Secondary Hypertension Research Articles

Adrenal venous sampling (AVS): Success of catheterization and concordance of imaging lateralization with AVS lateralization

Objective: Primary hyperaldosteronism (PA) is an important cause of secondary hypertension. One of the most crucial steps in the management of patients with PA is the determination of the laterality of aldosterone production (unilateral or bilateral disease). This study aimed to determine the success rate of adrenal venous sampling (AVS) and the concordance between imaging and AVS laterality. Material and Methods: The procedural, radiological, and laboratory data of the patients who underwent AVS were evaluated retrospectively. The Selectivity Index (SI) and Lateralization Index (LI) were used for catheterization success and laterality determination, respectively. The Contralateral Suppression Index (CSI) was used for laterality determination in cases of unilaterally failed AVS. Abdominal CT scans were evaluated for adrenal nodules and hyperplasia. Results: This study included 36 patients for catheterization success and 28 patients for laterality evaluation. The mean age was 56.08±9.01 years. The overall success rate was 88.9% (32 of 36 patients). The bilateral and unilateral successful catheterization rates were 52.8% and 36.2%, respectively. Unilateral disease was present in 15 (53.6%) patients based on AVS, right-sided in 9 (32.1%), and left-sided in 6 (21.4%) patients. Unilateral disease was present in 18 (64.3%) patients based on imaging, right-sided in 11 (39.3%), and left-sided in 7 (25%) patients. The proportion of agreement between imaging and AVS lateralization was 50% (14 of 28 patients). Conclusion: The overall success rate of AVS was high when unilateral success was included. In half of the patients with PA in this study, CT showed discordant disease laterality compared to AVS.

Beyond the Usual Suspects: Emerging Insights into Takayasu’s Arteritis and Its Role in Secondary Hypertension

Background: Pulselessness is the main sign of Takayasu's Arteritis (TAK), a granulomatous large artery vasculitis that mostly affects the aorta, major aortic branches, and pulmonary arteries. Renal artery stenosis is the source of arterial hypertension, which is common in TA. It is estimated that there are 2.6 incidences of Takayasu's arteritis per million people worldwide each year.
 Case Details: We report on an 18-year-old girl whose significant arterial hypertension on her left arm, identified during a routine check-up, was the primary manifestation of Takayasu's arteritis (TA). The left arm's systolic blood pressure was noticeably greater than the right's. Additionally, there was a difference in blood pressure between the legs and left arm. Auscultation revealed the presence of vascular bruits over the left subclavian regions. A CT angiography was used to establish the diagnosis of TA. The results indicated a substantial constriction at the right renal artery's origin and characteristics compatible with aortic arteritis of the thoracic and abdominal aorta with active disease given wall enhancement. Due to the disorder's rarity and the varied ways in which it manifests clinically, a delayed diagnosis and treatment are likely.
 Conclusion: Our study emphasizes that this illness can and does affect young people, and as such, patients presenting with suggestive symptoms and signs—especially young patients with unexplained hypertension—should be taken into consideration. Appropriate imaging and clinical suspicion are essential for the accurate diagnosis and treatment of TA patients. Several findings were found during the clinical examination, including signs of claudication, fever symptoms, involvement of major vessels including the aorta and its branches. This illustrates the condition of Takayasu's arteritis and what medical professionals should anticipate when treating it.

Abdominal aortic calcium and geometry in patients with essential hypertension

PurposeAbdominal aorta calcium (AAC) burden and dilatation are associated with an increased risk of mortality. The purpose of this study was to investigate determinants of AAC and abdominal aorta size in patients with essential hypertension. Materials and methodsPatients with uncomplicated essential hypertension who had undergone non-enhanced abdominal CT to rule out secondary hypertension in addition to biological test were recruited between 2010 and 2018. A semi-automatic system was designed to estimate the aortic size (diameter, length, volume) and quantify the AAC from mesenteric artery to bifurcation using the Agatston score. Determinants of aortic size and those related to AAC were searched for using uni- and multivariables analyses. ResultsAmong 293 randomly selected patients with hypertension (age 52 ± 11 [SD] years) included, 23% had resistant hypertension. Mean abdominal aorta diameter was 20.1 ± 2.1 (SD) mm. Eight (3%) patients had abdominal aorta aneurysm ≥ 30 mm and 58 (20%) had dilated abdominal aorta ≥ 27 mm. Median AAC score was 38 and calcifications were detected in the infra- and supra-renal abdominal aortic portions in 59% and 26% of the patients, respectively. After adjustment for age, male sex and body surface area, abdominal aorta diameter was positively associated with diastolic blood pressure (P = 0.0019). Smoking was the single variable associated with calcified abdominal aorta (P < 0.001) after adjustment for cofactors. In patients with calcifications of abdominal aorta, the score increased with smoking history (P < 0.001), statins treatment (P < 0.01), greater number of anti-hypertensive drugs (P < 0.01), larger abdominal aorta (P < 0.05) and greater systolic blood pressure (P < 0.05). Patients with resistant hypertension had more AAC in the supra-renal abdominal aorta portion than those without resistant hypertension (P < 0.01). ConclusionIn patients with essential hypertension, abdominal aorta dilation is related with diastolic blood pressure while AAC is associated with smoking history and resistant hypertension when located to the supra-renal abdominal aorta portion.

Unmasking the Silent Menace: A Case Report of Aldosterone-Secreting Adrenal Cortical Adenoma

Background: Adrenal cortical adenoma with aldosterone hypersecretion, the most prevalent cause of secondary hypertension, represents a significant subset of adrenal tumors with distinct clinical implications. Clinical Description: A 30-year-old female presented with generalized body pain for two years and multiple episodes of sudden onset progressive weakness of the upper and lower limbs. Management: The diagnosis was confirmed by serum aldosterone and plasma renin activity and a laparoscopic right adrenalectomy was performed. The histopathology of the removed specimen helped to rule out adrenal cortical carcinoma Conclusion: A prompt diagnosis and surgical management improves the quality of life for patients with such rare diseases.

Hypertension in NF1: A closer look at the primacy of essential hypertension versus secondary causes.

We aimed to analyze hypertension in neurofibromatosis type 1 (NF1) in a Finnish population-based cohort in 1996-2014. A cohort of 1365 individuals with confirmed NF1 was compared with a control cohort of 13,923 individuals matched for age, sex, and area of residence. Diagnoses of hypertension were retrieved from the Finnish Care Register for Health Care. These registered data were separately analyzed for secondary and essential hypertension. Purchases of antihypertensive drugs were queried from the Finnish Register of Reimbursed Drug Purchases. We identified 115 NF1 patients with hospital diagnosis of hypertension. Our findings revealed a hazard ratio (HR) of 1.64 (95% CI 1.34-2.00, p < 0.001) in NF1 versus controls. NF1 patients presented with a significantly increased hazard for both secondary hypertension (n = 9, HR 3.76, 95% CI 1.77-7.95, p < 0.001) and essential hypertension (n = 98, HR 1.73, 95% CI 1.39-2.14, p < 0.001). No difference in the HR of hypertension was observed between men and women, while NF1 patients with essential hypertension were, on average, younger than the controls. The proportions of individuals with antihypertensive medication did not differ between NF1 patients and controls (OR 0.85). NF1 is a risk factor for hypertension. Despite the recognized risk for secondary hypertension, essential hypertension is the predominant type in NF1.

Adrenal Vein Sampling in the Management of Primary Aldosteronism: The Added Value of Intraprocedural Cortisol Assessment.

Primary aldosteronism is the most common cause of secondary hypertension. Adrenal vein sampling is the gold standard for subtyping primary aldosteronism. However, this procedure is technically challenging and often has a low success rate. Our center is one of the very few performing this technique in our country with an increasing experience. The aim of this study was to evaluate the role of the cortisol intraprocedural assay in improving the performance of adrenal vein sampling. We enrolled all of the patients with primary aldosteronism that underwent adrenal vein sampling from February 2016 to April 2023. The cortisol intraprocedural assay was introduced in October 2021. We enrolled a total of 50 adrenal vein samplings performed on 43 patients with the diagnosis of primary aldosteronism. In this sample, 19 patients and 24 patients underwent adrenal vein sampling before and after intraprocedural cortisol measurement, respectively. The procedure was repeated in seven patients (one before and six after intraprocedural cortisol measurement), given the unsuccess of the first exam. Selectivity of the adrenal vein sampling was assumed if the serum cortisol concentration from the adrenal vein was at least five times higher than that of the inferior vena cava. Lateralization was assumed if the aldosterone to cortisol ratio of one adrenal vein was at least four times the aldosterone to cortisol ratio of the contralateral side. The mean age of the patients that underwent adrenal vein sampling (N = 43) was 55.2 ± 8.9 years, and 53.5% (n = 23) were female. The mean interval between the diagnosis of hypertension and the diagnosis of primary aldosteronism was 9.8 years (±9.9). At diagnosis, 62.8% of the patients (n = 27) had hypokalemia (mean value of 3 mmol/L (±0.34)), 88.4% (n = 38) had adrenal abnormalities on preprocedural CT scan, and 67.4% (n = 29) described as unilateral nodules. There were no statistically significant differences in the patients' baseline characteristics between the two groups (before and after intraprocedural cortisol measurement). Before intraprocedural cortisol measurement, adrenal vein sampling selectivity was achieved in 35% (n = 7) patients. Selectivity increased to 100% (30/30) after intraprocedural cortisol measurement (p < 0.001). With the exception of one patient who refused it, all patients with lateralized disease underwent unilateral adrenalectomy with normalization of the aldosterone to renin ratio postoperatively. The lack of effective alternatives in subtyping primary aldosteronism highlights the need to improve the success rate of adrenal vein sampling. In this study, intraprocedural cortisol measurement allowed a selectivity of 100%. Its addition to this procedure protocol should be considered, especially in centers with a low success rate.

Evaluation of the Expression and Localization of the Multifunctional Protein CacyBP/SIP and Elements of the MAPK Signaling Pathway in the Adrenal Glands of Rats with Primary and Secondary Hypertension.

Hypertension is a global civilization disease and one of the most common causes of death in the world. Organ dysfunction is a serious health consequence of hypertension, which involves damage to the heart, kidneys and adrenals. The interaction of recently discovered multifunctional protein-CacyBP/SIP with ERK1/2 and p38 kinases by regulating the activity and intracellular localization of these kinases may play an important role in the signaling pathways involved in the pathogenesis of hypertension. Due to the lack of data on this subject, we decided to investigate the localization, expression and possible relationship between the studied parameters in the adrenals under arterial hypertension. The study was conducted on the adrenals of rats with spontaneous and DOCA-salt hypertension. The expression of CacyBP/SIP, p-ERK1/2 and p-p38 was detected by immunohistochemistry and qRT-PCR. The results show a statistically significant decrease in CacyBP/SIP expression in the adrenal glands of hypertensive rats. With ERK1/2, there was a decrease in cortical immunoreactivity and an increase in the adrenal medulla of primary hypertensive rats. In contrast, in the adrenals of DOCA-salt rats, ERK1/2 immunoreactivity increased in the cortex and decreased in the medulla. In turn, p38 expression was higher in the adrenal glands of rats with primary and secondary hypertension. The obtained results may suggest the involvement of CacyBP/SIP in the regulation of signaling pathways in which MAP kinases play an important role and provide new insight into molecular events in hypertension. Moreover, they show the participation of CacyBP/SIP in response to oxidative stress.

Marine Organisms as Potential Sources of Inhibits ACE on Hypertension Patient

Abstract:&#x0D; Hypertension is a condition of chronic high blood pressure in the systemic arteries which is a major risk factor for cardiovascular disease, kidney disorders, and death. There are two types of hypertension, the primary hypertension is thought to be caused by hereditary factors, age, gender, race, and an unhealthy lifestyle. Secondary hypertension is caused by an obvious cause. The prevalence of hypertension in Indonesia is quite high with the highest incidence rate in South Kalimantan (44,1%) and the lowest in Papua (22,2%). The pathophysiology of hypertension involves the enzyme Angiotensin Converting Enzyme (ACE) which plays a role in regulating blood pressure. The process of converting Angiotensinogen to Angiotensin I, then Angiotensin II by ACE can cause vasoconstriction and fluid retention, which contribute to hypertension. The changes in circulation and blood vessel structure have played a role in the risk of hypertension complications, including stroke. The marine organisms such as fish, shellfish, cephalopods, seaweed, and algae contain peptides with antihypertensive, anticoagulant, antithrombotic, and hypercholesterolemic activities. For example, hydrolyzate of the jellyfish, Rhopilema esculentum can inhibit ACE with a high level of effectiveness. The current hypertension treatment often uses synthetic drugs such as ACE inhibitors and Angiotensin Receptor Blockers (ARBs), but these have undesirable side effects. Therefore, bioactive peptides from marine organisms can be an efficient and safe natural alternative. The research on protein hydrolysates from various sources has found ACE inhibitory activity and several peptides such as Trp-Pro-Met-Gly-Phe (WPMGF) and APP, KPLL, and VYPFPGPIPNSLPQNIPP were identified to have strong ACE inhibitory activity. These findings indicate the potential use of bioactive peptides from marine organisms as a natural alternative for the treatment and prevention of hypertension.

Standardized treatment protocols for hypertension: global availability, characteristics, and alignment with the hypertension guideline recommendations.

Hypertension control is suboptimal globally. Implementing evidence-based, simple, standardized treatment protocols (STPs) has been instrumental in effectively and efficiently improving treatment and control of hypertension. We aimed to identify, characterize, and critically appraise hypertension STPs. We defined STP as a series of steps for the pharmacological treatment of primary hypertension, with information on target population, BP threshold for treatment initiation, target BP, specific drugs/classes/doses, and follow-up frequency. STPs for adult patients were identified from the websites of relevant health organizations, Google search, and through expert consultations (until July 2023). STPs for secondary, gestational, or malignant hypertension or those that were templates/samples were excluded. Included STPs were critically appraised using HEARTS in the Americas Checklist for hypertension management in primary care and compared with the 2021 WHO hypertension management guideline recommendations. Fifty STPs were identified. All STPs had a stepwise treatment approach, involved guideline-recommended first-line drugs, and 98% consisted of at least four steps. Majority (54%) recommended monotherapy with calcium channel blockers as first-line treatment. Only 44% STPs recommended treatment initiation with combination therapy, and 16% recommended single-pill combinations. Most (62%) had dose-intensification as the second step. Most (74%) STPs did not provide complete dosing information. Only one STP mentioned a target time for achieving BP control. On average, STPs scored a performance of 68% on the HEARTS Checklist. Several STPs are available globally; however, most of them have enormous scope for improvement through interventions aimed at alignment with the latest evidence-based guidelines and multistakeholder engagement.

Primary hyperaldosteronism: the choice in favor of conservative surgery

Primary hyperaldosteronism (PHA) is the most common cause of secondary arterial hypertension among endocrine disorders. Given that patients with this pathology are at a higher risk of developing fatal and non-fatal cardiovascular events, early diagnosis and timely treatment are of great importance. Currently, the two main forms of PHA are aldosterone-producing adenoma and bilateral adrenal hyperplasia, which are treated with laparoscopic adrenalectomy or pharmacotherapy with mineralocorticoid receptor antagonists. Although most patients experience restoration of their functional and metabolic status after surgical intervention, some may develop postoperative adrenal insuffi ciency, which requires long-term hormone replacement therapy. This review examines the options for organ-preserving surgeries, such as partial adrenalectomy and selective embolization of the adrenal artery.

Adrenal ablation as a treatment for hypertension: analyzing the dielectric properties of adrenal glands for microwave ablation technologies

Abstract Adrenal gland-induced hypertension, also known as secondary hypertension, is a medical condition caused by an underlying adrenal pathology, most typically adrenocortical adenomas. Current clinical practices involve pharmacotherapy or surgical resection to treat adrenal gland diseases that cause hypertension. However, due to the limitations of these treatment options, microwave ablation (MWA) has emerged as a promising minimally invasive alternative. An accurate understanding of the dielectric properties of adrenal glands would support the further development and optimization of MWA technology for treating adrenal tumors. Only a few studies have examined the dielectric properties of both human and animal adrenal glands, and the sample sizes of these studies have been relatively small. Therefore, further dielectric data of human and animal adrenal glands are warranted. This paper presents the ex vivo dielectric properties of the ovine adrenal glands (medulla and cortex) and summarizes the published literature on dielectric data of adrenal glands from porcine, bovine, ovine, and human samples in the microwave frequency range to analyze the consistency and reliability of the reported data. The dielectric properties of the ovine adrenal glands (N = 8) were measured using an open-ended coaxial probe measurement technique at frequencies ranging from 0.5 to 8.5 GHz. This study also investigated the temperature-dependent dielectric properties of the ovine adrenal medulla ranging from 37 to 64°C at frequencies ranging from 0.5 to 8.5 GHz. The dielectric properties of the ovine adrenal medulla measured in this study were found to be consistent with the literature. Moreover, the review suggests that variations exist in the dielectric properties of the adrenal medulla and cortex among species. The study also found that the dielectric properties of the adrenal medulla decrease with increasing temperature, similar to other tissues for which temperature-dependent dielectric data have been reported. This summary of dielectric data of adrenal glands and the temperature-dependent dielectric properties of the ovine adrenal medulla will accelerate the development of MWA technologies for hypertension treatment.

KL-6 in adult polymyositis and dermatomyositis patients and its correlation with interstitial lung disease

BackgroundPulmonary involvement is still regarded as a common cause of morbidity in Polymyositis/Dermatomyositis. Interstitial lung disease can result in potentially fatal consequences such as ventilatory failure, secondary pulmonary arterial hypertension, or cor pulmonale. Early diagnosis of interstitial lung disease is hence a top priority in Polymyositis/Dermatomyositis patients. Krebs von den Lungen-6 is a transmembrane mucoprotein that has recently been identified as a promising marker for interstitial lung disease diagnosis and progression. As a result, it is regarded as a powerful predictor of interstitial lung disease severity. Thirty polymyositis/dermatomyocitis patients were enrolled in this study. Thirty age and sex matched healthy individuals were selected as control group. Cutaneous Dermatomyositis Disease Area Severity index(CDASI) was used for evaluation of skin severity, KL6 was measured using Elisa kit, High-resolution computed tomography, pulmonary function tests were made.ResultsSixteen female and 14 male patients had a mean age of 41.64–8.02 and amedian of the disease duration of 4 years. Fifteen patients (50%) had normal readings on High-resolution computed tomography of the chest HRCT chest, while the other half had significant HRCT chest findings. KL-6 concentrations were seen to be higher in Polymyositis/Dermatomyositis patients mainly those with ILD (mean ± SD 38.66 ± 22.98), compared to the control group (Mean ± S 589.04 ± 409) and in patients without ILD (Mean ± SD 86.70 ± 8.99), (p < 0.001). KL-6 serum concentrations were shown to have a significant connection with the HRCT score (r = 0.803, P < 0.001). Forced vital capacity (FVC%) (r = − 0.910, P < 0.001), forced expiratory volume in 1 s (FEV1%) (r = − 0.767, P < 0.001), and FEV1/FVC% (r = − 0.228, P = 0.112) were all inversely related to KL-6 concentrations.ConclusionIndividuals with PM and DM with concomitant ILD have increased KL-6 serum concentrations in comparison to myositis individuals without ILD, denoting its potential role in diagnosis and follow up of PM/DM with ILD. Further studies are needed to discuss the role of KL6 in large sample of the patient's population, and its correlation with other organ affection rather than ILD. Also to clarify the potentiality of adding the KL6 biomarker to the guidelines of treat to target for Rheumatic diseases with lung affection and to see the effect of treatment on KL6 serum level.

Resistant hypertension: challenges in everyday practice.

Resistant hypertension is defined as not achieving sufficient control of blood pressure (BP), that is, maintaining BP values equal to or above 140/90 mm Hg when using 3 antihypertensive drugs, including diuretics, properly combined and at maximum doses. The uncontrolled treated hypertension should be confirmed in out‑of‑office BP measurements, preferably with 24‑hour ambulatory BP monitoring. Demographic and clinical characteristics indicate that patients with resistant hypertension are older than the general population of patients with arterial hypertension and more often suffer from comorbidities. When resistant hypertension is suspected, it is necessary to assess whether optimal pharmacotherapy has been prescribed, including appropriate combinations of antihypertensive drugs and diuretics at appropriate doses. It is also important to exclude parallel use of drugs that may have unfavorable interactions leading to an increase in BP. A common cause of pseudoresistant hypertension is a patient's failure to comply with therapeutic recommendations, including a lack of lifestyle changes and nonadherence to the prescribed medication regimen. An important step in management of resistant hypertension is targeted screening with diagnostic tests for secondary hypertension. Expanding of the drug therapy beyond a 3‑drug regimen should include a mineralocorticoid receptor antagonist, in particular spironolactone. In selected patients, device‑based hypertension treatment might be considered.

Identification of Potential Modulators of a Pathogenic G Protein-Gated Inwardly Rectifying K+ Channel 4 Mutant: In Silico Investigation in the Context of Drug Discovery for Hypertension.

Genetic abnormalities have been associated with primary aldosteronism, a major cause of secondary hypertension. This includes mutations in the KCNJ5 gene, which encodes G protein-gated inwardly rectifying K+ channel 4 (GIRK4). For example, the substitution of glycine with glutamic acid gives rise to the pathogenic GIRK4G151E mutation, which alters channel selectivity, making it more permeable to Na+ and Ca2+. While tertiapin and tertiapin-Q are well-known peptide inhibitors of the GIRK4WT channel, clinically, there is a need for the development of selective modulators of mutated channels, including GIRK4G151E. Using in silico methods, including homology modeling, protein-peptide docking, ligand-binding site prediction, and molecular docking, we aimed to explore potential modulators of GIRK4WT and GIRK4G151E. Firstly, protein-peptide docking was performed to characterize the binding site of tertiapin and its derivative to the GIRK4 channels. In accordance with previous studies, the peptide inhibitors preferentially bind to the GIRK4WT channel selectivity filter compared to GIRK4G151E. A ligand-binding site analysis was subsequently performed, resulting in the identification of two potential regions of interest: the central cavity and G-loop gate. Utilizing curated chemical libraries, we screened over 700 small molecules against the central cavity of the GIRK4 channels. Flavonoids, including luteolin-7-O-rutinoside and rutin, and the macrolides rapamycin and troleandomycin bound strongly to the GIRK4 channels. Similarly, xanthophylls, particularly luteoxanthin, bound to the central cavity with a strong preference towards the mutated GIRK4G151E channel compared to GIRK4WT. Overall, our findings suggest potential lead compounds for further investigation, particularly luteoxanthin, that may selectively modulate GIRK4 channels.

Doxycycline-Induced Intracranial Hypertension Presenting as Unilateral Pulsatile Tinnitus.

Pulsatile tinnitus (PT) is increasingly recognized as a cardinal symptom of idiopathic intracranial hypertension (IIH). However, clinicians should remain aware of other causes of nonidiopathic or secondary intracranial hypertension manifesting as PT. We present 2 patients with isolated PT (without accompanying headache, blurred vision, and papilledema) thought to be secondary to tetracycline-induced intracranial hypertension. To our knowledge, these are the first cases of PT as the presenting symptom of this condition. A 41-year-old female (body mass index [BMI] 29 kg/m2) with ocular rosacea was initially treated with minocycline. Shortly after transitioning to oral doxycycline and erythromycin eye ointment, she noted left-sided PT. Her PT resolved after discontinuing doxycycline. In a second case, a 39-year-old female (BMI 19 kg/m2) with acne presented with a three-year history of left-sided PT while on long-term oral doxycycline for many years. She denied visual or auditory changes and atypical headaches. MRI findings were concerning for intracranial hypertension. Three months later, the patient was seen by neuro-ophthalmology, with findings suggesting prior papilledema. The patient reported PT improvement after discontinuing doxycycline. This case series highlights 2 cases of isolated PT as the sole symptom of intracranial hypertension that resolved with tetracycline cessation. The presentation and unexpected improvement following tetracycline discontinuation are atypical compared with previous reports of tetracycline-induced intracranial hypertension. Clinicians should maintain a high index of suspicion for all types of intracranial hypertension (idiopathic and secondary), even in patients with a lower BMI. Current and prior medications should be reviewed when considering the etiology of intracranial hypertension.

Patent Ductus Arteriosus and Bronchopulmonary Dysplasia–Associated Pulmonary Hypertension

Bronchopulmonary dysplasia (BPD) is often associated with pulmonary vascular disease and secondary pulmonary hypertension (PH). The pathogenesis of BPD-associated PH (BPD-PH) is complex and involves prenatal and postnatal factors that disrupt pulmonary vascular development, and patent ductus arteriosus (PDA) is a factor potentially associated with risk of BPD-PH that has been identified in very recent studies. To explore the association of PDA with BPD-PH using a bayesian model-averaged (BMA) meta-analysis of studies. PubMed and Embase were searched up to April 2023. Key search terms included BPD and PH. Studies examining infants with gestational age 32 weeks or less and reporting data on PDA and risk of BPD-PH. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Meta-Analysis of Observational Studies in Epidemiology reporting guidelines. Two independent reviewers extracted data, with a third reviewer checking for accuracy and completeness. Data pooling and effect size calculations were performed by BMA. The primary outcome was BPD-PH. BMA was used to calculate Bayes factors (BFs). The BF10 is the ratio of the probability of the data under the alternative hypothesis (H1, association of PDA with BPD-HP) over the probability of the data under the null hypothesis (H0). A total of 32 studies (8513 infants) were included. BMA showed that the evidence in favor of H1 was weak for any PDA (BF10 = 2.90; 10 studies), moderate for hemodynamically significant PDA (BF10 = 3.77; 3 studies), and extreme for surgically ligated or catheter-occluded PDA (BF10 = 294.9; 16 studies). In contrast, the evidence in favor of H0 was weak for medically treated PDA (BF10 = 0.55; 6 studies). In addition, BMA found strong evidence in favor of H1 when prolonged exposure to PDA was analyzed as a dichotomous variable (BF10 = 11.80; 6 studies) and extreme evidence (BF10 = 113.60; 3 studies) when PDA exposure time was analyzed as a continuous variable. In this bayesian meta-analysis, the data suggest that prolonged exposure to PDA might be associated with increased risk of pulmonary vascular disease in extremely preterm infants. This highlights the need to monitor for PH in high-risk preterm infants with prolonged exposure to PDA and to incorporate PH risk into clinical decisions regarding PDA management.

Aortic isthmus massive calcifications: an unusual case of secondary hypertension

We present the case of a 63-year-old woman who was hospitalized five times in 4 months for episodes of heart failure, associated with a sustained hypertension despite a fivefold therapy. The pathophysiological mechanism of the hypertension was a secondary hyperaldosteronism linked to a renal hypoperfusion due to the narrowing of the thoracic aorta by a huge calcified plaque, mimicking an aortic coarctation.

Hyperaldosteronism Screening and Findings From a Large Diverse Population With Resistant Hypertension Within an Integrated Health System.

Hyperaldosteronism (HA) is a common cause of secondary hypertension and may contribute to resistant hypertension (RH). The authors sought to determine and characterize HA screening, positivity rates, and mineralocorticoid receptor antagonist (MRA) use among patients with RH. A cross-sectional study was performed within Kaiser Permanente Southern California (7/1/2012-6/30/2017). Using contemporary criteria, RH was defined as blood pressure uncontrolled (≥ 130/80) on ≥ 3 medications or requiring ≥ 4 antihypertensive medications. The primary outcome was screening rate for HA defined as any aldosterone and plasma renin activity measurement. Secondary outcomes were HA screen positive rates and MRA use among all patients with RH. Multivariable logistic regression analysis was used to estimate odds ratio (with 95% confidence intervals) for factors associated with HA screening and for patients that screened positive. Among 102,480 patients identified as RH, 1977 (1.9%) were screened for HA and 727 (36.8%) screened positive for HA. MRA use was 6.5% among all patients with RH (22.5% among screened, 31.2% among screened positive). Black race, potassium < 4, bicarbonate > 29, chronic kidney disease, obstructive sleep apnea, and systolic blood pressure were associated with HA screening, but only Black race (1.55 [1.20-2.01]), potassium (1.82 [1.48-2.24]), bicarbonate levels (1.39 [1.10-1.75]), and diastolic blood pressure (1.15 [1.03-1.29]) were associated with positive screenings. The authors' findings demonstrate low screening rates for HA among patients with difficult-to-control hypertension yet a high positivity rate among those screened. Factors associated with screening did not always correlate with screening positive. Screening and targeted use of MRA may lead to improved blood pressure control and outcomes among patients with RH.

Combined General Anesthesia with Epidural Analgesia as a Modality for Adrenal Teratoma Resection in Patients with Coronary Arterial Disease

Background: Adrenalectomy in patients with coronary arterial disease poses a significant challenge requiring good preoperative evaluation, perioperative hemodynamic control, and a detailed and careful anesthetic strategy. Teratomas are benign tumors that develop from pluripotent cells with two or more germ cell layers. Teratomas can develop in the ovaries and testes. Retroperitoneal teratoma, particularly adrenal teratoma, is rare. Indications for adrenal gland surgery include hormonal secretory tumors and non-hormonal secretory tumors. &#x0D; Case presentation: A 66-year-old man complained of discomfort in the right upper abdomen. From the results of the CT scan, an adrenal teratoma was obtained, and an adrenalectomy operation was planned. The patient underwent adrenalectomy with general anesthesia. Induction was carried out with propofol titrating doses of 100-150 mg until the patient was hypnotized and intubated with Atracurium 30 mg IV. The patient underwent an arterial line and CVC with ultrasound guiding during surgery.&#x0D; Conclusion: Anesthetic techniques should aim to maintain a myocardial oxygen supply that is greater than required to avoid ischemia. It is necessary to control perioperative hypertension, hyperglycemia, hypokalemia, and blood cortisol levels and maintain the balance of myocardial oxygen supply.

Secondary hypertension screening: importance of emphasizing details and norms, focusing on target population

Secondary hypertension screening: importance of emphasizing details and norms, focusing on target population