Number Of Antihypertensive Agents Research Articles

Management of Hypertension in Children and Adolescents.

Hypertension in children and adolescents is becoming a greater problem in the developed world. Although traditionally thought of as usually secondary to renal, vascular, or endocrine causes, primary hypertension is becoming the most common form seen in childhood. This changing epidemiology is related to the recent obesity epidemic. The evaluation of high blood pressure in children is more involved than in adults and is aimed both at identifying secondary causes and to identify other co-morbidities of cardiovascular risk. Treatment of hypertension in childhood and adolescence is aimed at reducing cardiovascular risk. While there are a growing number of antihypertensive agents with FDA labeling for children, there remain far fewer options than for adults. This paper reviews the epidemiology, definitions, evaluations, and management of elevated blood pressure in children and adolescents.

Diuretics vs. placebo for postpartum blood pressure control in preeclampsia (DIUPRE): a randomized clinical trial.

BackgroundHypertension affects about 10 % of pregnancies and is responsible for both maternal and neonatal devastating complications such as eclampsia, HELLP syndrome, prematurity and maternal and neonatal death. The resolution of the disease occurs in the first twelve weeks postpartum. The behavior of blood pressure and occurrence of very high blood pressure episodes among women with severe preeclampsia is related to remodeling of the dynamics of body fluids with consequent increase in intravascular volume. The persistence of hypertension in critical levels results in increased puerperal morbidity.ObjectivesTo evaluate the effectiveness of furosemide in accelerating blood pressure recovery among women with severe preeclampsia.Methods/designA triple-masked placebo controlled clinical trial, will be conducted including 120 postpartum women with severe preeclampsia, after eclampsia prophylaxis with magnesium sulfate and with adequate diuresis. Women with chronic hypertension and users of diuretics will be deleted. Informed consent will be obtained from all participants. Patients will be randomized to receive furosemide (40 mg orally every twenty four hours) or placebo. The variables are systolic and diastolic blood pressure, frequency of hypertensive crises, need for maintenance of antihypertensive therapy, number of antihypertensive agents used to control blood pressure, urine output, length of hospital stay, adverse effects and maternal complications. This study was approved by the Research Ethics Committee in humans of our institution. All participants will be duly informed about the aims of the project and will be included only if they agree to participate voluntarily, signing the informed consent.Trial registrationThis study was registered on Clinical Trials.gov under the number NCT02163655. (http://clinicaltrials.gov/show/NCT02163655).

The Effects of Aldosterone Antagonists in Patients With Resistant Hypertension: A Meta-Analysis of Randomized and Nonrandomized Studies.

A few studies have shown aldosterone antagonists (AA) to be effective therapy in patients with resistant hypertension (RH). We performed a meta-analysis of randomized and nonrandomized studies of AA in patients with RH. We searched PUBMED, EMBASE, and CENTRAL for studies on the use of AA in patients with RH. Meta-analysis was performed using random-effects model. The change in office and ambulatory blood pressures (BP), effects on biochemical profile, change in the number of antihypertensive agents, and adverse events were main outcomes. We included 15 studies (3 randomized controlled trials, 1 nonrandomized comparative study, and 11 single-arm studies) with 1,204 total patients in the meta-analysis. In comparative studies, AA reduced systolic BP (SBP) by 24.26 mm Hg (95% CI: 8.65-39.87, P = 0.002) and diastolic BP (DBP) by 7.79 mm Hg (3.79-11.79, P = 0.0001). Similarly, AA reduced SBP by 22.74 mm Hg (18.21-27.27, P < 0.00001) and DBP by 10.49 mm Hg (8.85-12.13, P < 0.00001) in single-arm studies. AA resulted in significant change in serum electrolytes in single-arm studies but not in comparative studies. Significantly more adverse events were noted in single-arm studies but not in comparative studies. On the basis of the current meta-analysis, we conclude that AA is safe and effective therapy in patients with RH.

Контроль артеріального тиску в пацієнтів з ішемічною хворобою серця порівняно з пацієнтами без ішемічної хвороби серця

Основною умовою запобігання ускладненням артеріальної гіпертензії (АГ), у тому числі і при поєднанні з ішемічною хворобою серця (ІХС), є зниження артеріального тиску (АТ) до цільового рівня. Наявність ІХС розглядається як фактор, що може впливати на ефективність антигіпертензивної терапії. Досі майже не проводилося визначення та порівняння предикторів досягнення цільового АТ окремо в популяціях гіпертензивних пацієнтів з ІХС та без неї. Тому це стало метою нашого дослідження. У дослідження включений 9821 пацієнт (середній вік 58,90 ± 0,24 року) з АГ. Усі пацієнти залежно від наявності ознак ІХС були розподілені на дві групи: перша група — 4193 пацієнти без ознак ІХС; друга група — 5628 пацієнтів з ознаками ІХС. Діагноз ІХС встановлювався лікуючими лікарями. 531 лікар на свій розсуд призначав хворим з АГ антигіпертензивні препарати у дозах, які вважав за потрібне. Контроль ефективності лікування відбувався під час візитів — загалом 4 візити протягом 3 місяців. Пацієнтам під час візитів вимірювали офісний АТ, проводили електрокардіографію, оцінку прихильності до лікування за допомогою стандартної анкети, оцінку серцево-судинного ризику та опитування згідно з розробленою авторами дослідження анкетою. Мультифакторний регресійний аналіз застосовували для виявлення незалежних предикторів недостатньої ефективності терапії.Встановлено, що наявність ознак ІХС у пацієнтів з АГ асоціювалася з більшою частотою виявлення ускладнень (серцева недостатність, ураження нирок, інсульт) та цукрового діабету, факторів ризику (дисліпідемія, обтяжена спадковість, старший вік, високий АТ), що потребувало призначення більшої кількості антигіпертензивних препаратів. Пацієнти без ознак ІХС частіше мали шкідливі звички, а додаткова фізична активність хоча і була в переважної більшості хворих даної групи, але була недостатньою. Рівень систолічного (САТ) та діастолічного (ДАТ) АТ у другій групі був більш високим як на початку, так і в кінці спостереження, незважаючи на більш інтенсивне лікування (більшу кількість призначених антигіпертензивних препаратів). Цільового рівня АТ (&lt; 140/90 мм рт.ст.) було досягнуто в 68,7 % пацієнтів першої групи та лише в 51,1 % пацієнтів другої групи (Р &lt; 0,001). Групи пацієнтів з ІХС та без неї серед спільних предикторів недостатньої ефективності терапії мали лише високий рівень САТ (&gt; 160 мм рт.ст.) і ДАТ (&gt; 100 мм рт.ст.) на початку дослідження: імовірність збільшувалася у 3,83 і 2,81 та 3,92 і 2,5 раза відповідно для підвищених САТ і ДАТ у першій та другій групах. У пацієнтів без ІХС імовірність недосягнення цільового АТ також асоціювалася з підвищеним індексом маси тіла (β = 1,033, Р = 0,05) та більш рідким уживанням свіжих овочів та фруктів (β = 12,8, Р = 0,025). У другій групі ризик неефективного лікування збільшувався за наявності супутньої серцевої недостатності (β = 1,73, Р = 0,001) та зменшувався за наявності есенціальної, а не ренопаренхімної АГ (β = 0,76, Р = 0,05). Більш високий серцево-судинний ризик по-різному асоціювався з імовірністю недостатньої ефективності терапії: у першій групі — збільшував (β = 1,46, Р = 0,001), а у другій групі, навпаки, зменшував (β = 0,52, Р = 0,001). На початку дослідження лише 28,3 % пацієнтів першої групи та 19,5 % другої (Р &lt; 0,001) мали високу прихильність до лікування. Висока прихильність до лікування на початку дослідження сприяла зменшенню імовірності недосягнення цільового АТ на 36 % у першій групі, тоді як для пацієнтів з ІХС вона не мала незалежного значення. Проте висока прихильність в кінці дослідження у другій групі асоціювалася зі зменшенням ризику неефективності лікування на 46 %.Таким чином, хворі на АГ з ІХС та без неї мали різний контроль АТ та різні фактори, асоційовані з досягненням його цільового рівня, що дозволяє по-різному формувати тактику ведення пацієнтів.

Renal Artery Calcification and Stenosis in Potential Live Kidney Donors: Results of a UK-Wide National Survey of Transplant Surgeons.

Renal artery calcification (RAC) is highly associated with calcification in other vascular beds, independent of traditional risk factors. There is no evidence-based consensus on the suitability for live donor nephrectomy (LDN) in donors with non-flow limiting RAC or renal artery stenosis (RAS). This national survey aimed to explore opinions of all renal transplant surgeons in the UK. Methods: An online survey was distributed to 101 renal transplant surgeons from 23 institutions in the UK. Opinions were sought on donor suitability with unilateral or bilateral RAC or RAS, in the context of anti-hypertensive treatment (0, 1, 2 or 3+ agents) and presence or absence of other vascular disease. Results: The response rate was 66.3%.Table: No Caption available.Conclusions: This national survey has demonstrated that there is a tendency for UK transplant surgeons to consider a donor with RAC potentially suitable for LDN, however opinion varies depending on the number of anti-hypertensive agents, comorbidities and whether both renal arteries are affected. Most respondents consider bilateral RAS a contraindication to LDN, irrespective of comorbidities. Further studies are required to investigate.

Different expression of 11β-hydroxylase and aldosterone synthase between aldosterone-producing microadenomas and macroadenomas.

Aldosterone-producing adenoma is a major subtype of primary aldosteronism. The number of cases of these adenomas, which are below the detection limit of computed tomography but diagnosed by adrenal venous sampling, has recently been increasing. However, the pathophysiology of these adenomas, especially those manifesting clinically overt hyperaldosteronism despite their small size, remains unknown. Therefore, we examined the correlation between tumor size and the status of intratumoral steroidogenic enzymes involved in aldosterone biosynthesis using immunohistochemistry. Forty patients with surgically proven aldosterone-producing adenomas were retrospectively studied. Multidetector computed tomography, adrenal venous sampling, and laparoscopic adrenalectomy were performed in all of the patients studied. The tumor area at the maximum diameter of the sections was precisely measured by ImageJ software. The status of the steroidogenic enzymes was immunohistochemically analyzed, and the findings were evaluated according to the H-score system, based on both the number of immunopositive cells and relative immunointensity. Adrenal masses were not detected by computed tomography in 20 patients. Blood pressure, plasma aldosterone concentration, urinary aldosterone excretion, and the number of antihypertensive agents also decreased significantly after the surgery in these patients, as well as in the patients with adenomas detectable by computed tomography. Maximum tumor area obtained in the specimens was significantly correlated with preoperative plasma aldosterone concentration, urinary aldosterone excretion, and the H score of 11β-hydroxylase and was inversely correlated with the H score of aldosterone synthase. These results demonstrated that small adenomas could produce sufficient aldosterone to cause clinically overt primary aldosteronism because of the significantly higher aldosterone synthase expression per tumor area.

High incidence of secondary hypertension in patients referred for renal denervation – the Copenhagen experience

Percutaneous renal denervation is a new treatment option for patients with resistant hypertension and little is known about the eligibility of patients referred. 100 consecutive patients were referred for renal denervation from March 2011 through September 2012. Clinical data were prospectively extracted from letters and documents from referring clinics and from our physical examination. Of the 100 patients included, 68 were men and the mean age was 60 (± 12) years. Office blood pressure was 176 (± 28)/99 (± 19) mmHg and 24-h ambulatory blood pressure 156 (± 20)/88 (± 13) mmHg. The mean number of antihypertensive agents was 4.0 (± 1.6). Nearly four-fifths (82%) of the patients were categorized as having resistant hypertension based on the criteria stated by The American Heart Association's stated criteria. Nine patients declined interest in renal denervation before completing the clinical workup program. Thus, 91 patients were screened, and of those 51 were found to be candidates for renal denervation. Forty patients were not candidates, of which secondary hypertension was the most common cause (n = 10). Only 51% of patients referred for renal denervation were eligible for treatment. The prevalence of secondary hypertension was 10% of the referred population. Secondary hypertension should therefore be considered in the evaluation of candidates for renal denervation.

Relationship between Blood Pressure Variability and the Quality of Life

PurposeBlood pressure variability (BPV) is emerging as an important cardiovascular prognostic factor in addition to average blood pressure level. While there have been some suggestions for the determinants of the blood pressure variability, little is known about the relationship between the blood pressure variability and health-related quality of life (QOL).Materials and MethodsFifty-six men and women with mild hypertension were enrolled from local health centers in Republic of Korea, from April to October 2009. They self-monitored their blood pressure twice daily for 8 weeks. Pharmacological treatment was not changed during the period. Standard deviation and coefficient of variation of blood pressure measurements were calculated as indices of BPV. Measurements of QOL were done at initial and at 8-week follow-up visits.ResultsStudy subjects had gender ratio of 39:41 (male:female) and the mean age was 64±10 years. The mean home blood pressure's at week 4 and 8 did not differ from baseline. Total score of QOL at follow-up visit and change of QOL among two measurements were negatively correlated to BPV indices, i.e., higher QOL was associated with lower BPV. This finding persisted after adjustment for age, gender and the number of antihypertensive agents. Among dimensions of QOL, physical, mental and hypertension-related dimensions were associated particularly with BPV.ConclusionQOL may be a significant determinant of BPV. Improvement of QOL may lead to favorable changes in BPV.

Individualized treatment with multiple antihypertensive agents is often necessary when treating hypertension in obese patients

Treatment with a number of antihypertensive agents is usually necessary to achieve blood pressure control in patients with obesity-related hypertension. Diuretics, renin-angiotensin system inhibitors and dihydropyridine calcium channel blockers are commonly used first, with subsequent additions of aldosterone antagonists and/or dual α- and β-blocking agents as necessary. Treatment should be based on an understanding of the underlying mechanisms of obesity-related hypertension, and individualized according to patient characteristics and co-morbidities.

Mortalidad global en ancianos con hipertensión arterial: seguimiento prospectivo durante 6 años

IntroductionThe prevalence of high blood pressure (BP) in the elderly is high. Untreated hypertension can accelerate the rate of vascular aging. The aim of this study was to analyze, mortality, and the causes and predictors of mortality, in elderly patients with high BP and a 6-year follow-up. Patients and methodsA prospective, observational study was performed in 66 elderly patients with high BP, who were randomly recruited in Geriatrics and Nephrology consultations between January and April 2006 and were followed-up for 6 years (second evaluation between January and April, 2012). The mean age of the patients was 82.3±6 years (range, 69-97 year), and there were 50 women and 16 men. ResultsA total of 44 patients (66.6%) died during the 6-year follow-up. Among the known causes of mortality, the main cause was progressive deterioration in the patient's general health status (n=14), while less frequent causes were cardiovascular disease and stroke (n=9). No significant variations were found between survivors and nonsurvivors in the number of antihypertensive agents or in the types of drugs used in the baseline period, except for angiotensin II receptor blockers, which were less frequently used in nonsurvivors (P=.018).In the univariate analysis of the baseline characteristics, nonsurvivors were significantly older (P=.002), were mostly men (P=.006), had greater renal function impairment (P=.000), and higher levels of serum uric acid serum (SUA) (P=.000). In the multivariate Cox analysis, the only independent predictors of mortality were sex (P=.029) and SUA levels (P=.000). ConclusionsIn our cohort of hypertensive elderly patients, predictors of mortality were sex and SUA levels. The main cause of mortality was progressive deterioration in general health status.

The number of antihypertensive agents simply reflects the grade and the risk of atherosclerosis in patients with type 2 diabetes mellitus

Aims: The associations between the number of antihypertensive agents being taken by type 2 diabetic patients and 1) the grade of atherosclerosis according to non-invasive surrogate markers for atherosclerosis and 2) the other risk factor for atherosclerosis, were cross-sectionally investigated. Methods: The association between the blood pressure control and the clinical characteristics was evaluated in 1359 patients with type 2 diabetes mellitus. Results: The number of antihypertensive agents was 1.5 ± 1.4 (2.0 ± 1.2 among the 990 patients with hypertension). The proportion of patients taking no antihypertensive agents was 29%, 22% were taking one, 29% were taking two and 21% of the patients were taking three or more antihypertensive agents. The value of the ankle-brachial pressure index significantly decreased with the increase in the number of antihypertensive agents even if the blood pressure was corrected to the target value. The values of brachial-ankle pulse wave velocity and carotid intima-media thickness were also increased. The prevalence of risk factors for atherosclerosis, such as obesity, hyperlipidemia, chronic kidney disease, hyperuricemia and anemia was significantly elevated with the number of agents. Conclusions: The number of antihypertensive agents simply reflects the grade and risk of atherosclerosis in patients with type 2 diabetes mellitus.

1071 Gender differences in 24-hour blood pressure regulation in hypertensive patients with coronary atherosclerosis confirmed in angiography

Introduction: More and more evidence indicate that gender plays important role in hypertension and coronary atherosclerosis pathogenesis. The aim of our study was to assess 24-hour blood pressure profile in hypertensive men and women with established coronary atherosclerosis. Methods: We enrolled 891 patients with hypertension and coronary atherosclerosis confirmed in coronary angiography (at least one coronary stenosis ≥70%), divided into two groups: women, n = 276, mean age 66.4 ± 8.4 and men, n = 615, mean age 62.5 ± 9.5. Reverse dipper, Dipper, Non-dipper and Extreme dipper profiles were defined according to night fall of systolic blood pressure (SBP) and diastolic blood pressure (DBP). Results: Higher values of only DBP were observed in men in comparison to women as follows: 24-h (72.7 ± 8.3 mmHg vs. 68.5 ± 8.1 mmHg, p < 0.01), daytime (75.4 ± 8.6 mmHg vs. 71.4 ± 8.6 mmHg, p < 0.01) and nighttime (68.2 ± 9.0 mmHg vs. 63.7 ± 8.4 mmHg, p < 0.01). Our study revealed higher mean nocturnal/diurnal ratio (nighttime/daytime BP values) in men than women only for DBP (0.91 ± 0.06 vs. 0.89 ± 0.07, p < 0.02). There was lower prevalence of dippers in men than in women (39.7% vs. 47.8%, p < 0.02). The most common profiles were as follows: in men – non-dipper (43.2%) and in women – dipper (47.8%). The men group and the women group did not differ in treatment of hypertension (assessed either as number of antihypertensive agents or prevalence of using particular groups of antihypertensive drugs). Conclusion: Gender influences blood pressure regulation in patients with hypertension and coronary atherosclerosis. Dipper profile is more characteristic for women than for men.

A collaborative cardiologist-pharmacist care model to improve hypertension management in patients with or at high risk for cardiovascular disease.

Physician led collaborative drug therapy management utilizing clinical pharmacists to aid in the medication management of patients with hypertension has been shown to improve blood pressure control. With recommendations for lower blood pressures in patients with coronary artery disease, a cardiologist-pharmacist collaborative care model may be a novel way to achieve these more rigorous goals of therapy. The purpose of this project was to evaluate this type of care model in a high cardiac risk patient population. A retrospective cohort study determined the ability of a cardiologist-pharmacist care model (n=59) to lower blood pressure and achieve blood pressure goals (< 130/80 mmHg) in patients with or at high risk for coronary artery disease compared to usual cardiologist care (n=58) in the same clinical setting. The cardiologist-pharmacist care model showed a higher percentage of patients obtaining their goal blood pressure compared to cardiologist care alone, 49.2% versus 31.0% respectively, p=0.0456. Greater reductions in systolic blood pressure (-22 mmHg versus -12 mmHg, p=0.0077) and pulse pressure (-15 mmHg versus -7 mmHg, p=0.0153) were noted in the cardiologist-pharmacist care model. No differences in diastolic blood pressure were found. There was a shorter duration of clinic follow-up (7.0 versus 13.2 months, p=0.0013) but a higher frequency of clinic visits (10.7 versus 3.45, p<0.0001) in the cardiologist-pharmacist care model compared to usual care. The number of antihypertensive agents used did not change over the time period evaluated. This study suggests a team-based approach to hypertensive care using a collaborative cardiologist-pharmacist care model improves blood pressure from baseline in a high cardiac risk patient population and was more likely to obtain more stringent blood pressure goals than usual care.

Abstract 3356: Half the Stroke Survivors in the United States have Poorly Controlled Hypertension

Background: National guidelines recommend antihypertensive treatment to lower the risk of secondary strokes in both hypertensive and normotensive patients. The degree to which blood pressure (BP) is treated and controlled among stroke survivors in the US has not been systematically investigated. In this analysis of a nationwide database, we assessed recent patterns, predictors, and prognoses of antihypertensive drug use among survivors of a stroke. Methods: We reviewed prevalence and control of hypertension among adults with a history of stroke (based on self report) who participated in the National Health and Nutrition Examination Survey 1999 to 2004 with mortality follow-up through December 31, 2006. Logistic regression was used to determine predictors of poorly-controlled BP (&gt;140/90) and non-treatment. Cox models were used to examine the association between antihypertensive use vs. all-cause mortality, adjusting for confounders. Results: Among 9,145 participants aged ≥40 years, 490 reported previous stroke, corresponding to 4,755,372 (4%) of US adults. Of those with previous stroke, 72% had known hypertension, 47% had poorly controlled hypertension, and 8% had undiagnosed hypertension. Compared to those not taking antihypertensive medications, those on treatment were more likely to be significantly older, male, black non-Hispanic, diabetic, with elevated levels of BP, total cholesterol, and body mass index. In multivariable analyses, age (OR per year 1.05, 95% CI 1.02-1.09), female sex (OR 1.43, 95% CI 1.14-1.79), Hispanic ethnicity (OR 1.76, 95% CI 1.24-2.49) and diabetes (OR 2.12, 95% CI 1.50-2.99) were associated with poorly controlled BP, while subjects who had a previous myocardial infarction (OR 0.66, 95%CI 0.45-0.97), drank alcohol (OR 0.62, 95% CI 0.42-0.90) or were overweight (OR 0.62, 95% CI 0.49-0.78) were less likely to have poorly controlled BP. Among those with poorly controlled BP, hypercholesterolemia (OR 1.30, 95% CI 1.07-1.57) and male sex (OR 1.33, 95% CI 1.06-1.63) were predictors of non-treatment, whereas current smoking (OR 1.59, 95% CI 1.32-1.92) or overweight (OR 1.92, 95% CI 1.32-2.78) were linked to treatment. Those on antihypertensive medications had lower rates of all-cause mortality but this result did not reach significance (adjusted HR 0.87; 95% CI 0.33-2.32), and was not influenced by baseline BP or number of antihypertensive agents. Conclusion: Rates of antihypertensive therapy and BP control among stroke survivors in the United States are poor. One in two stroke survivors has poorly controlled hypertension. Several medical and lifestyle modification factors could be potential targets of intervention to bridge this evidence-practice gap.

Prevalence of arterial hypertension and the number and classes of antihypertensive drugs prescribed for patients late after kidney transplantation

There are limitations of the use of several classes of antihypertensive drugs in patients after kidney transplantation (KTx), as well as contradictory opinions on their effects on progression of graft dysfunction. In this study we assessed the prevalence of arterial hypertension (HA) and the antihypertensive agents used by the patients long after KTx. This retrospective evaluation of the number and classes of antihypertensive drugs was based on medical records of 348 patients (140 F, 208 M; mean age 49 ± 13 years) late after KTx (mean time after KTx 78 ± 43 months). The data were related to graft function. Ninety-three percent of patients after KTx required antihypertensive therapy. Only 8.7% were treated with 1 agent (mean eGFR 65.1 ± 27.4 ml/min), 26.3% received 2 drugs (eGFR 60.0 ± 25.8 ml/min), 34.2% received 3 drugs (eGFR 55.5 ± 23.4 ml/min), 20.1% received 4 drugs (eGFR 54.9 ± 24.9 ml/min), and 10.5% received ≥ 5 drugs (eGFR 45.9 ± 22.0 ml/min). The number of antihypertensive medications increased along with the deterioration of graft function. Dihydropyridine calcium antagonists (CCB) were the most common class of drugs recommended to the patients after KTx (81%), followed by β-adrenergic antagonists (74.4%); α-antagonists (40.2%), angiotensin-converting enzyme inhibitors (38.7%), diuretics (34.1%), clonidine (17.8%) and angiotensin II receptor blockers (9.5%). HA is highly prevalent in KTx patients. Multidrug therapy is usually required for the treatment of HA in this population. Dihydropyridine CCB is the most common class of antihypertensive drugs used by them. Graft function is a determining factor in the number of antihypertensive agents.<br />

Cardiovascular Risk in Kidney Transplant Recipients Receiving Mammalian Target of Rapamycin Inhibitors

Cardiovascular diseases (CVD) are the leading cause of mortality in renal transplant recipients. Various traditional and unconventional cardiovascular risk factors are potentiated by the adverse effects of immunosuppressive drugs. The mammalian target of rapamycin (mTOR) inhibitors have shown cardioprotective effects in experimental studies, but their influence on CVD in renal transplantation is unclear. The study included 115 kidney transplant recipients treated with mTOR inhibitors with steroids. A group of 38 patients received additionally small doses of calcineurin inhibitor. The control group consisted of 58 kidney transplant recipients randomly chosen among the population of patients transplanted at the same time, who received a calcineurin inhibitor, mycophenolate mofetil or sodium plus steroids. No differences in age, gender, duration of pretransplantat dialysis, time after transplantation, body mass index or glycated hemoglobin existed between the groups. Blood pressure and number of antihypertensive agents, high-density lipoprotein cholesterol, and uric acid levels were similar. The prevalence of diabetic, ischemic, or hypertensive nephropathy as the reason for end-stage renal disease was similar ( P = .08). The study group showed higher mean values of total cholesterol (249 vs 204.6 mg/dL; P < .0001) and low-density lipoprotein 136.5 vs 117.7 mg/dL; ( P = .015), as well as median values of triglycerides (202 vs 142 mg/dL; P < .0001) and proteinuria ( P = .0002). mean estimated glomerular filtration rate was lower in the study group (42.9 vs 51.9 mL/min; P = .0003). Posttransplant diabetes appeared in 38% of the study group compared to 20% of the controls ( P = .08). The incidence of coronary artery disease was higher among patients treated with mTOR inhibitors ( P = .04). CVD, defined as myocardial infarction, percutaneous coronary intervention, stroke, aortic aneurysm, pulmonary thromboembolism, sudden cardiac death appeared in 26 study group compared with four control patients ( P = .24). The risk of any CVD was not significantly higher among patients receiving mTOR inhibitors hazard ratio 1.94; 95% confidence interval 0.83–4.52). In conclusion, no correlation was observed between the duration of mTOR therapy and CVD.

Appropriate Cardiovascular Prevention is Not Implemented in Diabetic Hypertensive Patients Treated in General Practice

Introduction of guidelines and more effective cardiovascular prevention have taken place in Finland. This study clarified whether treatment of the Finnish diabetics reflects these changes. Antihypertensive, lipemic and diabetic care of diabetics in Finnish general practice was analyzed nationwide by using a questionnaire. Subjects that participated in the study were consecutive hypertensive patients that had met their general practitioners during a given week in 2006. Only 9.4 % of the diabetics reached the blood pressure target below 130/80 mmHg. Fifty-six % of the patients reached the target of glycocylated haemoglobin (GHbA1c) below 7.0 %. The low density lipoprotein (LDL) cholesterol was below 2.5 mmol/l (96.7 mg/dl) in 43.9 % of the patients. In multivariate model, young age and high GHbA1c associated with high diastolic blood pressure. Fewer patients with GHbA1c > 7 % reached the target pressure below 140/90 mmHg than those with GHbA1c ≤7.0 % (p<0.05), but no difference was found if the target was below 130/80 mmHg. Neither the number of antihypertensive agents nor home blood pressure monitoring did affect the blood pressure. Blood pressure control of the treated Finnish diabetics was poor. Metabolic targets were more commonly reached than the blood pressure target but still too seldom. The cardiovascular prevention is not implemented in Finnish diabetic patients treated in general practice.

27 SINGLE CENTER OUTCOME OF LAPAROSCOPIC ADRENALECTOMY FOR PATIENTS WITH UNILATERAL ALDOSTERONE EXCESS: LATERALIZING DISEASE BASED ON THE RESULTS OF ADRENAL VENOUS SAMPLING

You have accessJournal of UrologyAdrenal: Surgery/Tumors/Benign and Malignant Disease1 Apr 201127 SINGLE CENTER OUTCOME OF LAPAROSCOPIC ADRENALECTOMY FOR PATIENTS WITH UNILATERAL ALDOSTERONE EXCESS: LATERALIZING DISEASE BASED ON THE RESULTS OF ADRENAL VENOUS SAMPLING Shigeto Ishidoya, Akihiro Ito, Yoshihide Kawasaki, Susumu Miyazato, Yasuhiro Kaiho, Haruo Nakagawa, and Yoichi Arai Shigeto IshidoyaShigeto Ishidoya Sendai, Japan More articles by this author , Akihiro ItoAkihiro Ito Sendai, Japan More articles by this author , Yoshihide KawasakiYoshihide Kawasaki Yuzawa, Japan More articles by this author , Susumu MiyazatoSusumu Miyazato Sendai, Japan More articles by this author , Yasuhiro KaihoYasuhiro Kaiho Sendai, Japan More articles by this author , Haruo NakagawaHaruo Nakagawa Sendai, Japan More articles by this author , and Yoichi AraiYoichi Arai Sendai, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.089AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The Endocrine Society published Clinical Practice Guideline of primary aldosteronism (PA) (J Clin Endocrinol Metab 93: 3266, 2008), which recommended that the distinction between unilateral and bilateral adrenal disease should be made by adrenal venous sampling (AVS) when considering surgical treatment. This study assessed the clinical impact of the universal use of adrenal venous sampling (AVS) and to investigate the characteristics of patients with PA undergoing laparoscopic adrenalectomy in a single tertiary center. METHODS After screening examination, confirmatory test, and computed tomography (CT) were completed, all patients with biochemically diagnosed hyperaldosteronism underwent AVS for differentiating unilateral disease from bilateral idiopathic hyperaldosteronism. A total of 174 consecutive patients with unilateral aldosterone excess underwent unilateral laparoscopic adrenalectomy. RESULTS Surgically treated cohort was divided into 3 groups based on CT findings. One hundred and twenty-nine patients were associated with CT-positive macroadenoma (Type 1A: 74.1%), while 42 were associated with CT-negative microadenoma (Type 2A: 24.1%). Only 3 patients had adrenocortical hyperplasia (Type 3: 1.8%). Aldosterone level was normalized in all but 2 patients (98.9%) and the number of antihypertensive agents was significantly reduced within one month after adrenalectomy. One hundred and fifty-five (89.1%) of 174 patients showed resolution or improvement of hypertension. CONCLUSIONS Routine use of AVS could adequately detect lateralization in patients with unilateral aldosterone excess, which led to satisfactory short-term outcomes following surgery. This study showed that nearly one-fourth of patients with the unilateral form were associated with CT-negative aldosterone-producing microadenoma. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e10 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shigeto Ishidoya Sendai, Japan More articles by this author Akihiro Ito Sendai, Japan More articles by this author Yoshihide Kawasaki Yuzawa, Japan More articles by this author Susumu Miyazato Sendai, Japan More articles by this author Yasuhiro Kaiho Sendai, Japan More articles by this author Haruo Nakagawa Sendai, Japan More articles by this author Yoichi Arai Sendai, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Single-center Outcome of Laparoscopic Unilateral Adrenalectomy for Patients With Primary Aldosteronism: Lateralizing Disease Using Results of Adrenal Venous Sampling

To assess the clinical effect of the universal use of adrenal venous sampling and to investigate the characteristics of patients with primary aldosteronism undergoing laparoscopic adrenalectomy at a single tertiary care center. After the screening examination, confirmatory test, and computed tomography (CT) scans were completed, all patients with biochemically diagnosed hyperaldosteronism underwent adrenal venous sampling to differentiate unilateral disease from bilateral idiopathic hyperaldosteronism. A total of 174 consecutive patients with unilateral aldosterone excess underwent unilateral laparoscopic adrenalectomy. The surgically treated cohort was divided into 3 groups according to the CT findings. A total of 129 patients (74.1%) had findings associated with CT-positive macroadenoma (type 1A) and 42 (24.1%) with CT-negative microadenoma (type 2A). Only 3 patients (1.8%) had adrenocortical hyperplasia (type 3). The aldosterone level was normalized in all but 2 patients (98.9%), and the number of antihypertensive agents was significantly reduced within 1 month after adrenalectomy. Of the 174 patients, 155 (89.1%) showed resolution or improvement of hypertension. The routine use of adrenal venous sampling could adequately detect lateralization in patients with unilateral aldosterone excess, which led to satisfactory short-term outcomes after surgery. The results of the present study showed that nearly one fourth of patients with the unilateral form had a CT-negative aldosterone-producing microadenoma.

The Effect of Hyperuricemia on Endothelial Biomarkers and Renal Function in Kidney Allograft Recipients

Background Uric acid may play a pathogenic role in hypertension, cardiovascular morbidity, and kidney disease. The aim of this study was to assess the effect of serum uric acid on biomarkers of endothelial activation and renal function in kidney allograft recipients during 30 months of follow-up. Methods The study included 100 allograft recipients with stable renal function (estimated glomerular filtration rate (eGFR) >60 mL/min). The study was performed 34 ± 12 months after transplantation. The patients were followed prospectively for 30 months. Seventy patients displayed hyperuricemia (uric acid 7.5 ± 1.0 mg/dL) and 30 normouricemia (5.5 ± 0.9 mg/dL). Concentrations of plasma resistin, soluble vascular cell adhesion molecule 1 (sVCAM-1), soluble CD146, and high-sensitivity C-reactive protein (hs-CRP) were assessed in patients at the beginning and after 30 months of follow-up. Clinical outcomes and biomarker values were analyzed in these groups and compared to a control group of 26 healthy volunteers. Results Concentrations of resistin and CD146 were increased among the hyperuricemia versus the normouricemic group ( P < .05). Serum uric acid level correlated with sVCAM-1, hs-CRP, resistin, and sCD146 concentration in both groups of kidney recipients ( P < .01). Serum creatinine concentrations correlated with sVCAM-1, resistin, and sCD146 concentrations ( P < .01). There were significant direct correlations between uric acid and the number of antihypertensive agents ( P < .001) and inverse correlations between eGFR ( P < .001) and high-density lipoprotein cholesterol ( P < .04). Pulse pressure increased in hyperuricemic patients during follow-up ( P < .05). The decrease in eGFR during the 30-month follow-up was similar in both groups. No subject progressed to kidney allograft failure. Patient and graft survivals were 98% among hyperuricemic and 96.7% among normouricemic individuals. Conclusions Hyperuricemia may injure endothelial function via resistin-dependent mechanisms. It represents a risk factor for arterial stiffness. The elevated serum uric acid may not have a causal role in the progression of renal transplant injury over 30 months of follow-up.