Preeclampsia without hypertension occurring at 17 weeks of amenorrhea; a case report and review of literature

In general, the term "preeclampsia" refers to the presence of hypertension associated with proteinuria occurring after 20 weeks of gestation in a previously non-proteinuric and normotensive woman. A 24-year-old woman, known to be non-hypertensive, carried two pregnancies and lost two babies. In 2011, as she was carrying the third (twin) pregnancy at 17 weeks of amenorrhea, she was admitted to the hospital for an 8-kilogram excess weight gain between two antenatal visits spaced 4 weeks apart. The clinical examination revealed 140 mmHg systolic blood pressure and 80 mm Hg diastolic blood pressure. The following days, the systolic blood pressure ranged between 110 and 120 mm Hg. Furthermore, the presence of bilateral and symmetrical pitting edema of the lower limbs was reported. The laboratory assessment upon admission showed the following results, proteinuria; 3.3 g/24 h, total albumin; 1.7 g/dL, total protein; 5.4 g/dL and total calcium was 75 g/L. The test results for HIV serology, HBs antigen and HCV antibodies as well as antinuclear and native anti-DNA antibodies were negative. The treatment consisted of iron, folic acid and calcium supplementation. Cesarean section was scheduled for the 38th week. The immediate aftermath was simple. Formula feeding was recommended for the newborns and ramipril 1.25 mg was initiated in the mother once daily. The evolution was marked by a progressive reduction in proteinuria around 500 mg/24 h six months after delivery, and below 200 mg/24 h one year later. Pre-eclampsia before 20 weeks of gestation is rare. Hypertension, which is its main clinical sign, may be exceptionally absent at this stage.

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Predictors of one-year outcomes in chronic heart failure: the portrait of a middle income country

BMC Cardiovascular Disorders ◽

10.1186/s12872-019-1226-9 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Luciana Gioli-Pereira ◽

Fabiana G. Marcondes-Braga ◽

Sabrina Bernardez-Pereira ◽

Fernando Bacal ◽

Fábio Fernandes ◽

...

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Systolic Blood Pressure ◽

Systolic Heart Failure ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Major Public Health Problem ◽

Ventricular Ejection Fraction ◽

One Year ◽

Overall Mortality

Abstract Background Heart failure (HF) is a major public health problem with increasing prevalence worldwide. It is associated with high mortality and poor quality of life due to recurrent and costly hospital admissions. Several studies have been conducted to describe HF risk predictors in different races, countries and health systems. Nonetheless, understanding population-specific determinants of HF outcomes remains a great challenge. We aim to evaluate predictors of 1-year survival of individuals with systolic heart failure from the GENIUS-HF cohort. Methods We enrolled 700 consecutive patients with systolic heart failure from the SPA outpatient clinic of the Heart Institute, a tertiary health-center in Sao Paulo, Brazil. Inclusion criteria were age between 18 and 80 years old with heart failure diagnosis of different etiologies and left ventricular ejection fraction ≤50% in the previous 2 years of enrollment on the cohort. We recorded baseline demographic and clinical characteristics and followed-up patients at 6 months intervals by telephone interview. Study data were collected and data quality assurance by the Research Electronic Data Capture tools. Time to death was studied using Cox proportional hazards models adjusted for demographic, clinical and socioeconomic variables and medication use. Results We screened 2314 consecutive patients for eligibility and enrolled 700 participants. The overall mortality was 6.8% (47 patients); the composite outcome of death and hospitalization was 17.7% (123 patients) and 1% (7 patients) have been submitted to heart transplantation after one year of enrollment. After multivariate adjustment, baseline values of blood urea nitrogen (HR 1.017; CI 95% 1.008–1.027; p < 0.001), brain natriuretic peptide (HR 1.695; CI 95% 1.347–2.134; p < 0.001) and systolic blood pressure (HR 0.982;CI 95% 0.969–0.995; p = 0.008) were independently associated with death within 1 year. Kaplan Meier curves showed that ischemic patients have worse survival free of death and hospitalization compared to other etiologies. Conclusions High levels of BUN and BNP and low systolic blood pressure were independent predictors of one-year overall mortality in our sample. Trial registration Current Controlled Trials NTC02043431, retrospectively registered at in January 23, 2014.

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First 48 hours systolic blood pressure measurement at the acute phase of acute myocardial infarction is associated with one-year cardiovascular mortality among elderly patients

Archives of Cardiovascular Diseases Supplements ◽

10.1016/j.acvdsp.2018.10.035 ◽

2019 ◽

Vol 11 (1) ◽

pp. 19

Author(s):

B. Mouhat ◽

A. Putot ◽

J.C. Eicher ◽

F. Chagué ◽

J.C. Beer ◽

...

Keyword(s):

Myocardial Infarction ◽

Blood Pressure ◽

Acute Myocardial Infarction ◽

Elderly Patients ◽

Systolic Blood Pressure ◽

Acute Phase ◽

Cardiovascular Mortality ◽

Pressure Measurement ◽

Blood Pressure Measurement ◽

One Year

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Blood flow restriction in the upper and lower limbs is predicted by limb circumference and systolic blood pressure

European Journal of Applied Physiology ◽

10.1007/s00421-014-3030-7 ◽

2014 ◽

Vol 115 (2) ◽

pp. 397-405 ◽

Cited By ~ 52

Author(s):

Jeremy P. Loenneke ◽

Kirsten M. Allen ◽

J. Grant Mouser ◽

Robert S. Thiebaud ◽

Daeyeol Kim ◽

...

Keyword(s):

Blood Pressure ◽

Blood Flow ◽

Systolic Blood Pressure ◽

Blood Flow Restriction ◽

Lower Limbs ◽

Flow Restriction

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A difference in systolic blood pressure between arms and between lower limbs is a novel risk marker for diabetic nephropathy in patients with Type 2 diabetes

Hypertension Research ◽

10.1038/hr.2012.207 ◽

2013 ◽

Vol 36 (5) ◽

pp. 403-407 ◽

Cited By ~ 18

Author(s):

Hiroshi Okada ◽

Michiaki Fukui ◽

Muhei Tanaka ◽

Shinobu Matsumoto ◽

Yusuke Mineoka ◽

...

Keyword(s):

Blood Pressure ◽

Type 2 Diabetes ◽

Diabetic Nephropathy ◽

Systolic Blood Pressure ◽

Lower Limbs ◽

Risk Marker

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The Relationship between Ambulatory Blood Pressure and Echocardiographically Assessed Left Ventricular Hypertrophy

Clinical Science ◽

10.1042/cs061101s ◽

1981 ◽

Vol 61 (s7) ◽

pp. 101s-103s ◽

Cited By ~ 76

Author(s):

D. B. Rowlands ◽

M. A. Ireland ◽

D. R. Glover ◽

R. A. B. McLeay ◽

T. J. Stallard ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Left Ventricular Mass ◽

Left Ventricular Mass Index ◽

Ambulatory Monitoring ◽

Left Ventricular ◽

Once Daily ◽

Ventricular Mass Index ◽

Ventricular Mass

1. Continuous intra-arterial ambulatory monitoring of blood pressure was recorded in 46 patients with mild to moderate hypertension under standardized conditions. M-mode echocardiography was performed after recording and left ventricular mass index calculated by standard formulae. 2. Systolic blood pressure from continuous recording was significantly correlated with left ventricular mass index (mean 24 h: r = 0.543, n = 45, P < 0.001). Diastolic blood pressure exhibited a weaker but still significant correlation with left ventricular mass index (mean 24 h: r = 0.318, n = 45, P < 0.05). Casual systolic blood pressure was significantly correlated with left ventricular mass index (r = 0.476, n = 46, P < 0.001) but casual diastolic blood pressure did not correlate with left ventricular mass index (r = 0.245, n = 46). Awake blood pressure variability, age, resting plasma renin activity and resting plasma noradranaline levels did not have a significant correlation with left ventricular mass index. 3. Nine patients were treated for 16 weeks with once-daily timolol and repeat ambulatory monitoring and M-mode echocardiography was performed with the same protocol. 4. Once-daily timolol provided good 24 h control of blood pressure and repeat echocardiography showed a reduction in left ventricular mass index in that group of patients (t = 2.59, P < 0.05).

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One-Year Rates and Determinants of Poststroke Systolic Blood Pressure Control among Ghanaians

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2016.08.033 ◽

2017 ◽

Vol 26 (1) ◽

pp. 78-86 ◽

Cited By ~ 11

Author(s):

Fred Stephen Sarfo ◽

Gloria Kyem ◽

Bruce Ovbiagele ◽

John Akassi ◽

Osei Sarfo-Kantanka ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Blood Pressure Control ◽

Pressure Control ◽

One Year

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One-Year Systolic Blood Pressure Trajectory After Acute Ischemic Stroke

10.21203/rs.3.rs-536654/v1 ◽

2021 ◽

Author(s):

Keon-Joo Lee ◽

Beom Joon Kim ◽

Moon-Ku Han ◽

Joon-Tae Kim ◽

Kang Ho Choi ◽

...

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Systolic Blood Pressure ◽

Acute Ischemic Stroke ◽

Adverse Outcomes ◽

Stroke Onset ◽

Stroke Recurrence ◽

Stroke Patients ◽

One Year

Abstract Although the effect of blood pressure on post-stroke outcome is well-recognized, the long-term trajectory of blood pressure after acute ischemic stroke and its influence on outcomes have not yet been fully elucidated. From a multicenter prospective registry of acute ischemic stroke patients, 5,514 patients with measurements of systolic blood pressure (SBP) at more than 2 of 7 prespecified time-points, up to 1-year after stroke onset, were analyzed. Outcome measures, a composite of stroke recurrence, myocardial infarction and mortality, and each stroke recurrence and mortality, were prospectively collected up to 1-year after stroke onset. The study subjects were categorized into 4 groups according to their SBP trajectories: Low (27.0%), Moderate (59.5%), Persistently high (1.2%), and Slowly dropping (12.4%). After adjustments for pre-determined covariates, the Slowly dropping SBP Group was at higher risk of the composite outcome (hazard ratio, 1.32; 95% confidence interval, 1.05‒1.65), and mortality (1.35; 1.03‒1.78) compared to the Moderate SBP Group. Four main 1-year longitudinal SBP trajectories were identified after acute ischemic stroke. One trajectory, slowly dropping SBP, was particularly prone to adverse outcomes after stroke. These findings provide possible leads for future investigations of SBP control targets after stroke.

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Abstract 18574: Empagliflozin Reduces Systolic Blood Pressure in Dipper and Non-Dipper Patients with Type 2 Diabetes and Hypertension

Circulation ◽

10.1161/circ.130.suppl_2.18574 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Robert Chilton ◽

Ilkka Tikkanen ◽

Susanne Crowe ◽

Odd Erik Johansen ◽

Uli C Broedl ◽

...

Keyword(s):

Blood Pressure ◽

Type 2 Diabetes ◽

Heart Rate ◽

Systolic Blood Pressure ◽

Randomized Trial ◽

Sleep Time ◽

Phase Iii ◽

Once Daily ◽

Ambulatory Bp Monitoring

In a Phase III randomized trial (EMPA-REG BP™), patients with type 2 diabetes (T2DM) and hypertension (defined as mean seated office systolic blood pressure [SBP] 130-159 mmHg and diastolic BP [DBP] 80-99 mmHg at screening) received empagliflozin (EMPA) 10 mg (n=276), EMPA 25 mg (n=276) or placebo (PBO; n=271) once daily in the morning for 12 weeks (mean [SD] age 60.2 [9.0] yrs, HbA1c 7.90 [0.74] %, 24-h SBP 131.4 [12.3] mmHg, 24-h DBP 75.0 [7.8] mmHg). We assessed changes from baseline in SBP (mean 24-h, awake-time, sleep-time) via ambulatory BP monitoring at week 12 in patients categorized as dippers (sleep-time mean SBP ≤90% of awake-time mean; n=417) or non-dippers (sleep-time mean SBP >90% of awake-time mean; n=350). Baseline mean (SD) 24-h SBP (mmHg) was 129.9 (11.6) in dippers and 133.1 (12.4) in non-dippers. Adjusted mean (SE) changes from baseline in mean 24-h SBP (mmHg) in dippers were -0.2 (0.7) with PBO vs -3.8 (0.6) and -3.9 (0.7) with EMPA 10 and 25 mg, respectively (both p<0.001), and in non dippers were 1.0 (0.7) with PBO vs -1.6 (0.7) with EMPA 10 mg (p=0.013) and -3.8 (0.7) with EMPA 25 mg (p<0.001). Hourly mean SBP patterns over 24 h for dippers and non-dippers were maintained with EMPA 25 mg (Figure) and 10 mg. Adjusted mean (SE) changes from baseline in awake-time SBP (mmHg) in dippers were -0.5 (0.7) with PBO vs -4.6 (0.7) with EMPA 10 and 25 mg (both p<0.001), and in non dippers were 1.3 (0.8) with PBO vs -2.2 (0.8) with EMPA 10 mg (p=0.002) and -4.2 (0.7) with EMPA 25 mg (p<0.001). Adjusted mean (SE) changes from baseline in sleep-time SBP (mmHg) in dippers were 0.4 (0.8) with PBO vs -2.6 (0.8) with EMPA 10 mg (p=0.007) and -2.2 (0.8) with EMPA 25 mg (p=0.022), and in non-dippers were 0.1 (0.9) with PBO vs -0.5 (0.9) with EMPA 10 mg (p=0.603) and -3.2 (0.8) with EMPA 25 mg (p=0.006). There were no apparent differences in heart rate with EMPA vs PBO in dippers or non-dippers. In patients with T2DM and hypertension, EMPA 10 mg and 25 mg significantly reduced SBP vs PBO in dippers and non-dippers.

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