Elevated Blood Pressures in Obese Young Men With Mild Hypertension Are Sustained During the Day and Night

Objective Sustained blood pressures ≥160/110 during pregnancy and the postpartum period require timely antihypertensive therapy. Hospital-level experiences outlining the efforts to improve timely delivery of care within 60 minutes have not been described. The objective of this analysis was to assess changes in care practices of an inpatient obstetrical health care team following the implementation of a quality improvement initiative for severe perinatal hypertension during pregnancy and the postpartum period. Study Design In January 2016, NorthShore University HealthSystem Evanston Hospital launched a quality improvement initiative focusing on perinatal hypertension, as part of a larger, statewide quality initiative via the Illinois Perinatal Quality Collaborative. We performed a retrospective cohort study of all pregnant and postpartum patients with sustained severely elevated blood pressure (two severely elevated blood pressures ≤15 minutes apart) with baseline data from 2015 and data collected during the project from 2016 through 2017. Changes in clinical practice and outcomes were compared before and after the start of the project. Statistical process control charts were used to demonstrate process-behavior changes over time. Results Comparing the baseline to the last quarter of 2017, there was a significant increase in the administration of medication within 60 minutes for severe perinatal hypertension (p <0.001). Implementation of a protocol for event-specific debriefing for each severe perinatal hypertension episode was associated with increased odds of the care team administering medication within 60 minutes of the diagnosis of severe perinatal hypertension (adjusted odds ratio 3.20, 95% confidence interval 1.73–5.91, p < 0.01). Conclusion Implementation of a quality improvement initiative for perinatal hypertension associated with pregnancy and postpartum improved the delivery of appropriate and timely therapy for severely elevated blood pressures and demonstrated the impact of interdisciplinary communication in the process. Key Points

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Increased sensitivity of the arterial chemoreceptor drive in young men with mild hypertension

Cardiovascular Research ◽

10.1093/cvr/16.3.163 ◽

1982 ◽

Vol 16 (3) ◽

pp. 163-172 ◽

Cited By ~ 128

Author(s):

A. TRZEBSKI ◽

M. TAFIL ◽

M. ZOLTOWSKI ◽

J. PRZYBYLSKI

Keyword(s):

Mild Hypertension ◽

Young Men ◽

Increased Sensitivity ◽

Arterial Chemoreceptor

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INTERRELATION BETWEEN POLYFUNCTIONAL MONITORING DATA IN YOUNG MEN WITH PRE- OR MILD HYPERTENSION WITH DIFFERENT BLOOD PRESSURE DAILY PROFILE

Arterial’naya Gipertenziya (Arterial Hypertension) ◽

10.18705/1607-419x-2013-19-1-44-50 ◽

2013 ◽

Vol 19 (1) ◽

pp. 44-50 ◽

Cited By ~ 1

Author(s):

E. N. Kazidaeva ◽

Yu. L. Venevtseva

Keyword(s):

Blood Pressure ◽

Power Spectrum ◽

Mild Hypertension ◽

Young Men ◽

Holter Monitoring ◽

Left Ventricular ◽

Total Power ◽

Night Time ◽

Arterial Blood ◽

Functional Features

Objective. To examine the clinical signiﬁ cance of polyfunctional 24-hour Holter monitoring with simultaneous recording of electrocardiogram, blood pressure (BP) and respiratory efforts by respiratory inductance plethysmography (Incart, Russia) and functional features of young men with prehypertension or mild arterial hypertension with different proﬁ le of night arterial blood pressure (BP) decline («dippers», «non-dippers», «over-dippers»).Design and methods. We examined 43 adolescents and young men aged 16–26 years (mean age 19,4 ± 0,5 years). All of them underwent echocardiography («Vivid 7», GE); 48,8 % of patients were overweight or obese (body mass index, BMI > 24,9 kg/m2), and BMI was comparable in all groups. Results. Breathing disturbances (apnea/hypopnea episodes) were found in 86 % patients and were positively related with high frequency (HF) spectrum power of heart rate variability (HRV) at night-time and were not related with BMI, BP or type of night BP decline. The analysis of echocardiography revealed that in «non-dippers» (n = 18) left ventricular myocardial mass index (LVMMI) was higher (94,3 ± 16,6 g/m2) than in «over-dippers» (n = 15; 77,8 ± 10,3 g/m2, р < 0,001). In daytime «non-dippers» had lower HRV (total power spectrum and power in all three groups) and power spectrum of VLF and LF spectrum at night. The frequency of repolarization instability (transient T-wave inversion) and early repolarization syndrome was higher in «over-dippers» (66,7 %, р < 0,01). Circadian index of HR was also higher (150 %) in «over-dippers». The number of sleep apnea in «non-dippers» and «dippers» was higher (39,7 ± 29,7 and 37,1 ± 18,1 episodes per hour of sleep) than in «over-dippers» (22,3 ± 12,0 episodes per hour of sleep, р < 0,05), but the last group had more hypopneas.Conclusion. Breathing disturbances were a frequent, and, probably, physiological, ﬁ nding at polyfunctional 24-hour Holter monitoring in young overweight men with pre- or mild hypertension. There is a relationship between LVMMI and nocturnal BP dipping even in young men. Young «non-dippers» demonstrate the same clinical pattern as the older ones. «Over-dipper» type is characterized predominantly by lower HR at night and ECG repolarization abnormalities.

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A Painful Pulsatile Abdominal Mass in a Young Man with Elevated Blood Pressures: An Unusual Presentation of Phaeochromocytoma

Anaesthesia and Intensive Care ◽

10.1177/0310057x0203000418 ◽

2002 ◽

Vol 30 (4) ◽

pp. 490-494 ◽

Cited By ~ 2

Author(s):

B. M. K. Lee ◽

L. K. Ti

Keyword(s):

Abdominal Mass ◽

Ventilatory Support ◽

Young Patients ◽

Multiple Organ ◽

Unusual Presentation ◽

Adrenergic Blockade ◽

Elevated Blood ◽

Delay In Diagnosis ◽

Blood Pressures ◽

High Index Of Suspicion

We report an unusual presentation of phaeochromocytoma in a young man with a painful, pulsatile abdominal mass and elevated blood pressures. This led to a delay in diagnosis and resulted in the administration of triggers of catecholamine release, possibly causing a catecholamine surge. This caused the development of catecholamine-induced cardiomyopathy and multiple organ failure, requiring inotropic and ventilatory support, intra-aortic balloon pump and dialysis. Fortunately, his condition reversed with supportive treatment and alpha-adrenergic blockade. This illustrates the importance of having a high index of suspicion of phaeochromocytoma, especially in young patients with elevated blood pressures.

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