Risk Factors For Persistent Hypertension Research Articles

Identification of risk factors for postoperative persistent hypertension in patients with pheochromocytoma.

Surgical resection is the primary management for pheochromocytoma. However, some patients with pheochromocytoma still suffer from hypertension after successful adrenalectomy. The risk factors for postoperative persistent hypertension remain unclear. Thus the aim of the present study was to identify the risk factors of postoperative persistent hypertension in patients with pheochromocytoma concomitant with hypertension. We retrospectively analyzed 259 patients with pheochromocytoma who underwent adrenalectomy in our hospital between January 1, 2007, and December 31, 2018. Patients'demographics, comorbidities, and perioperative data were recorded. The odds ratio (OR) and 95% confidence interval were measured through binary logistic regression. The cutoff values and the area under the curve (AUC) for continuous risk factors of persistent hypertension after adrenalectomy were calculated through receiver operating characteristic curve analysis. Of the 259 patients, 40.9% (106/259) patients experienced postoperative persistent hypertension. Three independent risk factors of persistent hypertension in patients with pheochromocytoma after adrenalectomy were found to be older age (OR = 1.16, p = 0.037), longer duration of hypertension (OR = 3.10, p = 0.01), and concomitance with cardiovascular events (yes vs. no, OR = 17.17, p = 0.049). The cutoff value of age and duration of hypertension was 66 years (AUC = 0.741, p < 0.0001) and 27 months (AUC = 0.991, p < 0.0001), respectively. Collectively, older age, a longer duration of hypertension, and concomitance with cardiovascular events were independent risk factors of persistent hypertension in patients with pheochromocytoma after adrenalectomy. These findings may help in improving perioperative management and follow-up strategies.

Persistent hypertension at 3 months postpartum among women with hypertensive disorders of pregnancy at a tertiary hospital in Southwestern Uganda

Hypertension is a key contributor to the global epidemic of cardiovascular disease and is responsible for more deaths worldwide than any other cardiovascular risk factor. Hypertensive disorders of pregnancy, of which preeclampsia and eclampsia are the most common forms, have been shown to be a female-specific risk factor for chronic hypertension. This study aimed to determine the proportion and risk factors for persistent hypertension at 3 months after delivery among women with hypertensive disorders of pregnancy in Southwestern Uganda. This was a prospective cohort study of pregnant women with hypertensive disorders of pregnancy admitted for delivery at Mbarara Regional Referral Hospital in Southwestern Uganda from January 2019 to December 2019; however, women with chronic hypertension were excluded from the study. The participants were followed up for 3 months after delivery. Participants with a systolic blood pressure of ≥140 mm Hg or a diastolic blood pressure of ≥90 mm Hg or receiving antihypertension therapy at 3 months after delivery were considered to have persistent hypertension. Multivariable logistic regression was used to determine independent risk factors associated with persistent hypertension. A total of 111 participants with hypertensive disorders of pregnancy diagnosed at hospital admission were enrolled with a follow-up rate of 49% (54/111) at 3 months after delivery. Of these women, 21 of 54 (39%) had persistent hypertension 3 months after delivery. In the adjusted analyses, an elevated serum creatinine level (>106.08 µmol/L [≤1.2 mg/dL]) at admission for delivery was the only independent risk factor for persistent hypertension at 3 months after delivery (adjusted relative risk, 1.93; 95% confidence interval, 1.08-3.46; P=.03), controlling for age, gravidity, and eclampsia. Approximately 4 of 10 women presenting with hypertensive disorders of pregnancy at our institution remained hypertensive 3 months after delivery. Innovative strategies are needed to identify these women and provide long-term care to optimize blood pressure control and reduce future cardiovascular disease after hypertensive disorders of pregnancy.

Persistent Hypertension Up to One Year Postpartum among Women with Hypertensive Disorders in Pregnancy in a Low-Resource Setting: A Prospective Cohort Study.

Background:Hypertensive disorders in pregnancy (HDPs) are associated with lifelong cardiovascular disease risk. Persistent postpartum hypertension in HDPs could suggest progression to chronic hypertension. This phenomenon has not been well examined in low- and middle-income countries (LIMCs), and most previous follow-ups typically last for maximally six weeks postpartum. We assessed the prevalence of persistent hypertension up to one year in women with HDPs in a low resource setting and determined associated risk factors.Methodology:A prospective cohort study of women conducted at eight tertiary health care facilities in seven states of Nigeria. Four hundred and ten women with any HDP were enrolled within 24 hours of delivery and followed up at intervals until one year postpartum. Descriptive statistics were performed to express the participants’ characteristics. Univariable and multivariable logistic regressions were conducted to identify associated risk factors.Results:Of the 410 women enrolled, 278 were followed up to one year after delivery (follow-up rate 68%). Among women diagnosed with gestational hypertension and pre-eclampsia/eclampsia, 22.3% (95% CI; 8.3–36.3) and 62.1% (95% CI; 52.5–71.9), respectively, had persistent hypertension at six months and this remained similar at one year 22.3% (95% CI; 5.6–54.4) and 61.2% (95% CI; 40.6–77.8). Maternal age and body mass index were significant risk factors for persistent hypertension at one year [aORs = 1.07/year (95% CI; 1.02–1.13) and 1.06/kg/m2 (95% CI; 1.01–1.10)], respectively.Conclusion:This study showed a substantial prevalence of persistent hypertension beyond puerperium. Health systems in LMICs need to be organized to anticipate and maintain postpartum monitoring until blood pressure is normalized, or women referred or discharged to family physicians as appropriate. In particular, attention should be given to women who are obese, and or of higher maternal age.

590 - Risk factors of persistent hypertension after adrenalectomy for primary aldosteronism

590 - Risk factors of persistent hypertension after adrenalectomy for primary aldosteronism

MP12-07 THE IMPLICATION OF AORTIC CALCIFICATION ON PERSISTENT HYPERTENSION AFTER LAPAROSCOPIC ADRENALECTOMY IN PATIENTS WITH PRIMARY ALDOSTERONISM

You have accessJournal of UrologyAdrenal1 Apr 2016MP12-07 THE IMPLICATION OF AORTIC CALCIFICATION ON PERSISTENT HYPERTENSION AFTER LAPAROSCOPIC ADRENALECTOMY IN PATIENTS WITH PRIMARY ALDOSTERONISM Hayato Yamamoto, Naoki Fujita, Shingo Hatakeyama, Atsushi Imai, Takahiro Yoneyama, Yasuhiro Hashimoto, Takuya Koie, and Chikara Ohyama Hayato YamamotoHayato Yamamoto More articles by this author , Naoki FujitaNaoki Fujita More articles by this author , Shingo HatakeyamaShingo Hatakeyama More articles by this author , Atsushi ImaiAtsushi Imai More articles by this author , Takahiro YoneyamaTakahiro Yoneyama More articles by this author , Yasuhiro HashimotoYasuhiro Hashimoto More articles by this author , Takuya KoieTakuya Koie More articles by this author , and Chikara OhyamaChikara Ohyama More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2447AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To identify risk factors, including aortic calcification, for persistent hypertension in primary aldosteronism (PA) patients who underwent laparoscopic adrenalectomies. METHODS Between October 2000 and October 2015, we performed consecutive 101 laparoscopic adrenalectomies for unilateral PA patients. Of those, 95 patients who had at least one year follow-up periods were included. The patients were divided into two groups based on whether they had normal blood pressure without antihypertensive medications (resolved group) or still required medications (unresolved group) at one year after surgery. Variables included age, gender, body mass index, history of hypertension, dosage of antihypertensive medication score, presence of type 2 diabetes, subclinical Cushing syndrome, preoperative renal function, aldosteronoma resolution score (ARS), and abdominal calcification index (ACI). Univariate and multivariate logistic regression analyses were used to assess independent risk factors for persistent hypertension one year after surgery. RESULTS The complete resolution of hypertension without antihypertensive medication one year after adrenalectomy was 36/95 (38%). Preoperative antihypertensive medication score, systolic blood pressure, ACI were significantly higher, and ARS were significantly lower in the unresolved group than in the resolved group. Using multivariate logistic regression analysis, independent risk factors significantly correlating with persistent hypertension one year after surgery were ARS and ACI. CONCLUSIONS Adrenalectomy improved blood pressure and the need for antihypertensive medications, whereas ARS and ACI were potential independent risk factors for persistent hypertension one year after adrenalectomy. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e128 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Hayato Yamamoto More articles by this author Naoki Fujita More articles by this author Shingo Hatakeyama More articles by this author Atsushi Imai More articles by this author Takahiro Yoneyama More articles by this author Yasuhiro Hashimoto More articles by this author Takuya Koie More articles by this author Chikara Ohyama More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP12-08 SURGICAL AND HEMODYNAMIC OUTCOMES IN PATIENTS UNDERGOING PHEOCHROMOCYTOMA AND PARAGANGLIOMA SURGERY: A PROSPECTIVE COHORT STUDY

INTRODUCTION AND OBJECTIVES: To identify risk factors, including aortic calcification, for persistent hypertension in primary aldosteronism (PA) patients who underwent laparoscopic adrenalectomies. METHODS: Between October 2000 and October 2015, we performed consecutive 101 laparoscopic adrenalectomies for unilateral PA patients. Of those, 95 patients who had at least one year follow-up periods were included. The patients were divided into two groups based on whether they had normal blood pressure without antihypertensive medications (resolved group) or still required medications (unresolved group) at one year after surgery. Variables included age, gender, body mass index, history of hypertension, dosage of antihypertensive medication score, presence of type 2 diabetes, subclinical Cushing syndrome, preoperative renal function, aldosteronoma resolution score (ARS), and abdominal calcification index (ACI). Univariate and multivariate logistic regression analyses were used to assess independent risk factors for persistent hypertension one year after surgery. RESULTS: The complete resolution of hypertension without antihypertensive medication one year after adrenalectomy was 36/95 (38%). Preoperative antihypertensive medication score, systolic blood pressure, ACI were significantly higher, and ARS were significantly lower in the unresolved group than in the resolved group. Using multivariate logistic regression analysis, independent risk factors significantly correlating with persistent hypertension one year after surgery were ARS and ACI. CONCLUSIONS: Adrenalectomy improved blood pressure and the need for antihypertensive medications, whereas ARS and ACI were potential independent risk factors for persistent hypertension one year after adrenalectomy.

Implication of aortic calcification on persistent hypertension after laparoscopic adrenalectomy in patients with primary aldosteronism

To identify risk factors, including aortic calcification, for persistent hypertension in primary aldosteronism patients undergoing laparoscopic adrenalectomy. Between October 2000 and October 2015, we carried out 101 consecutive laparoscopic adrenalectomies for unilateral primary aldosteronism. Of these, 95 cases with at least 1 year of postoperative follow up were included. These were divided into two study groups based on whether they had normal blood pressure without antihypertensive medications (resolved group) or still required medications (unresolved group) at 1 year after surgery. Variables included age, sex, body mass index, history of hypertension, dosage of antihypertensive medication score, presence of type 2 diabetes, subclinical Cushing syndrome, preoperative renal function, aldosteronoma resolution score and abdominal calcification index. Univariate and multivariate logistic regression analyses were used to assess independent risk factors for persistent hypertension 1 year after surgery. The complete resolution of hypertension without antihypertensive medication 1 year after adrenalectomy was 36 out of 95 (38%). The preoperative antihypertensive medication score, systolic blood pressure and abdominal calcification index were significantly higher, and the aldosteronoma resolution score were significantly lower in the unresolved group than in the resolved group. Using multivariate logistic regression analysis, independent risk factors significantly correlating with persistent hypertension 1 year after surgery were aldosteronoma resolution score and abdominal calcification index. Laparoscopic adrenalectomy for primary aldosteronism is effective in improving blood pressure and reducing the need for antihypertensive medications. Aldosteronoma resolution score and abdominal calcification index represent potential independent risk factors for persistent hypertension 1 year after surgery.

Prevalence and risk factors for persistent hypertension after the puerperium in pregnancies complicated with hypertensive disorders

New onset hypertensive disorders arising in the second half (>20 weeks) of pregnancy may persist beyond the puerperium. Using prospective follow-up data comprising information on 198 previously normotensive-non proteinuric women who developed hypertensive disorders after 20 weeks’ gestation, we examined the prevalence and risk factors for persistence of hypertension after the puerperium. The prevalence of persistent hypertension was 25.8%. Compared with normotensive women, maternal age ≥35 years (OR = 14.89; 95% CI, 3.2–67.8), serum creatinine level (OR = 5.91; 95% CI,1.5–22.8), serum uric acid (OR = 37.49; 95% CI, 10.4–140.0) and maternal HIV infection (OR = 14.18; 95% CI, 1.5–132.0) were independently associated with persistent hypertension. Identification of women at risk of developing chronic hypertension after the puerperium can prevent morbidities related to hypertension

Factors associated with persistent hypertension after puerperium among women with pre-eclampsia/eclampsia in Mulago hospital, Uganda

BackgroundWomen with severe pre-eclampsia/eclampsia are at risk of developing chronic hypertension in future. Chronic hypertension may manifest initially as persistent hypertension at the end of the puerperium. The objective was to determine the incidence and maternal biochemical, hematological and socio-demographic risk factors for persistent hypertension in patients with pre-eclampsia/eclampsia.MethodsThis was a prospective cohort study conducted from November 2008 to May 2009 at Mulago hospital labor ward and postnatal clinic. Participants were 200 women managed for pre-eclampsia/eclampsia and followed up to the end of the puerperium. Data was collected through using pre-coded interviewer-administered questionnaires, checking medical records and laboratory investigations. STATA (release 9) software was used for data analysis. At bivariate analysis, the relative risk of persistent hypertension was estimated at the 95% confidence level. Using multivariate logistic regression analysis, factors that were independently associated with persistent hypertension were evaluated.ResultsFifty four (27.7%) out of the total 195 women had persistent hypertension after puerperium. Serum creatinine and the age of the patient were the only factors associated with persistence of hypertension after puerperium.ConclusionNearly every one in four mothers with pre-eclampsia/eclampsia are at risk of persistent hypertension after the puerperium. Serum creatinine, serum uric acid and participants' age were the only factors independently associated with persistence of hypertension after the puerperium.

Factors Influencing Outcome of Surgical Treatment for Primary Aldosteronism

Purpose: Primary aldosteronism due to an adrenal cortical adenoma is a surgically curable disease. However, hypertension is known to persist postoperatively in many patients. The aim of this study was to determine the factors influencing the long-term outcome of blood pressure after an adrenalectomy for a primary aldosteronism and to evaluate the changing pattern of renin and aldosterone. Method.: Forty-two cases of primary aldosteronism, which were operated on and followed up at the Department of Surgery, Seoul National University Hospital from January 1986 to June 2001 were included in this study. The subjects were classified into a normotensive group and a hypertensive group and the two groups were compared according to the clinical, biochemical and pathological parameters. Results: After surgery, the aldosterone concentration was decreased and the plasma renin activity was increased. During a mean follow-up period of 28 months, 31 patients (73.8%) had a normal blood pressure without an antihypertensive treatment. The significant risk factors for persistent hypertension were a family history of hypertension, a long duration of preoperative hypertension, a poor response of preoperative spironolactone. The hypertensive group had a higher level of postoperative plasma renin activity and an aldosterone concentration in the long-term follow-up period after surgery. Conclusion: A family history of hypertension, the duration of hypertension and the response to spironolactone were factors influencing persistent hypertension after surgery for a primary aldosteronism. A high level of plasma renin activity and aldosterone during the follow-up period is related to the persistent hypertension. Therefore, early detection and surgery for a primary aldosteronism would reduce the preoperative cardiovascular changes and improve the postoperative outcome.