scholarly journals Significance/role of family medicine physicians in early detection of secondary hypertension

2021 ◽  
Vol 26 (83) ◽  
pp. 71-82
Author(s):  
Marijana Jandrić-Kočič ◽  
Snežana Knežević
Keyword(s):  
Blood Pressure ◽  
Early Detection ◽  
Arterial Hypertension ◽  
Blood Pressure Monitoring ◽  
Left Kidney ◽  
Secondary Hypertension ◽  
Left Ventricular ◽  
Levothyroxine Sodium ◽  
Thyroid Peroxidase ◽  
Dietary Regimen

SUMMARY - Introduction: Secondary arterial hypertension has an identifiable underlying cause. Routine screening is not indicated given the low prevalence of the disease (5-10% arterial hypertension), longterm and costly diagnostic evaluation. Case report: An outpatient family medication presents a 34-year-old patient due to worsening, by then stable, arterial hypertension. She was found 12 months ago when reported to a private healthcare facility where she was allowed perindopril / amlodipine 4/5 mg, 1x1 tablet. So far healthy, it negates diseases of relevance to inheritance. Smoker. 24hour outpatient blood pressure monitoring checks for elevated diastolic blood pressure levels in 59,3% of measurements during the day and 59,2% of measurements during the night. Thyroid ultrasound checks for inhomogeneous structure, right flap 40x15x16 mm, left flap 42x15x16 mm. Abdominal ultrasound reduces left kidney, bilateral thinning cortex, left ventricular moderate hydronephrosis. The laboratory contains large amounts of tyrosimulating hormone as well as antibodies to thyroid peroxidase, decreased levels of free thyroxine and a slight increase in albumin in 24 hours of urine. The patient is referred for a consultative examination by a nephrologist and a nuclear medicine specialist. Same indicative hygiene dietary regimen and introduction of levothyroxine sodium tablets 100 mcg 1x 1 ¼ tablets (125 mcg). Antihypertensive therapy was discontinued at most months later, while levothyroxine sodium replacement therapy was reduced to 1 x 100 mcg. Conclusion: The work of a selected family physician in accordance with good clinical practice guidelines allows for the early detection, normalization or increase in the number of secondary hypertension, the reduction of the possibility of accommodation of irreversible changes in blood vessels, and coexisting essential hypertension.

scholarly journals Diagnostics and treatment of arterial hypertension in children and adolescents, overview of new clinical guidelines of the American Academy of Pediatrics

2019 ◽  
Vol 64 (4) ◽  
pp. 114-127 ◽  
Author(s):  
L. I. Agapitov ◽  
I. V. Cherepnina
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Children And Adolescents ◽  
Clinical Guidelines ◽  
Blood Pressure Monitoring ◽  
Ventricular Myocardium ◽  
Left Ventricular ◽  
Left Ventricular Myocardium ◽  
New Guidelines ◽  
Hypertension In Children

The article analyzes clinical guidelines oftheAmericanAcademy ofPediatrics dd 2017 “ClinicalPractice Guideline forScreening andManagement of High Blood Pressure in Children and Adolescents”. This document contains new values of blood pressure in children, replaces the term “prehypertension” with the term “elevated blood pressure”, provides a simplified classification of arterial hypertension in adolescents over 13 years and revisesthe guidelinesfor daily blood pressure monitoring and echocardiography. The documentspecifiesthe criteria for diagnosing increased body weight of the left ventricular myocardium, changesthe target blood pressure levels. This new guidelines helps to optimize the diagnostics and treatment of hypertension in children. At the same time there is need for further comprehensive analysis of clinicalrecommendations and assessment of their practicalsignificance for pediatrics.

scholarly journals Radiofrequency denervation of the renal arteries in patients with resistant arterial hypertension: 3 years of observation experience

2019 ◽  
Vol 16 (4) ◽  
pp. 65-69
Author(s):  
Nina Yu Savelyeva ◽  
Anna Yu Zherzhova ◽  
Ekaterina V Mikova ◽  
Liudmila I Gapon ◽  
Grigorii V Kolunin ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Antihypertensive Drugs ◽  
Blood Pressure Monitoring ◽  
Secondary Hypertension ◽  
Renal Arteries ◽  
Radiofrequency Denervation ◽  
Intact Kidney ◽  
Resistant Arterial Hypertension

Objective. To evaluate the efficiency of radiofrequency denervation of the renal arteries in patients with resi-stant arterial hypertension during a three-year follow-up. Materials and methods. The study involved 40 patients with resistant arterial hypertension aged 27 to 70 years (mean age 54.91±9.77 years) while receiving three or more antihypertensive drugs (including diuretic) in optimal doses. The conditions for inclusion in the study were considered resistant arterial hypertension with blood pressure (BP)>160/100 mm Hg, intact kidney function - glomerular filtration rate (MDRD)>45 ml/min - and the absence of secondary hypertension. All patients had sympatic radiofrequency denervation of renal arteries; its efficiency later was estimated according to the clinical measurement and ambulatory blood pressure monitoring (ABPM). Results. The level of office BP reliably differed initially and after 3 years: DSBP -34.48±6.44 mm Hg (p=0.001), DDBP - 22.29 mm Hg (p=0.001). According to ABPM results, reliable dynamics of systolic blood pressure was not observed. The data of DBP at night were significantly lower after 36 months; DDBP was -5.37±9.77 mm Hg. Conclusions. A marked decrease in the data of office SBP and DBP was observed, which proves the long-term efficiency of radiofrequency denervation of the renal arteries in patients with resistant hypertension. Accor-ding to ABPM results after 36 months, a significant decrease was registered among the DBP indicators at night and daytime.

scholarly journals Clinical-hemodynamic efficiency of fixed combined hypotensin therapy for patients with heavy arterial hypertension

2019 ◽  
Vol 21 (2) ◽  
pp. 48-51
Author(s):  
N R Gizi Azayeva
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Diastolic Pressure ◽  
Blood Pressure Monitoring ◽  
Systolic Pressure ◽  
Clinical Manifestations ◽  
Pressure Profile ◽  
Left Ventricular ◽  
Combination Drug ◽  
Efficacy Of Treatment

The efficacy of treatment was evaluated by the fixed combination drug «Exforge-H» in 40 patients suffering from grade 3 arterial hypertension. All patients underwent general clinical and laboratory and instrumental examination (electrocardiography, echocardiography, 24-hour blood pressure monitoring) before and after 6 months of treatment. It was established that treatment with «Exforge-H» statistically reliably reduces the level of blood pressure, normalizes the variability and daily blood pressure profile. So, two weeks after the start of treatment, the systolic and diastolic pressure levels during clinical measurement decreased by 32,1±2,7 and 30,4±1,9 mm Hg. Art. respectively. After 3 months of treatment, 60% of patients showed achievement of the target level of blood pressure, and after 6 months - 96%. High hypotensive efficacy of treatment was also demonstrated during the daily monitoring of blood pressure in all its indicators. A significant decrease in systolic and diastolic pressure was observed during the day and night hours. The amplitudes of systolic and diastolic pressure variability have also been improved. At the same time, the variability of systolic pressure during the day was reduced by 46%, diastolic - by 49%, and at night by 59,3 and 52,8%, respectively, indicating a normalization of blood pressure during the day. All this was also accompanied by a decrease in the clinical manifestations of the disease. So, after 6 months of treatment, 84% of patients had positive clinical dynamics: a decrease in cardiac and cerebral symptoms, as well as emotional lability, which positively correlated with a decrease in the level of clinical blood pressure. The cardioprotective effect of the drug is expressed in the form of regression of left ventricular hypertrophy. In general, the use of the three-component fixed drug «Exforge-H» (valsartan - 80 mg, amlodipine - 5 mg and hydrochlorothiazide - 12,5 mg) is manifested by an increased antihypertensive effect due to the influence of its constituents side effects and the development of metabolic changes.

scholarly journals Predicting the risk of left ventricular hypertrophy in children and adolescents with arterial hypertension on the basis of 24-hour blood pressure monitoring and metabolism indicators

2020 ◽  
Vol 1 ◽  
Author(s):  
Tamara Haiduk ◽  
Olha Haiduk ◽  
Irene Gubar
Keyword(s):  
Blood Pressure ◽  
Left Ventricular Hypertrophy ◽  
Arterial Hypertension ◽  
Children And Adolescents ◽  
Ventricular Hypertrophy ◽  
Blood Pressure Monitoring ◽  
Left Ventricular ◽  
Control Group ◽  
Immunoreactive Insulin ◽  
Pressure Monitoring

Abstract: Objective: To investigate the significance of 24-hr ambulatory blood pressure monitoring (ABPM) data and metabolism indicators, as well their correlation in predicting the risk of left ventricular hypertrophy (LVH) in children and adolescents with arterial hypertension (AH). Methods: We studied 118 children and adolescents, M±m 15.51±0.25 yrs, Boys/Girls – 104/14, with AH: 60 stable, 40 labile, 18 prehypertension (high-normal blood pressure), and a control group of 13 normotensive children, M±m 15,19±0,41 yrs, Boys/Girls – 10/3. All patients underwent a comprehensive anamnestic, clinical, laboratory, and instrumental examination, including 24-hr ABPM; indicators were standardized by gender and age. On Doppler echocardiography (echoCG), the left ventricular myocardial mass index (LVMI) was calculated. Lipid spectrum parameters were determined by biochemical method, venous blood glycemia by GOD-PAP, blood serum basal immunoreactive insulin by ELISA methods, insulin resistance (IR) by HOMA parameters calculation. Statistical processing was performed using the package of statistical analysis software STATISTICA. Results: Of a range of metabolism indicators, BMI, TG level, LDL/HDL ratio, HOMA index, 24-hr DBP index, and the stable character of AH identified as the most significant factors in predicting the risk of LVH in hypertensive children. All multivariate models of logistic regressions, which include BMI, can predict the probability of LVH with an accuracy of 79.7-84.7%, sensitivity - 57.5-77.5%, specificity - 86.4-91.0%. Conclusions: Obtained satisfactory concordance of the actual data with predictive models' results indicate the possibility of their use to predict the risk of LVH in children and adolescents with AH.

scholarly journals Correlation between 24-hour profile of blood pressure and ventricular arrhythmias and their prognostic significance in patients with arterial hypertension

2008 ◽  
Vol 65 (5) ◽  
pp. 353-358
Author(s):  
Dragan Djordjevic ◽  
Marina Deljanin-Ilic ◽  
Ivan Tasic
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Left Ventricular Mass ◽  
Ventricular Arrhythmias ◽  
Left Ventricular Mass Index ◽  
Blood Pressure Monitoring ◽  
Left Ventricular ◽  
Ventricular Mass Index ◽  
Ventricular Mass

Background/Aim. Left ventricular hypertrophy (LVH), apart from arterial hypertension, is a risk factor for electrophysiologic heart condition disorder and sudden cardiac death. The aim of this study was to examine a relationship between complex ventricular arrhythmias and parameters of 24-hour ambulatory blood pressure monitoring in the patients with arterial hypertension and left ventricular hypertrophy (LVH), as well as their prognostic significance during a five-year follow-up. Methods. Ninety patients with arterial hypertension and LVH were included in this study (mean age 55.2?8.3 years). There were 35 healthy people in the control group (mean age 54.5?7.1 years). Left ventricular mass index was 171.9?32.4 g/m2 in the LVH group and 102.4?13.3 g/m2 in the control group. Clinical examination, echocardiogram, 24-hour ambulatory blood pressure monitoring and 24-hour holter monitoring were done in all of the examined persons. Ventricular arrhythmias were classified by the Lown classification. Results. In the LVH group there were 54 (60.0%) of the patients with ? III Lown class. The best predictor of a Lown class were left ventricular mass index by using multivariate stepwise regression analyses (? = 0.212; p < 0.05) and small decrease of diastolic blood pressure during the night (? = -0.293; p < 0.01). The main predictor of bad prognosis was left ventricular mass index during a five year follow-up (? = 0.302; p < 0.01, for stepwise regression model: F = 8.828; p < 0.01, adjusted R2 = 0.091). Conclusion. Left ventricular arrhythmias are frequent in patients with lower decrease of blood pressure during the night. There was no correlation between the degree of ventricular arrhythmias and parameters from 24-hour blood pressure monitoring and a five-year prognosis in the patients with arterial hypertension and LVH. A bad five-year follow-up outcome of hypertensive disease depends on left ventricular mass index.

scholarly journals Left ventricular myocardial dysfunction and parameters of ambulatory blood pressure monitoring in patients with arterial hypertension and frailty

2021 ◽  
Vol 23 (1) ◽  
pp. 80-83
Author(s):  
Elena S. Fomina ◽  
◽  
Elena S. Fomina ◽  
Viktor S. Nikiforov ◽  
Elena V. Frolova ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Diastolic Function ◽  
Ambulatory Blood Pressure Monitoring ◽  
Ambulatory Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Myocardial Dysfunction ◽  
Left Ventricular ◽  
Pressure Monitoring ◽  
Time Index

Aim. To study and analyze the systolic and diastolic left ventricle (LV) function, parameters of the ambulatory blood pressure (BP) monitoring in patients over 65 years of age with arterial hypertension, depending on the presence of frailty. Materials and methods. We examined 77 patients over 65 years of age (25 men and 52 women) with arterial hypertension, who were divided into two groups: with the presence of frailty (38 people) and its absence (39 people). To detect frailty, we used the "Age is not a hindrance" questionnaire validated in Russia and the "Get up and go" test. The examination included echocardiography with tissue doppler and ambulatory BP monitoring. Results. In both groups, LV systolic function remained within normal values, while diastolic function was impaired. In the group of people without frailty, type 1 of left ventricular diastolic dysfunction prevailed in 63% of cases, in the group with frailty, type 2 of left ventricular diastolic dysfunction with increased filling pressure was registered in 77% of cases. In both groups, both isolated systolic arterial hypertension and normal indicators of SBP and DBP were recorded during the day. Systolo-diastolic hypertension and hypotension have been presented by individual cases. At the same time, significant differences (p<0.05) in the groups were revealed by the index of time of hypertension SBP at night and were higher in patients with frailty. Correlations were found between the time index of hypertension and SBP at night with the volume index of the left atrium in groups with frailty (0.34; p<0.05) and without frailty (0.40; p<0.05), as well as the time index of hypertension and SAD at night with the maximum rate of regurgitation on the tricuspid valve (0.42; p<0.05) and with estimated systolic pressure in the pulmonary artery (0.41; p<0.05) in the group with frailty. Conclusion. In the group of patients with arterial hypertension older than 65 years without frailty, violations of the left ventricular diastolic function by the type of slowing relaxation predominate, while in the group of patients with senile asthenia, violation of the left ventricular diastolic function by the type of pseudonormalization with increased filling pressure prevails. Features of the ambulatory BP monitoring of patients with hypertension older than 65 years with the presence of frailty are higher values of the time index of hypertension SBP at night. An increase in the time index of hypertension and SBP in patients with hypertension older than 65 years with frailty is associated with an increase in the volume of the left atrium, the rate of tricuspid regurgitation and systolic pressure in the pulmonary artery. The obtained data may indicate an adverse effect of frailty on the progression of heart failure in patients with arterial hypertension, which requires a comprehensive approach with the participation of a geriatrician in the management of such patients. Keywords: arterial hypertension, frailty, echocardiography, left ventricle, systolic function, diastolic function, ambulatory blood pressure monitoring, blood pressure For citation: Fomina ES, Nikiforov VS, Frolova EV, Reshetnik DA. Left ventricular myocardial dysfunction and parameters of ambulatory blood pressure monitoring in patients with arterial hypertension and frailty. Consilium Medicum. 2021; 23 (1): 80–83. DOI: 10.26442/20751753.2021.1.200476

Ambulatory blood pressure monitoring-based definition of true arterial hypertension

2020 ◽  
Vol 111 (6) ◽  
Author(s):  
Ramón C. Hermida ◽  
Artemio Mojón ◽  
José R. Fernández ◽  
Alfonso Otero ◽  
Juan J. Crespo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Ambulatory Blood Pressure Monitoring ◽  
Ambulatory Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Pressure Monitoring ◽  
Definition Of
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