scholarly journals Who should be screened for secondary causes of hypertension?

2011 ◽  
Vol 5 (4) ◽  
pp. 157-164
Author(s):  
Andrea Semplicini ◽  
Chiara Sandonà ◽  
Federica Stella ◽  
Tommaso Grandi
Keyword(s):  
Arteriovenous Fistula ◽  
Resistant Hypertension ◽  
Kidney Biopsy ◽  
Secondary Hypertension ◽  
Uncontrolled Hypertension ◽  
Hypertensive Patients ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up ◽  
Secondary Causes

The case of a 34-year-old patient with uncontrolled hypertension is described in this article, together with the diagnostic path followed in order to make the diagnosis, that finally reveals an arteriovenous fistula due to an old kidney biopsy. Uncontrolled or resistant hypertension may be caused by unrecognized secondary hypertension: we revise the clinical and laboratory criteria for selecting hypertensive patients in whom to look for secondary hypertension through the most appropriate diagnostic work up. A synthesis of the main causes of secondary hypertension is also provided in the discussion.

Hypertension in specific conditions/co-morbidities

ESC CardioMed ◽  
2018 ◽  
pp. 2465-2473
Author(s):  
Enrico Agabiti Rosei ◽  
Maria Lorenza Muiesan ◽  
Massimo Salvetti
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Age Groups ◽  
Optimal Management ◽  
Hypertensive Patients ◽  
Accurate Evaluation ◽  
Associated Conditions ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

The optimal management of hypertensive patients requires accurate evaluation of cardiovascular risk factors and co-morbidities. The therapeutic approach to hypertension may, in fact, be significantly different according to associated conditions. Among them, the presence of coronary heart disease, heart failure, cerebrovascular disease, chronic kidney disease, and specific age groups deserve special attention. In this chapter, the initial diagnostic work-up, the thresholds and targets for treatment, and the preferred drugs in specific conditions/co-morbidities will be briefly discussed.

Hypertension in specific conditions/co-morbidities

ESC CardioMed ◽  
2018 ◽  
pp. 2465-2473
Author(s):  
Enrico Agabiti Rosei ◽  
Maria Lorenza Muiesan ◽  
Massimo Salvetti
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Age Groups ◽  
Optimal Management ◽  
Hypertensive Patients ◽  
Accurate Evaluation ◽  
Associated Conditions ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

The optimal management of hypertensive patients requires accurate evaluation of cardiovascular risk factors and co-morbidities. The therapeutic approach to hypertension may, in fact, be significantly different according to associated conditions. Among them, the presence of coronary heart disease, heart failure, cerebrovascular disease, chronic kidney disease, and specific age groups deserve special attention. In this chapter, the initial diagnostic work-up, the thresholds and targets for treatment, and the preferred drugs in specific conditions/co-morbidities will be briefly discussed.

The Neglected Role of the Electrocardiogram in the Diagnostic Work-Up of Hypertensive Patients

2013 ◽  
Vol 20 (1) ◽  
pp. 39-43 ◽  
Author(s):  
Cesare Cuspidi ◽  
Annalisa Re ◽  
Raffaella Dell’Oro ◽  
Guido Grassi ◽  
Carla Sala
Keyword(s):  
Hypertensive Patients ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

scholarly journals Stroke masquerading as cardiac arrest: the artery of Percheron

2021 ◽  
Vol 14 (1) ◽  
pp. e238681
Author(s):  
Megan Quetsch ◽  
Sureshkumar Nagiah ◽  
Stephen Hedger
Keyword(s):  
Cardiac Arrest ◽  
Clinical Assessment ◽  
Altered Consciousness ◽  
Cognitive Changes ◽  
Consciousness Level ◽  
Artery Of Percheron ◽  
Conscious Level ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

The artery of Percheron (AOP) is a rare arterial variant of the thalamic blood supply. Due to the densely packed collection of nuclei it supplies, an infarction of the AOP can be devastating. Here we highlight a patient who had an AOP stroke in the community, which was initially managed as cardiac arrest. AOP strokes most often present with vague symptoms such as reduced conscious level, cognitive changes and confusion without obvious focal neurology, and therefore are often missed at the initial clinical assessment. This case highlights the importance of recognising an AOP stroke as a cause of otherwise unexplained altered consciousness level and the use of MRI early in the diagnostic work-up.

scholarly journals Death of unknown cause? Post-mortem diagnosis of fulminant course of an EBV-associated secondary hemophagocytic lymphohistiocytosis

2021 ◽  
Author(s):  
Josia Fauser ◽  
Stefan Köck ◽  
Eberhard Gunsilius ◽  
Andreas Chott ◽  
Andreas Peer ◽  
...  
Keyword(s):  
Immune Response ◽  
Case Report ◽  
Macrophage Activation ◽  
Post Mortem ◽  
Life Threatening ◽  
Appropriate Therapy ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up ◽  
Secondary Hemophagocytic Lymphohistiocytosis

SummaryHLH is a life-threatening disease, which is characterized by a dysregulated immune response with uncontrolled T cell and macrophage activation. The often fulminant course of the disease needs a fast diagnostic work-up to initiate as soon as possible the appropriate therapy. We present herein the case of a 71-year-old patient with rapidly progressive hyperinflammatory syndrome, which post mortem resulted in the diagnosis of EBV-associated HLH. With this case report, we intend to highlight the relevance of the HScore in the diagnosis of HLH, to create a greater awareness for EBV as a trigger of HLH, and to demonstrate the importance of treating EBV-associated HLH as early as possible.

scholarly journals COVID-19 lung injury as a primer for immune checkpoint inhibitors (ICIs)-related pneumonia in a patient affected by squamous head and neck carcinoma treated with PD-L1 blockade: a case report

2021 ◽  
Vol 9 (2) ◽  
pp. e001870
Author(s):  
Angelo Dipasquale ◽  
Pasquale Persico ◽  
Elena Lorenzi ◽  
Daoud Rahal ◽  
Armando Santoro ◽  
...  
Keyword(s):  
Lung Injury ◽  
Head And Neck ◽  
Checkpoint Inhibitors ◽  
Experimental Therapy ◽  
Common Mechanism ◽  
Nasopharyngeal Swab ◽  
Immune Mediated ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

By the beginning of the global pandemic, SARS-CoV-2 infection has dramatically impacted on oncology daily practice. In the current oncological landscape, where immunotherapy has revolutionized the treatment of several malignancies, distinguishing between COVID-19 and immune-mediated pneumonitis can be hard because of shared clinical, radiological and pathological features. Indeed, their common mechanism of aberrant inflammation could lead to a mutual and amplifying interaction.We describe the case of a 65–year-old patient affected by metastatic squamous head and neck cancer and candidate to an experimental therapy including an anti-PD-L1 agent. COVID-19 ground-glass opacities under resolution were an incidental finding during screening procedures and worsened after starting immunotherapy. The diagnostic work-up was consistent with ICIs-related pneumonia and it is conceivable that lung injury by SARS-CoV-2 has acted as an inflammatory primer for the development of the immune-related adverse event.Patients recovered from COVID-19 starting ICIs could be at greater risk of recall immune-mediated pneumonitis. Nasopharyngeal swab and chest CT scan are recommended before starting immunotherapy. The awareness of the phenomenon could allow an easier interpretation of radiological changes under treatment and a faster diagnostic work-up to resume ICIs. In the presence of clinical benefit, for asymptomatic ICIs-related pneumonia a watchful-waiting approach and immunotherapy prosecution are suggested.

scholarly journals The Road to Better Management in Resistant Hypertension–Diagnostic and Therapeutic Insights

Pharmaceutics ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 714
Author(s):  
Elisabeta Bădilă ◽  
Cristina Japie ◽  
Emma Weiss ◽  
Ana-Maria Balahura ◽  
Daniela Bartoș ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Renin Angiotensin System ◽  
Drug Regimen ◽  
Secondary Hypertension ◽  
Adverse Outcomes ◽  
Uncontrolled Hypertension ◽  
White Coat Hypertension ◽  
Mineralocorticoid Receptor Antagonist ◽  
Mortality And Morbidity

Resistant hypertension (R-HTN) implies a higher mortality and morbidity compared to non-R-HTN due to increased cardiovascular risk and associated adverse outcomes—greater risk of developing chronic kidney disease, heart failure, stroke and myocardial infarction. R-HTN is considered when failing to lower blood pressure below 140/90 mmHg despite adequate lifestyle measures and optimal treatment with at least three medications, including a diuretic, and usually a blocker of the renin-angiotensin system and a calcium channel blocker, at maximally tolerated doses. Hereby, we discuss the diagnostic and therapeutic approach to a better management of R-HTN. Excluding pseudoresistance, secondary hypertension, white-coat hypertension and medication non-adherence is an important step when diagnosing R-HTN. Most recently different phenotypes associated to R-HTN have been described, specifically refractory and controlled R-HTN and masked uncontrolled hypertension. Optimizing the three-drug regimen, including the diuretic treatment, adding a mineralocorticoid receptor antagonist as the fourth drug, a β-blocker as the fifth drug and an α1-blocker or a peripheral vasodilator as a final option when failing to achieve target blood pressure values are current recommendations regarding the correct management of R-HTN.

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