-
Revista Medica de Chile Feb 2013The present review examines the types of hypertension that women may suffer throughout life, their physiopathological characteristics and management. In early life, the... (Review)
Review
The present review examines the types of hypertension that women may suffer throughout life, their physiopathological characteristics and management. In early life, the currently used low-dose oral contraceptives seldom cause hypertension. Pregnancy provokes preeclampsia, its main medical complication, secondary to inadequate transformation of the spiral arteries and the subsequent multisystem endothelial damage caused by deportation of placental factors and microparticles. Hypertension in preeclampsia is an epiphenomenon which needs to be controlled at levels that reduce maternal risk without impairing placental perfusion. The hemodynamic changes of pregnancy may unmask a hypertensive phenotype, may exacerbate a chronic hypertension, or may complicate hypertension secondary to lupus, renovascular lesions, and pheochromocytoma. On the other hand a primary aldosteronism may benefit from the effect of progesterone and present as a postpartum hypertension. A hypertensive pregnancy, especially preeclampsia, represents a risk for cardiac, vascular and renal disease in later life. Menopause may mimic a pheochromocytoma, and is associated to endothelial dysfunction and salt-sensitivity. Among women, non-pharmacological treatment should be forcefully advocated, except for sodium restriction during pregnancy. The blockade of the renin-angiotensin system should be avoided in women at risk of pregnancy; betablockers could be used with precautions during pregnancy; diuretics, ACE inhibitors and angiotensin receptor antagonists should not be used during breast feeding. Collateral effects of antihypertensives, such as hyponatremia, cough and edema are more common in women. Thus, hypertension in women should be managed according to the different life stages.
Topics: Antihypertensive Agents; Female; Humans; Hypertension; Hypertension, Pregnancy-Induced; Menopause; Pregnancy; Sex Factors
PubMed: 23732498
DOI: 10.4067/S0034-98872013000200014 -
Journal of Clinical Hypertension... Jul 2008The epidemic of obesity in the United States and around the world is intensifying in severity and scope and has been implicated as an underlying mechanism in systemic... (Review)
Review
The epidemic of obesity in the United States and around the world is intensifying in severity and scope and has been implicated as an underlying mechanism in systemic hypertension. Obese hypertensive individuals characteristically exhibit volume congestion, relative elevation in heart rate, and high cardiac output with concomitant activation of the renin-angiotensin-aldosterone system. When the metabolic syndrome is present, insulin resistance and hyperinsulinemia may contribute to hypertension through diverse mechanisms. Blood pressure can be lowered when weight control measures are successful, using, for example, caloric restriction, aerobic exercise, weight loss drugs, or bariatric surgery. A major clinical challenge resides in converting short-term weight reduction into a sustained benefit. Pharmacotherapy for the obese hypertensive patient may require multiple agents, with an optimal regimen consisting of inhibitors of the renin-angiotensin-aldosterone system, thiazide diuretics, beta-blockers, and calcium channel blockers if needed to attain contemporary blood pressure treatment goals.
Topics: Antihypertensive Agents; Bariatric Surgery; Blood Pressure; Drug Therapy, Combination; Hemodynamics; Humans; Hypertension; Leptin; Metabolic Syndrome; Obesity; Renin-Angiotensin System; Risk Reduction Behavior; Sympathetic Nervous System; Weight Loss
PubMed: 18607142
DOI: 10.1111/j.1751-7176.2008.08178.x -
Annals of Agricultural and... Jun 2021Arterial blood pressure is one of the main vital signs reflecting body functions and, at the same time, the most important functional parameter of the cardiovascular...
INTRODUCTION
Arterial blood pressure is one of the main vital signs reflecting body functions and, at the same time, the most important functional parameter of the cardiovascular system. High blood pressure is the major modifiable cardiovascular risk factor.
OBJECTIVE
The aim of the study was assessment of the frequency of occurrence of cardiovascular risk factors, with particular consideration of arterial blood pressure.
MATERIAL AND METHODS
The study was conducted among 509 volunteers from Lublin in eastern Poland who participated in the prophylactic programme entitled 'White Sunday'. Standard measurements of blood pressure were performed using a TM-Z dial pressure gauge. The level of arterial blood pressure and socio-demographic parameters were analyzed.
RESULTS
Hypertension was more frequently observed in the group of males than females. The age group especially vulnerable to abnormal blood pressure values were those aged 51-60. Isolated hypertension significantly more often occurred in the group of respondents who mentioned hypertension in an interview, compared to those who reported its absence. Among 367 persons who, in preliminary interview, did not declare hypertension, 60 cases of isolated arterial hypertension were noted (16.3%). From among respondents who declared absence of hypertension in an interview, the largest age group diagnosed with isolated arterial hypertension were those aged 61-70 (17.9%).
CONCLUSIONS
Arterial hypertension is a civilisation disease which may be effectively prevented, simultaneously reducing the risk of premature death due to cardiovascular events, as well as reducing social and economic costs. International health organizations recommend the implementation of social screening programmes in order to diagnose high blood pressure and the promotion of routine measurements of arterial blood pressure.
Topics: Adult; Age Distribution; Aged; Blood Pressure; Female; Humans; Hypertension; Male; Middle Aged; Poland
PubMed: 34184517
DOI: 10.26444/aaem/134221 -
American Journal of Obstetrics &... Jan 2022Postpartum hypertension is a source of significant morbidity and mortality in the United States. While advances have been made in the peripartum management of...
BACKGROUND
Postpartum hypertension is a source of significant morbidity and mortality in the United States. While advances have been made in the peripartum management of hypertension, there is little data to guide ongoing management postpartum.
OBJECTIVE
To determine whether an association exists between (1) hospital readmission and (2) hypertension in the 12 hours before discharge and the prescription of antihypertensive medications at the time of discharge. The secondary objective included evaluating the median time to readmission for hypertensive complications.
STUDY DESIGN
This was a retrospective cohort study of all women with peripartum hypertension at a single tertiary care center over a 3-year period (2017-2019). Peripartum hypertension was defined as any systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg on 2 occasions, 4 hours apart, in the electronic medical record during the patients' admission for delivery. As potential risk factors for readmission, we also identified if the patients were discharged with a prescription for antihypertensive medication and assessed the blood pressure measurements during the 12 hours before discharge. The primary outcome of interest was postpartum readmission because of hypertensive complications. Readmission was defined as emergency room evaluation or hospital readmission because of hypertensive complications. Analysis was stratified into 4 comparison groups on the basis of the blood pressure and antihypertensive medications on discharge. The rate of postpartum readmissions was calculated. The risks of readmission were estimated using logistic regression and were adjusted for appropriate confounding variables.
RESULTS
Of 14,577 women who gave birth during the study period, 3480 (24%) met the definition of peripartum hypertension. Of those, 176 (5.1%) were readmitted within a median of 3 days from discharge. Sixty percent of patients readmitted had an International Classification of Diseases, Tenth Revision code for peripartum hypertension assigned by providers during their admission. Women with systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg before discharge were at a higher risk of readmission irrespective of being discharged with antihypertensive medication. Compared with those who were discharged normotensive, women who had hypertension in the 12 hours before discharge and were discharged with an antihypertensive prescription were at a significantly increased risk of readmission, adjusted odds ratio, 2.90; 95% confidence interval, 1.11-7.57.
CONCLUSION
Untreated hypertension within 12 hours before discharge was associated with a 32% higher risk of readmission in those who were not prescribed antihypertensive medications at discharge and a 3-fold increased risk of readmission in patients discharged on antihypertensive medication. These findings highlight the importance of treatment to normalize the blood pressure for at least 12 hours before discharge.
Topics: Antihypertensive Agents; Female; Humans; Hypertension; Patient Readmission; Postpartum Period; Retrospective Studies; United States
PubMed: 34757235
DOI: 10.1016/j.ajogmf.2021.100517 -
Journal of Clinical Hypertension... Jul 2008Secondary hypertension is common in clinical practice if a broad definition is applied. Various patterns of hypertension exist in the patient with an endocrine source of... (Review)
Review
Secondary hypertension is common in clinical practice if a broad definition is applied. Various patterns of hypertension exist in the patient with an endocrine source of their disease, including new-onset hypertension in a previously normotensive individual, a loss of blood pressure control in a patient with previously well-controlled blood pressure, and/or labile blood pressure in the setting of either of these 2 patterns. A thorough history and physical exam, which can rule out concomitant medications, alcohol intake, and over-the-counter medication use, is an important prerequisite to the workup for endocrine causes of hypertension. Endocrine forms of secondary hypertension, such as pheochromocytoma and Cushing's disease, are extremely uncommon. Conversely, primary aldosteronism now occurs with sufficient frequency so as to be considered "top of the list" for secondary endocrine causes in otherwise difficult-to-treat or resistant hypertension. Primary aldosteronism can be insidious in its presentation since a supposed hallmark finding, hypokalemia, may be variable in its presentation. It is important to identify secondary causes of hypertension that are endocrine in nature because surgical intervention may result in correction or substantial improvement of the hypertension.
Topics: Diagnosis, Differential; Endocrine System; Endocrine System Diseases; Humans; Hyperaldosteronism; Hypertension; Pheochromocytoma; Risk Factors
PubMed: 18607139
DOI: 10.1111/j.1751-7176.2008.08097.x -
International Journal of Molecular... Aug 2017Multikinase inhibitors (MKI) and mammalian target of rapamycin (mTOR) inhibitors prolong progression-free (PFS) and overall survival (OS) in the treatment of metastatic... (Review)
Review
Multikinase inhibitors (MKI) and mammalian target of rapamycin (mTOR) inhibitors prolong progression-free (PFS) and overall survival (OS) in the treatment of metastatic renal cell carcinoma (mRCC) by reducing angiogenesis and tumor growth. In this regard, the MKI lenvatinib and the mTOR inhibitor everolimus proved effective when applied alone, but more effective when they were administered combined. Recently, both drugs were included in clinical trials, resulting in international clinical guidelines for the treatment of mRCC. In May 2016, lenvatinib was approved by the American Food and Drug Administration (FDA) for the use in combination with everolimus, as treatment of advanced renal cell carcinoma following one prior antiangiogenic therapy. A major problem of treating mRCC with lenvatinib and everolimus is the serious adverse event (AE) of arterial hypertension. During the treatment with everolimus and lenvatinib combined, 42% of the patients developed hypertension, while 10% of the patients treated with everolimus alone and 48% of the of the lenvatinib only treated patients developed hypertension. Lenvatinib carries warnings and precautions for hypertension, cardiac failure, and other adverse events. Therefore, careful monitoring of the patients is necessary.
Topics: Animals; Antineoplastic Agents; Carcinoma, Renal Cell; Everolimus; Humans; Hypertension; Kidney Neoplasms; Neoplasm Metastasis; Phenylurea Compounds; Protein Kinase Inhibitors; Quinolines; TOR Serine-Threonine Kinases
PubMed: 28796163
DOI: 10.3390/ijms18081736 -
Current Hypertension Reports May 2014Hypertension is a powerful risk factor for cardiovascular mortality and morbidity, including heart failure with both preserved and reduced ejection fraction.... (Review)
Review
Hypertension is a powerful risk factor for cardiovascular mortality and morbidity, including heart failure with both preserved and reduced ejection fraction. Hypertensive heart disease (HHD) defines the complex and diverse perturbations of cardiac structure and function occurring secondary to hypertension. Left ventricular hypertrophy (LVH) is one of the most recognized features of HHD and is an established risk factor for adverse cardiovascular (CV) outcomes in hypertension. Beyond LVH, LV geometry provides additional information regarding the cardiac response to hypertension. Imaging studies from larger cohorts of hypertensive patients reveal wide variability in the prevalence of LVH and LV geometric patterns, with the prevalence of concentric LVH similar to that of eccentric LVH. Hypertension is also associated with concomitant impairments in LV diastolic and systolic function. It remains uncertain why patients develop different patterns of LVH, although demographics and clinical comorbidities appear to influence that response.
Topics: Animals; Echocardiography; Heart Failure; Heart Ventricles; Humans; Hypertension; Hypertrophy, Left Ventricular; Ventricular Remodeling
PubMed: 24639061
DOI: 10.1007/s11906-014-0428-x -
Journal of Clinical Hypertension... Oct 2013The Canadian Hypertension Education Program (CHEP) has published guidelines annually since 2000. The CHEP guidelines are a model of concise, comprehensive, up-to-date,... (Review)
Review
The Canadian Hypertension Education Program (CHEP) has published guidelines annually since 2000. The CHEP guidelines are a model of concise, comprehensive, up-to-date, evidence-rated guidelines for physicians who diagnose and treat hypertension. The guidelines address measurement of blood pressure and the definition of hypertension, secondary hypertension evaluation and treatment, and blood pressure targets and medication choices in patients with and without compelling indications. This review describes CHEP's process for developing guidelines and provides an overview of the 2013 recommendations.
Topics: Blood Pressure; Canada; Disease Management; Evidence-Based Medicine; Humans; Hypertension; Practice Guidelines as Topic
PubMed: 24088284
DOI: 10.1111/jch.12171 -
Iranian Journal of Kidney Diseases Jul 2011Resistant hypertension is an increasingly common medical problem, and patients with this condition are at a high risk of cardiovascular events. The prevalence of... (Review)
Review
Resistant hypertension is an increasingly common medical problem, and patients with this condition are at a high risk of cardiovascular events. The prevalence of resistant hypertension is unknown, but data from clinical trials suggest that 20% to 30% of hypertensive individuals may be resistant to antihypertensive treatment. The evaluation of these patients is focused on identifying true resistant hypertension and contributing and secondary causes of hypertension, including hyperaldosteronism, obstructive sleep apnea, chronic kidney disease, renal artery stenosis, and pheochromocytoma. Treatment includes removal of contributing factors, appropriate management of secondary causes, and use of effective multidrug regimens. More established approaches, such as low dietary salt and mineralocorticoid receptor blockers, and new technologies, such as carotid stimulation and renal denervation, have been used in the management of patients with resistant hypertension.
Topics: Antihypertensive Agents; Blood Pressure Determination; Cardiovascular Diseases; Drug Resistance; Drug Therapy, Combination; Female; Humans; Hypertension; Male; Mineralocorticoid Receptor Antagonists; Prognosis; Risk Assessment; Severity of Illness Index; Treatment Outcome
PubMed: 21725176
DOI: No ID Found -
BMC Cardiovascular Disorders Dec 2022Gender-based violence (GBV) is a significant global public health problem and the most prominent human rights violation severely impacting women's health and wellbeing....
BACKGROUND
Gender-based violence (GBV) is a significant global public health problem and the most prominent human rights violation severely impacting women's health and wellbeing. Therefore, the aim of this study is to evaluate the association between gender-based violence and hypertension in Kyrgyzstan Republic.
METHODS
This study was conducted using population-based data of women from the 2018 Kyrgyzstan Demographic and Health Survey. The odds ratio was calculated to measure the association between GBV and hypertension, and p-values < 0.005 was considered statistically significant.
RESULT
We included data of 4793 participants, and 621 (13%) of them had hypertension. Participants exposed to GBV were 24% more likely to have hypertension than unexposed participants (OR = 1.24, 95% CI: 1.03-1.48). Of all women with hypertension, 206 (33.0%) were exposed to GBV. Participants with secondary education or higher exposed to GBV were 24% more likely to be hypertensive than GBV unexposed women with the same education levels OR = 1.24, 95% CI: 1.04-1.49). Unemployed participants exposed to GBV were 45% more likely to develop hypertension than their unexposed counterparts (OR = 1.45, 95%CI: 1.15-1.81). Rural residents exposed to GBV were also 29% more likely to have hypertension than those unexposed to GBV (OR = 1.29, 95% CI: 1.04-1.59). The odds of hypertension among those exposed to GBV increase with age.
CONCLUSION
The study revealed that GBV is a significant factor of having hypertension among Kyrgyz women.
Topics: Female; Humans; Gender-Based Violence; Kyrgyzstan; Women's Health; Rural Population; Hypertension
PubMed: 36522737
DOI: 10.1186/s12872-022-02970-6