Background
Laparoscopic adrenalectomy (LA) is the gold standard treatment for unilateral primary aldosteronism. However, satisfactory results have also been published with radiofrequency ablation ...(RFA). The aim of this study was to compare LA and RFA for the treatment of primary aldosteronism.
Methods
A retrospective cohort study of the patients who underwent LA or RFA in a single center was performed. Morbidity and long-term effectiveness (cure rate and blood pressure control) were analyzed. A multivariate analysis with a propensity score was also performed.
Results
Thirty-four patients were included in the study, 24 in the LA group and 10 in the RFA group. Hypertension had been diagnosed a median of 12 years before the intervention. Hypertension was properly controlled before the intervention in 55.9% of the patients. Hypertensive crisis was more common during RFA (4.2% vs. 70.0%,
p
< 0.001), although no patient suffered any complication because of these crises. LA was longer (174.6 vs. 105.5 min,
p
= 0.001) and had a longer length of stay (median 2 vs 1 days,
p
< 0.001). No severe complications were observed in any of the patients. After a median follow-up of 46.2 months, more patients had hypertension cured and blood pressure controlled in the LA group (29.2% vs. 0%,
p
= 0.078 and 95.5% vs. 50.0%,
p
= 0.006, respectively). Also, patients in the LA group were taking less antihypertensive drugs (1.8 vs. 3.0,
p
= 0.054) or mineralocorticoid receptor antagonists (41.7% vs. 90.0%,
p
= 0.020). Multivariate analysis adjusted by propensity score showed that LA had an OR = 11.3 (
p
= 0.138) for hypertension cure and an OR = 55.1 (
p
= 0.040) for blood pressure control.
Conclusions
Although RFA was a less invasive procedure than LA, hypertension was cured and blood pressure was properly controlled in more patients from the LA group. Patients who underwent LA were taking less antihypertensive drugs than patients who had undergone RFA.
Lead (Pb), cadmium (Cd) and mercury (Hg) are toxic trace elements that represent a public health problem as risk factors for cardiovascular disease and hypertension (HT) and could also contribute to ...the development of resistant hypertension (rHT)
To compare the blood concentrations of Pb, Cd and Hg in subjects with resistant and non-resistant HT and to define whether there is a relationship between its levels and rHT.
Cross-sectional study. Subjects aged ≥ 21 to ≤ 80 years with a body mass index < 40 kg/m2 were recruited on a discretionary basis from October 2001 to October 2004 in a hypertension unit of a tertiary hospital amongst those sent to the hypertension unit by their family physician. Resistant hypertension was defined according to the American Heart Association (AHA) criteria. Whole blood concentrations of Cd, Pb and Hg were measured by electrothermal atomic absorption spectrometry.
46 out of 73 included subjects (63%) suffered from rHT. Blood Pb median: HT 3.9 (IQR 2.7–5.2) vs. rHT 3.6 (IQR 2.8–6.0) µg/dL (p=0.941). Blood Cd median: HT 0.07 (IQR 0.07–0.80) vs. rHT 0.30 (IQR 0.07–0.65) µg/L (p=0.681). Blood Hg median: HT 7.9 (IQR 5.8–12.9) vs. rHT 7.3 (IQR 4.6–13.3) µg/L (p=0.611). Considering the 75th percentile of each element (Pb: 5.55 µg/dL, Cd: 0.75 µg/L, Hg: 13.15 µg/L), a multiple logistic regression analysis (adjusted for age, BMI, diabetes mellitus, clearance of creatinine and only for Cd the smoking habit) showed an OR = 3.44 (0.84–14.10, p=0.086) for Pb, OR = 1.80 (0.39–8.24, p=0.451), for Cd and OR = 2.31 (0.59–9.14, p=0.232) for Hg. Moreover, the stratified analyses showed that men with Pb ≥5.55 µg/dL have a 14 times higher risk of suffering from rHT (p=0.026). Interestingly, a 9-fold increased risk was found for non-obese subjects with elevated Pb levels, above 5.55 µg/dL (p=0.029). Also in men, the probability of suffering from rHT was more than 7 times higher if Cd levels were ≥ 0.75 µg/L (p=0.076). Most smokers had higher Cd levels, with a high risk of suffering from rHT (ORa 12.6 (0.8–200.2), p=0.072).
A higher blood Pb levels, defined by the 75th percentile (Pb ≥ 5.55 µg/dL), is associated with a greater risk of suffering from rHT and to a lesser extent in the case of Cd and Hg.
The aim of this study was to investigate the cognitive state in women and its relation to menopause and hypertension (HTN). The authors included 1034 women aged 47.13±15.71 years. The prevalence of ...HTN was 47.1%, with 67.8% of patients treated and 48.6% controlled. Cognitive impairment was higher among hypertensive menopausal (mini‐Boston Naming Test: 7.4±3.1 vs 8.5±2.4, P<.001; Clock‐Drawing Test: 5.2±2 vs 5.6±1.6, P<.01). Using logistic regression adjusted by age and education level, statistical differences were found in the results from the mini‐Boston Naming Test between menopausal hypertensive vs menopausal normotensive women (odds ratio, 1.48; 95% confidence interval, 1.06–2.07; P=.021), and no difference between nonmenopausal hypertensive vs menopausal normotensive women (odds ratio, 0.89; 95% confidence interval, 0.51–1.57; P=.697). The P interaction between both groups was significant (P=.038). The possibility of alteration in cortical functions in menopausal hypertensive woman showed a relative increment of 48% (P=.021). The association between HTN and menopause increases the possibility of compromising the semantic memory by 50%.
BACKGROUNDCurrently there is no consensus regarding which add-on therapy to use in resistant hypertension. This study was designed to compare two treatment options, spironolactone (SPR) versus dual ...blockade of the renin–angiotensin–aldosterone system (RAAS).
METHODSForty-two patients with true resistant hypertension were included in the study. An open-label prospective crossover design was used to add a second RAAS blocker to previous treatment and then SPR following 1 month of wash-out. BP was measured in the office and by ambulatory blood pressure monitoring (ABPM). Changes in laboratory tests were also studied for both treatments. The predictive values of aldosterone–renin ratio (ARR) and serum potassium of determining the antihypertensive response were analyzed for both arms.
RESULTSFollowing the first stage of dual blockade, SBP dropped significantly both in office (reduction of 12.9 ± 19.2 mmHg)) and by ABPM (reduction of 7.1 ± 13.4 mmHg). Office DBP was unchanged but was significantly reduced as measured by ABPM (3.4 ± 6.2 mmHg). On SPR treatment, office BP was reduced 32.2 ± 20.6/10.9 ± 11.6 mmHg. By ABPM the reduction was 20.8 ± 14.6/8.8 ± 7.3 mmHg (P < 0.001). The BP control was achieved by 25.6% of patients in dual blockade and 53.8% in SPR with office blood pressure. By ABPM, 20.5% were controlled on dual blockade and up to 56.4% with SPR. Serum potassium was a weak inverse predictor of the blood pressure-lowering effect of SPR.
CONCLUSIONSPR has a greater antihypertensive effect than dual blockade of the RAAS in resistant hypertension. SPR at daily doses of 25–50 mg shows a potent antihypertensive effect when added to prior regimes of single RAAS axis blockade in patients with resistant arterial hypertension.
Most hypertensive patients, despite a proper control of their cardiovascular risk factors, have cardiovascular complications, evidencing the importance of controlling and/or reversing target-organ ...damage. In this sense, endothelial dysfunction has been associated with the presence of cardiovascular risk factors and related cardiovascular outcomes. Since hypertension often clusters with other risk factors such as dyslipemia, diabetes and obesity, in this study we have investigated the effect of intensive multifactorial treatment on circulating vascular progenitor cell levels on high-risk hypertensive patients.
We included108 hypertensive patients receiving intensive multifactorial pharmacologic treatment and dietary recommendations targeting blood pressure, dyslipemia, hyperglycemia and weight for 12 months. After the treatment period, blood samples were collected and circulating levels of endothelial (CD34+/KDR+, CD34+/VE-cadherin+) and smooth muscle (CD14+/endoglin+) progenitor cells were identified by flow cytometry. Additionally, plasma concentration of vascular endothelial growth factor (VEGF) was determined by ELISA.
Most hypertensive patients (61±12 years, 47% men) showed cardiovascular parameters within normal ranges at baseline. Moreover, body mass index and the majority of the biochemical parameters (systolic and diastolic blood pressure, fasting glucose, total cholesterol, HDL-c, LDL-c, creatinine and hs-CRP) significantly decreased overtime. After 12 months of intensive treatment, CD34+/KDR+ and CD14+/endoglin+ levels did not change, but CD34+/VE-cadherin+ cells increased significantly at month 12 0.9(0.05-0.14)% vs 0.05(0.02-0.09)% P<0.05. However, VEGF plasma concentration decreased significantly overtime 89.1(53.9-218.7) vs 66.2(47.5-104.6) pg/mL, P<0.05.
Long-term intensive treatment in hypertensive patients further improves cardiovascular risk and increases circulating EPCs, suggesting that these cells could be a therapeutic target.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Microalbuminuria is a known marker of subclinical organ damage. Its prevalence is higher in patients with resistant hypertension than in subjects with blood pressure at goal. On the other hand, some ...patients with apparently well-controlled hypertension still have microalbuminuria. The current study aimed to determine the relationship between microalbuminuria and both office and 24-hour ambulatory blood pressure. A cohort of 356 patients (mean age 64±11 years; 40.2% females) with resistant hypertension (blood pressure ≥140 and/or 90 mm Hg despite treatment with ≥3 drugs, diuretic included) were selected from Spanish hypertension units. Patients with estimated glomerular filtration rate <30 mL/min/1.73 m were excluded. All patients underwent clinical and demographic evaluation, complete laboratory analyses, and good technical-quality 24-hour ambulatory blood pressure monitoring. Urinary albumin/creatinine ratio was averaged from 3 first-morning void urine samples. Microalbuminuria (urinary albumin/creatinine ratio ≥2.5 mg/mmol in males or ≥3.5 mg/mmol in females) was detected in 46.6%, and impaired renal function (estimated glomerular filtration rate <60 mL/min/1.73 m) was detected in 26.8%. Bivariate analyses showed significant associations of microalbuminuria with older age, reduced estimated glomerular filtration rate, increased nighttime systolic blood pressure, and elevated daytime, nighttime, and 24-hour diastolic blood pressure. In a logistic regression analysis, after age and sex adjustment, elevated nighttime systolic blood pressure (multivariate odds ratio, 1.014 95% CI, 1.001 to 1.026; P=0.029) and reduced estimated glomerular filtration rate (multivariate odds ratio, 2.79 95% CI, 1.57 to 4.96; P=0.0005) were independently associated with the presence of microalbuminuria. We conclude that microalbuminuria is better associated with increased nighttime systolic blood pressure than with any other office and 24-hour ambulatory blood pressure monitoring parameters.
Blood pressure reduction is associated with a reduced risk for cardiovascular events and death, particularly in patients with both hypertension and type 2 diabetes mellitus.
The aim of this study was ...to compare theantihypertensive efficacy, tolerability, and effect on metabolic risk factors of manidipine, a new dihydropyridine calcium channel antagonist, and enalapril, a widely used angiotensin-converting enzyme inhibitor, in patients with mild to moderate essential hypertension and type 2 diabetes.
This multicenter, double-blind trial compared manidipine and enalapril in patients with type 2 diabetes and hypertension (diastolic blood pressure DBP 90–104 mm Hg, systolic blood pressure SBP ≤190 mm Hg). Following a 3-week, single-blind placebo run-in period, eligible patients were randomized to receive either manidipine 10 mg or enalapril 10 mg once daily for 24 weeks. The dose was doubled after 3 weeks in patients who had not responded to treatment (DBP ≥90 mm Hg). The primary efficacy end point was change in DBP from baseline to the end of the study. Secondary outcomes were the responder rate (DBP <90 mm Hg and/or a DBP reduction of ≥10 mm Hg) at the end of the study. Other secondary measures were changes from baseline to the end of the study in heart rate and in the following measures obtained by ambulatory blood pressure monitoring (ABPM): 24-hour, daytime, and nighttime mean DBP and SBP, and the trough:peak ratio. Blood glucose, glycosylated hemoglobin (HbA
1c), total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, uric acid, and creatinine were measured at the end of the placebo run-in period and the end of treatment. The study had 80% power to detect a between-treatment difference in mean sitting DBP of >3 mm Hg.
One hundred twenty-four patients were enrolled in the study. After the placebo run-in period, 13 patients were excluded from the study: 4 for DBP values outside the specified limits, 7 at their request, and 2 for adverse events. Thus, 111 patients met the eligibility criteria and were randomized to treatment (53 manidipine, 58 enalapril). The population consisted of 61 men and 50 women with a mean (SD) age of 62 (11) years and a body mass index of 28.2 (2.4) kg/m
2. Among patients who completed the study, drug doses were doubled in 67.6% (25/37) of patients in the manidipine group and 60.0% (24/40) of patients in the enalapril group (
P = NS). Similar reductions in blood pressure were observed in both groups, from a mean (SD) of 164 (12)/97.5 (5) mm Hg at baseline to 141 (12)/84.5 (6) mm Hg at the end of the study in the manidipine group (
P < 0.01), and from 159 (12)/98 (4) mm Hg to 139 (12)/86 (8) mm Hg in the enalapril group (
P < 0.01). The proportion of responders was 66.7% (32/48) in the manidipine group and 60.0% (30/50) in the enalapril group; the difference between groups was not significant. Twenty-four-hour ABPM revealed significant (
P < 0.01) and similar reductions in blood pressure in both groups, with a trough:peak ratio of ∼-50%. Neither drug affected heart rate. Among the statistically significant changes in metabolic parameters, significant reductions in HbA
1c (from 6.7% 1.4% to 6.2% 1.1%) and blood glucose concentrations (from 152 44 to 143 44 mg/dL) were observed only in the manidipine group (
P < 0.05). The incidence of adverse events was similar between groups.
In the present study, manidipine wasas metabolically neutral and as effective as enalapril in reducing blood pressure in hypertensive patients with type 2 diabetes, providing a sustained 24-hour antihypertensive effect.
OBJECTIVE:To determine if the clinical or biochemical markers used in pregnancy can be applied as early predictors of gestational hypertension.
DESIGN:Prospective cohort study. Population315 pregnant ...women referred from the Prenatal Diagnosis Unit between weeks 10–13 of pregnancy and followed up to the childbirth.
METHODS:Biomarkers were measured in serum specimens in the first and second trimester of pregnancy. Blood pressure (BP) was measured in the first, second and third trimester.
RESULTS:The cumulative incidence of gestational hypertension was 6.01%. In the first trimester gestational hypertension predictors were uric acid greater than 3.15 mg/dl (P = 0.01), BMI greater than 24 kg/m (P = 0.003) SBP at least 120 mmHg (P = 0.02) and DBP at least 71 mmHg (P = 0.007). After applied multivariate analysis just uric acid and SBP were statistically significant.
CONCLUSION:In our cohort of healthy pregnant women uric acid above 3.15 mg/dl and SBP at least 120 mmHg are consistent predictors of gestational hypertension in the first trimester. The most important implication of our study is the possibility to identify in the first trimester women at risk to develop gestational hypertension using available markers.
Resumen Introducción Estudiar la opinión del médico de atención primaria (MAP) de la información de los pacientes remitida desde el médico especialista en hipertensión arterial (MEHTA). Diseño ...Estudio observacional descriptivo. Emplazamiento Realizado a nivel nacional. Participantes Médicos de atención primaria que reciben hipertensos estudiados por MEHTA. Métodos Se utilizó el consenso de derivación de la SEH-LELHA, y una encuesta en la que se recogían en la visita basal las características demográficas, antropométricas, presión y causa de derivación; en la posderivación se añaden preguntas sobre: tiempo utilizado en estudiar al paciente, modificaciones del diagnóstico y fármacos. Además se preguntó sobre el tiempo en recibir respuesta y se pidió la valoración del informe que le remite el MEHTA. Resultados Participaron 578 investigadores de AP que incluyeron 1.715 pacientes válidos. Edad 60,7 ± 13,3 años, varones 62,7%. En prederivación los pacientes tomaban 2,3 ± 1,2 fármacos antihipertensivos, y 2,5 ± 1,2 en posderivación; la presión arterial pasó de 166 ± 21.6 / 97,7 ± 12,6 mmHg a 143 ± 14,4 / 85,5 ± 10,5 mmHg. Los pacientes controlados (PA < 140 y < 90 mmHg) pasaron del 5,8 al 32,2%. El tiempo transcurrido entre la visita al hospital y la recepción del informe fue de 72 ± 64 días. Se realizó ampliación del estudio por parte del MEHTA en 1.250 casos (72,9%). El MAP médico de familia recibió informe reglado en el 80,3% de los casos. Globalmente, el 63% de los MAP están totalmente de acuerdo con la actuación del especialista, el 29% parcialmente de acuerdo y el 2% nada de acuerdo. La derivación se ha valorado mediante opinión subjetiva del MAP como efectiva o muy efectiva en el 86% de los pacientes y nada efectiva en el 9%. Conclusiones La comunicación entre niveles es clave en el cuidado de algunos pacientes hipertensos, como corresponde a una entidad crónica.
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