Known History Of Hypertension Research Articles

Renal artery embolization in a case of renal cell carcinoma with intractable hematuria with acute myocardial infarction

Introduction: Renal artery embolization is a valuable treatment option for various renal tumors, both malignant and benign. The indications for this procedure include preoperative arterial embolization of large and vascular renal cell carcinoma to reduce intraoperative hemorrhagic complications, management of malignant renal tumors in patients who are not suitable candidates for surgery, treatment of symptomatic hematuria and palliative care for metastatic renal cancer. Case Report: In this case report, we present the case of a 56-year-old female with a known history of hypertension and cerebrovascular accident, who presented with complaints of hematuria and urinary retention. A diagnosis of left renal mass suggestive of renal cell carcinoma was made. The patient was planned for left radical nephrectomy and advised to discontinue aspirin for a week. However, on the morning of surgery, she experienced acute myocardial infarction and had to be hospitalized in intensive cardiac care. Aspirin was restarted, leading to recurrent severe hematuria. The patient underwent renal artery embolization, which successfully controlled the hematuria. Following cardiac stabilization, radical nephrectomy was performed three months later. The surgery and post-operative period were uneventful. Conclusion: This case study demonstrates the use of renal artery embolization as an effective modality for controlling hematuria, and temporizing management in a case of renal cell carcinoma where surgery was not immediately feasible due to a medical emergency.

Optical coherence tomography angiography value for detection of early retinal microvascular changes in systemic hypertension

Purpose The aim of this study was to assess the macula and optic disc vessel density (VD) and perfusion and the anatomical alterations at the fovea and optic nerve in chronic treated hypertension (HTN) patients who exhibited no signs of hypertensive retinopathy using optical coherence tomography angiography (OCTA). Patients and methods This is a prospective case–control study that included 37 participants. They were subdivided into two groups: the hypertensive group that included 22 patients (mean age=51.9±5.9 years), with no clinically evident signs of hypertensive retinopathy, and the control group that included 15 individuals (mean age=48.8±3.7 years) with no known history of HTN or other chronic systemic diseases. OCTA scans covering a 6.0×6.0 mm area for the macula and a 4.5×4.5 mm region for the optic nerve head were performed to evaluate the VD, the foveal avascular zone area, macular thickness, and retinal nerve fiber layer (RNFL) thickness. The correlation of the VD measurements with the RNFL thickness was evaluated. Results The hypertensive patients exhibited a significantly lower overall mean macular VD (45.8±6.0) compared to the control group (48.5±2.9, P=0.017). In addition, they exhibited a significantly lower superficial VD in the superior hemifield (46.4±5.3 and 48.6±2.9, respectively, P=0.030). On the other hand, the deep vascular density in the superior hemifield showed no significant difference between the two groups. In addition, the hypertensive patients were found to have a significantly lower average RNFL thickness (103.2±17.8 μm) compared to the control group (117.1±14.1 μm, P=0.001), with specific statistically significant reductions in the superior (P=0.002) and inferior (P=0.004) sectors. Although the central ganglion cell-inner plexiform layer thickness did not reach statistically significant difference between the two groups (HTN: 50.7±12.0 μm vs. control: 55.7±8.8 μm, P=0.055), the hypertensive group exhibited statistically significant reductions in the ganglion cell-inner plexiform layer thickness in the superior (P<0.001), inferior (P=0.002), nasal (P=0.003), and temporal (P=0.001) sectors compared to the controls. There was no statistically significant difference in the size of the foveal avascular zone between the two groups. Conclusion OCTA revealed subclinical alterations in the retinal microvasculature parameters among the hypertensive patients without clinical signs of hypertensive retinopathy, in comparison to normotensive individuals.

Family History of Hypertension and Echocardiographic Left Ventricular Hypertrophy in Hypertensive Nigerians.

Studies on the relationship between a family history of hypertension and left ventricular hypertrophy are sparse. We evaluated this relationship in patients with essential hypertension. A total of 1668 patients with essential hypertension were consecutively enrolled in the prospective Federal Medical Centre Abuja Hypertension Registry. First-degree family history was defined by the presence of a known history of hypertension in any or both parents, siblings, and children. Echocardiographic left ventricular hypertrophy was diagnosed using the criteria of the American Society of Echocardiography and the European Association of Cardiovascular Imaging. The prevalence of a family history of hypertension, echocardiographic, and electrocardiographic left ventricular hypertrophy were 61.7%, 46.8%, and 30.8%, respectively. After multivariable adjustment, paternal history of hypertension [OR: 1.56, CI: 1.20-2.05, p=0.001] was associated with an increased risk of echocardiographic left ventricular hypertrophy, while maternal history of hypertension [OR: 0.72, CI 0.58-0.91, p=0.006] was associated with a reduced risk. Age ≥50 years (p=0.026), duration of hypertension ≥1 year (p=0.047), and heart failure (p < 0.001) were associated with an increased risk of left ventricular hypertrophy, while male sex (p < 0.001) was associated with a reduced risk. Our study showed that a paternal history of hypertension is associated with an increased left ventricular hypertrophy risk among patients with essential hypertension, while maternal history is protective.

Inguinal Arteriovenous Malformation

Arteriovenous malformations (AVMs) are rare disorders, with inguinal region involvement being particularly uncommon, as they typically manifest in the neck, limbs, trunk, and intracranial or extracranial sites. Despite their varied presentation across organs and tissues, AVMs can lead to cardiac failures due to high output, necessitating management even in asymptomatic cases. We present the case of a 37-year-old male with a known history of hypertension and severe depressive disorder, referred to the urology department for bilateral renal calculi evaluation. The patient complained of sudden-onset, moderate-intensity left-sided flank pain, with no signs of infection or constitutional symptoms. A non-contrast CT scan revealed bilateral renal calculi and an intriguing mass in the scroto-inguinal region. Further investigation through contrast-enhanced computed tomography identified an AVM originating from the right internal iliac artery, located a few millimeters next to the scrotum. A multidisciplinary team, including interventional radiology, urology, and vascular surgery, collaborated to develop a curative strategy. Angioembolization was performed successfully in a single session, involving catheterization and ligation of the feeder vessel using a lipiodol-glue mixture. Postoperatively, the patient remained stable with mild pyrexia (99°F), a heart rate of 76 bpm, and blood pressure fluctuating between 110-125 mmHg systolic and 72-80 mmHg diastolic. The absence of glue leakage upon saline injection confirmed the effectiveness of embolization. The patient experienced relief from pain and was mobilized on the second postoperative day. This case underscores the importance of a comprehensive approach in managing rare presentations of AVMs, emphasizing successful angioembolization as a viable therapeutic option

Abstract P227: Resistant Hypertension In Young Patient- A Case Of Conn’S Syndrome

Abstract: Resistant hypertension (HTN) is defined as elevated blood pressure (BP) while being on three different antihypertensive medications at maximum recommended doses which include diuretics or BP that requires four different antihypertensives. One of the secondary causes of resistant HTN is Conn's Syndrome (CS). CS is mainly due to excessive secretions of aldosterone (aldo), Aldo is a mineralocorticoid hormone that maintains sodium and potassium homeostasis. Excessive secretion can result in hypernatremia and hypokalemia. This is a case of a young patient who presented with resistant hypertension and low potassium. Case: A 47-year-old African American with a known history of HTN presented with a seizure-like episode due to elevated BP and low potassium (K) of 2.6 with a creatinine of 2.2 (baseline creatinine 1.2). He was non-compliant with BP medication hydrochlorothiazide. During hospitalization, BP remained elevated with low K even with K supplementation. BP regimen was broadened to amlodipine, carvedilol, hydralazine, losartan, and spironolactone. Further evaluation showed elevated plasma aldo and low renin with a ratio &gt;30. CT abdomen with contrast confirmed a right adrenal gland adenoma measuring 1.8 cm x 2.0 cm. Ultimately, the patient underwent robot-assisted right adrenalectomy, and adrenal vein sampling (AVS) confirmed CS. The right AVS showed an aldo level &gt;3000 ng/dl and the left adrenal aldo level was 37.6 ng/dl. After successful surgery, BP medicines were cut down to spironolactone. A few months later, BP improved, and all medications were discontinued. Discussion: Aldosterone poses proinflammatory, prothrombotic, and profibrotic changes that in the long-term cause end-organ damage. For these reasons, diagnosing hyperaldosteronism early in young patients is crucial to avoid further complications. Adrenalectomy is a treatment of choice in most cases, many patients could also benefit from pharmacotherapy, especially with newer medications that are not anti-androgenic and nonsteroidal like finerenone. Hyperaldosteronism can be simply diagnosed by checking serum morning aldo level and renin level. Therefore, screening for hyperaldosteronism should be done frequently in young patients with resistant HTN.

#3505 DIAGNOSING HYPERTENSION IN HEMODIALYSIS PATIENTS USING HOME VERSUS ROUTINE PERIDIALYTIC BP MEASUREMENTS

Abstract Background and Aims Although routine blood pressure (BP) measurements taken shortly before or after dialysis provide imprecise reflection of interdialytic ambulatory BP, this method continues to form the basis for the diagnosis of hypertension among patients on hemodialysis. Home BP monitoring (HBPM) is a guideline-recommended technique that may improve the diagnosis of hypertension in this population. Using 44-hour ambulatory BP monitoring (ABPM) as the reference-standard method, this study aimed to compare the diagnostic performance of home versus routine pre- and postdialysis BP recordings in hemodialysis patients. Method In 70 stable patients with end-stage kidney disease receiving thrice-weekly hemodialysis, BP was assessed with the following methods: (i) routine predialysis and postdialysis BP measurements averaged over 2 weeks; (ii) HBPM for 7 days (dublicate morning and evening measurements, Microlife WatchBP Home N); (iii) ABPM (20 min intervals over an entire interdialytic interval - 44 hours, Microlife WatchBPO3). Results The mean age of the patients was 65.3±13.3 years; 45 patients (64%) were males, and 62 (88.7%) had a known history of hypertension. The mean [95% confidence interval (CI)] of the difference between ambulatory systolic BP (SBP) and (i) predialysis SBP was 11.43 (8.24, 14.62) mmHg, (ii) postdialysis SBP was 3.9 (0.37, 7.56) mmHg, and (iii) home SBP was 8.61 (6.05, 11.17). The area under the receiver operating characteristic curve for the detection of an ambulatory daytime SBP ≥135 mmHg was significantly higher for home SBP measurements 0.934 (95% CI: 0.871-0.996) as compared to predialysis 0.778 (95% CI: 0.643-0.913) and postdialysis 0.766 (95% CI: 0.623-0.909) BP recordings (P = 0.02 for both comparisons). 1-week averaged home SBP at the cut-off point of 141.0 mmHg provided the best combination of high sensitivity (85.7%) and high specificity (92.9%) in diagnosing systolic ambulatory hypertension. Conclusion The present study shows that among patients on hemodialysis, HBPM for 1 week provides greater accuracy than 2-week averaged routine pre- and postdialysis BP recordings in the diagnosis of hypertension confirmed by the reference-standard method of interdialytic ABPM.

P104: Using Bicarbonate based purge solution (BBPS) as the sole anticoagulant in Impella 5.5-A novel approach

The Impella® (Abiomed; Danvers, MA) pumps are percutaneous, transvalvular mechanical circulatory support (MCS) devices that propel blood from left ventricle to aorta that are used to augment cardiac output in management of high-risk percutaneous coronary intervention (HRPCI), acute heart failure, or cardiogenic shock. These systems utilize a flow of purge fluid that runs countercurrent to the blood flow which prevents inline thrombosis and protein deposition. Guidelines generally recommend heparin-dextrose purge fluid, with BBPS reserved for patients with heparin intolerance or active bleeding. We present the first case of use of BBPS as an elective choice for purge fluid in a patient with severe cardiogenic shock. Patient is 56-year-old male with known history of hypertension, diabetes and hyperlipidemia who presented with acute onset shortness of breath secondary to acute heart failure in the setting of myocardial infarction. He underwent a HRPCI for a non revascularizable three vessel coronary artery disease. He was readmitted for cardiogenic shock complicated with ventricular tachycardia, fibrillation and high risk of sudden cardiac death, necessitating inpatient transplant evaluation. Left heart catheterization showed pulmonary artery pressure of 59/63, wedge of 29 and cardiac index of 2 on 0.125mcg/kg/hr of milrinone. He received aggressive diuresis, antiarrhythmics and inotropic support. With increasing milrinone requirement, Impella 5.5 was placed and his antiplatelet regimen was changed from oral prasugrel to intravenous cangrelor with aspirin. A clinical decision was made to use BBPS instead of heparin purge, based on institutional experience and clinical data. Purge pressure, flow, lactate dehydrogenase and hematocrit have remained stable about 1.5ml/hr, 500mm Hg, 230U/L and 30% respectively for 22 days post-impella placement as the patient awaits transplantation Limited retrospective studies and recent animal data from ABIOMED, have shown no change in purge pressure or flow with BBPS. However, most of the data remains limited to use in heparin intolerant patients. Our experience has indicated the possibility to use BBPS without systemic anticoagulation with no short-term complication.

HOME BP MONITORING IMPROVES THE DIAGNOSIS OF HYPERTENSION IN HEMODIALYSIS PATIENTS

Objective: Although routine blood pressure (BP) measurements taken shortly before or after dialysis provide imprecise reflection of interdialytic ambulatory BP, this method continues to form the basis for the diagnosis of hypertension among patients on hemodialysis. Home BP monitoring (HBPM) is a guideline-recommended technique that may improve the diagnosis of hypertension in this population. Using 44-hour ambulatory BP monitoring (ABPM) as the reference-standard method, this study aimed to compare the diagnostic performance of home versus routine pre- and postdialysis BP recordings in hemodialysis patients. Design and method: In 70 stable patients with end-stage kidney disease receiving thrice-weekly hemodialysis, BP was assessed with the following methods: (i) routine predialysis and postdialysis BP measurements averaged over 2 weeks; (ii) HBPM for 7 days (dublicate morning and evening measurements, Microlife WatchBP Home N); (iii) ABPM (20 min intervals over an entire interdialytic interval - 44 hours, Microlife WatchBPO3). Results: The mean age of the patients was 65.3±13.3 years; 45 patients (64%) were males, and 62 (88.7%) had a known history of hypertension. The mean [95% confidence interval (CI)] of the difference between ambulatory systolic BP (SBP) and (i) predialysis SBP was 11.43 (8.24, 14.62) mmHg, (ii) postdialysis SBP was 3.9 (0.37, 7.56) mmHg, and (iii) home SBP was 8.61 (6.05, 11.17). The area under the receiver operating characteristic curve for the detection of an ambulatory daytime SBP equal or higher than 135 mmHg was significantly higher for home SBP measurements 0.934 (95% CI: 0.871-0.996) as compared to predialysis 0.778 (95% CI: 0.643-0.913) and postdialysis 0.766 (95% CI: 0.623-0.909) BP recordings (P = 0.02 for both comparisons). 1-week averaged home SBP at the cut-off point of 141.0 mmHg provided the best combination of high sensitivity (85.7%) and high specificity (92.9%) in diagnosing systolic ambulatory hypertension. Conclusions: The present study shows that among patients on hemodialysis, HBPM for 1 week provides greater accuracy than 2-week averaged routine pre- and postdialysis BP recordings in the diagnosis of hypertension confirmed by the reference-standard method of interdialytic ABPM.

Study of the Efficacy of Ischemia Reversal Program along with Restricted Diet in an Elderly Myocardial Ischemic Patient with a Known History of Hypertension - A Case Study

The biggest global cause of morbidity and mortality, according to the World Health Organization, are cardiovascular diseases (CVDs). Consequently, there is a need for new therapeutic modalities that will complement current CVD care tools. To evaluate the effectiveness of the Ischemia Reversal Program along with a restricted diet in an elderly myocardial ischemic patient with other comorbidities like Hypertension (HTN) and Hypokinesia. 60-year-old male had a myocardial ischemia episode in April 2020 and received standard allopathic medical care. The patient had a history of HTN. This patient opted for Ischemia Reversal Program (IRP) and dietary modification with Ayurveda-based medicines as an add-on complementary treatment to accelerate the healing process. The patient had elevated HTN (SBP/DBP: 123/74) according to the ambulatory blood pressure monitoring (ABMP) report which was reduced post-intervention (SBP/DBP: 109/66). The patient also showed hypokinetic anterior wall LV according to the 2D ECHO report while the post-intervention 2D ECHO report showed no regional wall motion abnormality. Findings of our study suggest that IRP which includes Ayurveda-based Panchakarma therapy along with dietary modifications can serve as treatment for patients with myocardial ischemia and other comorbidities like HTN, and hypokinesia.

49. The Differences of Clinical Characteristics between Coronary Artery Disease Patients with and without Hypertension

Background: Hypertension may appear concomitantly and share the same pathophysiology with other comorbidities of coronary artery disease (CAD), which may indicate a relation between the two. This study aims to compare the differences between CAD patients with and without hypertension. Methods: This retrospective study includes subjects from the CAD registry in Dr. Hasan Sadikin General Hospital Bandung, from March-September 2022. Hypertension was defined as blood pressure $140/90 mmHg, known history of hypertension, or routinely consumed hypertension medication. Salt intake, history of smoking, low physical activity, body mass index (BMI), heart failure (HF), stroke, type-2 diabetes mellitus (T2DM), chronic kidney disease (CKD), obstructive sleep apnea (OSA), dyslipidemia, and chronic obstructive pulmonary disease (COPD) were compared between CAD patients with and without hypertension. Results: From 173 subjects included in this study, 124 (71.7%) subjects had hypertension, consist of 66.7% of male population and 93.8% of female population. The mean age in CAD patients with hypertension were higher than without hypertension (59.8 ± 8.3 vs 56.4 ± 8.8 years). There was no significant difference (p-value &gt;0.05) regarding salt intake, history of smoking, low physical activity, BMI, diabetes, CKD, OSA, dyslipidemia, and COPD. Significant difference was found with age, female, HF, and stroke (p-value &lt; 0.05). Multivariate analysis showed that hypertension was only independently associated with age [OR 1.04 (1–1.08, p-value 0.045)], female [OR 6.97 (1.57–30.86 p-value 0.01)], and HF [OR 3.5 (1.01–12.82, p-value 0.048)]. Conclusion: CAD patients with hypertension was higher in female, older population, and those who have heart failure compared to CAD patients without hypertension.

Cataract Prevalence and Its Associated Factors among Adult People Aged 40 Years and above in South Ari District, Southern Ethiopia

Background. Cataract is the leading cause of blindness in Ethiopia. However, the treatment was only surgery; the expected person could not use the surgical service. So far, the World Health Organization’s goal of 2,000 people using the treatment out of a million people could not be met. Objective. The aim of this study was to assess the prevalence of cataract and factors associated with among adult people aged 40 years and above in South Ari district of South Omo Zone, Ethiopia. Method. A community-based cross sectional study was conducted in South Ari district of South Omo Zone, Ethiopia; samples were selected using simple random sampling and eye examination. Data were collected using pretested structured questionnaires. Data quality was ensured by daily supervision completeness and consistency. The data were coded, entered, and cleaned by using Epi.info version 7 and were analyzed by using SPSS version 20. Bivariate and multivariable analysis was carried by binary logistic regression. Significances were declared by using a p value of &lt;0.05 and AOR of confidence intervals. Result. In this study, the prevalence of cataract was found to be 7.8% (95% CI: 5.0–10.6). There is an increased chance of developing cataract among females (AOR 3.52; 95% CI: 1.39–8.83), individuals with known history of hypertension (AOR 4.5; 95% CI 1.56–13.21), adults aged 70–79 years (AOR 5.07 95% CI: 1.09–23.62), and adults aged 80 years and above (AOR 6.01; 95% CI: 1.29–27.92). Conclusions. Cataract prevalence was found to be high among the study participants. Age, sex, and known history of hypertension were factors associated with cataract.

ECG QUIZ

Our patient was a 61-year-old lady who had a known history of hypertension, diabetes mellitus, old cerebral infarcts and epilepsy. In February 2000 she was admitted to Princess Margaret Hospital after a fall which resulted in fracture neck of femur. In ward she was witnessed to suffer from cardiac arrest. External electrical defibrillation with 200 Joules successfully resumed her vital signs.

Renal infarction mimicking cholecystitis: a case report of a patient presenting with stroke

Objective: Renal infarction which is a rare phenomenon can be missed on the patient’s work up making its incidence low. Case Presentation: We report a 68-year-old lady with known history of hypertension presented with epigastric pain and vomiting for 4 days. During her stay in the emergency room, she developed sudden onset of left-sided weakness. Electrocardiogram was normal sinus rhythm. Computed tomography scan of the abdomen showed acute pancreatitis with partial impingement of superior mesenteric vein. Conclusion: Imaging s showed cholelithiasis without evidence of cholecystitis and lower pole right renal infarct likely secondary to obstruction of the right lower renal artery due to calcified plaques at their origin from the aorta. Subsequently, the patient was kept on antiplatelets and planned for discharge uneventfully.

FREQUENCY OF SEVERELY ELEVATED BLOOD PRESSURE ON ADMISSION IN KNOWN HYPERTENSIVE PATIENTS PRESENTING WITH ACUTE HAEMORRHAGIC STROKE

Objectives: To determine the frequency of severely elevated blood pressure on admission in known hypertensive patients presenting with acute hemorrhagic stroke. Methodology: This cross-sectional Study conducted at Neurology Department, Lady Reading Hospital, Peshawar, the duration of study is 6 months from 2/12/2020 to 2/5/2021. In the present study a total of 90 patients 20 to 70 years old patients of either sex with a known history of hypertension (HTN) who present with acute hemorrhagic stroke were included in the study. The blood pressure of these patients was measured at the time of admission. The weight of the patient in kilograms was measured with the help of a digital electronic scale and height was measured with the help of a stadio-meter. Results: In the present study mean age was 53 years with standard deviation (SD) ± 10.02. Sixty two percent patients were male and 38% patients were female. Mean body mass index (BMI) was 26 kg/m2 with SD ± 3.31. Mean duration of hypertension was 3 years with SD ± 3.14. Eighty eight percent patients had use of antihypertensive medications while 12% patients’ did not had use of antihypertensive medications. Eighty percent patients had compliance with antihypertensive medications while 20% patients didn’t had compliance with antihypertensive medications. More over 18% patients had extremely raised blood pressure while 82% patients’ didn’t had very high blood pressure. Conclusion: Our study concludes that the frequency of severely elevated blood pressure was 18% on admission in known hypertensive patients presenting with acute hemorrhagic stroke.

Prevalence of Hypertension and Related Characteristics: Perspectives from an Outpatient Podiatric Medical Clinic.

Hypertension is a highly prevalent condition in the general population, conferring a high risk of significant morbidity and mortality. Associated with the condition are many well-characterized controllable and noncontrollable risk factors. This study aimed to identify the prevalence of hypertension in the outpatient podiatric medical clinic setting and to determine the relevance of hypertension risk factors in this setting. A survey tool was created to characterize relevant risk factors, and systolic and diastolic blood pressures were recorded. Descriptive statistics were generated after conclusion of enrollment. Analysis was also performed to determine the relationship between individual risk factors and systolic blood pressure. Of the 176 patients, 56 (31.8%) had an incidentally high blood pressure at intake, including 18.5% of patients without a known history of hypertension and 38.5% with a known history of hypertension. Three risk factors were found to be significantly associated with increasing systolic blood pressure: weight (P = .022), stress level (P = .017), and presence of renal artery stenosis (P = .021). There was also a near-statistically significant inverse relationship between systolic blood pressure and amount of time spent exercising (P = .068). Overall, a relatively high prevalence of incidental hypertension was identified, including among patients not previously diagnosed as having hypertension. Consideration of risk factors and awareness of the prevalence of the condition can be useful for practitioners, even as they manage presenting podiatric medical concerns. Future investigations may consider interventional or preventive strategies in the outpatient clinic setting.

Burden of hypertension in Ghana - Analysis of awareness and screening campaign in the Ashanti Region of Ghana.

ObjectivesHypertension is a major risk factor for cardiovascular mortality globally and in Ghana. May Measurement Month (MMM) is a global awareness and screening campaign initiated by the International Society of Hypertension.MethodsParticipants were recruited by opportunist sampling in the Ashanti region of Ghana. The blood pressures of participants were measured three times and the mean of the last two readings was used for the analysis. Simple and multiple logistic regression was used to determine the predictors of hypertension.ResultsThe MMM 2018 awareness and screening campaign enrolled 5054 participants with a mean age of 39.4 ± 14.7 years. There were 2553 (50.6%) males, 987 (20.1%) of respondents had never checked their blood pressure and 676 (13.9%) had a prior history of hypertension. The prevalence of hypertension was 37.4%. We found that 589(66.8%) of 822 respondents with high blood pressure did not have a history of hypertension. Respondents with a known history of hypertension on medication were 442 (65.9%) and 219(68.0%) of 322 respondents on medication had uncontrolled hypertension. The predictors of high blood pressure in a multiple logistic regression were increasing age (OR = 1.05 CI 1.05–1.06, p < 0.001), history of alcohol intake (OR = 1.33 CI 1.04 −1.70, p = 0.02), overweight (OR = 1.4 CI 1.14–1.76, p = 0.001) and obesity (OR = 1.32, CI 1.01–1.74, p = 0.047).ConclusionThere is a high prevalence of hypertension in the Ashanti region in Ghana. Most participants with hypertension were not aware and the majority of those with hypertension on medications were uncontrolled. This calls for more education and screening of hypertension to decrease cardiovascular mortality.

Adverse Perinatal Outcomes Associated with Stage 1 Hypertension in Pregnancy: A Retrospective Cohort Study.

To determine if women who newly met criteria for stage 1 hypertension in early pregnancy were at increased risk for adverse perinatal outcomes compared with normotensive women. We conducted a retrospective cohort study of women who had prenatal care at a single institution and subsequently delivered a live infant between December 2017 and August 2019. Women with a singleton gestation who had at least two prenatal visits prior to 20 weeks of gestation were included. We excluded women with known chronic hypertension or other major maternal illness. Two groups were identified: (1) women newly diagnosed with stage 1 hypertension before 20 weeks of gestation (blood pressure [BP]: 130-139/80-89 on at least two occasions) and (2) women with no known history of hypertension and normal BP (<130/80 mm Hg) before 20 weeks of gestation. The primary outcome was any hypertensive disorder of pregnancy; secondary outcomes were indicated preterm birth and small for gestational age. Generalized linear models were used to compare risk of adverse outcomes between the groups. Of the 1,630 women included in the analysis, 1,443 women were normotensive prior to 20 weeks of gestation and 187 women (11.5%) identified with stage 1 hypertension. Women with stage 1 hypertension were at significantly increased risk for any hypertensive disorder of pregnancy (adjusted risk ratio [aRR]: 1.86, 95% confidence interval [CI]: 1.12-3.04) and indicated preterm birth (aRR: 1.83, 95% CI: 1.12-3.02). Black women and obese women with stage 1 hypertension were at increased for hypertensive disorder of pregnancy compared with white women and nonobese women, respectively (aRR: 1.32, 95% CI: 1.11-1.57; aRR: 1.69, 95% CI: 1.39-2.06). These results provide insight about the prevalence of stage 1 hypertension and inform future guidelines for diagnosis and management of hypertension in pregnancy. Future research is needed to assess potential interventions to mitigate risk. · Stage 1 hypertension increased risk for hypertensive disorders of pregnancy and indicated preterm birth.. · Among women with stage 1 hypertension, risk of severe preeclampsia was 2.6 times higher than normotensive women.. · Black and obese women with stage 1 hypertension were at additional risk for adverse outcomes..

A Challenging Case of Atypical Hemolytic Uremic Syndrome in a Young African American Patient

BackgroundIt is known that malignant hypertension (mHTN) and thrombotic microangiopathy (TMA) commonly coexist. Deciding which phenomenon preceded the other remains a clinical dilemma, specifically in African American patients. However, making that determination is of utmost importance because the management will be different, and that can have dramatic effects on prognosis and outcomes. Herein, we report a case of atypical hemolytic uremic syndrome (aHUS) presenting as mHTN.Case PresentationA 35-year-old African American male with known history of hypertension, presented with nausea, vomiting, and diarrhea for four days. He also reported fatigue and exertional shortness of breath. Upon presentation, his blood pressure was 260/160 mmHg, otherwise physical exam was unremarkable. Initial work up showed hemoglobin of 8.8 g/dL (baseline 13.5), platelet count of 21,000/mL (baseline 250,000), serum creatinine of 16.99 mg/dL (baseline 0.99), MCV (84 fl), increased reticulocyte production index (3.58), increased LDH (1709 U/L), undetectable haptoglobin, and numerous schistocytes on peripheral blood smear. He was admitted as a case of hypertensive emergency and TMA. IV labetalol and hemodialysis were started. Given his gastrointestinal symptoms; stool for Shigella and E.Coli O157:H7 were checked and they were negative.Given the severity of his hematologic derangements and difficult to control blood pressure, we decided to proceed with renal biopsy to rule out primary aHUS which showed thrombotic microangiopathy, global glomerulosclerosis, moderate interstitial fibrosis and tubular atrophy suggestive of aHUS or rheumatologic disorders like systemic sclerosis and arguing against malignant HTN as the sole player. ANA and anti-Scl-70 antibodies were negative. Final impression was aHUS by exclusion, and patient received meningococcal vaccines (Menactra and Bexsero) in preparation to start eculizumab. aHUS genetic panel was sent which came back equivocal as it showed mutations of unknown significance (homozygous missense mutation in the MASP2 gene and 2 heterozygous mutations in the C2 gene).He was started on eculizumab 900 mg weekly for 4 weeks then 1200 mg biweekly starting week 5. He was seen in the office 2 months after initial presentation and receiving 5 doses of Eculizumab. His kidney function showed improvement with > 2 liters of urine output daily, blood pressure was better controlled. A decision by nephrology was made to give him a break from dialysis and remains dialysis-free a year later.DiscussionaHUS is a rare disorder with an estimated prevalence of seven per one million children in Europe. It causes uninhibited activation of complement factors that leads to renal endothelial damage and activation of coagulation cascade leading to TMA. The diagnosis of aHUS requires the fulfillment of the classical triad (microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure) with a positive gene mutation or antibodies to complement factors. However, absence of these mutations or antibodies, as in the presented case, do not exclude the diagnosis. The early diagnosis of aHUS is necessary for treatment with eculizumab, a monoclonal antibody against C5 to block the terminal complement cascade. Kidney biopsy can be helpful in equivocal cases especially if it shows only the typical changes of malignant hypertension which essentially rules out aHUS. Hypertension with concurrent TMA is treated with strict BP control which is often enough to resolve TMA features and restores renal function, at least partially. On the contrary, aHUS causing severe HTN needs more sophisticated testing and blockade of the terminal complement component to improve outcome; that's why the distinction of which one is the primary process is of utmost importance. Our case emphasizes the importance of having low threshold for testing for aHUS in patients with mHTN and TMA, especially in African American patients where malignant HTN is known to happen more commonly, and to notice the subtle hints that may help in this distinction, such as profound hemolysis or thrombocytopenia out of proportion to what one would expect from mHTN alone. Early recognition of aHUS may save a patient's kidney. DisclosuresNo relevant conflicts of interest to declare.

A case of hematuria and vomiting in the emergency room: Never forget the emphysematous pyelonephritis

We describe the case of a 68-year-old man with a known history of hypertension and diabetes mellitus presented to our Emergency Department, complaining of hematuria and vomiting in the last 12 hours, stypsis and urinary incontinence in the last week, and worsening hyporexia in the last 6 months. Bedside ultrasound documented a slight right pleural effusion with B lines in the middle and basal right field, gastrectasis, dilated fluid-filled bowel loops, potential signs of gas in the upper right quadrant, grade 3 bilateral hydronephrosis, and bladder globe. Abdominal CT scan confirmed the bilateral hydroureteronephrosis and showed the right kidney with Emphysematous Pyelonephritis (EPN) with extension into the perinephric and muscular planes for 24 cm, and initial EPN in the left kidney. A RT-PCR nasopharyngeal swab for SARS CoV-2 was negative. A diagnosis of ileum paretic, acute renal failure and urosepsis due to EPN was made.

Transurethral resection of bladder tumor surgery conducted using epidural anesthesia and obturator nerve block in an elderly multimorbid male

Epidural Anesthesia (EA) is mainly used for perioperative and postoperative analgesia, usually combined with Spinal Anesthesia (SA) or General Anesthesia (GA). It is safe, easy to perform, and has multiple applications. The benefits of Regional Anesthesia (RA) over general anesthesia include superior analgesia, reduced opioid consumption, reduced pulmonary complications, improved gastrointestinal function, early mobilization, a reduced need for thrombo-prophylaxis, early discharge, and higher patient satisfaction. Anesthesia for urological surgeries has unique problems due to patient factors and procedure complexity. An 84-year older man with a known history of hypertension/ Coronary Artery Disease (CAD)/ complete Left Bundle Branch Block (LBBB)/ dilated cardiomyopathy/ glottic carcinoma/ mixed airway disease, with an ejection fraction of 30%, was scheduled to undergo Transurethral Resection of Bladder Tissue (TURBT) for carcinoma bladder mass. It was done under EA and an ipsilateral obturator nerve block.