Treatment of Hypertension in the Patient with Cardiovascular Disease * *Abbreviations: ACEI, angiotensin converting enzyme inhibitor; ACS, acute coronary syndromes; AF, atrial fibrillation; MI, myocardial infarction; ARB, angiotensin II type 1 receptor blocker; BB, beta-adrenergic receptor blocker; BP, blood pressure; CCB, calcium channel blocker; CVD, cardiovascular disease; CHD, coronary heart disease; DM, diabetes mellitus; DBP, diastolic blood pressure; ESRD, end-stage renal disease; HF, heart failure; HTN, hypertension; ISH, isolated systolic hypertension; LVEF, left ventricular ejection fraction; LVMI, left ventricular mass index; LVH, left ventricular hypertrophy; PP, pulse pressure; PAD, peripheral arterial disease; PWV, pressure wave velocity; RAAS, renin-angiotensin-aldosterone system; RWT, relative wall thickness; SBP, systolic blood pressure; U.S., United States.

2007 ◽  
pp. 625-646
Author(s):  
George Chrysant ◽  
Suzanne Oparil
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Enzyme Inhibitor ◽  
Arterial Disease ◽  
Left Ventricular ◽  
Receptor Blocker ◽  
Left Ventricular Ejection ◽  
Peripheral Arterial ◽  
Stage Renal Disease ◽  
End Stage

Abstract 17623: A Case of Biopsy-proven Immunoglobulin G4-Related Disease Associated With Multiple Giant Coronary Artery Aneurysms, Peripheral Arterial Aneurysms, End Stage Renal Disease, and Heart Failure

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Mark D Benson ◽  
Cathryn Byrne-Dugan ◽  
Dale Adler ◽  
Mark Feinberg ◽  
Deepak Bhatt
Keyword(s):  
Heart Failure ◽  
Coronary Artery ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Coronary Arterial Disease ◽  
Related Disease ◽  
Stage Renal Disease ◽  
End Stage

A 54-year-old man with remote large cell non-Hodgkin’s lymphoma in remission following R-CHOP and severe atopic dermatitis was transferred from another hospital with a non-ST elevation myocardial infarction. Over the preceding year, the patient had suffered recurrent admissions for acutely decompensated heart failure with a newly depressed left ventricular ejection fraction (LVEF) of 20% by echocardiography and rapidly progressive end-stage renal disease of unclear etiology requiring the initiation of hemodialysis. Prior workup had demonstrated an infrarenal abdominal aortic aneurysm and bilateral common iliac artery aneurysms with subsequent computed tomography (CT) additionally demonstrating a superior mesenteric artery aneurysm. The patient was taken for immediate coronary arteriography, which demonstrated giant aneurysms in the left main and right coronary arteries, as well as multivessel severe stenoses. CT coronary angiogram demonstrated significant circumferential wall thickening throughout the coronary vasculature. Given concern for IgG4-related disease (IgG4-RD), a renal biopsy was pursued that confirmed the diagnosis. 18F-fluorodeoxyglucose positron emission tomography-CT identified only mild aortic inflammation. The patient was treated with high-dose steroids and rituximab. The serological inflammatory markers improved, and he underwent coronary artery bypass grafting. Pericardial, aortic adventitial, left internal mammary artery, and saphenous vein biopsies showed cardiovascular involvement of IgG4-RD. The patient has been maintained on rituximab with normalization of his LVEF and no recurrence of chest pain over the past eighteen months. IgG4-RD is a fibroinflammatory systemic disease newly described in 2003 and only recently found to involve the cardiovascular system with several reports of peripheral aneurysmal disease. To our knowledge, the current case represents the first report of a patient successfully treated for biopsy-proven IgG4-RD associated with coronary artery disease and left ventricular systolic dysfunction. IgG4-RD may represent a novel mechanism underlying some forms of peripheral and coronary arterial disease and may offer new insights into vascular biology.

Effect of Ultrafiltration on Sleep Apnea and Cardiac Function in End-Stage Renal Disease

2020 ◽  
Vol 51 (2) ◽  
pp. 139-146 ◽  
Author(s):  
Toru Inami ◽  
Owen D. Lyons ◽  
Elisa Perger ◽  
Azadeh Yadollahi ◽  
John S. Floras ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Renal Disease ◽  
Cardiac Function ◽  
End Stage Renal Disease ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Systolic And Diastolic Function ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Rationale: End-stage renal disease (ESRD) patients have high annual mortality mainly due to cardiovascular causes. The acute effects of obstructive and central sleep apnea on cardiac function in ESRD patients have not been determined. We therefore tested, in patients with ESRD, the hypotheses that (1) sleep apnea induces deterioration in cardiac function overnight and (2) attenuation of sleep apnea severity by ultrafiltration (UF) attenuates this deterioration. Methods: At baseline, ESRD patients, on conventional hemodialysis, with left ventricular ejection fraction (LVEF) >45% had polysomnography (PSG) performed on a non-dialysis day to determine the apnea-hypopnea index (AHI). Echocardiography was performed at the bedside, before and after sleep. Isovolumetric contraction time divided by left ventricular ejection time (IVCT/ET) and isovolumetric relaxation time divided by ET (IVRT/ET) were measured by tissue doppler imaging. The myocardial performance index (MPI), a composite of systolic and diastolic function was also calculated. One week later, subjects with sleep apnea (AHI ≥15) had fluid removed by UF, followed by repeat PSG and echocardiography. ­Results: Fifteen subjects had baseline measurements, of which 7 had an AHI <15 (no–sleep-apnea group) and 8 had an AHI ≥15 (sleep-apnea group). At baseline, there was no overnight change in the LVEF in either the no-sleep-apnea group or the sleep-apnea group. In the no-sleep-apnea group, there was also no overnight change in MPI, IVCT/ET and IVRT/ET. However, in the sleep-apnea group there were overnight increases in MPI, IVCT/ET and IVRT/ET (p = 0.008, 0.007 and 0.031, respectively), indicating deterioration in systolic and diastolic function. Following fluid removal by UF in the sleep-apnea group, the AHI decreased by 48.7% (p = 0.012) and overnight increases in MPI, IVCT/ET and IVRT/ET observed at baseline were abolished. Conclusions: In ESRD, cardiac function deteriorates overnight in those with sleep apnea, but not in those without sleep apnea. This overnight deterioration in the sleep-apnea group may be at least partially due to sleep apnea, since attenuation of sleep apnea by UF was accompanied by elimination of this deleterious overnight effect.

scholarly journals Peripheral Arterial Disease Screening in End-Stage Renal Disease

2013 ◽  
Vol 57 (5) ◽  
pp. 54S
Author(s):  
Houssam K. Younes ◽  
Mark G. Davies ◽  
Javier Anaya-ayala ◽  
Hosam F. El-Sayed ◽  
Jean Bismuth ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Arterial Disease ◽  
Disease Screening ◽  
Peripheral Arterial ◽  
Stage Renal Disease ◽  
End Stage

Prevalence of Peripheral Arterial Disease among End Stage Renal Disease Patients

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
R R W Morkos ◽  
A M Shabana ◽  
A S Elserafy ◽  
H F Hanna
Keyword(s):  
End Stage Renal Disease ◽  
Arterial Disease ◽  
Control Group ◽  
P Value ◽  
Asymptomatic Patients ◽  
Function Test ◽  
Peripheral Arterial ◽  
Stage Renal Disease ◽  
End Stage ◽  
Regular Hemodialysis

Abstract Background Patients with End Stage Renal Disease are more susceptible to develop Peripheral Arterial Disease. so, screening is helpful for early diagnosis. Objectives The aim of this study is to screen and calculate the prevalence of asymptomatic patients on regular hemodialysis for presence of PAD. Aim of Study The aim of this study is to screen and calculate the prevalence of asymptomatic patients on regular hemodialysis for presence of PAD. Patients and Methods The study included 100 asymptomatic patients on regular hemodialysis and below 60 years old to be screened for presence of PAD. Patients who refused the test, above 60 years old, or diabetic have been excluded from the study. All selected patients have been subjected to complete history taking, full clinical examination including extremities examination, Lab workup including; CBC, liver function test, kidney function test, A1C level, lipid profile, Resting 12 lead ECG, Echocardiography to assess systolic function, valvular disease, and resting SWMA, and ABI assessment using the Doppler. Patients then were divided into two groups; control group who has negative PAD with ABI &gt; 0.9 and study group who has PAD with ABI ≤ 0.9. Results It was found that the prevalence of PAD among ESRD patients is 26%. Regarding the laterality; 21% had bilateral PAD and the rest 5% had unilateral disease. The results showed that females had statistically significant higher risk of developing PAD that males. 55% of patients were females and the other 45% were males. 36.4% of females studied had positive ABI but only 13.3% of studied males found positive for PAD. The p value was 0.017. The study showed also that A1C level in patients who have no diabetes carries statistically significant results. The mean A1C level for the study group was 5.56 ± 0.70 and the control group was 4.92 ± 0.73. The p value was 0.000. The A1C level cut off value was &gt; 5.3. This means that patients who have A1C &gt; 5.3 should be paid more attention and be screened because they have higher risk to develop PAD. Conclusion Renal impairment is an important risk factor for developing PAD in absence of traditional risk factors such as DM, hypertension, or dyslipidemia. Prevalence of PAD was 26% in our study. ABI is a simple non-invasive modality of screening for PAD. Females are at higher risk to develop PAD than males by ∼ 2.7 fold. Although diabetes is absent, A1C level &gt; 5.3 is significantly correlating with the risk of PAD.

scholarly journals The Association Between Inflammatory Markers and Hypertension. A Call for Anti-Inflammatory Strategies?

2006 ◽  
Vol 6 ◽  
pp. 1262-1273
Author(s):  
Néstor H. García ◽  
Luis I. Juncos
Keyword(s):  
Blood Pressure ◽  
Endothelial Dysfunction ◽  
Beta Blockers ◽  
Organ Damage ◽  
Left Ventricular ◽  
Cardiovascular Damage ◽  
Inflammatory State ◽  
Anti Inflammatory ◽  
Stage Renal Disease ◽  
End Stage

The most important goal of antihypertensive therapy is to prevent the complications associated with hypertension (stroke, myocardial infarction, end-stage renal disease, etc). For this, secondary targets such as left ventricular hypertrophy, proteinuria, dementia, and other signs of hypertension-induced organ damage help the physician to assess risks and monitor treatment efficacy. New treatment targets may be arising, however. One such target may be endothelial dysfunction. In effect, endothelial dysfunction not only may precede the elevation of blood pressure, but may also pave the way to conditions often associated with hypertension, such as diabetes, arteriosclerosis, microalbuminuria, congestive heart failure, and tissue hypertrophy. Because inflammation often accompanies endothelial dysfunction, approaches to counteract inflammation are now being evaluated. For this, antagonists of the renin-angiotensin-aldosterone system, statins, and beta blockers are all being tested. All of these agents seem to prevent or delay the induction of proinflammatory molecules aside from, and in addition to, their specific effects on blood pressure. The focus of this review is to update some of the animal and human research showing that hypertension sets off an inflammatory state and also to consider some of the anti-inflammatory approaches that may prevent the development of endothelial dysfunction, and the subsequent renal and cardiovascular damage.

Potential Nontraditional Applications of Statins

2003 ◽  
Vol 37 (7-8) ◽  
pp. 1063-1071 ◽  
Author(s):  
James M McKenney
Keyword(s):  
Peripheral Arterial Disease ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Acute Coronary Syndromes ◽  
Arterial Disease ◽  
Data Sources ◽  
Coronary Syndromes ◽  
Peripheral Arterial ◽  
Stage Renal Disease ◽  
End Stage

OBJECTIVE: To review the current evidence for use of hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) in nontraditional lipid-related applications, including acute coronary syndromes, peripheral arterial disease, stroke, and renal disease, and to describe ongoing trials evaluating the role of statins in these conditions. DATA SOURCES: Clinical literature was identified by a MEDLINE search (1990–November 2002) using ≥1 of the following search terms: acute coronary syndrome(s), angina pectoris, atherosclerosis, atorvastatin, clinical trials, diabetes mellitus, end-stage renal disease, fluvastatin, lovastatin, myocardial infarction, peripheral arterial disease, pravastatin, simvastatin, statins, and stroke. Treatment guidelines issued by professional and governmental organizations, such as the American Diabetes Association, American Heart Association, National Cholesterol Education Program, National Kidney Foundation, and National Stroke Foundation, were reviewed. STUDY SELECTION AND DATA EXTRACTION: Articles identified from the data sources were included if they pertained to the conditions described in the objectives and provided unique information concerning use of statins. DATA SYNTHESIS: Substantial evidence exists for the use of statins in acute coronary syndromes. Meta-analyses of data from major clinical trials indicate that statins prevent first and recurrent stroke, and large-scale trials are underway to evaluate the efficacy of statins in this setting. Accumulating evidence suggests that statins may be beneficial in reducing the morbidity and mortality associated with peripheral arterial disease and end-stage renal disease, and results from ongoing trials may confirm these benefits. Statins may also have a future role in amelioration of other conditions associated with atherosclerosis, such as diabetes mellitus. CONCLUSIONS: A large body of evidence supports the evaluation of statins in clinical settings beyond primary and secondary prevention of morbidity and mortality associated with coronary atherosclerosis.

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