Case Of Chronic Hypertension Research Articles

A rare case series on hypertensive encephalopathy manifesting as psychosis

Abstract Hypertensive encephalopathy is a rare condition which is a clinically and radiologically diagnosed disorder. It usually presents in known hypertensive cases among young- and middle-aged adults. Although it presents with altered consciousness and other multisystem manifestations, symptoms of psychosis are rarely seen; management of the disorder is proper blood pressure control. Now, we present two cases of de novo hypertension and a case of chronic hypertension with no history of psychiatric illness and presented with symptoms of irritability, confusion, and hallucinations. To our knowledge, these are the few case reports showing psychosis in hypertensive patients presented with hypertensive encephalopathy. Categories: Internal Medicine, Psychiatry, Neurology

Stroke in Pregnancy: A Case Report.

case reports; hypertension; intracerebral haemorrhage; pregnancy; stroke.

Effects of pregnancy complicated with Takayasu arteritis on maternal and fetal outcomes

Objective: To explore the effects of pregnancy complicated with Takayasu arteritis (TA) on maternal and fetal outcomes. Methods: The clinical data of 17 TA patients with pregnancy and finally terminated admitted to the First Affiliated Hospital of Zhengzhou University from January 2012 to December 2020 were collected and the maternal and infant outcomes were retrospectively analyzed. Results: Among the 24 pregnancies in 17 TA patients in our hispital, 11 patients in our hospital were primiparous (46%, 11/24) and 13 patients were multiparous (54%, 13/24); 4 cases of chronic hypertension before pregnancy (17%, 4/24), and 20 cases of non-hypertension (83%, 20/24) were abserved. Apart from the thoracoabdominal artery type, 15 cases (63%, 15/24) of brachiocephalic type, 8 cases (33%, 8/24) of extensive type, and 1 case of pulmonary artery type (4%, 1/24) were included in TA classification; the renal artery was damaged in 7 cases (7/8) of the extensive type. Among the 24 pregnancies of 17 TA patients, 8 cases of pregnancy complications occurred, including 4 cases (17%, 4/24) of preeclampsia, one case of (4%, 1/24) new-onset hypertension during pregnancy, exacerbation of existing hypertension, thrombocytopenia and ischemic stroke respectively; 3 cases of induced abortion, 1 case of induced labor, and 20 cases of final delivery were found. Of the 20 final deliveries, 3 cases (15%, 3/20) were delivered through the vagina; 17 cases (85%, 17/20) were delivered by cesarean section; 3 cases (15%, 3/20) of fetal growth restriction and 6 cases of oligohydramnios (30%, 6/20) were occurred. The median gestational age of pregnancy termination of 17 full-term neonates (85%, 17/20) and 3 premature neonates (15%, 3/20) was 38.4 weeks (range:29.6-40.9 weeks). All premature women were complicated with pre-eclampsia or severe pre-eclampsia, which lead to premature birth; the birth weight of the neonates was (2 791±783) g. Neonatal asphyxia occurred in 3 cases (15%, 3/20), and 6 cases (30%, 6/20) were admitted to the neonatal intensive care unit. None of the newborns died. The patients were followed up for 3 months to 7 years. Except for one case who underwent surgical treatment 3 years after delivery and died of intraoperative hemorrhage, the other 16 patients were in stable condition; all the newborns grew and developed well. The incidences of maternal and infant adverse events were higher in those with chronic hypertension, renal artery involvement, and no use of hormones and aspirin during pregnancy, but the differences were not statistically significant (all P>0.05). Conclusions: Pregnancy with TA has adverse effects on maternal and infant outcomes. To reduce the occurrence of maternal and child adverse events, the condition of TA patients should be fully assessed before pregnancy, multidisciplinary cooperation, regular treatment, strengthened monitoring of the condition, timely treatment of complications, selection of appropriate delivery methods after pregnancy, and vigilance of postpartum complications should be properly carried out.

A Case of Chronic Hypertension with Superimposed Preeclampsia in Hypertensive Emergency

Preeclampsia is defined as BP > 140/90 mmHg on 2 occasions 4-6 hours apart, which occurs in pregnancy after 20^th week of period of gestation, which involves multi organ system. Hypertensive emergency is a spectrum of Preeclampsia which is an acute crisis. We present a case, from our clinic, of a pregnant woman who was referred here with Hypertensive emergency, she was a known case of chronic hypertension with superimposed preeclampsia in hypertensive emergency, and was managed effectively with Anti hypertensives and was taken up for emergency Lscs and was managed in ICU post-operatively and was alter discharged after her recovery.

475: Do competing risks matter? The case of chronic hypertension and the incidence of severe preeclampsia

475: Do competing risks matter? The case of chronic hypertension and the incidence of severe preeclampsia

The frequency of hypertensive disorders during pregnancy in maternal deaths in Isfahan Province, Iran

BACKGROUND: The findings of incidence or prevalence studies can help managers and policy makers evaluate the degree of changes and its relation with the performed interventions. This study aimed to determine the frequency of hypertensive disorders during pregnancy in maternal deaths that occurred during 2006-10 in Isfahan Province, Iran. METHODS: This descriptive, cross-sectional study assessed all maternal deaths that occurred during 2006-10 in Isfahan. Data was collected by reviewing available documents using a checklist whose validity has been approved by experts. Data was analyzed by descriptive statistics and chi-square and Fisher's exact tests in SPSS 12 . RESULTS: In total, 58 women who had died due to complications of pregnancy and childbirth were studied. The mean age of the subjects was 30.2 ± 6.5 years (range: 17-45 years). From 22.4% of maternal deaths which were due to gestational hypertension, 92.3% were preeclampsia and eclampsia. One case of chronic hypertension (7.7%) was also observed. Other types of hypertension in pregnancy were not detected. The first direct cause of maternal death was hypertension disorders. Underlying diseases (36.2%) and bleeding (18.9%) were the other major causes of death. CONCLUSION: The number of deaths caused by blood pressure disorders, as a direct and important factor in maternal deaths, reduced during the 5-year course of study. In order to improve pregnancy outcomes, measures should be taken for early detection and diagnosis of these disorders. Keywords: Hypertension, Pregnancy, Maternal Mortality Rate, Preeclampsia, Eclampsia

Altered vascular function in fetal programming of hypertension.

Reduced endothelium-dependent vasorelaxation partly due to loss of nitric oxide (NO) bioavailability occurs in most cases of chronic hypertension. Intrauterine nutritional deprivation has been associated with increased risk for hypertension and stroke, associated with relaxant dysfunction and decreased vascular compliance, but the underlying mechanisms are not known. The present studies were undertaken to investigate whether endothelial dysfunction associated with altered NO-dependent vasodilatation pathways is also observed in a model of in utero programming of hypertension. Pregnant Wistar rats were fed a normal (18%), low (9%), or very low (6%) protein isocaloric diet during gestation. Vasomotor response of resistance cerebral microvessels (<50 micro m) was studied in adult offspring of dams fed the 18% and 9% protein diets by a video imaging technique. Endothelial NOS (eNOS), soluble guanylate cyclase (sGC), and K(Ca) channel expression were measured by Western blot. NO synthase (NOS) activity was measured enzymatically as well as in situ by NADPH diaphorase staining. Litter size and survival to adulthood were not affected by the diets. Birth weights of offspring of dams fed the 6% diet were markedly lower than those of dams fed the 9% diet, which were marginally lower than those of controls. Systolic blood pressures of adult offspring of mothers in the 6% and 9% groups were comparably greater (156+/-2 and 155+/-1 mm Hg, respectively) than that of control offspring (137+/-1 mm Hg); we therefore focused on the 9% and 18% groups. Cerebral microvessel constriction to thromboxane A(2) mimetic and dilation to carba-prostaglandin I(2) did not differ between diet groups. In contrast, vasorelaxation to the NO-dependent agents substance P and acetylcholine was diminished by 50% in low protein-exposed offspring, but eNOS expression and activity were similar between the 2 diet groups. Vasorelaxant response to the NO donor sodium nitroprusside was also decreased and was associated with reduced (by 50% to 65%) cGMP levels and sGC expression. cGMP analogues caused comparable vasorelaxation in the 2 groups. Expression of K(Ca) (another important mediator of NO action) and relaxation to the K(Ca) opener NS1619 were unchanged by antenatal diet. Maternal protein deprivation, which leads to hypertension in the offspring, is associated with diminished NO-dependent relaxation of major organ (cerebral) microvasculature, which seems to be largely attributed to decreased sGC expression and cGMP levels. The study provides an additional explanation for abnormal vasorelaxation in nutrient-deprived subjects in utero.

Pathogenesis of hypertension and implications for its therapeutic management.

Excluding elevations in blood pressure secondary to primary hemodynamic changes and the relatively rare disorders in which hypertension is an accompaniment of extrarenal disturbances, hypertensive cardiovascular disease is attributable to dysfunction of the kidney. In a small group of patients, the elevation in blood pressure is mediated or intensified by a circulating pressor agent secreted by the kidney and detectable in the untreated plasma of the renal venous effluent. This unidentified pressor agent differs from renin and angiotensin, neither of which plays a primary role in the pathogenesis of renal hypertension. Most cases of chronic hypertension, including essential hypertension, are attributable to the loss of a normal renal function concerned in the maintenance of the normotensive state. This fuction appears to be humoral in nature, and replacement therapy with this humoral agent affords the prospect of a rational approach to the effective therapy of essential and related forms of hypertensive cardiovascular disease.

THE ARTERIOLAR LESIONS OF GLOMERULONEPHRITIS

It has been known since the time of Gull and Sutton¹that lesions of the arterioles are present in many cases of arterial hypertension. In a previous communication²I presented the results of a study of the arteriolar lesions of essential hypertension. Under this term were included the numerous—and probably etiologically diverse— "cases of chronic hypertension which neither clinically nor anatomically can be demonstrated to have evolved from antecedent inflammatory disease of the kidneys or from urinary obstruction." It was concluded that the arteriolar lesions (arteriolosclerosis) occurring in essential hypertension result from the increased wear and tear incidental to the hypertension, being a pathologic exaggeration of similar, though slighter, changes in the arterioles which are a physiologic accompaniment of advancing years. If the view that the arteriolosclerotic lesions are the result of the hypertension is correct, it would be expected that these lesions would be found not only in essential

ANATOMIC FINDINGS IN ESSENTIAL HYPERTENSION

The concept of essential hypertension includes those cases of chronic hypertension which neither clinically nor anatomically can be demonstrated to have evolved from antecedent inflammatory disease of the kidneys or from urinary obstruction. The clinical picture of essential hypertension is, as a rule, quite distinctive, and has become widely known, in recent years, through the publications of Huchard, 1 Janeway, 2 Allbutt, 3 Volhard 4 and others, in their respective countries. As a result of these studies, it is now possible to diagnose essential hypertension with a fair degree of certainty in the large majority of cases. But we are occasionally confronted at necropsy by a secondary (i. e., postnephritic) contracted kidney, despite the fact that the clinical features of the case gave no indication that the hypertension was associated with inflammatory disease of the kidneys. Because of such rather exceptional cases, essential hypertension cannot be unequivocally defined by the absence of clinical evidence