[PP.23.15] RELATIONSHIP BETWEEN PATIENT CHARACTERISTICS, RISK FACTORS, FREQUENCY OF PRIMARY ALDOSTERONISM AND THE NUMBER OF ANTIHYPERTENSIVE DRUGS IN PATIENTS WITH TRUE RESISTANT HYPERTENSION

Resistant hypertension is defined as uncontrolled blood pressure despite the use of three antihypertensive drugs, including a diuretic, in optimal doses. Treatment resistance can be attributed to poor adherence to antihypertensive drugs, excessive salt intake, physician inertia, inappropriate or inadequate medication, and secondary hypertension. Drug-induced hypertension, obstructive sleep apnoea, primary aldosteronism, and chronic kidney disease represent the most common secondary causes of resistant hypertension. Several drugs can induce or exacerbate pre-existing hypertension, with non-steroidal anti-inflammatory drugs being the most common due to their wide use. Obstructive sleep apnoea and primary aldosteronism are frequently encountered in patients with resistant hypertension and require expert management. Hypertension is commonly found in patients with chronic kidney disease and is frequently resistant to treatment, while the management of renovascular hypertension remains controversial. A step-by-step approach of patients with resistant hypertension is proposed at the end of this review paper.

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Resistant and refractory arterial hypertension: similarities and differences, new approaches to diagnosis and treatment

Systemic Hypertension ◽

10.26442/2075-082x_2018.3.11-13 ◽

2018 ◽

Vol 15 (3) ◽

pp. 11-13 ◽

Cited By ~ 2

Author(s):

A V Aksenova ◽

T E Esaulova ◽

O A Sivakova ◽

I E Chazova

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Arterial Hypertension ◽

Treatment Failure ◽

Resistant Hypertension ◽

Antihypertensive Treatment ◽

Patient Characteristics ◽

Refractory Hypertension ◽

Long Time ◽

Similarities And Differences

Refractory hypertension is a novel phenotype of antihypertensive treatment failure. The terms "refractory hypertension" and "resistant hypertension" were considered interchangeable for a long time and related to difficult-to-treat hypertension. Recently, the term "refractory hypertension" refers to a very small group of patients who do not really reach the target blood pressure for maximum antihypertensive therapy. In this review we discuss similarities and contrasts definition, prevalence, patient characteristics, risk factors, and possible underlying etiologies of refractory and resistant hypertension.

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Should all Hypertensive Patients be Screened for Primary Aldosteronism?

Current Hypertension Reviews ◽

10.2174/1573402114666180507153549 ◽

2019 ◽

Vol 15 (1) ◽

pp. 54-56

Author(s):

Stelina Alkagiet ◽

Konstantinos Tziomalos

Keyword(s):

Resistant Hypertension ◽

Primary Aldosteronism ◽

Large Scale ◽

Controlled Trial ◽

The Other ◽

Limited Data ◽

Hypertensive Patients ◽

Randomized Controlled ◽

Increased Risk ◽

Prospective Randomized Controlled Trial

Primary aldosteronism (PA) is not only a leading cause of secondary and resistant hypertension, but is also quite frequent in unselected hypertensive patients. Moreover, PA is associated with increased cardiovascular risk, which is disproportionate to BP levels. In addition, timely diagnosis of PA and prompt initiation of treatment attenuate this increased risk. On the other hand, there are limited data regarding the usefulness of screening for PA in all asymptomatic or normokalemic hypertensive patients. More importantly, until now, no well-organized, large-scale, prospective, randomized controlled trial has proved the effectiveness of screening for PA for improving clinical outcome. Accordingly, until more relevant data are available, screening for PA should be considered in hypertensive patients with spontaneous or diuretic-induced hypokalemia as well as in those with resistant hypertension. However, screening for PA in all hypertensive patients cannot be currently recommended.

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Candida infective endocarditis: A retrospective study of patient characteristics and risk factors for death in 703 U.S. cases, 2015-2019

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa628 ◽

2020 ◽

Author(s):

Jonathan P Huggins ◽

Samuel Hohmann ◽

Michael Z David

Keyword(s):

Risk Factors ◽

Hospital Mortality ◽

Liver Failure ◽

Patient Characteristics ◽

Medication Administration ◽

Small Sample ◽

Risk Of Death ◽

Opiate Abuse ◽

Small Sample Sizes ◽

Valve Pathology

Abstract Background Candida endocarditis is a rare, sometimes fatal complication of candidemia. Past investigations of this condition are limited by small sample sizes. We used the Vizient clinical database to report on characteristics of patients with Candida endocarditis and to examine risk factors for in-hospital mortality. Methods This was a multicenter, retrospective cohort study of 703 inpatients admitted to 179 United States hospitals between October 2015 and April 2019. We reviewed demographic, diagnostic, medication administration, and procedural data from each patient’s initial encounter. Univariate and multivariate logistic regression analyses were used to identify predictors of in-hospital mortality. Results Of 703 patients, 114 (16.2%) died during the index encounter. One hundred and fifty-eight (22.5%) underwent an intervention on a cardiac valve. On multivariate analysis, acute and subacute liver failure was the strongest predictor of death (OR 9.2, 95% CI 4.8 –17.7). Female sex (OR 1.9, 95% CI 1.2 – 3.0), transfer from an outside medical facility (OR 1.8, 95% CI 1.1 – 2.8), aortic valve pathology (OR 2.7, 95% CI 1.5 – 4.9), hemodialysis (OR 2.1, 95% CI 1.1 – 4.0), cerebrovascular disease (OR 2.2, 95% CI 1.2 – 3.8), neutropenia (OR 2.5, 95% CI 1.3 – 4.8), and alcohol abuse (OR 2.9, 95% CI 1.3 – 6.7) were also associated with death on adjusted analysis, whereas opiate abuse was associated with a lower odds of death (OR 0.5, 95% CI 0.2 – 0.9). Conclusions We found that the inpatient mortality rate was 16.2% among patients with Candida endocarditis. Acute and subacute liver failure was associated with a high risk of death while opiate abuse was associated with a lower risk of death.

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Higher-Than-Expected Rates of Distal Radioulnar Joint Fixation in Radial Shaft Fractures: Location of Fracture Matters

Hand ◽

10.1177/15589447211006836 ◽

2021 ◽

pp. 155894472110068

Author(s):

Joanne Y. Zhang ◽

Aneesh V. Samineni ◽

David C. Sing ◽

Alyssa Rothman ◽

Andrew B. Stein

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

Patient Characteristics ◽

Distal Radioulnar Joint ◽

Older Age ◽

Radioulnar Joint ◽

Factors Associated ◽

Shaft Fractures ◽

Male Sex ◽

Preoperative Patient

Background: The purpose of this study was to evaluate rates of distal radioulnar joint (DRUJ) fixation based on location of the radial shaft fracture and risk factors associated with postoperative complications following radial shaft open reduction internal fixation (ORIF). Methods: Adult patients who underwent isolated radial shaft ORIF from 2014 to 2018 were identified from American College of Surgeons National Surgical Quality Improvement Program database and stratified by fracture location and by the presence or absence of DRUJ fixation. Preoperative patient characteristics and postoperative complications were compared to determine risk factors associated with DRUJ fixation. Results: We identified 1517 patients who underwent isolated radial shaft ORIF, of which 396 (26.1%) underwent DRUJ fixation. Preoperative patient characteristics and postoperative complications were similar between cohorts. Distal radioulnar joint fixation was performed in 50 (30.7%) of 163 distal radial shaft fractures, 191 (21.8%) of 875 midshaft fractures, and 3 (13.0%) of 23 proximal shaft fractures ( P = .025). Risk factors for patients readmitted include male sex (odds ratio [OR] = 12.76, P = .009) and older age (OR = 4.99, P = .035). Risk factors for patients with any postoperative complication include dependent functional status (OR = 6.78, P = .02), older age (50-69 vs <50) (OR = 2.73, P = .05), and American Society of Anesthesiologists (ASA) ≥3 (OR = 2.45, P = .047). Conclusions: The rate of DRUJ fixation in radial shaft ORIF exceeded previously reported rates of concomitant DRUJ injury, especially among distal radial shaft fractures. More distally located radial shaft fractures are significantly associated with higher rates of DRUJ fixation. Male sex is a risk factor for readmission, whereas dependent functional status, older age, and ASA ≥3 are risk factors for postoperative complications.

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Perioperative outcomes for pediatric neurosurgical procedures: analysis of the National Surgical Quality Improvement Program–Pediatrics

Journal of Neurosurgery Pediatrics ◽

10.3171/2016.10.peds16414 ◽

2017 ◽

Vol 19 (3) ◽

pp. 361-371 ◽

Cited By ~ 11

Author(s):

Benjamin J. Kuo ◽

Joao Ricardo N. Vissoci ◽

Joseph R. Egger ◽

Emily R. Smith ◽

Gerald A. Grant ◽

...

Keyword(s):

Risk Factors ◽

Quality Improvement ◽

Univariate Analysis ◽

Patient Characteristics ◽

Quality Improvement Program ◽

Neurosurgical Procedures ◽

Continuous Variables ◽

Improvement Program ◽

Surgical Quality ◽

Defect Repair

OBJECTIVE Existing studies have shown a high overall rate of adverse events (AEs) following pediatric neurosurgical procedures. However, little is known regarding the morbidity of specific procedures or the association with risk factors to help guide quality improvement (QI) initiatives. The goal of this study was to describe the 30-day mortality and AE rates for pediatric neurosurgical procedures by using the American College of Surgeons (ACS) National Surgical Quality Improvement Program–Pediatrics (NSQIP-Peds) database platform. METHODS Data on 9996 pediatric neurosurgical patients were acquired from the 2012–2014 NSQIP-Peds participant user file. Neurosurgical cases were analyzed by the NSQIP-Peds targeted procedure categories, including craniotomy/craniectomy, defect repair, laminectomy, shunts, and implants. The primary outcome measure was 30-day mortality, with secondary outcomes including individual AEs, composite morbidity (all AEs excluding mortality and unplanned reoperation), surgical-site infection, and unplanned reoperation. Univariate analysis was performed between individual AEs and patient characteristics using Fischer's exact test. Associations between individual AEs and continuous variables (duration from admission to operation, work relative value unit, and operation time) were examined using the Student t-test. Patient characteristics and continuous variables associated with any AE by univariate analysis were used to develop category-specific multivariable models through backward stepwise logistic regression. RESULTS The authors analyzed 3383 craniotomy/craniectomy, 242 defect repair, 1811 laminectomy, and 4560 shunt and implant cases and found a composite overall morbidity of 30.2%, 38.8%, 10.2%, and 10.7%, respectively. Unplanned reoperation rates were highest for defect repair (29.8%). The mortality rate ranged from 0.1% to 1.2%. Preoperative ventilator dependence was a significant predictor of any AE for all procedure groups, whereas admission from outside hospital transfer was a significant predictor of any AE for all procedure groups except craniotomy/craniectomy. CONCLUSIONS This analysis of NSQIP-Peds, a large risk-adjusted national data set, confirms low perioperative mortality but high morbidity for pediatric neurosurgical procedures. These data provide a baseline understanding of current expected clinical outcomes for pediatric neurosurgical procedures, identify the need for collecting neurosurgery-specific risk factors and complications, and should support targeted QI programs and clinical management interventions to improve care of children.

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Improvement of Blood Pressure Control by Adherence Check in Patients With Apparent Treatment-Resistant Hypertension: A Case Series

Clinical Medicine Insights Case Reports ◽

10.1177/1179547620904884 ◽

2020 ◽

Vol 13 ◽

pp. 117954762090488

Author(s):

Keiko Hosohata ◽

Ayaka Inada ◽

Saki Oyama ◽

Takashi Doi ◽

Iku Niinomi ◽

...

Keyword(s):

Blood Pressure ◽

Resistant Hypertension ◽

Antihypertensive Drugs ◽

Case Series ◽

Pressure Control ◽

Supporting Evidence ◽

Treatment Resistant ◽

Uncontrolled Blood Pressure ◽

Important Challenge ◽

Prescribed Medicines

Adherence to medications is an important challenge while treating chronic disease such as resistant hypertension, which is defined as uncontrolled blood pressure (BP) despite treatment with more than 3 antihypertensive drugs to achieve targets. It is possible that poor adherence is the most significant contributor to rates of pseudo-resistance among treated hypertensive patients. In this report, we describe 4 patients with apparent treatment-resistant hypertension, who received intervention to promote adherence by pharmacists who set the prescribed medicines in a weekly medication calendar and conducted a weekly pill count. The results showed that the intervention of pharmacists to medication adherence improved systolic BP in patients with apparent treatment-resistant hypertension; however, further controlled trials are required to strengthen supporting evidence.

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Abstract WP186: Pregnancy Associated Hemorrhagic Strokes Differ in Mechanisms and Risk Factors Compared with Hemorrhagic Strokes in Non-pregnant Young Women and Men

Stroke ◽

10.1161/str.48.suppl_1.wp186 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Eliza C Miller ◽

Kathryn M Sundheim ◽

Joshua Z Willey ◽

Amelia K Boehme ◽

Randolph S Marshall

Keyword(s):

Risk Factors ◽

Young Adults ◽

Pregnant Women ◽

Patient Characteristics ◽

Postpartum Women ◽

Stroke Registry ◽

Good Outcome ◽

Cerebral Vasoconstriction ◽

History Of ◽

Stroke Mechanism

Background: Pregnancy-associated hemorrhagic stroke (HS), while rare, is a significant cause of maternal mortality. Prior studies have suggested that the pathophysiology of HS may differ in pregnant/postpartum women when compared with HS in other young adults. Methods: We conducted a single-center retrospective analysis of a prospectively collected stroke registry, for patients aged 18-45, admitted with HS of any type from 01/2008-03/2015. We reviewed charts for study variables, including patient characteristics, risk factors, stroke mechanisms, and outcomes. Good outcome was defined as modified Rankin score of 0-2 at time of discharge. We compared study variables between three groups: pregnant/postpartum women, non-pregnant/postpartum women, and men. Results: Of 219 young adults with HS during the study period, 93 (42%) were men and 126 (58%) were women, of whom 19 (15.1%) were pregnant/postpartum. Among men, 58 (62.4%) had ICH and 41 (33.3%) had SAH, 31 (75.6%) of which were aneurysmal. Among non-pregnant women, 49 (45.8%) had ICH and 61 (57%) had SAH, 53 (87%) of which were aneurysmal. Among pregnant/postpartum women, 10 had ICH (52.6%) and 11 (57.9%) had SAH, 1 of which was aneurysmal. Compared with men and with non-pregnant women, pregnant/postpartum women had fewer vascular risk factors, were more likely to have history of migraine, and were more likely to have the reversible cerebral vasoconstriction syndrome as stroke mechanism (11/19, 57.9% versus 0/93 men and 2/107 non-pregnant women, p=0.0001). While there were no deaths in the pregnant/postpartum group, there were no significant differences between groups in good outcome (Table). Conclusions: In our analysis, pregnancy-associated hemorrhages were uniquely non-aneurysmal and associated with fewer cerebrovascular risk factors than age-matched men and non-pregnant women, suggesting there is a pregnancy-specific pathophysiology for HS that requires special consideration.

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