scholarly journals Resistant arterial hypertension in patient with pheochromocytoma/paraganglioma

2020 ◽  
Vol 26 (6) ◽  
pp. 77-85
Author(s):  
L. A. Mishchenko ◽  
L. V. Bezrodna ◽  
O. O. Matova ◽  
O. A. Tovkay ◽  
P. O. Lishchynskyi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Adrenal Gland ◽  
Arterial Hypertension ◽  
Blood Plasma ◽  
Clinical Case ◽  
Abdominal Cavity ◽  
The Body ◽  
Resistant Arterial Hypertension ◽  
The Right ◽  
Carotid Paragangliomas

Clinical case of pheochromocytoma accompanied by paraganglioma in patient with resistant arterial hypertension is presented. Pheochromocytoma/paraganglioma is the neoplasm, which produces catecholamines and consists of adrenomedullary chromaffin cells of adrenal glands or sympathic and parasympathic ganglia. Clinical course of disease depends on character and number of catecholamines which are excreted by neoplasm as well as how stable or episodic their release into the blood plasma is. Therefore, there is a persistent increase in blood pressure or hypertension has a paroxysmal (crisis) course. A feature of this clinical case is the absence of some characteristic diagnostic criteria. A targeted search was made for secondary causes of increased blood pressure despite the normal content of catecholamines in daily urine, the absence of adrenal gland changes during ultrasound. The clinical manifestations of pheochromocytoma, in addition to elevated blood pressure, were the presence of headache and palpitations. Significant weight loss by the patient over the past 1.5 years was noted which was caused by increased metabolism against the background of activation of the sympathoadrenal system. When performing duplex scanning of brachiocephalic arteries in the bifurcation region of both common carotid arteries, oval formations with clear even contours were revealed, which gave reason to suspect the atypical location of pheochromocytoma. Multispiral computed tomography with contrasting was performed of: abdominal cavity, adrenal gland, kidneys and renal arteries. In the course of the study, a rounded hypervascular formation with clear even contours was found in the body of the medial leg of the right adrenal gland. To clarify the diagnosis in the patient, the content of adrenaline and norepinephrine in the blood plasma was studied. An increase in norepinephrine by more than 4 times indicated the presence of a catecholamine-producing tumor. Thus, the diagnosis of pheochromocytoma of the right adrenal gland was confirmed and carotid paragangliomas of the neck were identified. The patient underwent laparoscopic adrenalectomy, as well as the removal of carotid paragangliomas of the neck. Doses of antihypertensive drugs were significantly reduced, blood pressure decreased to the level of 130–140/80–90 mm Hg. This clinical case illustrates the need to focus doctors on the possibility of this pathology in the absence of characteristic laboratory and instrumental abnormalities, which requires a persistent search for the causes of hypertension.

scholarly journals Baroreflex activation therapy for resistant hypertension: results from mid-term prospective ambulatory blood pressure registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Sindt ◽  
T Madej ◽  
S Grimm ◽  
M Knaut
Keyword(s):  
Blood Pressure ◽  
Side Effects ◽  
Pressure Drop ◽  
Arterial Hypertension ◽  
Antihypertensive Drugs ◽  
Drug Resistant ◽  
Baroreflex Activation Therapy ◽  
Activation Therapy ◽  
Resistant Arterial Hypertension

Abstract Objectives First generation baroreflex activation therapy (BAT) devices showed clinical efficacy in patients with drug-resistant arterial hypertension (AHT), but the safety profile was insufficient. Data regarding efficacy of second-generation devices were generated mostly from office blood pressure (BP) measurements or short-term 24-hour ambulatory blood pressure measurements (ABPM). We present a mid-term prospective registry to evaluate the efficacy and safety of recent BAT devices. Purpose The purpose of our study was to find a method that helps patients with drug-resistant arterial hypertension to control their blood pressure. Further we sought to reduce the overall amount of antihypertensive drugs to lessen side effects, as well as the effects of polypharmacy. Methods All patients receiving Barostim neo between November 2013 and June 2019 for resistant AHT were prospectively included into this observational study. ABPM was performed at baseline, in 3-month intervals in the first year after BAT implantation and in 6-month intervals afterwards for up to 42 months. Patients were assigned into two groups of responders and non-responders. Non-responders had a mean blood pressure drop (BPD) below 5mmHg. Responders in turn were categorized into 3 sub-groups (low-BPD between 5–9 mmHg, medium-BPD between 10–19 mmHg and high-BPD ≥20 mmHg). The primary efficacy end-points were changes in systolic and diastolic BP and number of antihypertensive medications. The primary safety end point was BAT-related major adverse events (MAE). Results 64 patients (mean age 63 years, 67% males) were included. Only patients who completed a 24-hour ABPM during a follow up were counted in the statistical analysis. We had an overall responder rate of 67.8%. Out of those 15.4% had low-BPD, 38.4% medium-BPD and 46.2% had a high-BPD. Systolic BP decreased over the 3.5-years period from 168±17 mmHg to 149±19 mmHg (n=19, mean change −18.8 mmHg; 95% confidence interval [CI]: −29.32 to −8.36; p<0.0007). Diastolic BP decreased from 97±16 to 85±12 mmHg (n=19, mean change −11.7 mmHg; 95% CI: −19.2 to −4.2; p<0.0021). The mean number of antihypertensive drugs was reduced from 6.9±1.3 to 5.2±1.5 (n=19, mean change −1.7; 95% CI: −0.8 to −0.27; p<0.0009). The time course of primary end-points is shown in Fig.1. Freedom from BAT-related MAE was 93.5%. 4 perioperative complications (1 pocket bleeding, 1 pocket infection, 1 N. hypoglossus palsy, 1 hoarseness) resolved without residual side effects. There were five non BAT related deaths (7,8%) in the follow up period. Conclusion Systolic and diastolic ABP, as well as number and dosage of antihypertensive drugs decreased significantly during 3.5-years follow-up after Barostim neo implantation in 64 consecutive patients (of whom 62 completed at least one follow-up). No MAE associated with BAT were observed after the perioperative period. However, further controlled trials are needed to confirm the long-term efficacy of BAT. Figure 1. Mean blood pressure drop Funding Acknowledgement Type of funding source: None

HYPERTENSION IN EMBRYOMA (WILMS' TUMOR)

PEDIATRICS ◽  
1949 ◽  
Vol 3 (2) ◽  
pp. 201-207
Author(s):  
JAMES G. HUGHES ◽  
HERMAN ROSENBLUM ◽  
LACY G. HORN
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Clinical Features ◽  
Wilms Tumor ◽  
Hypertensive Encephalopathy ◽  
Renal Ischemia ◽  
Cerebral Anoxia ◽  
Cardiac Decompensation ◽  
First Case ◽  
The Right

A case of Wilms' tumor of the right kidney is presented, in which the dominant clinical features were extreme elevation of blood pressure and hypertensive encephalopathy, associated with cardiac decompensation and death. Generalized convulsions and right hemiplegia developed, believed to have been due to cerebral anoxia incident to angiospasm. No metastases were found, and no other cause for arterial hypertension was discovered. This patient is thought to be the first case reported where death from Wilms' tumor was due to the hypertensive factor. The literature with reference to the association of hypertension with Wilms' tumor is reviewed. The mechanisms by which Wilms' tumors may produce unilateral renal ischemia with arterial hypertension are discussed. The presence of clearcut hypertension in a child with a kidney area mass points toward the probability of a Wilms' tumor.

scholarly journals Effects of Renal Denervation on Ambulatory Blood Pressure Measurements in Patients With Resistant Arterial Hypertension

2014 ◽  
Vol 37 (5) ◽  
pp. 307-311 ◽  
Author(s):  
Thomas Lambert ◽  
Hermann Blessberger ◽  
Verena Gammer ◽  
Alexander Nahler ◽  
Michael Grund ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Ambulatory Blood Pressure ◽  
Renal Denervation ◽  
Pressure Measurements ◽  
Resistant Arterial Hypertension ◽  
Ambulatory Blood Pressure Measurements

PHAEOCHROMOCYTOMA OF URINARY BLADDER

1962 ◽  
Vol 39 (1) ◽  
pp. 1-12 ◽  
Author(s):  
R. Mićić ◽  
M. Kičić ◽  
S. Adanja
Keyword(s):  
Blood Pressure ◽  
Urinary Bladder ◽  
Arterial Hypertension ◽  
Bladder Wall ◽  
Short Review ◽  
Uneventful Recovery ◽  
Urinary Bladder Wall ◽  
The Right ◽  
Catecholamines In Urine

ABSTRACT A case of phaeochromocytoma localized in the urinary bladder wall above the right ureter in a 19 years old male is described. The patient had a sustained arterial hypertension between 170/120 and 260/170, without haematuria, with regular headache and palpitations immediately after urination. Catecholamines in urine 409 and 340 micrograms per day. A partial resection of the urinary bladder wall was performed with extirpation of a tumour weighing 40 g. Size of the tumour 80 × 60 × 60 mm. The tumour contained 1.5 mg adrenaline and 0.03 mg noradrenaline per g of tissue. Postoperatively blood pressure 140/90, catecholamines in the urine normal, and the patient made an uneventful recovery. The last follow-up ten months after operation. A short review of previously published cases is given.

scholarly journals INFLUENCE OF NOCTURNAL INCREASE OF BLOOD PRESSURE ON CARDIAC REMODELING IN PATIENTS WITH ARTERIAL HYPERTENSION

2019 ◽  
Vol 19 (1-2) ◽  
pp. 65-69
Author(s):  
A. I Miroshnichenko ◽  
K. M Ivanov
Keyword(s):  
Blood Pressure ◽  
Left Ventricle ◽  
Right Ventricle ◽  
Arterial Hypertension ◽  
Antihypertensive Therapy ◽  
Cardiac Remodeling ◽  
Interventricular Septum ◽  
Posterior Wall ◽  
The Right ◽  
Group 1

Actuality. Arterial hypertension (AH) is the main risk factor for the development of cardiovascular diseases, disability and cardiovascular mortality. Episodes of blood pressure (BP) increase during the day in patients receiving antihypertensive therapy are an unfavourable factor contributing to the development and progression of cardiac remodeling. Aim. The purpose of the research is to study the features of changes in the structural and functional state of the heart under the influence of high blood pressure at night in patients with arterial hypertension with the dynamic three-year observation. Material and methods. 47 patients with the diagnosis of AH were examined. Patients were divided into two groups, randomized by age, duration and severity of AH. Group 1 included 24 patients who as a result of ambulatory blood pressure monitoring (ABPM) on the background of combined antihypertensive therapy suffered from constantly increased BP at night. The second group combined 23 patients without the increase in BP during the night according to the ABPM with antihypertensive therapy. The examination included measurement of the office BP, ABPM, two-fold echocardiography with a three-year interval. Results. When assessing the indices of office BP in the groups, there were no significant differences, all patients achieved the target values of BP. In patients in Group 1, higher values of BP were observed during the day, according to ABPM. Echocardiography over a three year period of observation revealed a more pronounced increase in diastolic interventricular septum thickness, the thickness of the left ventricle posterior wall during diastole, sizes of left atrium in the patients of the first group, patients of the second group had a more pronounced thickness of the left ventricle posterior wall during systole. The increase in the size of the right ventricle was revealed in both groups. Conclusions. 1) In patients with the increase in blood pressure at night, the values of BP variability were higher during the day. 2) Three-year dynamic observation revealed that the increase in BP at night in patients with hypertension facilitated acceleration of cardiac remodelling and was associated with an increase in the left ventricular posterior wall, interventricular septum thickness, the size of the left atrium, and the size of the right ventricle.

scholarly journals The Effects of Moderate and High-Intensity Interval Training in Cardiac Rehabilitation of Bodybuilders with Arterial Hypertension: a Randomized Controlled Trial

2020 ◽  
Vol 100 (6) ◽  
pp. 108-113
Author(s):  
A.B. Miroshnikov ◽  
A.D. Formenov ◽  
A.B. Smolensky
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
High Intensity ◽  
Controlled Trial ◽  
Sport Activity ◽  
Interval Training ◽  
Training Group ◽  
The Body ◽  
Control Group ◽  
High Intensity Interval

Athletes of power sports, often appear to us as a model of a beautiful and healthy body, but the health of the cardiovascular system ofthese athletes has long falls under the gaze of cardiologists and sport physicians. Purpose of the study. A comparative analysis of the influence of a uniform and high-intensity aerobic exercise on blood pressure lowering power sports athletes with hypertension. Research Methods. The study involved 83 representatives of power sports (bodybuilding) with arterial hypertension. The average age of male athletes was 31.2 ± 4.5 years, and the body mass index was 32.4 ± 2.8 kg/m 2. To achieve this goal, the following methods were used: examination, interrogation, triple measurement of blood pressure, ergospirometry and methods of mathematical statistics. Athletes were randomized into three groups: interval training group (n = 33), uniform training (n = 30) and control group (n = 20). For 120 days (3 times a week), the athletes of the main groups performed various aerobic work programs, and the control group athletes trained according to their traditional strength protocol. Results. After 120 days of physical rehabilitation, a similar, significant decrease in systolic and diastolic blood pressure occurred in themain intervention groups. A decrease in blood pressure in the control group was not statistically significant. Conclusions. Despite the similar benefits in cardio-rehabilitation interval work required 38% less time, which can significantly affect adherence to a non-specific for this sport activity and screening of participant’s lengthy rehabilitation.

scholarly journals OPERATION STRESS AND ITS INFLUENCE ON THE SYSTEM CHANGES IN CASE OF ABDOMINAL COMBINED TRAUMA (EXPERIMENTAL RESEARCH)

2018 ◽  
Vol 17 (2) ◽  
pp. 31-36
Author(s):  
V. O. Krylyuk ◽  
V. K. Hrodetsʹkyy ◽  
S. O. Sokolʹnyk ◽  
O. V. Fedosyeyeva ◽  
H. Yu. Tsymbalyuk
Keyword(s):  
Superoxide Dismutase ◽  
Abdominal Cavity ◽  
The Body ◽  
Control Group ◽  
Systemic Response ◽  
Antioxidant Protection ◽  
Operational Stress ◽  
Experimental Animals ◽  
Ischemic Reperfusion ◽  
The Right

The aim of the study was to study the possibility of using a hemostatic biological haemostatic to stop bleeding from the parenchymal organs of the abdominal cavity using the surgical method of Damage control. The experiment was performed on laboratory rats that were divided into three groups: a control group, a group where, after injury, the liver wound was sutured with standard sutures and a group where the wound was plastered with a biological hemostatic agent. In order to determine the operational stress, we studied the enzymatic link of antioxidant protection - the level of catalase and superoxide dismutase. To study the indices in all experimental animals, the following tissues were taken: the lower lobe of the right lung, the proportion of the liver where the wounds were applied, the gastrocnemius muscle below the harness and the right kidney. The control points of the study were 1, 3 and 7 days after injury. During working with experimental animals, they adhered to all ethical norms established by international rules. The effect of operational stress on the enzymatic component of antioxidant protection in the tissues of the kidneys, liver, lungs and muscles was studied in the study of the combined trauma of the abdominal cavity complicated by massive bleeding and ischemic-reperfusion syndrome of the extremity. The changes in the indices of superoxide dismutase and catalase were studied. The following result was obtained: tamponing the liver wound with chitosan was a quick and effective means of temporary bleeding stop. At the same time, the duration of the operation was reduced from 19.8 to 12.5 minutes (by 36.8%) (p <0.05). Also, the level of catalase and superoxide dismutase was significantly lower in the group where the chitosan of the liver injury was used in comparison with the study group where standard stitches were applied. The deviations, which are determined in lung, liver, kidney and muscle tissues in RG-1 are evidence of the depth of their lesion and dysfunction, is a favorable factor for the further development of the triggering mechanisms of the systemic response of the body to inflammation and multiple organ failure. In contrast to the RG-2 rapid development of the systemic response was avoided. We can assume that ischemic-reperfusion syndrome is a stimulating factor in the development of systemic changes, although this statement requires further proof. It is also important to further prospective study of this topic in terms of the following questions: what effect has chitosan on liver tissue with prolonged exposure (more than 2 days) and what effect does additional injection of infusion solutions have as an agent for the treatment of hypovolemic shock.

scholarly journals The clinical case of successful combined treatment of refractory arterial hypertension. Case report

2021 ◽  
Vol 93 (9) ◽  
pp. 1086-1090
Author(s):  
Tatiana D. Solntseva ◽  
Anastasiia R. Denisova ◽  
Olga A. Sivakova ◽  
Nikolai M. Danilov ◽  
Dmitrii V. Pevzner ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Case Report ◽  
Arterial Hypertension ◽  
Antihypertensive Therapy ◽  
Renal Denervation ◽  
Clinical Case ◽  
Combined Treatment ◽  
Cardiovascular Complications ◽  
Refractory Hypertension ◽  
Clinical Variant

In recent years, there has been an increase of patients with arterial hypertension, one of the variants of which is refractory arterial hypertension. This unfavorable clinical variant of the course of hypertension worries clinicians, due to the higher risk of developing cardiovascular complications, realizing the need for a better control of blood pressure. The presented clinical case demonstrates the successful combined treatment of refractory hypertension using antihypertensive therapy and renal denervation.

scholarly journals HYPERTENSIVE ANGIORETINOPATHY IN A CHILD WITH PHEOCHROMOCYTOMA. CLINICAL CASE

2018 ◽  
Vol 13 (4) ◽  
pp. 189-192
Author(s):  
E. V Denisova ◽  
N. A Osipova ◽  
L. A Katargina
Keyword(s):  
Arterial Hypertension ◽  
Treatment Strategy ◽  
Clinical Case ◽  
Interdisciplinary Cooperation ◽  
Pathological Process ◽  
Hypertensive Retinopathy ◽  
Somatic Condition ◽  
Comprehensive Examination ◽  
The Right ◽  
Hypertension In Children

Purpose: to present a clinical case of a child with hypertensive retinopathy developed against the background of undiagnosed pheochromacytoma and primarily regarded as neuroretinitis. The description of the case shows that a comprehensive examination of the child together with a pediatrician and endocrinologist allowed to identify the etiology of the pathological process and choose the right treatment strategy. Discussion. It is important to note that the alertness of the pediatric ophthalmologist in terms of the development of hypertensive retinal angiopathy is reduced. Arterial hypertension in children is much less common than in adults, and cases of hypertensive retinal lesions in children are rare. This can lead to a number of errors in the diagnosis and treatment of eye pathology, as well as underestimation of the severity of the General somatic condition of the child, in this connection it is important to emphasize the importance of close interdisciplinary cooperation in the examination and treatment of children of ophthalmic profile.

scholarly journals Magnetic resonance imaging of the aortic wall as a risk index for acute ischemic stroke in patients with resistant arterial hypertension

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
N Ryumshina ◽  
A E Sukhareva ◽  
O V Mochula ◽  
T A Shelkovnikova ◽  
A S Maksimova ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Arterial Hypertension ◽  
Acute Ischemic Stroke ◽  
Contrast Enhancement ◽  
Renal Denervation ◽  
Aortic Wall ◽  
Control Group ◽  
Contrast Enhanced ◽  
Resistant Arterial Hypertension

Abstract Aim To value the possible relationship between the intensity of neoangiogenesis in the aortic wall in patients with resistant arterial hypertension and the subsequent development of ischemic cerebral disorders in them over a three-year follow-up. Materials and methods This study comprised 36 patients with resistant hypertension, in whom the renal denervation was carried out. MRI of the brain and also with contrast enhancement of the aorta and kidneys were examined. MRI studies included T2 and T1 spin-echo MRI, and also coronal slices, with suppression of the signal from adipose tissue (TR=150 ms, TE = 4 ms), before and in 12–15 minutes after contrast-enhanced. The diameter and thickness of the wall of the descending aorta were measured. Index of the enhancement of the aortic wall was calculated as the ratio of intensities of the wall after, and before contrast-enhanced. 9 according to MRI data - developed an acute ischemic stroke during this period, and 27 had no cerebral circulation disorders. The control group consisted of individuals without hypertension (n=12). Results After renal denervation, the systolic blood pressure significantly decreased in all patients for more than 15 mm Hg. In groups of patients with ischemic stroke, and without it, the diameter of the aortic lumen at the level above the renal arteries was 22,1±2,4 mm and 22,8±2,7 mm, respectively; the aortic wall thickness was 3,9±0,7 mm and 3,7±0,8 mm. In control subjects without hypertension, the wall thickness was less than 2,7 mm (on average 2,2±0,4 mm), with an aortic diameter of 21,3±0,9. As to the index of enhancement (as a marker of neoangiogenesis intensity) in the control group, in everybody, the IE was &lt;1,12. In patients with stroke within 3 years after renal denervation, IE = 2,12±0,31, and in patients without stroke IE = 1,66±0,19. The value of IE = 1,82 was the best for separating groups with and without stroke in the three years endpoint, as from the ROC analysis. Conclusion Contrast enhancement of the aortic wall in MRI is associated with the risk of brain ischemic stroke in patients with resistant arterial hypertension, even when blood pressure control is achieved by renal denervation. This makes it possible to predict the risk of stroke in these patients more reliably and encourages the inclusion of agents that reduce the activity of inflammation and pathological neoangiogenesis in the aortic wall, to the spectrum of antihypertensive therapy. FUNDunding Acknowledgement Type of funding sources: None. Brain MRI T2WI MRI of the kidneys and aorta, T1WI

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