Severe High Blood Pressure Research Articles

KPs improve renal function and blood vessels function by balance the sFlt-1:PlGF ratio in L-NAME-induced SHRSP preeclampsia rats

Preeclampsia (PE) is one of the major problems for global healthy burden. It affects 2 to 8% of all pregnancies and causes both maternal and infant morbidity and mortality. Kefir peptides are products from many kinds of prebiotic fermentation in whole milk by kefir grain. In this study, we used the N(ω)-nitro-L-arginine methyl ester (L-NAME) in drinking water to mimic the preeclampsia in spontaneous hypertension rat stroke-prone (SHRSP) pregnant rats, the rats were assigned to five treatment groups: the normal group, untreated group, L-NAME group, L-NAME+KPs (LD and HD dose diets) for 20-day experiment. Data showed that rats only gave the L-NAME group induced severe high blood pressure, urine protein, placenta damage, and embryo reabsorption. After KPs pre-administration significantly reduced urine protein production and generalized vessel endothelial dysfunction, anti-oxidative, and anti-inflammation levels in SHRSP rats placenta. In conclusion, kefir peptides is a multipurpose peptide that can suppress oxidative stress, HIF-1a, anti-TNF-α and IL-6 inflammation levels, reducing urine protein production and generalized vessel endothelial dysfunction and balance the sFlt-1:PlGF ratio through blocking eNOS/NO. KPs might be a promising protective nutraceutical agent for early pregnancies. The Higher Education Sprout Project by the Ministry of Education (MOE-112-S-0023) in Taiwan. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Hypertension - An Ayurvedic approach

Hypertension is severe high blood pressure caused by a stressful lifestyle, in which the blood vessels have persistently elevated pressure, making it difficult for the heart to pump. Because of this increased pressure on the heart, the pressure on the blood vessels that supply the different tissues and organs of the body increases and can damage the corresponding organs. It is an early stage of pathogenesis and a risk factor for the development of diseases affecting, for example, the heart, brain, kidneys, etc. Many people with hypertension are undiagnosed for a long time or until diagnosed incidentally, so it can be considered a silent killer. About 1.13 billion people worldwide suffer from hypertension, so normalizing abnormally high blood pressure is a difficult task. In Ayurveda, systemic hypertension can be understood as the participation of vitiated Doshas, ​​​​​​where Vata and Pitta are the dominant Tridoshas, ​​​​​​which prevent the movement of these Doshas in the respective Srotas. The concept of Avarana (occlusion in Dosha functioning in a normal state) gives a better understanding of hypertension, which should be considered for better results in Ayurvedic treatment of diseases. Therefore, an attempt will be made here to understand hypertension from Ayurvedic concepts and to discuss the management of this condition from an Ayurvedic perspective.

Hemorrhagic stroke in the context of pre-eclampsia on pregnancy of 28 weeks of gestation: A case report and review of the literature

Strokes are rare but serious accidents during pregnancy, they are responsible for high mortality and morbidity, preeclampsia and stroke are significantly linked. Endothelial dysfunction, impaired cerebral self regulation, and severe high blood pressure are, probably, the cause of many strokes in pregnant women

PS-R05-6: A CASE OF ACUTE KIDNEY INJURY WITH THROMBOTIC MICROANGIOPATHY CAUSED BY MALIGNANT HYPERTENSION

A 31-year-old man was transferred to our hospital because of severe hypertension, acute kidney injury (AKI) and thrombotic microangiopathy (TMA). A month earlier, the patient sought medical attention for epigastric pain. Upper gastrointestinal endoscopy revealed hemorrhagic gastric ulcer, and hemostasis was performed. At that time, his was found to have severe high blood pressure (200/140 mmHg), together with low levels of hemoglobin (Hb) (10.5 g/dL) and platelet (Plt) count (107 x 109/L). One week later, gastric ulcer tended to improve, but the blood pressure was still high (192/122 mmHg), along with severe abnormalities in creatinine (Cr) (10.7 mg/dL), Hb (6.6 g/dL) and Plt levels (139 x 109/L). On the following day, the serum Cr level increased to 13.7 mg/dL, while Hb and Plt levels decreased to 6.3 g/dL and 111 x 109/L, respectively. He was referred and admitted to a local affiliated hospital. Because the patient was considered as AKI due to dehydration and anemia, fluid replacement and blood transfusion were performed. However, his renal function was worsened further and pulmonary congestion appeared, which required initiation of hemodialysis therapy. Because low platelet counts, high LDH levels and schistocytes in peripheral blood were observed, he was diagnosed with TMA and transferred to our hospital. Laboratory data on admission revealed as follows: the plasma renin activity (PRA), 7.8 ng/ml/h, plasma aldosterone concentration (PAC), 443 pg/mL, plasma adrenaline, 12 pg/mL, noradrenaline, 172 pg/ml, ACTH, 17.3 pg/mL, cortisol, 6.9 g/dL, and TSH, 1.71 IU/mL. Renal artery stenosis was not observed by renal artery ultrasound. Echocardiography showed hypertrophy of the left ventricle. Funduscopic examination showed retinal hemorrhages. Renal biopsy revealed a large number of collapsed glomeruli, onion skin lesions in the arterioles and interlobular arteries, luminal narrowing due to thrombosis, and fibrin accumulation on the blood vessel walls, which lead to histological diagnosis of malignant nephrosclerosis and TMA. Intensive treatment with a calcium channel blocker, an ACE inhibitor, and other antihypertensive agents resulted in improved hypertension, and normalized platelet count and LDH levels, together with reduced PRA (3.2 ng/ml/h) and PAC (208 pg/mL). However, withdrawal from hemodialysis was not achieved. We consider that in this case TMA was caused by malignant hypertension due to essential hypertension. We conclude that early detection and intervention for hypertension are mandatory to prevent the progression of malignant hypertension and related organ damages.

Super hypertension or very severe hypertension in a sub-Saharan country: Epidemiological, clinical, therapeutical and evolutive patterns

High blood pressure occurs early in sub-Saharan Africa and its forms are frequently severe with rapid damage to target organs. To describe the epidemiological, clinical, therapeutical and evolutive patterns of super hypertension in Yaoundé University Teaching Hospital. This study is an observation cohort over a period of 9 months (January 2016 to September 2016). We recruited from members of the public who accepted voluntary blood pressure screening offered in various localities in Yaoundé and were aged 18 years or over. Of a total of 6519 people, 1875 (28.8%) presented a high blood pressure. Amongst them, 37 presented a super hypertension (a systolic blood pressure 250 mmHg and/or diastolic blood pressure 150 mmHg in presence or not of complications), corresponding to a prevalence of 2% of all hypertensive patients. Our cohort comprised 33 of these individuals who accepted the invitation to participate in the study. The mean age was 49.3 years, with a sex ratio of 0.7. Twenty-three (70%) of the patients were known hypertensive for a mean time of 10 years, out of 9% were regularly reviewed, but none on medications. The mean of cardiovascular risk factors was 7, with 91% who had an excess salt intake. Dyspnea and headache were the main symptoms. The means systolic blood pressure and diastolic blood pressure were respectively 244.9 mmHg and 144.8 mmHg. Twenty-six (78.8) patients were either overweight or obese. We noticed a fundoscopy stage II or III in 21.1% of the cases. Seventy percent of the cases had left ventricular hypertrophy on electrocardiogram and 18.2 on echography. Complications were noticed on admission in 60.6% of all cases, it was mainly signs of renal failure. Acute kidney injury occurred in 15.15% of the cases during follow-up. The average rate of blood pressure control over 6 months was 3%. The main cause of poor blood pressure control was lack of therapeutic compliance. We noticed refractory high blood pressure in 4 (12.1%) cases and registered one death at the 3rd month of follow-up due to acute kidney injury. Super hypertension or very severe high blood pressure is a youth's pathology. Its early detection reduces significantly the high morbi-mortality. However, its efficient management needs minimal additional resources.

„Maligne“ Hypertonie und atypisches hämolytisch-urämisches Syndrom (aHUS)

Severe or malignant hypertension with functional damage to the heart, brain or kidneys is a rare but very dangerous disease. The disease is characterized not only by the severe high blood pressure but also by the accompanying organ damage. The high blood pressure leads to damage to the endothelium in large and small vessels and therefore induces endothelial cell dysfunction with vasoconstriction, inflammation and thrombosis. These high blood pressure crises can be triggered by a variety of mechanisms. One of these mechanisms is thrombotic microangiopathy (TMA). The TMA, particularly in disorders of the complement system, leads to damage to the endothelium in the microcirculation with organ failure. Simultaneously, one of the clinical features of the disease is the high blood pressure. The diagnostics of TMA, which is caused by the clinical symptom of severe hypertension, are not easy. It necessitates a very meticulous clinical examination of the patient in order to determine the extent of organ damage and the progression at an early stage. Concomitant laboratory investigations provide indications but so far there are no certain laboratory diagnostics for complement-mediated TMA. When an atypical hemolytic uremic syndrome (aHUS) is suspected inhibitors of the complement system should be initiated as early as possible.

Prevalence, complications and factors associated with severely elevated blood pressure in patients with hypertension: a cross-sectional study in two hospitals in Yaoundé, Cameroon.

Introductionseverely elevated blood pressure significantly increases cardiovascular morbidity and mortality in hypertensive Black patients. The objective of this study was to determine the prevalence, complications and factors associated with severe high blood pressure in hypertensive patients in Yaoundé, Cameroon.Methodswe conducted a cross-sectional study in the outpatient and cardiology units of two teaching hospitals in Yaoundé. We included consenting hypertensive patients aged over 18 years. We first measured their blood pressure (BP), then we collected their sociodemographic data, cardiovascular risk factors, follow-up data, and ended with a complete physical examination. We performed a regression analysis to assess correlates of severe hypertension.Resultswe included a total of 153 patients with 33 (21.6%) of them having severe hypertension. Among the 33 patients, 16 (48.5%) were male and 17 (51.5%) were female. Their mean age was 60.52 ± 12.83 years. Chronic kidney disease (78.8%), hypertensive retinopathy (69.7%) and left ventricular hypertrophy (48.5%) were the most common complications. On multiple logistic regression analysis, inadequate follow-up was independently associated with severe hypertension (adjusted OR=7.09; 95% CI [2.29-21.9]).Conclusionseverely elevated BP is common among hypertensive patients in our setting with important physical and economic consequences. Increased patients awareness and improving access to primary care physicians and cardiologists, through health insurance or other means, may be an effective strategy for reducing cardiovascular morbidity and mortality among hypertensive Black patients.

Corticosurrenaloma: About a Pediatric Case

Introduction: This study aims to describe the outcome of adrenocortical cancer in children through observation. Observation: A 10-year-old girl with no previous pathological history. She presented headaches and severe hypertension with clinical and biological signs of hyperandrogenism for 6 months. An abdominal CT scan showed an encapsulated left adrenal mass without local or regional invasion or secondary location. A pheochromocytoma or adrenal neuroblastoma was first suspected. The blood pressure was stable at 130/65 mmHg under antihypertensive drugs. She underwent a complete tumor resection without any intraoperative incident. The pathologic study confirmed the adrenocortical carcinoma scored Weiss 7. The severe high blood pressure reappeared 2-year later despite antihypertensive drugs. The thoracic abdominal and pelvic CT scan showed a locally advanced tumor recurrence in the left adrenal gland with parenchymal nodes in the lungs and liver. The outcome was fatal despite medical and surgical management. Conclusion: Adrenocortical cancer is a rare tumor. It is important to hormonal testing in the presence of Cushing’s syndrome in children. It can give a strong indication of the diagnostic possibilities. Histology confirms the diagnosis. The evolution is covered by complications, in particular recurrence with life-threatening metastases.

Ischemic Stroke; A Severe Complication In Patients Admitted To Resuscitation

Stroke is a real public health problem because of its incidence and morbimortality. Ischemic stroke (AVCI) accounts for 80% of strokes. It is the third leading cause of overall mortality in industrialized countries, after heart disease and cancer, and the leading cause of physical disability acquired. The objective of our study was to describe the clinical characteristics, and factors of Cardiovascular Risk (LRIF) and the factors associated with death in patients admitted for stroke (AVCI) and them in a resuscitation ward. Methods: Retrospective study over a 12-month period (between January 1, 2018 and January 1, 2019), conducted in the medical-surgical emergency room. Results: A total of 147 strokes: 110 AVCI (84%). The age of the patients included in the study ranged from 49 to 77 years. The average age was 66 years - 10.9 years, 75% of AVCI occurring after 65 years. Sex divided into 47 women (42.72%). And 63 men (57.28%). Ischemic strokes: The main vascular risk factors three risk factors: severe high blood pressure (0.007), diabetes (0.05) and emboligenic heart disease (0.017). Other risk factors found are tobacco (13.09%), obesity (10.7%), dyslipidemia (08.3%), alcohol (7.1%). 17, 8% of patients had a history of formed stroke or TIA (Table 1). The onset of neurological symptomatology was brutal in 70% (77 patients). The clinical examination at admission found consciousness disorders with a NIHSS score of 5 to 15 in 45.54% of cases (49 patients). 23 patients (20.9%) had a NIHSS score of 15 and 39 patients (35.45). Para clinical cardiac evaluation (ECG, Echocoeur) objective a complete arrhythmia by atrial fibrillation (AC/FA) in 11.4% of cases, left atrial hypertrophy in 40% of cases and left ventricular hypertrophy in 89% of cases. The length of hospitalization in resuscitation ranged from 1 to 46 days with an average of 13.4 days (-10.1). Among the 110 patients 22 died or (20%). Three risk factors associated with the poor prognosis: NIHSS SUP(p - 0.0001), anisocoria(p - 0.006) and long stay in reanimation(p - 0.013). Conclusion: Ischemic strokes have a major public health impact in terms of mortality or morbidity because of the physical and psychological consequences they can cause. The management of cardiovascular risk factors, the first of which is the HTA, keeps its interest with the peculiarity of diabetic balance and the cessation of tobacco in combination with a diet. Cardiovascular assessment (ACFA, HAG, HVG) plays an important role in stroke management. Primary and secondary stroke prevention requires the prevention of thromboembolic accidents (ACFA) Stroke remains a challenge.

Identification of Factors Associated With Delayed Treatment of Obstetric Hypertensive Emergencies

(Abstracted from Am J Obstet Gynecol 2020;223:250.e1–250.e11) Obstetric hypertensive emergency is a serious hypertensive disorder that can complicate pregnancy and lead to maternal death. It is defined as acute-onset and severe high blood pressure (BP) that lasts for 15 minutes or longer.

Renovascular Hypertension Due To Bilateral Renal Artery Stenosis: A Case Report Of A 4-Month-Old Infant

Renovascular hypertension is one of the most common causes of secondary hypertension. Renovascular hypertension causes 5-10% of childhood hypertension. Renal artery stenosis is the most important cause of renovascular hypertension. Patients with renovascular hypertension may be asymptomatic or present with many symptoms such as headache, vomiting, convulsion, heart disease, and sudden death. In renovascular hypertension, surgical treatment may be required in severe high blood pressure that does not respond to medical treatment. In this study, we present a four-month-old infant who developed renovascular hypertension due to bilateral renal artery stenosis, which was controlled by angiotensin II receptor blockers.

Control of hypertension during postpartum acute renal failure

Arterial hypertension (HT) is a major health problem in Algeria due to its high frequency, delayed diagnosis and multiple maternal-fetal complications. Associated with HT during post-partum (PP), the acute kidney failure (AKF) is the leading cause of morbidity and mortality. We aimed: – to determine the incidence of AKF associated with severe high blood pressure during post-partum; – to identify factors favoring the occurrence of pregnancy-related HT and 3/to establish the etiologies of AKF. Our retrospective study included 48 patients during post-partum presenting HT and AKF, admitted in the department of nephrology from January 2013 to December 2016. In our hospital, 13000 deliveries and 2500 caesarean sections are performed every year; average patients’ age: 30.1; 71% of patients were multiparous. The incidence of AKF was 0.74‰ of deliveries (one AKF/1343), 41% had a pregnancy medical follow-up. HT occurred in 87% of cases. The creatinin level was > 35 mg/L in 45% of cases. Etiologies: HELLP syndrome (20 cases), acute tubular necrosis (16 cases), cortical necrosis (2 cases). Triple anti-hypertensive therapy was taken by 14 patients, 43% had dialysis, 13 patients recovered normal kidney function in less than 10 days and 3 patients remained on chronic dialysis. AKF complicates 1 delivery/1300; it needs dialysis in 1case/8000; these percentages are higher than those reported in the literature (1 AKF/4000 deliveries and hemodialysis for 1/15000 patients). HELLP syndrome is the most common cause of pregnancy-related AKF (41.6%), occurring before 38 amenorrhea weeks (AW). Acute tubular necrosis is the second cause, it occurs after 38 AW, is secondary to bleeding, infectious complications and nephrotoxic drugs; HT is volume dependent and requires dialysis. Favoring factors are multiple pregnancies, increased maternal age, obesity and long delay of care of pregnancy toxemia because of lack of regular monitoring. HT associated with post-partum AKF is relatively frequent, secondary to HELLP syndrome and tubular necrosis. The prognosis depends on the early diagnosis and treatment and on the preventive measures during the pregnancy (self-measurement of blood pressure monitoring or ambulatory measurement of blood pressure, screening for proteinuria and uric acid analysis).

Echocardiography in patients with chest x-ray diagnosis of cardiomegaly at an academic hospital in Zambia


 Background: Cardiomegaly is the most diagnosed condition on Chest X-ray (CXR) at the study site. However, little is found on the association between cardiomegaly and echocardiography (ECHO) findings at this site. The main objective of this study was to establish whether there is an association between cardiomegaly diagnosed on a CXR and ECHO findings of the same patient.
 Methods and Materials: This retrospective study involved the retrieving of data from files of 124 patients who had cardiomegaly diagnosed on CXR and had undergone an ECHO examination. The study sought to establish whether there is an association between cardiomegaly diagnosed on a CXR and ECHO findings of the same patients.
 Results: There was a positive association between cardiomegaly diagnosed on CXR and ECHO findings and the association was significant at 5%. In addition, there was also a strong association between age and cardiomegaly and the association was also significant at 5%. The Chi-square results at 5% level of significance showed that there is not enough evidence to suggest an association between gender and cardiomegaly. Therefore, both women and men have an equal chance of acquiring cardiomegaly. Left Ventricular Diastolic Dysfunction was the most prevalent condition, having been seen in more than 50% of patients. Most of the conditions identified in patients were very severe. In addition, 70% of these patients had a raised blood pressure with 43% having severely raised blood pressure.The test results also showed that 66% of patients in the sample had increased blood flow on Doppler measured at certain points of the heart with 6% of the patients having severely increased blood flow. Patients with increased blood flow showed an increase in blood pressure with those with severe increased blood flow showing a strong positive association with severe high blood pressure.
 Conclusion: These findings show that there is a strong association between cardiomegaly diagnosed on CXR to ECHO findings of the same patient. Therefore, echocardiography should be done on all patients diagnosed with cardiomegaly on CXR. In addition, priority should be given to elderly patients (65 years and above) as most of these had both severe cardiomegaly and one or more cardiovascular diseases.

Echocardiography in Patients with Chest X-ray Diagnosis of Cardiomegaly at an Academic Hospital in Zambia

Background: Cardiomegaly is the most diagnosed condition on Chest X-ray (CXR) at the study site. However, little is found on the association between cardiomegaly and echocardiography (ECHO) findings at this site. The main objective of this study was to establish whether there is an association between cardiomegaly diagnosed on a CXR and ECHO findings of the same patient.
 Methods and Materials: This retrospective study involved the retrieving of data from files of 124 patients who had cardiomegaly diagnosed on CXR and had undergone an ECHO examination. The study sought to establish whether there is an association between cardiomegaly diagnosed on a CXR and ECHO findings of the same patients.
 Results: There was a positive association between cardiomegaly diagnosed on CXR and ECHO findings and the association was significant at 5%. In addition, there was also a strong association between age and cardiomegaly and the association was also significant at 5%. The Chi-square results at 5% level of significance showed that there is not enough evidence to suggest an association between gender and cardiomegaly. Therefore, both women and men have an equal chance of acquiring cardiomegaly. Left Ventricular Diastolic Dysfunction was the most prevalent condition, having been seen in more than 50% of patients. Most of the conditions identified in patients were very severe. In addition, 70% of these patients had a raised blood pressure with 43% having severely raised blood pressure.The test results also showed that 66% of patients in the sample had increased blood flow on Doppler measured at certain points of the heart with 6% of the patients having severely increased blood flow. Patients with increased blood flow showed an increase in blood pressure with those with severe increased blood flow showing a strong positive association with severe high blood pressure.
 Conclusion: These findings show that there is a strong association between cardiomegaly diagnosed on CXR to ECHO findings of the same patient. Therefore, echocardiography should be done on all patients diagnosed with cardiomegaly on CXR. In addition, priority should be given to elderly patients (65 years and above) as most of these had both severe cardiomegaly and one or more cardiovascular diseases.

Development and Evaluation of press coated tablets of Carvedilol using solid dispersion prepared by spray drying technique

Carvedilol is a non-selective beta and alpha blocker which is insoluble in water. It is used in the treatment of mild to severe congestive heart failure (CHF) and high blood pressure. As the solubility is very poor the bioavailability is only 25–35%. The problem of poor solubility can be overcome using any of the physical or chemical methods of solubility enhancement. The purpose of this research was to improve the solubility of Carvedilol by spray drying technique using hydrophilic polymers β-Cyclodextrin and Plasdone-K30. Prepared solid dispersions were evaluated for drug content, saturation solubility and in-vitro drug release study. The compatibility and surface morphology was studied by Fourier Transforms Infrared spectroscopy (FTIR), Differential Scanning Calorimetry (DSC) and Scanning Electron Microscopy (SEM) respectively. The spray dried solid dispersions of Carvedilol were incorporated into press coated tablets and were subjected to various precompression and postcompression parameters. The effect of the various barrier layer compositions on the lag time was studied. This research emphasizes on the role of chronotherapy for treatment of hypertension.

OP.2B.03] RECENTLY DIAGNOSED SEVERE HIGH BLOOD PRESSURE IN A SUB-SAHARAN COUNTRY

Objective: High Blood Pressure (HBP) is a worldwide public health problem. It can be particularly severe in the Black race. Recent studies in Cameroon, showed an alarming prevalence (29.7%), leading us to want to study the epidemiological, clinical, therapeutic and evaluative aspects of severe (BP up to 180/110 mm Hg), recently diagnosed HBP in Yaoundé. Our objective was to determine the clinical presentations, evolution on treatment and observance. Design and method: We conducted nine months prospective cohort study, from January to September 2016 in Yaounde teaching Hospital. We recruited from members of the public who accepted voluntary blood pressure screening offered in various localities in Yaounde, and were aged 18 years or over. Results: Of a total of 6,519 people who participated in the screening, 1,875 (28.8%) presented a HBP and 363 (5.6%) had severe HBP. Our cohort comprised 153 (42.1%) of these individuals with sustained severe hypertension, not on medication, who accepted the invitation to participate in the study. The range 45–54 years and 55–64 years were the most represented; the sex ratio was 0.9. The cardiovascular risk factors number range from 5 to 8 with a median of 6. Systolic BP ranged from 184 to 225 mmHg with a median of 200 mmHg; while the diastolic BP ranged between 111–132.5 mmHg with a median of 119 mmHg. Kidney injury (78.8%) was the main complication. We identified 3 clinical forms: hypertensive emergencies 121 (79.1%) cases and hypertensive crises 32 (20.9%) cases. In these two groups, 33 (21.6%) patients presented with ‘super HBP’ (a blood pressure op to 250/150 mmHg). The average rate of BP control over 6 months was 39%. The main cause of poor BP control was lack of therapeutic compliance. We registered one death at the 3rd month of follow up due to acute kidney injury. Conclusions: Severe high blood pressure is frequent in Yaounde and the main complication is renal feature. The lack of therapeutic observance remain the major problem of BP control.

Hypertensive urgency or high blood pressure variability?

Hypertensive urgency (HU) is a common reason particularly for elderly patients to seek medical advice. Severe asymptomatic hypertension and situational high blood pressure (BP) in patients with its high variability is frequently taken as HU. The use of short-acting antihypertensive drugs is not only indicated in these situations, but it may also increase the risk of cardiovascular events (CVE). Over the past decade, increased BP variability is an independent predictor for a higher risk of CVE. Among the major groups of antihypertensive drugs, there are calcium antagonists, mainly amlodipine, which has the greatest potential to reduce BP variability. Thus, calcium antagonists can be considered as first-line drugs for patients with high BP variability.

New Daily Persistent Headache.

New Daily Persistent Headache.

112 Massive proteinuria in superimposed preeclampsia significantly increased the maternal organ involvements

Introduction It is recently recognized that the amount of proteinuria is not mainly contributed to the prognosis of preeclampsia or superimposed preeclampsia [1]. Thus the severity of proteinuria tends to be unimportant and unreliable criteria for the management of preeclamptic disease. On the other hand, it is reported that preeclampsia with greater proteinuria was easy to lead the complication of the adverse maternal outcomes [2]. We now studied how the amount of proteinuria is correlated to the maternal complications especially in superimposed preeclampsia. Methods The retrospective observational study according to the standard clinical management of preeclampsia was performed in 56 pregnant cases of superimposed preeclampsia. All cases were hospitalized for the management of preeclamptic conditions and should terminate the pregnancy in the state of uncontrollable severe high blood pressure, massive proteinuria (over 10 g/day), the complications of the maternal organ involvements such as HELLP syndrome or fetal jeopardy conditions. The urinary protein was evaluated by the daily urinary collection, or spot urine/creatinine ratio. Univariate and multivariate logistic regression analysis were conducted how the obstetric features such as the severity of blood pressure, proteinuria, or the onset of disease could correlate to these organ involvements. Statistical analysis was performed using with SPSS v21. Result 25 (43.9%) cases complicated with any maternal organ involvements were observed in 59 cases. The involvements of HELLP syndrome, thrombocytopenia, or elevated liver enzymes (HELLP related disorders) were observed in 19 cases (33.3%), and those of maternal CNS disorders such as eclampsia was 2 cases (3.5%). Proteinuria over 3 g/day were correlated to any of maternal organ involvements (adjusted Odds ratio 2.86, 95%CI 0.63–13.02, p = 0.18), and more the onset of diastolic high BP under 28 weeks gestation correlated significantly (aOR 4.57, 95%CI 0.86–24.22, p = 0.07) . No relations between the maternal organ involvements and high blood pressure in superimposed preeclampsia. HELLP related disorders tended more correlation to high proteinuria of 3–8 g/day (aOR 4.30 95%CI 0.93–19.80, p = 0.06), 8–12 g/day (aOR 3.74, 95%CI 0.63–22.32, p = 0.15), and showed significantly high correlation to proteinuria over 12 g/day (aOR 12.678, 95%CI 1.53–105.2, p = 0.02). Conclusion 59 cases of superimposed preeclampsia showed high rate of any of the maternal organ involvements in this observational study. These involvements were correlated to the early onset of hypertension under 28 weeks, and had more correlation to high amount of proteinuria than severe hypertension. Furthermore massive proteinuria over 12 g/day had significantly correlated to HELLP related disorders. Additionally not massive but large amount of proteinuria, that is under12 g/day did not show linear increase in complicating the maternal involvements. We then concluded the necessity of measuring the amount of proteinuria in the management of superimposed preeclampsia, and the massive proteinuria over 12 g/day might have the risk of complicating with the maternal organ involvements especially HELLP syndrome or its correlating disorders.

New High Blood Pressure Treatment Guidelines

High Blood Pressure is a common medical condition. If it is not checked or treated, it can damage body organs such as the brain, heart, and kidneys. A number of problems such as heart disease and stroke are caused by high blood pressure. Blood pressure is measured by taking the systolic pressure (the upper number) followed by the diastolic pressure (the lower number). High blood pressure occurs when either of these numbers is too high which can happen with no symptoms. Signs and symptoms in instances of severe High Blood Pressure may include headache, feeling weak and tired, dizzy or light headed, chest pain or tightness, fast heart rate, visual or hearing problems, and shortness of breath.