Hypertension

In patients presenting with severe hypertension, what constitutes a true emergency?

Is it necessary to prescribe lipid-lowering therapy for a patient with a mildly elevated total cholesterol level (240 mg/dL), a low-density lipoprotein (LDL) cholesterol level of 120 mg/dL, and a high high-density lipoprotein (HDL) cholesterol level of 100 mg/dL?

Torsades de pointes, or polymorphic ventricular tachycardia, seen on ECG includes wide complex QRS morphology tachycardia, axis deviation of the QRS complexes around baseline.

A 50-year-old man with end-stage renal disease secondary to long-standing hypertension had an elevated hematocrit and progressively increasing hemoglobin levels. For the past 7 years, he had been receiving hemodialysis 3 times a week. He denied headache, flushing, easy bruising, bleeding, nausea, vomiting, chest pain, dyspnea, and other symptoms. He was not receiving exogenous erythropoietin.

WINSTON-SALEM, N.C. -- A simple exercise test measuring the ratio of oxygen consumption to carbon dioxide production can predict mortality risks in systolic heart failure, said researchers here.

SAN FRANCISCO -- Pregnant women who have disordered breathing patterns during sleep may be at elevated risk of developing diabetes and high blood pressure -- including eclampsia and pre-eclampsia.

SAN DIEGO -- In utero exposure to selective serotonin reuptake inhibitors was not significantly associated with the risk for cardiac malformations or persistent pulmonary hypertension, researchers reported here.

CHICAGO -- Fixed combination doses of a calcium-channel blocker and an angiotensin-receptor blocker appear to improve hypertension treatment, researchers said here.

CHICAGO -- Obesity appears to be associated with an increased risk of diastolic rather than systolic hypertension subtypes, researchers said here.

CHICAGO -- For the lack of a convenient abbreviation, a diuretic with a good track record for hypertension is often spurned on prescription pads, said researchers here.

HELSINKI, Finland -- When babies born prematurely with a low birth weight become young adults, they are likely to have higher levels of insulin resistance, glucose intolerance, and higher blood pressure than those born at term, researchers here reported.

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.