Hypertension

NEW YORK -- Aliskiren, the first oral antihypertensive agent in the renin-inhibitor class, is no better at reducing blood pressure than older agents, and in some patients may actually increase blood pressure, claimed two reviewers.

SEATTLE -- Lowering blood pressure with centrally active angiotensen enzyme inhibitors may have the added benefit of reducing the risk of cognitive decline, researchers here reported.

FLORENCE, Italy -- An ultrasound measurement of liver thickness predicted portal hypertension in patients with hepatitis C-related cirrhosis, researchers here found.

Patients with congenital heart disease and pulmonary arterial hypertension (PAH) are at risk for severe deterioration during pregnancy and delivery. We discuss the case of a 38-year-old woman who presented to the emergency department complaining of dyspnea 6 days after giving birth to her first child via cesare- an section. When PAH is untreated, maternal mortality may exceed 50%, but aggressive PAH treatment offers improved outcomes. Moreover, initial improvement in functional status made with parenteral prostanoids can be maintained with combination oral therapy.

A 57-year-old man requests an extensive medical evaluation as part of a transition in the ownership of his business. He is generally healthy, although he reports that his capacity for physical exertion has diminished over the past several years. He denies chest pain with effort, dyspnea at night or on exertion, cough, and sputum production.

ABSTRACT: Patients who experience an acute myocardial infarction (MI) are at very high risk for recurrent cardiovascular events. Both site-supervised and home-based cardiac rehabilitation programs can effectively reduce all-cause and cardiovascular mortality. Start risk factor reduction as soon as possible; pharmacotherapy is best initiated while patients are still in the hospital. All patients who have had an MI should receive aspirin, an angiotensin-converting enzyme inhibitor, and a ß-blocker, unless these agents are contraindicated or are not tolerated. Prescribe aggressive lipid-lowering therapy to bring patients' low-density lipoprotein cholesterol levels to below 70 mg/dL. For smokers, quitting is the single most important change they can make to reduce future risk of MI.

What is "normal" blood pressure (BP)? Is it different from optimal BP?

For several months, a 52-year-old woman has had burning discomfort in the region of her lower sternum and frequent acid/sour sensations in her throat; the symptoms are usually associated with burping after meals and recumbency.

COLOGNE, Germany -- Chocolate, the ultimate comfort food, has won another health vote of confidence, a reduction in blood pressure. Tea -- black or green -- did not.

MONTRÉAL -- Restless legs syndrome may boost nocturnal blood pressure and exacerbate cardiovascular disease risks, particularly among older patients, investigators here suggested.

Among patients in whom angioedema developed while they were being treated with an ARB, 50% had previously had a similar reaction to angiotensin-converting enzyme (ACE) inhibitors, according to one report.

Numerous randomized trials have evaluated antihypertensive regimens in various settings, including those complicated by at least one other vascular disorder. Among these trials are the Modification of Diet in Renal Disease (MDRD) Study in hypertensive patients with kidney disease; the Comparison of AMlodipine versus Enalapril to Limit Occurrences of Thrombosis (CAMELOT) Study and the INternational VErapamil-trandolapril STudy (INVEST) in patients with hypertension and coronary disease; and the Perindopril pROtection aGainst REcurrence of Stroke Study (PROGRESS) in hypertensive patients who have had a stroke.

NEW ORLEANS -- Torcetrapib, an investigational cholesteryl ester transfer protein (CTEP) that spikes HDLs but boosts blood pressure, may have proatherogenic effects, according to results from a pair of ultrasound studies.

UTRECHT, The Netherlands -- Coffee for women, and its effect on their blood pressure, is an exception to the maxim that moderation in all things is a good approach to life, contend researchers here.

DALLAS -- Pre-participation cardiovascular evaluation of young competitive athletes to rule out Marfan syndrome, murmur, aortic coarctation, and hypertension could reduce the risk of sudden death, contend new guidelines.

ROCKVILLE, Md. -- The FDA said today it has approved aliskiren (Tektuma), the first oral direct renin inhibitor for treatment of hypertension.

**Until the 1990s, hypertension was largely defined using only the criterion of elevated DBP. However, with the aging and increased longevity of the population, the incidence of predominantly systolic hypertension is on the rise. Isolated systolic hypertension (ISH) is now the most common subtype of hypertension in American adults. The third National Health and Nutrition Examination Survey (NHANES III, 1988-1991) reported that 75% of persons with hypertension were 50 years or older and that about 80% of those untreated or inadequately treated had ISH.1

Although the definition of orthostatic hypotension requires that the significant drop in blood pressure observed on standing be sustained for 3 minutes (which provides evidence of true autonomic failure), clinicians who use this as a diagnostic criterion may be doing many patients a disservice. Most people who fall as a result of a drop in blood pressure do so on arising, as they get up from a bed or chair. Moreover, many hip fractures caused by falls occur in patients who experience a drop in blood pressure on standing. If patients can stand for 3 minutes without wavering or falling, their body is accommodating well.

ABSTRACT: In patients with jaundice and normal liver function, the cause of hyperbilirubinemia is an isolated disorder of bilirubin metabolism. In patients with hyperbilirubinemia who have abnormal liver enzyme levels, hepatocellular disease must be differentiated from cholestatic liver injury. In general, if the cause of jaundice is global hepatocellular dysfunction, the serum alanine aminotransferase and aspartate aminotransferase levels will be predominantly elevated. If the cause is cholestasis, the serum alkaline phosphatase and gγ-glutamyl peptidase levels will be elevated. In most patients, imaging studies will be needed. The initial workup should include abdominal ultrasonography, which can identify dilated intrahepatic and extrahepatic biliary ducts as well as findings that may suggest cirrhosis or signs of portal hypertension, including splenomegaly and ascites.

BOSTON -- Daily use of over-the-counter analgesics -- including aspirin -- significantly increased the risk that men will develop new-onset hypertension, researchers here reported.

WALTHAM, Mass. -- Pulse pressure, the difference between systolic and diastolic pressures, may be a risk factor for the onset of atrial fibrillation independent of arterial pressure and other known factors, researchers said.

ORLANDO -- A novel intravenous calcium channel blocker seems safe and at least as effective as one of the standard blood-pressure-lowering drug in cardiac surgery, a researcher said here.

WASHINGTON -- An observational study of 60,000 postmenopausal women found that about 40% have prehypertension, and that level of blood pressure was associated with a 58% higher risk of cardiovascular death than for normotensive women.

UTRECHT, The Netherlands -- Even if hypertension during pregnancy subsides after delivery, a risky postmenopausal second act may await, researchers reported.

BALTIMORE -- Eighteen million American men ages 20 or older have erectile dysfunction, generally attributed to the effects of diabetes, hypertension, or physical inactivity, researchers here reported.