Rate Of Hypertension In Patients Research Articles

PS-BPC06-2: CLINICAL CHARACTERISTICS OF COMORBID HYPERTENSION AND CORONARY ARTERY DISEASE IN 10 YEARS: RESULTS FROM CHINA

Background: Little is known regarding the clinical profiles of patients with comorbid hypertension and coronary artery disease (HT-CAD) in China. Methods: The current study was conducted in a large-scale tertiary hospital that gathered nationwide patients of China. A total of 32,355 CAD patients with and without hypertension admitted from 5 August 2008 to 22 July 2018 were identified in this cross-sectional study. The demographic characteristics, diagnosis records, relevant examinations, treatment patterns, and in-hospital outcomes of patients were abstracted via electronic medical record database. We analyzed the overall comorbidity rate, blood pressure control, clinical characteristics and their temporal change of patients with HT-CAD in the current study. Results: The overall comorbidity rate of hypertension in patients with CAD was 64.12% (N = 20,747) and did not significantly change during 2008 to 2018. Female CAD patients and CAD patients in east coastal regions had significantly higher comorbidity rate of hypertension. Among patients with HT-CAD, the BP was controlled at < 140/90 mmHg in 52.39% and < 130/80 mmHg in 27.03%. The control rate of < 130/80 mmHg increased during 2008 to 2018, whereas the control rate of < 140/90 mmHg did not change significantly. Compared with the counterparts with nonHT-CAD, patients with HT-CAD had higher incidence of cardiovascular-related comorbidities, and most of these comorbidities showed an increasing trend over the study period. Conclusions: Hypertension is the most prevalent comorbidity in Chinese patients with CAD. Patients with HT-CAD have an increasing health burden and should be paid with special attention to improve their cardiovascular outcomes.

PS-C03-4: THE REAL WORLD TRENDS IN BLOOD PRESSURE OF DIALYSIS PATIENTS IN JAPAN USING THE WEB-BASED DATABASE

Objective: Hypertension is common in dialysis patients, which is frequent as well as poorly controlled. Blood pressure (BP) has a J curve relationship with cardiovascular disease and survival in dialysis patients; however, optimal BP is not well defined. We wanted to learn about the clinical characteristics of Japanese patients undergoing dialysis and the prevalence of cardiovascular death based on systolic blood pressure (SBP) using the Web based Analysis of Dialysis Data Archives (WADDA) system database. Design and Methods: We enrolled the patients undergoing dialysis who were recorded pre dialysis SBP from 2012 to 2020 using WADDA system 2.1. According to the Japanese Society of Hypertension guidelines 2019 (JSH 2019), we classified SBP and evaluated their trends over time by gender and age. Moreover, we evaluated the association between SBP and cardiovascular death. Results: Using the 2020 database, we looked at 336,759 Japanese patients undergoing dialysis (222,510 men and 114,249 women). The mean age was 69.4 ± 12.5 years, the mean dialysis history was 7.4 ± 7.7 years, and the mean pre dialysis SBP was 152.3 ± 24.7 mmHg. Among these patients, 72% had hypertension, 56.4% had diabetes, 28.9% had ischemic heart disease, and 25.4% had cerebrovascular disease. From 2012 to 2020, there was no change in the percentage of hypertension in each age group. The rate of grade II and III hypertension was predominantly male in the younger population (the twenties to fifties), but it shifted to females in the older population (over sixties). This gender disparity was more pronounced in the grade III hypertension group. Patients with cerebrovascular death had higher rates of hypertension (60.7 percent [gradeI; 26.2%, gradeII; 17.3%, gradeIII; 17.3%]) than those with heart failure death (32.9 percent [gradeI; 18.3%, gradeII; 8.4%, gradeIII; 6.2%]). Conclusion: Using the WADDA system, we summarized recent trends in BP of Japanese dialysis patients. We discovered that the rate of hypertension in patients undergoing dialysis has remained high (around 70%) and has not changed over the last decade. Furthermore, we discovered higher rates of hypertension, particularly in younger males, implying that optimal BP management for these populations may reduce cerebrovascular mortality.

The Efficacy and Safety of Budesonide/Glycopyrronium/Formoterol in the Treatment of COPD in the Elderly.

Objective Chronic obstructive pulmonary disease (COPD) is a major and difficult disease of the chronic respiratory system that is common and frequent, with a huge disease burden. The aim of this study was to investigate the efficacy and safety of budesonide/glyburide/formoterol fumarate (BGF) in the treatment of COPD. Methods A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library, and Web of Science. The basic features of the seven pieces of literature were identified using the search strategy. The sample size range was 130∼1264. Results The effects of BGF increased FEV1 in patients with COPD (mean difference = 2.86, 95%CI: 2.71–3.01, p < 0.00001). The effects of BGF improved in patients with ≥1 TEAE in patients with COPD, and was not statistically significant after treatment (Odds rate = 1.00, 95%CI: 0.85–1.17, p=0.97). The effects of BGF increased in patients with TEAEs related a to study treatment in patients with COPD (odds rate = 1.27, 95% CI: 1.03–1.57, p=0.02). The effects of BGF in decreased patients with serious TEAEs in patients with COPD (odds rate = −0.02, 95% CI: −0.03–−0.00, p=0.04). The effects of BGF decreased the death rate in patients with COPD, and were not statistically significant after treatment (odds rate = 0.77, 95% CI: 0.31–1.97, p=0.59). The effects of BGF decreased the hypertension rate in patients with COPD (odds rate = 0.92, 95% CI: 0.44–1.89, p=0.81), and was not statistically significant after treatment. The effects of BGF increased pneumonia in patients with COPD (odds rate = 1.55, 95% CI: 0.81–2.97, p=0.19), and were not statistically significant after treatment. The effects of BGF increased FEV1, increased patients with TEAEs related a to study treatment, and decreased patients with serious TEAEs in patients with COPD. Conclusion This study elucidates the efficacy and safety of BGF in the treatment of COPD with a view to providing a clinical reference.

TEN YEARS TREND OF HYPERTENSION AWARENESS, TREATMENT, AND CONTROL RATE IN KOREA

Abstract Objective: We analyzed the Korean National Health and Nutrition Examination Survey (KNHANES) database to determine the trend of hypertension awareness, treatment, and control rate in Korea during the last 10 years. In addition, we tried to investigate the effect of chronic medical conditions such as diabetes mellitus, obesity, hypercholesterolemia, and chronic kidney disease on hypertension management. Design and method: The KNHANES, which was conducted by the Korea Centers for Disease Control and Prevention, was a cross-sectional, nationally representative survey in which a stratified multistage sampling design was used. Results: A total of 59,282 adults older than 20 years were included in the analysis. Mean age was 50.7 ± 16.4 years and male subjects were 42.6%. The prevalence of hypertension, hypercholesterolemia, diabetes mellitus, obesity, and chronic kidney disease (CKD) were significantly increased during the last 10 years. The prevalence of diabetes mellitus, hypercholesterolemia, obesity, and CKD was significantly higher in the hypertensive patients compared to normotensive subjects. Especially, there was a clustering of those cardiovascular risk factors, which was more prominent as people get older. During the last 10 years, the awareness, treatment, and control rate of hypertension have been significantly improved. The treatment and control rates of hypertension was higher in patients having multimorbidity, which imply the multimorbidity have a favorable effect on the treatment and control of hypertension in Korean population. Conclusions: Hypertension treatment, control rate have been improved during the last 10 years. Higher rate of awareness, treatment and control rate of hypertension in patients having multimorbidity suggest that more aggressive surveillance or treatment for the multimorbid hypertensive patients might be associated with the improvement of hypertension treatment and control rate in Korea.

High rate of hypertension in patients with m.3243A>G MELAS mutations and POLG variants

Animal studies suggest that decreased vascular mitochondrial DNA copy number can promote hypertension. We conducted a chart review of blood pressure and hemodynamics in patients with either mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS, n = 36) or individuals with variants in the mitochondrial DNA polymerase gamma (POLG, n = 26). The latter included both pathogenic variants and variants of unknown significance (VUS). Hypertension rates (MELAS 50%, POLG 50%) were elevated relative to Canadian norms in 20–39 (MELAS) and 40–59 (MELAS and POLG) years of age groups. Peripheral resistance was high in the hypertensive versus normotensive patients, potentially indicative of microvascular disease. Despite antihypertensive treatment, systolic blood pressure remained elevated in the POLG versus MELAS group. The risk of hypertension was not associated with MELAS heteroplasmy. Hypertension rates were not different between individuals with known pathogenic POLG variants and those with VUS, including common variants. Hypertension (HT) also did not differ between patients with POLG variants with (n = 17) and without chronic progressive external opthalmoplegia (n = 9) (CPEO). HT was associated with variants in all three functional domains of POLG. These findings suggest that both pathogenic variants and several VUS in the POLG gene may promote human hypertension and extend our past reports that increased risk of HT is associated with MELAS.

PARAMETERS OF SPECTRAL AND TEMPORAL ANALYSIS OF HEART RATE VARIABILITY IN THE CONDITIONS OF DISREGULATION OF APOPTOTIC ACTIVITY IN BRONCHOPULMONARY PATHOLOGY AND COMORBIDITY WITH ARTERIAL HYPERTENSION

According to numerous reports, the prevalence rate of systemic arterial hypertension in patients with chronic pulmonary diseases varies from 0.4 to 27.7%. The number of authors have shown a decrease in heart rate variability against the background of hypertension, mainly due to the SDNN (the standard deviation of the normal-to-normal RR intervals) and RMSSD (the root mean square of successive RR-interval differences), indicating a decrease in parasympathetic effects on the heart rhythm and a relative increase in sympathetic tone.&#x0D; Objective: to study changes in heart rate variability parameters depending on the level of apoptotic processes in patients with arterial hypertension against the background of chronic obstructive pulmonary disease.&#x0D; Materials and methods. We examined 25 men with a diagnosis of arterial hypertension stage II and chronic obstructive pulmonary disease stage II without clinically significant comorbidities, whose average age was 51.72±1.22; more than 80% of them were active smokers, pack-years index was 17.06±2.41, the harmful professional factor were indicated by 1/4 people.&#x0D; The verification of arterial hypertension was carried out in accordance with the Order of the Ministry of Health of Ukraine dated May 24, 2012 № 384. All patients were diagnosed with stage II of hypertension. Arterial hypertension degree was diagnosed in 12% patients – first, in 28% patients – second and in 60% patients, respectively, third. Participants expressed their willingness to be included in medical research.&#x0D; Results. Index SDNN statistically significantly (p&lt;0.05) in parallel with the elevation of the values ​​of the marker of apoposis of caspase-9 decreased by 13.68%, comparing between groups of patients less and more than IV quartile according to the values ​​of caspase-9. The LF (Low Frequency power: frequency activity in the 0.04 - 0.15Hz range) value in patients with a cohort of less and more than IV quartile according to the values ​​of caspase-9 showed a statistically significant decrease by 32.67% (p &lt;0.05). HF (High Frequency power: frequency activity in the 0.15 - 0.40Hz range) with an increase in the activity of apoptosis processes according to the values ​​of caspase-9 decreased most significantly significant, by 48.92% (p &lt;0.05).&#x0D; To assess the direction, the tightness and the nature of the relationship between the indices between the studied variables, a regression analysis was conducted to construct a functional dependence. As independent argument (X) considered the level of caspase-9 activity, and as a dependent variable (Y) considered the indicator LF / HF (LF/HF Ratio: A ratio of Low Frequency to High Frequency). The obtained data indicated that the correlation between numerical variables in patients with caspase-9 level less than 4 quartiles had an unreliable character, while in patients with high expression of this cysteine ​​protease the correlation obtained with a high degree of accuracy and adequacy was approximated by the model of exponential form, and namely: Y = 4,0578 * exp (0,0901 * X) at R = 0,547, R2 = 0,30, normalized R2 = 0,29, p = 0,0083).&#x0D; Conclusion. Elevation of the state of the sympathetic part of the autonomic nervous system and a decrease in the activity of the parasympathetic part of the autonomic support, which can potentially be associated with an increased risk of serious cardiovascular cases in patients with this comorbidity, were found in patients with chronic obstructive pulmonary disease against the background of arterial hypertension.

Long-term effects of ibrutinib on blood pressure in patients with chronic lymphocytic leukemia (CLL).

e19009 Background: Ibrutinb is approved for treatment of CLL. Hypertension (HTN) has been reported as a side effect of ibrutinib in 1-23% of patients. We previously reported HTN in CLL patients after 6 months of treatment with ibrutinib. In this study we describe the effects of long-term treatment with ibrutinib on blood pressure (BP). Methods: We performed a retrospective study, evaluating 150 CLL patients on ibrutinib-based clinical trials from 2010 to 2015. Patient demographics, co-morbidities, tobacco use, anti-HTN therapy were recorded. BP was evaluated at baseline and sequentially for up to 5 yrs. New onset HTN was defined as systolic BP (SBP) of ≥ 130 mmHg and/or diastolic BP (DBP) ≥ 80 on two separate visits with no prior HTN or anti-HTN therapy. An increase in baseline SBP by ≥10 and/or increase in DBP by ≥10 was considered significant regardless of the absolute BP. Univariate logistic regression analysis was performed to assess relationship of HTN risk factors and new HTN. Results: Patients’ median age was 65 yrs (68% male and 88% white). Median follow-up was 3 yrs. Pre-existing HTN was present in 44% of patients, 40% were on anti-HTN therapy prior to ibrutinib. New HTN developed in 65% of patients without prior diagnosis of HTN; 32 % of patients were started on anti-HTN therapy or received additional anti-HTN therapy. Of the patients who experienced an increase in BP, 33% experienced isolated systolic HTN. Median SBP was 130 at baseline, 132 at 1mo, 137 at 3mo, 135 at 6mo, 139 at 12mo, 138 at 3yrs, 144 at 5yrs (mean increase in SBP: 7.2, P &lt; 0.001). In patients whose SBP was &lt; 130 at baseline the median SBP was 119 at baseline, 122 at 1mo, 134 at 3mo, 130 at 6mo, 134 at 12mo, 135 at 3yrs and 141 at 5yrs (mean increase in SBP: 15.7, p &lt; 0.001). 74% of patients experienced and increase in SBP ≥10. New HTN on ibrutinib was not associated with: tobacco use, obesity, chronic kidney disease or obstructive sleep apnea (p &gt; 0.05). Conclusions: In this study we demonstrated a high rate of new HTN in patients on prolonged ibrutinib treatment. HTN in these patients is persistent, linear and independent of other risk factors. The increase in BP remained despite initiation of anti-HTN therapy. Additional studies are ongoing to define cardiovascular and renal complications associated with HTN in these patients.

Diabetes with hypertension in China: current status of epidemiology and management

<p indent=0mm>Diabetes is often accompanied by hypertension, which significantly increases the risk of cardiocerebrovascular and kidney diseases. Data from studies in China show that the detection rate of hypertension in patients with diabetes is about 60%, whereas the literature reports this rate to be ranging from 24.3% to 70.3%. The goal of blood pressure measurement among patients with diabetes is controversial in different guidelines. Based on data from China, a target systolic blood pressure of <sc><130 mmHg</sc> is recommended. However, the control rate of hypertension is low in patients with diabetes. Most of the guidelines recommend angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists as the first-line antihypertensive drugs for patients with diabetes. Metformin, GLP-1 receptor agonists, SGLT-2 inhibitors, etc. have a synergistic antihypertensive effect. Lifestyle interventions, especially salt restriction, have a dominant effect on blood pressure control; however, there is a lack of relevant clinical research. Metabolic surgery can improve diabetes in patients with refractory hypertension. Additional clinical studies and evidence-based medicine are warranted to develop a Chinese guideline for subjects with diabetes mellitus with hypertension.

Correlation between changes in inflammatory cytokines and the combination with hypertension in patients with type 2 diabetes mellitus.

We aimed to analyze the relationship between the combination with hypertension and the level of inflammatory cytokines in peripheral serum in patients with type 2 diabetes mellitus (DM), and to explore the value of inflammatory cytokines in predicting type 2 DM combined with hypertension. A total of 120 patients diagnosed with type 2 DM in our hospital from March 2014 to September 2016 were selected. The clinical data were retrospectively analyzed. These patients were divided into the combination with hypertension group (N.=56) and the non-combination with hypertension group (N.=64), including 75 males and 45 females. Duration of DM, fasting plasma glucose (FPG), glycosylated hemoglobin A1c (HbA1c) and also levels of inflammatory cytokines (hs-CRP, TNF-α and IL-6) in the combination with hypertension group were all significantly higher than those in the non-combination with hypertension group (P<0.05). The incidence rate of hypertension in patients with high-level hs-CRP, high-level TNF-α and high-level IL-6 were significantly higher than that in patients with normal levels (P<0.05). Type 2 DM patients with high-level inflammatory cytokines had significantly longer duration of DM, and higher FPG and HbA1c values than those with normal levels (P<0.05). Results also showed that hs-CRP, TNF-α and IL-6 were positively correlated with FPG, HbA1c and the hypertension grade, and FPG and HbA1c were also positively correlated with the hypertension grade.Logistic regression analysis revealed that hs-CRP, TNF-α, IL-6, the duration of DM, BMI, FPG, HbA1c, TC and LDL had independent values in predicting Type 2 DM combined with hypertension (P<0.05). Levels of serum hs-CRP, TNF-α and IL-6 are significantly elevated in patients with type 2 DM combined with essential hypertension, which are important factors affecting changes in blood glucose. The higher the level of inflammatory cytokines is, the higher the grade of hypertension will be.

Is tinnitus an early voice of masked hypertension? High masked hypertension rate in patients with tinnitus

ABSTRACTObjectives: Tinnitus is hearing a sound without any external acoustic stimulus. There are some clues of hypertension can cause tinnitus in different ways. The aim of the study was to evaluate the relationship between tinnitus and masked hypertension including echocardiographic parameters and severity of tinnitus.Methods: This study included 88 patients with tinnitus of at least 3 months duration and 85 age and gender-matched control subjects. Tinnitus severity index was used to classify the patients with tinnitus. After a complete medical history, all subjects underwent routine laboratory examination, office blood pressure measurement, hearing tests and ambulatory blood pressure monitoring. Masked hypertension is defined as normal office blood pressure measurement and high ambulatory blood pressure level.Results: Baseline characteristics in patients and controls were similar. Prevalence of masked hypertension was significantly higher in patients with tinnitus than controls (18.2% vs 3.5%, p = 0.002). Office diastolic BP (76 ± 8.1 vs. 72.74 ± 8.68, p = 0.01), ambulatory 24-H diastolic BP (70.2 ± 9.6 vs. 66.9 ± 6.1, p = 0.07) and ambulatory daytime diastolic BP (73.7 ± 9.5 vs. 71.1 ± 6.2, p = 0.03) was significantly higher in patients with tinnitus than control group. Tinnitus severity index in patients without masked hypertension was 0 and tinnitus severity index in patients with masked hypertension were 2 (1–5).Conclusion: This study demonstrated that masked hypertension must be kept in mind if there is a complaint of tinnitus without any other obvious reason.

Membranous nephropathy occurring with type2diabetes mellitus .

The incidence of type 2 diabetes mellitus (T2DM) is increasing, and membranous nephropathy (MN) occurs frequently with T2DM. We investigated the clinicopathological features and outcomes of patients with T2DM and MN. A total of 137 patients with biopsy-proven MN and T2DM were enrolled in this retrospective study. Another 100 MN patients without diabetes mellitus served as a control group. The clinicopathological features, treatment responses, and outcomes were analyzed and compared between groups. According to the renal biopsy findings, isolated MN (D group) was observed in 86 patients, and MN superimposed on diabetic nephropathy (DN) (DN group) was observed in 51 patients. The mean age at the time of renal biopsy and the rate of hypertension in patients with MN were higher than in the control group. Male gender (odds ratio (OR), 2.887; 95% CI, 1.244-6.702), duration of diabetes (OR, 1.009; 95% CI, 1.001-1.016,), and diabetic retinopathy (OR, 2.862; 95% CI, 1.219-6.721) were independent predictors of DN. Lesions due to global glomerulosclerosis, interstitial fibrosis/tubular atrophy (IFTA), and the afferent arterioles were more severe in patients with diabetic MN. There were no differences in the rates of complete remission (CR) between the D and control groups. Diabetic MN usually presents in ageing and clinically hypertensive patients and is associated with severe global glomerulosclerosis, IFTA, and afferent arterial lesions histologically. Patients with pure MN with DM can frequently achieve remission. Gender (male), duration of diabetes, and diabetic retinopathy may serve as indicators of DN. .

Higher Prevalence and Awareness, but Lower Control Rate of Hypertension in Patients with Diabetes than General Population: The Fifth Korean National Health and Nutrition Examination Survey in 2011

BackgroundWe investigated the prevalence, awareness, treatment, and control rate of hypertension in Korean adults with diabetes using nationally representative data.MethodsUsing data of 5,105 adults from the fifth Korea National Health and Nutrition Examination Survey in 2011 (4,389 nondiabetes mellitus [non-DM]), 242 newly diagnosed with DM (new-DM), and 474 previously diagnosed with DM (known-DM), we analyzed the prevalence of hypertension (mean systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or use of antihypertensive medication) and control rate of hypertension (blood pressure [BP] <130/80 mm Hg).ResultsThe prevalence of hypertension in diabetic adults was 54.6% (44.4% in new-DM and 62.6% in known-DM, P<0.0001 and P<0.0001, respectively) compared with non-DM adults (26.2%). Compared to non-DM, awareness (85.7%, P<0.001) and treatment (97.0%, P=0.020) rates were higher in known-DM, whereas no differences were found between new-DM and non-DM. Control rate among all hypertensive subjects was lower in new-DM (14.9%), compared to non-DM (35.1%, P<0.001) and known-DM (33.3%, P=0.004). Control rate among treated subjects was also lower in new-DM (25.2%), compared to non-DM (68.4%, P<0.0001) and known-DM (39.9%, P<0.0001).ConclusionHigher prevalence and low control rate of hypertension in adults with diabetes suggest that stringent efforts are needed to control BP in patients with diabetes, particularly in newly diagnosed diabetic patients.

Pheochromocytomas in adrenal medulla or extra-adrenal and multiple endocrine neoplasms:a clinicopathologic analysis of 181 cases

To analyze the change in the incidence of pheochromocytomas in adrenal medulla or extra-adrenal and multiple endocrine neoplasm type 2 (MEN2), to summarize the clinical characteristics of benign, potentially malignant and malignant pheochromocytomas and to investigate the correlation between clinical manifestations and pathological changes. Statistic analysis was performed to detect the incidence, constituent ratio, mean diagnostic age, sex proportion and correlation between clinical manifestions and pathologic changes in pheochromocytomas in adrenal medulla or extra-adrenal gland and MEN2 from 1993 to 2008 in the Department of Pathology, the General Hospital of Tianjin Medical University with Runs test, ANOVA, t test and chi-square test. The total number of biopsies within the 16 years was 167 702 cases (average 10 481 cases per year). The numbers (detectable rate) of total adrenal diseases, pheochromocytomas in adrenal medulla and extra-adrenal glands were 910 (0.54%), 139 (0.08%), and 42 (0.03%) cases, respectively. The numbers (constituent ratio) of benign, potentially malignant and malignant of pheochromocytomas in adrenal medulla were 102 cases (73.4%), 29 cases (20.9%) and 8 cases (5.7%), respectively; in the 102 cases of benign tumors, patients with MEN2 were 8 (7.8%); the three groups of the tumors in extra-adrenal sites were 18 (42.8%) cases, 12 (28.6%) cases and 12 (28.6%) cases. There were no changes in the detectable rate and constituent ratio of adrenal diseases, benign, potential malignant and malignant pheochromocytomas in adrenal medulla or extra-adrenal glands and patients with MEN2 during the past 16 years (P > 0.05), but there was a tendency that malignant transformation was gradually increased with age, which was more commonly found in male patients than females. The mean age at diagnosis of patients with benign and potentially malignant pheochromocytomas was 42.7 years (ranged from 10 - 74 years), and 40.1 years (13 - 66 years), respectively, which were younger than patients with malignant pheochromocytomas (51.6 years, P < 0.05); the mean age of patients with benign and potentially malignant pheochromocytomas in extra-adrenal sites was 43.1 years (ranged from 20 - 75 years) and 45.2 years (28 - 65 years) that were older than those with malignant (37.8 years, ranged from 14 - 58 years, P < 0.05). It was spectacular that patients with malignant pheochromocytoma in adrenal medulla (51.6 years) were older than that in extra-adrenal sites (37.8 years); all the patients with MEN2 were female benign pheochromocytoma in adrenal medulla, whose age (38.9 years) was younger than that of benign lesions (42.7 years, P < 0.05), in which thyroid medullary carcinoma appeared early than pheochromocytomas in adrenal medulla. The detectable rate of hypertension in patients with malignant pheochromocytomas in adrenal medulla and in extra-adrenal sites were less than that in benign and potentially malignant ones (P < 0.05). The bilateral lesions more commonly found in malignant pheochromocytoma (25.0%) than benign (15.7%) and potentially malignant pheochromocytomas (6.9%) only in adrenal medulla. Relapse rates in both adrenal and extra-adrenal tumors were rising from benign (11.8%, 0), potentially malignant (13.8%, 25.0%), to malignant (33.3%, 37.5%) groups; the average diameter of pheochromocytomas in both adrenal and extra-adrenal sites was increasing from benign (4.2 cm, 4.0 cm), potentially malignant (5.3 cm, 5.6 cm) to malignant (7.3 cm, 6.9 cm) groups (P < 0.05). The diagnostic criteria of benign, potentially malignant and malignant pheochromocytomas in adrenal medulla and in extra-adrenal sites are well established according to the WHO classification of endocrine tumors (2004). The closer relationship is found between clinical manifestations and pathologic changes. The definite type and nature of pheochromocytomas are mainly rested upon the pathologic examination.

Treating Acute Hypertension in the Hospital

Physicians treat chronic hypertension almost exclusively in ambulatory care settings according to evidence-based guidelines1 based on blood pressure (BP) measurements obtained under prescribed conditions.2 Other recommendations cover how to deal with hypertension in dialysis units2 and emergency departments,3 but none address a very commonly encountered problem: what to do about acutely elevated BP (which I refer to below in the common parlance of “acute hypertension”) in patients hospitalized for reasons other than hypertension. Indeed, excluding articles on patients with hypertensive emergencies and urgencies, there is little published about treatment of acutely elevated BP in hospitalized patients, although the practice seems to be common and based on firmly held, but poorly justified, beliefs.4 In this commentary, I argue for developing a rational approach to treating acute hypertension that de-emphasizes “treating the numbers” and focuses on patient safety. ### How Common Is Acute Hypertension in Hospitalized Patients? Most patients hospitalized for reasons other than hypertensive emergency or urgency who subsequently sporadically manifest acute hypertension deemed worthy of clinical concern probably also have chronic hypertension. In recent national data of hospitalizations, hypertension was listed as a primary diagnosis (International Classification of Diseases [ICD]–9 CM code 401) for 301 000 admissions but as a secondary diagnosis for 9 003 000 hospitalizations.5 These figures are probably an underestimate of the actual prevalence of hypertension in inpatients because 29% of the US adult population is now affected.6 One estimate of the rate of hypertension in patients in our center (the University of Michigan Health System[UMHS]) can be derived from patients attending our anesthesiology preoperative evaluation clinic, who have an incidence of 26.7% of stage 1 and 10.9% of stage 2 hypertension (unpublished data, 2010). Using these prevalence figures, during a 1-year period (October 1, 2007, to September 30, 2008) in which there were 29 545 adult admissions to …

Aspirin Resistance

Recent studies have described the incidence (approximately one in eight high-risk patients will experience a further atherothrombotic event over a 2-year period) of aspirin (acetylsalicylic acid) resistance and its possible background. The aim of this study was to compare the characteristics (risk profile, previous diseases, medications and haemorrheological variables) of patients in whom aspirin provided effective platelet inhibition with those in whom aspirin was not effective in providing platelet inhibition. 599 patients with chronic cardio- and cerebrovascular diseases (355 men, mean age 64 +/- 11 years; 244 women, mean age 63 +/- 10 years) taking aspirin 100-325 mg/day were included in the study. Blood was collected between 8:00am and 9:00am from these patients after an overnight fast. The cardiovascular risk profiles, history of previous diseases, medication history and haemorrheological parameters of patients who responded to aspirin and those who did not were compared. Platelet and red blood cell (RBC) aggregation were measured by aggregometry, haematocrit by a microhaematocrit centrifuge, and plasma fibrinogen by Clauss' method. Plasma and whole blood viscosities were measured using a capillary viscosimeter. Compared with aspirin-resistant patients, patients who demonstrated effective aspirin inhibition had a significantly lower plasma fibrinogen level (3.3 g/L vs 3.8 g/L; p < 0.05) and significantly lower RBC aggregation values (24.3 vs 28.2; p < 0.01). In addition, significantly more patients with effective aspirin inhibition were hypertensive (80% vs 62%; p < 0.05). Patients who had effective platelet aggregation were significantly more likely to be taking beta-adrenoceptor antagonists (75% vs 55%; p < 0.05) and ACE inhibitors (70% vs 50%; p < 0.05), whereas patients with ineffective platelet aggregation were significantly more likely to be taking HMG-CoA reductase inhibitors (statins) [52% vs 38%; p < 0.05]. Use of statins remained an independent predictor of aspirin resistance even after adjustment for risk factors and medication use (odds ratio 5.92; 95% CI 1.83, 16.9; p < 0.001). The mechanisms underlying aspirin resistance are multifactorial. Higher fibrinogen concentrations increase RBC aggregation and can also result in increased platelet aggregation. The higher rate of hypertension in patients with effective platelet aggregation on aspirin could explain the differences in beta-adrenoceptor antagonist and ACE inhibitor use between these patients and aspirin-resistant patients. Furthermore, an additive effect of these drugs may contribute to effective antiplatelet therapy. It is also possible that drug interactions with statins might reduce aspirin bioavailability and/or activity, thereby reducing platelet inhibition in aspirin-resistant patients.