scholarly journals Generalized Seizure in Severe Hypertension

2021 ◽  
Vol 2 (5) ◽  
Author(s):  
Mercy Ekeoma Azubuko-Udah ◽  
Mary Oluwaseun Olowere ◽  
Gabriel Alugba ◽  
Elohor Sandra Otite ◽  
Arthur Dilibe ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Blood Pressure ◽  
Renal Insufficiency ◽  
Severe Hypertension ◽  
Premature Mortality ◽  
Clonic Seizure ◽  
Wave Activity ◽  
Peripheral Vascular ◽  
Generalized Seizures

Hypertension can be defined as systolic blood pressure (BP) ≥130 and diastolic blood pressure ≥80, usually associated with multiple adverse clinical outcomes, including stroke, heart failure, myocardial infarction, renal insufficiency/failure, peripheral vascular disease, retinopathy, dementia, and premature mortality. Our patient was a middle-aged man who had an episode of clonic seizure in the background of severe hypertension. EEG revealed bilateral sharp wave activity in the central, parietal, and temporal regions, indicating generalized seizures. There was remission of his seizure after controlling his blood pressure.

scholarly journals Heart Failure Predictors in a Group of Patients with Myocardial Infarction

2016 ◽  
Vol 4 (3) ◽  
pp. 435-438 ◽  
Author(s):  
Sokol Myftiu ◽  
Petrit Bara ◽  
Ilir Sharka ◽  
Artan Shkoza ◽  
Xhina Belshi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Chronic Renal Disease ◽  
University Hospital ◽  
Peripheral Vascular ◽  
Coronary Syndrome

AIM: The present study considers of the prevalence of heart failure (HF) in patients suffering from acute myocardial infarction (AMI) in the University Hospital Centre of Tirana (UHCT) “Mother Theresa”; the demographic and clinical characteristics of the sample during hospitalization; and the main predictors of heart failure occurrence inside the group of patients suffering an AMI.MATERIAL AND METHODS: During a period of study from 2013-2015 we studied demographic and clinical data from 587 consecutive patients presenting with AMI; Framingham criteria were adopted for classifying patients with HF upon admission.RESULTS: A Killip class ≥ 2 was the main diagnostic criterion of HF during hospitalisation. HF was identified in 156 patients (26.6%). The subgroup with HF had significant differences when compared with the other patients with regard to age, sex (male), heart rate upon admission, systolic blood pressure on admission, previous episodes of AMI, glycemia on admission, previous antihypertensive treatment, previous revascularization procedures, peripheral vascular disease, chronic renal disease, ejection fraction (EF), anemia, and atrial fibrillation presence. Independent predictors for HF occurrence in the logistic regression model were EF, previous revascularization, peripheral vascular disease, age, sex, previous AMI, systolic blood pressure upon admission, and anaemia.CONCLUSION: As a conclusion, HF seems to be a common occurrence after AMI, in spite of changes in the epidemiological profile of the acute coronary syndrome. An increase in the incidence is registered as well, parallel to a decrease in the mortality following AMI. Attention must be shown for highly risked subpopulations, aged persons, patients with the previous coronary disease, and concomitant conditions.

Abstract 17638: Systemic Cardiovascular Effects of Intravenous Urocortin 2 and Urocortin 3 in Patients with Heart Failure and Healthy Volunteers

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Colin G Stirrat ◽  
Sowmya Venkatasubramanian ◽  
Tania Pawade ◽  
Andrew Mitchell ◽  
Anoop Shah ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Cardiac Index ◽  
Healthy Volunteers ◽  
Diastolic Blood Pressure ◽  
Cardiovascular Effects ◽  
Peripheral Vascular ◽  
Patients With Heart Failure ◽  
Group A ◽  
Urocortin 3

Introduction: Urocortin 2 (UCN 2) and urocortin 3 (UCN 3) are endogenous peptide hormones with an emerging role in the pathophysiology and treatment of heart failure. For the first time, we examined the systemic cardiovascular effects of both UCN 2 and UCN 3 in healthy volunteers and patients with heart failure. Methods: Seven healthy volunteers (Group A) and nine patients with stable chronic heart failure (Group B, New York Heart Association class II and III, left ventricular ejection fraction <35%) on optimal medical therapy underwent non-invasive oscillometric sphygmomanometry and impedance cardiography during incremental intravenous infusions of sodium nitroprusside (0.15/0.5/1.5 μg/kg/min), UCN 2 (0.16/0.48/1.6 μg/min), UCN 3 (5/15/50 μg/min) and saline placebo in a randomised double blind two-way cross over study. Results: Other than diastolic blood pressure (78 vs 72 mmHg for Group A and B respectively, p<0.05), haemodynamic variables were similar at baseline of each infusion and were unchanged by saline placebo infusion (p>0.05 for all). SNP, UCN2 and UCN 3 infusions increased heart rate and cardiac index, and reduced systolic and diastolic blood pressure and peripheral vascular resistance index (PVRI) in both healthy volunteers and patients with heart failure (p<0.05 for all; see Figure 1). There were no significant differences in the changes in cardiac index or PVRI between healthy volunteers and patients with heart failure during either UCN 2 or UCN 3 infusions (p>0.05). Conclusion: Intravenous UCN 2 and especially UCN 3 increase cardiac output and reduce peripheral vascular resistance. This favourable haemodynamic profile suggests that UCN 2 and UCN 3 hold exciting therapeutic potential for the treatment of acute heart failure.

Myocardial reperfusion reverses the J-curve association of cardiovascular risk and diastolic blood pressure in patients with left ventricular dysfunction and heart failure after myocardial infarction: insights from the EPHESUS trial

2020 ◽  
Vol 41 (17) ◽  
pp. 1673-1683 ◽  
Author(s):  
Michael Böhm ◽  
João Pedro Ferreira ◽  
Felix Mahfoud ◽  
Kevin Duarte ◽  
Bertram Pitt ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Cox Regression ◽  
Cardiovascular Death ◽  
Left Ventricular ◽  
Coronary Perfusion ◽  
Increased Risk ◽  
The Impact

Abstract Aims The described association of low diastolic blood pressure (DBP) with increased cardiovascular outcomes could be due to reduced coronary perfusion or is simply due to reverse causation. If DBP is physiologically relevant, coronary reperfusion after myocardial infarction (MI) might influence DBP–risk association. Methods and results The relation of achieved DBP with cardiovascular death or cardiovascular hospitalization, cardiovascular death, and all-cause death was explored in 5929 patients after acute myocardial infarction (AMI) with impaired left ventricular function, signs and symptoms of heart failure, or diabetes in the EPHESUS trial according to their reperfusion status. Cox regression models were used to assess the impact of reperfusion status on the association of DBP and systolic blood pressure (SBP) with outcomes in an adjusted fashion. In patients without reperfusion, lower DBP &lt;70 mmHg was associated with increased risk for all-cause death [adjusted hazard ratios (HRs) 1.80, 95% confidence interval (CI) 1.41–2.30; P &lt; 0.001], cardiovascular death (HR 1.70, 95% CI 1.3–3.22; P &lt; 0.001), cardiovascular death or cardiovascular hospitalization (HR 1.54, 95% CI 1.26–1.87; P &lt; 0.001). In patients with reperfusion, the risk increase at low DBP was not observed. At low SBP, risk increased independently of reperfusion. A sensitivity analysis in the subgroup of patients with optimal SBP of 120–130 mmHg showed again risk reduction of reperfusion at low DBP. Adding the treatment allocation to eplerenone or placebo into the models had no effects on the results. Conclusion Patients after AMIs with a low DBP had an increased risk, which was sensitive to reperfusion therapy. Low blood pressure after MI identifies in patients with particular higher risk. These data support the hypothesis that low DBP in patients with stenotic coronary lesions is associated with risk, potentially involving coronary perfusion pressure and the recommendations provided by guidelines suggesting lower DBP boundaries for these high-risk patients.

Heart Failure Events in a Clinical Trial on Arterial Hypertension: New Insights Into the SPRINT Trial

Hypertension ◽  
2021 ◽  
Vol 78 (5) ◽  
pp. 1241-1247
Author(s):  
Piotr Sobieraj ◽  
Peter M. Nilsson ◽  
Thomas Kahan
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Standard Treatment ◽  
Hazard Ratio ◽  
Intensive Treatment ◽  
Coronary Syndrome ◽  
End Point ◽  
Reduced Risk

SPRINT (Systolic Blood Pressure Intervention Trial) showed that intensive lowering of systolic blood pressure to <120 mm Hg was beneficial, as compared with standard treatment in which systolic blood pressure is lowered to <140 mm Hg. The proposal that the results of SPRINT were mainly driven by the reduction of heart failure events has undermined the main conclusion of the study. Therefore, this study aimed to assess whether the intensive treatment group was also associated with a reduced risk of cardiovascular events when heart failure events were excluded from the primary composite end point. The SPRINT data were analyzed with a redefined composite end point including myocardial infarction, acute coronary syndrome other than myocardial infarction, stroke, and cardiovascular death (excluding heart failure events). The results show that intensive treatment (<120 mm Hg) is associated with a reduced risk for the redefined composite end point (hazard ratio, 0.79 [95% CI, 0.66–0.95]; P =0.012), as compared with the standard treatment (<140 mm Hg), and with results similar to the original SPRINT findings (hazard ratio, 0.75 [95% CI, 0.64–0.89]; P <0.001). Overall, the main results of SPRINT are not driven by a reduction in heart failure events. Moreover, this post hoc analysis supports the use of a more intensive treatment strategy for high-risk hypertensive patients. Graphic Abstract: An online graphic abstract is available for this article.

Abstract P088: Perceptions of Alcohol as Heart Healthy: The Health eHeart Study

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Isaac R Whitman ◽  
Mark J Pletcher ◽  
Eric Vittinghoff ◽  
Kourtney E Imburgia ◽  
Carol Maguire ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Red Wine ◽  
Controlled Trials ◽  
Cross Sectional ◽  
History Of ◽  
Sectional Analysis ◽  
Influence Behavior

Background: Moderate consumption of alcohol may provide protection against myocardial infarction and mortality, but also likely increases blood pressure and incidence of atrial fibrillation. Despite the absence of rigorous controlled trials on the actual cardiovascular benefits of alcohol, the lay press frequently portrays alcohol as “heart healthy” (HH). No study to date has described individuals’ perceptions regarding the health effects of alcohol, how they gained this perception, nor how that perception may influence behavior. Methods: We performed a cross-sectional analysis of data obtained between March 8, 2013 to September 29, 2014 from consecutive participants enrolled in the Health eHeart Study, a prospective, internet-based cohort study. The characteristics of participants that reported alcohol as HH were determined. Results: A total of 5,417 participants answered questions regarding their perception of alcohol. Thirty percent (n=1,707) viewed alcohol as HH, 39% (n=2,157) viewed it as bad for the heart, and 31% (n=1,718) were unsure. Of those reporting alcohol as HH, 78% cited lay press as a source of their knowledge, 14% cited their doctor, and 92% reported that red wine exclusively was HH. In adjusted analyses, older age, higher education, higher income, and United States residence were associated with a perception of alcohol as HH (Figure). Those with a history of heart failure (HF) were significantly less likely to cite alcohol as HH. Compared to those who did not report alcohol as HH, those who perceived alcohol as HH consumed more alcohol (median 5 drinks per week, IQR 2-8 vs. median 3 drinks, IQR 1-7, p=0.001; adjusted: 10% more alcohol per week, 95% CI 1-20% more, p=0.02). Conclusions: Among more than 5,000 consecutive Health eHeart participants, approximately one third believe alcohol is HH and one third believes it is not. Those who believe alcohol is HH were of higher socioeconomic status, more likely to be American, less likely to have HF, and reported drinking more alcohol.

scholarly journals Hypertension Management in the High Cardiovascular Risk Population

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Ilir Maraj ◽  
John N. Makaryus ◽  
Anthony Ashkar ◽  
Samy I. McFarlane ◽  
Amgad N. Makaryus
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Diabetic Patients ◽  
Hypertension Management ◽  
High Cardiovascular Risk ◽  
Risk Population ◽  
Real Challenge ◽  
Prevention Of Cardiovascular Disease

The incidence of hypertension is increasing every year. Blood pressure (BP) control is an important therapeutic goal for the slowing of progression as well as for the prevention of Cardiovascular disease. The management of hypertension in the high cardiovascular risk population remains a real challenge as the population continues to age, the incidence of diabetes increases, and more and more people survive acute myocardial infarction. We will review hypertension management in the high cardiovascular risk population: patients with coronary heart disease (CHD) and heart failure (HF) as well as in diabetic patients.

Drugs for rapidly lowering blood pressure

1979 ◽  
Vol 17 (16) ◽  
pp. 61-63
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Intracranial Pressure ◽  
Subarachnoid Haemorrhage ◽  
Severe Hypertension ◽  
Dissecting Aneurysm ◽  
Hypertensive Encephalopathy ◽  
Acute Pulmonary Oedema ◽  
Raised Intracranial Pressure ◽  
Old People

In most patients with severe hypertension it is safest to lower the blood pressure gradually over an hour or so using oral medication, e. g. with hydralazine + propranolol. The lowering of blood pressure within minutes is necessary only when life is threatened by hypertensive encephalopathy, dissecting aneurysm of the aorta, continuing cerebral or subarachnoid haemorrhage, acute pulmonary oedema secondary to severe hypertension, or eclampsia. If hypertension is due to raised intracranial pressure it should not be treated unless the intracranial pressure has first been reduced. Rapid or excessive reduction of blood pressure can precipitate cerebral or myocardial infarction, particularly in old people, and in patients with long-standing hypertension.

Thiazide Diuretics as Chronic Antihypertensive Therapy in Patients with Severe Renal Disease—Is There a Role in the Absence of Diuresis?

2012 ◽  
Vol 46 (11) ◽  
pp. 1554-1558 ◽  
Author(s):  
Cynthia Y Chan ◽  
Evan J Peterson ◽  
Tien MH Ng
Keyword(s):  
Blood Pressure ◽  
Renal Insufficiency ◽  
Renal Disease ◽  
Key Words ◽  
Kidney Failure ◽  
Antihypertensive Effect ◽  
Thiazide Diuretics ◽  
Peripheral Vascular ◽  
Mesh Terms ◽  
Severe Renal Disease

OBJECTIVE: To determine whether thiazides have a chronic antihypertensive effect, in the absence of diuresis, in patients with severe renal disease (creatinine clearance <30 mL/min) or in those receiving dialysis. DATA SOURCES: A search was performed in PubMed, CENTRAL, and International Pharmaceutical Abstracts, using MeSH terms and/or key words. MeSH terms included kidney failure, chronic and exploded terms hydrochlorothiazide, renal dialysis, and thiazides. Key words included thiazide*, hydrochlorothiazide, chlorothiazide, chlorthalidone, indapamide, metolazone, methyclothiazide, bendroflumethiazide, hemodialysis, dialysis, kidney failure, renal failure, renal insufficiency, hypertension, vasodilation, vascular, and diuretics. STUDY SELECTION AND DATA EXTRACTION: All relevant English-language publications were evaluated. Studies evaluating the efficacy of thiazides in renal insufficiency or dialysis were limited to those that included blood pressure measurements. Studies were included only if treatment duration was at least 4 weeks to evaluate chronic antihypertensive effects. DATA SYNTHESIS: Thiazide diuretics are associated with a chronic reduction in peripheral vascular resistance secondary to a purported vasodilatory effect. However, few clinical studies have evaluated the chronic antihypertensive efficacy of thiazide and thiazide-like diuretics in patients with severe renal disease or those on dialysis. Agents studied include hydrochlorothiazide, chlorothiazide, indapamide, and metolazone, with results varying by drug and patient population. Hydrochlorothiazide 25–200 mg daily, chlorothiazide 500 mg twice daily, and indapamide 2.5 mg daily provided long-term blood pressure reduction in patients with severe renal disease who were not on dialysis. In studies involving patients on dialysis, hydrochlorothiazide 50 mg daily and metolazone 5 mg daily did not affect blood pressure; however, 1 study suggested that indapamide 2.5 mg daily may confer an antihypertensive effect. All studies were small (≤12 subjects) and had methodological limitations. CONCLUSIONS: Thiazide diuretics may decrease peripheral vascular resistance independent of natriuresis. However, because current clinical data are inconclusive as to the efficacy of these agents at chronically lowering blood pressure in patients with severe renal disease or in those on dialysis, thiazide diuretics cannot be routinely recommended for this indication.

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