-
Blood Pressure 2003To determine causes of treatment resistance in patients with refractory hypertension, and to estimate the prevalence of true resistant hypertension.
OBJECTIVE
To determine causes of treatment resistance in patients with refractory hypertension, and to estimate the prevalence of true resistant hypertension.
METHODS
We studied 50 consecutive patients referred with refractory hypertension after exclusion of hypokalemia and stenosis of the renal artery. Ambulatory blood pressure monitoring was performed in all patients to detect white-coat effect. The patients were hospitalized, antihypertensive drugs were withdrawn and a screening for secondary hypertension was performed. In addition, these patients, and a control group of essential hypertensives controlled with three antihypertensive drugs, underwent a OGTT with 75 g of glucose.
RESULTS
Primary normokalemic hyperaldosteronism was diagnosed in seven patients. Two patients had a pheochromocytoma and six had white-coat effect. The 35 remaining patients with true resistant hypertension shown significant differences in serum insulin and HOMA IR when compared with the control group.
CONCLUSIONS
These findings show that among normokalemic treatment-resistant hypertension, the presence of hyperaldosteronism and pheochromocytoma is quite high. Moreover, treatment resistance in hypertensive patients appears to be associated with insulin resistance.
Topics: Adrenal Gland Neoplasms; Adult; Blood Pressure Monitoring, Ambulatory; Case-Control Studies; Drug Resistance; Female; Glucose Tolerance Test; Humans; Hyperaldosteronism; Hypertension; Insulin Resistance; Male; Middle Aged; Pheochromocytoma; Prevalence
PubMed: 12875476
DOI: 10.1080/08037050310009950 -
Journal of Hypertension. Supplement :... May 1989Circadian blood pressure rhythms were examined in subjects exhibiting various forms of secondary and essential hypertension and in normotensive subjects with and without... (Comparative Study)
Comparative Study
Circadian blood pressure rhythms were examined in subjects exhibiting various forms of secondary and essential hypertension and in normotensive subjects with and without renal disease. Indirect ambulatory blood pressure recordings were performed in 284 subjects for 24 h. In contrast to patients with essential hypertension and to normotensive healthy subjects, the circadian fluctuations of blood pressure were reduced in secondary hypertensives and in normotensive renal patients. In renal hypertensives, these alterations in the diurnal blood pressure variations were dependent on the degree of renal failure. Calculations based on comparisons of the mean sleeping and mean daytime blood pressures identified 89.8% of the essential hypertensives and 72.5% of the patients with secondary hypertension. A large proportion of the patients with secondary hypertension had very high blood pressure levels during sleep, in many cases even exceeding the daytime levels. Thus, 24-h ambulatory blood pressure curves from patients with secondary and essential hypertension can be distinguished from each other. In secondary hypertension, blood pressure monitoring during both day and night is particularly useful for evaluating frequently severe nocturnal hypertension, which may require particular treatment.
Topics: Blood Pressure Determination; Circadian Rhythm; Female; Humans; Hypertension; Hypertension, Renal; Male; Monitoring, Physiologic; Sleep
PubMed: 2760715
DOI: No ID Found -
Journal of Human Hypertension Oct 1991Essential hypertension is primarily hereditary. The property inherited is present in all cells but because of adaptation and differentiation it is particularly prominent... (Review)
Review
Essential hypertension is primarily hereditary. The property inherited is present in all cells but because of adaptation and differentiation it is particularly prominent in systemic vascular smooth muscle. This inherited property is manifested functionally as increased reactivity to vasoactive substances, such as (-)noradrenaline and angiotensin II. This abnormal function is present before the onset of hypertension. Vascular hypertrophy and hyperplasia are not only caused by hyperactivity of the smooth muscle and by the hypertension itself but are also trophic effect of the agonists, especially noradrenaline. The only two proteins in vascular smooth muscle which can produce both contractile and trophic effects are the guanosine triphosphate binding protein (Gs) and phospholipase C. Phospholipase C has already been demonstrated to be abnormally active in response to agonists in the spontaneously hypertensive rat and in human essential hypertension. The Gs protein is less likely to be critically abnormal since it is active in the vascular smooth muscle relaxation cascade as well as in contraction. None of the other proteins involved in vascular smooth muscle contraction or relaxation affect both contractile reactivity and cellular growth. There are many secondary effects dependent upon the phospholipase C abnormality such as calcium (Ca2+) cellular content, Ca2+ Mg2+ ATPase pump effects and possibly Ca2+ Na+ exchange. There are also many secondary effects impinging on the phospholipase C abnormality including changes in noradrenaline and angiotensin II metabolism. Present antihypertensive therapy is directed largely at secondary factors dependent upon or influencing the primary phospholipase C cascade. The path is now open for a more direct and basic diagnostic and therapeutic attack.
Topics: Humans; Hypertension
PubMed: 1770474
DOI: No ID Found -
The Western Journal of Medicine Mar 1995Hypertension is a frequently encountered abnormality in patients being prepared for surgical procedures. This condition complicates anesthetic and postoperative... (Review)
Review
Hypertension is a frequently encountered abnormality in patients being prepared for surgical procedures. This condition complicates anesthetic and postoperative management, but careful monitoring and treatment allow hypertensive patients to tolerate surgery safely. Particular attention should be directed toward continuing antihypertensive medicine until the time of the surgical procedure or initiating treatment before it, monitoring the blood pressure frequently after the operation, and controlling postoperative hypertension with one of many parenteral agents available. The possibility of the presence of secondary hypertension and cardiovascular complications of hypertension should be considered during the preoperative assessment.
Topics: Humans; Hypertension; Surgical Procedures, Operative
PubMed: 7725703
DOI: No ID Found -
American Journal of Hypertension Apr 2024Patients with resistant hypertension are the group of hypertensive patients with the highest cardiovascular risk.
BACKGROUND
Patients with resistant hypertension are the group of hypertensive patients with the highest cardiovascular risk.
METHODS
All rules and guidelines for treatment of hypertension should be followed strictly to obtain blood pressure (BP) control in resistant hypertension. The mainstay of treatment of hypertension, also for resistant hypertension, is pharmacological treatment, which should be tailored to each patient's specific phenotype. Therefore, it is pivotal to assess nonadherence to pharmacological treatment as this remains the most challenging problem to investigate and manage in the setting of resistant hypertension.
RESULTS
Once adherence has been confirmed, patients must be thoroughly worked-up for secondary causes of hypertension. Until such possible specific causes have been clarified, the diagnosis is apparent treatment-resistant hypertension (TRH). Surprisingly few patients remain with true TRH when the various secondary causes and adherence problems have been detected and resolved. Refractory hypertension is a term used to characterize the treatment resistance in hypertensive patients using ≥5 antihypertensive drugs. All pressor mechanisms may then need blockage before their BPs are reasonably controlled.
CONCLUSIONS
Patients with resistant hypertension need careful and sustained follow-up and review of their medications and dosages at each term since medication adherence is a very dynamic process.
Topics: Humans; Antihypertensive Agents; Hypertension; Blood Pressure; Medication Adherence; Vasoconstrictor Agents
PubMed: 38124494
DOI: 10.1093/ajh/hpad118 -
Critical Care Clinics Apr 2001In summary, patients presenting with a true hypertensive emergency should be diagnosed quickly and promptly started on effective parenteral therapy (typically... (Review)
Review
In summary, patients presenting with a true hypertensive emergency should be diagnosed quickly and promptly started on effective parenteral therapy (typically nitroprusside 0.5 microgram/kg/min or fenoldopam 0.1 microgram/kg/min) in an intensive care unit. Blood pressure should be reduced about 25% gradually over 2 to 3 hours. Oral antihypertensive therapy (often with an immediate-release calcium antagonist) can be instituted after 6 to 12 hours of parenteral therapy, and consideration should be given to secondary causes of hypertension after transfer out of the intensive care unit. Because of advances in antihypertensive therapy and management, "malignant hypertension" should be truly malignant no longer.
Topics: Antihypertensive Agents; Blood Pressure; Emergencies; Humans; Hypertension; Nifedipine
PubMed: 11450325
DOI: 10.1016/s0749-0704(05)70176-7 -
Wiener Medizinische Wochenschrift (1946) Sep 2006Early occurences of organ damage, mainly in the cardiovascular system, the central nervous system, of the kidney or the retina, are hallmarks of a malign course in... (Review)
Review
Early occurences of organ damage, mainly in the cardiovascular system, the central nervous system, of the kidney or the retina, are hallmarks of a malign course in arterial hypertension. Peracute hypertensive emergencies can lead to a rapid deterioration of organ functions, a slower development is observed in patients with therapy-resistant forms of arterial hypertension. In the following article we discuss the historical trends in terminology and epidemiology, clinical symptoms, and possible causes for therapy-resistant hypertension. The latter mainly focuses on possible secondary forms of hypertension and on thoughts on therapy-resistance in primary, idiopathic arterial hypertension, as well as on possible therapeutic approaches.
Topics: Antihypertensive Agents; Drug Resistance; Humans; Hypertension; Hypertension, Malignant
PubMed: 17041804
DOI: 10.1007/s10354-006-0332-3 -
Nephrologie & Therapeutique Oct 2008Therapeutic control of primary or secondary hypertension remains insufficient because of the presence of individual phenotypic variations of factors acting on sodium... (Review)
Review
Therapeutic control of primary or secondary hypertension remains insufficient because of the presence of individual phenotypic variations of factors acting on sodium excretion and vasoconstriction. The study of monogenic models of hypertension allows to highlight some genetic mutations, mainly responsible of sodium regulation. In some cases, polymorphisms of such genes are found with an increased frequency in hypertensive patients. Each polymorphism by itself is not sufficient to cause hypertension, but their accumulation in a patient increases the hypertensive risk in primary or secondary hypertension. Understanding familial hyperaldosteronism type 1, Liddle or Ulick syndrome, activating mutations of minéralocorticoide receptor or Gordon syndrome give indications on pathophysiology of primary hypertension. Study of some mitochondrial defects or of genes implicated in renal dysplasia also seems interesting area of research. In the future, search for such mechanisms would allow a rational and oriented use of diuretics and antihypertensive therapies.
Topics: Adrenal Gland Neoplasms; Adrenal Hyperplasia, Congenital; Epithelial Sodium Channels; Humans; Hyperaldosteronism; Hypertension; Kidney; Mineralocorticoid Excess Syndrome, Apparent; Pheochromocytoma; Sodium
PubMed: 18448411
DOI: 10.1016/j.nephro.2008.02.005 -
BMC Research Notes Oct 2016Arterial hypertension is a major cause of death worldwide. For the most part, treatment for hypertension can be performed on an outpatient basis. However, some patients...
BACKGROUND AND AIMS
Arterial hypertension is a major cause of death worldwide. For the most part, treatment for hypertension can be performed on an outpatient basis. However, some patients also require inpatient treatment, and the contributing factors for this remain unknown. Therefore, the primary objective of the present study was to determine which patient characteristics are associated with inpatient treatment for arterial hypertension.
METHODS
Here, we conducted a mono-centric study of 103 hypertensive subjects, who were treated as inpatients in the Department of Nephrology and rheumatology of the university medical faculty of Göttingen. Therapies were not altered, and data collection was performed retrospectively. In addition to epidemiological information, the following data were recorded: patient symptoms, blood pressure (BP), anti-hypertensive therapy, and concomitant diseases (e.g., renal and cardiovascular conditions).
RESULTS
Approximately half (53 %) of all subjects treated on an inpatient basis displayed elevated BP (>140/90 mmHg), while the remaining 47 % of patients showed normotensive readings (<140/90 mmHg) following admission. Moreover, 34 % of patients could be classified as therapy refractory. The main reasons for hospital admission were hypertension-related symptoms, including shortness of breath, dizziness, and headache (69 %). These patients were multi-morbid, with approximately 60 % displaying a secondary form of hypertension. Indeed, over half of the subjects showed renoparenchymatous forms of hypertension, and a large percentage of patients received hypertension-inducing drugs (32 %). Moreover, a high proportion of inpatients were treated with reserve antihypertensives, with the most commonly used drug being Moxonidin.
CONCLUSION
The majority of hypertensive patients were hospitalized due to their clinical symptoms and not as a result of BP values alone. The high proportion of patients with secondary forms of hypertension or treated with BP-boosting medications was striking.
Topics: Aged; Antihypertensive Agents; Female; Germany; Humans; Hypertension; Male; Middle Aged; Patient Admission
PubMed: 27776558
DOI: 10.1186/s13104-016-2285-y -
Frontiers in Endocrinology 2023Metabolic disorders are involved in the development of numerous cancers, but their association with the progression of cervical cancer is unclear. This study aims to...
BACKGROUND
Metabolic disorders are involved in the development of numerous cancers, but their association with the progression of cervical cancer is unclear. This study aims to investigate the association between metabolic disorders and the pathological risk factors and survival in patients with early cervical cancer.
METHODS
Patients with FIGO IB1 (2009) primary cervical cancer who underwent radical hysterectomy and systematic pelvic lymph node dissection at our institution from October 2014 to December 2017 were included retrospectively. Clinical data regarding the metabolic syndrome and surgical pathology of the patient were collected. The correlations between metabolic disorders (hypertension, hyperglycemia, and obesity) and clinicopathological characteristics as well as survival after surgery were analyzed.
RESULTS
The study included 246 patients with clinical IB1 cervical cancer, 111 (45.1%) of whom had at least one of the comorbidities of hypertension, obesity, or hyperglycemia. Hypertension was positively correlated with parametrial invasion and poorly differentiated histology; hyperglycemia was positively correlated with stromal invasion; obesity was negatively associated with lymph node metastasis; but arbitrary disorder did not show any correlation with pathologic features. Hypertension was an independent risk factor for parametrial invasion (OR=6.54, 95% CI: 1.60-26.69); hyperglycemia was an independent risk factor for stromal invasion (OR=2.05, 95% CI: 1.07-3.95); and obesity was an independent protective factor for lymph node metastasis (OR=0.07, 95% CI: 0.01-0.60). Moreover, the patients with hypertension had a significantly lower 5-year OS rate (70.0% vs. 95.3%, <0.0001) and a significantly lower 5-year PFS rate than those without hypertension (70.0% vs. 91.2%, =0.010).
CONCLUSION
Hypertension and hyperglycemia are positively associated with local invasion of early cervical cancer, which need to be verified in multi-center, large scale studies.
Topics: Female; Humans; Uterine Cervical Neoplasms; Retrospective Studies; Lymphatic Metastasis; Hyperglycemia; Neoplasm Staging; Hypertension; Obesity
PubMed: 38152132
DOI: 10.3389/fendo.2023.1280060