Incidence of Hypertension in Patients Undergoing Surgery at Dhulikhel Hospital - Kathmandu University Hospital.

Background Hypertension is an important public health challenge worldwide and is most important modifiable risk factor for cardiovascular, cerebrovascular and renal disease. Blood pressure determination forms an integral part of anaesthesiologist’s evaluation of hispatient’s condition prior to and during surgery. Data are not available which indicate changes in blood pressure occurring preanaesthetically in hospitalized patients. There are several risks from untreated preoperative hypertension in perioperative and postoperative phase. Objective To know the incidence of hypertension in preoperative patients undergoing major surgery Methods This retrospective observational study was based on the data collected from preanaesthetic checkup record book from January 2010 to December 2010. Results A total of 955 patients were studied and analyzed in terms of hypertension and demographic characteristics. The total incidence of hypertension in preoperative phase was 10.16%. Among them 64.9% being male and 35.1% female. Maximum incidence was found in age group 50-59 years i.e. 26.6%. Among the case detected maximum patients i.e. 52% were patients with newly diagnosed hypertension and among those under medications 61.1% were using calcium channel blockers. ConclusionKnowing the incidence will help in proper preoperative optimization of the hypertensive patients and also help in decreasing the incidence of postoperative complications.DOI: http://dx.doi.org/10.3126/kumj.v9i2.6286 Kathmandu Univ Med J 2011;9(2):40-43

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Cardiac Function and Structure in Longitudinal Analysis of Echocardiography in Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.3747/pdi.2009.00007 ◽

2010 ◽

Vol 30 (3) ◽

pp. 353-361 ◽

Cited By ~ 6

Author(s):

Hiroaki Io ◽

Yuuki Ro ◽

Yoshimi Sekiguchi ◽

Tetsutaro Shimaoka ◽

Jiro Inuma ◽

...

Keyword(s):

Blood Pressure ◽

Peritoneal Dialysis ◽

Cardiac Function ◽

Antihypertensive Drugs ◽

Vena Cava ◽

Left Ventricular ◽

University Hospital ◽

Wave Flow ◽

Channel Blockers ◽

Aggressive Treatment

♦ BackgroundEchocardiography is widely used for the evaluation of cardiac structures and function. The prognostic value of assessment of left cardiac atrium (LA) size in peritoneal dialysis (PD) patients is still unclear. The objective of the present study is to investigate prospectively a longitudinal monitoring of echocardiography parameters after start of PD. We also investigated a correlation study among plasma atrial natriuretic peptide (ANP) level, LA size, and cardiac function undergoing aggressive treatment.♦ MethodsCorrelation among plasma ANP, LA size, and cardiac function was prospectively analyzed by Doppler echocardiography in 32 PD patients in Juntendo University Hospital, Tokyo. Measurement of these parameters was performed at 0, 6, 12, 18, and 24 months after start of PD. All patients were treated with an angiotensin type 1 receptor blocker to control blood pressure to less than 140/90 mmHg. Other antihypertensive drugs such as diuretics and/or calcium channel blockers were added if blood pressure rose to over 140/90 mmHg. Hemoglobin and hematocrit levels were targeted at 10.0 g/dL and 30.0% respectively with recombinant human erythropoietin treatment. A diuretic was added or patients decreased their water intake if ANP was more than 43.0 pg/mL or LA diameter (LAD) more than 39 mm, and for other basic markers of volume status. Cardiac function was measured before and after drainage of PD fluid to evaluate the influence of cardiac function.♦ ResultsLAD at start of dialysis (36 ± 4.6 mm) decreased significantly to 33 ± 3.3 mm ( p < 0.05), 33 ± 3.2 mm ( p < 0.05), and 33 ± 3.6 mm ( p < 0.05) after 6, 12, and 24 months, respectively. Ejection fraction after 6 months was significantly increased compared with that at start of dialysis ( p < 0.05). Left ventricular mass index (LVMI) after 6, 12, and 24 months was significantly decreased compared with that at start of dialysis ( p < 0.05). ANP was 56 ± 39 pg/mL at start of dialysis and decreased significantly to 33 ± 19 pg/mL after 24 months ( p < 0.05). ANP was significantly correlated with LAD ( r = 0.412, p < 0.01), transmitral A wave flow velocity ( r = 0.429, p < 0.01), and LVMI ( r = 0.426, p < 0.01). Instillation of the dialysis fluid did not affect any parameters except inferior vena cava dimension.♦ ConclusionsThis study demonstrates a reduction in LA size and LVMI in PD patients followed over 24 months. Left ventricular structure, contraction, and compliance were well preserved in PD patients undergoing aggressive treatment based on measurements of plasma ANP and LAD.

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A Comparative study to assess the effectiveness and safety of cilnidipine versus amlodipine in patients with newly diagnosed essential hypertension: insights from a single centre prospective observational study

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20170830 ◽

2017 ◽

Vol 6 (3) ◽

pp. 648

Author(s):

Ramya Y. S. ◽

Jayanthi C. R. ◽

Raveendra K. R. ◽

Pradeep Kumar B. T.

Keyword(s):

Blood Pressure ◽

Essential Hypertension ◽

Side Effects ◽

Calcium Channel ◽

Calcium Channel Blockers ◽

Channel Blockers ◽

Newly Diagnosed ◽

Open Label ◽

Amlodipine Group ◽

Pedal Edema

Background: Calcium channel blockers (CCBs) are proposed to play a pivotal role for the management and control of hypertension. Dihydropyridine-type calcium channel blockers (CCBs) like Amlodipine are frequently used because for their strong antihypertensive and minimal adverse side effects. However, it is commonly associated with the causation of pedal edema among the patients. Cilnidipine, which is a novel new generation calcium channel blocker, is presumed to cause lesser pedal edema with a satisfactory clinical control of hypertension along with negligible side effects. This study was carried out to compare clinical effectiveness and safety profile between Amlodipine and Cilnidipine.Methods: A prospective, randomized, open label study of 12 weeks’ duration was conducted amongst 60 patients with newly diagnosed essential hypertension. 30 patients of one group received Tab. Amlodipine 5 mg and 30 patients of same age groups received Tab. Cilnidipine 10mg.Results: There was a highly statistically significant decrease in the level of blood pressure in the Cilnidipine group compared to the Amlodipine group mainly at day 90 (P<0.001). Cilnidipine treated group had a fall in blood pressure of 23 ± 8 mmHg and the Amlodipine group had a decrease in the blood pressure of 12±7mmHg. Additionally, there was also significant reduction in pulse rate in the cilnidipine group. Only 4 patients in the Cilnidipine group developed ankle edema which completely disappeared at the end of 12 weeks of therapy compared to 9 patients in the Amlodipine group which persistently worsened at the completion of the study.Conclusions: Our study concluded that cilnidipine was a well-tolerated anti-hypertensive drug amongst patients with newly diagnosed essential hypertension and associated with minor adverse effects.

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Frequency of metabolic syndrome in patients with newly diagnosed Type II Diabetes at DOW University Hospital, Karachi-Pakistan.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.11.4654 ◽

2021 ◽

Vol 28 (11) ◽

pp. 1546-1551

Author(s):

Muhammad Umar Khan ◽

Akhtar Ali Baloch ◽

Muhammad Arsalan ◽

Syed Muhammad Adnan

Keyword(s):

Blood Pressure ◽

Metabolic Syndrome ◽

Waist Circumference ◽

Type Ii Diabetes ◽

University Hospital ◽

Diabetic Patients ◽

Type Ii ◽

Newly Diagnosed ◽

Cross Sectional ◽

The Mean

Objectives: To determine the prevalence of metabolic syndrome in patients with newly diagnosed type 2. Study Design: Descriptive Cross Sectional study. Setting: Dow University Hospital. Period: October 2018 to January 2019. Material & Methods: A total 342 patients prevalence of metabolic syndrome in patients with newly diagnosed type II diabetes at Dow University Hospital, Karachi, Pakistan. Data was collected through a questionnaire which is designed to record the age, gender, BMI, FBS, Waist circumference, blood pressure, HDL and triglyceride level of newly diagnosed of diabetic patients. Frequency and percentages were calculated for these variables. SPSS version 21 was used to analyze the overall results. Results: A total of 342 new diagnosed diabetic were included in this study. 189 (55.26%) were males and 153 (44.74%) were females. The mean + SD of age was 48.21±9.28 years. The mean + SD of FBS was about 192±43 mg/dl with ranges from 98 to 482 mg/dl. The mean + SD of Serum TG was about 243±152 mg/dl with ranges from 189 to 325 mg/dl. The mean + SD HDL was about 38.9±9.23 mg/dl with ranges from 12 to 102 mg/dl. The mean + SD of waist circumference was about 110.5±11.90 cm. The mean + SD systolic & diastolic blood pressure was about 150 + 8.23 & 98 + 11.28 respectively. The mean + SD of BMI was 29.23+ 11.23. Metabolic syndrome was diagnosed in 252 (73.68%) in newly diabetic patients. Conclusion: Metabolic syndromes were highly associated with newly diagnosed type II diabetes patients.

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THE USE OF MEDICINES IN TREATING HYPERTENSION IN HUE UNIVERSITY HOSPITAL

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2016.2.11 ◽

2016 ◽

pp. 76-84

Author(s):

Khoa Bao Chau Thai ◽

Thi Hong Phuong Vo

Keyword(s):

Blood Pressure ◽

Channel Blocker ◽

Enzyme Inhibitor ◽

Antihypertensive Drugs ◽

Good Prognosis ◽

Target Blood Pressure ◽

University Hospital ◽

Key Words Hypertension ◽

Cross Sectional ◽

Positive Effects

Background: Hypertension is a common condition in the world as well as in Viet Nam. If hypertension isn’t treated well, it can cause many serious complications. Controlling target blood pressure will bring positive effects on reducing mortality rate and also disabilities caused by diseases related to hypertension. Objectives: (1) Analyzing the use of medicines in treating hypertension. (2) Evaluating the effects of medicine usage in treating hypertension at the hospital of Hue University of Medicine and Pharmacy. Materials and methods: 388 patients were diagnosed as having hypertension with inpatient care at the Cardiovascular Department of Hue University of Medicine and Pharmacy’s hospital, using cross-sectional descriptive study methods. Results: All antihypertensive drugs in the research were contained in the antihypertensive list recommended by Vietnamese Society of Cardiology. Angiotensin converting enzyme inhibitor and calcium channel blocker were the two most popular drug groups (96.6% and 71.4%, respectively). The rate of using multi-therapy regimens was higher than the rate of using uni-therapy regimens in both initial therapies (64.7%>35.3%) and final therapies (61.9%>38.1%). The rate of patients having interactions between antihypertensive drugs and the other kinds of drugs was 7.5%. The rate of patients having reasonable prescriptions was 84.3%. Evaluating the effects of medicine usage in treatments showed that the rate of patients reaching target blood pressure before leaving the hospital was 67.3%. Most patients were evaluated as having good prognosis after treatment, up to 81.7%. Conclusions: All antihypertensive drugs in the research were contained in the antihypertensive list recommended by Vietnamese Society of Cardiology. The rate of using multi-therapy regimens was higher than the rate of using uni-therapy regimens. The rate of drug interactions was quite low; most patients were evaluated as having good prognosis after treatment. Key words: hypertension, antihypertensive drugs.

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The Capabilities of Amlodipine/Lisinopril Single-Pill Combination in the Treatment of Newly Diagnosed Arterial Hypertension in a Middle-Aged Patient (Case Report)

Rational Pharmacotherapy in Cardiology ◽

10.20996/1819-6446-2020-03-03 ◽

2020 ◽

Vol 16 (2) ◽

pp. 221-230

Author(s):

A. I. Kochetkov ◽

M. V. Lopukhina ◽

E. A. Kotaeva ◽

A. A. Kirichenko ◽

O. D. Ostroumova

Keyword(s):

Blood Pressure ◽

Arterial Hypertension ◽

Left Ventricular ◽

Favorable Effect ◽

Newly Diagnosed ◽

Functional Changes ◽

Collagen Formation ◽

Cardiovascular Morbidity And Mortality ◽

Single Pill ◽

Left Atrial Stiffness

Arterial hypertension (AH) is one of the most significant modifiable risk factors that increase cardiovascular morbidity and mortality worldwide, including Russia. The complex of structural and functional changes in the heart that occurs during AH consists not only in the formation of left ventricular (LV) myocardial hypertrophy, but also in the myocardial stiffness increasing due to collagen formation and cardiomyocytes apoptosis. These abnormalities are substrate for diastolic function disturbances, electrical myocardial instability and ischemia. The article provides a clinical case of amlodipine/lisinopril single-pill combination (A/L SPC) use in real clinical practice in a patient with stage II grade 2 newly diagnosed AH and its effect on blood pressure and echocardiographic myocardial fibrosis markers, including speckle tracking parameters The high antihypertensive efficacy of A/L SPC, a favorable effect on blood pressure circadian rhythm, as well as pronounced target-organ protective properties, in particular the ability to reduce LV and left atrial stiffness, were demonstrated. So, we conclude that A/L SPC improve the elastic properties of the left heart.

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Recommendation and Acceptance of Counselling for Familial Cancer Risk in Newly Diagnosed Breast Cancer Cases

Breast Care ◽

10.1159/000517021 ◽

2021 ◽

pp. 1-6

Author(s):

Karin Kast ◽

Julia Häfner ◽

Evelin Schröck ◽

Arne Jahn ◽

Carmen Werner ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Risk ◽

Genetic Counselling ◽

Primary Breast Cancer ◽

Ductal Carcinoma ◽

Familial Cancer ◽

University Hospital ◽

Tumor Board ◽

Newly Diagnosed ◽

Familial Cancer Risk

Background: In clinical routine, not every patient who is offered genetic counselling and diagnostics in order to investigate a familial cancer risk predisposition opts for it. Little is known about acceptance of counselling and testing in newly diagnosed breast cancer cases in Germany. Methods: All primary breast cancer cases and patients with DCIS (ductal carcinoma in situ) treated at the University Hospital of Dresden between 2016 and 2019 were included. The number of tumor board recommendations for genetic counselling on the basis of the GC-HBOC risk criteria was recorded. Acceptance was analyzed by number of cases with counselling in the GC-HBOC-Center Dresden. Results: Of 996 primary breast cancer and DCIS cases, 262 (26.3%) were eligible for genetic counselling. Recommendation for genetic counselling was accepted by 64.1% (168/262). Of these 90.5% (152/168) opted for molecular genetic analysis. The acceptance rate for counselling increased between 2016 and 2019 from 58.3 to 72.6%. Altogether, 20.4% (31/152) patients were found to carry a pathogenic variant in the breast cancer genes BRCA1 or BRCA2. Conclusion: Acceptance of recommendation is increasing as clinical consequences augment. Optimization in providing information about hereditary cancer risk and in accessibility of counselling and testing is required to further improve acceptance of recommendation.

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Screening for atrial fibrillation during automated blood pressure measurement among patients admitted to internal medicine ward

Internal and Emergency Medicine ◽

10.1007/s11739-021-02691-2 ◽

2021 ◽

Author(s):

Giacomo Pucci ◽

Edoardo Santoni ◽

Valeria Bisogni ◽

Camilla Calandri ◽

Alberto Cerasari ◽

...

Keyword(s):

Internal Medicine ◽

Atrial Fibrillation ◽

Blood Pressure ◽

Adult Population ◽

Blood Pressure Measurement ◽

University Hospital ◽

Daily Routine ◽

Internal Medicine Ward ◽

Clinical Conditions ◽

Electrocardiogram Ecg

AbstractAtrial fibrillation (AF), the commonest sustained cardiac arrhythmia affecting the adult population, is often casually discovered among hospitalized people. AF onset is indeed triggered by several clinical conditions such as acute inflammatory states, infections, and electrolyte disturbance, frequently occurring during the hospitalization. We aimed to evaluate whether systematic AF screening, performed through an automated oscillometric blood pressure (BP) device (Microlife WatchBP Office AFIB, Microlife AG, Switzerland), is effective for detecting AF episodes in subjects admitted to an Internal Medicine ward. 163 patients consecutively hospitalized at the Unit of Internal Medicine of the “Santa Maria” Terni University Hospital between November 2019 and January 2020 (mean age ± standard deviation: 77 ± 14 years, men proportion: 40%) were examined. Simultaneously with BP measurement and AF screening, a standard 12-lead electrocardiogram (ECG) was performed in all subjects. AF was diagnosed by ECG in 29 patients (18%). AF screening showed overall 86% sensitivity and 96% specificity. False negatives (n = 4) had RR-interval coefficient of variation lower than true positives (n = 25, p < 0.01), suggesting a regular ventricular rhythm during AF. The repeated evaluation substantially confirmed the same level of agreement. AF screening was positive in all patients with new-onset AF (n = 6, 100%). Systematic AF screening in patients admitted to Internal Medicine wards, performed using the Microlife WatchBP Office AFIB, is feasible and effective. The opportunity to implement such technology in daily routine clinical practice to prevent undiagnosed AF episodes in hospitalized patients should be the subject of further research.

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Low profile REBOA device for increasing systolic blood pressure in hemodynamic instability: single-center 4-year experience of use of ER-REBOA

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-020-01586-9 ◽

2021 ◽

Author(s):

David T. McGreevy ◽

Mitra Sadeghi ◽

Kristofer F. Nilsson ◽

Tal M. Hörer

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Hemodynamic Instability ◽

Balloon Occlusion ◽

University Hospital ◽

Trauma Patients ◽

Single Center ◽

Hemorrhage Control ◽

Single Center Experience ◽

Low Profile

Abstract Background Hemodynamic instability due to torso hemorrhage can be managed with the assistance of resuscitative endovascular balloon occlusion of the aorta (REBOA). This is a report of a single-center experience using the ER-REBOA™ catheter for traumatic and non-traumatic cases as an adjunct to hemorrhage control and as part of the EndoVascular resuscitation and Trauma Management (EVTM) concept. The objective of this report is to describe the clinical usage, technical success, results, complications and outcomes of the ER-REBOA™ catheter at Örebro University hospital, a middle-sized university hospital in Europe. Methods Data concerning patients receiving the ER-REBOA™ catheter for any type of hemorrhagic shock and hemodynamic instability at Örebro University hospital in Sweden were collected prospectively from October 2015 to May 2020. Results A total of 24 patients received the ER-REBOA™ catheter (with the intention to use) for traumatic and non-traumatic hemodynamic control; it was used in 22 patients. REBOA was performed or supervised by vascular surgeons using 7–8 Fr sheaths with an anatomic landmark or ultrasound guidance. Systolic blood pressure (SBP) increased significantly from 50 mmHg (0–63) to 95 mmHg (70–121) post REBOA. In this cohort, distal embolization and balloon rupture due to atherosclerosis were reported in one patient and two patients developed renal failure. There were no cases of balloon migration. Overall 30-day survival was 59%, with 45% for trauma patients and 73% for non-traumatic patients. Responders to REBOA had a significantly lower rate of mortality at both 24 h and 30 days. Conclusions Our clinical data and experience show that the ER-REBOA™ catheter can be used for control of hemodynamic instability and to significantly increase SBP in both traumatic and non-traumatic cases, with relatively few complications. Responders to REBOA have a significantly lower rate of mortality.

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