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Uncontrolled Hypertension (uncontrolled + hypertension)
Selected AbstractsCushing's Syndrome With Uncontrolled Hypertension, Occasional Hypokalemia, and Two PregnanciesJOURNAL OF CLINICAL HYPERTENSION, Issue 7 2010Joel Handler MD First page of article [source] Late Acceleration of Treated Uncontrolled HypertensionJOURNAL OF CLINICAL HYPERTENSION, Issue 10 2008Joel Handler MD First page of article [source] Uncontrolled Hypertension: Whose Problem Is It?JOURNAL OF CLINICAL HYPERTENSION, Issue 3 2003Domenic A. Sica MD Guest Editor No abstract is available for this article. [source] Improvement In Blood Pressure Control With Impedance Cardiography-Guided Pharmacologic Decision MakingCONGESTIVE HEART FAILURE, Issue 1 2004Donald L. Sharman MD Previous reports have demonstrated improvement in blood pressure (BP) control utilizing noninvasive hemodynamic measurements with impedance cardiography (ICG). The purpose of this article is to report the effect of utilizing ICG-guided decision making to treat uncontrolled hypertension in a community generalist setting. Patient medical records were retrospectively reviewed for subjects on two antihypertensive agents with systolic blood pressure ,140 mm Hg or diastolic blood pressure ,90 mm Hg. All subjects were treated utilizing a previously published ICG-guided treatment algorithm. Twenty-one subjects met the BP and medication criteria. BP at entry was 157.2±13.9/78.7±9.9 mm Hg. Subjects were treated for 215±85 days (5.0±2.0 visits). After ICG-guided treatment, 12/21 (57.1%) achieved sustained BP control (p<0.001). BP was lowered to 141.6±22.0 (p<0.001)/77.1±10.7 (p>0.05) mm Hg. Antihypertensive agents increased from 2.0±0.0 to 2.5±0.7 (p<0.05). In this series of subjects with uncontrolled BP taking two antihypertensive agents, ICG-guided pharmacologic decision making resulted in significant reduction in BP and improvement in BP control. [source] Characterizing blood pressure control in individuals with Type 2 diabetes: the relationship between clinic and self-monitored blood pressureDIABETIC MEDICINE, Issue 9 2003R. S. Mazze Abstract Aims To determine the relationship between blood pressure (BP) measurement in the clinic and self-monitored blood pressure (SMBP); and to evaluate the accuracy of self-reported data in patients with Type 2 diabetes treated intensively for hypertension. Methods Seventy subjects had baseline and 1-week follow-up clinic BP measured using an Omron 907® automated device. During a contemporaneous 14-day period these subjects measured their BP at least four times each day using an Omron IC® semiautomatic portable monitor which, unknown to them, contained an onboard memory capable of storing BP with corresponding time and date. Results There was no significant difference between mean clinic and mean self-monitored BP. Correlations between clinic BP and SMBP were r = 0.61 (P < 0.0001) for systolic BP and r = 0.69 (P < 0.0001) for diastolic BP. Clinic BP classified 56 subjects as uncontrolled hypertension (BP , 130/80 mmHg, adjusted for diabetes) and 14 subjects as controlled hypertension. Using World Health Organization-International Society of Hypertension criteria for SMBP (, 125/75 mmHg), 55 cases of clinic classified uncontrolled hypertension were confirmed, resulting in 98% sensitivity. Clinic and SMBP agreed in one case of controlled hypertension, resulting in 7% specificity. For all subjects, the median percent of values exceeding SMBP criteria for controlled hypertension was systolic 92% and diastolic 70%. Self-reporting precision averaged 89 ± 10% (range 45,100%); under-reporting was 25 ± 16% (ranging from 0 to 56%) and over-reporting was 12 ± 15% (ranging from 0 to 46%). The overall logbook mean was not significantly different from the downloaded data from the Omron IC® monitors. Conclusions SMBP was able to identify 13 patients with uncontrolled hypertension who, by clinic BP measurement, had been classified as controlled. [source] Pseudohyperaldosteronism, Liquorice, and HypertensionJOURNAL OF CLINICAL HYPERTENSION, Issue 2 2008Bruno Sontia PhD Consumption of large quantities of liquorice can cause hypokalemia and hypertension. These effects are associated with increased cortisol-mediated activation of renal mineralocorticoid receptors and hypoaldosteronism. The authors describe a patient with long-standing hypokalemia and uncontrolled hypertension related to excessive ingestion of liquorice. The case highlights the importance of obtaining a detailed dietary history, especially considering the increasing use of liquorice-containing foods, teas, and herbal products. The authors also discuss secondary causes of hypertension, focusing on pseudohyperaldosteronism. [source] Aortic Dissection and Third-Degree Atrioventricular Block in a Patient With a Hypertensive CrisisJOURNAL OF CLINICAL HYPERTENSION, Issue 1 2008Nikolaos Lionakis MD A 55-year-old man with a history of uncontrolled hypertension was admitted because of an episode of severely elevated blood pressure. An electrocardiogram revealed complete atrioventricular block while imaging showed a dissecting aneurysm of the descending thoracic and abdominal aorta, type B according to the Stanford classification. Laboratory tests revealed significant increases in serum C-reactive protein. Coronary arteriography was performed and was negative for coronary artery disease. A VDD pacemaker was placed, and a combination of 4 antihypertensive agents was used as treatment. Type B aortic dissection may present with a wide range of manifestations. The authors suggest that measurement of C-reactive protein may be used in hypertensive patients to help reflect vascular injury and its degree, progression, and prognosis. Disorders of intraventricular conductivity are rarely seen in both types of dissection of the aorta (type A, B). Atrioventricular conductivity disorders that result in complete atrioventricular block have been reported only in patients with type A dissection (before the bifurcation of the subclavian artery). In this particular case, however, the authors diagnosed an atrioventricular conductivity disorder causing atrioventricular block in a patient with type B dissection. Consequently, the authors speculate that myocardial fibrosis, as a result of long-standing hypertension, could be the main pathogenetic mechanism leading to the development of such phenomena, resulting from a potential expanding of the fibrotic process to the atrioventricular conduction system. [source] Patient Knowledge and Awareness of Hypertension Is Suboptimal: Results From a Large Health Maintenance OrganizationJOURNAL OF CLINICAL HYPERTENSION, Issue 4 2003Mark Alexander PhD; Patient knowledge and awareness of hypertension are important factors in achieving blood pressure control. To examine hypertensive patients' knowledge of their condition, the authors randomly surveyed 2500 hypertension patients from a large health maintenance organization; questionnaires were supplemented with clinic blood pressure measurements. Approximately 72% of the subjects completed surveys. Of patients with uncontrolled hypertension (systolic blood pressure [SBP] 140 mm Hg and/or diastolic blood pressure [DBP] 90 mm Hg), only 20.2% labeled their blood pressure as "high" and 38.4% as "borderline high." Forty percent of respondents couldn't recall their most recent clinic-based SBP and DBP values. Overall, 71.7% and 61% were unable to report a target SBP or DBP, respectively, or identify elevated targets based on the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) criteria. Most patients perceived DBP to be a more important risk factor than SBP. Hypertensive patients' awareness of blood pressure targets and current hypertension control status, particularly with respect to SBP, is suboptimal. The authors' findings support the need to improve patient education for better management of hypertension. [source] Heart failure from diastolic dysfunction related to hypertension: Guidelines for managementJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 5 2005APRN-BCArticle first published online: 6 OCT 200, DeAnn Thomas-Kvidera MSN Purpose To provide advanced practice nurses with a greater understanding of the pathophysiology, diagnostics, and management of diastolic dysfunction resulting from hypertension. Data sources Electronic database searches were performed using Medline and CINAHL. Data were obtained from medical textbooks and research and review articles. Conclusions As the number of older adults with heart failure (HF) continues to increase, so will the need for effective care and guidance. In addition to further testing of appropriate pharmacologic regimens, adherence factors such as medication costs and patients' functional abilities must be considered. Implications for practice HF resulting from diastolic dysfunction has emerged as a separate entity over the past 10,15 years. One of the most common causes of diastolic dysfunction is uncontrolled hypertension. Populations at greatest risk include elders, particularly women, and African Americans. [source] Utilization of excimer laser debulking for critical lesions unsuitable for standard renal angioplasty,LASERS IN SURGERY AND MEDICINE, Issue 9 2009On Topaz MD Abstract Background The energy emitted by ultraviolet laser is avidly absorbed in atherosclerotic plaques. Conceptually, it could be applied for debulking of selected atherosclerotic renal artery stenoses. We describe early experience with revascularization of critical renal artery lesions deemed unsuitable for standard renal angioplasty. Institutional Review Board permission to conduct the data analysis was obtained. Methods Among 130 percutaneous renal artery interventions with balloon angioplasty and adjunct stenting, there were 12 (9%) patients who underwent laser debulking prior to stenting. These patients presented with critical (95±3.5% stenoses) lesions (11 de novo, 1 stent restenosis) deemed unsuitable for standard renal angioplasty because of marked eccentricity and presence of thrombus. Indications for intervention included preservation of kidney function, treatment of uncontrolled hypertension, management of congestive heart failure, and treatment of unstable angina. Blood pressure and estimated glomerular filtration rate (eGFR) were measured pre- and 3 weeks post-intervention. Results A baseline angiographic stenosis of 95±3.5% was reduced to 50±13% with laser debulking. There were no laser-induced complications. Post-stenting the angiographic residual stenosis was 0%. The mean gradient across the lesions was reduced from baseline 85±40 to 0,mmHg. A normal post-intervention antegrade renal flow was observed in all patients. Baseline mean systolic BP of 178±20,mmHg decreased to 132±12,mmHg (P<0.0001) and mean diastolic pressure of 85±16,mmHg reduced to 71±9,mmHg (P,=,0.01). A pre-intervention mean eGFR of 47.7±19,ml/min/1.73,m2 increased to 56±20.4,ml/min/1.73,m2 (P,=,0.05) post-procedure. The interventions were not associated with major renal or cardiac adverse events. During follow-up one patient developed transient contrast-induced nephropathy. Conclusions Debulking of select renal artery stenoses with laser angioplasty followed by adjunct stenting is feasible. Further prospective, randomized studies will be required to explore the role of debulking and laser angioplasty in renal artery revascularization. Lasers Surg. Med. 41:622,627, 2009. © 2009 Wiley-Liss, Inc. [source] Allograft diabetic nephropathy may progress to end-stage renal diseasePEDIATRIC TRANSPLANTATION, Issue 4 2004Moro O. Salifu Abstract:, Mesangial expansion and glomerular basement membrane thickening characteristic of diabetic nephropathy recur in diabetic recipients of renal allografts from non-diabetic donors but progression to renal failure is minimally documented. Three female renal allograft recipients (aged 40, 62 and 73 yr), who developed end-stage renal disease (ESRD) due to recurrent diabetic nephropathy (two patients) and de novo diabetes (one patient) are reported. Onset of proteinuria, uncontrolled hypertension, azotemia, renal allograft pathologic findings and the need for hemodialysis were analyzed. None of the kidney donors (one cadaver, two living related) had known diabetes or perturbed glucose metabolism pre-transplantation. The three patients presented had different varieties of diabetes; type 1, type 2 and new onset diabetes after transplantation (NODAT). In each subject, proteinuria was detected by dipstick at a mean of 8.3 yr (range 8,9) post-transplantation and increased to the nephrotic range (3.7,4.8 g/day) inducing hypoalbuminemia and azotemia. A histopathologic diagnosis of allograft diabetic nephropathy was made in a mean of 11.7 yr (range 10,14), based on glomerular basement membrane thickening, nodular and diffuse intercapillary glomerulosclerosis, arteriolosclerosis, and tubular atrophy with marked tubular basement membrane thickening characteristic of advanced diabetic nephropathy. All three patients manifested uremia and resumed hemodialysis. Two patients died from sepsis within 2 months and one patient died 2.5 yr later after resumption of maintenance hemodialysis. We infer that recurrent or de novo diabetic nephropathy in renal allografts follows a clinical decade-long course irrespective of diabetes. Reports of ESRD due to allograft diabetic nephropathy (ADN) have been limited because of shorter survival of diabetic transplant recipients and few kidney biopsies performed in patients with chronic allograft dysfunction. The occurrence of allograft diabetic nephropathy in some, but not all patients, however, suggests that individual genetic variability modulates disease expression. [source] Usefulness of translesional pressure gradient and pharmacological provocation for the assessment of intermediate renal artery diseaseCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 3 2006Noah J. Jones MD Abstract Objective: We sought to determine the hemodynamic significance of intermediate RAS by measuring translesional systolic pressure gradients (TSPG), using a pressure-sensing guidewire at baseline and after acetylcholine (ACh) induced hyperemia, following selective renal artery angiography. Background: Renal artery stenosis (RAS) is a cause of reversible hypertension and nephropathy. Stenting effectively relieves RAS, however improvement in blood pressure control or renal function is variable and unpredictable. Hemodynamic significance is usually present with RAS when diameter stenosis is >75%, but is less predictable in intermediate (30%,75%) RAS. Methods: Twenty-two patients (26 renal arteries) with uncontrolled hypertension underwent invasive hemodynamic assessment because of intermediate RAS, defined as radiocontrast angiographic diameter stenosis (DS) between 30% and 75% (quantitative DS was measured prospectively). Translesional pressure gradients were measured using a 0.014" pressure-sensing wire. Hyperemia was induced by administration of intrarenal ACh. Results: Visual and measured angiographic lesion severity did not correlate with TSPG either at baseline (visual DS, R2 = 0.091, P = 0.13; measured DS, R2 = 0.124, P = 0.07) or with hyperemia (visual DS, R2 = 0.057, P = 0.24; measured DS, R2 = 0.101, P = 0.12). Baseline and maximal hyperemic gradient did correlate (R2 = 0.567; P < 0.05). Pharmacological provocation produced a significant increase in TSPG (mean; baseline, 18 ± 21 vs. hyperemia, 34 ± 41 mm Hg; P < 0.05). A hemodynamically significant lesion (TSPG > 20 mm Hg) was found in 14/26 (54%) arteries (13 patients); 13 (60%) patients subsequently underwent renal artery stenting for hemodynamically significant RAS. At follow-up (at least 30 days), there was a significant decrease in systolic blood pressure (mean; 167 ± 24 vs. 134 ± 19 mm Hg; P < 0.001). Conclusions: Intrarenal administration of ACh induces hyperemia and can be used to unmask resistive renal artery lesions. Gradient measurement and induced hyperemia may be warranted in the invasive assessment of intermediate renal artery stenoses, rather than relying on stenosis severity alone. Further study is needed to determine whether translesional pressure gradients and pharmacological provocation predict clinical benefit after renal artery stenting. © 2006 Wiley-Liss, Inc. [source] | ||||||||||