Need For Antihypertensive Therapy Research Articles

The metabolic profiles of patients with autologous hematopoietic stem cell transplantation with graft versus host disease.

e24010 Background: Graft versus host disease (GvHD) is a serious inflammatory complication of hematopoietic stem cell transplant (HSCT) and a leading contributor to morbidity and mortality in HSCT patients. Previous studies have identified increased risk of cardiovascular death in HSCT patients who develop GvHD and characterized echocardiographic changes associated with chronic GvHD. However, details of the metabolic derangements in HSCT patients who develop GvHD remain poorly studied. Methods: This is a retrospective study of patients who underwent HSCT at H. Lee Moffitt Cancer Center and later developed severe chronic GVHD at 1 year. Metabolic data including weight, blood pressure, and lipid profile were recorded at baseline and at 1 year after HSCT. Results: Between January 1, 2010, and December 31, 2020, 1805 patients who received allogeneic HSCT were reviewed. At 1 year, 371 patients (20.5%) had severe GVHD. Compared to baseline, patients had higher total cholesterol (209 vs 183 mg/dL, P < 0.001), high-density lipoprotein (61 vs 47 mg/dL, P < 0.001), and triglycerides (211 vs 163 mg/dL, P < 0.001) at 1 year of follow up. Low-density lipoprotein values were not significantly different (107 vs 102 mg/dL, p = 0.15). Patient weight was significantly less at 1 year (163 vs 183 lbs, p < 0.001). Although blood pressure was not significantly different between baseline and 1 year, more patients were placed on antihypertensive medications at 1 year (50% vs 31%). Conclusions: This study finds that patients who undergo allogeneic HSCT and subsequently develop severe GVHD are at risk for metabolic derangements that may worsen cardiovascular health. We specifically demonstrate an increased need for antihypertensive therapy and elevations in total cholesterol and serum triglycerides. Further research is needed on the impact of these derangements on major adverse cardiac events and the role of cardiovascular risk factor management in these patients.

Features of the treatment of arterial hypertension in elderly patients

Arterial hypertension (AH) is one of the most common problems in the elderly and one of the most important cardiovascular risk factors. AH in the elderly has features with a high incidence of ISAH and is characterized by a high level of SBP and a low level of DBP, which creates certain problems for the safety of treatment. The need for antihypertensive therapy in elderly patients has received convincing evidence of the effectiveness of reducing mortality and cardiovascular complications. The purpose of this scientific review was to raise awareness of the problem of treating hypertension in elderly patients, including those with low DBP. The results of studies and meta-analyzes evaluating the efficacy and safety of standard and intensive SBP reduction in elderly patients, as well as the results of the effect of antihypertensive therapy on DBP levels, especially at baseline low DBP (<70 mmHg), are presented. The studies identified the main groups of antihypertensive drugs that provide an effective and safe reduction in blood pressure in elderly patients, have a cardioprotective effect and do not adversely affect comorbidities. These include: diuretics of the thiazide-like group, calcium channel blockers, as well as additional indications and concomitant conditions – ACE inhibitors and antigotensin II receptor blockers. Several meta-analyses have shown the benefit of intensively lowering SBP < 120 mmHg before the standard target level SBP < 140 mmHg. in elderly patients as a lower risk of fatal and non-fatal cardiovascular events and overall mortality. Thus, the impact of intensive SBP reduction was beneficial in preventing 1 case of MACE (NNT = 38) and in preventing 1 case of total mortality (NNT = 85); while the rate of harm in the form of arterial hypotension was significantly high (NNH = 778). With regard to the effect on the level of DBP in elderly patients with hypertension or ISAH, an inverse relationship between DBP and adverse coronary events was revealed and a J-curve was described, confirmed in a number of studies (INVEST, ARIC, SPRINT). Moreover, with an initially low DBP (<70 mmHg), a significant increase in the frequency of outcomes and the relative risk of outcomes was noted. It is not easy to decide on antihypertensive therapy in such situations. The evidence base of studies suggests the benefit of lowering SBP for the prevention of cardiovascular events in elderly patients, but with caution and individual approach. It is important to take into account individual patient characteristics such as cognition, autonomy, and frailty/frailty when setting target BP.

The use of loop diuretics in the context of hypertensive disorders of pregnancy: a systematic review and meta-analysis.

Addressing volume expansion may improve the management of hypertension across the pregnancy continuum. We conducted a systematic review to summarize the evidence on the use of loop diuretics in the context of hypertensive disorders during pregnancy and the postpartum period. Medline, Embase, Cochrane library, ClinicalTrials.gov, and Google Scholar were searched for original research articles published up to 29 June 2021. Of the 2801 results screened, 15 studies were included: eight randomized controlled trials, six before-after studies, and one cohort study. Based on random effects meta-analysis of before-after studies, antepartum use of loop diuretics was associated with lower DBP [mean difference -17.73 mmHg, (95% confidence intervals -34.50 to -0.96); I2 = 94%] and lower cardiac output [mean difference -0.75 l/min, (-1.11 to -0.39); I2 = 0%], with no difference in SBP, mean arterial pressure, heart rate, or total peripheral resistance. Meta-analysis of randomized controlled trials revealed that postpartum use of loop diuretics was associated with decreased need for additional antihypertensive patients [relative risk 0.69, (0.50-0.97); I2 = 14%], and an increased duration of hospitalization [mean difference 8.80 h, (4.46-13.14); I2 = 83%], with no difference in the need for antihypertensive therapy at hospital discharge, or persistent postpartum hypertension. Antepartum use of loop diuretics lowered DBP and cardiac output, while their postpartum use reduced the need for additional antihypertensive medications. There was insufficient evidence to suggest a clear benefit. Future studies focusing on women with hypertensive pregnancy disorders who may most likely benefit from loop diuretics are required.

Hypertension and asymptomatic hyperuricemia: algorithm of diagnostics and management (literature review)

Objective. To determine the diagnostic criteria for asymptomatic hyperuricemia as a cardiovascular risk factor, the need for antihypertensive therapy and urate-reducing therapy in patients with hypertension; to develop an algorithm for the management of hypertensive patients with asymptomatic hyperuricemia. Search strategy and methodology. The following key words were used for the search: “asymptomatic hyperuricemia” and “hypertension” in four databases — PubMed, Medscape, E-library Yandex.ru. Results. The review included 79 sources, including 1 monograph, 11 international and Russian guidelines, consensus documents, 67 reviews, observational, non-randomized, randomized clinical trials, their meta-analyses, requirements for uric acid blood tests. The review presents a definition, prevalence and diagnostic criteria for asymptomatic hyperuricemia, depending on the assessment method and factors affecting the concentration of uric acid, as well as the pathogenetic mechanisms of hyperuricemia. The linear relationship between uric acid level with the risk of hypertension, dyslipidemia, cardiovascular diseases and complications. The review discusses drug-induced hyperuricemia, the effect of various antihypertensive and lipid-lowering drugs on the blood concentration of uric acid, the indications for urate-reducing therapy in asymptomatic hyperuricemia. Conclusions. An algorithm for the management of patients with asymptomatic hyperuricemia and hypertension is proposed.

The Relationship between Intracranial Hemorrhage after Intravenous Thrombolytic Therapy and the Need for Antihypertensive Treatment During and after Infusion in Acute Ischemic Stroke

Background: This study aims to determine which factors increase the risk of intracerebral hemorrhage after tissue plasminogen activator (tPA) treatment in patients with acute ischemic stroke and to investigate whether there is a relationship between the need for antihypertensive therapy during and after tPA infusion and the risk of intracerebral hemorrhage. Materials and Methods: Consecutive patients who applied to our stroke center with acute ischemic stroke and received IV tPA treatment in the first 4.5 h between 2012 and 2020 were included in the study. The demographic data of patients, stroke risk factors, drugs used before the stroke, neurological examinations, cranial computed tomographys (CTs) before and after tPA, antihypertensive usage during IV tPA and in the 24-h period after treatment, hospital mortality rates, and modified Rankin Scale scores in the 3rd month were evaluated retrospectively. Patients with intracerebral bleeding were divided into groups according to bleeding subtypes and whether they were symptomatic. Results: Intracranial bleeding was detected in 48 of 214 patients included in this study. Nineteen of these (8.8%) were classified as symptomatic intracerebral hemorrhage according to the National Institute of Neurological Disorders and Stroke and 14 (6.5%) according to the definition of the European Cooperative Acute Stroke Study. In the multiple logistic regression analysis, intracranial bleeding was significantly associated with 24th h systolic blood pressure and the need for antihypertensive usage. Conclusions: Blood pressure regulation should be done carefully during tPA infusion and in the first 24 h. In addition, cranial CT scanning in patients who need antihypertensive usage may enable earlier detection of intracranial bleeding.

Cardiovascular events following pregnancy complicated by pre-eclampsia with emphasis on comparison between early- and late-onset forms: systematic review and meta-analysis.

To elucidate whether pre-eclampsia (PE) and the gestational age at onset of the disease (early- vs late-onset PE) have an impact on the risk of long-term maternal cardiovascular complications. MEDLINE, EMBASE and Scopus databases were searched until 15 April 2020 for studies evaluating the incidence of cardiovascular events in women with a history of PE, utilizing combinations of the relevant MeSH terms, keywords and word variants for 'pre-eclampsia', 'cardiovascular disease' and 'outcome'. Inclusion criteria were cohort or case-control design, inclusion of women with a diagnosis of PE at the time of the first pregnancy, and sufficient data to compare each outcome in women with a history of PE vs women with previous normal pregnancy and/or in women with a history of early- vs late-onset PE. The primary outcome was a composite score of maternal cardiovascular morbidity and mortality, including cardiovascular death, major cardiovascular and cerebrovascular events, hypertension, need for antihypertensive therapy, Type-2 diabetes mellitus, dyslipidemia and metabolic syndrome. Secondary outcomes were the individual components of the primary outcome analyzed separately. Data were combined using a random-effects generic inverse variance approach. MOOSE guidelines and the PRISMA statement were followed. Seventy-three studies were included. Women with a history of PE, compared to those with previous normotensive pregnancy, had a higher risk of composite adverse cardiovascular outcome (odds ratio (OR), 2.05 (95% CI, 1.9-2.3)), cardiovascular death (OR, 2.18 (95% CI, 1.8-2.7)), major cardiovascular events (OR, 1.80 (95% CI, 1.6-2.0)), hypertension (OR, 3.93 (95% CI, 3.1-5.0)), need for antihypertensive medication (OR, 4.44 (95% CI, 2.4-8.2)), dyslipidemia (OR, 1.32 (95% CI, 1.3-1.4)), Type-2 diabetes (OR, 2.14 (95% CI, 1.5-3.0)), abnormal renal function (OR, 3.37 (95% CI, 2.3-5.0)) and metabolic syndrome (OR, 4.30 (95% CI, 2.6-7.1)). Importantly, the strength of the associations persisted when considering the interval (< 1, 1-10 or > 10 years) from PE to the occurrence of these outcomes. When stratifying the analysis according to gestational age at onset of PE, women with previous early-onset PE, compared to those with previous late-onset PE, were at higher risk of composite adverse cardiovascular outcome (OR, 1.75 (95% CI, 1.0-3.0)), major cardiovascular events (OR, 5.63 (95% CI, 1.5-21.4)), hypertension (OR, 1.48 (95% CI, 1.3-1.7)), dyslipidemia (OR, 1.51 (95% CI, 1.3-1.8)), abnormal renal function (OR, 1.52 (95% CI, 1.1-2.2)) and metabolic syndrome (OR, 1.66 (95% CI, 1.1-2.5). Both early- and late-onset PE represent risk factors for maternal adverse cardiovascular events later in life. Early-onset PE is associated with a higher burden of cardiovascular morbidity and mortality compared to late-onset PE. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

982 Postpartum diuretic therapy in women with preeclampsia: a meta-analysis

Our objective was to conduct a systematic review and meta-analysis using available data from RCTs that evaluated the use of diuretic therapy in the postpartum management of preeclampsia. A systematic literature review was conducted using PubMed, Cochrane, and Embase using relevant search terms. Secondary citations from retrieved papers were also reviewed. We performed a meta-analysis of randomized trials of deliveries complicated by preeclampsia who were treated with a diuretic or placebo/no treatment in the immediate postpartum period. Clinical characteristics, outcome measures, treatment subtypes were extracted. Outcome data were abstracted and meta-analysis was conducted using the Mantel-Haenszel fixed effects model with test of heterogeneity. Five RCTs met inclusion criteria, with 590 women (Treatment n=296, Control n=294). The treatment group needed significantly less inpatient anti-hypertensive medication or dose escalation p<0.015 (3 studies, n=482, odds ratio (OR) 0.61, 95% confidence interval (CI) 0.42 to 0.91). Use of diuretic therapy was also associated with fewer women requiring anti-hypertensive medication at discharge (5 studies, n=590, OR 0.67, 95% CI 0.47 to 0.94, p=0.02). Among the subset of women with preeclampsia with severe features, diuretic therapy was associated with significantly less additional anti-hypertensive medication use (2 studies, n=170, OR 0.24, 95% CI 0.11 to 0.52, p=0.0003), and these patients were less likely to require an anti-hypertensive medication at discharge (3 studies, n=260, OR 0.38, 95% CI 0.21 to 0.67, p=0.001). No statistically significant differences were noted in readmissions for hypertensive control, length of hospital stay, or adverse events. Postpartum administration of a loop diuretic following delivery complicated by preeclampsia decreases the need for additional postpartum anti-hypertensive therapy or dose escalation and decreases the need for anti-hypertensive therapy at time of discharge. Additional research is needed to elucidate optimal treatment regimens to maximize efficacy and minimize risk.

Surgical Versus Percutaneous Stenting Treatment of Isolated Aortic Coarctation: Long-Term Follow-Up

Background: In recent decades, aortic stenting has become a promising alternative to surgery for both native aortic coarctation and re-stenosis in children and adults. However, comparative long-term outcomes have poorly been investigated. Methods: We included 212 patients with previous aortic repair (19 ± 8.7 years) divided into 3 groups: 139 with single-time surgical repair (CoA-S group); 18 with single-time percutaneous stenting (CoA-PS group); and 55 hybrid patients with multiple aortic procedures because of re-coarctation occurrence (CoA-H group). All patients underwent 24-hour ambulatory blood pressure monitoring and trans-thoracic echocardiography. Results: After a median follow-up of 17 years after aortic repair, antihypertensive therapy was recorded in a significantly higher proportion of patients (83%) in CoA-PS group compared to 65% and 46% of CoA-H and CoA-S groups, respectively (p = 0.002). Pulse pressure values were higher in CoA-PS patients compared to the others (p < 0.001). Echocardiogram showed significant residual aortic gradient in 50% of CoA-PS and 73% of CoA-H patients compared to 33% of CoA-S patients (p < 0.0001). Indeed, stenting was associated to higher incidence of re-coartaction (p < 0.0001). At multivariate regression Cox analysis adjusted for age at repair and need for antihypertensive therapy, percutaneous stenting was an independent predictor of echocardiographic evidence of re-coarctation (p ≤ 0.001). Conclusion: Aortic coarctation stenting was independently associated with re-coartaction occurrence during long-term follow up when compared to surgical procedures. Furthermore, patients with aortic stenting had lower blood pressure control at 24-hour ambulatory blood pressure monitoring and higher need for antihypertensive therapy.

Efficacy of Postpartum Furosemide Therapy on Blood Pressure Recovery in Patients with Severe Preeclampsia: A Randomized Clinical Trial

Background: Hypertensive disorders are an important cause of maternal mortality and morbidity, and severe preeclampsia is the most common cause [Baha M. Sibia, AJOG (2012)]. The blood pressure rises progressively during the first 5 days after delivery, and it is due to mobilization of 6-8 liters of liquid, and 950 meq of accumulated sodium,from interstitial and extravascular space to intravascular space[Davison JM and Dunlop W, Seminars in Nephrology,4:198–207 (1984)].Severe rising of blood pressure may lead to complications, such as renal failure, pulmonary edema, eclampsia, intracranial hemorrhage, stroke, coma and death [Baha M. Sibia, AJOG (2012)].Therefore, postpartum anti-hypertensive therapy can prevent these complications and diminishes maternal mortality and morbidity rate.&#x0D; Objective: This investigation was done to evaluate whether a short course of postpartum furosemide therapy in patients with severe preeclampsia accelerates blood pressure recovery, reduces antihypertensive drugs usage, prevents complications such as eclampsia and finally diminishes hospitalization.&#x0D; Study design: In a randomized clinical trial, 90 patients with severe preeclampsia participated. After spontaneous onset of diuresis and discontinuation of sulfate magnesium, patients were randomly allocated to receive either no therapy or 20 mg oral furosemide daily for five days with oral potassium supplementation. Postpartum blood pressure, the need for antihypertensive therapy, rate of complications and duration of hospitalization between treatment and control groups were compared.&#x0D; Results: Mean systolic blood pressure on the third day after delivery was not different significantly between treatment and control groups(127.9±10.2 compared with 130 ± 11.5 mm-Hg, P=0.36). Mean diastolic blood pressure on the third day after delivery was not different between two groups. Patients in treatment group required less antihypertensive therapy during hospitalization (26.7% compared with 33.3%, P=0.64) but the difference was not significant. Eclampsia occurred in two patients in control group and not occurred in treatment group. Duration of hospitalization was not affected by the intervention.&#x0D; Conclusion: Brief postpartum furosemide therapy in patients with severe preeclampsia may not be effective in postpartum blood pressure recovery and reducing the need for antihypertensive therapy. It may be useful to prevent complications such as eclampsia. Duration of hospitalization was not affected by the intervention.&#x0D; Bangladesh Journal of Medical Science Vol.18(3) 2019 p.636-640

Applicability of the Systolic Blood Pressure Intervention Trial (SPRINT) to the Canadian Population

BackgroundThe Systolic Blood Pressure Intervention Trial (SPRINT) showed significant reductions in major cardiovascular events and all-cause mortality with a systolic blood pressure (BP) goal of < 120 mm Hg compared with < 140 mm Hg. We sought to determine the proportion of Canadian adults who meet SPRINT eligibility criteria. MethodsWe conducted a cross-sectional study using cycles 1-3 of the nationally representative Canadian Health Measures Survey to estimate the prevalence and characteristics of Canadian adults between the ages of 20 and 79 who meet SPRINT eligibility criteria: age ≥ 50 years, elevated systolic BP of 130-180 mm Hg, and increased cardiovascular risk (with chronic kidney disease, Framingham Risk Score ≥ 15% in 10 years, and/or cardiovascular disease) but without diabetes, stroke, or end-stage renal disease. ResultsAn estimated 1.3 million (5.2%) Canadian adults met SPRINT eligibility criteria; 14.3% (95% confidence interval, 10.6%-17.9%), or 182,600 people, were not previously considered to have hypertension or need for antihypertensive therapy. Of adults aged 50-79 years treated for hypertension, 18.7% (95% confidence interval, 15.5%-21.8%), or 754,400 individuals, would potentially benefit from treatment intensification. ConclusionsIf fully implemented, intensive systolic BP lowering to < 120 mm Hg in SPRINT-eligible high-risk individuals would substantially increase the proportion of Canadian adults receiving BP treatment initiation or intensification.

Risk factors for arterial hypertension after liver transplantation

Arterial hypertension represents a common complication of immunosuppressive therapy after liver transplantation (LT). The aim of the study is to evaluate the prevalence and risk factors associated with hypertension after LT. From a cohort of 323 cirrhotic patients who underwent LT from 2008 to 2012, 270 patients were retrospectively evaluated, whereas 53 (16.4%) patients deceased. Hypertension was defined as blood pressure ≥140/90 mm Hg in at least two visits and/or the need for antihypertensive therapy. The prevalence of hypertension was 15% before LT and significantly increased up to 53% after LT (P < .001). Mean follow-up was 43 ± 19 months. In normotensive (NT) subjects at baseline, 35.9% developed sustained hypertension after LT, whereas 15.2% developed transient hypertension within the first month after LT, and then returned NT. The development of sustained hypertension after LT was related to the mammalian target of rapamycin inhibitor treatment (odds ratio [OR], 4.02; 95% confidence interval [CI], 1.26–13.48; P = .02), alcoholic cirrhosis before LT (OR, 3.38; 95% CI, 1.44–8.09; P = .005), and new-onset hepatic steatosis after LT (OR, 2.13; 95% CI, 1.10–4.11; P = .02). Tacrolimus, the etiology and severity of liver disease, and other immunosuppressive regimens were not related to the development of hypertension after LT. In our cohort, the prevalence of arterial hypertension has increased up to 53% after LT, and metabolic comorbidities and immunosuppressive treatment with mammalian target of rapamycin inhibitors are the risk factors for the development of hypertension after LT.

What Clinical Interventions Have Been Implemented to Prevent or Reduce Postpartum Hypertension Readmissions? A Clin-IQ.

A literature review was conducted to determine what clinical interventions have been studied and implemented to prevent and/or reduce postpartum hypertension readmissions. Appropriate verbal and printed educational materials should be given to the patient prior to discharge with use of the "teach back" method. Patients and health care providers within the multidisciplinary team should be educated on the warning signs and symptoms of worsening hypertensive disease and when to appropriately involve the obstetrician. The use of text messaging may be useful in preventing hospital readmissions by increasing patient follow-up and compliance and appropriately managing patients in the postpartum period. Treating postpartum patients with furosemide may decrease blood pressure and prevent postpartum hypertension and the need for antihypertensive therapy.

Benefit of endovascular stenting for aortic coarctation on systemic hypertension in adults

Endovascular stenting is a recognised treatment strategy for aortic coarctation (CoA) in adults. We assessed systemic hypertension control and the need for antihypertensive therapy after CoA stenting in adults. Data were collected prospectively on 54 patients (36 men; mean age: 34 ± 16 years) who underwent endovascular stenting for CoA over a 7-year period. Five patients were excluded as they did not attend follow-up appointments. Patients underwent clinical examination, including right arm systolic blood pressure (SBP) and 24-hour ambulatory blood pressure monitoring at baseline, 6-12 weeks and 9-12 months. There was a significant fall in mean peak-to-peak systolic gradient (PG) across the CoA after stenting (26 ± 11 mmHg vs. 5 ± 4 mmHg; P<0.01). There were successive reductions in right arm SBP and ambulatory SBP at baseline, 6-12 weeks and 9-12 months post-procedure (right arm: 155 ± 18 mmHg vs. 137 ± 17 mmHg vs. 142 ± 16 mmHg, respectively; all P-values <0.01; ambulatory: 142 ± 14 mmHg vs. 132 ± 16 mmHg vs. 131 ± 15 mmHg, respectively; all P-values <0.01). Twenty-four patients had severe CoA (PG >25 mmHg before stenting); baseline SBP was significantly higher in severe versus non-severe patients (160 mmHg vs. 148 mmHg; P=0.02). The absolute reduction in PG after stenting was significantly higher in the severe group (31 ± 7 mmHg vs. 14 ± 5 mmHg; P<0.0001), but there was no significant difference in SBP between groups at 6-12 weeks (141 mmHg vs. 135 mmHg; P=0.21) or 9-12 months (139 mmHg vs. 139 mmHg; P=0.96). Endovascular stenting of CoA results in a significant reduction in SBP at 6-12 weeks, which is sustained at 9-12 months, with similar outcomes in severe and non-severe CoA groups.

When the chimney is blocked: malignant renovascular hypertension after endovascular repair of abdominal aortic aneurysm

BackgroundThe Chimney graft (CG) procedure is one of the novel modification techniques of the endovascular aneurysm repair (EVAR) surgery to treat suprarenal and juxtarenal abdominal aortic aneurysms. Other indications for the use of CG placement include thoracic and thoracoabdominal aneurysms with supraortic branches orifice involvement and cases of common iliac artery aneurysms with or without internal iliac artery involvement. The technique is used in patients who due to aortic-neck morphology and lack of adequate fixation and/or sealing zones are not eligible for standard EVAR. In this procedure, a parallel stent-graft is placed adjacent to the main body of the aortic endograft to maintain blood supply to renovisceral or supraortic branches, once the body of the aortic stent-graft is deployed. Symptomatic occlusions of the CG with novel renovascular hypertension were not described until now.Case presentationA-64-year-old male patient, presented with new-onset malignant hypertension, 13 months after an EVAR operation with CG placement to the left renal artery. The patient was on preventive clopidrogel therapy, which was withheld temporarily for several days, one month before presentation. Imaging studies revealed a novel form of iatrogenic renovascular hypertension, caused by occlusion of the CG. Any attempt to recanalize the covered stent or revascularize the left kidney was rejected and conservative treatment was chosen. Seven months after presentation, blood pressure was within normal ranges with little need for antihypertensive therapy.ConclusionsPhysicians should be aware that the novel emerging techniques of EVAR to overcome the limitations of the aortic-neck anatomy may still adversely influence the renal outcome with potential development of new-onset hypertension.

096 Endovascular stenting for native coarctation of the aorta using the CP Numed covered stent: Abstract 096 Table 1

Introduction Primary endovascular stenting is now a recognised alternative treatment strategy to surgical treatment for native coarctation in adults. The availability of covered stents has made coarctation stenting more attractive, with less periprocedural complications and long-term follow-up. Objective To assess early outcomes and blood pressure control in adults with a native aortic coarctation of the aorta undergoing primary endovascular stenting. DESIGN: - Primary data were collected prospectively from patients with native coarctation and systemic hypertension that underwent stenting of aortic coarctation using the CP Numed covered stent over 3 years period. Patients were assessed with 24 h ambulatory blood pressure monitoring (ABP) prior to the procedure (pre-stenting), at 6 weeks and 1 year following endovascular stenting. Results There were 23 patients (14 male). Twenty-one patients had procedure under general anaesthesia. The procedure was technically successful in all patients. Mean age was 34±14 years. Peak aortic gradient across the coarctation fell from 26±12 mmHg to 7±5 mmHg (p Conclusion Significant improvements in the clinical and ABP blood pressure following stenting with the CP Numed covered stent are seen at 6 weeks sustained at 1 year. However there is a continued need for anti-hypertensive therapy and long term follow-up is required. (*As compared to the pre-stenting).

Blood pressure in acute ischemic stroke and mortality: a study with noninvasive blood pressure monitoring

In acute ischemic stroke, a transient elevation of blood pressure is common; its significance and its relationship with the neurological outcome are still unclear. In 71 consecutive patients with acute ischemic stroke, aged 25-94 years, admitted to our unit, we investigated the relationships between the blood pressure variation during the first 24 h and mortality at 3 months (study endpoint). Neurological status was assessed with the National Institutes of Health Stroke Scale. Blood pressure was measured with bedside noninvasive blood pressure monitoring every 15 min. The mean of four measurements at the emergency department and the mean of 12 measures (during a 3-h interval) at 12 and at 24 h after stroke onset were considered for analysis. Antihypertensive treatment was given in accordance with the Recommendations for Stroke Management of European Stroke Initiative. In the whole series, 21% were atherothrombotic, 32% cardioembolic, 34% lacunar, and 13% of unknown or other cause. Blood pressure was 160+ or -3/86+ or -2 mmHg at the emergency department, 148+ or -3/82+ or -2 mmHg at 12 h, and 147+ or -3/81+ or -2 mmHg at 24 h (P<0.05). Four patients (11%) of those in whom mean blood pressure decreased >5 mmHg, and 12 (33%) of the others, in whom mean blood pressure decreased < or =5 mmHg or did not decrease, reached the endpoint (P<0.05). According to the multivariate Cox model, NIHSS score at the emergency department (95% confidence interval: 1.025-1.238, P=0.013) and age (95% confidence interval: 1.007-1.259, P=0.038) were predictors of reaching the endpoint, whereas mean blood pressure reduction 24 h after stroke onset had a protective effect (95% confidence interval: 0.845-0.995, P=0.038). Diabetes, mean blood pressure at the emergency department and the need for antihypertensive therapy did not correlate with the outcome. Noninvasive blood pressure monitoring during the first 24 h of acute ischemic stroke may be useful in the prognostic stratification by showing moderate blood pressure decrease, either spontaneous or drug induced, which is associated with a favorable prognosis at 3 months.

Does Uric Acid Have a Pathogenetic Role in Graft Dysfunction and Hypertension in Renal Transplant Recipients?

Uric acid (UA) may play a pathogenetic role in hypertension and kidney disease. We explored the prevalence of hyperuricemia and the relationship of UA to graft function and hypertension in prevalent renal transplant recipients (RTR). Baseline and follow-up data were collected on 90 RTR (mean age 51 yrs, 53% male, median transplant duration 7 years). Graft function was estimated using MDRD Study Equation 7. At baseline, 70% RTR had hyperuricemia (UA >7.0 mg/dl (0.42 mmol/L) in men and >6.0 mg/dl (0.36 mmol/L) in women) compared to 80% after 2.2 years (P=0.06). UA was not associated with blood pressure (BP) level but was higher in RTR with a history of hypertension compared to those without (8.6+/-1.8 vs. 7.3+/-2.2 mg/dl, [0.51+/-0.11 vs. 0.43+/-0.13 mmol/L], P=0.003) and in RTR on > or =3 antihypertensive medications compared to those taking less (9.1+/-1.6 vs. 7.6+/-1.8 mg/dL, [0.54+/-0.1 vs. 0.45+/-0.11 mmol/L], P<0.001). A history of hypertension was independently predictive of UA (beta 0.06, [95% CI 0.02 to 0.10], P=0.007) in addition to sex, cyclosporine dose, prednisolone dose, estimated glomerular filtration rate (eGFRMDRD) and beta-blocker therapy. UA was independently predictive of follow-up eGFRMDRD (beta -22.2 [95% CI -41.2 to -3.2], P=0.02) but did not predict change in eGFRMDRD over time. UA was independently associated with requirement for antihypertensive therapy (beta 0.34, [95% CI 1.05 to 1.90], P=0.02). Hyperuricemia is common in RTR and is associated with need for antihypertensive therapy and level of graft function.

A prospective randomized trial of magnesium sulfate in severe preeclampsia: Use of diuresis as a clinical parameter to determine the duration of postpartum therapy

The purpose of this study was to assess the use of the onset of diuresis in the determination of the duration of postpartum magnesium sulfate therapy among patients with severe preeclampsia. A prospective randomized trial of postpartum therapy with magnesium sulfate was conducted. The control group received 24 hours of therapy, and the study group received therapy until the onset of diuresis (urine output >100 mL/hr for 2 consecutive hours). The Student t test, chi 2 test, and Fisher's exact test were used for analysis of data; a probability value of <.05 was considered statistically significant. There were 50 patients in the control group and 48 patients in the study group. There was no difference in maternal demographic data, severe disease criteria, blood pressure, 24-hour postpartum urine output, or need for antihypertensive therapy. The study group had a significantly shorter duration of therapy, and no patient had eclampsia or required the re-initiation of therapy. The use of the onset of diuresis in the postpartum period as the determinant clinical parameter for the discontinuation of magnesium sulfate in patients with severe preeclampsia was associated with no untoward outcomes or need for the re-initiation of treatment.

Hormone replacement therapy and arterial blood pressure in postmenopausal women with hypertension

Background. Data on the effect of hormone replacement therapy (HRT) on blood pressure (BP) in hypertensive menopausal women are limited. Objective. To investigate the association between HRT and longitudinal changes in BP in hypertensive menopausal women. Patients and methods. We recruited a total of 161 hypertensive menopausal women (mean age = 52.2±6.6 years) attending the hypertension clinic in our hospital that required HRT to attenuate the effect of menopause symptoms. These women were followed for up to 36 months, being evaluated every 6 months with measurements of their BP, weight and the number of drugs needed to control their BP. We also measured serum cholesterol levels before and after the initiation of HRT. Results. The systolic BP remained unaffected throughout the whole follow‐up period, whereas the diastolic BP was slightly reduced at 6, 24 and 36 months. This decrease was accompanied by an increased need for antihypertensive medication throughout the entire follow‐up period, while the body weight also increased at 18, 24 and 36 months. No particular differences were noted with respect to ethnicity, history of pre‐eclampsia or surgical menopause, before and after the initiation of HRT. Serum cholesterol levels remained unchanged during the evaluation period. Oestrogen–progestogen combination therapy use was associated with a lower diastolic BP and a smaller number of antihypertensive drugs compared to other forms of HRT. Conclusion. HRT use does not have an adverse gross effect on BP in hypertensive menopausal women who need it, although there may be an increased need for antihypertensive therapy during the 36‐month follow‐up period of our study.

Postpartum Preeclampsia Management With Furosemide: A Randomized Clinical Trial

This investigation was undertaken to estimate whether a brief postpartum course of furosemide for patients with preeclampsia benefits recovery and shortens hospitalization by enhancing diuresis, lessening severe hypertension, and reducing the need for antihypertensive therapy. Two hundred sixty-four patients with preeclampsia were enrolled. After spontaneous onset of postpartum diuresis and discontinuation of intravenous magnesium sulfate, patients were randomly assigned to receive either no therapy or 20 mg oral furosemide daily for 5 days with oral potassium supplementation. Patient outcomes were compared between treatment groups with regard to classification of hypertensive disease. Only postpartum patients with severe preeclampsia (n = 70) who received furosemide compared with controls had significantly lower systolic blood pressure by postpartum day 2 (142 +/- 13 mm Hg compared with 153 +/- 19 mm Hg, P < .004) and required less antihypertensive therapy during hospitalization (14% compared with 26%, P = .371) and at discharge (6% compared with 26%, P = .045). No benefit was shown for patients with mild preeclampsia (n = 169) or superimposed preeclampsia (n = 25). Neither length of hospitalization nor frequency of delayed postpartum complications was positively affected by the intervention. Brief postpartum furosemide therapy for patients with severe preeclampsia seems to enhance recovery by normalizing blood pressure more rapidly and reducing the need for antihypertensive therapy. Shortening of hospitalization and reduction of delayed postpartum complications were not benefitted.