scholarly journals Anesthetic management of hypertensive patients

2020 ◽  
Vol 63 (9) ◽  
pp. 519-525
Author(s):  
Duk Kyung Kim
Keyword(s):  
Angiotensin Receptor Blockers ◽  
Anesthetic Management ◽  
Target Organ Damage ◽  
Perioperative Period ◽  
Organ Damage ◽  
Target Organ ◽  
Clear Understanding ◽  
Converting Enzyme Inhibitors ◽  
Hypertensive Patients ◽  
Increased Risk

It is important for the clinicians to have a clear understanding of the anesthetic implications and increased risks due to hypertension to ensure safe surgical procedures in hypertensive patients. Preoperative hypertension is associated with greater intraoperative hemodynamic lability and an increased risk of perioperative cardiovascular complications. In addition to the patients’ baseline blood pressure (BP), the presence and severity of target organ damage and cardiovascular comorbidities should be evaluated preoperatively. Delaying surgery in hypertensive patients may be justified if there is an evidence of target organ damage that can be improved by such a delay. Further evaluation of suspected target organ damage before the surgery is also justified. Except withholding angiotensin-converting enzyme inhibitors/angiotensin receptor blockers 10 to 24 hours before the surgery, the continuation of preoperative antihypertensive therapy is generally recommended. Though maintaining perioperative BP within the range of 80%–90% to 110%–120% of the baseline BP (permissible BP decrease/increase ≤10%–20%) is generally recommended, an individualized and pathophysiology-based approach to control BP might be the best option throughout the perioperative period. In other words, BP targets in the perioperative period should be determined based on the type of surgery, patients’ baseline BP, risks of hypotension-related organ ischemia, and hypertension-related bleeding.

scholarly journals Effects of irbesartan on phenotypic alterations in monocytes and the inflammatory status of hypertensive patients with left ventricular hypertrophy

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jingsi Zhang ◽  
Lina Yang ◽  
Yanchun Ding
Keyword(s):  
Ventricular Hypertrophy ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Left Ventricular ◽  
Target Organ ◽  
Dependent Manner ◽  
Concentration Dependent Manner ◽  
Hypertensive Patients ◽  
Inflammatory Status ◽  
Tnf Α

Abstract Background Circulating monocytes and tissue macrophages play complex roles in the pathogenesis of hypertension and the resulting target organ damage. In this study, we observed alterations in the monocyte phenotype and inflammatory state of hypertensive patients with left ventricular hypertrophy (LVH) and studied the effects of irbesartan in these patients. This study might reveal a novel mechanism by which irbesartan alleviates LVH, and it could provide new targets for the prevention and treatment of hypertensive target organ damage. Methods CD163 and CD206 expression on monocytes and IL-10 and TNF-α levels in the serum of hypertensive patients with or without LVH and of healthy volunteers were detected. Furthermore, we treated monocytes from the LVH group with different concentrations of irbesartan, and then, CD163, CD206, IL-10 and TNF-α expression was detected. Results We found, for the first time, that the expression of CD163, CD206 and IL-10 in the LVH group was lower than that in the non-LVH group and healthy control group, but the TNF-α level in the LVH group was significantly higher. Irbesartan upregulated the expression of CD163 and CD206 in hypertensive patients with LVH in a concentration-dependent manner. Irbesartan also increased the expression of IL-10 and inhibited the expression of TNF-α in monocyte culture supernatants in a concentration-dependent manner. Conclusions Our data suggest that inflammation was activated in hypertensive patients with LVH and that the monocyte phenotype was mainly proinflammatory. The expression of proinflammatory factors increased while the expression of anti-inflammatory factors decreased. Irbesartan could alter the monocyte phenotype and inflammatory status in hypertensive patients with LVH. This previously unknown mechanism may explain how irbesartan alleviates LVH. Trail registration The study protocols were approved by the Ethical Committee of the Second Affiliated Hospital of Dalian Medical University. Each patient signed the informed consent form.

scholarly journals Target organ damage in hypertensive patients: correlation between retinal arteriovenular ratio and left ventricular geometric patterns

2013 ◽  
Vol 28 (4) ◽  
pp. 274-278 ◽  
Author(s):  
R Meazza ◽  
C Scardino ◽  
L Grosso Di Palma ◽  
G L Perrucci ◽  
E Gallazzi ◽  
...  
Keyword(s):  
Target Organ Damage ◽  
Organ Damage ◽  
Left Ventricular ◽  
Target Organ ◽  
Hypertensive Patients ◽  
Geometric Patterns

Prevalence of target organ damage in treated hypertensive patients

2000 ◽  
Vol 18 (6) ◽  
pp. 803-809 ◽  
Author(s):  
Cesare Cuspidi ◽  
Laura Lonati ◽  
Lorena Sampieri ◽  
Iassen Michev ◽  
Giuseppe Macca ◽  
...  
Keyword(s):  
Target Organ Damage ◽  
Organ Damage ◽  
Target Organ ◽  
Hypertensive Patients

Abstract P182: Microangiopathic Complications In Malignant Hypertension: An Under-appreciated Form Of Target Organ Damage

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Akhil Jain ◽  
Bhumika Singhal ◽  
Rishabh Jindal ◽  
Chinmay Jani ◽  
Puneet K Gupta
Keyword(s):  
Target Organ Damage ◽  
Organ Damage ◽  
Pooled Analysis ◽  
Target Organ ◽  
Malignant Hypertension ◽  
Forest Plot ◽  
Significant Heterogeneity ◽  
Therapeutic Implications ◽  
Increased Risk ◽  
Hematological Changes

Fig 1: Summary of Malignant Hypertension Studies having Microangiopathic Complications along with Forest Plot Microangiopathic Complications in Malignant Hypertension: An underappreciated form of Target Organ Damage Background: Renal thrombotic microangiopathy is a clinically important complication of malignant hypertension (MHT), but its incidence in MHT has been sparsely studied. Our aim was to study the incidence of microangiopathic changes (MaC) in MHT. Methods: We searched Google Scholar database studies directly reporting MaC (mentioning either microangiopathic hemolytic anemia or thrombotic angiopathy) in presence of MHT. We used OpenMeta[Analyst] for the pooled analysis. Results: From 1967 to 2019, 9 studies were included. Maximum likelihood random-effects method showed pooled proportion estimate of having MaC in MHT to be 0.4 (95 CI: 0.3, 0.5; p<0.1). Significant heterogeneity with I 2 =82.56%, p <0.1 was found. Subgroup analysis showed pooled proportion of MaC in MHT to be 0.5 (95 CI: 0.4,0.7, p<0.1) for studies before 2000; whereas 0.2 (95 CI: 0.2, 0.3, p<0.1) for studies after 2000. Sex-wise distribution was reported in 7 studies, risk ratio of having MaC in MHT in female was found to be 1.24 compared to male. Conclusion: Our analysis suggests decreasing incidence of MaC in MHT over the past couple of decades and increased risk of this complication in females, although significant heterogeneity exists among studies reporting microangiopathic changes in malignant hypertension. More prospective observational studies are needed to better define the epidemiology of the hematological changes that occur in MHT since they have important therapeutic implications.

Essential hypertension: Diagnosis, assessment, and treatment

2020 ◽  
pp. 3753-3778
Author(s):  
Bryan Williams ◽  
John D. Firth
Keyword(s):  
Blood Pressure ◽  
Essential Hypertension ◽  
Severe Hypertension ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Target Organ ◽  
Elevated Blood ◽  
Hypertensive Patients ◽  
Assessment And Treatment ◽  
Hypertension Diagnosis

Essential hypertension is invariably symptomless and usually detected by routine screening or opportunistic measurement of blood pressure. However, once a patient has been labelled as ‘hypertensive’ it is not uncommon for them to associate preceding symptoms to their elevated blood pressure. Some patients will claim that they can recognize when their blood pressure is elevated, usually on the basis of symptoms such as plethoric features, palpitations, dizziness, or a feeling of tension. Screening surveys have demonstrated that these symptoms occur no more commonly in untreated hypertensive patients than they do in the normotensive population. However, there are two important caveats to the symptomless nature of essential hypertension: (1) symptoms may develop as a consequence of target organ damage, (2) headache may be a feature of severe hypertension.

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