Normotensive Patients Research Articles

Interactions between hypertension and inflammatory tone and the effect on blood pressure and outcomes in patients with COVID-19.

Arterial hypertension represented one of the most common comorbidities in patients with COVID‐19. However, the impact of hypertension on outcome in COVID‐19 patients is not clear. Close connections between inflammation and blood pressure (BP) have been described, and inflammation plays a key role in the outcome for patients with COVID‐19. Whether hypertension impairs the relationship between inflammation, BP, and outcomes in this context is not known. The aim of this study was to examine the effects of the interactions between inflammation and hypertension status on BP and clinical outcome in patients hospitalized with COVID‐19. We designed a retrospective study in 129 patients hospitalized with COVID‐19 at Toulouse University Hospital. The hospital outcome was admission to the intensive care unit or death. The inflammatory markers were blood C‐reactive protein level (CRP), neutrophil to lymphocyte, and platelet to lymphocyte ratios. We identified strong correlations between CRP (P < .01) and the other inflammatory markers recorded on admission (P < .001) with mean BP within 3 days after admission in normotensive patients, whereas these correlations were absent in patients with hypertension. Also, we observed after multivariate adjustment (P < .05) that CRP level predicted a worse prognosis in hypertensive patients (relative risk 2.52; 95% confidence intervals [1.03‐ 6.17]; P = .04), whereas CRP was not predictive of outcome in patients without hypertension. In conclusion, the study revealed that in COVID‐19 patients, hypertension impairs the relationship between inflammation and BP and interacts with inflammation to affect prognosis. These findings provide insights that could explain the relationship between hypertension and outcomes in COVID‐19 patients.

Angiotensin (1-12) in Humans With Normal Blood Pressure and Primary Hypertension.

The importance of canonical versus noncanonical mechanisms for the generation of angiotensins remains a major challenge that, in part, is heavily swayed by the relative efficacy of therapies designed to inhibit renin, ACE (angiotensin-converting enzyme), or the Ang II (Angiotensin II) receptor. Ang (1-12) (angiotensin [1-12]) is an Ang II forming substrate serving as a source for Ang II-mediated tissue actions. This study identifies for the first time the presence of Ang (1-12) in the blood of 52 normal (22 women) and 19 (13 women) patients with hypertension not receiving antihypertensive medication at the time of the study. Normal subjects of comparable ages and body habitus had similar circulating plasma Ang (1-12) concentrations (women: 2.02±0.62 [SD] ng/mL; men 2.05±0.55 [SD] ng/mL, P>0.05). The higher values of plasma Ang (1-12) concentrations in hypertensive men (2.51±0.49 ng/mL, n=6) and women (2.33±0.63 [SD] ng/mL, n=13) were statistically significant (P<0.02) and correlated with elevated plasma renin activity, systolic and pulse pressure, and plasma concentrations of NT-proBNP (N-terminal prohormone BNP). The increased plasma Ang (1-12) in patients with hypertension was not mirrored by similar changes in plasma angiotensinogen and Ang II concentrations. The first identification of an age-independent presence of Ang (1-12) in the blood of normotensive subjects and patients with hypertension, irrespective of sex, implicates this non-renin dependent substrate as a source for Ang II production in the blood and its potential contribution to the hypertensive process.

Relation between Glycemic Control among the Patients with Type 2 DM and Level of Blood Pressure

Introduction: Inadequate glycemic control among patients with type 2 diabetes constitutes a major public health problem and risk factor for the development of diabetes related complications. Hypertension is a common co-morbid condition of diabetes. Hypertension as a factor for poor glycemic control in diabetes patients has not been properly evaluated in Bangladesh. The aim of the study was to assess status of glycemic control among patients with Type 2 DM depending on the level of blood pressure in a tertiary care hospital.&#x0D; Method: This cross sectional study was carried out among 200 adult patients of either gender with type 2 diabetes mellitus, in the Department of Medicine and endocrinology, Dhaka Medical College Hospital from January to June 2015.&#x0D; Results: The mean age of the respondents were 56.85(±10.84) years, ranging from 35 to 77 years. Among 200 patients, 129 (64.5%) were hypertensive and 71 (35.5%) were normotensive with a mean duration of hypertension was 10.03 (±3.39) years. The mean HbA1c for all diabetic, hypertensive and normotensive patients were 7.41% (±1.35), 7.63% (±1.30) and 7.02% (±1.37) respectively. The mean HbA1c was significantly higher in hypertensive than normotensive group (p=0.002). The mean HbA1c was also significantly higher in patients with duration of hypertension (p=0.03) for more than 10 years and in patients who used beta blocker (p=0.005) and diuretics (p=0.02) as hypertensive medication. Among the patients with normal BMI and on dietary modification, those who were hypertensive had significantly higher (p=0.00008) mean HbA1c (7.12(±0.99)) than those were normotensive (5.01(±0.01)).&#x0D; Conclusion: The glycemic control in type 2 DM is found to be poor among the hypertensive patients. There is a complex association of multiple factors like age, gender, duration of hypertension and medications strongly influence the glycemic control of type 2 diabetics with hypertension.&#x0D; J MEDICINE JAN 2021; 22 (1) : 12-17

Developing a scoring tool to estimate the risk of deterioration for normotensive patients with acute pulmonary embolism on admission

BackgroundIt is important to identify deterioration in normotensive patients with acute pulmonary embolism (PE). This study aimed to develop a tool for predicting deterioration among normotensive patients with acute PE on admission.MethodsClinical, laboratory, and computed tomography parameters were retrospectively collected for normotensive patients with acute PE who were treated at a Chinese center from January 2011 to May 2020 on admission into the hospital. The endpoint of the deterioration was any adverse outcome within 30 days. Eligible patients were randomized 2:1 to derivation and validation cohorts, and a nomogram was developed and validated by the aforementioned cohorts, respectively. The areas under the curves (AUCs) with 95% confidence intervals (CIs) were calculated. A risk-scoring tool for predicting deterioration was applied as a web-based calculator.ResultsThe 845 eligible patients (420 men, 425 women) had an average age of 60.05 ± 15.43 years. Adverse outcomes were identified for 81 patients (9.6%). The nomogram for adverse outcomes included heart rate, systolic pressure, N-terminal-pro brain natriuretic peptide, and ventricle/atrial diameter ratios at 4-chamber view, which provided AUC values of 0.925 in the derivation cohort (95% CI 0.900–0.946, p < 0.001) and 0.900 in the validation cohort (95% CI 0.883–0.948, p < 0.001). A risk-scoring tool was published as a web-based calculator (https://gaoyzcmu.shinyapps.io/APE9AD/).ConclusionsWe developed a web-based scoring tool that may help predict deterioration in normotensive patients with acute PE.

Jugular vein diameter: A new player in normotensive pulmonary embolism

PurposeThe majority of the patients with pulmonary embolism (PE) are those with normotensive PE. Right ventricular dysfunction (RVD) and myocardial injury markers are associated with mortality although they have a low predictive impact. Here, we aim to study the performance characteristics of jugular vein diameter to predict 30-day mortality. Materials and methodsIn this prospective, observational cohort study, we included normotensive patients who were diagnosed with PE using computed tomography angiography or scintigraphy in the emergency service. The demographic characteristics, blood pressures, pulses, shock indexes, troponin and lactate levels, echocardiography findings, and internal jugular vein diameters (IJV) of the patients were recorded. Testing characteristics of IJV in predicting 30-day mortality were studied. ResultsThe mean age of the 81 patients was 66.8±16.9 years and 37% of them were male. Age, shock index, lactate, RVD, PESI, and IJV diameters during inspiration and expiration were indicators for 30-day mortality. The cut-off value obtained using the ROC curve for mortality was an IJV-exp-AP of ≤8.9 mm (sensitivity,73.3%; specificity,92.4%; +LR,9.68; −LR,0.29; NPD,93.8%; PPD,68.7%; area under the curve, 0.76; 95% confidence interval, 0.65–0.84; p=0.004). ConclusionIJV diameter is an indicator of 30-day mortality. It can be used to detect low-risk patients.

Evaluating the Sensitivity of (miR-378) as a Circulatory Screening Biomarker for Diabetic Cardiomyopathy: Comparative Study

Background: Diabetic cardiomyopathy is one of the serious complication of diabetes mellitus, with a silentdevelopment and it is often underestimated, Currently available diagnostic techniques are limited in theirability to identify patients who present with uncommon symptoms or silent myocardiopathy in its earlystages.Aim: To evaluate role of miRNA-378 compared to GLS as a sensitive biomarker for early detection ofsubclinical diabetic cardiomyopathy.Method: This case control study involved 75 DM2 patients from Merjan Medical City in addition to ageand sex-matched 25 apparently healthy subjects . The echocardiographic assessment for GLS was donefor control group (H) and normotensive diabetic patients and these patients were divided into (CD) groupwithout cardiomyopathy, and (M)group with cardiomyopathy diagnosed by negative GLS and positive GLS,respectively. Group (F) include Hypertensive and/or ischemic diabetic patients with overt heart failure .conventional Echocardiography was performed to all patients and control groups, all of them were of normalEF, except group F who have EF less than 40%. Bloodsampling was done for all and miRNA extraction andanalysis done according to the manufacturer recommendations.Results: There is significant elevation in miR-378 Ct value between H in one side &amp; other three diabeticgps. (CD, M, F) as presented in table (3-17) (p&lt; 0.05). There is significant elevation in miR-378 Ct value inM than CD groups. There is significant elevation in Ct value in F than M gp. (p=0.000). In the ROC curve(AUC) was 0.965. The sensitivity and specificity were 0.978 and 0.646, respectively according to the chosencut-off value.Conclusion: This study showed that miRNA-378 could be regarded as a novel sensitive biomarker whichcould play a significant role for early detection of subclinical diabetic cardiomyopathy

Comparison of hemodynamic changes in normotensive and hypertensive patients following tracheal intubation with laryngoscope versus intubating laryngeal mask airway.

Background: Intubating laryngeal mask airway is used for blind endotracheal intubation and is also considered to cause less stress response as compared to intubation following conventional laryngoscope. Aim: To determine whether Intubating laryngeal mask airway or Laryngoscopy cause minimal stress response following intubation in normotensive as well as in hypertensive patients. Methods: This was a randomized control trial study. Two control groups were formed. They were age 18 to 65 years belonging to ASA I and II. Group, I patients was intubated with Macintosh laryngoscope and group II were intubated with the help of ILMA. Vitals monitored were Heart rate, Systolic blood pressure, diastolic blood pressure and mean arterial pressure at baseline, before induction, after induction, after intubation at 1, 3 and 5 minutes intervals. Pharyngolaryngeal morbidity was also recorded and followed for 24 hours following procedures. Results were analyzed using Mann-Whitney Test and the Independent t-test. The qualitative variables were analyzed using the Chi-Square test/Fisher’s Exact test. Result: Demographics, as well as vital parameters, showed no significant differences between the two groups. The decrease in stress response was seen in normotensive patients only in group II but not in hypertensive patients. Conclusion: Intubating laryngeal mask airway did not help in blunting the stress response when compared with Macintosh laryngoscope in hypertensive patients but a decrease in stress response was seen in normotensive patients at 3 minutes after intubation. Though it can be used as an alternative method for intubation.

Normotensive and hypertensive Immunoglobulin a nephropathy with ischemic renal injury: clinicopathological characteristics and prognosis

Objectives This study aimed to investigate the clinicopathological characteristics and prognosis of normotensive and hypertensive IgAN patients with ischemic renal injury. Methods A total of 344 cases of IgAN with ischemic renal injury were included in the study, including 99 normotensive IgAN patients (28.8%) and 245 hypertensive IgAN patients (71.2%). In addition, 467 IgAN patients without ischemic renal injury were included as controls, including 205 normotensive patients and 262 hypertensive patients. Clinicopathological and prognostic data were collected and analyzed. Results Compared with patients without ischemic renal injury, IgAN patients with ischemic renal injury displayed a higher proportion of hypertention, a higher proportion of ischemic glomerulosclerosis, tubular atrophy/interstitial fibrosis and vascular lesions (all p < .05). There was no significant difference in cumulative survival between the normotensive IgAN patients groups (Log-rank χ2 = 0.479; p = .489). Furthermore, ischemic renal injury was not a risk factor for end-point events in normotensive IgAN patients (HR = 1.103; 95% CI: 0.279–4.365; p = .889). There was lower cumulative survival in hypertensive IgAN patients with ischemic renal injury (Log-rank χ2 = 11.352, p = .001). Moreover, ischemic renal injury was a risk factor for end-point events in hypertensive IgAN patients (HR = 1.889; 95% CI: 1.124–3.178; p = .016). Conclusions Ischemic renal injury can occur in normotensive IgAN patients. Although the pathological changes may not affect the long-term prognosis of normotensive IgAN patients, the prognosis for hypertensive IgAN patients remains poor. Therefore, increased attention should be paid to the clinical management of ischemic lesions in hypertensive IgAN patients.

Detection of hypotension during spinal anesthesia for caesarean section with continuous non-invasive arterial pressure monitoring and intermittent oscillometric blood pressure monitoring in patients treated with ephedrine or phenylephrine

Introduction/Objective. Despite frequent side effects such as hypotension, spinal anesthesia (SA) is still one of the best anesthetic methods for elective cesarean section (CS). Intermittent, oscillometric, noninvasive blood pressure monitoring (NIBP) frequently leads to missed hypotensive episodes. The objective was to compare continuous non-invasive arterial pressure (CNAP) monitoring with NIBP in the terms of efficiency to detect hypotension. Methods. In this study, we compared CNAP and NIBP monitoring for hypotension detection in 76 patients divided into two groups of 38 patients treated with ephedrine (E) or phenylephrine (P), during threeminute intervals, starting from SA, by the end of the surgery. Results. In E group, significantly lower mean systolic blood pressure (SBP) values with CNAP compared with NIBP (p = 0.008) was detected. By monitoring CNAP, we detected 31 (81.6%) hypotensive patients in E group and significantly lower number, 20 (52.6%), with NIBP (p = 0.001), while in P group CNAP detected 34 patients (89.5%) and NIBP only 18 (47.3%), p = 0.001. By monitoring CNAP, we detected significantly higher number of hypotensive intervals in E and P groups (p &lt; 0.001). Umbilical vein pH was lower within hypotensive compared with normotensive patients in E and P groups, with CNAP and NIBP, respectively (p &lt; 0.001, p = 0.027 in E, and p = 0.009, p &lt; 0.001, in P group). Conclusion. CNAP is more efficient in hypotension detection for CS during SA, which allows faster treatment of hypotension, thus improving fetal and maternal outcome.

A Subtle Decline in Cardiac Mechanics is correlated with Albuminuria in Asymptomatic Normotensive Patients with Type 2 Diabetes Mellitus: A Two Dimensional Strain Echocardiography Study.

Background:Type 2 diabetes mellitus (T2DM) insidiously affects the myocardium with subsequent cardiomyopathy and induces microvascular damage in the kidneys reflected by albuminuria. We aimed to investigate the relationship between albuminuria and subclinical left ventricular (LV) systolic dysfunction in asymptomatic normotensive patients with T2DM assessed by two-dimensional speckle-tracking echocardiography.Materials and Methods and Results:Sixty normotensive patients with T2DM were included and subdivided into two subgroups, each including thirty patients according to the presence of albuminuria, together with thirty control subjects. All underwent echocardiographic examination, including LV regional and global longitudinal strain (GLS) measurements. Laboratory tests were withdrawn, including serum glycated hemoglobin (HbA1C) and albumin–creatinine ratio (ACR). When compared to the control group, patients with T2DM had a significantly lower average peak systolic LV GLS (−16.18% ± 2.78% vs. −18.13% ± 2.86%, P < 0.001), however, there was no significant difference in average peak systolic LV GLS between both diabetic subgroups (−15.57% ± 2.77% in the albuminuric subgroup vs. −16.79% ± 2.70% in the nonalbuminuric subgroup, P = 0.077). Moreover, there was a significant correlation between ACR and reduction of GLS in patients with T2DM and albuminuria (r = 0.55, P = 0.002). However, this correlation was absent in patients with T2DM without albuminuria (r = 0.107, P = 0.573).Conclusions:Patients with T2DM have subclinical LV systolic dysfunction with a reduction of average LV GLS that correlates with ACR in patients with T2DM and albuminuria.

First Trimester Mean Platelet Volume, Neutrophil to Lymphocyte Ratio, and Platelet to Lymphocyte Ratio Values Are Useful Markers for Predicting Preeclampsia.

Background: Preeclampsia complicates 2% to 8% of all pregnancies. Systemic inflammatory response (SIR) markers are widely used in the diagnosis of many inflammatory diseases and in the prediction of complicated pregnancies. This study examined the diagnostic value of SIR markers during the first trimester of pregnancy to predict preeclampsia development.Methods: This retrospective case-control study was conducted from January 2020 to May 2020. We included 94 patients diagnosed with mild preeclampsia, 107 patients diagnosed with severe preeclampsia, and 100 normotensive pregnant patients as controls. We obtained the first trimester (6 to 14 weeks) complete blood cell counts for all patients. We used a receiver operating characteristic curve to evaluate the cutoff, sensitivity, and specificity values.Results: First trimester mean platelet volume (MPV), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) values were significantly higher in patients who developed preeclampsia in later pregnancy weeks. The optimal cutoff value for MPV was 10.65 fL, with a sensitivity of 63.7% and a specificity of 65.0%. The best predictor for preeclampsia was NLR at an optimal cutoff value of 4.12, with a sensitivity of 82.1% and specificity of 62.0%. At a cutoff value of 131.8, PLR predicted preeclampsia with a sensitivity rate of 65.0% and a specificity rate of 60.2%.Conclusion: The results of this study suggest that first trimester MPV, NLR, and PLR values are clinically useful markers in the prediction of preeclampsia. The increased first trimester values of MPV, NLR, and PLR also indicate that inflammation may play a crucial role in preeclampsia pathogenesis.

Revelation of subclinical left ventricular diastolic dysfunction in patients with type 2 diabetes mellitus using 2016 ASE/ EACVI guidelines.

Background:Few studies have used the 2016 American Society of Echocardiography/ European Association of Cardiovascular Imaging (ASE/EACVI) guidelines to detect left ventricular diastolic dysfunction (LVDD) among asymptomatic normotensive type 2 diabetes mellitus (T2DM) patients.Methods:200 asymptomatic non-hypertensive diabetic cases and 281 controls matched for age and body mass index without evidence of arrhythmias, valvular, myocardial, pericardial or coronary artery disease underwent diastology assessment using 2 dimensional and M-mode echocardiography along with tissue Doppler imaging.Results:The presence of LVDD was seen to be significantly higher among the members of the diabetic group compared to the controls (35 vs. 14; P=0.001). The diabetics with LVDD had a longer duration of diabetes {8.04±7.75 vs. 5.27±5.49 years; P=0.04}, along with higher glycated hemoglobin (HbA1c) {8.40±1.38 vs. 7.80±1.60% ; P=0.05}, fasting blood glucose (FBS) {211.35±78.15 vs. 187.89±107.90 mg/dL; P=0.009, 2 hour post prandial blood glucose} (PPBS) {237.89±107.9 vs. 211.35±78.15 mg/dL; P=0.04}, serum triglyceride (TG) {246.91±171.82 vs. 163.44±99.37 mg/dL; P=0.008} yet had lower serum very low density lipoprotein levels (VLDL) {19.74±15.01 vs. 27.61±17.89 mg/dL; P=0.01}.Conclusion:This is one of the few studies so far to have demonstrated a higher occurrence of LVDD specifically among asymptomatic normotensive T2DM patients using the 2016 ASE/EACVI guidelines.

When the worst is not that bad: Bordeaux protocol safety and efficacy in renovascular malignant hypertension

Malignant arterial hypertension is a poorly known pathology, with a poor prognosis in absence of adequate emergency care. Since 1995, the excellence center in Bordeaux University Hospital has been implementing a therapeutic protocol based on rapid titration of angiotensin converting enzyme inhibitor for the management of these acute patients. This “Bordeaux protocol” has demonstrated its effectiveness and safety but its widespread use is limited by the fear of complications in patients with renal artery stenosis. The objective of this study is to compare the protocol safety and efficacy in patients with renovascular and non-renovascular malignant hypertension. Our retrospective case-control study compared 2 groups of patients from the Bordeaux cohort of malignant hypertension since 2008. The first group included patients with renovascular malignant hypertension and the second one the rest of the cohort. We excluded patients managed in non-urgent basis. We included 10 patients with renovascular malignant hypertension and 74 control patients. No serious adverse events occurred in both groups (acute kidney failure requiring dialysis, threatening hyperkalemia, sudden drop in blood pressure requiring immediate attention). Discontinuation of ACE inhibitors for significant elevation of creatinine occurred once in each group ( P = 0.22). Blood pressure drop between admission and discharge was similar in the 2 groups (-73mmHg ± 43 mmHg vs. −75mmHg ± 31.7 in the control group, P = 0.9). One-month prevalence of normotensive patients was also comparable (85% vs. 73% in the control group, P = 0.67). Efficacy and safety of the “Bordeaux Protocol” is maintained in patients with renovascular malignant hypertension, thanks to close monitoring. These results need to be replicated to be widespread.

Comparison Of Fentanyl And Clonidine In Attenuation Of Haemodynamic Response To Laryngoscopy And Endotracheal Intubation

Background: Laryngoscopy and endotracheal intubation has led to provision of safer anaesthesia due to better control of airway and ventilation. It is associated with reflex sympathetic stimulation resulting in an increase in heart-rate and blood-pressure, which is known as pressor response to laryngoscopy and intubation.Various drugs have been used to avoid this pressor response. This study was aimed to assess the effects of IV Fentanyl and IV Clonidine on pressor responses occurring due to laryngoscopy and intubation in normotensive patients posted for a planned surgical procedure under general anaesthesia.Methods: Approval from the institutional ethical committee was taken for the study. We conducted this study in 60 patients belonging to ASA grade I and II, of 18 to 65 years of age, of either sex, scheduled for planned surgical procedures under general anaesthesia.Patients were randomly allocated into 2 groups; the study drug was injected IV slowly 10 mins before induction.Group-F: received Inj Fentanyl 2mcg/kgGroup-C: received Inj. Clonidine 2mcg/kgObservations were noted in terms of heart-rate, systolic-BP, diastolic-BP, mean-BP and spO2.Results: We observed that Clonidine pre-treatment provided better blunting of stress response duringlaryngoscopy and intubation without causing clinically significant sedation, respiratory depression, bradycardiaor hypotension compare to Fentanyl.Conclusion:We came to a conclusion that Clonidine provided better response compare to Fenatanyl in obliterating the rise in heart-rate and blood pressure on laryngoscopy and intubation.

Retrospective Analysis of Diagnosis, Treatment and Prognosis of Hypokalemic Normotensive patients who were followed up in Nephrology Clinic due to renal potassium loss

Retrospective Analysis of Diagnosis, Treatment and Prognosis of Hypokalemic Normotensive patients who were followed up in Nephrology Clinic due to renal potassium loss

MicroRNA 21 and microRNA 155 levels in resistant hypertension, and their relationships with aldosterone

Aim MicroRNAs (miRNAs) are non-coding RNA molecules that serve as regulators following gene expression transcription. While studies have investigated the role of miRNAs in the pathogenesis of essential hypertension (HT), very few have considered their place in the pathogenesis of resistant hypertension (RH). The purpose of this study was to investigate levels of miRNA 21 and miRNA 155 in RH and their relationships with aldosterone. Method Thirty-two normotensive patients, 30 newly diagnosed HT patients, and 20 RH patients were included in the study. Patients’ demographic data were recorded, and office blood pressure measurement and 24-h ambulatory blood pressure monitoring (24-h ABPM) were performed. Blood specimens were collected for miRNA 21, miRNA 155 and aldosterone measurement. MiRNA 21 and miRNA 155 levels in the control and patient groups and their relations with other demographic and biochemical parameters were then subjected to analysis. Results No difference was determined in miRNA 155 levels between the groups, but miRNA 21 and aldosterone levels were significantly higher in the RH group (p < 0.001 and <0.05, respectively). At correlation analysis, miRNA 21 exhibited positive correlation with aldosterone, age, office SBP, 24-h ABPM all-day SBP. A 9.6 copy/uL level for miRNA 21 predicted presence or absence of RH with 95% sensitivity and 71% specificity (AUC:0.823, 95% CI (0.72–0.92). Conclusion The study results revealed significantly higher miRNA 21 and aldosterone in RH patients than in healthy individuals and newly diagnosed hypertensives.

Complications of White-coat Hypertension Compared to a Normotensive and Hypertensive Population.

Background:Accumulating evidence demonstrates that white-coat hypertension (WCH) are associated with several risks and complications. In this study, we aimed to investigate the adverse effects of WCH compared with hypertensive and normotensive patients.Methods:A retrospective cohort study was conducted over five years. Blood pressure (BP) data was collected from both clinic visits and 24-h ambulatory blood pressure monitoring (ABPM) reports. Epidemiological data and complications, cardiac and noncardiac, were also recorded.Results:In total, 286 participants who were followed up for at least three years were included. The sample was divided into 99 normotensive patients (as a control group), 94 patients with clinically diagnosed hypertension (HTN), and 93 patients with WCH. Ischemic heart disease (IHD) was the most noted complication in the WCH group with a relative risk of 9.58 (1.23–74.16) (P = 0.008). Acute coronary syndrome (ACS) was significantly correlated with a relative risk of 2.06 (0.52–13.38). No significant correlation was noted with noncardiac complications. Both HTN and WCH groups showed a significant association with blood pressure variability (BPV). WCH was associated with an increased BPV in ambulatory daytime systolic measurements (P = 0.031) and a unique increase in diastolic measurement variability in office BP measurements (P = 0.020).Conclusion:WCH should be managed as HTN. WCH is associated with cardiac complications, particularly IHD, specifically in patients 55 years and older. WCH was significantly associated with a higher BPV in both ABPM and office-based measurements.

Normotensive presentation in primary aldosteronism: A report of two cases

Normotensive patients with primary aldosteronism (PA) are relatively rare. Herein, we report two patients with normotensive PA and present a literature review to improve an understanding of the disease. Patient 1, a 56-year-old man, presented with recurrent hypokalemia that lasted for more than 2 years. Patient 2 was a 33-year-old man who presented with sexual dysfunction and was diagnosed with a prolactinoma combined with adrenal insufficiency and hypogonadism. Neither of these patients had hypertension that was detectable on repeated manual measurements. In both patients, a typical biological profile of PA was demonstrated that included hypokalemia with kaliuresis, elevated plasma aldosterone concentration (PAC), suppressed plasma renin concentration, and a high aldosterone-to-renin ratio. Both patients did not have sufficiently suppressed PAC on the saline infusion test, confirming the diagnosis of PA. Computed tomography of the adrenal gland and adrenal venous sampling suggested an aldosteronoma, which was confirmed by lateralized hypersecretion of aldosterone. After removal of the benign adenoma, the biochemical abnormalities were corrected. As hypertension is not necessarily a sign of PA, we propose that all patients with hypokalemia should be screened for PA in order to prevent cardiovascular complications while balancing economics and effectiveness.

Relationship among Preoperative, Pre and Postinduction Blood Pressure in Normotensive and Hypertensive Patients

Abstract Objectives: This study aimed to verify the relationship between blood pressure (BP) obtained during preoperative evaluation at preinduction and compared to BP at 20 min after induction for normotensive and hypertensive patients. Methods: Data from patients who underwent elective surgical procedures from July 2018 to September 2019 were retrospectively extracted and analyzed. The data included patient characteristics (age, sex, weight, height, body mass index (BMI)), physical status (ASA classification), comorbidities, medications in use, and mean arterial BP (MAP) recorded preoperatively (MAPpre-op), before induction of anesthesia (MAPpre-ind), and 20 min after induction (MAPpost-ind). Results: A total of 1026 patients were selected, 341 were included in the final analysis (normotensive patients (GNT n = 203), treated hypertensive patients (GTREAT n = 98), untreated hypertensive patients (GNO TREAT n = 40). There was an increase in the median MAP from preoperation to preinduction in the total sample and the three groups (GNT, GTREAT, and GNO TREAT). There was a statistically significant reduction in MAPpost-ind concerning MAPpre-ind and MAPpre-op in the three groups. The three groups' comparison showed a statistically significant difference between MAPpost-ind and MAPpre-ind and between MAPpost-ind and MAPpre-op. Conclusions: Our study showed that normotensive and hypertensive patients showed a significant BP increase at the preinduction time point. Treated and untreated hypertensive patients had a more considerable increase in preinduction BP and BP reduction at 20 min after anesthesia induction than normotensive patients. These changes were more significant in hypertensive patients without treatment.

Lipid Profile in Preeclampsia Patients as Compared to Normal Patient

The main objective of the study was to see the association of dyslipidemia in preeclampsia (PET) as compare to normotensive (NT) patients. It was a descriptive study done in Nepal Medical College Teaching Hospital Department of Obstetrics and Gynecology from April 2019 from April 2020. A total of 75 PET (test group) and 75 NT (control group) in their third trimester were included. Their fasting lipid profile was studied. It was found that triglyceride (TG) and very low density lipoprotein (VLDL) was significantly high among PET group as compared to that of NT patients. The mean TG of PET group was 266.11± 98.61 and the NT group was 187±58.56 (p=0.00) and the mean VLDL of PET group was 46.00±15.31 and NT group was 37.88±12.85 (p=0.001). On the other hand, the total cholesterol (TC), low density lipoprotein (LDL) and high density lipoprotein (HDL) were not significantly different in both the groups. It was also found that with the severity of the disease (Preeclampsia), the level of TG and VLDL increased significantly. Therefore, among the investigation done for PET, we should include lipid profile, especially the TG and VLDL. Furthermore, TG and VLDL should be measured serially (at least once a week) so as to predict the progress of PET and manage the patient accordingly.