High Blood Pressure Episodes Research Articles

PHEOCHROMOCYTOMA AS A RARE CAUSE OF MYOCARDIAL INFARCTION

Objective: A 41-year-old man was admitted to the cardiac care unit with acute chest pain radiating to his left arm. For the previous 20 years, he had episodes of high blood pressure accompanied by shivering, sweating, anxiety, and headaches. Electrocardiography revealed ST elevation in the II, III, and aVF leads, as well as reciprocal ST depression in the I and aVL leads. Echocardiography showed hypokinesis of the mid inferior and basal inferior segments. Troponin level increased from 0.005 to 0.177 ng/ml. Aneurysms in the coronary arteries were discovered during an urgent coronary angiography. The patient was prescribed aspirin, angiotensin-converting enzyme inhibitor, and calcium channel blocker and discharged from the hospital. Design and method: Further testing included computed tomography (CT) of the aorta and coronary arteries. The aorta had no pathological findings, but the right coronary artery was dilated in the middle segment. A CT scan of the abdomen revealed a mass in the left adrenal gland, and later abdominal and retroperitoneal magnetic resonance imaging revealed a lipid-poor left adrenal mass. Biomarkers of adrenal gland function were evaluated and blood adrenalin (150 pg/ml normal range ‹125pg/ml) and noradrenalin (680pg/ml normal range ‹600pg/ml) levels were mildly elevated. The 24-hour urinary vanillylmandelic acid level was elevated (76,6umol vs. the normal range of 68umol). Cortisol and aldosterone levels in the blood were within normal ranges. Lateral transperitoneal adrenalectomy was eventually performed successfully. Results: Histological examination of the mass revealed a pheochromocytoma. The patient's blood pressure returned to normal after the left adrenalectomy, and episodes of sweating and anxiety accompanied by an acute increase in blood pressure disappeared. Conclusions: Pheochromocytoma is a rare neuroendocrine tumor that can cause life-threatening cardiovascular complications such as myocardial infarction and cardiac arrhythmias. Unfortunately, the clinical pattern of pheochromocytoma frequently remains without typical manifestations and needs detailed laboratory and radiological confirmation. This case emphasizes the importance of a comprehensive assessment of the patient with arterial hypertension, even in the presence of subclinical sympathetic overactivity.

Oil-producing enterprise

Arterial hypertension is an urgent health problem worldwide causing an increase in temporary and permanent disability, invalidity and mortality due to cardiovascular diseases. Researchers recognize the multifactorial nature of arterial hypertension, but environmental factors are of particular potential importance. The working conditions at oil production enterprises are characterized by a more pronounced influence of these factors which may predispose for early development of disadaptation disorders, functional changes in immune and humoral regulation, and, finally, for increased risk of cardiovascular diseases in people engaged in oil production. The aim of the present work was to study the features of immunity and humoral risk factors of arterial hypertension in hypertensive employees at an oil-producing enterprise. To this purpose, a comparative analysis of lymphocyte subpopulations (CD3+CD4+, CD3+CD25+), markers of apoptosis (CD3+CD95+, TNFR, p53, Bax, Annexin V-FITC+7AAD), phagocytic activity of leukocytes (absolute phagocytosis index), and the levels of vascular humoral factors (nitric oxide and homocysteine) was performed in employees of an oil production enterprise exposed to adverse production factors. The observational group consisted of employees with established episodes of increased blood pressure. A comparison group consisted of individuals without clinical manifestations of cardiovascular disease. As a result of the clinical and laboratory examination of employees at the oil-producing enterprise with arterial hypertension, some functional changes in immune regulation were revealed. This group was characterized by a significantly (p 0.05) decreased CD3+CD4+, and CD3+CD25+ lymphocyte contents, along with increased levels of regulatory CD127 lymphocytes against the comparison group (p 0.05). The workers at an oil production enterprise with arterial hypertension are characterized by decreased (p 0.05) phagocytic activity of peripheral blood leukocytes using the criteria of absolute phagocytosis. We found some signs of inhibited lymphocyte apoptosis (p 0.05), i.e., a decrease in CD95+, TNFR, and p53 over the background values, as well as increased Bax levels over the comparison group (p 0.05). However, the content of TNFR and p53 significantly (p 0.05) exceeded the reference level, regardless of previous arterial hypertension episodes. Development of the high blood pressure episodes among the employees at oi-producing plant showed a significant association (p 0.05) with elevated levels of homocysteine and nitric oxide concentrations which are known to induce endothelial dysfunction, atherogenesis and, hence, a persistent increase in blood pressure.

PATIENTS WITH PARAFUNCTIONAL HABITS: ASSESSMENT OF THE PSYCHOLOGICAL STATUS AND ITS REPERCUSSIONS BEFORE ORAL AND MAXILLOFACIAL SURGERIES

Introduction: Parafunctional habits are behaviors that are not part of the functional and physiological needs of the components of the stomatognathic system and can be indicative of stress, anxiety and/or depression. They can generate complications during and after oral and maxillofacial surgeries. Objective: To estimate the prevalence of parafunctional habits and psychological status in patients undergoing oral and maxillofacial surgeries, their associated factors and their interference with the course of the dental procedure. Material and Method: The study is a field research, characterized by being observational, with a cohort design, with a quali-quantitative approach. A stratified probability sampling was carried out in patients from the CEO of surgery at Asces-Unita and the Clínica Ortoestetica de Toritama, to verify if there are factors in public and private care that may interfere during and after oral and maxillofacial surgeries.The research instruments were questionnaires based on the Beck Depression. Inventory-BDI, the Beck Anxiety Inventory-BAI, the LIPP Stress Symptoms Inventory. Results and Discussion: 116 patients were interviewed, among which 88 (75.86%) are from the Surgery CEO of the Centro Universitário Tabosa de Almeida-ASCES UNITA and 28 (24.13%) are from the Orthoesthetic Clinic of Toritama/PE. Of those interviewed, 64 (55.17%) patients had some parafunctional habit, 61 (52.58%) patients had some psychological disorder and 68 (58.62%) patients had some surgical complication. Factors such as stress, anxiety and depression can impair the surgical process as well as the patient’s recovery, generating a greater probability of episodes of high blood pressure, more intense bleeding in surgeries and a reduction of immune resistance, as well as leading to disorders psychosomatic. Conclusion: Thus, after crossing the variables, it was confirmed that there is a relationship between surgical complications with parafunctional habits and psychological disorders.

Autonomic Dysreflexia following Spinal Cord Injury.

Autonomic dysreflexia (AD) is a potentially life-threatening condition of the autonomic nervous system following spinal cord injury at or above T6. One of the most common symptoms is a sudden increase in blood pressure induced by afferent sensory stimulation owing to unmodulated reflex sympathetic hyperactivity. Such episodes of high blood pressure might be associated with a high risk of cerebral or retinal hemorrhage, seizures, heart failure, or pulmonary edema. In-depth knowledge is, therefore, crucial for the proper management of the AD, especially for spine surgeons, who encounter these patients quite often in their clinical practice. Systematical review of the literature dealing with strategies to prevent and manage this challenging condition was done by two independent reviewers. Studies that failed to assess primary (prevention, treatment strategies and management) and secondary outcomes (clinical symptomatology, presentation) were excluded. A bibliographical search revealed 85 eligible studies that provide a variety of preventive and treatment measures for the subjects affected by AD. As these measures are predominantly based on noncontrolled trials, long-term prospectively controlled multicenter studies are warranted to validate these preventive and therapeutic proposals.

Determinants of preeclampsia and eclampsia among women delivering in county hospitals in Nairobi, Kenya

Background: Preeclampsia is defined as the onset of a new episode of high blood pressure in a woman usually after 20 weeks gestation plus proteinuria, whereas eclampsia is defined as generalized seizures in a pregnant woman who generally has preeclampsia criteria. Preeclampsia and eclampsia are hypertensive disorders of pregnancy and thus, among the top causes of maternal death worldwide. The objective of this study was to investigate risk factors for preeclampsia/eclampsia. Methods: This was a hospital-based unmatched case-control study carried out among women of reproductive age (15-49 years) who have given birth at Nairobi County Hospitals and admitted to the postnatal ward July-September 2019 with a sample size of 352 participants (88 cases and 264 controls). All cases were selected, while controls were simple random sampled, as per eligibility criteria. Information or data were gathered using a structured interviewer-administered questionnaire and data abstraction tool. Descriptive analysis was carried out, where, categorical variables were presented in percentages or proportions, whereas; continuous variables were presented in means, standard deviations, and range. This was followed by a bivariable mixed-effect logistic regression analysis and a multivariable mixed-effect logistic regression analysis using the significant variables from bivariable analysis. Results: Of all the 88 cases enrolled in the study 5 (5.68%) had eclampsia and 83 (94.32%) had preeclampsia. There was a significant association between personal history of hypertension (AOR=7.1; 95% CI: 2.6-19.3, p=0.001), Occupation as a housewife (AOR=3.1; 95% CI: 1.1-8.8, p=0.034), nulliparity (AOR=7.5; 95% CI: 1.5-37.5, p=0.015) , primiparity (AOR=2.1; 95% CI: 1.1-4.2, p=0.031), advanced maternal age 35-49 years (AOR=5.9; 95% CI: 1.1-33.3, p=0.042), and the occurrence of preeclampsia/eclampsia. Conclusions: The following conclusions were made regarding the study findings: Personal history of hypertension, older/advanced maternal age (35-49 years), occupation, and parity were factors significantly associated with preeclampsia/eclampsia.

Zinc deficiency induces hypertension by promoting renal Na+ reabsorption.

Zn2+ deficiency (ZnD) is a common comorbidity of many chronic diseases. In these settings, ZnD exacerbates hypertension. Whether ZnD alone is sufficient to alter blood pressure (BP) is unknown. To explore the role of Zn2+ in BP regulation, adult mice were fed a Zn2+-adequate (ZnA) or a Zn2+-deficient (ZnD) diet. A subset of ZnD mice were either returned to the ZnA diet or treated with hydrochlorothiazide (HCTZ), a Na+-Cl- cotransporter (NCC) inhibitor. To reduce intracellular Zn2+ in vitro, mouse distal convoluted tubule cells were cultured in N,N,N',N'-tetrakis(2-pyridylmethyl)ethylenediamine (TPEN, a Zn2+ chelator)- or vehicle (DMSO)-containing medium. To replete intracellular Zn2+, TPEN-exposed cells were then cultured in Zn2+-supplemented medium. ZnD promoted a biphasic BP response, characterized by episodes of high BP. BP increases were accompanied by reduced renal Na+ excretion and NCC upregulation. These effects were reversed in Zn2+-replete mice. Likewise, HCTZ stimulated natriuresis and reversed BP increases. In vitro, Zn2+ depletion increased NCC expression. Furthermore, TPEN promoted NCC surface localization and Na+ uptake activity. Zn2+ repletion reversed TPEN effects on NCC. These data indicate that 1) Zn2+ contributes to BP regulation via modulation of renal Na+ transport, 2) renal NCC mediates ZnD-induced hypertension, and 3) NCC is a Zn2+-regulated transporter that is upregulated with ZnD. This study links dysregulated renal Na+ handling to ZnD-induced hypertension. Furthermore, NCC is identified as a novel mechanism by which Zn2+ regulates BP. Understanding the mechanisms of ZnD-induced BP dysregulation may have an important therapeutic impact on hypertension.

Abstract P350: Early Signs of Stress Induced Arterial Hypertension During Cardiopulmonary Testing and Advantages in Cardiac Risk Lowering

Goal: to study early signs and hypertension reaction features during cardiopulmonary exercise testing (CPET) in intellectually working men with rare episodes of stress induced blood pressure (BP) increase. Methods: 47 patients (pats) with periodic episodes of high BP due to high level of stress were included (all men, 42 ± 4.6 years old). Risk factors: smoking had 83% of pats, high cholesterol level 87%, glucose intolerance 39%, family history of high BP 14%. All pats had normal BMI and no signs of visceral fat and target organ damage, 54% used hypotensive therapy non-systemically, 98% complained for sleep disorders. CPET was done for optimal training regime appointment. Baseline BP was 134± 2,8 mm Hg. Most of the pats demonstrated low physical tolerance level (6,7±0.4 MET). All patients demonstrated hypertensive reaction during test, and that was the reason for test stop. 68% of pats demonstrated systolic BP 220 mm Hg at respiratory compensation point (RCP) and RER 1,17 ± 0.01, 32% of pats demonstrated it earlier than RCP and at RER 0.85± 0.06. All pats got recommendations with optimal physical and pulse regime for training. All the patients had 3 ± 1 moderate intensive aerobic training per week for 34 ± 10.7 min. Results: in 6 months all the patients demonstrated increase in physical tolerance (ΔVO2 5,3 ±1,3 ml/kg/min). Patients with hypertension reaction at RCP showed significantly lower baseline BP (124.6± 3.5mm Hg vs 131.2 ± 4.1 mm Hg in other patients, p <0.05), only 14% demonstrated hypertensive reaction during CPET vs 89% in other patients, p <0.05 and mentioned less hypertension episodes during 6 months (7 ± 3 episodes vs 24 ± 2, p <0.05). 96% pats of this group demonstrated higher level of physical tolerance (load 9,8 ± 0.3 MET vs 7.6± 1.1 MET, p <0,05). Also, they didn't show abnormalities in glucose intolerance test. Conclusion: hypertension reaction at RCP during CPET in intellectually working man with episodic stress induced increase of blood pressure can be a predictor of great benefit in life style modification, cardiac risk lowering and arterial hypertension control

FORMULATION AND EVALUATION OF TASTE MASKED FAST DISSOLVING TABLET OF PRAZOSIN HYDROCHLORIDE

The objective of this study was to control the elevated blood pressure in the patient with sudden episode of high blood pressure having markedly reduced function ability and restlessness. In such a case rapid onset of action is required. Prazosin Hydrochloride is drug with short biological half life. The purpose of study is to mask the bitter taste of drug and provide rapid onset of action. Inclusion complex of drug and I²-Cyclodextrin can prepare by kneading method to mask the bitter taste of drug. 32 full factorial design was implemented, direct compression method were used to prepare tablet. F2 batch among all other batches showed disintegration time 55 sec with 98.56%drug release within 5min. thus it can be concluded the fast dissolving tablet can be formulated for antihypertensive drug. Keyword: Prazosin Hydrochloride, I²-Cyclodextrin, Kneading method, Inclusion Complex, Antihypertensive, Drug Release.

Study of heat shock protein gene 70 (HSP70) expression and its polymorphous marker (+ 1267A> G) in women under exposure to a long-term stress.

There was studied the HSP70 gene and its polymorphic marker + 1267A> G (rs754888705) in the HSP70 gene expression in32 women under long-term stress, which was caused by inpatient treatment of their oncologic child. A control group included 25 women without long-term stress factors. There was studied a correlation between the expression level of the HSP70 gene in women and their high blood pressure (BP) episodes. The average duration of stress in the group of children's mothers was 7.3 (2.5-11.5) months. Anxiety level according to HADS in the main group was significantly increased and amounted to 8.7 (7-10) points, in the control group 5 (2-7) points. Depression level in the main group was significantly higher and amounted to 7.7 (7-9) points, in the control group 3.3 (1-5) points. Comparison of the HSP70 gene expression level in blood of young women of the main study group with expression level of this gene in the control group showed a statistically significant predominance of HSP70 gene expression in the main group. The episodes of high BP in women who were under stress conditions did not influence the expression level of the HSP70 gene. Analysis of the alleles of the polymorphic marker frequency in the gene HSP70-2 1267A> G (rs754888705) in the main and control groups showed a statistically significant predominance of allele A in the group of mothers under stress, and predominance of the allele G in the control group. Comparative analysis of the polymorphic marker genotype frequencies in the gene HSP70-2 1267A> G (rs754888705) showed that the AA genotype is significantly more frequent in mothers with episodes of BP increase compared to women without it. An increased level of the HSP70 gene expression in peripheral blood leukocytes in mothers with a life-threatening disease of their child indicates the damaging effect of long-lasting psychoemotional stress at the cellular level and activation of the protective reaction mediated by HSP70. Studying of the genotype AA characteristics of the polymorphic marker A1267G (rs754888705) of the HSP70-2 gene in women under long-lasting stress will let us evaluate the role of genetic factors in hypertensive reactions development.

Clonidine versus Captopril for Severe Postpartum Hypertension: A Randomized Controlled Trial.

BackgroundChanges during the puerperium are still unclear, particularly in women with hypertension. The choice of antihypertensives, both to control very high blood pressure episodes and to keep blood pressure stable, also requires further elucidation. Currently, there are no clear data to guide the decision for the choice of postpartum antihypertensives. Captopril plays an important role in the treatment of very high blood pressure episodes and may be used postpartum. Clonidine has been used as an alternative in pregnant or postpartum women with contraindications to captopril, with satisfactory effect. The objective of the present study was to evaluate the effectiveness and safety of clonidine compared to captopril for treating severe postpartum hypertension.Methods and findingsA randomized, drug-controlled, triple-blind clinical trial evaluating postpartum women receiving captopril or clonidine. Inclusion criteria consisted of: women with hypertensive disorders of pregnancy systolic blood pressure (SBP) ≥180 mmHg and/or diastolic blood pressure (DBP) ≥110 mmHg], requiring magnesium sulfate. Exclusion criteria were: heart disease, smoking, illicit drug use, contraindications to captopril, clonidine or oral medication, and having used captopril/clonidine previously. The primary outcome was the frequency of very high blood pressure episodes while in the obstetric intensive care unit. A total of 90 postpartum women met the study inclusion criteria, with 45 randomized to each group. There were fewer very high blood pressure episodes during hospitalization (2.1 ± 2.1 vs. 3.5 ± 4.7, p = 0.08), greater percentage reduction in SBP (14.0% ± 8.6% vs. 10.8% ± 8.8%, p = 0.08) and fewer women requiring sodium nitroprusside (2.3% vs. 13.3%; RR: 0.17; 95%CI: 0.02–1.39; p = 0.06) in the clonidine group compared to the captopril group; however, these differences were not significant. The groups were similar regarding daily mean SBP or DBP; however, on the third postpartum day, mean SBP was lower in the clonidine compared to the captopril group (151.9 ± 11.8 mmHg vs. 158.1 ± 13.6 mmHg, p = 0.02). Although not statistically significant, adverse reactions were more common in the captopril group (28.8%) compared to the clonidine group (18.6%).ConclusionClonidine and captopril represent safe, effective treatments for severe postpartum hypertension.Trial registrationclinicaltrials.gov: www.clinicaltrial.gov, NCT01761916.

Awareness and management of elevated blood pressure among human immunodeficiency virus–infected adults receiving antiretroviral therapy in urban Zambia: a call to action

ABSTRACT The prevalence of high blood pressure (HBP) and hypertension (HTN), awareness of the diagnoses, and use of anti-hypertensive drugs were examined among human immunodeficiency virus (HIV)-infected individuals on antiretroviral therapy (ART) in Zambia’s capital Lusaka. Within a prospective cohort based at two public sector ART clinics, BP was measured at ART initiation and every 6 months thereafter as a routine clinic procedure. Predictors of HBP (systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg) during one year on ART were analyzed using logistic regression, and the proportion with HTN (2+ episodes of HBP >3 months apart) described. A phone survey was used to understand patient awareness of HBP, use of anti-hypertensive drugs, and history of cardiovascular events (CVE; myocardial infarction or stroke). Among 896 cohort participants, 887 (99.0%) had at least one BP measurement, 98 (10.9%) had HBP, and 57 (6.4%) had HTN. Increasing age (10-year increase in age: adjusted odds ratio [AOR] = 1.50; 95% confidence interval [CI] 1.20–1.93), male sex (AOR = 2.33, 95% CI 1.43–3.80), and overweight/obesity (AOR = 4.07; 95% CI 1.94–8.53) were associated with HBP. Among 66 patients with HBP, 35 (53.0%) reported awareness of the condition, and nine (25.7%) of these reported having had a CVE. Only 14 (21.2%) of those reached reported ever taking an anti-hypertensive drug, and one (1.5%) was currently on treatment. These data suggest that major improvements are needed in the management of HBP among HIV-infected individuals in settings such as Zambia.

Diuretics vs. placebo for postpartum blood pressure control in preeclampsia (DIUPRE): a randomized clinical trial.

BackgroundHypertension affects about 10 % of pregnancies and is responsible for both maternal and neonatal devastating complications such as eclampsia, HELLP syndrome, prematurity and maternal and neonatal death. The resolution of the disease occurs in the first twelve weeks postpartum. The behavior of blood pressure and occurrence of very high blood pressure episodes among women with severe preeclampsia is related to remodeling of the dynamics of body fluids with consequent increase in intravascular volume. The persistence of hypertension in critical levels results in increased puerperal morbidity.ObjectivesTo evaluate the effectiveness of furosemide in accelerating blood pressure recovery among women with severe preeclampsia.Methods/designA triple-masked placebo controlled clinical trial, will be conducted including 120 postpartum women with severe preeclampsia, after eclampsia prophylaxis with magnesium sulfate and with adequate diuresis. Women with chronic hypertension and users of diuretics will be deleted. Informed consent will be obtained from all participants. Patients will be randomized to receive furosemide (40 mg orally every twenty four hours) or placebo. The variables are systolic and diastolic blood pressure, frequency of hypertensive crises, need for maintenance of antihypertensive therapy, number of antihypertensive agents used to control blood pressure, urine output, length of hospital stay, adverse effects and maternal complications. This study was approved by the Research Ethics Committee in humans of our institution. All participants will be duly informed about the aims of the project and will be included only if they agree to participate voluntarily, signing the informed consent.Trial registrationThis study was registered on Clinical Trials.gov under the number NCT02163655. (http://clinicaltrials.gov/show/NCT02163655).

Clonidine Compared With Captopril for Severe Postpartum Hypertension [114

INTRODUCTION: The choice of antihypertensives, both to control very high blood pressure episodes and to keep blood pressure stable, in postpartum women is controversial and requires further elucidation. OBJECTIVE: To evaluate the effectiveness and safety of clonidine compared with captopril for treating severe postpartum hypertension. METHODS: A randomized, drug-controlled, triple-blind clinical trial evaluating 90 postpartum women receiving 25 mg oral captopril or 0.1 mg clonidine for treatment of severe postpartum hypertension. Student's t test, Pearson χ2 test, and Fisher's exact test were used in the statistical analysis. Repeated-measures analysis was performed. All P values were two-tailed and significance level was established at 5%. RESULTS: There were fewer very high blood pressure episodes during hospitalization, greater percentage reduction in systolic blood pressure, and fewer women requiring sodium nitroprusside in the clonidine group compared with the captopril group; however, these differences were not significant. The groups were similar regarding daily mean systolic blood pressure or diastolic blood pressure; however, on the third postpartum day, mean systolic blood pressure was lower in the clonidine compared with the captopril group. Although not statistically significant, adverse reactions were more common in the captopril group (28.8%) compared with the clonidine group (18.6%). CONCLUSION: Both clonidine and captopril represent safe, effective treatments for severe postpartum hypertension. We consider that antihypertensive treatment with clonidine may constitute a good alternative for avoiding postpartum very high blood pressure episodes with certain advantages such as a shorter hospital stay and lower treatment costs. In addition, clonidine can be used in women with acute renal injury for whom captopril is contraindicated.

57-OR

Objectives To evaluate the effectiveness and safety of clonidine compared to captopril for treating severe postpartum hypertension. Methods A randomized, drug-controlled, triple-blind clinical trial evaluating 90 postpartum women receiving captopril or clonidine. Inclusion criteria consisted of: women with hypertensive disorders of pregnancy [systolic blood pressure (SBP) equal or above 180 mmHg and/or diastolic blood pressure (DBP) equal or above 110 mmHg], requiring magnesium sulfate. Exclusion criteria were: heart disease, smoking, illicit drug use, contraindications to captopril, clonidine or oral medication, and having used captopril/clonidine previously. Student’s t-test, the Pearson chi-square test and Fisher’s exact test were used in the statistical analysis. Repeated measures analysis was performed, and sphericity assumed. All p-values were two-tailed and significance level was established at 5%. Results There were fewer very high blood pressure episodes during hospitalization (2.1 ± 2.1 vs. 3.5 ± 4.7, p = 0.08), greater percentage reduction in SBP (14.0 ± 8.6% vs. 10.8 ± 8.8%, p = 0.08) and fewer women requiring sodium nitroprusside (2.3% vs. 13.3%; RR: 0.17; 95%CI: 0.02–1.39; p = 0.06) in the clonidine group compared to the captopril group; however, these differences were not significant. The groups were similar regarding daily mean SBP or DBP; however, on the third postpartum day, mean SBP was lower in the clonidine compared to the captopril group (151.9 ± 11.8 mmHg vs. 158.1 ± 13.6 mmHg, p = 0.02). Although not statistically significant, adverse reactions were more common in the captopril group (28.8%) compared to the clonidine group (18.6%). Conclusions Clonidine and captopril represent safe, effective treatments for severe postpartum hypertension. Disclosures L. Katz: None. C. Noronha Neto: None. S. Maia: None. I. Coutinho: None. A.S. Souza: None. M.M. Amorim: None.

Index of Suspicion

An 18-year-old girl presents with nighttime fevers to 39°C for 8 days. She complains also of headache, myalgia, and rash during the fevers. Eighteen days ago, she removed a tick from her neck after attending a festival in the northeastern United States. One week ago, she presented to her pediatrician with a sore throat and rash. She was hyponatremic (sodium, 129 mEq/dL) and was started on doxycycline for presumed Rocky Mountain spotted fever (RMSF). Her condition has not improved. She admits to multiple unprotected sexual encounters and cocaine abuse. The girl appears weak. Her vital signs include temperature of 38.7°C; heart rate, 84 beats per minute; respiratory rate, 20 breaths per minute; and blood pressure, 113/73 mm Hg. A salmon-colored macular rash is present on her trunk and proximal extremities. She also exhibits dermatographia. There are no mucosal lesions. The liver is enlarged to 2.5 cm beyond the rib margin, and she has right upper quadrant tenderness. Her muscles are tender to deep palpation in all four extremities. She is able to bear weight but refuses to ambulate due to bilateral lower extremity myalgia and arthralgia. A CBC demonstrates a normochromic, normocytic anemia, and leukocytosis with a left shift. ESR and CRP are elevated at 109 mm/hour and 19.8 mg/dL, respectively. A mild transaminitis is present. Ultrasonography reveals a mildly enlarged and echogenic liver. Small pleural and pelvic effusions are present on CT scan. A bone marrow biopsy and a glycosylated ferritin fraction are obtained. A clinical diagnosis is made. An 11-year old Hispanic boy who had poststreptococcal reactive arthritis (PSRA) and rheumatic fever (RF) diagnosed at age 6 years has been symptom-free while taking oral penicillin (PCN). Two months ago, he developed lemon-sized, reddish, painful subcutaneous nodules that were warm to touch on both lower extremities and revealed acute …

Severe intellectual disability, omphalocele, hypospadia and high blood pressure associated to a deletion at 2q22.1q22.3: case report

BackgroundRecently, array-comparative genomic hybridization (aCGH) platforms have significantly improved the resolution of chromosomal analysis allowing the identification of genomic copy number gains and losses smaller than 5 Mb. Here we report on a young man with unexplained severe mental retardation, autism spectrum disorder, congenital malformations comprising hypospadia and omphalocele, and episodes of high blood pressure. An ~ 6 Mb interstitial deletion that includes the causative genes is identified by oligonucleotide-based aCGH.ResultsOur index case exhibited a de novo chromosomal abnormality at 2q22 [del(2)(q22.1q22.3)dn] which was not visible at the 550 haploid band level. The deleted region includes eight genes: HNMT, SPOPL, NXPH2, LOC64702, LRP1B, KYNU, ARHGAP15 and GTDC1.DiscussionaCGH revealed an ~ 6 Mb deletion in 2q22.1 to 2q22.3 in an as-yet unique clinical case associated with intellectual disability, congenital malformations and autism spectrum disorder. Interestingly, the deletion is co-localized with a fragile site (FRA2K), which could be involved in the formation of this chromosomal aberration. Further studies are needed to determine if deletions of 2q22.1 to 2q22.3 define a new microdeletion syndrome.

Central Serous Chorioretinopathy as a Presenting Symptom of Endogenous Cushing Syndrome: A Case Report

To report a case of Cushing syndrome due to adrenocortical adenoma revealed by central serous chorioretinopathy. A 45-year-old man presented with blurred vision and metamorphopsia in the left eye. He reported few episodes of high blood pressure in the last 3 months. Visual acuity was 20/40 in the left eye. Fundus oculi examination revealed central serous chorioretinopathy in the left eye. Grade 1 hypertension was found. Increased serum and urinary levels of cortisol and reduced serum levels of ACTH were observed. Diagnosis of Cushing syndrome was made. Computed tomography scan revealed a right adrenal mass that was surgically removed; histologic examination showed an adrenocortical adenoma. Three months after surgical treatment, visual acuity improved to 20/20 and central serous chorioretinopathy completely resolved. Central serous chorioretinopathy may be the presenting symptom of Cushing syndrome in a patient with adrenocortical adenoma.

S18.3 Adaptations of the vasculature following spinal cord injury

In rats, spinal cord injury (SCI) produces a marked increase in the strength of neurovascular transmission in arterial vessels located bellow the level of the lesion [1]. Data from humans with SCI indicates that this change is also present and that it contributes to generating episodes of high blood pressure (autonomic dysreflexia) triggered by bladder distension and other sensory stimuli [2]. In humans, it is suggested that the decrease in ongoing sympathetic nerve activity following SCI produces an increase in vascular smooth muscle sensitivity to noradrenaline (NA) and that this change accounts for the augmentation of neurovascular transmission. This suggestion is based on animal experiments where short-term (up to 2 weeks) interruption of sympathetic nerve activity or denervation results in vascular smooth muscle becoming ‘supersensitive’ to NA. However, we have recently demonstrated that this change is transient and is not present in arteries where sympathetic nerve traffic has been interrupted for 7–8 weeks. These findings accord with our demonstration that SCI-induced augmentation of neurovascular transmission in rats cannot be explained by an increased reactivity of the vascular smooth muscle to NA [1].

Recurrent posterior reversible encephalopathy syndrome in mitochondrial disorder

Objectives. Recurrent posterior reversible encephalopathy syndrome (PRES) has not been reported in association with multi-system mitochondrial disorder (MID). Case report. In a 60-year-old HIV-negative, Caucasian female with short stature, double vision, struma, memory impairment, chronic renal failure requiring hemodialysis, seizures, intermittent atrial fibrillation, arterial hypertension, hyperlipidemia, anemia, hypacusis, tinnitus, and a daughter with multiple sclerosis, short stature and hypothyroidism; another daughter with schizophrenia, and a son who died from encephalopathy at age 3 months, an MID was suspected. At age 53 years, she experienced sudden, transient blindness for 2 days bilaterally during an episode of high blood pressure with complete recovery within 2 weeks. At age 60 years, a similar episode occurred. Four weeks later, she experienced a third PRES episode with high blood pressure, seizures, impaired consciousness and reversible blindness for 2 days. MRI at the second episode was indicative of a PRES, and MRI at the third episode additionally revealed occipital bleedings, acute embolic stroke and features indicating PRES. Conclusions. This case indicates that MID may be associated with recurrent PRES, triggered by recurrent episodes of high blood pressure. Whether high blood pressure was a manifestation of the MID or related to other causes remains speculative. PRES does not seem to be a primary but is rather a secondary manifestation of an MID.

Mechanisms of blood pressure variability-induced cardiac hypertrophy and dysfunction in mice with impaired baroreflex

Enhanced blood pressure variability contributes to left ventricular hypertrophy and end-organ damage, even in the absence of hypertension. We hypothesized that the greater number of high-blood pressure episodes associated with enhanced blood pressure variability causes cardiac hypertrophy and dysfunction by activation of mechanosensitive and autocrine pathways. Normotensive mice were subjected to sinoaortic baroreceptor denervation (SAD) or sham surgery. Twelve weeks later, blood pressure variability was doubled in SAD compared with sham-operated mice. Blood pressure did not differ. Cardiac hypertrophy was reflected in greater heart/body weight ratios, larger myocyte cross-sectional areas, and greater left ventricular collagen deposition. Furthermore, left ventricular atrial and brain natriuretic peptide mRNA expression was greater in SAD than in sham-operated mice. SAD had higher left ventricular end-diastolic pressures and lower myocardial contractility indexes, indicating cardiac dysfunction. Cardiac protein content of phosphorylated p125 focal adhesion kinase (p125 FAK) and phosphorylated p38 mitogen-activated protein kinase (p38 MAPK) was greater in SAD than in sham-operated mice, indicating activation of mechanosensitive pathways of cardiac hypertrophy. Furthermore, enhanced cardiac renin and transforming growth factor-beta1 (TGFbeta1) protein content indicates activation of autocrine pathways of cardiac hypertrophy. Adrenal tyrosine hydroxylase protein content and the number of renin-positive glomeruli were not different, suggesting that sympathetic activation and the systemic renin-angiotensin system did not contribute to cardiac hypertrophy. In conclusion, more frequent blood pressure rises in subjects with high blood pressure variability activate mechanosensitive and autocrine pathways leading to cardiac hypertrophy and dysfunction even in the absence of hypertension.