Need For Antihypertensive Treatment Research Articles

What Is the Current Best Drug Treatment for Hypertensive Heart Failure With Preserved Ejection Fraction? Review of the Totality of Evidence.

More than 90% of patients developing heart failure (HF) have an epidemiological background of hypertension. The most frequent concomitant conditions are type 2 diabetes mellitus, obesity, atrial fibrillation, and coronary disease, all disorders/diseases closely related to hypertension. HF outcome research focuses on decreasing mortality and preventing hospitalization for worsening HF syndrome. All drugs that decrease these HF endpoints lower blood pressure. Current drug treatments for HF are (i) angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor neprilysin inhibitors, (ii) selected beta-blockers, (iii) steroidal and nonsteroidal mineralocorticoid receptor antagonists, and (iv) sodium-glucose cotransporter 2 inhibitors. For various reasons, these drug treatments were first studied in HF patients with a reduced ejection fraction (HFrEF). However, subsequently, they have been investigated and, as we see it, documented as beneficial in HF patients with a preserved left ventricular ejection fraction (LVEF, HFpEF) and mostly hypertensive etiology, with effect estimates assessed partly on top of background treatment with the drugs already proven effective in HFrEF. Additionally, diuretics are given on symptomatic indications. Considering the totality of evidence and the overall need for antihypertensive treatment and/or treatment of hypertensive complications in almost all HF patients, the principal drug treatment of HF appears to be the same regardless of LVEF. Rather than LVEF-guided treatment of HF, treatment of HF should be directed by symptoms (related to the level of fluid retention), signs (tachycardia), severity (NYHA functional class), and concomitant diseases and conditions. All HF patients should be given all the drug classes mentioned above if well tolerated.

#4470 THE IMPACT OF RESIDUAL NATRIURESIS ON INTRADIALYTIC HYPERTENSION IN PATIENTS ON ISONATRIC DIALYSIS: A MONOCENTRIC STUDY AT THE FRANCK JOLY HOSPITAL CENTER

Abstract Background and Aims Intradialytic hypertension (IDH) is an elevation of blood pressure recorded during dialysis monitoring and at the end of the session relative to the values recorded at the connection. Hypervolemia and positive sodium balance are the main mechanisms. Isonatric dialysis allows a restoration of natremia corresponding to an optimal state of cellular hydration at the end of the session, and residual natriuresis is related to the state of extracellular hydration. Hence, their potential role in the appearance of IDH. The objective of this study is to measure the impact of residual natriuresis on IDH in patients on chronic isonatric hemodialysis. Method Transversal, descriptive and analytical study, having examined 12 last dialysis sessions of December 2023 of 65 patients in chronic hemodialysis (780 dialysis sessions) at the FRANCK JOLY Hospital Center in French Guiana. The primary outcome was the presence of intradialytic hypertension (IDH), defined as a difference in mean blood pressure ≥ 15 mmHg at disconnection from branching, or the need for antihypertensive treatment during the session with as main explanatory variables: residual natriuresis and sodium perdialytic concentration. Welche, Mann Whitney, Fisher and chi2 tests were used in univariate analysis and logistic regression in multivariate analysis to determine factors associated with IDH. The significance threshold was set at: p < 0.005. Results The 65 files analyzed had a predominance of women at 55%. 780 dialysis sessions were reviewed, including 206 with IDH, or nearly 1/4 of the sessions. 37% of patients were affected by IDH with a sex ratio of 1. 94% of patients had a history of hypertension and 22% were diabetic. 57% of patients had zero residual diuresis. The average interdialytic weight gain was 2.3 kg. 48% had at least triple antihypertensive therapy. The average duration of a dialysis session was 4 hours, the mean KT/V was 1.2; The mean natremia was 138 mEq/L and the mean perdialytic sodium concentration was 140 mEq/L. The median residual natriuresis was 8.55[0; 26.2] mEq/L. The mean NT-proBNP level was 2407 pg/ml. In univariate analysis, residual natriuresis and perdialytic natremia were not statistically associated with HID. Factors significantly associated with IDH were a number of antihypertensive treatments, NT-proBNP level and duration of dialysis session. In multivariate analysis: the high number of antihypertensive treatments and the increased duration of the dialysis session emerged as risk factors for IDH. Indeed, when the number of antihypertensives increased by 1 unit, the IDH score was multiplied on average by 2.74 (p<0.001), and when the session duration (h) increased by 0.1 units, the IDH score was multiplied by an average of 1.39 (p = 0.019). Residual natriuresis appeared as a protective factor against interdialytic weight gain, because when urinary sodium (mEq/l) increased by 10 units, mean interdialytic weight gain (kg) decreased by an average of -0.116 (p = 0.043). Conclusion Intradialytic hypertension is common and multifactorial. Antihypertensive combination therapy, usually reflecting resistant high blood pressure, is a major risk factor. The present study, at the expense of the definition criteria used, did not find significant associations with perdialytic natremia and residual natriuresis. However, the latter remains protective against interdialytic hypervolemia. Hence, the need for its preservation.

Isolated diastolic hypertension is not a benign situation regarding hypertension mediated organ damage in patients with first diagnosed and never treated essential hypertension

Abstract Background Isolated diastolic hypertension (IDH) usually remains untreated as it is considered benign compared to isolated systolic or combined systolic/diastolic hypertension. Hypertension mediated organ damage (HMOD) needs to be assessed in each individual hypertensive patient in order to estimate cardiovascular risk. We aimed to investigate the HMOD differences between first diagnosed and never treated patients with IDH compared to normotensive subjects. Methods From 550 first diagnosed and never-treated hypertensive and non-diabetic patients, we studied 81 patients with IDH (mean age = 49±9, 63% males, 26% smokers) and 53 normotensives (mean age = 51±13, 30% males, 28% smokers). Office and ambulatory blood pressure monitoring (24h ABPM), CV risk factors [smoking, obesity (BMI), hyperlipidemia and HMOD [aortic stiffness (PWV), left ventricular diastolic dysfunction (EEa), cardiac mass (LVMI) and cardiac hypertrophy (LVH), coronary arteries microcirculation (CFR), carotid intima-media thickness (cIMT) were estimated in each hypertensive patient as well as normotensive subject. Results IDH patients had similar age, BMI, lipid profile, central systolic BP and smoking habit, and increased systolic (139±12 vs. 133±18, p=0.03), diastolic (89±9 vs. 84±9 mmHg, p=0.02) and mean office BP (106±9 vs. 82±9 mmHg, p<0.001) as well as 24h systolic (125±3 vs. 119±6 mmHg, p<0.001) and diastolic ABPM (84±4 vs. 73±4 mmHg, p<0.001) compared to normotensives. Regarding HMOD, IDH patients had LVH in 7/81 (9%). Increased LVMI (79±18 vs. 69±18 g/m2, p=0.01) and IMT (0.9±0.2 vs. 0.8±0.1 mm, p=0.01) but similar PWV, E/Ea and CFR were found compared to normotensives. In multiple regression analysis (age and weight were used as independent variables), LVMI was independently related to office systolic (Beta=0.26, p=0.02) and diastolic BP (Beta=0.28, p=0.01) as well as central diastolic BP (r=0.38, p=0.04) while no relationship was found between LVMI and 24h ABPM. Conclusions The presence of HMOD in IDH in first diagnosed and never treated patients with arterial hypertension underscores the need for antihypertensive treatment (life style changes and medication). As HMOD may regress with successful antihypertensive treatment, there is still time for physicians to reduce future CV events in those patients. Funding Acknowledgement Type of funding sources: None.

The Relationship Of Depression-Anxiety Inspection And Hypertension In Newly Diagnosed Young Hypertensive Patients

Aim: Hypertension (HT) is a very important risk factor for cerebrovascular, renal and various vascular diseases, especially
 cardiovascular diseases. It is seen in almost 1/3 of the adult world population and its incidence is gradually increasing.
 95% of HT is essential and various reasons are emphasized in the etiology. Conditions that cause psychological stress,
 especially depression; Although the relationship between them is not clear, it was seen as a risk factor for HT. Because
 they will live with HT for a long time, early diagnosis and treatment is important, especially in young patients. Predisposing
 factors should also be taken into account in treatment. Anxiety and depression, which are called increased sympathetic
 activity in young people, can be a trigger for HT. In this study, we wanted to investigate the susceptibility to depressionanxiety in newly diagnosed young hypertensive patients. According to the result, we thought that we could make new
 recommendations in the treatment of HT.
 Materials and Methods: 175 patients under the age of 45 with newly diagnosed HT and 125 individuals under 45 without
 any health problems were included in the study. Those diagnosed with HT with secondary reasons and those with chronic
 diseases such as coronary artery disease (CAD), diabetes mellitus (DM), chronic renal failure (CRF), congestive heart failure
 (CHF) were excluded from the study. Testing was performed with the Hospital Depression Anxiety Scale (HDAS). In this test
 for both anxiety and depression; 0-7 points were considered normal, 8-10 points were considered borderline, and over 11
 points were considered abnormal.
 Results: When the results were evaluated, there was no difference between the groups in terms of age, gender, and
 routine biochemical tests. Both depression and anxiety scales were found to be significantly higher in the HT group. In
 young hypertensive patients, we have seen that HT and depression-anxiety frequently coexist.
 Conclusion: In this case, we should definitely examine the psychological stress states of young patients we diagnosed with
 HT. It would be appropriate to refer patients who we think may have depression and anxiety for psychological support and
 treatment. When psychological problems are treated, HT may improve without the need for antihypertensive treatment.
 Thus, we can develop new approaches in HT treatment.

ISOLATED DIASTOLIC HYPERTENSION IS NOT A BENIGN SITUATION REGARDING HYPERTENSION MEDIATED ORGAN DAMAGE IN PATIENTS WITH FIRST DIAGNOSED AND NEVER TREATED ESSENTIAL HYPERTENSION

Objective: Isolated diastolic hypertension (IDH) usually remains untreated as it is considered benign compared to isolated systolic or combined systolic/diastolic hypertension. Hypertension mediated organ damage (HMOD) needs to be assessed in each individual hypertensive patient in order to estimate cardiovascular risk. We aimed to investigate the HMOD differences between first diagnosed and never treated patients with IDH compared to normotensive subjects. Design and method: We studied 68 non-diabetic, first diagnosed and never-treated hypertensive patients with IDH (mean age = 49 + 9, 65% males, 24% smokers) and 30 normotensives (mean age = 51 + 10, 17% males, 20% smokers). Office and ambulatory blood pressure monitoring (24 h ABPM), CV risk factors [smoking, obesity (BMI), hyperlipidemia and HMOD [aortic stiffness (PWV), left ventricular diastolic dysfunction (EEa), cardiac hypertrophy (LVMI), coronary arteries microcirculation (CFR), carotid intima-media thickness (cIMT) were estimated in each hypertensive patient as well as normotensive subject. Results: IDH patients had similar age, BMI and smoking habit, decreased LDL-C and increased diastolic (89 + 9 vs. 84 + 9 mmHg, p = 0.02) and mean office BP (106 + 9 vs. 99 + 12 mmHg, p = 0.01) as well as 24 h systolic (126 + 3 vs. 119 + 6 mmHg, p < 0.001) and diastolic ABPM (84 + 4 vs. 73 + 4 mmHg, p < 0.001) compared to normotensives. Regarding HMOD, IDH patients had increased LVMI (78 + 17 vs. 68 + 19 g/m2, p = 0.03) and IMT (0.9 + 0.1 vs. 0.8 + 0.1 mm, p = 0.03) but similar PWV, E/Ea and CFR compared to normotensives. LVMI was related to diastolic (r = 0.32, p = 0.008) and mean (r = 0.32, p = 0.01) office BP in IDH patients. Conclusions: The presence of HMOD in patients with first diagnosed and never treated IDH underscores the need for antihypertensive treatment (life style changes and medication). As HMOD may regress with successful antihypertensive treatment, there is still time for physicians to reduce future CV events in those patients.

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.

IS BARIATRIC SURGERY A TREATMENT FOR HYPERTENSION AND FOR THE OTHER COMPONENTS OF THE METABOLIC SYNDROME?

Abstract Objective: Our objective is to determine the impact of weight loss obtained by bariatric surgery on the components of the metabolic syndrome such as visceral obesity, atherogenic dyslipidemia, glycemic disorders and hypertension secondary. Design and method: This is a retrospective pilot study including 59 patients subjected to bariatric surgery (gastric sleeve laparoscopy) during 2016 at Ponderas Academic Hospital Bucharest, Romania. We have reviewed the hospital database for blood tests, diabetes, cardiologic and surgery consultations before surgery and at 12 months follow up. We tracked the evolution of the following parameters: body mass index, waist circumference, weight, blood sugar, triglycerides, high density cholesterol, low density cholesterol, glycated hemoglobin, liver enzymes, the presence or absence of hypertension, dyslipidemia and diabetes and the necessary for antihypertensive, lipid lowering and antidiabetic treatment. 51 of the patients (86%) were hypertensive, 48 of them had chronic antihypertensive oral treatment and 3 of them were equilibrated by low salt diet. Results: The need for antihypertensive treatment was reduced by 60%, only 19 out of 48 patients still had chronic blood pressure lowering treatment at 12 moths follow up. Patients still on treatment had lower doses or fewer classes of the initial drugs. BMI decreased by 38%; waist was reduced by 31%, weight declined by 41%; blood sugar was lowered by 16%, triglycerides decreased by 37%; high density cholesterol increased by 18%, low density cholesterol decreased by 9%. In diabetic patients glycated hemoglobin decreased by 28% and the necessity for antidiabetic medical treatment dropped by 69%. The decline was statistically significant for al variables (P < 0.001) except for low density cholesterol. Blood sugar values registered a more accelerated decrease in the first 6 months. Conclusions: Weight loss obtained by bariatric surgery in this study, improves metabolic syndrome in all of its components. The lower decrease in LDL Cholesterol in our study can be partly explained by the borderline values at the baseline. Longer retrospective analyses and prospective studies, expanding the number of patients are necessary and in progress, in order to determine the recurrence or new onset of hypertension.

462 Postpartum antihypertensive treatment in preeclamptic patients – correlation to clinical and placental findings

We aimed to examine if clinical and placental findings in preeclampsia (PET) can predict the need for anti-hypertensive treatment in the postpartum. This was a retrospective cohort of live singleton deliveries at 24.0 – 42.0 weeks gestation complicated by PET. Included were deliveries, we excluded patients with chronic hypertension and anti-hypertensive treatment during pregnancy. Obstetric outcomes and placental pathology reports were compared between patients who required antihypertensive treatment during the postpartum period (treatment group) and patients who did not (no treatment group). A total of 276 deliveries with a diagnosis of PET were analyzed – 90 in the treatment group and 186 in the no treatment group. There were no differences between the groups regarding demographics and previous PET. Significantly more patient in the treatment group delivered prematurely - 61.1% vs. 34.9%, p<0.001. The rate of severe preeclampsia was significantly higher in the treatment group - 91.1% vs 56.9%, respectively, p<0.001, and a higher rate of cesarean delivery was also noted in this group - 84.4% vs. 63.9%, p<0.001. On placental examination, a higher rate of marginal and retroplacental hematomas was noted in the treatment group (p=0.02), as was a trend for more maternal vascular lesions (p=0.05). In a logistic regression analysis, gestational age (OR 0.87, 95% CI 0.80-0.94, p=0.001) and severe PET (OR 7.26, 95% CI 3.20-16.47, p<0.001) were found independently correlated to post-partum treatment. In separate regression analysis among patients treated while hospitalized, nulliparity (OR 0.49, 95%CI 0.25-0.98, p=0.04) was also found significantly correlated with treatment at discharge. Antihypertensive treatment in the postpartum correlates to PET severity and gestational age, while nulliparous patients are also likely to require treatment after discharge

Böbrek Nakli Sonrası Önemli Bir Komplikasyon: Transplant Renal Arter Stenozu

Renal transplantation is a preferred treatment option because of its low long-term mortality and increased quality of life. However, complications after transplantation affect graft and patient survival. Transplant Renal Artery Stenosis (TRAS) is the most common vascular complication following renal transplantation affecting 1-23% of patients. Although it usually causes refractory hypertension, it can also cause graft loss. Although Peripheral Angiography (Digital subtraction angiography) is the gold standard for the diagnosis of TRAS, Doppler USG has become a primary imaging method because it is portable, inexpensive and noninvasive. There are surgical and endoluminal options in the treatment. In this report, a 16-year-old girl who had renal artery stenosis at the 4th month after renal transplantation and underwent percutaneous transluminal balloon angioplasty was reported. She is now in her second year of transplantation without any need for antihypertensive treatment and with preserved graft function.

TRANSPLANT RENAL ARTER STENOZU: TEK MERKEZ DENEYİMİ

<div><!--block-->Objective: Transplant renal artery stenosis (TRAS) and post-transplant arterial hypertension is a treatable cause of allograft dysfunction and graft loss. The risk factors for the development of TRAS include: donor age, prolonged and delayed graft function, cold ischemia time,concomitant CMV infection and surgical technique. Percutaneous transluminal angioplasty (PTA) has proven successful in treating TRAS in 60-90% of cases by providing renal reperfusion. In this study,we evaluated six TRAS cases in our clinic.&nbsp;<br><br>Material and Method: We evaluated patients retrospectively from medical records who underwent transplantation in 2017. We recorded the age, gender, creatinine, other findings during transplantation, and the demographic features of transplant patients with TRAS.&nbsp;<br><br>Results: TRAS was reported in 6 of 26 cases. The presence of iliac artery stenosis associated with renal artery stenosis was seen in two patients with CMV PCR (+). Patients underwent PTA and stent implantation. The need for antihypertensive treatment of the patients lessened during follow-up.&nbsp;<br><br>Conclusion: TRAS is one of the reasons for allograft dysfunction after kidney transplantation. For this reason it should be kept in mind when determining the cause of the allograft disfunction. In addition to other risk factors, surgical technique plays an important role in the development of TRAS. Graft function can be preserved with early intervention.</div>

Resistant Hypertension and Atherosclerotic Renal Artery Stenosis: Effects of Angioplasty on Ambulatory Blood Pressure. A Retrospective Uncontrolled Single-Center Study.

The effect of renal artery angioplasty on blood pressure in patients with true resistant hypertension and atherosclerotic renal artery stenosis has not been fully investigated due to the exclusion of these patients from most trials. In this study, we assessed the benefits of renal angioplasty on daytime ambulatory blood pressure (dABP) in this subgroup of patients. Medical records of our hypertension department were retrospectively analyzed from 2000 to 2016. Seventy-two patients were identified with resistant hypertension (dABP >135 or 85 mm Hg despite at least 3 antihypertensive drugs, including a diuretic) and atherosclerotic renal artery stenosis treated by angioplasty. Atherosclerotic renal artery stenosis was unilateral in 57 patients and bilateral in 15 patients. The mean age of the patients was 67.8±11.2 years; dABP was 157±16/82±10 mm Hg despite 4.0±1.0 antihypertensive treatments; estimated glomerular filtration rate was 52 (41-63) mL/min. After renal angioplasty, dABPM decreased by 14.0±17.3/6.4±8.7 mm Hg (P<0.001 for both), and the number of antihypertensive treatments decreased to 3.6±1.4 (P=0.002) with no significant change in estimated glomerular filtration rate. A high baseline systolic dABP and a low body mass index were independent predictors of systolic dABP changes. The decrease in dABP was confirmed in a subgroup of patients at one and 3 years of follow-up (N=31 and N=18 respectively, P≤0.001 for systolic and diastolic blood pressure at both visits). In this retrospective uncontrolled single-center study, angioplasty in patients with atherosclerotic renal artery stenosis and with true resistant hypertension significantly decreased dABP, reducing the need for antihypertensive treatment with no change in estimated glomerular filtration rate.

Body composition and arterial stiffness in pediatric patients with chronic kidney disease.

This study investigated the impact of body composition in the arterial stiffness of children with chronic kidney disease (CKD). Fat mass (FM), fat tissue index (FTI), fat-free mass (FFM), fat-free tissue index (FFTI), and FFTI/FTI were measured in 26 patients and 25 healthy controls by bio-impedance analysis. Data on patient's body mass index (BMI) for height-age, serum albumin, glomerular filtration rate (GFR), blood pressure status, and pulse wave velocity (PWV) were collected in patients. Patients presented lower levels of FM and FFM compared to healthy controls (p = 0.04 and p = 0.055 respectively). In patient group, BMI height-age z-score was positively correlated to FTI (r2 = 0.574, p < 0.001) and FFTI (r2 = 0.338, p = 0.001) and negatively correlated to FFTI/FTI (r2 = 0.263, p = 0.007). Serum albumin was positively correlated only with FFM among body composition data (r2 = 0.169, p = 0.037). PWV z-score was positively correlated to FFTI (r2 = 0.421, p = 0.006) and inversely correlated to FFTI/FTI ≥ 2.5 (r2 = 0.317, p = 0.003). Patients with FFTI/FTI ≥ 2.5 presented lower levels of PWV regardless the need for antihypertensive treatment. Serum albumin ≥ 3.8mg/dl and FFTI/FTI ≥ 2.5 were independently associated with a lower risk for high PWV, after adjustment for age, sex, and GFR (OR 0.009, 95% CI 0.000-0.729 and OR 0.039, 95% CI 0.002-0.680). All underweight [2 (7.7%)] and overweight [4 (15.4%)] patients presented high PWV. Among normal weight patients, FFTI/FTI ratio ≥ 2.5 was significantly associated with lower PWV z-score (p = 0.013). Both underweight and overweight are associated with arterial stiffness. Targeting FFTI/FTI ≥ 2.5 could be protective against cardiovascular disease in normal weight children.

Cardiovascular risk factors in children after kidney transplantation – From short‐term to long‐term follow‐up

Cardiovascular-related mortality is 100-fold higher in pediatric renal transplant recipients than in the age-matched general population. Seventy-seven post-renal transplant children's charts were reviewed for cardiovascular risk factors at two and six months after transplantation (short term) and at two yr after transplantation and the last follow-up visit (mean 7.14 ± 3.5 yr) (long term). Significant reduction was seen in cardiovascular risk factors prevalence from two months after transplantation to last follow-up respectively: Hypertension from 52.1% to 14%, hypercholesterolemia from 48.7% to 33%, hypertriglyceridemia from 50% to 12.5%, anemia from 29.6% to 18.3%, hyperparathyroidism from 32% to 18.3% and hyperglycemia from 11.7% to 10%, and left ventricular hypertrophy from 25.8% at short term to 15%. There was an increase in the prevalence of obesity from 1.5% to 3.9% and of CKD 3-5 from 4.75% to 24%. The need for antihypertensive treatment decreased from 54% to 42%, and the percentage of patients controlled by one medication rose from 26% to 34%, whereas the percentage controlled by 2, 3, and 4 medications decreased from 21.9%, 5.5%, and 1.4% to 6%, 2%, and 0. Children after renal transplantation appear to have high rates of cardiovascular risk factors, mainly on short-term follow-up.

Usefulness of Exercise-Induced Hypertension as Predictor of Chronic Hypertension in Adults After Operative Therapy for Aortic Isthmic Coarctation in Childhood

Chronic hypertension is a major concern in adults who have undergone resection of coarctation of the aorta (CoA) in childhood. In otherwise healthy subjects, exercise-induced hypertension is prognostic for chronic hypertension; however, the prognostic value in patients with CoA remains unknown. The aim of the present study was to evaluate the predictive value of exercise-induced hypertension for chronic hypertension in these patients. In the present prospective follow-up study, 74 patients with CoA (58% men, age 30.9 ± 9.5 years) underwent ambulatory blood pressure (BP) monitoring and exercise testing twice from 2001 to 2009 with a follow-up period of 6.3 ± 0.8 years. Hypertension was defined as a mean systolic BP ≥140 mm Hg and/or mean diastolic BP ≥90 mm Hg or the need for antihypertensive treatment. Exercise-induced hypertension was defined as a mean systolic BP of <140 mm Hg and peak exercise systolic BP of ≥200 mm Hg. At baseline, 27 patients (36%) were hypertensive, 11 (15%) had exercise-induced hypertension, and 36 (49%) were normotensive. At follow-up, all 27 hypertensive patients remained hypertensive. Of the 11 with exercise-induced hypertension, 7 (64%) had developed chronic hypertension, and 4 (36%) continued to have exercise-induced hypertension. Of the 36 normotensive patients, 7 (19%) had developed hypertension, 12 (33%) had developed exercise-induced hypertension, and 17 (47%) remained normotensive. On multivariate analysis, baseline maximum exercise systolic BP was independently associated with the mean systolic BP at follow-up (β = 0.13, p = 0.005). In conclusion, the maximum exercise systolic BP was a predictor for chronic hypertension in patients with CoA. These findings demonstrate the clinical importance of exercise-induced hypertension and warrant additional study into the long-term consequences of exercise-induced hypertension and the potential beneficial role of early antihypertensive treatment in adult patients after CoA repair with exercise-induced hypertension.

The Role of Unilateral Adrenalectomy in ACTH‐Independent Macronodular Adrenal Hyperplasia (AIMAH)

ACTH-independent macronodular adrenal hyperplasia (AIMAH) is a rare cause of Cushing's syndrome. Bilateral adrenalectomy is considered the treatment of choice, with subsequent lifetime steroid replacement, but unilateral adrenalectomy has been recently proposed to reduce the secreting tissue. This prospective study was designed to evaluate the long-term results of unilateral adrenalectomy in AIMAH concerning the main laboratory and clinical abnormalities and the patient's quality of life. Seven consecutive patients with confirmed AIMAH underwent unilateral adrenalectomy of the largest gland. ACTH and cortisol levels, arterial blood pressure (BP), glycometabolic parameters, and patient's subjective perception of health-related quality of life (by the SF-36 questionnaire) were measured preoperatively and postoperatively. No surgery-related morbidity occurred. One patient with a large contralateral adrenal enlargement required a completion adrenalectomy after 7 months because of persistent hypercortisolism. At a median follow-up of 53 (range, 27-68) months, the remaining six patients were cured, because serum and urinary free cortisol levels significantly decreased and ACTH increased, thus regaining the normal range. Both systolic and diastolic BP levels significantly reduced: 50% of patients definitively became normotensive, and the remaining patients reduced the need for antihypertensive treatment; 40% of patients suffering from preoperative diabetes were cured, whereas 40% reduced the need for hypoglycemizing drug. SF-36 evaluation of the health-related quality of life confirmed a significant amelioration. Unilateral adrenalectomy of the largest gland can be an effective and safe treatment for AIMAH in case of asymmetric involvement. It may achieve long-term remission of Cushing's syndrome and improve BP values, glycemic control, and patient's quality of life.

Is sodium restriction important to hypertension? The argument for.

Is sodium restriction important to hypertension? The argument for.

Sustained beneficial effects on blood pressure during long time retrospective follow-up after endovascular treatment of renal artery occlusion.

We retrospectively evaluated short- and long-term effects of percutaneous transluminal renal angioplasty (PTRA) with or without stent placement of renal artery occlusion (RAO) upon blood pressure (BP), serum (s)-creatinine, and the need for antihypertensive treatment in 34 RAO patients who underwent PTRA during 1996-2002. In 24/34 (71%) treatment was considered technically successful, 22/24 (92%) were treated with PTRA + stent, two with only PTRA. Patients were followed for mean 2.6 (range 0-8) years, during which 14/34 (41%) patients died. In all 34 patients, systolic and diastolic BP (SBP and DBP) before treatment were 184 +/- 30/95 +/- 15 mmHg and had decreased at discharge (to 157 +/- 21/80 +/- 10 mmHg; P < 0.001 for both SBP and DBP), and remained lower after 1 year (154 +/- 20/83 +/- 7 mmHg; P < 0.001 for SBP and P < 0.01 for DBP), and at last follow-up (148 +/- 20/80 +/-12 mmHg; P < 0.001 for both SBP and DBP). No changes occurred in s-creatinine or the number of antihypertensive drugs. Similar results were seen in the subgroup of 24/34 (71%) patients in whom treatment was technically successful. Among the 24 patients undergoing technically successful PTRA, absence of nephrosclerosis (P = 0.035) and a shorter duration of hypertension (P = 0.020) predicted favourable clinical outcome. No adverse effects upon s-creatinine or the need for antihypertensive medication were seen in patients in whom treatment was considered a technical failure. Seven of these patients were treated with PTRA of another renal artery than the occluded, or with embolisation. In conclusion, RAO can be treated with endovascular techniques. Technically successful results with decreasing blood pressure levels were obtained in 71% of patients.

Prescription diététique dans l’hypertension artérielle

Lifestyle measures are an important tool in high blood pressure management and should be tailored for each individual. They are used to lower blood pressure (reduction of alcohol consumption and salt intake, increased physical activity, weight loss) and to address other risk factors (smoking, hyperlipidemia, diabetes…). Lifestyle measures should be instituted as soon as possible and may reduce the need for antihypertensive treatment. The main difficulty is certainly to convince asymptomatic patients to accept these recommendations.

Can we Stratify Risk to Guide Therapy Presented at WHO-ISH Meeting. September 29, 1998. Fukuoka, Japan

The relation of blood pressure to cardiovascular (CVD) disease is direct, continuous, and independent. Nevertheless, blood pressure alone is a poor predictor of CVD events. In fact, the totality of factors, including smoking, cholesterol, diabetes, target organ damage, and existing cardiovascular disease, together, permit discrimination of persons with similar blood pressure into subgroups with event expectations that might differ by more than twenty-fold. Thus, absolute CVD risk, rather than level of blood pressure, should determine the need for antihypertensive treatment. In addition, conventional treatment, even when effective, prevents only 25% of expected events. Observational study of long term treated patients provides the basis for pre-treatment stratification of CVD risk in patients who will maintain “normal” blood pressure in treatment. This stratification scheme makes it possible to modulate the intensity of therapy to match the potential for CVD prevention. Finally, specific risk factors, influenced by particular antihypertensive therapies, may guide drug selection in individual cases.

Treatment of arterial hypertension in the elderly with nitrendipine: Preliminary results

Arterial hypertension affects about 40% of the population over 65 years of age. This disorder can cause changes in the quality of life of elderly subjects, as well as affect survival rates. The need for antihypertensive treatment is therefore clear. For these reasons, we studied a group of 39 elderly patients of both sexes, between 60 and 88 years of age, suffering from essential arterial hypertension, treated with nitrendipine, a new dihydropyridine calcium antagonist, administered at doses varying from 10–30 mg/day, for a period of 90 days. The preliminary results of this study have shown that blood pressure values of almost all the patients treated were normalized, and left ventricular hypertrophy was also reduced in those patients with this complication. No changes were observed in glucose or lipid metabolism; in fact, there was a decrease in total cholesterol and an increase in high-density lipoprotein cholesterol. We plan to continue treatment of these patients with nitrendipine for 12 months in order to confirm these data and to detect any action of the drug on atherosclerotic plaques.