Abstract 4358317: Emergence of Hypertension in Thyroid Cancer Patients on BRAF ± MEK Inhibitors: A Closer Look at Incidence and Contributing Risk Factors

Background: Preeclampsia or eclampsia is a collection of symptoms that can occur in pregnant women, women in labor, and in the puerperium phase, characterized by hypertension and proteinuria. The condition is sometimes accompanied by convulsions to coma, called eclampsia. The direct cause of maternal mortality rate (MMR) is bleeding (30%), eclampsia (25%), parturition time (5%), abortion complications (8%), and infections (12%). National maternal mortality rate in 2007 was 228/100.000 live births. MMR in Central Java in 2008 was 114.42 / 100,000. Banyumas, one of regencies in Central Java has the highest total fertility rate (2.31). MMR in 2009 was 41 cases due to cause’s preeclampsia/eclampsia, 9 cases (22%). Methods: Case-control, located in Banyumas. Subjects in this study drawn from the study population by accidental sampling; those are pregnant women who were diagnosed as preeclampsia. The sample consisted of 276 pregnant women (138 cases and 138 controls). Measurement of risk factors (anxiety) used a questionnaire T-MAS. Estimated magnitude of the risk factors determined by the odds ratio (OR) stratified by previous test and multivariate analysis to control the confounder. Results: 59 (42.8%) experienced anxiety. The results of bivariate analysis between the main variables of anxiety with the incidence of preeclampsia in pregnant women shown OR=7.84; (CI=3.967-15.501); p<0.01. Then, the results of bivariate analysis of external variables with preeclampsia: a history of preeclampsia OR=19.24; (CI:2.524-146.246); p<0.01, a history of descendants of preeclampsia OR=8.52 (CI=2.903-25.049);p<0.01, history of hypertension OR=12.50; (CI=3.714-42.065); p<0.01, and the history of the ANC OR=3.00; (CI=1.560-5.784); P<0.01. From the stratified analysis, a history of hypertension is a confounder with the difference of OR=24.2%. There are an interaction between anxiety and a history of preeclampsia, hypertension and offspring with the incidence of preeclampsia. The results of multivariate analysis of anxiety showed OR=11.36; (CI=5.400-23.902); p<0.01, a history of preeclampsia OR=11.050; (CI=1.285-95.057); p=0.02, a history of descendants of preeclampsia OR=8.46; (CI=2.636-27.200); p<0.01; history of hypertension OR=10.50; (CI=2.834-38.958); p<0.01, and the history of the ANC: OR=2.75; (CI=1.209-6.274), p=0.01. Equation model 3 can be accepted: Preeclampsia = -1,958 + 2,430 (anxiety) + 2,402 (history of preeclampsia) + 2,136 (history of descendants of preeclampsia) + 2,352 (history of hypertension) + 1,013 (history of the ANC) Conclusion: Anxiety associated with the occurrence of preeclampsia. History of hypertension is a confounding variable. Furthermore, a history of preeclampsia, hypertension and history of descendants of preeclampsia are the giver of the effect of modification. In the multivariate analysis of main variables and external variables related to the incidence of preeclampsia is anxiety, a history of preeclampsia, history of descendants of preeclampsia, a history of hypertension and history of the ANC. Keywords: preeclampsia, anxiety, T-Mas (Taylor Manifest Anxiety Scale)

Prediction and prevention of atrial fibrillation in patients with high blood pressure or history of hypertension

Obesity Is Associated With Family History of ESRD in Incident Dialysis Patients

Role of Ultrasound-Guided Evaluation of Dyspnea in the Coronavirus Disease 2019 Pandemic

Development of Hypertension and Atrial Fibrillation Following Diagnosis of B-Cell Malignancies - a Retrospective Analysis of US Marketscan Insurance Claims Database

Bruton's Tyrosine Kinase Inhibition Is Associated with Manageable Cardiac Toxicity

A Real-World Comparative Analysis of Hypertension and Time to Treatment Failure with Acalabrutinib Vs Ibrutinib in Treatment-Naïve Patients with Chronic Lymphocytic Leukemia or Small Lymphocytic Lymphoma

An Assessment of Race As a Risk Factor for Doxorubicin-Related Cardiotoxicity in Diffuse Large B Cell Lymphoma

To the Editor: As noted by Asfar et al. (April 24 issue),1 a major concern related to targeting a relatively low mean arterial blood pressure in patients with septic shock is that the brain is at risk for ischemia in this condition. The risk of potential brain ischemia is particularly pertinent among patients with a history of arterial hypertension, because their cerebral autoregulatory curve may be shifted to the right.2 Indeed, cerebral ischemia may contribute to sepsis-associated encephalopathy and persistent neurocognitive dysfunction.3 However, neither the primary nor the secondary outcomes in the study by Asfar et al. involved any measures of neurocognitive function. A mean arterial blood pressure of approximately 65 to 90 mm Hg describes the lower limit of autoregulation in healthy persons,4 and the same level appears to be present in critically ill patients with sepsis who do not have a history of hypertension.5 Before the findings by Asfar et al. are implemented in major guidelines, we think that further studies should address the way in which cerebral hemodynamics are specifically affected in patients with sepsis and a history of hypertension, as well as whether targeting a relatively high mean arterial blood pressure improves long-term neurocognitive function.

Successful pregnancy in a Swyer syndrome patient with preexisting hypertension

e16051 Background: Recent data have shown that cardiotoxicity represents a potentially important side-effect in patients treated with sunitinib. We reviewed cardiac adverse events in patients with metastatic renal cell carcinoma (RCC) who underwent treatment with this agent. Methods: The medical records of 175 patients with metastatic RCC treated with sunitinib at eight Italian Institutions were retrospectively reviewed. Alterations in left ventricular ejection fraction (LVEF) and blood pressure were evaluated. Patients with pre-existing cardiac risk factors were specifically scrutinized for increased expression of cardiac changes. Results: Grade 3 hypertension was seen in 17 patients (9.7%); in twelve of these 17, hypertension developed after receiving the third sunitinib cycle. Among these 17 patients, 12 (70.6%) also experienced left-ventricular systolic (LVEF) dysfunction; in all, 33 of the 175 patients (18.9%) developed some degree of cardiac abnormality, of which 12 were of classified as grade 3 LVEF dysfunction and/or congestive heart failure (CHF) (6.9%). A significant univariate association for predictors of CHF were history of hypertension (p=0.008), history of coronary heart disease (p=0.0005) and prior treatment with an angiotensin converting enzyme inhibitor (ACE) (p= 0.04). Multivariate analysis suggested that a history of coronary artery disease (OR 18, 95% CI, 4–160 p 0.005) and hypertension (OR 3, 95% CI, 1.5–80 p 0.04) were the only significant independent predictors of CHF. Conclusions: Patients undergoing sunitinib, especially those with a previous history of hypertension and coronary heart disease, are at increased risk for cardiovascular events and should be monitored for exacerbations of their hypertension and for evidence of LVEF dysfunction during treatment. [Table: see text]

Introduction Burn patients with co-morbid hypertension are at elevated risk of complications, including edema and wound development. Hypertension may exacerbate burn recovery by increasing vascular resistance and systemic inflammation, which impairs tissue perfusion and delays wound healing. Edema, often exacerbated by hypertension, impairs local circulation and lymphatic drainage, further complicating recovery by promoting fluid accumulation and tissue damage. This study evaluates the relationship between hypertension, edema, and wound development in lower extremity burn patients. Methods A retrospective analysis using the TriNetX database identified adult (&amp;gt;18 years) lower extremity (LE) burn patients. Patients were categorized into three group cohorts: (1) LE burns without a history of hypertension or hypertension treatment, (2) LE burns with a history of untreated hypertension, and (3) LE burns with hypertension and a history of treatment with antihypertensives (beta blockers, peripheral vasodilators, diuretics, RAAS agents, calcium channel blockers). The cohorts were balanced using propensity score matching of age at index, race, and ethnicity covariates. The incidence of lower extremity swelling or edema, and lower extremity wound development three months post-burn, to account for initial healing time, was assessed. Statistical analysis compared percent risk and number of instances, using t-tests with a significance threshold of p &amp;lt; 0.05. Results Compared to Cohort 1, Cohort 2 had significantly more edema (p &amp;lt; 0.05), higher percent risk (5.7% vs 3.1%, p &amp;lt; 0.0001) of edema, and higher percent risk of lower extremity wounds (4.9% vs 2.3%, p &amp;lt; 0.0001). Cohort 3 had significantly higher percent risk of lower extremity edema (14.2% vs 1.7%, p &amp;lt; 0.0001) and superficial injuries or open wounds (11.9% vs 2.7%, p &amp;lt; 0.0001), compared to Cohort 1. Additionally, Cohort 3 had a higher risk of developing worse complications compared to Cohort 2, including increased superficial injuries or open wounds (11.6% vs 4.9%, &amp;lt; 0.0001) and edema (14.3% vs 4.1%, &amp;lt; 0.0001). Conclusions The data suggests a correlation between preexisting hypertension and increased edema and wound complications in lower extremity burn patients. According to our data, hypertension management showed worse lower extremity burn complications. Further research is needed to clarify the role of specific antihypertensives on wound healing and to explore how hypertension severity impacts lower extremity burn outcomes. Applicability of Research to Practice The findings suggest hypertension management and close monitoring with tailored cardiovascular interventions can reduce complications. This could influence clinical practice by encouraging early intervention in burn units, targeting patients with cardiovascular co-morbidities to improve recovery and reduce long-term complications. Funding for the Study N/A

Objective To investigate the relevant factors of type 2 diabetes mellitus(T2DM) with cerebral infarction(CI). Methods A total of 323 patients with T2DM from February 2012 to March 2017 in Inner Mongolia medical university affiliated hospital were included in this study. 150 patients with T2DM and CI were considered as experiment group, 173 cases of T2DM without CI were considered as control group. The clinical data of two groups were analyzed. Results The history of diabetes, smoking and hypertension were longer in experiment group than in control group (P<0.05). The patients in experiment group had higher fasting blood glucose(FBG), glycosylated hemoglobin(HbA1c), total triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), non-HDL-C, homocysteine(Hcy), fibrinogen(FIB), retinol binding protein 4(RBP4) and lower HDL-C, apolipoprotein A1(ApoA1) than the patients in control group(P<0.05). Multiple-factor logistic regression analysis showed that long-term smoking, long history of hypertension, high TG, high LDL-C, high non-HDL-C, high Hcy, high RBP4, low HDL-C and low ApoA1 were risk factors for CI in patients with T2DM (P<0.05). After adjusting common variables (diabetes history, hypertension history, smoking history, HbA1c, TG, TC), multiple-factor logistic regression analysis showed that LDL-C, non-HDL-C, Hcy, RBP4 were risk factors for CI in T2DM (P<0.05). HDL-C and ApoA1 were protective factors for CI in T2DM (P<0.05). Conclusion The risk factors for CI in patients with T2DM include long-term smoking, long hypertension history, high HbA1c, high TG, high LDL-C, high non-HDL-C, high Hcy, high RBP4, low HDL-C and low ApoA1. Patients should be advised to quit smoking, control blood glucose and blood pressure, and regulate blood lipid levels. Key words: Type 2 diabetes mellitus; Cerebral infarction; Relevant factors

Preeclampsia for the Nephrologist: Current Understanding in Diagnosis, Management, and Long-term Outcomes.

BackgroundMortality after ST-elevation myocardial infarction (STEMI) is dependent from best-medical treatment after initial event.ObjectivesDetermining the impact of prescription of guideline-recommended therapy after STEMI in two cohorts, patients with and without history of arterial hypertension, on survival.Methods1,025 patients of the Cologne Infarction Model registry with invasively adjudicated STEMI were dichotomized according to their history of arterial hypertension. We recorded prescription rates and dosing of RAS-inhibitors, β-blockers and statins in all patients. The primary outcome was all-cause death. Mean follow-up was 2.5 years.ResultsMean age was 64 ± 13 years, 246 (25%) were women. 749 (76%) patients had a history of hypertension. All-cause mortality was 24.2%, 30-day and 1-year mortality was 11.3% and 16.6%, respectively. History of hypertension correlated with lower mortality (hazard ratio [HR], @30 days: 0.41 [0.27-0.62], @1 year: 0.37 [0.26-0.53]). After adjusting for age, sex, Killip-class, diabetes mellitus, body-mass index, kidney function and statin prescription at discharge 1-year mortality HR was 0.24 (0.12-0.48). At discharge, prescription rates for RAS-inhibitors, β-blockers and statins, as well as individual dosing and long-term persistence of RAS-inhibitors were higher in patients with history of hypertension. On the same lines, prescription rates for RAS-inhibitors, β-blockers and statins at discharge correlated significantly with lower mortality regardless of history of hypertension.ConclusionPatients with history of hypertension show higher penetration of guideline recommended drug therapy after STEMI, which may contribute to better survival. Better tolerance of β-blockers and RAS-inhibitors in patients with history of hypertension, not hypertension itself, likely explains these differences in prescription and dosing.