Classification Of Hypertension Research Articles

640: Impact of insurance status on outcomes in women with hypertensive disorders in pregnancy

Hypertension in pregnancy is associated with adverse maternal and neonatal outcomes. Yet, data on the association of insurance status, classification of hypertension in pregnancy and outcomes have not been well described. We sought to compare outcomes in women with hypertensive disorders of pregnancy by private versus public insurance. This is a retrospective cohort study of subjects with a hypertensive disorder of pregnancy that delivered ≥23 weeks gestation at a single institution in Oregon (October ‘13 - May ’17). The cohort began with the 2013 American College of Obstetricians and Gynecologists Executive Summary on Hypertension in Pregnancy, which advised surveillance for severe features of disease in women with hypertension. Utilizing ICD-9 and ICD-10 discharge codes, followed by individual chart review, we abstracted data on severe features into four groups: i) chronic hypertension; ii) gestational hypertension; iii) preeclampsia (PE) without severe features and, iv) PE with severe features. We then stratified subjects into two groups by insurance status: i) Medicaid (public insurance) or ii) individual or group health insurance (private insurance). Demographic and outcome data were abstracted, with analysis by chi-square, t-test, and logistic regression. Among 8,645 deliveries, 1,188 (13.7%) were delivered with a hypertensive disorder of pregnancy. Medicaid covered 54.97% (653) of these deliveries; 43.18% (513) were covered by private insurance, and 1.85% (22) were unknown. There were a similar percentage of Medicaid patients in each hypertensive group (p=0.17). Compared to subjects with private insurance, those with Medicaid had more severe features of preeclampsia, primarily severe systolic BP ≥160 mmHg. Neonates of subjects with Medicaid had more preterm births, intensive care unit admissions and respiratory distress syndrome (Table 1). The association between Medicaid, severe features of preeclampsia and adverse neonatal outcomes persisted after multivariable adjustment (Table 2). Medicaid insurance did not associate with a particular hypertensive disorder, yet those with Medicaid experienced more severe features of preeclampsia and higher rates of adverse neonatal outcomes. More research is needed to understand potential risk factors and ways to improve outcomes for those with publicly funded insurance.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Association of Low Serum Magnesium Levels in Type 2 Diabetes Mellitus with & without Hypertension

Background: Diabetes Mellitus is a widespread metabolic abnormality that constitutes a most important physical dilemma in the world. Hypomagnesaemia accelerates the rate of diabetic complications. Objective: To analyze the association of magnesium levels in DM (Type 2 Diabetes Mellitus) with and without complication of Hypertension. Design: It was a comparative analytical study. Setting: This research was carried out in medicine department, Peoples Medical College Hospital, Nawabshah from March 2016 to February 2017. Samples: 245 patients with Type 2 DM after fulfilling the selection criteria were included, out of them 123 with hypertension and 122 without hypertension. Methods: After a short-lived consultation, all the subjects were categorized for variable analyses like age, gender, Type 2 DM with and without hypertension, duration of diabetes and presence of hypomagnesaemia. Joint National Committee (JNC 8) classification of Hypertension was applied to collect data. Blood samples were drawn for research purpose in fasting state for serum magnesium level analyses on the basis of hypertension and without hypertension. Results: In 245 diagnosed Type 2 diabetic patients, 160 were males and 85 were females. Out of them, 123 were hypertensive while 122 were non hypertensive. Normal magnesium was present in 120 (48.97%) and low magnesium was present in 125 (51.02%) patients overall. A decreased serum level of magnesium was observed in 52.04% hypertensive subjects with diabetes and 50% non-hypertensive subjects with diabetes. Conclusion: Frequency of decreased serum magnesium is widespread in T2DM with and without hypertension.

The study of the pharmacists’ competence in providing the additional services to the population

Aim. To study the competence of pharmacists when measuring blood pressure to visitors of pharmacies and substantiate the necessity for standardization of the additional service to improve the quality of service.Materials and methods. The analysis of domestic regulatory legal acts, sociological research, generalizations were used.Results. Regulatory and legal acts regarding prevention and treatment of arterial hypertension in Ukraine provides for the participation of pharmacy professionals for promotion of health knowledge among the population and identifying persons with high blood pressure. The standards of Good Pharmacy Practice specify the pharmacist’s duty to provide services in screening of patients with high-risk diseases. The questionnaire of retail pharmacists, who provide, if necessary, the additional services to consumers, has been carried out. The procedure of preparing visitors of pharmacies to blood pressure measurement and the final stage of explanation of the results and giving recommendations have been studied. The violations of the method of blood pressure measuring and the lack of knowledge of the pharmacy specialists concerning the classification of arterial hypertension by the level of blood pressure have been identified. The reasonability of placing information of the educational nature regarding measurement of blood pressure and interpretation of the results on the websites of pharmacy networks with mandatory references to official and evidence literary sources has been proven.Conclusions. The results of the survey of pharmacies regarding measurement of blood pressure for visitors have shown the lack of awareness concerning rendering the additional services in practice and explanation of the results. The necessity of standardization of the specified additional service for providing the proper level of service of the population has been determined.

New insights into the recognition, classification and management of systemic sclerosis-associated pulmonary hypertension.

Pulmonary hypertension is a common complication of systemic sclerosis (SSc), and remains a leading cause of morbidity and mortality. We will review recent developments in the recognition, classification and treatment of pulmonary hypertension in SSc. Advances in screening for pulmonary arterial hypertension (PAH) and use of exercise haemodynamics may help to identify pulmonary vascular disease earlier in SSc. Recent studies have led to changes in recommendations for adjunct therapy and selection of pulmonary vasodilators for the treatment of SSc-associated PAH. Recent advances in the diagnosis, classification and management of pulmonary hypertension in SSc have continued to improve our understanding of this challenging disease. Ongoing investigation in the pathogenesis of this disease will afford the opportunity to develop targeted therapies to improve outcomes for SSc patients with pulmonary hypertension.

Individualized prevention against hypertension based on Traditional Chinese Medicine Constitution Theory: A large community-based retrospective, STROBE-compliant study among Chinese population.

Traditional Chinese Medicine Constitution (TCMC) theory states that individuals with a biased TCMC are more likely to suffer from specific diseases. However, little is known regarding the influence of TCMC on susceptibility to hypertension. The aim of this study is to examine the possible relationship between TCMC and hypertension. Retrospective evaluation and observation were performed using the STROBE guidelines checklist. A large community-based cross-sectional study was conducted between 2009 and 2013 in Changsha, China. TCMC was assessed using a questionnaire that included 68 items. TCMC distributions and the associations of different TCMCs with hypertension risk were analyzed. In total, 144,439 subjects underwent evaluations of TCMC and blood pressure (BP). There were significant differences in the hypertension prevalence among the various TCMC groups (P < .01). An adjusted logistic regression model indicated that those with phlegm wetness, yin deficiency, blood stasis, or qi deficiency were more likely to have hypertension. Analysis of the clinical characteristics related to TCMC indicated that different TCMCs corresponded to different hypertension classifications using Western medicine criteria; for example, phlegm wetness with hypertension was similar to obesity-related hypertension. Our results suggest that phlegm wetness, yin deficiency, blood stasis, and qi deficiency have different effects on the prevalence of hypertension. More attention should be paid to TCMCs associated with susceptibility to hypertension, and corresponding preventive and therapeutic treatments should be developed according to different TCMCs.

Efficacy and safety of long-term imatinib therapy for patients with pulmonary veno-occlusive disease and pulmonary capillary hemangiomatosis.

Pulmonary veno-occlusive disease (PVOD) and pulmonary capillary hemangiomatosis (PCH) are categorized as Group 1' in the clinical classification of pulmonary hypertension. No medical therapy has been proven to be effective in patients with PVOD/PCH. Imatinib is a molecular targeted drug and was expected to be effective in patients with pulmonary arterial hypertension. We evaluated its efficacy and safety in patients with PVOD/PCH. In the present observational study, 9 patients with PVOD/PCH received imatinib. Clinical data including exercise capacity and hemodynamics at baseline and at follow-up were compared. Survival rate of patients treated with imatinib was compared to those of 7 patients who did not treated with imatinib. Imatinib was prescribed at doses of 100-400mg/day and was well-tolerated. At follow-up, World Health Organization functional class and brain natriuretic peptide levels significantly improved. Mean pulmonary arterial pressure was significantly reduced (from 56.8±8.3 to 43.7±9.0mmHg) with preserved cardiac index. Patients were treated with imatinib for 797.2±487.0 days. Seven patients (77.8%) died and 2 patients (22.2%) underwent lung transplantation. Mean survival time in patients treated with imatinib therapy was 1493.7±196.3 days (95% confidence interval, 1108.9-1878.5 days), significantly longer than those without imatinib treatment (713.0±258.1 days, log-rank test, P=0.04). Imatinib improved exercise capacity, hemodynamics and survival in patients with PVOD/PCH. In patients with PVOD/PCH, who have no effective medical therapy available, imatinib might function as a bridge to lung transplantation, and may become a potential therapeutic option to improve their survival.

Evaluación diagnóstica en hipertensión arterial pulmonar

Pulmonary arterial hypertension is a rare pathological condition of the pulmonary circulation, and is defined as the increase in pulmonary arterial pressure (PAPm) ≥ 25mm Hg with a trough of ≤ 15mm Hg and pulmonary vascular resistance (PVR) of > 3 Wood Units, determined at rest and using right-heart catheterisation. Pulmonary arterial hypertension belongs to Group 1 of the pulmonary hypertension classification, a group consisting of conditions considered as “rare”, and its diagnosis requires ruling out the presence of other causes of pulmonary hypertension. The complexity of the disease and the use of highly specialised procedures for its diagnosis makes it necessary and desirable to refer to experienced or reference centres in the management of the disease. However, there are diagnostic approaches that could be brought forward in Primary Health Care centres and thus, speed up the diagnostic process.

A study on the prevalence and awareness of hypertension among women in the reproductive age group and the factors contributing to it in a rural area of Jorhat district, Assam

Background: Hypertension has been identified as one of the major causes of morbidity and mortality in both developed and developing nations. Prevalence is seen to be increasing in the rural areas, especially among the females in the reproductive age group. The prevalence of hypertension is found to be high in Assam, while the awareness is quite low thus necessitating a study in this regard.Methods: A total of 400 women in the reproductive age group were selected from Bagchung block, Jorhat by Simple Random Sampling. They were interviewed and their blood pressure was measured along with some anthropometric variables. Classification of hypertension was done as per the US Seventh Joint National Committee (JNC 7) report on the prevention, evaluation and treatment of high BP.Results: A total of 23.5% prevalence of hypertension was found among the study subjects. 44.5% of the total was in the pre hypertensive stage. 77% of them had heard of hypertension while only 20% were aware of its side effects. Extra salt intake, family history and underlying medical conditions were the major risk factors.Conclusions: Knowledge, awareness on hypertension in women in this part of the district is poor and the prevalence is high and their life style practices are grossly contributing to it. Therefore, efforts should be geared towards improving the levels of awareness of the women regarding hypertension and the risk factors.

Invasive haemodynamic evaluation of the pulmonary circulation in pulmonary hypertension.

The term pulmonary hypertension refers to a serious condition characterised by high pulmonary vascular pressure, mainly as a consequence of various cardiac and respiratory diseases. Current clinical classification of pulmonary hypertension considers five distinct groups. Transthoracic echocardiography represents the first and most important noninvasive screening tool for estimating the probability of pulmonary hypertension. The diagnostic approach to pulmonary hypertension is supported by a proposed algorithm, which identifies the underlying cause. The definitive diagnosis and classification of pulmonary hypertension requires invasive confirmation of an elevated pulmonary artery mean pressure during a right heart catheterisation at rest. Pulmonary artery wedge pressure assessment has a pivotal role in differentiating precapillary from postcapillary pulmonary hypertension. The correct acquisition and interpretation of invasive pulmonary haemodynamic variables play a central role, not only in confirming the diagnosis but also in prognostication and treatment decision-making. During right heart catheterisation correct zero levelling of the external pressure transducer and pressure tracing readings at end-expiration should be assured. Obese patients and patients with obstructive lung diseases require special attention, given that spontaneous positive end-expiratory intrathoracic pressures are frequently observed. Because pressure and flow determinations with a fluid-filled flow-directed thermodilution catheter are potentially insufficiently precise, it is recommended to average at least three measurements. Acute vasoreactivity testing is indicated only in selected patients. Recent data suggest that invasive pulmonary haemodynamic measurement during exercise may be more sensitive than resting haemodynamics for early diagnosis, for treatment response assessment and for prognostic purposes.

Idiopathic pulmonary arterial hypertension: current approach to diagnosis and pharmacological treatment

Current aspects of diagnosis, classification and therapy of pulmonary hypertension (PH) were reviewed in the article. A new classification, including all known clinical variants of PH, and functional classification were presented. A diagnostic algorithm with routine diagnostic methods and highly sensitive innovative techniques (CT-angiography of the lungs, perfusion scintigraphy, the right heart catheterization, etc.) was shown. The author discussed prognostic factors of 1-year survival, general pathogenic mechanisms including endothelin and prostacyclin pathways and a role of nitric oxide and soluble guanylate cyclase stimulators. Assessment criteria of acute vasoreactivity test results were reviewed. Typical therapeutic approaches including calcium channel blockers, oxygen, anticoagulants and diuretics were described. Main classes of specific drugs were listed such as endothelin receptor antagonists, prostacyclins, soluble guanylate cyclase stimulators, phosphodiesterase 5 inhibitors, selective prostacyclin receptor agonists. Current investigations are directed to searching new effective and safe drugs that could improve outcomes, slow down progression of the disease and improve quality of the patient’s life.

Nadciśnienie płucne w przebiegu chorób lewego serca — aktualne leczenie i kierunki rozwoju terapii

Chronic heart failure is a disease with growing importance in modern cardiology. In spite of a significant progress the treatment results are still far from satisfactory. Pulmonary hypertension (PH) is a harbinger of poor prognosis in this group of patients increasing the risk of hospitalisation and death. Pulmonary hypertension secondary to left heart diseases is a result of diastolic and systolic dysfunction leading to increased left ventricular filling pressures. That, in turn, is followed by further unfavourable pathophysiological and functional changes in pulmonary circulation ultimately causing right ventricular failure. Diagnosis and treatment of pulmonary hypertension is not an easy task. Thankfully, the development of diagnostic methods, uniformed terminology and a new classification of pulmonary hypertension allow for faster and more precise diagnosis and qualification of patients to the appropriate clinical subgroup. Right heart catheterization is crucial for the final diagnosis and classification of pulmonary hypertension. Proper methodology of the examination and drawing appropriate conclusions from available haemodynamic and clinical data is essential for further therapeutic management. Most of targeted therapies are addressed to patients with pulmonary arterial hypertension and the administration of these drugs in PH-LHD was either not sufficiently studied in randomized trials or was proved to cause the harm. There is a distinct need for further research on basic mechanisms of PH-LHD as well as on novel therapeutic strategies that may stimulate the development of new guidelines on the treatment of this growing population of PH patients.

Automated recognition of hypertension through overnight continuous HRV monitoring

Hypertension is a common and chronic disease, caused by high blood pressure. Since hypertension often has no warning signs or symptoms, many cases remain undiagnosed. Untreated or sub-optimally controlled hypertension may lead to cardiovascular, cerebrovascular and renal morbidity and mortality, along with dysfunction of the autonomic nervous system. Therefore, it could be quite valuable to predict or provide early warnings about hypertension. Heart rate variability (HRV) analysis has emerged as the most valuable non-invasive test to assess autonomic nervous system function, and has great potential for detecting hypertension. However, HRV indicators may be subtle and present at random, resulting in two challenges: how to support continuous monitoring for hours at a time while being unobtrusive, and how to efficiently analyze the collected data to minimize data collection and user burden. In this paper, we present a machine learning-based approach for detecting hypertension, using a waist belt continuous sensing system that is worn overnight. Using 24 hypertension patients and 24 healthy controls, we demonstrate that our approach can differentiate hypertension patients from healthy controls with 93.33% accuracy. This represents a promising approach for performing hypertension classification in the field, and also we would improve its performance based on a large number of hypertensive subjects monitored by the proposed pervasive sensors.

GAGAL JANTUNG KIRI DAN HIPERTENSI PULMONAL

In patients with left heart failure, pulmonary hypertension and right ventricular dysfunction is a common condition and has important implications in the development of disease, disability and death, so it required special attention. Pulmonary hypertension is the most common form with approximately 65-80% of cases. Although today is already highly developed understanding of the pathophysiology and clinical assessment, as well as setting the hemodynamic definition and classification of pulmonary hypertension in left heart failure, but the interrelation hemodynamics in pulmonary hypertension combination of pre- and post-capillary is still very complex, and there is no evidence-based recommendations the handling of pulmonary hypertension is left heart failure. Here, we will discuss the prevalence and significance of pulmonary hypertension and cardiac dysfunction Right in patients with both heart failure with ejection fraction decreased, as well as heart failure with ejection fraction, as well as provides an overview of the pathophysiology of the complex due to the interaction of cardiopulmonary left heart failure, which can supports the evolution of the phenotype of the left ventricle into the right ventricle phenotype through the travel history of heart failure. Next, we will discuss fenoitp pulmonary hypertension by combining the clinical context, the assessment of non-invasive and invasive hemodynamic variables in a structured diagnostic assessment.

Phenomapping for the Identification of Hypertensive Patients with the Myocardial Substrate for Heart Failure with Preserved Ejection Fraction.

We sought to evaluate whether unbiased machine learning of dense phenotypic data ("phenomapping") could identify distinct hypertension subgroups that are associated with the myocardial substrate (i.e., abnormal cardiac mechanics) for heart failure with preserved ejection fraction (HFpEF). In the HyperGEN study, a population- and family-based study of hypertension, we studied 1273 hypertensive patients utilizing clinical, laboratory, and conventional echocardiographic phenotyping of the study participants. We used machine learning analysis of 47 continuous phenotypic variables to identify mutually exclusive groups constituting a novel classification of hypertension. The phenomapping analysis classified study participants into 2 distinct groups that differed markedly in clinical characteristics, cardiac structure/function, and indices of cardiac mechanics (e.g., phenogroup #2 had a decreased absolute longitudinal strain [12.8 ± 4.1 vs. 14.6 ± 3.5%] even after adjustment for traditional comorbidities [p < 0.001]). The 2 hypertension phenogroups may represent distinct subtypes that may benefit from targeted therapies for the prevention of HFpEF.

Hypertension in the Neonatal Period: An Update.

There has been a growing interest among neonatologists and paediatricians regarding identification and evaluation of hypertension in the neonatal period. Despite the emergent normative data on blood pressure values in term and preterm neonates over the last two decades, there is still controversy regarding correct definition and classification of hypertension. This article will discuss the current definitions, available normative data and etiology of neonatal hypertension. There is paucity of records in terms of efficacy of antihypertensive drugs in this specific population and management is usually experience based, causing considerable heterogeneity amongst different units. This review article will also cover the evaluation, management, outcomes and follow up of neonatal hypertension with latest advances in this field.

Современная классификация и диагностика легочной гипертензии

Современная классификация и диагностика легочной гипертензии

Surgically Curable Pulmonary Hypertension

ABSTRACT Chronic thromboembolic pulmonary hypertension is 1 of 5 classifications of pulmonary hypertension. A patient with progressive dyspnea on exertion for the past 2 years underwent diagnostic ...

Clinical classification and initial diagnosis of pulmonary hypertension: recommendations of the Cologne Consensus Conference 2016

The 2015 European Guidelines on Diagnosis and Treatment of Pulmonary Hypertension are also valid for Germany. The guidelines contain detailed information about the clinical classification and diagnosis of pulmonary hypertension, and furthermore provide novel recommendations for risk stratification and follow-up assessments. However, the practical implementation of the European Guidelines in Germany requires the consideration of several country-specific issues and already existing novel data. This requires a detailed commentary to the guidelines, and in some aspects an update already appears necessary. In June 2016, a Consensus Conference organized by the PH working groups of the German Society of Cardiology (DGK), the German Society of Respiratory Medicine (DGP) and the German Society of Pediatric Cardiology (DGPK) was held in Cologne, Germany. This conference aimed to solve practical and controversial issues surrounding the implementation of the European Guidelines in Germany. To this end, a number of working groups was initiated, one of which was specifically dedicated to the clinical classification and initial diagnosis of PH. This article summarizes the results and recommendations of this working group.

Contemporary diagnosis and management of pulmonary hypertension

Pulmonary hypertension (PH) encompasses a group of diseases associated with an elevated mean pulmonary artery pressure (mPAP) ≥25 mm Hg at rest. The symptoms of PH are non-specific, and it...

Hypertensive Disorders in Pregnancy

In pregnancy, both mother and fetus benefit from blood pressure in normal ranges. There is discrepancy in the normenclature and thresholds for classification of hypertension in pregnancy and for initiation of antihypertensive treatment in different international guidelines. Systolic and diastolic blood pressure values that are associated with normal outcome are notably lower than any recommended treatment threshold in pregnancy. Tight blood pressure control under 85 mmHg diastolic is save and significantly prevents severe maternal hypertension as could be demonstrated in CHIPS. Close blood pressure monitoring comprising modern methods and devices including telemonitoring allows early recognition of risk developments and optimal guidance of antihypertensive therapy starting early in pregnancy. Only a few pharmacological substances are suitable for antihypertensive treatment in pregnancy.