scholarly journals Clinical Practice Patterns of Hypertensive Disease in Pregnancy among Korean Obstetricians

2021 ◽  
Vol 25 (3) ◽  
pp. 221-229
Author(s):  
Tae Gyu Ahn ◽  
Yeon Hee Kim ◽  
Yun Sook Kim ◽  
Jae Eun Shin ◽  
Young-Lim Oh ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Clinical Practice ◽  
Practice Patterns ◽  
Antihypertensive Drugs ◽  
Antihypertensive Agents ◽  
Delivery Method ◽  
Hypertensive Disease ◽  
Clinical Practice Patterns ◽  
Elevated Liver Enzymes ◽  
Prophylactic Aspirin

Purpose: The purpose of this study was to investigate the clinical practice patterns of Korean obstetricians and gynecologists the diagnosis and management of hypertensive disease in pregnant women. Methods: From April 2015 to October 2015, questionnaire was distributed via email to obstetricians who were members of the Society for Maternal and Fetal Medicine. The survey consisted of 37 questions in 6 categories. Responses to the questions on the management of hypertensive disorders of pregnancy, from diagnosis to treatment, were evaluated. Results: A total of 93 obstetricians and gynecologists responded to the survey. High blood pressure was allocated the highest priority as an index mainly used when deciding to hospitalize patients with hypertensive disease during pregnancy, followed by pregnancy symptoms, proteinuria, and blood test results. Calcium channel blocker (CCB) for oral administration and hydralazine for injection were preferred as antihypertensive drugs mainly used to control severe hypertension. Regarding the delivery method for hypertensive disease during pregnancy, in cases of preeclampsia, 63% of the respondents chose the delivery method according to the cervical status, and in cases of hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome and eclampsia, which increased in severity, 52% and 31% responded that the delivery method was determined according to the cervical status, respectively. In cases of mild preeclampsia, the 70% of respondents preferred 37–38 weeks of gestation for the delivery time. Regarding the use of aspirin in patient with hypertension during pregnancy, 52% of the respondents occasionally administered aspirin, and in patients with a history of hypertensive disease during pregnancy, only 43% were administered prophylactic aspirin. Conclusion: Domestic obstetricians regarded blood pressure as the most meaningful factor when treating women with hypertension during pregnancy and considered blood pressure control as important. The preferred antihypertensive agents were oral CCB and hydralazine injections, and the choice of delivery method was determined according to the condition of the cervix and severity of the disease. Even in women with high risk factors for preeclampsia, prophylactic aspirin was administered in as low as 50%, of patients, possibly may due to the absence of domestic guidelines for aspirin use during pregnancy. Korean guidelines for prophylactic aspirin administration during pregnancy is needed based on additional research on the efficacy of aspirin for domestic women in the future.

Clinical Practice Patterns Suggest Female Patients Prefer Female Endoscopists

2015 ◽  
Vol 60 (10) ◽  
pp. 3149-3150 ◽  
Author(s):  
Jessica Davis ◽  
Brandon Rieders ◽  
Marie L. Borum
Keyword(s):  
Clinical Practice ◽  
Practice Patterns ◽  
Clinical Practice Patterns ◽  
Female Patients

scholarly journals Blood Pressure Control: Stroke and Stroke Prevention

2005 ◽  
Vol 6 (1_suppl) ◽  
pp. S8-S11
Author(s):  
Hans-Christoph Diener
Keyword(s):  
Blood Pressure ◽  
Stroke Prevention ◽  
Antihypertensive Drugs ◽  
Angiotensin Receptor Blockers ◽  
Antihypertensive Agents ◽  
Pressure Control ◽  
Angiotensin Receptor ◽  
Risk Of Death ◽  
Pressure Lowering ◽  
Receptor Blockers

Hypertension is the most important modifiable risk factor for primary and secondary stroke prevention. All antihypertensive drugs are effective in primary prevention: the risk reduction for stroke is 30—42%. However, not all classes of drugs have the same effects: there is some indication that angiotensin receptor blockers may be superior to other classes of antihypertensive drugs in stroke prevention. Seventy-five percent of patients who present to hospital with acute stroke have elevated blood pressure within the first 24—48 hours. Extremes of systolic blood pressure (SBP) increase the risk of death or dependency. The aim of treatment should be to achieve and maintain the SBP in the range 140—160 mmHg. However, fast and drastic blood pressure lowering can have adverse consequences. The PROGRESS trial of secondary prevention with perindopril + indapamide versus placebo + placebo showed a decrease in numbers of stroke recurrences in patients given both active antihypertensive agents, more impressive for cerebral haemorrhage.There were also indications that active treatment might decrease the development of post-stroke dementia.

A 2017 SURVEY OF THE CLINICAL PRACTICE PATTERNS IN THE MANAGEMENT OF RELAPSING GRAVES DISEASE

2019 ◽  
Vol 25 (1) ◽  
pp. 55-61 ◽  
Author(s):  
Shlomit Koren ◽  
Miriam Shteinshnaider ◽  
Karen Or ◽  
Dror Cantrell ◽  
Carlos A. Benbassat ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Practice Patterns ◽  
Graves Disease ◽  
Clinical Practice Patterns

scholarly journals Clinical practice patterns in indirect peroral cholangiopancreatoscopy: outcome of a European survey

2021 ◽  
Vol 09 (11) ◽  
pp. E1704-E1711
Author(s):  
Pauline M.C. Stassen ◽  
Pieter Jan F. de Jonge ◽  
George J.M. Webster ◽  
Mark Ellrichmann ◽  
Arno J. Dormann ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Bile Duct ◽  
Online Survey ◽  
Practice Patterns ◽  
International Consensus ◽  
Clinical Practice Patterns ◽  
European Survey ◽  
Standardized Protocol ◽  
Pancreatic Duct Stones

Abstract Background and aims Indirect peroral cholangiopancreatoscopy (IPOC) is a relatively new diagnostic and therapeutic tool for biliopancreatic diseases. This international survey aimed to evaluate clinical practice patterns in IPOC among endoscopists in Europe. Methods An online survey was developed comprising 66 questions on the use of IPOC. Questions were grouped into four domains. The survey was sent to 369 endoscopists who perform IPOC. Results 86 respondents (23.3 %) from 21 different countries across Europe completed the survey. The main indications for cholangioscopy were determination of biliary strictures (85 [98.8 %]) and removal of common bile duct or intrahepatic duct stones (79 [91.9 %]), accounting for an estimated use of 40 % (interquartile range [IQR] 25–50) and 40 % (IQR 30–60), respectively, of all cases undergoing cholangioscopy. Pancreatoscopy was mainly used for removal of pancreatic duct stones (68/76 [89.5 %]), accounting for an estimated use of 76.5 % (IQR 50–95) of all cases undergoing pancreatoscopy. Only 13/85 respondents (15.3 %) had an institutional standardized protocol for targeted cholangioscopy-guided biopsy sampling. IPOC with lithotripsy was used as first-line treatment in selected patients with bile duct stones or pancreatic stones by 24/79 (30.4 %) and 53/68 (77.9 %) respondents, respectively. Conclusions This first European survey on the clinical practice of IPOC demonstrated wide variation in experience, indications, and techniques. These results emphasize the need for prospective studies and development of an international consensus guideline to standardize the practice and quality of IPOC.

scholarly journals The first Russian national multicenter study - ROBLS (Russian Optimal Blood pressure Lowering Study)

2003 ◽  
Vol 9 (5) ◽  
pp. 151-154
Author(s):  
Yu. N. Belenkov ◽  
I. Ye. Chazova
Keyword(s):  
Blood Pressure ◽  
Intensive Care ◽  
Treatment Group ◽  
Multicenter Study ◽  
Antihypertensive Drugs ◽  
Antihypertensive Agents ◽  
Fixed Dose ◽  
Care Group ◽  
Routine Treatment ◽  
Optimal Blood Pressure

ROBIS is the first large multicenter study performed in Russia. The Objective of the study was to compare the efficiency, safely, and impact of two treatment policies (the application of an algorithm to the stepwise use of 4 classes of antihypertensive agents in an intensive care group and random antihypertensive therapy in a routine treatment group) on the incidence of cardiovascular events in patients with arterial hypertension. Design: This is a national multicenter open consecutive prospective study. The patients meeting the criteria of inclusion were randomly divided into two equal groups, one of them (an intensive care group) received therapy with a nifedipine retard in Fixed dose for 4 weeks. In patients who failed to achieve the target level of blood pressure (BP), the therapy was supplemented by enalapril, 20 mg, hydrochlorothiazide, 25 mg, and metoprolol, 50 mg, at a 4-week interval. After achieving the target BP level, the patients continued the treatment with which the level had been attained. If the antihypertensive effect of therapy was found to disappear, the above drugs were successively supplemented. The other group (a routine treatment group) continued to be treated with the antihypertensive drugs prescribed in the polyclinic (Fig. 1). BP and heart rate were monitored and the patients' complaints and adverse reactions were recorded on repeated visits 4, 8, 12, 16, 24, 52, 64, 70, 88, and 104 weeks after the initiation of therapy. Control blood and urine analyses and ECG studies were made 12, 16, 52, and 104 weeks after therapy.

scholarly journals Therapieresistente und ‑refraktäre Hypertonie

2020 ◽  
Vol 145 (02) ◽  
pp. 87-91
Author(s):  
Rainer Düsing
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Drugs ◽  
Antihypertensive Agents ◽  
Treatment Resistance ◽  
Secondary Hypertension ◽  
White Coat Hypertension ◽  
Diagnostic Challenge ◽  
Refractory Hypertension ◽  
Mineralocorticoid Receptor Antagonist ◽  
Apparent Resistance

AbstractHypertension is defined as resistant to treatment when treatment fails to lower office systolic and diastolic blood pressure values to < 140/90 mmHg. The treatment strategy should include lifestyle measures and appropriate doses of three or more drugs acting by different mechanisms including a diuretic. An updated definition of treatment resistance includes all patients with ≥ 4 antihypertensive agents of different classes irrespective of their on-treatment blood pressure. The term “refractory” hypertension has been suggested for patients with uncontrolled blood pressure on ≥ 5 antihypertensive drugs including the thiazide-like diuretic chlorthalidone and the mineralocorticoid receptor antagonist spironolactone. “Pseudo resistance” especially due to white coat hypertension and non-adherence with the prescribed medication has to be ruled out to be able to identify patients with “true” treatment resistance. Therefore, before distinguishing true from pseudo resistance, the term “apparent” resistance should be used. While the prevalence of apparent resistance may be in the range of 10–15 % of treated patients, the exact prevalence of true resistance remains unknown due to the lack of appropriate studies but is likely to be rather small including a high proportion of patients with secondary forms of hypertension. Once identified most patients with true treatment resistance should receive intensified drug treatment primarily by expanded diuretic usage. Thus, resistant hypertension is primarily a diagnostic challenge: identifying patients with true resistance and those with secondary hypertension.

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