scholarly journals Primary hyperaldosteronism as a possible cause of resistant arterial hypertension

2021 ◽  
Vol 17 (4) ◽  
pp. 20-23
Author(s):  
Novella M. Chikhladze
Keyword(s):  
High Risk ◽  
Arterial Hypertension ◽  
Resistant Hypertension ◽  
Heterogeneous Group ◽  
Primary Hyperaldosteronism ◽  
Diagnostic Screening ◽  
Resistant Arterial Hypertension ◽  
Possible Cause

The review examines the prevalence of resistant arterial hypertension in low-renin forms of hyperaldosteronism. Possible reasons for existing differences in data on the prevalence of a heterogeneous group of primary hyperaldosteronism in the resistant course of hypertension are analyzed. Categories of patients at high risk of primary hyperaldosteronism depending on the severity of hypertension are considered. Based on the results of research, including our own data, it is shown that in most cases, tumor and hyperplastic forms of primary hyperaldosteronism are associated with severe and resistant hypertension, and the importance of diagnostic screening in this category of patients is justified.

scholarly journals Rational combination therapy in resistant arterial hypertension

2011 ◽  
Vol 17 (4) ◽  
pp. 384-390
Author(s):  
I. V. Emelianov ◽  
A. O. Konradi
Keyword(s):  
Combination Therapy ◽  
Arterial Hypertension ◽  
Resistant Hypertension ◽  
Drug Resistant ◽  
Therapeutic Approaches ◽  
Rational Combination ◽  
Resistant Arterial Hypertension

The article reviews therapy in drug-resistant hypertension. Current therapeutic approaches to treatment and rational combination therapy are discussed.

scholarly journals Symptomatic arterial hypertension associated with primary hyperaldosteronism

2017 ◽  
Vol 23 (3) ◽  
pp. 224-230 ◽  
Author(s):  
A. N. Kalyagin ◽  
V. A. Beloborodov ◽  
T. M. Maksikova
Keyword(s):  
Surgical Treatment ◽  
Lactate Dehydrogenase ◽  
Arterial Hypertension ◽  
Resistant Hypertension ◽  
Creatine Phosphokinase ◽  
Primary Hyperaldosteronism ◽  
Adrenal Tumors ◽  
Therapeutic Practice ◽  
Conn’S Syndrome ◽  
Rare Phenomenon

Objective.Primary hyperaldosteronism (PGA) (Conn’s syndrome) is a relatively rare phenomenon in therapeutic practice, occurring in 4,7–9%. In resistant hypertension (HTN) the rate of PGA achieves 10–20%. Often it results from the aldosterone-producing adrenal tumors and manifests by symptomatic HTN, neuromuscular, and renal symptoms. We present the cases of successful verification and surgical treatment of PGA. HTN patients and patients with rhabdomyolysis symptoms (increased creatine phosphokinase or lactate dehydrogenase) require further examination to exclude PGA. 

scholarly journals Russian Medical Society for Arterial Hypertension expert consensus. Resistant hypertension: detection and management

2021 ◽  
Vol 93 (9) ◽  
pp. 1018-1029
Author(s):  
Anna V. Aksenova ◽  
Olga A. Sivakova ◽  
Nataliia V. Blinova ◽  
Nikolai M. Danilov ◽  
Evgeniia M. Elfimova ◽  
...  
Keyword(s):  
Arterial Hypertension ◽  
Resistant Hypertension ◽  
Lifestyle Changes ◽  
Diagnostic Methods ◽  
Medical Society ◽  
Hypertension Detection ◽  
Improve Blood Pressure Control ◽  
Obstructive Sleep ◽  
Radiofrequency Denervation ◽  
Resistant Arterial Hypertension

The diagnosis of resistant arterial hypertension allows us to single out a separate group of patients in whom it is necessary to use special diagnostic methods and approaches to treatment. Elimination of reversible factors leading to the development of resistant arterial hypertension, such as non-adherence to therapy, inappropriate therapy, secondary forms of arterial hypertension, leads to an improvement in the patient's prognosis. Most patients with resistant hypertension should be evaluated to rule out primary aldosteronism, renal artery stenosis, chronic kidney disease, and obstructive sleep apnea. The algorithm for examining patients, recommendations for lifestyle changes and a step-by-step therapy plan can improve blood pressure control. It is optative to use the most simplified treatment regimen and long-acting combined drugs. For a separate category of patients, it is advisable to perform radiofrequency denervation of the renal arteries.

scholarly journals MRI of the arterial wall in resistant hypertension associated with type 2 diabetes mellitus

2020 ◽  
Vol 23 (1) ◽  
pp. 29-36
Author(s):  
Nadezhda I. Ryumshina ◽  
Alla Y. Falkovskaya ◽  
Anna M. Gusakova ◽  
Victor F. Mordovin ◽  
Vladimir Y. Usov
Keyword(s):  
Diabetes Mellitus ◽  
Arterial Hypertension ◽  
Contrast Enhancement ◽  
Resistant Hypertension ◽  
Arterial Wall ◽  
Renal Arteries ◽  
Metabolic Markers ◽  
Arterial Walls ◽  
Reactive Protein ◽  
Resistant Arterial Hypertension

BACKGROUND: Damage of arterial walls in diabetes mellitus associated with arterial hypertension is major factor delivering lesion of target organs. Currently, enough data is not available about imaging and quantitative evaluations of arterial wall. There is no enough data available about the relations between MRI and inflammatory and metabolic markers in patients with resistant arterial hypertension concomitant with diabetes mellitus. AIMS: Quantitative assessment of the intensity of paramagnetic contrast enhancement of the arterial wall, in particular renal arteries walls, in relation with inflammatory and metabolic markers in patients with resistant arterial hypertension concomitant with diabetes mellitus. MATERIALS AND METHODS: The study groups were comprised of 28 patients (ageing 60,76,5 years) with resistant hypertension accompanied with diabetes mellitus and 17 patients (aging 57,75,0 years) with resistant hypertension without diabetes mellitus. The average systolic/diastolic pressure obtained from a 24-h monitor study was as high as 156,816,9/81,9,013,5 mm Hg in the group with diabetes and 154,811,9/88,510,4 mm Hg in the group without diabetes. The values of glycaemia, the level of glycated haemoglobin, and C-reactive protein were determined. The MRI studies were carried out using 1,5 Т MRI Toshiba Vantage Titan scanner. After that, the intravenous contrast enhancement has been carried out (with 0,5 М paramagnetic, as 0,2 ml/Kg). The index of enhancement (IE) was then calculated from these data, as a ratio of intensities of contrast-enhanced image to the initial nonenhanced MRI scan. RESULTS: The correlation was obtained for IE of arterial wall and data of blood pressure. Increased IE was correlated with ageing and hemodynamic factors. Also the correlation was observed for IE proximal, medium and distal parts of renal arteries and values of glycaemia and NOMA-index were obtained. Negatively correlated values for IE and adiponectin in the group with diabetes mellitus were obtained. The association between IE and C-reactive protein remained significant in the group without diabetes mellitus. CONCLUSIONS: MRI with contrast enhancement of arterial walls allows evaluating the anatomy of renal arteries and allows quantifying the pathophysiologic factors of their walls in patients with resistant hypertension accompanied with diabetes mellitus. MRI characteristics of the arterial wall were associated not only with hemodynamic and metabolic data, but also with markers of inflammation.

Role of genetic factors in the development of hypertension in young patients with metabolic syndrome

2020 ◽  
pp. 23-32
Author(s):  
Elena Korneeva ◽  
Mikhail Voevoda ◽  
Sergey Semaev ◽  
Vladimir Maksimov
Keyword(s):  
Metabolic Syndrome ◽  
High Risk ◽  
Arterial Hypertension ◽  
Genetic Factors ◽  
Young Patients ◽  
Integrin Αiibβ3 ◽  
Ace Gene ◽  
The Metabolic Syndrome

Results of the study related to polymorphism of ACE gene (rs1799752)‎, integrin αIIbβ3, and CSK gene (rs1378942) influencing development of arterial hypertension in young patients with metabolic syndrome are presented. Hypertension as a component of the metabolic syndrome was detected in 15.0% of young patients. Prevalence of mutant alleles of the studied genes among the examined patients was quite high, so homozygous DD genotype was found in 21.6%, and mutant D allele of the ACE gene in 47.4%. A high risk of hypertension in patients with MS was detected in carriers of the T allele of the CSK (rs1378942) gene – 54.8%, which was most often observed in a combination of polymorphic ACE and CSK gene loci (p = 0.0053).

A QUESTIONNAIRE-BASED, MULTICENTER REGISTRY OF RESISTANT AND PSEUDO-RESISTANT ARTERIAL HYPERTENSION IN POLAND – A PILOT STUDY

2019 ◽  
Vol 72 (10) ◽  
Author(s):  
Andrzej Kulach ◽  
Paweł Stachowiak ◽  
Marek Prasal ◽  
Katarzyna Sawicka ◽  
Wojciech Kosmala ◽  
...  
Keyword(s):  
Pilot Study ◽  
Arterial Hypertension ◽  
Resistant Arterial Hypertension ◽  
Multicenter Registry

scholarly journals Insights on safety and efficacy of renal artery denervation for uncontrolled-resistant hypertension in a high risk population with chronic kidney disease: first Italian real-world experience

2021 ◽  
Author(s):  
Federico Marin ◽  
Simone Fezzi ◽  
Alessia Gambaro ◽  
Francesco Ederle ◽  
Gianluca Castaldi ◽  
...  
Keyword(s):  
High Risk ◽  
Medical Therapy ◽  
Resistant Hypertension ◽  
Univariate Analysis ◽  
Daily Practice ◽  
Renal Sympathetic Denervation ◽  
High Risk Population ◽  
Safety And Efficacy ◽  
Renal Artery Denervation

Abstract Aims To evaluate the safety and efficacy of catheter-based radiofrequency renal sympathetic denervation (RSD) in a daily practice population of patients with uncontrolled resistant hypertension, on top of medical therapy. Methods Consecutive unselected patients with uncontrolled resistant hypertension undergoing RSD were enrolled. Office and ambulatory blood pressure (BP) measurements were collected at baseline and 3, 6 and 12 months after RSD. Efficacy was assessed even in patients with an estimated glomerular filtration rate (eGFR) below 45 mL/min/1.73 m2. Patients were defined as responders if systolic BP decreased by at least 5 mmHg at ambulatory BP or by 10 mmHg at office BP at their last follow-up visit. Results Forty patients with multiple comorbidities underwent RSD from 2012 to 2019. Baseline office and ambulatory BP was 159.0/84.9 ± 26.2/14.9 mmHg and 155.2/86.5 ± 20.9/14.0 mmHg, respectively. At 12-month follow up a significant reduction in office and ambulatory systolic BP, respectively by − 19.7 ± 27.1 mmHg and by − 13.9 ± 23.6 mmHg, was observed. BP reduction at 12-month follow-up among patients with eGFR < 45 mL/min was similar to that obtained in patients with higher eGFR. Twenty-nine patients (74.4%) were responders. Combined hypertension, higher ambulatory systolic BP and lower E/E’ at baseline emerged as predictors of successful RSD at univariate analysis. No major complications were observed and renal function (was stable up to 12 months), even in patients with the lowest eGFR values at baseline. Conclusion RSD is safe and feasible in patients with uncontrolled resistant hypertension on top of medical therapy, even in a high-risk CKD population with multiple comorbidities, with a significant reduction in systolic BP and a trend towards a reduction in diastolic BP lasting up to 12 months. Graphic abstract

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