprofen in elderly hypertensive patients with mild renal impairment.

    PubMed

    Furey, S A; Vargas, R; McMahon, F G

    1993-01-01

    To determine the renovascular effects of nonprescription ibuprofen in the maximum labeled over-the-counter (OTC) dosage for 7 days, and to compare these effects with those of two other available OTC analgesics, aspirin and acetaminophen, we evaluated 25 elderly patients with mild thiazide-treated hypertension and mild renal insufficiency. Under double-blind conditions, patients were randomly allocated to one of three treatment groups: ibuprofen 400 mg 3 times/day, aspirin 650 mg 3 times/day, or acetaminophen 650 mg 3 times/day. Blood pressure and indexes of renal function (blood urea nitrogen, creatinine clearance, serum electrolytes) were measured over 7 days in a clinical research center. None of the treatments had a clinically significant effect on blood pressure. Renal function indexes also remained unchanged during all three treatments. We conclude that elderly patients with mild thiazide-treated hypertension and mild renal insufficiency seem not to be at risk of developing additional renal compromise or of having their hypertension control diminished by treatment with these OTC analgesics for 7 days. PMID:8469621

  14. Anticoagulation in patients with pulmonary arterial hypertension: An update on current knowledge.

    PubMed

    Roldan, Tamara; Landzberg, Michael J; Deicicchi, David J; Atay, Julie K; Waxman, Aaron B

    2016-02-01

    Pulmonary hypertension is a severe clinical condition characterized by molecular and anatomic changes in pulmonary circulation. It is associated with increased pulmonary vascular resistance, which leads to right-sided heart failure if left untreated and, ultimately, death. Treatment of patients with pulmonary arterial hypertension (PAH) involves a complex strategy that takes into consideration disease severity, general and supportive measures, and combination drug regimens. Abnormalities of blood coagulation factors, anti-thrombotic factors, and the fibrinolytic system may contribute to a prothrombotic state in patients with idiopathic PAH. These physiologic changes, in concert with the presence of non-specific risk factors for venous thromboembolism such as heart failure and immobility, are thought to be the basis for oral anticoagulation in PAH. Several observational studies provide helpful information in favor of anticoagulation use in idiopathic PAH but not in other pulmonary hypertension etiologies. Guideline recommendations are based on the lack of prospective comparative trials in this regard. For that reason, large differences exist in the use of anticoagulants in different countries and centers. More studies should be carried out to clarify the risks and the potential benefits of anticoagulant use in a heterogeneous population of patients who are already at considerable life risk. PMID:26527532

  15. Doppler Flow Wire Evaluation of Renal Blood Flow Reserve in Hypertensive Patients with Normal Renal Arteries

    SciTech Connect

    Beregi, Jean-Paul; Mounier-Vehier, Claire; Devos, Patrick; Gautier, Corinne; Libersa, Christian; McFadden, Eugene P.; Carre, Alain

    2000-09-15

    Purpose: To study the vasomotor responses of the renal microcirculation in patients with essential hypertension.Methods: We studied the reactivity of the renal microcirculation to papaverine, with intraarterial Doppler and quantitative arteriography, in 34 renal arteries of 19 hypertensive patients without significant renal artery stenosis. Isosorbide dinitrate was given to maximally dilate proximal renal arteries. APV (average peak blood flow velocity) was used as an index of renal blood flow.Results: Kidneys could be divided into two distinct subgroups based on their response to papaverine. An increase in APV of up to 55% occurred in 21 kidneys, an increase > 55% in 13 kidneys. Within each group the values were normally distributed. Both baseline APV and the effect of papaverine on mean velocity differed significantly between groups.Conclusion: There seems to be a subgroup of patients with essential hypertension that has an impaired reactivity to papaverine, consistent with a functional impairment of the renal microcirculation. Further studies are required to determine whether this abnormality contributes to or results from elevated blood pressure.

  16. Low Literacy is associated with Uncontrolled Blood Pressure in Primary Care Patients with Hypertension and Heart Disease

    PubMed Central

    McNaughton, Candace D.; Jacobson, Terry A.; Kripalani, Sunil

    2014-01-01

    Objectives Evaluate the association between low literacy and uncontrolled blood pressure (BP) and their associations with medication adherence. Methods Cross-sectional study of 423 urban, primary care patients with hypertension and coronary disease. The relationship between low literacy (Rapid Estimate of Adult Literacy in Medicine ≤44) and uncontrolled BP (≥140/90 mmHg, ≥130/80 mmHg for patients with diabetes) was evaluated by crude and adjusted logistic regression. Relationships with self-reported adherence and refill adherence were explored using adjusted linear and logistic regression. Results Overall, 192 (45%) subjects had low literacy and 227 (52.9%) had uncontrolled BP. Adjusting for age, gender, race, employment, education, mental status, and self-reported adherence, low literacy was associated with uncontrolled BP (OR 1.75, 95% CI 1.06–2.87). Lower self-reported adherence was associated with uncontrolled BP; the relationship between refill adherence and uncontrolled BP was not statistically significant. Conclusions Low literacy is independently associated with uncontrolled BP. Practice Implications Awareness of the relationships among patient literacy, BP control, and medication adherence may guide healthcare providers as they communicate with patients. PMID:24882088

  17. Cystic Fibrosis below the Diaphragm: Abdominal Findings in Adult Patients.

    PubMed

    Lavelle, Lisa P; McEvoy, Sinead H; Ni Mhurchu, Elaine; Gibney, Robert G; McMahon, Colm J; Heffernan, Eric J; Malone, Dermot E

    2015-01-01

    Cystic fibrosis (CF) is the most common lethal autosomal recessive disease in the white population. Mutation of the CF transmembrane conductance regulator gene on chromosome 7 results in production of abnormally viscous mucus and secretions in the lungs of patients with CF. A similar pathologic process occurs in the gastrointestinal tract, pancreas, and hepatobiliary system. Inspissated mucus causes luminal obstruction and resultant clinical and radiologic complications associated with the disease process. Pancreatic involvement can result in exocrine and endocrine insufficiency, pancreatic atrophy, fatty replacement, or lipomatous pseudohypertrophy. Acute and chronic pancreatitis, pancreatic calcification, cysts, and cystosis also occur. Hepatic manifestations include hepatic steatosis, focal biliary and multilobular cirrhosis, and portal hypertension. Biliary complications include cholelithiasis, microgallbladder, and sclerosing cholangitis. The entire digestive tract can be involved. Distal ileal obstruction syndrome, intussusception, appendicitis, chronic constipation, colonic wall thickening, fibrosing colonopathy, pneumatosis intestinalis, gastroesophageal reflux, and peptic ulcer disease have been described. Renal manifestations include nephrolithiasis and secondary amyloidosis. The educational objectives of this review are to reveal the abdominal manifestations of CF to facilitate focused analysis of cross-sectional imaging in adult patients. Life expectancy in patients with CF continues to improve because of a combination of aggressive antibiotic treatment, improved emphasis on nutrition and physiotherapy, and development of promising new CF transmembrane conductance regulator modulators. As lung function and survival improve, extrapulmonary conditions, including hepatic and gastrointestinal malignancy, will be an increasing cause of morbidity and mortality. Awareness of the expected abdominal manifestations of CF may assist radiologists in identifying

  18. [Treatment of hypertension in patients with coronary arterial disease].

    PubMed

    Rosas-Peralta, Martín; Borrayo-Sánchez, Gabriela; Madrid-Miller, Alejandra; Ramírez-Arias, Erick; Pérez-Rodríguez, Gilberto

    2016-01-01

    Reports of randomized controlled trials and prospective observational studies provide the most reliable data on the association between blood pressure and coronary heart disease (CHD). The totality of the evidence indicate a strong association between blood pressure and coronary heart disease, which is continuous at levels of less than 115 mm Hg of systolic. In general, 60 to 69 years of age, 10 lower mm Hg systolic blood pressure is associated with lower risk of one-fifth of a coronary heart disease event. The size and shape of this Association are consistent in all regions, for men and women and life-threatening events such as stroke and myocardial infarction. Trials that compared active treatment with placebo or no treatment have shown that the benefits of reducing blood pressure with different classes of drugs (e.g., diuretics, beta-blockers, ACE inhibitors, calcium antagonists) are quite similar, with about a fifth of reduction in coronary heart disease. The important points in this review are: First, that the relative benefit to the decline in blood pressure for the prevention of coronary heart disease appears to be constant in a range of different populations. Second, it is likely that considerable benefit with blood pressure low below thresholds of "traditional" blood pressure (140/90 mm Hg), especially in those with high absolute risk. Third, start, reduce with caution -especially in adult- and keep the maximum tolerance of blood pressure reduction is an issue more important than the choice of the initial agent. PMID:27428346

  19. Associations between dietary patterns and hypertension among Korean adults: the Korean National Health and Nutrition Examination Survey (2008-2010)

    PubMed Central

    Shin, Ji-Ye; Kim, Ji-Myung

    2013-01-01

    The objective of this study is to identify the dietary patterns associated with the risk of hypertensions among Korean adults using data from the Korean National Health and Nutrition Examination Survey (KNHANES, 2008-2010). This study analyzes data from 11,883 subjects who participated in the health and nutrition survey, aging from 20 to 64 years. We performed factor analysis based on the weekly mean intake frequencies of 36 food groups to identify major dietary patterns. We identified three major dietary patterns in both sexes, namely "traditional", "western" and "dairy and carbohydrate" patterns. Participants in the highest quartile of western pattern scores had significantly higher blood pressure, serum total cholesterol, and triglyceride levels than those in the lowest quartile. Although not statistically significant, a trend (P for trend = 0.0732) toward a positive association between the western dietary pattern and hypertension risk was observed after adjustments for age, sex, education, income, body mass index (BMI), smoking, physical activity, and energy intake. The dairy and carbohydrate pattern was inversely related with BMI and blood pressures and positively associated with serum high-density lipoprotein (HDL)-cholesterol. After adjusting the age, sex, education, income, BMI, smoking, physical activity and energy intake, the dairy and carbohydrate pattern showed inverse associations with hypertension prevalence (OR = 0.64, 95% CI = 0.55-0.75; P for trend < 0.0001). Intakes of fiber, sodium, and antioxidant vitamins were significantly higher in the top quartile for the traditional pattern than in the lowest quartile for the traditional pattern (P for trend < 0.0001). Intakes of fiber (P for trend < 0.0001), calcium (P for trend < 0.0001), retinol (P for trend = 0.0164), vitamin B1 (P for trend = 0.001), vitamin B2 (P for trend < 0.0001), niacin (P for trend = 0.0025), and vitamin C (P for trend < 0.0001) were significantly increased across quartiles for

  20. Prevalence, Awareness, Treatment and Control of Hypertension in Indonesian Adults Aged ≥40 Years: Findings from the Indonesia Family Life Survey (IFLS)

    PubMed Central

    Mamun, Abdullah Al; Reid, Christopher; Huxley, Rachel R.

    2016-01-01

    Objective Hypertension is the major driver of the cardiovascular epidemic facing Indonesia in the 21st century. Understanding the socioeconomic inequalities associated with hypertension is essential for designing effective intervention strategies. The aim of the current study was to use sub-nationally representative survey data to examine socio-demographic inequalities in the prevalence, diagnosis and management of hypertension in Indonesian adults. Methods We investigated factors associated with hypertension prevalence, diagnosis, treatment and control using data on self-reported diagnosis and treatment, and blood pressure measurements, collected from 9755 respondents aged 40 years and up in the 2007 Indonesian Family Life Survey (IFLS 4). Results Age-standardized prevalence of hypertension among the study participants was 47.8% (95% CI: 46.8, 48.9), of which almost 70% were undiagnosed. Hypertension was significantly higher in women than men (52.3% versus 43.1%, p-value<0.001). Prevalence of hypertension increased significantly with ageing (Pfor trend <0.001). Over 91% (men: 92.1%, women: 90.0%) of hypertension cases were uncontrolled. Gender, education and socioeconomic status had differential impact on the diagnosis of hypertension and in receiving treatment. Conclusions Overall, less than a third were aware of their hypertension and a quarter of those on medication had their blood pressure effectively controlled. Men and those of younger age were more vulnerable to have undiagnosed and untreated hypertension. Substantial effort should be given to improve awareness about the condition and making provision for early diagnosis and treatment. PMID:27556532

  1. Heart rate variability and target organ damage in hypertensive patients

    PubMed Central

    2012-01-01

    Background We evaluated the association between linear standard Heart Rate Variability (HRV) measures and vascular, renal and cardiac target organ damage (TOD). Methods A retrospective analysis was performed including 200 patients registered in the Regione Campania network (aged 62.4 ± 12, male 64%). HRV analysis was performed by 24-h holter ECG. Renal damage was assessed by estimated glomerular filtration rate (eGFR), vascular damage by carotid intima-media thickness (IMT), and c