Malignant hypertension

2015 ◽  
Author(s):  
Caroline Whitworth ◽  
Stewart Fleming
Keyword(s):  
Blood Pressure ◽  
Renal Failure ◽  
Thrombotic Microangiopathy ◽  
Left Ventricular ◽  
Malignant Hypertension ◽  
Smoking History ◽  
Clinical State ◽  
Hypertensive Retinopathy ◽  
Fibrinoid Necrosis ◽  
Increased Risk

Malignant hypertension (MH) is recognized clinically by elevated blood pressure together with retinal haemorrhages or exudates with or without papilloedema (grades III or IV hypertensive retinopathy); and may constitute a hypertensive emergency or crisis when complicated by evidence of end-organ damage including microangiopathic haemolysis, encephalopathy, left ventricular failure, and renal failure. Though reversible, it remains a significant cause of end-stage renal failure, and of cardiovascular and cerebrovascular morbidity and mortality in developing countries.MH can complicate pre-existing hypertension arising from diverse aetiologies, but most commonly develops from essential hypertension. The absolute level of blood pressure appears not to be critical to the development of MH, but the rate of rise of blood pressure may well be relevant in the pathogenesis. The pathogenesis of this transformation remains unclear.The pathological hallmark of MH is the presence of fibrinoid necrosis (medial vascular smooth muscle cell necrosis and fibrin deposition within the intima) involving the resistance arterioles in many organs. Fibrinoid necrosis is not specific to MH and this appearance is seen in other conditions causing a thrombotic microangiopathy such as haemolytic uraemic syndrome, scleroderma renal crisis, antiphospholipid syndrome, and acute vascular rejection post transplant. MH can both cause a thrombotic microangiopathy (TMA) but can also complicate underlying conditions associated with TMA.The pathophysiological factors that interact to generate and sustain this condition remain poorly understood. Risk factors include Afro-Caribbean race, smoking history, younger age of onset of hypertension, previous pregnancy, and untreated hypertension associated with non-compliance or cessation of antihypertensive therapy.Evidence from clinical studies and animal models point to a central role for the intrarenal renin–angiotensin system (RAS) in MH; there is good evidence for renal vasoconstriction and activation of the renal paracrine RAS potentiating MH once established; however, there may also be a role in the predisposition of MH suggested by presence of increased risk conferred by an ACE gene polymorphism in humans and polymorphisms for both ACE and AT1 receptor in an animal model of spontaneous MH. Other vasoactive mediators such as the endothelin and the inflammatory response may be important contributing to and increasing endothelial damage. There have been no randomized controlled trials to define the best treatment approach, but progressive lowering of pressures over days is considered safest unless made more urgent by critical clinical state. It seems logical to introduce ACE inhibition cautiously and early, but in view of the risk of rapid pressure lowering some recommend delay.

Thrombotic Microangiopathy in Cocaine Abuse–Associated Malignant Hypertension: Report of 2 Cases With Review of the Literature

2007 ◽  
Vol 131 (12) ◽  
pp. 1817-1820 ◽  
Author(s):  
Xin Gu ◽  
Guillermo A. Herrera
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Thrombotic Microangiopathy ◽  
Cocaine Abuse ◽  
Illicit Drugs ◽  
Malignant Hypertension ◽  
Fibrinoid Necrosis ◽  
Elevated Blood ◽  
Review Of The Literature ◽  
Accelerated Hypertension

Abstract Cocaine is one of the most commonly used illicit drugs. Acute renal failure is an emergent complication in patients with acute cocaine intoxication. It is well known that rhabdomyolysis and vasoconstriction can be important pathogenetic mechanisms resulting in acute renal failure in these patients. Clinically, although cocaine abuse is associated with elevated blood pressure, persistent accelerated hypertension reaching levels diagnostic of malignant hypertension is uncommon. Cocaine-induced malignant hypertension associated with morphologic features of thrombotic macroangiopathy has been rarely mentioned in the literature. We report 2 cases of cocaine abuse–associated malignant hypertension with renal failure. Kidney biopsies revealed thrombotic microangiopathy with fibrinoid necrosis of arterioles and glomerular tufts. Cocaine-mediated endothelial injury and platelet activation may play important pathogenetic roles in cocaine abusers who develop acute renal failure and malignant hypertension.

scholarly journals Premature Ventricular Complexes on Screening Electrocardiogram and Risk of Ischemic Stroke

Stroke ◽  
2015 ◽  
Vol 46 (5) ◽  
pp. 1365-1367 ◽  
Author(s):  
Sunil K. Agarwal ◽  
Jennifer Chao ◽  
Frederick Peace ◽  
Suzanne E. Judd ◽  
Brett Kissela ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Racial Differences ◽  
Proportional Hazards Model ◽  
Geographic Region ◽  
Left Ventricular ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Premature Ventricular Complexes ◽  
Increased Risk

Background and Purpose— Premature ventricular complexes (PVCs) detected from long-term ECG recordings have been associated with an increased risk of ischemic stroke. Whether PVCs seen on routine ECG, commonly used in clinical practice, are associated with an increased risk of ischemic stroke remains unstudied. Methods— This analysis included 24 460 participants (aged, 64.5+9.3 years; 55.1% women; 40.0% blacks) from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study who were free of stroke at the time of enrollment. PVCs were ascertained from baseline ECG (2003–2007), and incident stroke cases through 2011 were confirmed by an adjudication committee. Results— A total of 1415 (5.8%) participants had at least 1 PVC at baseline, and 591 developed incident ischemic stroke during an average (SD) follow-up of 6.0 (2.0) years. In a cox proportional hazards model adjusted for age, sex, race, geographic region, education, previous heart disease, systolic blood pressure, blood pressure–lowering medications, current smoking, diabetes mellitus, left ventricular hypertrophy by ECG, and aspirin use and warfarin use, the presence of PVCs was associated with 38% increased risk of ischemic stroke (hazard ratio [95% confidence interval], 1.38 [1.05–1.81]). Conclusions— PVCs are common on routine screening ECGs and are associated with an increased risk of ischemic stroke.

scholarly journals Faktor Determinan yang Berhubungan dengan Upaya Pengendalian Hipertensi di PSTW Budi Luhur Kota Jambi

2020 ◽  
Vol 9 (2) ◽  
pp. 234
Author(s):  
Fithriyani Fithriyani ◽  
Miko Eka Putri
Keyword(s):  
Blood Pressure ◽  
Elderly People ◽  
The Elderly ◽  
Smoking History ◽  
Bivariate Analysis ◽  
Projection Data ◽  
Moderate Activity ◽  
Cross Sectional ◽  
Major Health Problem ◽  
Increased Risk

Aging is a natural process that can not be avoided, running continuously, and continuously. Based on population projection data the number of elderly people will increase where the most number is found at the age of 60-64 years 94,012 people. Increasing age decreases bodily functions, decreased organ function and changes in blood pressure, therefore the elderly are advised to check their blood pressure regularly. As they age, blood pressure in the elderly will increase so that there is a higher risk of developing hypertension. Hypertension is a major health problem throughout the world, causing a high prevalence and is associated with an increased risk of cardiovascular disease. Some things that need to be considered in an effort to control hypertension include regular exercise, adequate rest, medical, traditional, regulate diet and reduce salt consumption one teaspoon per day. The purpose of this study was to determine the determinants and factors associated with efforts to control hypertension in the elderly at PSTW Budi Luhur, Jambi City. The research method uses descriptive analysis design with cross sectional approach. Samples were conducted for the elderly with hypertension. The research instrument was in the form of questionnaire sheets by interview. The results obtained 40% of elderly people have a history of smoking, 45% are quite good in consuming food, 60% elderly with moderate activity and 60% elderly are good in controlling hypertension. The results of bivariate analysis showed that there was no correlation between determinant factors (smoking history, food consumption, physical activity) and hypertension control efforts in the elderly in PSTW Budi Luhur, Jambi City

Severe renal failure and thrombotic microangiopathy induced by malignant hypertension successfully treated with spironolactone

2018 ◽  
Vol 67 (3) ◽  
pp. 208-214
Author(s):  
H.M. Villafuerte Ledesma ◽  
J.M. Peña Porta ◽  
P. Iñigo Gil ◽  
P. Martin Azara ◽  
J.E Ruiz Lalglesia ◽  
...  
Keyword(s):  
Renal Failure ◽  
Thrombotic Microangiopathy ◽  
Malignant Hypertension ◽  
Severe Renal Failure

P950Synergistic impact of renal failure and left ventricular dysfunction on short- and long-term mortality in patients with STEMI undergoing primary PCI

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A S Pavlovic ◽  
D Milasinovic ◽  
Z Mehmedbegovic ◽  
V Dedovic ◽  
D Jelic ◽  
...  
Keyword(s):  
Renal Failure ◽  
Cox Regression ◽  
Negative Impact ◽  
Reference Group ◽  
Left Ventricular ◽  
Primary Pci ◽  
Catheterization Laboratory ◽  
Lv Dysfunction ◽  
Risk Of Mortality ◽  
Increased Risk

Abstract Background Impaired left ventricular function (LV) and renal failure (RF) have both been separately associated with increased risk of mortality in ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Purpose Our aim was to comparatively evaluate the relative impact of LV dysfunction and renal failure (RF) on the risk of mortality in primary PCI-treated STEMI patients. Methods 5878 patients admitted for primary PCI during 2009–2015, from a prospectively kept, electronic registry of a high-volume catheterization laboratory, were included in the analysis. LV dysfunction was defined as EF<40%, and RF as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 according to Cockcroft-Gault formula. Adjusted Cox regression models were used to assess 30-day and 3-year mortality hazard, with patients with EF≥40% and normal renal function serving as the reference group. Results RF was documented in 17.1% (n=1006), whereas 36.5% had LV dysfunction (n=2141). LV dysfunction and RF were separately associated with increased crude mortality rates, whereas the concurrence of both resulted in the highest mortality rate at 30 days (0.7% if no RF and normal EF vs. 5.4% if RF alone vs. 3.9% if EF<40% alone vs. 12.6% if both RF and EF<40%; p<0.001), and at 3 years (5.7% if no RF and normal EF vs. 29.0% if RF alone vs. 19.0% if EF<40% alone vs. 47.4% if both RF and EF<40%; p<0.001). After multivariable adjustment for other significant mortality predictors, such as age, previous stroke, diabetes, hyperlipidemia, anemia and Killip≥2, RF and LV dysfunction were associated with a comparable increase in mortality risk at 30 days (HR=4.1 and HR=3.7, respectively, p<0.001 for both) and at 3 years (HR=2.8 and HR=2.7, respectively, p<0.001 for both). Importantly, the combined presence of RF and low EF was independently associated with a marked increase in both 30- day (HR=6.5, 95% CI 3.7–11.4, p<0.001), and 3-year mortality (HR=4.3, 95% CI 3.3–5.6, p<0.001). Kaplan Meier cumulative mortality curves Conclusion Apart from each being independently associated with an increased risk of mortality, the concurrence of renal failure and LV dysfunction had a synergistic negative impact on the prognosis of primary PCI-treated STEMI patients

Myocardial reperfusion reverses the J-curve association of cardiovascular risk and diastolic blood pressure in patients with left ventricular dysfunction and heart failure after myocardial infarction: insights from the EPHESUS trial

2020 ◽  
Vol 41 (17) ◽  
pp. 1673-1683 ◽  
Author(s):  
Michael Böhm ◽  
João Pedro Ferreira ◽  
Felix Mahfoud ◽  
Kevin Duarte ◽  
Bertram Pitt ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Cox Regression ◽  
Cardiovascular Death ◽  
Left Ventricular ◽  
Coronary Perfusion ◽  
Increased Risk ◽  
The Impact

Abstract Aims The described association of low diastolic blood pressure (DBP) with increased cardiovascular outcomes could be due to reduced coronary perfusion or is simply due to reverse causation. If DBP is physiologically relevant, coronary reperfusion after myocardial infarction (MI) might influence DBP–risk association. Methods and results The relation of achieved DBP with cardiovascular death or cardiovascular hospitalization, cardiovascular death, and all-cause death was explored in 5929 patients after acute myocardial infarction (AMI) with impaired left ventricular function, signs and symptoms of heart failure, or diabetes in the EPHESUS trial according to their reperfusion status. Cox regression models were used to assess the impact of reperfusion status on the association of DBP and systolic blood pressure (SBP) with outcomes in an adjusted fashion. In patients without reperfusion, lower DBP &lt;70 mmHg was associated with increased risk for all-cause death [adjusted hazard ratios (HRs) 1.80, 95% confidence interval (CI) 1.41–2.30; P &lt; 0.001], cardiovascular death (HR 1.70, 95% CI 1.3–3.22; P &lt; 0.001), cardiovascular death or cardiovascular hospitalization (HR 1.54, 95% CI 1.26–1.87; P &lt; 0.001). In patients with reperfusion, the risk increase at low DBP was not observed. At low SBP, risk increased independently of reperfusion. A sensitivity analysis in the subgroup of patients with optimal SBP of 120–130 mmHg showed again risk reduction of reperfusion at low DBP. Adding the treatment allocation to eplerenone or placebo into the models had no effects on the results. Conclusion Patients after AMIs with a low DBP had an increased risk, which was sensitive to reperfusion therapy. Low blood pressure after MI identifies in patients with particular higher risk. These data support the hypothesis that low DBP in patients with stenotic coronary lesions is associated with risk, potentially involving coronary perfusion pressure and the recommendations provided by guidelines suggesting lower DBP boundaries for these high-risk patients.

P3833Low heart rate variability is associated with future arrhythmic events in hypertension

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Terentes-Printzios ◽  
C Vlachopoulos ◽  
L Korogiannis ◽  
G Christopoulou ◽  
P Xydis ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Primary Endpoint ◽  
Target Organ Damage ◽  
Roc Curves ◽  
Organ Damage ◽  
Left Ventricular ◽  
Target Organ ◽  
Increased Risk

Abstract Background/Introduction Cardiac autonomic dysfunction and target organ damage are associated with increased cardiovascular mortality and arrhythmias. Purpose The aim of the study was to investigate the effect of heart rate variability (HRV) and markers of target organ damage in the prognosis of future arrhythmic events. Methods We studied 292 untreated at baseline hypertensives (mean age 53±13, 153 males). Cardiac autonomic function was evaluated by analysis of short-term HRV measures over 24-h using 24-h ambulatory blood pressure monitoring and the standard deviation of the measurements. Echocardiography was also performed and left ventricular mass index (LVMI) was estimated with the Demereux formula. Aortic stiffness was assessed with carotid-femoral pulse wave velocity (cfPWV) and wave reflections with aortic augmentation index corrected for heart rate (Alx@75). Patients were followed up for a median period of 13 years. The primary endpoint was a composite of atrial/ventricular tachycardias, symptomatic multiple premature ventricular contractions, second and third-degree heart blocks and pacemaker/defibrillator placement. Results In comparison without events, patients with the primary endpoint (n=37, 13%) had lower 24-h daytime HRV (9.6 beats per minute vs. 11.1 beats per minute, p=0.005), higher systolic blood pressure (168 mmHg vs. 163 mmHg, p=0.003), higher cfPWV (8.4 m/s vs. 7.7 m/s, p=0.005), higher LVMI (133 g/m2 vs. 122 g/m2, p=0.002) and higher AIx@75 (29.0% vs. 26.3%, p=0.043). In further analysis, receiver operating characteristic (ROC) curves were generated to evaluate the ability of HRV, cfPWV, LVMI and AIx@75 to discriminate subjects with arrhythmic events. The area under the curve (AUC) and 95% CIs of the ROC curves were AUC=0.35 (95% CI: 0.26–0.44, p=0.003) for HRV, AUC=0.64 (95% CI: 0.54–0.73, P<0.006) for cfPWV, AUC=0.67 (95% CI: 0.58–0.75, P=0.001) for LVMI and AUC=0.55 (95% CI: 0.47–0.64, P=0.298) for AIx@75 (Figure). In Cox regression analysis, only HRV was associated with increased risk of arrhythmic events (Hazard ratio per 1 unit =0.87, 95% Confidence intervals 0.76 to 0.995, p=0.043) when adjusted for age, gender, cfPWV, LVMI and AIx@75. ROC curves of HRV & target organ damage Conclusions Low heart rate variability is associated with increased risk of future arrhythmic events suggesting an early sympathovagal imbalance that could lead to future events in hypertension.

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