Previous History Of Hypertension Research Articles

P50. Microalbuminuria is a predictor of adverse pregnancy outcomes including preeclampsia

Abnormal urinary protein loss is a marker associated with a diverse range of renal diseases including preeclampsia. Current measures of urine protein used in the diagnostic criteria for the diagnosis of preeclampsia include urine protein:creatinine ratio and 24-hour urine protein. However very little is known about the value of urine albumin:creatinine ratio (uACR) in pregnancy. In this study we examined the prognostic value of microalbuminuria detected antepartum to predict adverse pregnancy outcomes. This is a single-centre retrospective analysis of 84 pregnant women over the age of 16 attending a tertiary ’high-risk’ pregnancy outpatient clinic between July 2010 and June 2013. Utilising medical records, antepartum peak uACR level and pregnancy maternal and fetal outcomes were recorded. To be included in the study, the participant had to have at least one uACR measurement performed during pregnancy (excluding measurements performed at or near to delivery). uACR measurements were obtained at various time points in the pregnancy, from gestational periods 0–19+6 weeks, 20–27+6 weeks, 28–33+6 weeks. As not all participants had uACR measurements at each of these time points, the peak uACR measurement prior to 34 weeks gestation (and prior to delivery date, to ensure that the uACR was not measured at the time of an adverse pregnancy outcome such as preeclampsia) was chosen for the final analysis. Patient characteristics, medications (particularly the use of aspirin and calcium), blood pressure, urinalysis, serum creatinine, fetal and maternal outcomes of the pregnancy were collected from patient medical records and electronic databases. Those patients who did not have at least one uACR performed prior to <34 wks or did not have data on the pregnancy outcomes of interest were excluded from the study. Out of 116 patients attending the renal pregnancy clinic between July 2010 and June 2013, 33 patients were excluded due to absence of at least one uACR performed prior to <34 wks or missing data on the pregnancy outcomes, leaving 83 patients for the final analysis. The women had a mean age of 33.1 (±5.4) years. Mean BMI was 29.4 (±8.1) kg/m2. Almost half the population (47.6%) had a previous history of hypertension, one fifth (20.2%) had a previous history of preeclampsia, and more than a third (36.9%) had chronic kidney disease. Over a third of the population (36.9%) had diabetes mellitus (DM) either in the form of gestational diabetes mellitus (GDM), Type 2 DM or Type 1 DM. The primary outcome was a composite of poor maternal and fetal outcomes including preeclampsia, maternal death, eclampsia, stillbirth, neonatal death, IUGR, premature delivery and placental abruption. As the antepartum peak uACR level (in mg/mmol) increased from normoalbuminuria (uACR <3.5) to microalbuminuria (uACR 3.5–35) to macroalbuminuria (>35), the percentage of women with the primary composite outcome increased in a stepwise fashion (13.8% to 24.1% to 62.1%, respectively, p < 0.001). After adjusting for covariates including history of hypertension, chronic kidney disease and aspirin therapy during pregnancy, micro- and macroalbuminuria remained significant predictors of the primary outcome. We have shown that antepartum peak uACR is a useful simple marker to help predict adverse maternal and fetal outcomes. Further prospective studies are required to assess uACR as a prognostic tool in pregnancy before it can be applied in clinical practice.

Carcinoma de endometrio: cuadro clínico-patológico

Con la finalidad de identificar el cuadro clínico patológico y determinar el estadío clínico, se analizó retrospectivamente información de 38 pacientes con carcinoma de endometrio admitidas al hospital Belén, Trujillo, Perú, desde 1966 a 1996. La edad promedio en la serie total fue 53,1 ± 11,4 años (rango, 22 a 8,3 años).La edad media de presentación de la menarquía fue 13,4 ± 1,6 años y de la menopausia (n=25) 48,2 ± 3,6 años. Once pacientes, fueron nulíparas (28,9%), cinco (13,2%) presentaron ovario poliquístico, cuatro (10,5%) tuvieron historia previa de hipertensión arterial, dos (5,3%) diabetes mellitus y dos (5,3%) historia personal de otro cáncer primario. El tiempo promedio de enfermedad fue 7,9 meses. Los síntomas más comunes fueron sangrado genital (89,5%) y dolor pélvico (52,6%). El signo más frecuente fue útero aumentado de tamaño (44,7%). El rendimiento diagnóstico de la biopsia de endometrio (n=15) y de la dilatación mas curetaje (n=7) fue 80% y 85,7%, respectivamente. En 12 de 13 pacientes en estadío I, el Papanicolaou fue negativo. De acuerdo a la FIGO, 73,7% de las pacientes estuvo en estadío clínico I, 15,8% en estadío III, 7,9% en estadío IV y 2,6% en estadío II. El adenocarcinoma fue el tipo histológico más frecuente (75,7%) seguido del adenoacantoma (8,1%). En el estadío I, 18 casos fueron carcinomas bien diferenciados y hubo 10 casos entre moderada y pobremente diferenciados. El diagnóstico precoz y el estadiaje adecuado son pasos previos muy importantes al tratamiento definitivo del cáncer endometrial.

Higher blood pressure as a risk factor for diseases other than stroke and ischemic heart disease.

Hypertension is an established risk factor for stroke, ischemic heart disease,1,2 and renal dysfunction.3 The management and prevention of hypertension are important to the prevention of these diseases. Recent evidence has suggested that hypertension also plays a central role in the underlying pathophysiological condition or at prodromal stages before the development of these diseases. Accumulating evidence also indicates that hypertension seems to be linked with common noncardiovascular diseases including dementia, cancer, oral health diseases (OHDs), and osteoporosis. In this brief review, we organize the reported results about the associations between hypertension and these diseases, discussing mainly epidemiological surveys, with the goal of clarifying the relationships between these diseases and hypertension. ### Atrial Fibrillation Atrial fibrillation (AF) is one of the most common types of chronic arrhythmia and is a risk factor for ischemic stroke.4 The Framingham Heart Study revealed that hypertension increases the risk of AF by factors of 1.5 for men and 1.4 for women.5 The Women’s Health Study and a cohort study of Norwegian men showed that high-normal blood pressure (BP) was associated with incident AF.6,7 All of these cohort studies were conducted in Westerners, and these associations were also confirmed in a recent Japanese cohort study.8 In that investigation, compared with normal BP and normal weight, systolic prehypertension with overweight was shown to be associated with an increased risk of incident AF ( P for interaction=0.04). Arterial stiffness, left ventricular hypertrophy, and increased left atrial size are important mediators of the relationship between BP and incident AF.9 Higher systolic BP (SBP) and overweight may mutually exacerbate left ventricular hypertrophy and hypertension, and consequently, they may synergistically increase the risk of AF. ### Chronic Kidney Disease and High BP Chronic kidney disease (CKD) is characterized by a progressive decline in an individual’s glomerular filtration rate over several decades, …

The effect of preexisting hypertension on early neurologic results of patients with an acute spinal cord injury.

Retrospective case-control. To characterize changes in American Spinal Injury Association Motor Score (AMS) in patients treated with relative hypertension (HTN) (mean arterial pressure (MAP) > 85 mm Hg for 5 days) with and without preexisting HTN. A regional spinal cord injury (SCI) center in Pennsylvania, United States. All patients with an acute SCI who were treated with induced HTN (MAP goal above 85) in the intensive care unit (ICU) for at least 5 days were identified. Patients were stratified based on the presence of preexisting HTN, and the change in the AMS between admission and day 5 was determined. Predictors of outcome were identified using correlation analysis and multiple linear regression. Ninety-two patients met inclusion criteria of which 22 had a previous history of HTN. HTN was a predictor of poor early outcome. Patients with HTN had an average decline in their AMS of 7.6, compared with an average decrease of only 0.6 in the AMS of patients without HTN (P=0.04). HTN had no effect (P>0.05) on other in-hospital variables including length of stay, length of stay in the ICU, complications or mortality. Additionally, multiple linear regression analysis demonstrated that diabetes, coronary artery disease and pulmonary disease had no effect on the change in AMS. Chronic HTN is an independent risk factor for poor early neurologic recovery in patients treated with relative HTN for an acute SCI. This is independent of age and other comorbidities.

MP50-15 EVALUATION OF DE NOVO HYPERTENSION AFTER ROBOTIC PARTIAL NEPHRECTOMY: A SINGLE CENTER ANALYSES

You have accessJournal of UrologyKidney Cancer: Evaluation and Staging III1 Apr 2015MP50-15 EVALUATION OF DE NOVO HYPERTENSION AFTER ROBOTIC PARTIAL NEPHRECTOMY: A SINGLE CENTER ANALYSES Oktay Akca, Homayoun Zargar, Peter Caputo, Daniel Ramirez, Riccardo Autorino, Luis Felipe Brandao, Humberto Laydner, Hiury Andrade, Robert J. Stein, and Jihad H. Kaouk Oktay AkcaOktay Akca More articles by this author , Homayoun ZargarHomayoun Zargar More articles by this author , Peter CaputoPeter Caputo More articles by this author , Daniel RamirezDaniel Ramirez More articles by this author , Riccardo AutorinoRiccardo Autorino More articles by this author , Luis Felipe BrandaoLuis Felipe Brandao More articles by this author , Humberto LaydnerHumberto Laydner More articles by this author , Hiury AndradeHiury Andrade More articles by this author , Robert J. SteinRobert J. Stein More articles by this author , and Jihad H. KaoukJihad H. Kaouk More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2926AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The kidney plays an important role in regulating arterial blood pressure. The aim of this study is to evaluate development of de novo hypertension (HT) in patients who underwent robotic partial nephrectomy (RPN). Further we aimed to identify potential patient and surgery related factors that may contribute to HT after RPN. METHODS Our RPN database of 665 patients, between May 2007 and May 2013, was retrospectively assessed to identify patients with no history of previous HT. This cohort was divided into patient who remained normotensive and patients who developed de-novo HT after surgery. We compared these two groups in terms of demographics, tumor characteristics, perioperative and postoperative findings. RESULTS We identified 211 patients with no HT before RPN surgery. Postoperatively, 34 (16.1%) developed de-novo HT. The use of anti-lipid drug therapy prior to surgery (P=0.016), hospital stay (P=0.03) and use of Satinsky clamp (P=0.001) were significantly different between the two groups. After multivariable analysis, body mass index (BMI) (OR 1.07 (95%CI (1.01,1.14); p=0.04), use of anti-Lipid drugs (OR 2.7 95%CI (1.07,6.67); p=0.03) and use of Satinsky clamp (OR 2.9 95%CI (1.02,8.34); p=0.04) were found to be independent risk factors associated with the development of HT. CONCLUSIONS Patients undergoing RPN may be at risk for the development of HT. Lifestyle and surgical technique may play an important role in the development of de novo HT following RPN. This study identifies BMI and the use of anti-lipid medications as lifestyle dependent factors and the use of Satinsky clamp as a surgical dependent factor for the development of de novo HT following RPN. Comparison of demographics, perioperative findings and postoperative outcomes between Hypertensive and Non-Hypertensive patients Non-Hypertensive De Novo Hypertensive P Patient Number 177 (83.9%) 34 (16.1%) - Age, Mean±SD (years) 49.6±12 53.5±13.6 0.09 BMI, Mean±SD (kg/m2) 28.1±5.8 30±7.3 0.1 ASA, Median (IQR) 2 (2-3) 2 (2-3) 0.7 Pre-Op eGFR, Median (IQR) (mL/min/1.73 m2) 92.8 (83.7-105.9) 90.1 (76.6-107.9) 0.43 DM, n (%) 33 (18.6) 7 (20.8) 0.79 Anti-Lipid Drug Before Surgery 34 (19.2%) 13 (38.2%) 0.016 Renal Score Median (IQR) 7 (5-9) 8 (6-9) 0.46 WIT, Median (IQR) (min) 20 (16-25) 21 (17-28) 0.36 Venous Clamping, N (%) 110 (62.1) 27 (79.4) 0.059 Satinsky, N (%) 31 (17.5) 15 (44.1) 0.001 eGFR preservation 1 year % (IQR) 88.7 (89.2-96.7) 83.5 (69.6-99) 0.22 Time to DeNovo HT Developed, Median (IQR) Days - 373 (130-1118) - © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e616-e617 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Oktay Akca More articles by this author Homayoun Zargar More articles by this author Peter Caputo More articles by this author Daniel Ramirez More articles by this author Riccardo Autorino More articles by this author Luis Felipe Brandao More articles by this author Humberto Laydner More articles by this author Hiury Andrade More articles by this author Robert J. Stein More articles by this author Jihad H. Kaouk More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Robotic thoracic surgery of the right posterior inferior mediastinal mass.

The patient was admitted due to “a mediastinal mass found during health check-up four months ago”. Four months ago, she was admitted in a local hospital due to gas poisoning, during which CT showed a right posterior mediastinal mass. Later she was then discharged after the gas poisoning was resolved. She then visited our hospital for surgical treatment. She has a previous history of hypertension for 20 years and diabetes for 7 years. She underwent resection of uterine myoma 10 years ago.

Abstract MP86: Effects of Immediate Blood Pressure Reduction on Death and Major Disability in Acute Ischemic Stroke Patients by History of Hypertension and Use of Antihypertensive Medications

Introduction: The effects of blood pressure (BP) reduction on clinical outcomes among acute stroke patient remain uncertain. Hypothesis: We tested the effects of immediate BP reduction on death and major disability at 14 days or hospital discharge and 3-month follow-up in acute ischemic stroke patients with and without a previous history of hypertension or use of antihypertensive medications. Methods: The China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) randomly assigned patients with ischemic stroke within 48 hours of onset and elevated systolic BP (SBP) to receive antihypertensive treatment (N=2,038) or to discontinue all antihypertensive medications (N=2,033) during hospitalization. Randomization was stratified by participating hospitals and use of antihypertensive medications. Study outcomes were assessed at 14 days or hospital discharge and 3-month post-treatment follow-up. The primary outcome was death and major disability (modified Rankin Scale score≥3), and secondary outcomes included recurrent stroke and vascular events. Results: Mean SBP was reduced 12.7% in the treatment group and 7.2% in the control group within 24 hours after randomization (P&lt;0.001). Mean SBP was 137.3 mmHg in the treatment group and 146.5 in the control group at day 7 after randomization (P&lt;0.001). At 14 days or hospital discharge, the primary and secondary outcomes were not significantly different between the treatment and control groups by subgroups. At the 3-month follow-up, recurrent stroke was significantly reduced in the antihypertensive treatment group among patients with a history of hypertension (odds ratio 0.43, 95% CI 0.24-0.75, P=0.003) and among patients with a history of use of antihypertensive medications (odds ratio 0.41, 95% CI 0.20-0.84, P=0.01). All-cause mortality (odds ratio 2.84, 95% CI 1.11-7.27, P=0.03) was increased among patients without a history of hypertension. Conclusion: Immediate BP reduction lowers recurrent stroke among acute ischemic stroke patients with a previous history of hypertension or use of antihypertensive medications at 3 months. On the other hand, BP reduction increases all-cause mortality among patients without a history of hypertension.

48-OR

Objectives The development of preeclampsia is considered to be related to maternal immune and genetic factors. HLA-C is one of the major histocompatibility antigens that plays an important role in regulating maternal fetal interface. However, epidemiological studies show that paternal risk factors can play a role in the development of preeclampsia. The aim of this study is to explore the relationship between paternal and fetal HLA-C allelic polymorphisms and preeclampsia in Chinese Han population. Methods 34 spouses and fetuses of women with preeclampsia and 37 spouses and fetuses of healthy pregnant women were included in the case-control study. All pregnant women were at the third trimester of gestation. The HLA-C genes from blood genomic DNA were genotyped by polymerase chain reaction–sequencing-based typing (PCR-SBT) genotyping method. The associations of HLA-C alleles with the disease were expressed as P and odds ratios (ORs). Results No differences were observed in the spouses’ age, body mass index, contraception method or previous history of hypertension and cardiovascular disease. Gestational age was shorter (36.39 ± 3.15 vs. 39.31 ± 1.14, p p ∗ 08:01:01G was significantly higher in the spouses of preeclamptic women, compared with that in the spouses of normotensive women (14.7 vs. 2.7%, P = 0.010, OR = 6.207, 95%CI (1.308, 29.451)). There was no statistical difference in the frequency of fetal HLA-C alleles ( p > 0.05). Conclusions Pregnant women with spouses carrying HLA-C ∗ 08:01:01G have a greater risk for the developing of preeclampsia in Chinese Han population. Disclosures H. Yu: None. N. Pan: None. Y. Shen: None. S. Jin: None. J. Zhai: None. D. Qiao: None. L. Chen: None. W. Xu: None. F. Miao: None. Y. He: None. M. Ren: None. J. Zhang: None.

Risk factors for endometrial cancer in black and white women: a pooled analysis from the Epidemiology of Endometrial Cancer Consortium (E2C2).

Endometrial cancer (EC) is the most common gynecologic cancer in the USA. Over the last decade, the incidence rate has been increasing, with a larger increase among blacks. The aim of this study was to compare risk factors for EC in black and white women. Data from seven cohort and four case-control studies were pooled. Unconditional logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals for each risk factor in blacks and whites separately. Data were pooled for 2,011 black women (516 cases and 1,495 controls) and 19,297 white women (5,693 cases and 13,604 controls). BMI≥30 was associated with an approximate threefold increase in risk of EC in both black and white women (ORblack 2.93, 95 % CI 2.11, 4.07 and ORwhite 2.99, 95% CI 2.74, 3.26). Diabetes was associated with a 30-40% increase in risk among both groups. Increasing parity was associated with decreasing risk of EC in blacks and whites (p value=0.02 and <0.001, respectively). Current and former smoking was associated with decreased risk of EC among all women. Both black and white women who used oral contraceptives for 10+years were also at reduced risk of EC (OR 0.49, 95% CI 0.27, 0.88 and OR 0.69, 95% CI 0.58, 0.83, respectively). Previous history of hypertension was not associated with EC risk in either group. The major known risk factors for EC exert similar effects on black and white women. Differences in the incidence rates between the two populations may be due to differences in the prevalence of risk factors.

Expanded Criteria Donors Allow Successful Expansion On the Donor and Recipient Pools. A Single Centre Experience.

Background: Due to the constant increase in waiting lists and the lower disponibility of young donors, the number of transplants from expanded criteria donors is growing continuously. However, their use is still controversial as graft survival could be negatively affected. The aim of the present study was to analyze the donor characteristics that influence graft survival. Patients and methods: It is a retrospective and observational single centre study in which 634 consecutive deceased donor kidney transplants, performed in our Unit between 2000 and 2012 were included. Donor and recipient characteristics and graft outcome were obtained from the electronic medical records. Kidneys from donors with a serum creatinine above 2.5 mg/dl and older than 65 years with more than 25% of glomerulosclerosis in the kidney biopsy were not accepted for transplantation. Results: The mean age of recipients was 52.9±13.0 years, 207 (32.6%) aged more than 60 years. In addition, 67.9% of donors have died by cerebrovascular disease, 46.5 % were more that 60 year old, 35.5% had a previous history of hypertension and 7.7% had a serum creatinine above 1.5 mg/dl. Altogether, 55.0% of grafts came from expanded criteria donors. Furthermore, 61 out of 233 biopsied grafts had >10% of sclerotic glomeruli. As our policy is to transplant old-for-old, there was a significative relationship between recipient and donor age (r=0.691; 95%CI 0.648-0.729;p<0.001). Graft and patient survival at 5 years were 80% and 92% respectively. Cox univariate analysis showed that time on dialysis, donor last serum creatinine, a previous history of donor hypertension and peak PRA were the variables associated with graft survival. In the multivariate analysis; peak PRA (HR:1.01; IC95% 1.00-1.01; p=0.041), donor hypertension (HR:1.86; IC95% 1.27-2.73; p=0.001) and donor serum creatinine (HR 1.20; 95%CI 1.07-1.36;p=0.003) remained in the model. No association was observed between % of donor glomerulosclerosis and graft function at 6 months or survival at 5 years. Conclusions: Our study shows that the use of expanded criteria donors provide satisfactory survival rates and allow increasing the number of transplants. Only donor serum creatinine and a previous history of hypertension but not age were the variables associated with graft survival.

Abstract P101: Hypertension in Pregnancy and Risk of Hypertension in Later Life: The Bogalusa Heart Study

Background: Few studies have examined whether hypertension in pregnancy imposes long-term cardiovascular risk compared to a normal pregnancy. The objective of this study was to examine if previous history of hypertension in pregnancy is a risk for hypertension after pregnancy. Methods: A case-control analysis was performed using the Bogalusa Heart Study database. Cases were defined as women whose systolic blood pressure ≥140 mmHg or diastolic ≥ 90 mmHg, or having hypertension treatment. Controls were defined as women with normal blood pressure. After exclusions, 604 women (67% white and 33% black, aged 32-44 years) were included for analysis. Univariable and multivariable logistic regression were used to estimate the odds ratio (OR) and 95% confidence interval (CI). Results: The prevalence of hypertension in women was 12.1% (73/604). Hypertensive women had higher proportion of previous history of hypertension in pregnancy (25/73, 34%) than normotensive controls (83/531, 13.7%), with an OR of 2.81 (95% CI: 1.64-4.81). After adjustment for age, race, body mass index and smoking, adjusted OR (aOR) of having previous history of hypertension in pregnancy for developing hypertension later was 1.36 (1.00-3.75). In addition, age, black ethnicity and body mass index were associated with hypertension, with aORs of 1.16 (1.09-1.25), 3.73 (2.13-6.52), and 1.09 (1.05-1.13), respectively. Conclusions: Hypertension in pregnancy may be associated with an increased risk of hypertension in later life. Further studies are needed to separate the effect of pregnancy-induced hypertension and pre-exiting chronic hypertension on the subsequent risk of hypertension later in life.

Representativeness of RELAX-AHF Clinical Trial Population in Acute Heart Failure

The Relaxin for the Treatment of Acute Heart Failure (RELAX-AHF) trial enrolled 1161 patients admitted to the hospital for acute heart failure (AHF) to evaluate the therapeutic efficacy of serelaxin, a recombinant form of human relaxin-2. We characterized how representative RELAX-AHF clinical trial enrollees were to those patients with AHF found in international registries. We examined 196 770 AHF admissions from the Acute Decompensated Heart Failure National Registry-United States and Acute Decompensated Heart Failure National Registry-International registries. Patients were considered RELAX-AHF-type if they met the following criteria: discharge diagnosis of heart failure, systolic blood pressure >125 mm Hg, dyspnea at rest or with mild exertion, intravenous diuretic use, glomerular filtration rate of 30 to 75 mL/min per 1.73 m(2), hemoglobin >8 g/dL, and no use of intravenous inotropes or vasopressors. Baseline characteristics and treatments of RELAX-AHF-type and non-RELAX-AHF-type patients were compared. A Cox model was used to evaluate inpatient mortality. Among both Acute Decompensated Heart Failure National Registry-United States and Acute Decompensated Heart Failure National Registry-International registries, 20.7% (n=38 485) and 16.2% (n=1749) of patients met basic criteria for RELAX-AHF entry, respectively. These patients were more likely to be older, be women, have a previous history of hypertension, have preserved ejection fraction, and have better renal function. In-hospital mortality was lower in RELAX-AHF-type than in non-RELAX-AHF-type patients, even after multivariable adjustment (hazard ratio, 0.59; 95% confidence interval, 0.53-0.66; P<0.0001). Patients potentially eligible for RELAX-AHF represent ≈2 in 10 patients with AHF in the United States, Latin America, or Asia-Pacific. These patients differ significantly from other hospitalized patients based on clinical characteristics and outcomes.

Impact of Fluoroscopically-Visible Fluttering Flap on Clinical Diagnosis of Acute Aortic Dissection

![Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4] A 71-year-old man with a previous history of hypertension presented to our clinic because of chest pain. The electrocardiogram showed ST-segment elevation in inferior leads with reciprocal ST-segment depression, consistent with

Prevalence of Undiagnosed Hypertension in the Emergency Department

Background:Hypertension (HTN) is a serious health problem that threatens one fourth of the adult population in some countries.Objectives:This study aimed to assess the prevalence and outcome of undiagnosed hypertensive patients admitted to the emergency department.Materials and Methods:This cross-sectional study was conducted from March 2009 to March 2010 at Imam Hossein Medical and Educational Center, Teheran, Iran. A total of 2070 patients aged 18 years and older were admitted to the emergency department without previous HTN history. Blood pressure was taken and repeated 10 minutes later if initial systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg. Those who matched the inclusion criteria entered the study for further follow-up. A numerical pain score was also used for pain intensity assessment. Chi-Square and Mann Whitney U tests were performed to compare differences between sex, age and education of the participants.Results:Based on the inclusion criteria, 346 patients entered the study, out of which 168 qualified for further evaluation and follow-up. Forty eight patients (28.6%) were finally diagnosed with high blood pressure. Our study showed that the prevalence of undiagnosed HTN was 4.8%. Significant differences between blood pressure, age, pain score and education level (P < 0.001) were found. This implies that old age, poor education and low pain score are positively associated with hypertension.Conclusions:Blood pressure readings in emergency departments should not be readily attributed to pain or anxiety. Diagnosis must be based on meticulous follow-up and precise examinations.

Successful treatment of high-risk acute promyelocytic leukemia in very elderly patients using all-trans retinoic acid plus reduced-dose idarubicin

To the Editor,Theintroductionofall-transretinoicacid(ATRA)therapyhasmarkedly improved the outcome for younger patients withacute promyelocytic leukemia (APL) [1, 2]; however, theoptimal treatment regimen for elderly APL patients remainsunclearbecausefewpatientsover70yearsofageareincludedin clinical trials [3]. Here, we report the successful use ofATRA plus reduced-dose idarubicin to treat nonagenarianhigh-risk APL patients.Patient 1 (Fig. 1a), a 91-year-old woman with a previoushistory of hypertension and cerebral infarction, was admittedto our hospital with fever and bleeding. Her Eastern Cooper-ativeOncologyGroupPerformanceStatus(ECOG-PS)was4.Laboratoryresultswereasfollows:hemoglobin(Hb),103g/l;white blood cell (WBC) count, 36.2×109/l; platelet (Plt)count, 51×109/l; serum lactate dehydrogenase (LDH),1,437 IU/l; prothrombin time-international normalized ratio(PT-INR),1.41;activatedpartialthromboplastintime(APTT),34.5 s; fibrinogen, 157 mg/dl; and D-dimer, 315.7 μg/dl.Polymerase chain reaction analysis of peripheral blood cellsidentified the PML-RARα fusion gene. The patient receivedATRA (45 mg/m

Office Blood Pressure, Ambulatory Blood Pressure Monitoring, and Echocardiographic Abnormalities in Women With Polycystic Ovary Syndrome

Whether or not blood pressure (BP) and heart function of women with polycystic ovary syndrome (PCOS) are altered remains unclear, albeit subtle abnormalities in the regulation of BP observed in these women might suggest a mild masculinization of their cardiovascular system. To study the influence of obesity and androgen excess on BP and echocardiographic profiles of women with the syndrome, we conducted a cross-sectional case-control study comparing office and ambulatory BP monitoring, as well as echocardiographic assessments, in 63 premenopausal women with the classic phenotype, 33 nonhyperandrogenic women with regular menses, and 25 young men. Forty-nine subjects were lean and 72 had weight excess (body mass index ≥25 kg/m(2)). Participants had no previous history of hypertension and were nonsmokers. Men showed the highest BP readings, and the lowest readings were observed in control women, whereas women with PCOS had intermediate values. Undiagnosed hypertension was more common in subjects with weight excess irrespective of sex and hyperandrogenism. Women with PCOS and weight excess showed frequencies of previously undiagnosed hypertension that were similar to those of men with weight excess and higher than those observed in nonhyperandrogenic women. Lastly, male sex, weight excess and hypertension, the latter in men as well as in women with PCOS, increased left ventricular wall thickness. In summary, our results show that patients with classic PCOS and weight excess frequently have undiagnosed BP abnormalities, leading to target organ damage.

New Translocation (7:17) In Variant Acute Promyelocytic Leukemia With ATRA Resistance

BackgroundAcute promyelocytic leukemia (APL) is characterized by pathologic promyelocytes, chromosomal translocations t(15:17) (q22; q21) and clinical and cytological response to all-transretinoic acid (ATRA). A significant minority of patients with APL have variant translocations involving RARα gene with a different partner, not involving PML. These APL variant translocations may or not respond to ATRA treatment. Case reportA routine laboratory evaluation, before minor surgery, revealed leukocytosis, thrombocytopenia and blasts presence in peripheral blood (PB), in an otherwise asymptomatic 70-year-old man. He had a previous history of hypertension, dyslipidemia, ischemic heart disease, double coronary bypass and prostatectomy for non-malignant prostatic hypertrophy.Peripheral blood (PB) count: hemoglobin concentration 12g/dL, platelet count: 21x109/L and white blood cell count (WBC): 35x109/L. Peripheral blood smear: myelemia exhibiting 74% blasts (including myeloid blast and promyelocytes) with fine chromatin pattern, heterogeneous and frequently convoluted nuclei and one to three prominent nucleoli. The cytoplasm of these cells was basophilic with scanty purple granules. No Auer rods were found. The basic coagulation tests were normal(INR, APTT and fibrinogen) but D Dimer was 33.87 µg/ml. Normal biochemistry was shown, except for GGT 85 U/L and lactate dehydrogenase 2244 U/L.Bone marrow (BM) aspirate was unsuccessful (”dry tap”) but the bone trephine revealed an infiltration of 80% myeloid blasts. Cytochemistry: myeloperoxidase stain was deeply positive and chloroacetate and non-specific esterase stains were negative. Flow cytometry immunophenotype on PB was consistent with AML, likely M3 leukemia, with an atypical phenotype (MPO+, CD117+low, CD34+, CD13++, CD45+, CD15-,CD133-, CD33+, HLA-DR+low het , CD5-, CD7-, CD11b- , CD56+het, CD10-, CD8-,CD4-, CD45RA+, CD19-, CD2-, Glya-, CD71+low, CD38-, CD1a-, CD41-, CD14-).The analysis of the PML/RARα fusion gene, according to standard protocols, was negative. FISH studies showed 2 PML signals and 3 RARα copies, suggesting a possible variant rearrangement of this gene. FISH and molecular biology did not detect transcript for t(15:17), (5:17) or (11:17); so RARα was translocated with a strange partner.Suspecting of a variant APL, the patient was treated with ATRA plus Idarrubicin. After 4 weeks treatment, deep neutropenia was observed but no granulocytic maturation. That suggested us resistance to ATRA. Thus, we changed the treatment to a classical induction scheme for AML. The patient attained cytologic remission, which he mantains so far with conventional chemotherapy.Karyotype study was subsequently performed, identified an unbalanced rearrangement between 7q and 17q. Currently, we are identifying and sequencing the fusion partner of RARα. ConclusionWe report a novel case of variant acute promyelocytic leukemia with the karyotype der (7) t(7;17) (q11;q21). The morphology of PB and BM was critical for initial diagnosis and treatment decisions. Disclosures:No relevant conflicts of interest to declare.

Clinical significance of subclinical carotid atherosclerosis and its relationship with echocardiographic parameters in non-diabetic chronic kidney disease patients

BackgroundNon-diabetic chronic kidney disease (CKD) patients are a heterogeneous group with a variety of prognosis. We investigated the role of subclinical carotid atherosclerosis for the prediction of adverse cardiovascular (CV) outcomes in these patients, and tried to identify clinical and echocardiographic parameters associated with subclinical carotid atherosclerosis.MethodsAs a prospective design, 182 asymptomatic non-diabetic CKD patients underwent carotid ultrasonography and Doppler echocardiography. Carotid atherosclerosis was defined as a carotid intima-media thickness ≥1.0 mm and/or the presence of plaque.ResultsDuring the mean follow-up period of 28.8 ± 16.1 months, 23 adverse CV events occurred. Patients with carotid atherosclerosis (99, 54.4%) showed significantly higher rates of annual CV events than those without (8.6 vs. 1.5%, p <0.001). Particularly, the presence of carotid plaque was a powerful predictor of adverse CV outcomes (OR 7.80, 95% CI 1.45-45.97). Clinical parameters associated with the presence of subclinical carotid atherosclerosis were old age, previous history of hypertension, increased pulse pressure, and higher high-sensitivity C-reactive protein (hs-CRP) level. By echocardiography, early diastolic mitral annular velocity (E’) and the ratio of early peak transmitral inflow velocity (E) to E’ (E/E’) were closely related with the presence of carotid atherosclerosis. A multivariate analysis showed that age, hs-CRP, and E/E’ were significant determinants of carotid atherosclerosis.ConclusionsCarotid plaque, even subclinical, was closely associated with a poor prognosis in non-diabetic CKD patients. Increased age, hs-CRP level, and E/E’ ratio may be useful markers suggesting the presence of carotid atherosclerosis in these patients.

Dysontogenetic Pancreatic Cysts in a Patient with a Wallenberg Syndrome

Introduction: Pancreatic cysts are a heterogeneous group of lesions that may be benign or malignant. It is accepted that true cysts occur as a result of developmental anomalies related to the sequestration of primitive pancreatic ducts. Case Presentation: A male patient, 57years old, with previous history of hypertension and cerebrovascular disease (stroke and occlusion of the central retinal vein in 2005) was submitted to abdominal imaging for study of urinary complaints. The imaging study (CT abdominal later complemented by magnetic resonance image) revealed multiple cystic pancreatic formations with associated calcifications without wirsung dilatation or solid nodular lesions suggestive of malignancy. He also had multiple renal cysts and an unilocular cystic lesion suggestive of mesenteric cystic lymphangioma. These lesions were not previously known, neither the patient had symptoms suggestive of pancreatic disease. He was recently diagnosed with acute ischemic stroke in the left half of the medulla oblongata secondary to dissection of an aneurysm of the left vertebral artery (Wallenberg syndrome). There were multiple irregularities in the caliber of the branches of the circle of Willis with dilations and stenosis, setting a vascular pattern of vasculitic type. However, immunological study was negative, with no evidence of retinal abnormalities, including vasculitis. Discussion: Pancreatic polycystic disease is a rare condition, usually asymptomatic, although it may present with nonspecific abdominal pain, vomiting, jaundice or pancreatitis. It may occur singly or in association with renal cysts, liver, central nervous system or retinal abnormalities. Bleeding, infection, rupture or obstruction of the cysts may develop, and treatment includes monitoring, drainage or resection. Conclusion: We present a patient with dysontogenetic pancreatic cysts and no evidence of cystic lesions of the central nervous system. It is questionable whether this patient will have involvement of the central nervous system in the future.Figure

Influence of hypertension on acute myocardial infarction

Objective To explore the influence of hypertension on acute myocardial infarction.Methods According to patients with or without previous history of hypertension,100 patients with acute myocardial infarction were divided into the observation group(with previous history of hypertension) 58 cases and control group (without previous history of hypertension) 42 cases.The onset of chest pain,cardiac function classification,complications,hospital mortality were compared between the two groups.Results The probability of the onset of chest pain of the observation group(77.59％) was significantly higher than that of the control group(47.62％) (χ2 =9.616,P ＜0.05).The patients with heart function of class I in the observation group(29.31％) was significantly less than that in the control group(54.76％) (χ2 =6.575,P ＜ 0.05).The incidence of heart failure (46.55％) and arrhythmia (51.72 ％) of the observation group was significantly higher than those in the control group (23.81％,2 8.57 ％)(χ2 =5.405,11.152,all P ＜ 0.05) ； The hospital mortality of the observation group (20.69％) was significandy higher than that of the control group(14.29％) (χ2 =10.952,P ＜ 0.05).Conclusion Hypertension may have an obvious effect on acute myocardial infarctiont.Controlling hypertension actively,giving comprehensive nursing to patients and health education can help to control the fatality rate. Key words: Hypertension; Myocardial Infarction