Long-standing Essential Hypertension Research Articles

Correlation of renal volume on ultrasound with renal function tests in hypertensives in University of Benin Teaching Hospital

Background: Long-standing essential hypertension can initiate changes in renal size and alteration in renal function which can be assessed using ultrasound and biochemical tests, respectively. Ultrasound is a noninvasive and affordable investigative modality that is readily available. Patients and Methods: One hundred and fifty patients consisting of 54 (36%) males and 96 (64%) females with essential hypertension attending cardiology outpatient clinic were recruited and investigated after obtaining an informed consent. Renal volume was calculated from ultrasound measurement of renal dimensions. Blood sample was assessed for serum creatinine and estimated glomerular filtration rate calculated using the Cockcroft and Gault (CG) and modification of diet in renal disease (MDRD) formulae. Data analysis was performed using Statistical package for Social Sciences version 17.0. Results: The mean renal volume was 115.7 ± 29.2 cm3 on the right and 132.4 ± 40.2 cm3 on the left. The mean renal volumes for males were 126.1 ± 27.9 cm3 and 141.1 ± 40.6 cm3 while values for female patients were 109.9 ± 28.2 cm3 and 127.5 ± 9.4 cm3 on the right and left, respectively. Differences in renal sizes on both sides were not statistically significant, P = 0.120 and 0.063. Values were significantly higher in male patients compared to the female patients, for both sides (P = 0.001 and 0.046 on the right and left, respectively). Mean serum creatinine was 0.9 ± 0.03 mg/dl. Conclusion: Male hypertensive patients had significant higher renal volume values than females. However, renal volume did not correlate with duration of hypertension for all the patients. There was no correlation between renal volume and renal function using CG and MDRD formula.

30-Year-Old Man With Outside-of-Hospital Cardiac Arrest

30-Year-Old Man With Outside-of-Hospital Cardiac Arrest

Should renal color Doppler ultrasonography be a routine test in newly diagnosed hypertensive patient?

: European Society of Hypertension/European Society of Cardiology guidelines recommend calculation of estimated glomerular filtration rate and evaluation of urinary albumin excretion rate as routine tests in the initial evaluation and during the follow-up of all hypertensive patients. However, from a clinical point of view, renal ultrasound - a noninvasive, readily available and cheap imaging modality - could contribute to the better evaluation of a hypertensive patient by identifying common causes of secondary hypertension (HTN) originating from the kidney and more recently by detecting renal injury in severe or long-standing essential HTN by measuring renal resistive indexes. The purpose of this review is to summarize the actual evidence which could support a larger use of renal ultrasound in the work-up of patients with newly diagnosed HTN.

Renal Resistive Index and Urinary N-acetyl-?-glucosaminidase as Predictors of Early Renal Involvement in Patients WithEssential Hypertension

Background: The long-standing essential hypertension causes renal injury. N-acetyl-beta -glucosaminidase (NAG) was considered as an indicator of the functional status of the renal tubules. The resistive index (RI), measured at the level of the interlobar arteries, is thought to reflect downstream vascular impedence and therefore, has been suggested as a measure of renal arterial stiffness. The aim of this study was to investigate whether changes in renal function assessed by urinary N-acet yl-beta-gl ucosaminidase (NAG) and proteinurea are present in hypertensive patients with normal serum creatinine and the association of these changes with renal vascular resistance assessed by ultrasound Doppler. Methods: The study enrolled 78 patients with essential hypertension and 57 age- and sex-matched normotensive subjects. BMI, creatinine, creatinine clearance, uric acid, lipid profile, total proteins, NAG and creatinine in urine were assessed. RI was evaluated by ultrasound Doppler of the interlobar arteries. Results : Hypertensive patients had significantly higher urinary excreted NAG, total urinary proteins and RI than controls. RI was significantly correlated with age, systolic blood pressure, hypertension duration, total proteins, total cholesterol, excreted NAG and creatinine clearance. In multivariate analysis RI was significantly and independently influenced by NAG and creatinine clearance. Conclusion: Early glomerular and tubular dysfunctions precede the overt changes in serum creatinine and glomerular filtration rate in hypertensive patients. Resistive index is increased along with these abnormalities. So, it should be regarded as a marker of early renal and systemic vascular damage and could help identify hypertensive patients for whom more aggressive preventive and therapeutic measures are advisable. doi:10.4021/wjnu2w

Lercanidipine-associated nocturia

Sir, A 64-year-old man had longstanding essential hypertension without target organ damage and mild benign prostatic hypertrophy treated with alfuzocin 2.5 mg qd and associated with nocturia once a night. He was otherwise healthy and blood pressure was well controlled (125/80 mmHg) by long-term treatment with enalapril (20 mg bid), losartan 50 mg/hydrochlorothiazide 12.5 mg qd, metoprolol 200 mg qd (morning) and amlodipine 10 mg qd (evening). Significant bilateral pitting ankle edema (+2) developed after several months, and no other cause than amlodipine could be found. There were no signs …

Renal Sympathetic-Nerve Ablation for Uncontrolled Hypertension

To the Editor: The renal sympathetic nerves have been identified as a major contributor to the complex pathophysiology of hypertension in both experimental models and in humans.1 Patients with essential hypertension generally have increased efferent sympathetic drive to the kidneys, as evidenced by elevated rates of renal norepinephrine spillover, defined as the amount of transmitter that escapes neuronal uptake and local metabolism and thus “spills over” into the circulation. Hypertension is also characterized by an increased rate of sympathetic-nerve firing, possibly modulated by afferent signaling from renal sensory nerves.2–4 A 59-year-old male patient with long-standing essential hypertension that was . . .

An 88-Year-Old Woman Facing the End of Life

Dr DALEY: Mrs J is an 88-year-old widow who has had multiple recent episodes of congestive heart failure [CHF] requiring hospitalization. She lives alone in an assisted living center for senior citizens in a suburb of Boston, Mass. She has 1 daughter, Mrs V, who is very involved in her care. She has Medicare insurance and a supplemental Medigap insurance policy. Mrs J has long-standing essential hypertension, coronary artery disease with stable angina pectoris, aortic stenosis, and an elevated alkaline phosphatase suggestive of Paget disease of the bone. She has chronic CHF, paroxysmal atrial fibrillation, 2 to 3 episodes of angina per week relieved by nitroglycerin, and recurrent episodes of flash pulmonary edema, necessitating 4 hospital admissions in the previous 10 months. Within the past year, Mrs J refused needle biopsy for evaluation of a multinodular goiter. Functionally, she needs assistance only with bathing, but notes fatigue and some shortness

SYMPATHETIC ACTIVITY AND PRESYNAPTIC ADRENOCEPTOR FUNCTION IN PATIENTS WITH LONGSTANDING ESSENTIAL HYPERTENSION

To assess the contribution of the sympathetic nervous system to the hypertension in patients with longstanding essential hypertension. Overall sympathetic function, presynaptic adrenoceptors and neuronal re-uptake were examined after withdrawal of medication for at least 3 weeks in eight patients with longstanding essential hypertension and in eight carefully matched normotensive control subjects. Minimal forearm vascular resistance after 10 min ischaemia was used as a measure of structural vascular changes. Overall sympathetic tone was assessed using tilt testing and pressor dose infusion of noradrenaline. The presence and function of presynaptic adrenoceptors and the neuronal re-uptake of noradrenaline were evaluated in the forearm using tracer noradrenaline kinetics with measurement of forearm noradrenaline plasma appearance rate and noradrenaline plasma spillover. Intra-arterial infusions of tritiated noradrenaline, the endogenous alpha- and beta-adrenoceptor agonist adrenaline, the alpha-adrenoceptor blocker phentolamine, the non-adrenergic vasodilator sodium nitroprusside and the neuronal re-uptake inhibitor desipramine were given in the forearm. We found that the hypertensives had higher minimal forearm vascular resistance, indicating structural vascular changes; decreased overall sympathetic activity, indicated by a lower basal whole-body noradrenaline production rate; enhanced vasopressor sensitivity for exogenously administered noradrenaline with decreased arterial baroreflex sensitivity; indications of decreased forearm neuronal re-uptake; evidence consistent with the presence of presynaptic, release-facilitating beta-adrenoceptors in the forearm, apparently not functionally different between the two groups; and undecisive evidence for the presence of functional presynaptic alpha-adrenoceptors in the forearm. In patients with longstanding essential hypertension we found decreased overall sympathetic activity, with indications of decreased forearm neuronal re-uptake, which might have a compensatory role. We found indications of structural vascular changes and diminished baroreflex sensitivity in the hypertensives, which contribute to the hypertension. However, peripheral presynaptic, release-facilitating beta-adrenoceptors seem to be present, which are functionally not clearly different between the two groups. Observations on peripheral presynaptic alpha-adrenoceptors were inconclusive.

Scintigraphic assessment of atrial function in patients with longstanding hypertension.

Right and left atrial function were assessed using Fourier analysis of gated radionuclide images in 14 normal subjects and 50 patients with long-standing essential hypertension. Slopes representing filling and early diastolic emptying were similar for both atria; however, early diastolic emptying of the left atrium was slowed markedly in the hypertensive group (42.6 +/- 18.6 counts/sec., vs. 79 +/- 16 in normal persons; p less than 0.001), implying a reduction in left ventricular compliance. The right ventricular ejection fraction was depressed in hypertensive patients compared with normal subjects (37.1 +/- 6% vs. 43.4 +/- 8.1%; p less than 0.01). These findings may be helpful in understanding the effect of hypertension on the left and right heart and could have prognostic and therapeutic implications as well.

Hemodynamic role of extracellular fluid in hypertension.

Plasma volume is usually lower in patients with essential hypertension than in normal subjects. Normal or expanded plasma volume in some hypertensive patients may respect either a specific hypervolemic subset of the disease or the upper end of a continuum of volume values. Difficulties in defining these groups stem from the small numbers of subjects studied, from the need for a reliable reference index for volume measurements, and from the multiple factors which may affect intravascular volume. Differences in plasma volume cap influence choice of antihypertensive therapy; patients with expanded volume tend also to have slightly exchangeable sodium and greater extracellular fluid (ECF) volume and to respond well to diuretic therapy. There is also some evidence that low plasma renin activity is more frequent among hypervolemic patients. Essential hypertensives as a group have low plasma to interstitial fluid volume ratio (PV/IF), indicating that ECF distribution between the intravascular and interstitial compartments is shifted toward the latter. This is probably related to altered capillary filtration pressure due to increased venous resistance. Hypovolemic essential hypertensives have significantly lower (P less than 0.01) PV/IF ratio than hypervolemic, but whether this is related to differences in neural venous tone is only speculative. Hemodynamic studies revealed no difference in cardiac output between hypertensive patients with contracted blood volume and those with hypervolemia; total peripheral resistance was even higher in the latter, suggesting that "vasoconstriction" is not different between the two groups. It is widely believed that the relationship between ECF expansion and hypertension depends on the development of hypervolemia, increased cardiac output, and subsequent rise in total peripheral resistance reducing volume expansion and normalizing systemic flow while maintaining a high blood pressure. This sequence of events has been demonstrated in some human and experimental forms of hypertension but not in all. Metyrapone-induced hypertension in dogs could be sustained for up to 6 weeks by increased output with no evidence of "autoregulation" developing, and similar observations were reported in some anephric patients. Complementing these findings are observations of elevated cardiac output in some patients with long-standing essential hypertension or primary aldosteronism. It is therefore suggested that the spectrum of hemodynamic changes associated with volume disturbances in hypertension is too wide to be forced under one hypothesis alone and that neurogenic and other factors may play an important role in that complex relationship.