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Sample records for included hypertension coronary

  1. Relationship of Hypertension to Coronary Atherosclerosis and Cardiac Events in Patients With Coronary Computed Tomographic Angiography.

    Science.gov (United States)

    Nakanishi, Rine; Baskaran, Lohendran; Gransar, Heidi; Budoff, Matthew J; Achenbach, Stephan; Al-Mallah, Mouaz; Cademartiri, Filippo; Callister, Tracy Q; Chang, Hyuk-Jae; Chinnaiyan, Kavitha; Chow, Benjamin J W; DeLago, Augustin; Hadamitzky, Martin; Hausleiter, Joerg; Cury, Ricardo; Feuchtner, Gudrun; Kim, Yong-Jin; Leipsic, Jonathon; Kaufmann, Philipp A; Maffei, Erica; Raff, Gilbert; Shaw, Leslee J; Villines, Todd C; Dunning, Allison; Marques, Hugo; Pontone, Gianluca; Andreini, Daniele; Rubinshtein, Ronen; Bax, Jeroen; Jones, Erica; Hindoyan, Niree; Gomez, Millie; Lin, Fay Y; Min, James K; Berman, Daniel S

    2017-08-01

    Hypertension is an atherosclerosis factor and is associated with cardiovascular risk. We investigated the relationship between hypertension and the presence, extent, and severity of coronary atherosclerosis in coronary computed tomographic angiography and cardiac events risk. Of 17 181 patients enrolled in the CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) who underwent ≥64-detector row coronary computed tomographic angiography, we identified 14 803 patients without known coronary artery disease. Of these, 1434 hypertensive patients were matched to 1434 patients without hypertension. Major adverse cardiac events risk of hypertension and non-hypertensive patients was evaluated with Cox proportional hazards models. The prognostic associations between hypertension and no-hypertension with increasing degree of coronary stenosis severity (nonobstructive or obstructive ≥50%) and extent of coronary artery disease (segment involvement score of 1-5, >5) was also assessed. Hypertension patients less commonly had no coronary atherosclerosis and more commonly had nonobstructive and 1-, 2-, and 3-vessel disease than the no-hypertension group. During a mean follow-up of 5.2±1.2 years, 180 patients experienced cardiac events, with 104 (2.0%) occurring in the hypertension group and 76 (1.5%) occurring in the no-hypertension group (hazard ratios, 1.4; 95% confidence intervals, 1.0-1.9). Compared with no-hypertension patients without coronary atherosclerosis, hypertension patients with no coronary atherosclerosis and obstructive coronary disease tended to have higher risk of cardiac events. Similar trends were observed with respect to extent of coronary artery disease. Compared with no-hypertension patients, hypertensive patients have increased presence, extent, and severity of coronary atherosclerosis and tend to have an increase in major adverse cardiac events. © 2017 American Heart Association, Inc.

  2. Nitric oxide and coronary vascular endothelium adaptations in hypertension

    Directory of Open Access Journals (Sweden)

    Andrew S Levy

    2009-12-01

    Full Text Available Andrew S Levy*, Justin CS Chung*, Jeffrey T Kroetsch*, James WE RushDepartment of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada; *These authors contributed equally to this workAbstract: This review highlights a number of nitric oxide (NO-related mechanisms that contribute to coronary vascular function and that are likely affected by hypertension and thus become important clinically as potential considerations in prevention, diagnosis, and treatment of coronary complications of hypertension. Coronary vascular resistance is elevated in hypertension in part due to impaired endothelium-dependent function of coronary arteries. Several lines of evidence suggest that other NO synthase isoforms and dilators other than NO may compensate for impairments in endothelial NO synthase (eNOS to protect coronary artery function, and that NO-dependent function of coronary blood vessels depends on the position of the vessel in the vascular tree. Adaptations in NOS isoforms in the coronary circulation to hypertension are not well described so the compensatory relationship between these and eNOS in hypertensive vessels is not clear. It is important to understand potential functional consequences of these adaptations as they will impact the efficacy of treatments designed to control hypertension and coronary vascular disease. Polymorphisms of the eNOS gene result in significant associations with incidence of hypertension, although mechanistic details linking the polymorphisms with alterations in coronary vasomotor responses and adaptations to hypertension are not established. This understanding should be developed in order to better predict those individuals at the highest risk for coronary vascular complications of hypertension. Greater endothelium-dependent dilation observed in female coronary arteries is likely related to endothelial Ca2+ control and eNOS expression and activity. In hypertension models, the coronary vasculature has not been

  3. f antihypertensive of coronary heart disease Hypertension in a rural

    African Journals Online (AJOL)

    1990-07-21

    Jul 21, 1990 ... The association between hypertension and coronary risk factors and the effect of antihypertensive treatment on coro- nary risk were investigated in rural South African whites aged. 15 - 64 years. Almost 25% of men (range 1,9 - 46,6%) and almost 27% of women (2,1 - 56,2%) were hypertensive or.

  4. Prevalence, predictors, and outcomes in treatment-resistant hypertension in patients with coronary disease.

    Science.gov (United States)

    Bangalore, Sripal; Fayyad, Rana; Laskey, Rachel; Demicco, David A; Deedwania, Prakash; Kostis, John B; Messerli, Franz H

    2014-01-01

    Increasingly, apparent treatment-resistant hypertension has been recognized. However, much of the prevalence, predictors, and outcomes are largely unknown, especially in patients with coronary artery disease. We evaluated 10,001 patients with coronary artery disease who were enrolled in the Treating to New Targets trial. Apparent treatment-resistant hypertension was defined as blood pressure ≥ 140 mm Hg despite 3 antihypertensive agents or hypertension. In a multivariable model adjusting for baseline differences, the treatment-resistant hypertension group had a 64% increase in primary outcome (hazard ratio [HR], 1.64; 95% confidence interval [CI], 1.39-1.94; P hypertension group. In addition, patients with apparent treatment-resistant hypertension had a 71% increase in major coronary event (P hypertension group. Results were largely similar whether the definition of apparent treatment-resistant hypertension was based on a blood pressure ≥ 140 mm Hg despite 3 agents or a blood pressure hypertension is associated with a marked increase in the risk of cardiovascular morbidity and mortality, including an increase in all-cause death. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. The Impact of Hypertension on Patients with Acute Coronary Syndromes

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    Claudio Picariello

    2011-01-01

    Full Text Available Arterial chronic hypertension (HTN is a well-known cardiovascular risk factor for development of atherosclerosis. In order to explain the relation between HTN and acute coronary syndromes the following factors should be considered: (1 risk factors are shared by the diseases, such as genetic risk, insulin resistance, sympathetic hyperactivity, and vasoactive substances (i.e., angiotensin II; (2 hypertension is associated with the development of atherosclerosis (which in turn contributes to progression of myocardial infarction. From all the registries and the data available up to now, hypertensive patients with ACS are more likely to be older, female, of nonwhite ethnicity, and having a higher prevalence of comorbidities. Data on the prognostic role of a preexisting hypertensive state in ACS patients are so far contrasting. The aim of the present paper is to focus on hypertensive patients with ACS, in order to better elucidate whether these patients are at higher risk and deserve a tailored approach for management and followup.

  6. Association between short sleep and body mass index, hypertension among acute coronary syndrome patients in coronary care unit.

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    Sepahvand, Elham; Jalali, Rostam; Mirzaei, Maryam; Kargar Jahromi, Marzieh

    2014-11-26

    Patients with coronary diseases admitted to special care unit often suffer from sleep disorders, which may cause physiological changes and adversely affect patient's health. The relationship between sleep disorders and obesity is an important factor in studies on sleep disorders and other chronic diseases in all groups, including cardiovascular diseases. Understanding this relationship may increase the chance of progress in effective medical interventions in sleep disorders and obesity. This study was designed to evaluate the association between short sleep and Body Mass Index (BMI), hypertension among acute coronary syndrome patients. In this descriptive analytical study, 221 coronary patients admitted to coronary care unit and general wards were investigated. Data were collected through a researcher-made questionnaire whose validity and reliability had been confirmed. Data were analyzed with SPSS-16 software. A total of 221 patients with acute coronary diseases (including myocardial infarction and angina pectoris) with a mean age of 61.27 years were studied, of whom 61.5% were male and 38.5% were female. A significant association was observed between short sleep and higher BMI (P=0.000). About half the patients (49.3%) had a history of hypertension, and sleep disorders were also significantly related to hypertension (P=0.006). In this study, sleep disorders were patients' main complaint. Researchers found that patients with less than 5 hours or more than 9 hours sleep at night were more likely to have hypertension compared to patients that slept 7-8 hours. Lack of sleep affects metabolism, and daily energy expenditure reduces with increased immobility. In this study, a significant relationship was observed between BMI and sleep duration among hospitalized patients in coronary care unit (P=0.000), and sleep disorders increased with higher BMI. Short of sleep increases sympathetic tonus, cortisol level, and activation of inflammatory pathways, impairing glucose

  7. Diagnosis of coronary artery disease in hypertensive patients

    International Nuclear Information System (INIS)

    Cuocolo, A.; Esposito, S.; Acampora, C.; Squame, C.

    1988-01-01

    Exercise radionuclide ventriculography (ERV) is considered a superior non-invasive screening test for coronary artery disease (CAD). ERV showed, however, a low specificity in hypertensive patients (H). The diagnostic accuracy of EAR and thallium-201 myocardial scintigraphy (M) was evaluated in 23 patients (H) with chest pain and positive ECG-strees test. All patients underwent ERV and M, randomly, in different days. Finally, they all underwent coronary angiography: CAD was diagnosed in case of luminal narrowing ≥ 70% in 1 major coronary artery at least. Eleven patients had severe CAD. ERV was considered positive for CAD in presence of ex-induced abnormality of wall motion and/or in case of ex-induced ejection fraction increase ≤ 5% respect to the basal values. M was considered positive for CAD when perfusion defects were observed in early images only. ERV showed low diagnostic accuracy. On the contrary M had both sensibility and specificity, and a high positive and negative predictive value in the diagnosis of CAD. M is thus suggested as the non-invasive methodology of choice in hypertensive patients with suspected CAD

  8. Clinical value of 201Tl lung/heart ratio during exercise in hypertensive patients with coronary artery disease

    International Nuclear Information System (INIS)

    Ouyang Wei; He Guorong; Liu Jinhua; Huang Yuying

    2002-01-01

    Objective: The purpose of the study was to evaluate the relationship between 201 Tl lung/heart ratio during exercise and left ventricular diastolic function and its diagnostic value on severity of coronary artery disease. Methods: One hundred and two patients with documented coronary artery disease were divided into three groups, including no hypertension, hypertension without or with left ventricular hypertrophy groups. Exercise/delay 201 Tl myocardial perfusion tomography was performed on all patients included. Lung/heart ratio was defined on the anterior planar image obtained during exercise tomography. Results: The lung/heart ratios during exercise in no hypertension (0.43 +- 0.09, P 0.05). The lung/heart ratios of multi-vessel disease subgroup in no hypertension (0.46 +- 0.10 vs 0.40 +- 0.09, P 0.05). When lung/heart ratio was≥0.45, the sensitivities for predicting the presence of multi-vessel disease were 82%, 90%, 40% and specificities were 75%, 75%, 45%, respectively, in no hypertension, hypertension without and with hypertrophy groups. In no hypertension (r=0.402, P 0.05). In no hypertension (r=-0.413, P<0.01), hypertension without (r=-0.662, P<0.01) and with hypertrophy groups (r=-0.408, P<0.05), lung/heart ratios all showed a significant reverse correlation with correspondent E/A ratios. Conclusions: The exercise lung/heart ratios has a better diagnostic value for multi-vessel disease and left ventricular diastolic function abnormalities of coronary artery disease with or without hypertension, but not for multi-vessel disease in hypertension patients complicated with myocardial hypertrophy

  9. Correlation between serum Hcy content and coronary atherosclerosis severity in patients with H-type hypertension and coronary heart disease

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    Xiao-Mei Li

    2017-03-01

    Full Text Available Objective: To analyze the correlation between serum Hcy content and coronary atherosclerosis severity in patients with H-type hypertension and coronary heart disease. Methods: 48 patients with H-type hypertension and coronary heart disease were selected as observation group, and 57 patients with normal hypertension and coronary heart disease were selected as control group. Echocardiography was used to determine coronary lesion parameters, enzymelinked immunosorbent assay (ELISA was used to determine serum levels of homocysteine (Hcy and coronary heart disease-related indexes, and the correlation between Hcy levels and coronary heart disease was further analyzed. Results: Serum Hcy level of observation group was higher than that of control group (P<0.05, absolute GLPSS value and E/A value under echocardiography were less than those of control group while E-DT and E/e value were higher than those of control group (P<0.05; serum adiponectin (APN level was lower than that of control group while P-selectin, asymmetric dimethylarginine (ADMA, oxidized high-density lipoprotein (OX-HDL, MMP-2, MMP-9, lipoprotein-associated phospholipase A2 (Lp-PLA2 and Resistin levels were higher than those of control group (P<0.05; Hcy was negatively correlated with absolute GLPSS value, E/A value and APN level, and was positively correlated with E-DT value, E/e value as well as P-selectin, ADMA, OX-HDL, MMP-2, MMP-9, Lp- PLA2 and Resistin levels (P<0.05. Conclusions: There is direct correlation between serum Hcy levels and the severity of coronary heart disease in patients with H-type hypertension and coronary heart disease, it can be a reliable way to early screen for coronary heart disease and evaluate the illness, and it is also a new target of coronary heart disease intervention.

  10. Pattern of Presentation of Coronary Artery Disease in Hypertensive ...

    African Journals Online (AJOL)

    ) and left ventricular hypertrophy (LVH). Hypertensives have a threefold increase in cardiac death (due to either CAD or to cardiac failure). In Sudan hypertension complications were increasing in incidence and prevalence. Evaluating chest ...

  11. [Evaluation of coronary risk and its relationship to health actions in hypertensive patients].

    Science.gov (United States)

    Silva, Viviane Rassele; Molina, Maria Del Carmen Bisi; Cade, Nagela Valadão

    2014-01-01

    The risk of developing acute coronary events was evaluated according to Framingham criteria and health actions performed to hypertensive patients at a Health Unit Family of Vitória-ES. This is a observational, cross-sectional study, involving 330 hypertensive. The sample considered a 50% prevalence of the disease. Data were collected from medical records and the variables were the coronary risk, blood pressure, the number of visits, educational activities and prescribed drugs. ANOVA was used to compare variables and paired t-test for comparison of pressure during the study period, with significance level of 5%. Respectively, 115 (34.8%) subjects had low risk for myocardial infarction or death from coronary heart disease in the next 10 years; 67 (20.4%) had average risk; and 148 (44.8%) had high-risk. Only the amount of prescribed medications showed significant relationship with high coronary risk.

  12. Mapping genetic determinants of coronary microvascular remodeling in the spontaneously hypertensive rat

    Czech Academy of Sciences Publication Activity Database

    Mancini, M.; Petretto, E.; Kleinert, C.; Scavone, A.; De, T.; Cook, S.; Šilhavý, Jan; Zídek, Václav; Pravenec, Michal; d´Amati, G.; Camici, P.G.

    2013-01-01

    Roč. 108, č. 1 (2013), s. 316 ISSN 0300-8428 R&D Projects: GA MŠk(CZ) LH11049; GA MŠk(CZ) LL1204; GA ČR(CZ) GAP301/12/0696 Institutional support: RVO:67985823 Keywords : arterial hypertension * coronary circulation * myocardial ischemia * spontaneously hypertensive rat * recombinant inbred strains Subject RIV: EB - Genetics ; Molecular Biology Impact factor: 5.955, year: 2013

  13. Uncontrolled hypertension is associated with coronary artery calcification and electrocardiographic left ventricular hypertrophy

    DEFF Research Database (Denmark)

    Nielsen, Mette Lundgren; Pareek, Manan; Gerke, O

    2015-01-01

    We conducted a 1:2 matched case-control study in order to evaluate whether the prevalence of coronary artery calcium (CAC) and electrocardiographic left ventricular hypertrophy (LVH) or strain was higher in patients with uncontrolled hypertension than in subjects from the general population...

  14. Swimming training prevents coronary endothelial dysfunction in ovariectomized spontaneously hypertensive rats

    Directory of Open Access Journals (Sweden)

    E.R.G. Claudio

    Full Text Available Estrogen deficiency and hypertension are considered major risk factors for the development of coronary heart disease. On the other hand, exercise training is considered an effective form to prevent and treat cardiovascular diseases. However, the effects of swimming training (SW on coronary vascular reactivity in female ovariectomized hypertensive rats are not known. We aimed to evaluate the effects of SW on endothelium-dependent coronary vasodilation in ovariectomized hypertensive rats. Three-month old spontaneously hypertensive rats (SHR, n=50 were divided into four groups: sham (SH, sham plus swimming training (SSW, ovariectomized (OVX, and ovariectomized plus swimming training (OSW. The SW protocol (5 times/week, 60 min/day was conducted for 8 weeks. The vasodilatory response was measured in isolated hearts in the absence and presence of a nitric oxide synthase inhibitor (L-NAME, 100 µM. Cardiac oxidative stress was evaluated in situ by dihydroethidium fluorescence, while the expression of antioxidant enzymes (SOD-2 and catalase and their activities were assessed by western blotting and spectrophotometry, respectively. Vasodilation in SHR was significantly reduced by OVX, even in the presence of L-NAME, in conjunction with an increased oxidative stress. These effects were prevented by SW, and were associated with a decrease in oxidative stress. Superoxide dismutase 2 (SOD-2 and catalase expression increased only in the OSW group. However, no significant difference was found in the activity of these enzymes. In conclusion, SW prevented the endothelial dysfunction in the coronary bed of ovariectomized SHR associated with an increase in the expression of antioxidant enzymes, and therefore may prevent coronary heart disease in hypertensive postmenopausal women.

  15. [Treatment of hypertension in patients with coronary arterial disease].

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    Rosas-Peralta, Martín; Borrayo-Sánchez, Gabriela; Madrid-Miller, Alejandra; Ramírez-Arias, Erick; Pérez-Rodríguez, Gilberto

    2016-01-01

    Reports of randomized controlled trials and prospective observational studies provide the most reliable data on the association between blood pressure and coronary heart disease (CHD). The totality of the evidence indicate a strong association between blood pressure and coronary heart disease, which is continuous at levels of less than 115 mm Hg of systolic. In general, 60 to 69 years of age, 10 lower mm Hg systolic blood pressure is associated with lower risk of one-fifth of a coronary heart disease event. The size and shape of this Association are consistent in all regions, for men and women and life-threatening events such as stroke and myocardial infarction. Trials that compared active treatment with placebo or no treatment have shown that the benefits of reducing blood pressure with different classes of drugs (e.g., diuretics, beta-blockers, ACE inhibitors, calcium antagonists) are quite similar, with about a fifth of reduction in coronary heart disease. The important points in this review are: First, that the relative benefit to the decline in blood pressure for the prevention of coronary heart disease appears to be constant in a range of different populations. Second, it is likely that considerable benefit with blood pressure low below thresholds of "traditional" blood pressure (140/90 mm Hg), especially in those with high absolute risk. Third, start, reduce with caution -especially in adult- and keep the maximum tolerance of blood pressure reduction is an issue more important than the choice of the initial agent.

  16. Marital Status, Hypertension, Coronary Heart Disease, Diabetes, and Death among African American Women and Men: Incidence and Prevalence in the Atherosclerosis Risk in Communities (ARIC) Study Participants

    Science.gov (United States)

    Schwandt, Hilary M.; Coresh, Josef; Hindin, Michelle J.

    2010-01-01

    Heart disease is the leading cause of death in the United States, and African Americans disproportionately experience more cardiovascular disease, including coronary heart disease (CHD), hypertension, and diabetes. The literature documents a complex relationship between marital status and health, which varies by gender. We prospectively examine…

  17. Audit of health care quality for patients with essential hypertension, chronic coronary artery disease, chronic heart failure, acute coronary syndrome: principles of organization, algorithm of implementation

    Directory of Open Access Journals (Sweden)

    Gridnev V.I.

    2016-12-01

    Full Text Available The article presents principal stages of audit of healthcare quality delivered to patients with cardiovascular diseases. The schedule of measures related to every audit stage is presented. Usefulness of the registry of patients with arterial hypertension, chronic coronary artery disease, chronic heart failure and the registry of acute coronary syndrome for purposes of clinical audit in medical practice is considered.

  18. Endothelial and non-endothelial coronary blood flow reserve and left ventricular dysfunction in systemic hypertension

    Directory of Open Access Journals (Sweden)

    Aloísio Marchi Rocha

    2009-04-01

    Full Text Available OBJECTIVES: We evaluated the impairment of endothelium-dependent and endothelium-independent coronary blood flow reserve after administration of intracoronary acetylcholine and adenosine, and its association with hypertensive cardiac disease. INTRODUCTION: Coronary blood flow reserve reduction has been proposed as a mechanism for the progression of compensated left ventricular hypertrophy to ventricular dysfunction. METHODS: Eighteen hypertensive patients with normal epicardial coronary arteries on angiography were divided into two groups according to left ventricular fractional shortening (FS. Group 1 (FS >0.25: n=8, FS=0.29 ± 0.03; Group 2 (FS <0.25: n=10, FS= 0.17 ± 0.03. RESULTS: Baseline coronary blood flow was similar in both groups (Group 1: 80.15 ± 26.41 mL/min, Group 2: 100.09 ± 21.51 mL/min, p=NS. In response to adenosine, coronary blood flow increased to 265.1 ± 100.2 mL/min in Group 1 and to 300.8 ± 113.6 mL/min (p <0.05 in Group 2. Endothelium-independent coronary blood flow reserve was similar in both groups (Group 1: 3.31 ± 0.68 and Group 2: 2.97 ± 0.80, p=NS. In response to acetylcholine, coronary blood flow increased to 156.08 ± 36.79 mL/min in Group 1 and to 177.8 ± 83.6 mL/min in Group 2 (p <0.05. Endothelium-dependent coronary blood flow reserve was similar in the two groups (Group 1: 2.08 ± 0.74 and group Group 2: 1.76 ± 0.61, p=NS. Peak acetylcholine/peak adenosine coronary blood flow response (Group 1: 0.65 ± 0.27 and Group 2: 0.60 ± 0.17 and minimal coronary vascular resistance (Group 1: 0.48 ± 0.21 mmHg/mL/min and Group 2: 0.34 ± 0.12 mmHg/mL/min were similar in both groups (p= NS. Casual diastolic blood pressure and end-systolic left ventricular stress were independently associated with FS. CONCLUSIONS: In our hypertensive patients, endothelium-dependent and endothelium-independent coronary blood flow reserve vasodilator administrations had similar effects in patients with either normal or decreased left

  19. [Glucometabolic abnormalities survey among outpatients without previous diabetes diagnosis and with coronary artery disease and hypertension].

    Science.gov (United States)

    Chen, Yun-dai; Li, Dan-dan; Dong, Wei; Li, Li; Luo, Jun; Yang, Jie-fu; Qu, Zheng; Li, Shu-guang; Cheng, Xiao-jie; Ji, Han-hua; Zhao, Yan; Huang, Dang-sheng

    2013-12-01

    To explore the status of glucometabolic abnormalities in cardiological outpatients without previous diabetes diagnosis and with coronary artery disease (CAD) and hypertension. Patients without previous diagnosis of diabetes but with hypertension and CAD aged 18 years or above were recruited from cardiology departments of 11 general hospitals in China. Demographic data, disease diagnosis and medical history were collected. Physical examination and questionnaire survey were performed after the random blood glucose test. Oral glucose tolerance test (OGTT) examination was made for patients with fasting blood glucose ≥ 6.1 mmol/L or postprandial random glucose ≥ 7.8 mmol/L. Adjusted prevalence rates were used in the study. A total of 7778 patients were included in 11 centers. After preliminary screening by fasting blood glucose and random blood glucose tests, 3861 patients were required to take OGTT, and 3019 (78.2%) patients actually took the test. 1287 out of 3019 patients screened with OGTT were diagnosed with diabetes, and the adjusted diabetes prevalence rate was 18.64% (1287/6904). The prevalence rate of diabetes was 19.87% (95/478), 9.22% (352/3819) and 14.81% (153/1033) in patients with CAD, hypertension, and CAD combined with hypertension, respectively. A total of 996 patients were diagnosed with impaired glucose tolerance (IGT) and its prevalence was 14.43% (996/6904). Of the enrolled population, 153 patients with random blood glucose lower than 7.8 mmol/L were also screened with OGTT test, 26.14% (40/153) patients met the diagnostic criteria of diabetes. A high prevalence of diabetes is found in patients without previous diagnosis of diabetes and with hypertension and CAD consulting at cardiology departments. We thus suggest to perform OGTT in this patient cohort to improve the early diagnosis of IGT and diabetes, and prevent missed detection of type 2 diabetes mellitus or IGT in cardiovascular patients with normal fasting blood glucose. Our results

  20. Male Gender and Arterial Hypertension are Plaque Predictors at Coronary Computed Tomography Angiography

    Science.gov (United States)

    Oliveira, Joselina Luzia Menezes; Hirata, Mario Hiroyuki; Sousa, Amanda Guerra de Moraes Rego; Gabriel, Fabíola Santos; Hirata, Thiago Dominguez Crespo; Tavares, Irlaneide da Silva; Melo, Luiza Dantas; Dória, Fabiana de Santana; Sousa, Antônio Carlos Sobral; Pinto, Ibraim Masciarelli Francisco

    2015-01-01

    Background Systemic Arterial Hypertension (SAH) is one of the main risk factors for Coronary Artery Disease (CAD), in addition to male gender. Differences in coronary artery lesions between hypertensive and normotensive individuals of both genders at the Coronary Computed Tomography Angiography (CCTA) have not been clearly determined. Objective To Investigate the calcium score (CS), CAD extent and characteristics of coronary plaques at CCTA in men and women with and without SAH. Methods Prospective cross-sectional study of 509 patients undergoing CCTA for CAD diagnosis and risk stratification, from November 2011 to December 2012, at Instituto de Cardiologia Dante Pazzanese. Individuals were stratified according to gender and subdivided according to the presence (HT +) or absence (HT-) of SAH. Results HT+ women were older (62.3 ± 10.2 vs 57.8 ± 12.8, p = 0.01). As for the assessment of CAD extent, the HT+ individuals of both genders had significant CAD, although multivessel disease is more frequent in HT + men. The regression analysis for significant CAD showed that age and male gender were the determinant factors of multivessel disease and CS ≥ 100. Plaque type analysis showed that SAH was a predictive risk factor for partially calcified plaques (OR = 3.9). Conclusion Hypertensive men had multivessel disease more often than women. Male gender was a determinant factor of significant CAD, multivessel disease, CS ≥ 100 and calcified and partially calcified plaques, whereas SAH was predictive of partially calcified plaques. PMID:25861034

  1. Estrogen therapy may counterbalance eutrophic remodeling of coronary arteries and increase bradykinin relaxation in a rat model of menopausal hypertension.

    Science.gov (United States)

    Matrai, Mate; Hetthéssy, Judit R; Nadasy, Gyorgy L; Szekacs, Bela; Mericli, Metin; Acs, Nandor; Monos, Emil; Arbib, Nissim; Varbiro, Szabolcs

    2016-07-01

    Hypertension causes adverse remodeling and vasomotor alterations in coronaries. Hormones such as estrogen may help counterbalance some of these effects. The aim of this study was to analyze the effects of ovariectomy and estrogen therapy in a rat model of menopausal hypertension induced by angiotensin II (AII). We investigated diameter, tone, and mechanics of intramural coronaries taken from ovariectomized female rats (n = 11) that received chronic AII treatment to induce hypertension, and compared the results with those found in female rats that were also given estrogen therapy (n = 11). The "hypertensive control" group (n = 11) underwent an abdominal sham operation, and received AII. After 4 weeks of AII treatment, side branches of left anterior descendent coronary (approximately 200 μm in diameter) were isolated, cannulated with plastic microcannulas at both ends, and studied in vitro in a vessel chamber. The inner and outer diameter of the arteries were measured by microangiometry, and spontenuous tone, wall thickness, wall cross-sectional area, tangential stress, incremental distensibility, circumferential incremental elastic modulus, thromboxane agonist-induced tone, and bradykinin-induced dilation were calculated. In hypertension, intramural small coronaries show inward eutrophic remodeling after ovariectomy comparing with hypertensive controls. Estrogen therapy had an opposite effect on vessel diameter. Hormone therapy led to an increase in spontaneous tone, allowing for greater dilatative capacity. Estrogen may therefore be considered to counterbalance some of the adverse changes seen in the wall of intramural coronaries in the early stages of chronic hypertension.

  2. Use of Mixed Methods Research in Research on Coronary Artery Disease, Diabetes Mellitus, and Hypertension: A Scoping Review.

    Science.gov (United States)

    Campbell, David J T; Tam-Tham, Helen; Dhaliwal, Kirnvir K; Manns, Braden J; Hemmelgarn, Brenda R; Sanmartin, Claudia; King-Shier, Kathryn

    2017-01-01

    Mixed methods research, the use of both qualitative and quantitative methods within 1 program of study, is becoming increasingly popular to allow investigators to explore patient experiences (qualitative) and also measure outcomes (quantitative). Coronary artery disease and its risk factors are some of the most studied conditions; however, the extent to which mixed methods studies are being conducted in these content areas is unknown. We sought to comprehensively describe the characteristics of published mixed methods studies on coronary artery disease and major risk factors (diabetes mellitus and hypertension). We conducted a scoping review of the literature indexed in PubMed, Medline, EMBASE, and CINAHL. We identified 811 abstracts for screening, of which 254 articles underwent full-text review and 97 reports of 81 studies met criteria for inclusion. The majority of studies in this area were conducted in the past 10 years by nurse researchers from the United States and United Kingdom. Diabetes mellitus was the most common content area for mixed methods investigation (compared with coronary artery disease and hypertension). Most authors described their rationale for using mixed methods as complementarity and did not describe study priority or how they reconciled differences in methodological paradigms. Some mixed methods study designs were more commonly used than others, including concurrent timing and integration at the interpretation stage. Qualitative strands were most commonly descriptive studies using interviews for data collection. Quantitative strands were most commonly cross-sectional observational studies, which relied heavily on self-report data such as surveys and scales. Although mixed methods research is becoming increasingly popular in the area of coronary artery disease and its risk factors, many of the more advanced mixed methods, qualitative, and quantitative techniques have not been commonly used in these areas. © 2016 American Heart Association

  3. Contrast induced nephropathy in hypertensive patients after elective percutaneous coronary intervention

    Science.gov (United States)

    Aryfa Andra, Cut; Khairul, Andi; Aria Arina, Cut; Mukhtar, Zulfikri; Nyak Kaoy, Isfanuddin

    2018-03-01

    Contrast induced nephropathy (CIN) is the third lead cause of hospital acquired renal failure and was associated with significant morbidity and mortality. We hypothesized that hypertension is an independent risk factor for the development of CIN in patients undergoing elective percutaneous coronary intervention (PCI). The case-control method was used, 138 patients scheduled for elective PCI. We measured serum creatinine at baseline and after 24 hours of the procedure. CIN was defined as arising in serum creatinine of at least 44 μmol/l (0,5 mg/dl) or 25% rise from baseline. All patients received low osmolality nonionic contrast during PCI. Hypertension was defined as self-reported a history of treated or untreated diagnosed high blood pressure. One hundred thirty-eight patients (74,6%) were male, and 35 patients (25,4%) were female. Among the 138 patients, 86 (62,3%) were hypertensive patients whereas 52 (37,7%) were nonhypertensive patients. There was no difference in baseline serum creatinine levels and the amount of contrast media in patient with and without CIN. CIN developed in 42 patients, 39 patients (92,9%) were hypertensive compared to 3 patients (7,1%) without hypertension with p value < 0,05. (Odds ratio 16,8, 95% CI 4.542 - 62,412). This study showed that hypertension was a risk factor for the development of CIN

  4. Augmented agonist-induced Ca(2+)-sensitization of coronary artery contraction in genetically hypertensive rats. Evidence for altered signal transduction in the coronary smooth muscle cells.

    Science.gov (United States)

    Satoh, S; Kreutz, R; Wilm, C; Ganten, D; Pfitzer, G

    1994-01-01

    The Ca2+ responsiveness of vascular smooth muscle myofilaments is not unique: it is increased during neuro-humoral activation and decreased during beta-adrenergic stimulation. In this study we tested whether an augmented Ca2+ responsiveness of smooth muscle myofilaments may contribute to the increased coronary tone observed in hypertension using beta-escin-permeabilized coronary arteries from 3-mo-old stroke-prone spontaneously hypertensive rats (SHRSP) and their age matched normotensive reference strain (WKY rats). In intact coronary arteries, the response to 5-hydroxytryptamine (5-HT) but not to KCl was larger in SHRSP than in WKY rats. In beta-escin permeabilized coronary arteries in which the receptor effector coupling is still intact, 5-HT enhanced force at constant submaximal (Ca2+) (pCa 6.38) to a greater extent in SHRSP. The Ca2+ sensitizing effect of 5-HT was mimicked by GTP gamma S (0.01-10 microM); again this effect was larger in SHRSP. In the absence of 5-HT or GTP gamma S the Ca2+ force relation was similar in both groups. Forskolin induced relaxation at constant submaximal (Ca2+). This desensitizing effect was smaller in SHRSP than in WKY rats. In conclusion, this study shows that intracellular signalling pathways involved in modulating the Ca2+ responsiveness of coronary smooth muscle myofilaments are altered in the genetically hypertensive animals favoring a hypercontractile state in the coronary circulation. PMID:7929815

  5. Prevalence of hypertension among obese and non-obese patients with coronary artery disease

    International Nuclear Information System (INIS)

    Khan, S.B.; Noor, L.; Awan, Z.A.; Shahab-ud-Din; Shah, S.S.

    2010-01-01

    Background: Globally, obesity is now recognised as an epidemic. The degree of obesity is proportional to the rate of development of cardiovascular diseases, hence, resulting in a dramatic increase in morbidity and mortality. Apart from obesity, hypertension is another well recognised risk factor contributing to coronary artery disease (CAD). The precise prevalence of obesity-related hypertension varies with age, race and gender; and is yet unknown in our population. The objective of this study was to determine the prevalence of hypertension in obese and non-obese patients with diagnosed CAD. Methods: This hospital based descriptive study was conducted in Cardiology Department of Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from March 15, 2007 to May 30, 2008. A total of 200 patients with diagnosed CAD were enrolled, 100 were found obese and 100 non-obese. Results: Among these, a total of 111 (55.5%) were found to be hypertensive, 66 (59.46%) of these were obese and 45 (40.54%) non-obese (p=0.003). Conclusion: Obese patients with CAD had significantly more frequent hypertension. (author)

  6. Effect of tamoxifen on the coronary vascular reactivity of spontaneously hypertensive female rats

    Directory of Open Access Journals (Sweden)

    M.V. Borgo

    2011-08-01

    Full Text Available Tamoxifen has been associated with a reduction in the incidence of myocardial infarction. However, the effects of tamoxifen on coronary reactivity have not been fully elucidated. The objective of this study was to determine the effects of chronic treatment with tamoxifen on coronary vascular reactivity in spontaneously hypertensive rats (SHR. Female SHR were divided into four groups (N = 7 each: sham-operated (SHAM, sham-operated and treated with tamoxifen (10 mg/kg by gavage for 90 days (TAMOX, ovariectomized (OVX, and ovariectomized and treated with tamoxifen (OVX+TAMOX. Mean arterial pressure (MAP, heart rate (HR, coronary perfusion pressure (CPP, and coronary vascular reactivity were measured. MAP and HR were reduced (9.42 and 11.67%, respectively in the OVX+TAMOX group compared to the OVX group (P < 0.01. The coronary vascular reactivity of the OVX+TAMOX group presented smaller vasoconstrictor responses to acetylcholine (2-64 µg when compared to the OVX group (P < 0.01 and this response was similar to that of the SHAM group. The adenosine-induced vasodilator response was greater in the TAMOX group compared to the SHAM and OVX groups (P < 0.05. Baseline CPP was higher in OVX+TAMOX and TAMOX groups (136 ± 3.6 and 130 ± 1.5 mmHg than in OVX and SHAM groups (96 ± 2 and 119 ± 2.3 mmHg; P < 0.01. Tamoxifen, when combined with OVX, attenuated the vasoconstriction induced by acetylcholine and increased the adenosine-induced vasodilatory response, as well as reducing the MAP, suggesting beneficial effects of tamoxifen therapy on coronary vascular reactivity after menopause.

  7. Prevalence and management of hypertension in patients with acute coronary syndrome vary with gender: Observations from the Chinese registry of acute coronary events (CRACE).

    Science.gov (United States)

    Lin, Yun; Pan, Weiqi; Ning, Shangqiu; Song, Xiantao; Jin, Zening; Lv, Shuzheng

    2013-07-01

    Hypertension affects one billion people worldwide and is an independent risk factor for death after acute coronary syndrome (ACS). The aim of this study was to examine the prevalence and medical treatment of hypertension among 1,301 ACS patients enrolled into the Chinese registry of acute coronary events (CRACE) trial. Analyses were performed by gender, with both genders combined and according to international practice. Multivariable models identified factors associated with use of different classes of antihypertensive medication, and examined the correlation between hypertension and gender with mortality. The use of angiotensin‑converting enzyme inhibitors (ACEI), β-blockers, calcium channel blockers (CCBs) and diuretics increased in both genders during management of presenting ACS. Hypertensive men were more likely to have been receiving β-blockers when they were discharged (77.2%) than women (69.2%). Hypertensive women were more likely to have received diuretics when they were discharged (28.4%) than men (22%). ACEI use increased by ~60% (absolute increase) in both women and men as a result of ACS treatment, but remained similar between the genders, and the same phenomenon was observed in the use of CCBs. Moreover, hypertensive women were less likely to receive evidence‑based medication to treat their acute coronary event than men (for women and men, respectively: β-blocker, 69.2 vs. 77.2%; ACEI, 85.8 vs. 87.5%). Hypertension is more prevalent in women than in men with ACS, and its medical management varies with gender, but it has a similar association with mortality in both genders. Opportunities exist to improve medical therapy and outcomes for women with hypertension.

  8. Radiologically revealed spine osteoporosis in male with hypertension and coronary heart disease

    Directory of Open Access Journals (Sweden)

    P A Chizhov

    2005-01-01

    Full Text Available Radiologically revealed spine osteoporosis in male with hypertension and coronary heart disease Objective. To study prevalence and intensity of spine osteoporosis (OP in men suffering from hypertension (H and coronary heart disease (CHD. Material and methods. 101 men with H and CHD aged 50 to 78 years (mean age 60,6±0,85 years and 37 men of control group without cardiovascular diseases aged 50-66 years (mean age 58,6±0,74 years were examined. Clinical examination, radiological, radiomorphometric spine examination and echocardioscopy were performed. Results. OP was revealed in 34,65% of main group pts what is 3,2 times more frequent than in control group (10,8%, p<0,05. OP intensity in men with H and CHD was significantly higher than in healthy people. Vfertebral fractures were revealed in 12,87+3,3% of main group pts and only in 2,7±2,7% in control group (p<0,05. OP development dependence from cardiac history duration and cardiac pathology severity was demonstrated. Conclusion. The results of the study show significantly higher prevalence of spine OP among men suffering from H and CHD. Long history and severity of cardiovascular pathology clinical signs promote OP frequency and severity increase.

  9. Relative risk of hypertension and coronary artery disease in diabetes mellitus

    International Nuclear Information System (INIS)

    Chaudhary, G.M.D.

    2001-01-01

    During the year 1996-1997, 3275 diabetic patients, registered in Diabetic Clinic of Jinnah Hospital, Lahore, were studied to note the effect of various variables of diabetes mellitus (DM) on hypertension (HTN) and coronary artery diseases (CAD). Out of these 1402 (42.8%) were hypertensive patients. HTN was observed more frequently in obese, older age, longer duration of DM, poor glycemic control and dyslipidemia with p<0.0001. The relative risk (RR) of HTN was significantly increased (p<0.001) in obese (M2.53, F7.77 times), older age (M 3.69,F 9.64 times), longer duration of Dm (2.3 times for both sexes), poor glycemic control (M 2.89, F 4.75 times) and dyslipedemia (M 1.62-5.27, F2.56-9.53 times). While the RR of CAD due to HTN was 4.6 times (M5.4, F4.2 times) (p<0.0001) as compared to normotensive diabetic patients. The risk of developing HTN is more in female diabetics and of CAD in male hypertensive diabetic patients. It is concluded that obesity, older age, poor glycemic control, longer duration of DM and dyslipidemia increases the risk of HTN 2-9.5 times and HTN increases the risk of CAD by 4-5 times, hence requiring aggressive and comprehensive treatment of the diabetes mellitus syndrome. (author)

  10. Relationship between dietary approaches to stop hypertension score and presence or absence of coronary heart diseases in patients referring to Imam Hossein Hospital, Tehran, Iran

    OpenAIRE

    Mokhtari, Zeinab; Nasrollahzadeh, Javad; Miri, Reza; Rashidkhani, Bahram; Hosseini, Saeed

    2013-01-01

    BACKGROUND The dietary approaches to stop hypertension (DASH) dietary pattern reduces blood pressure. However, there is little information about the relationship between DASH and coronary heart diseases. This study aimed to assess the relationship between a DASH-style diet adherence score and coronary heart diseases (CHD) in patients referring for coronary angiography. METHODS In this study, 201 adults (102 males, 99 females) within the age range of 40-80 years who referred for coronary angio...

  11. Pomegranate peel extract attenuates oxidative stress by decreasing coronary angiotensin-converting enzyme (ACE) activity in hypertensive female rats.

    Science.gov (United States)

    Dos Santos, Roger L; Dellacqua, Lais O; Delgado, Nathalie T B; Rouver, Wender N; Podratz, Priscila L; Lima, Leandro C F; Piccin, Mariela P C; Meyrelles, Silvana S; Mauad, Helder; Graceli, Jones B; Moyses, Margareth R

    2016-01-01

    Based on the antioxidant properties of pomegranate, this study was designed to investigate the effects of pomegranate peel extract on damage associated with hypertension and aging in a spontaneously hypertensive rat (SHR) model. The influence of pomegranate consumption was examined on systolic blood pressure (SBP), angiotensin-converting enzyme (ACE) coronary activity, oxidative stress, and vascular morphology. Four- or 28-wk-old SHR model rats were treated for 30 d, with terminal experimental animal age being 8 and 32 wk, respectively, with either pomegranate extract (SHR-PG) or filtered water (SHR). Data showed significant reduction in SBP and coronary ACE activity in both age groups. The levels of superoxide anion, a measure of oxidative stress, were significantly lower in animals in the SHR-PG group compared to SHR alone. Coronary morphology demonstrated total increases in vascular wall areas were in the SHR group, and pomegranate peel extract diminished this effect. Pomegranate peel extract consumption conferred protection against hypertension in the SHR model. This finding was demonstrated by marked reduction in coronary ACE activity, oxidative stress, and vascular remodelling. In addition, treatment was able to reduce SBP in both groups. Evidence indicates that the use of pomegranate peel extract may prove beneficial in alleviating coronary heart disease.

  12. Hypertension and obesity comorbidities increases coronary risk, affects domains of sexual function and sexual quality of life.

    Science.gov (United States)

    Alidu, H; Owiredu, W K B A; Amidu, N; Gyasi-Sarpong, C K; Dapare, P P M; Bawah, A T; Obirikorang, C; Luuse, A T

    2017-11-27

    About 25% of the world's adult population suffers from arterial hypertension with about 1.5 billion estimated to develop hypertension by 2025. Hypertensive patients have been reported to have a higher risk of developing diabetes and sexual dysfunction. Hypertension have been linked with lubricative and orgasmic difficulties in females, as wel as ED and vascular disease in men. Obesity has also been linked to ED in diabetic males as well as several aspects of female sexuality. Hypertension and obesity are closely related, each occurring in greater frequency with the other, it is only logical to think that comorbidities of obesity and hypertension could increase the risk of cardiovascular disease and SD. This research looks at the relationship between hypertension and obesity comorbidities and its association with sexual function in type II diabetics. Diabetic patients who were at least 18 years old and were engaged in a stable heterosexual relationships for at least 1 year were recruited for this study. Participants were categorized into the -HYP/-OB, +HYP/-OB and the +HYP/+OB groups. Sexual function was assessed using the GRISS-M and GRIS-F for the diabetic males and females respectively. Early morning fasting blood samples was used in lipid profile as well as FBG assay. The Coronary risk was estimated as Total/HDL Cholesterol. Triglyceride levels and coronary risk were highest in the +HYP/+OBES group, followed by the +HYP/-OBES group, with the -HYP/-OBES group recording the lowest levels. PE and infrequency recorded the highest score among the +HYP/+OBES group with the +HYP/-OBES group recording the lowest scores. SQoL was highest amongst the -HYP/-OBES group, with the +HYP/+OBES group recording the lowest scores. Anorgasmia and avoidance increased along the shades of HYP/OBES groups. Comorbidities of hypertension and obesity increases the risk of coronary disease, affects some domains of sexual function and decreases the SQoL of diabetics.

  13. Pomegranate Extract Enhances Endothelium-Dependent Coronary Relaxation in Isolated Perfused Hearts from Spontaneously Hypertensive Ovariectomized Rats

    Science.gov (United States)

    Delgado, Nathalie T. B.; Rouver, Wender do N.; Freitas-Lima, Leandro C.; de Paula, Tiago D.-C.; Duarte, Andressa; Silva, Josiane F.; Lemos, Virgínia S.; Santos, Alexandre M. C.; Mauad, Helder; Santos, Roger L.; Moysés, Margareth R.

    2017-01-01

    Decline in estrogen levels promotes endothelial dysfunction and, consequently, the most prevalent cardiovascular diseases in menopausal women. The use of natural therapies such as pomegranate can change these results. Pomegranate [Punica granatum L. (Punicaceae)] is widely used as a phytotherapeutic agent worldwide, including in Brazil. We hypothesized that treatment with pomegranate hydroalcoholic extract (PHE) would improve coronary vascular reactivity and cardiovascular parameters. At the beginning of treatment, spontaneously hypertensive female rats were divided into Sham and ovariectomized (OVX) groups, which received pomegranate extract (PHE) (250 mg/kg) or filtered water (V) for 30 days by gavage. Systolic blood pressure was measured by tail plethysmography. After euthanasia, the heart was removed and coronary vascular reactivity was assessed by Langendorff retrograde perfusion technique. A dose-response curve for bradykinin was performed, followed by L-NAME inhibition. The protein expression of p-eNOS Ser1177, p-eNOS Thr495, total eNOS, p-AKT Ser473, total AKT, SOD-2, and catalase was quantified by Western blotting. The detection of coronary superoxide was performed using the protocol of dihydroethidium (DHE) staining Plasma nitrite measurement was analyzed by Griess method. Systolic blood pressure increased in both Sham-V and OVX-V groups, whereas it was reduced after treatment in Sham-PHE and OVX-PHE groups. The baseline coronary perfusion pressure was reduced in the Sham-PHE group. The relaxation was significantly higher in the treated group, and L-NAME attenuated the relaxation in all groups. The treatment has not changed p-eNOS (Ser1177), total eNOS, p-AKT (Ser473) and total AKT in any groups. However, in Sham and OVX group the treatment reduced the p-eNOS (Thr495) and SOD-2. The ovariectomy promoted an increasing in the superoxide anion levels and the treatment was able to prevent this elevation and reducing oxidative stress. Moreover, the treatment

  14. Hormonal therapy with estradiol and drospirenone improves endothelium-dependent vasodilation in the coronary bed of ovariectomized spontaneously hypertensive rats

    International Nuclear Information System (INIS)

    Borgo, M.V.; Claudio, E.R.G.; Silva, F.B.; Romero, W.G.; Gouvea, S.A.; Moysés, M.R.; Santos, R.L.; Almeida, S.A.; Podratz, P.L.; Graceli, J.B.; Abreu, G.R.

    2015-01-01

    Drospirenone (DRSP) is a progestin with anti-aldosterone properties and it reduces blood pressure in hypertensive women. However, the effects of DRSP on endothelium-dependent coronary vasodilation have not been evaluated. This study investigated the effects of combined therapy with estrogen (E2) and DRSP on endothelium-dependent vasodilation of the coronary bed of ovariectomized (OVX) spontaneously hypertensive rats. Female spontaneously hypertensive rats (n=87) at 12 weeks of age were randomly divided into sham operated (Sham), OVX, OVX treated with E2 (E2), and OVX treated with E2 and DRSP (E2+DRSP) groups. Hemodynamic parameters were directly evaluated by catheter insertion into the femoral artery. Endothelium-dependent vasodilation in response to bradykinin in the coronary arterial bed was assessed using isolated hearts according to a modified Langendorff method. Coronary protein expression of endothelial nitric oxide synthase and estrogen receptor alpha (ER-α) was assessed by Western blotting. Histological slices of coronary arteries were stained with hematoxylin and eosin, and morphometric parameters were analyzed. Oxidative stress was assessed in situ by dihydroethidium fluorescence. Ovariectomy increased systolic blood pressure, which was only prevented by E2+DRSP treatment. Estrogen deficiency caused endothelial dysfunction, which was prevented by both treatments. However, the vasodilator response in the E2+DRSP group was significantly higher at the three highest concentrations compared with the OVX group. Reduced ER-α expression in OVX rats was restored by both treatments. Morphometric parameters and oxidative stress were augmented by OVX and reduced by E2 and E2+DRSP treatments. Hormonal therapy with E2 and DRSP may be an important therapeutic option in the prevention of coronary heart disease in hypertensive post-menopausal women

  15. Hormonal therapy with estradiol and drospirenone improves endothelium-dependent vasodilation in the coronary bed of ovariectomized spontaneously hypertensive rats

    Directory of Open Access Journals (Sweden)

    M.V. Borgo

    2016-01-01

    Full Text Available Drospirenone (DRSP is a progestin with anti-aldosterone properties and it reduces blood pressure in hypertensive women. However, the effects of DRSP on endothelium-dependent coronary vasodilation have not been evaluated. This study investigated the effects of combined therapy with estrogen (E2 and DRSP on endothelium-dependent vasodilation of the coronary bed of ovariectomized (OVX spontaneously hypertensive rats. Female spontaneously hypertensive rats (n=87 at 12 weeks of age were randomly divided into sham operated (Sham, OVX, OVX treated with E2 (E2, and OVX treated with E2 and DRSP (E2+DRSP groups. Hemodynamic parameters were directly evaluated by catheter insertion into the femoral artery. Endothelium-dependent vasodilation in response to bradykinin in the coronary arterial bed was assessed using isolated hearts according to a modified Langendorff method. Coronary protein expression of endothelial nitric oxide synthase and estrogen receptor alpha (ER-α was assessed by Western blotting. Histological slices of coronary arteries were stained with hematoxylin and eosin, and morphometric parameters were analyzed. Oxidative stress was assessed in situ by dihydroethidium fluorescence. Ovariectomy increased systolic blood pressure, which was only prevented by E2+DRSP treatment. Estrogen deficiency caused endothelial dysfunction, which was prevented by both treatments. However, the vasodilator response in the E2+DRSP group was significantly higher at the three highest concentrations compared with the OVX group. Reduced ER-α expression in OVX rats was restored by both treatments. Morphometric parameters and oxidative stress were augmented by OVX and reduced by E2 and E2+DRSP treatments. Hormonal therapy with E2 and DRSP may be an important therapeutic option in the prevention of coronary heart disease in hypertensive post-menopausal women.

  16. Hormonal therapy with estradiol and drospirenone improves endothelium-dependent vasodilation in the coronary bed of ovariectomized spontaneously hypertensive rats

    Energy Technology Data Exchange (ETDEWEB)

    Borgo, M.V.; Claudio, E.R.G.; Silva, F.B.; Romero, W.G.; Gouvea, S.A.; Moysés, M.R.; Santos, R.L.; Almeida, S.A. [Departamento de Ciências Fisiológicas, Centro de Ciências da Saúde, Universidade Federal de Espírito Santo, Vitória, ES (Brazil); Podratz, P.L.; Graceli, J.B. [Departamento de Morfologia, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, ES (Brazil); Abreu, G.R. [Departamento de Ciências Fisiológicas, Centro de Ciências da Saúde, Universidade Federal de Espírito Santo, Vitória, ES (Brazil)

    2015-11-17

    Drospirenone (DRSP) is a progestin with anti-aldosterone properties and it reduces blood pressure in hypertensive women. However, the effects of DRSP on endothelium-dependent coronary vasodilation have not been evaluated. This study investigated the effects of combined therapy with estrogen (E2) and DRSP on endothelium-dependent vasodilation of the coronary bed of ovariectomized (OVX) spontaneously hypertensive rats. Female spontaneously hypertensive rats (n=87) at 12 weeks of age were randomly divided into sham operated (Sham), OVX, OVX treated with E2 (E2), and OVX treated with E2 and DRSP (E2+DRSP) groups. Hemodynamic parameters were directly evaluated by catheter insertion into the femoral artery. Endothelium-dependent vasodilation in response to bradykinin in the coronary arterial bed was assessed using isolated hearts according to a modified Langendorff method. Coronary protein expression of endothelial nitric oxide synthase and estrogen receptor alpha (ER-α) was assessed by Western blotting. Histological slices of coronary arteries were stained with hematoxylin and eosin, and morphometric parameters were analyzed. Oxidative stress was assessed in situ by dihydroethidium fluorescence. Ovariectomy increased systolic blood pressure, which was only prevented by E2+DRSP treatment. Estrogen deficiency caused endothelial dysfunction, which was prevented by both treatments. However, the vasodilator response in the E2+DRSP group was significantly higher at the three highest concentrations compared with the OVX group. Reduced ER-α expression in OVX rats was restored by both treatments. Morphometric parameters and oxidative stress were augmented by OVX and reduced by E2 and E2+DRSP treatments. Hormonal therapy with E2 and DRSP may be an important therapeutic option in the prevention of coronary heart disease in hypertensive post-menopausal women.

  17. Judgment value of brachial-ankle pulse wave velocity for lesion severity in hypertension patients with coronary arteriosclerosis

    Directory of Open Access Journals (Sweden)

    Zhong Zhao

    2016-07-01

    Full Text Available Objective: To analyze the judgment value of brachial-ankle pulse wave velocity for lesion severity in hypertension patients with coronary arteriosclerosis. Methods: A total of 100 cases of hypertension patients with coronary arteriosclerosis who received physical examination in Physical Examination Centre of our hospital were collected as research subjects of observation group, 100 cases patients with primary hypertension alone who received treatment in our hospital during the same period were selected as control group, brachial-ankle pulse wave velocity and ultrasound coronary area were detected, serum was collected to detect the levels of coronary arteriosclerosis illness-related indicators in it, and the judgment value of brachialankle pulse wave velocity for coronary arteriosclerosis severity was further analyzed. Results: PWV value of observation group was higher than that of control group while ABI value was lower than that of control group; intravascular ultrasound inspection showed that blood vessel volume, lumen volume and plaque volume of observation group were larger than those of control group; serum Hcy, Ox-LDL and ApoB/ApoA1 values of observation group were higher than those of control group while APN value was lower than that of control group; serum Lp-PLA2, sTWEAK, CML and bFGF values of observation group were higher than those of control group while secKlotho, Chrelin and MPO values were lower than those of control group; PWV and ABI values were directly correlated with disease severity-related factors. Conclusions: Brachial-ankle pulse wave velocity can effectively judge the lesion severity of hypertension patients with coronary arteriosclerosis, can be used as one of the accurate indicators to guide treatment and judge prognosis in clinical practice, and has important clinical value.

  18. Observations on the presence of insulin resistance in patients with essential hypertension and coronary heart disease

    International Nuclear Information System (INIS)

    Zhu Mei; Wu Guo

    2006-01-01

    Objective: To investigate the presence of insulin resistance in patients with essential hypertension (EH) and coronary heart disease (CHD). Methods: Fasting and 2h post oral 75g glucose blood sugar (with oxidase method), insulin and C-peptide (with RIA) levels were examined in 52 patients with EH, 40 patients with CHD and 35 controls. Results: The fasting and 2h post o- ral glucose serum levels of glucose, insulin and C-peptide in the patients were significantly higher than those in the controls (P < 0.01), suggesting presence of impaired glucose tolerance and insulin resistance. Conclusion: Impaired glucose tolerance due to insulin resistance was demonstrated in the studied patients with EH or CHD. (authors)

  19. Association of impaired endothelial glycocalyx with arterial stiffness, coronary microcirculatory dysfunction, and abnormal myocardial deformation in untreated hypertensives.

    Science.gov (United States)

    Ikonomidis, Ignatios; Voumvourakis, Astrinos; Makavos, George; Triantafyllidi, Helen; Pavlidis, George; Katogiannis, Konstantinos; Benas, Dimitris; Vlastos, Dimitris; Trivilou, Paraskevi; Varoudi, Maria; Parissis, John; Iliodromitis, Efstathios; Lekakis, John

    2018-03-02

    We investigated the association of endothelial glycocalyx damage with arterial stiffness, impairment of coronary microcirculatory function, and LV myocardial deformation in 320 untreated hypertensives and 160 controls. We measured perfused boundary region (PBR) of the sublingual microvessels, a marker inversely related with glycocalyx thickness, coronary flow reserve (CFR), and Global Longitudinal strain (GLS) by echocardiography, pulse wave velocity (PWV), and central systolic blood pressure (cSBP). Hypertensives had higher PBR, PWV cSBP, and lower CFR and GLS than controls (P < .05). In hypertensives, increased PBR was associated with increased cSBP, PWV, and decreased CFR and GLS after adjustment for age, sex, BMI, smoking LV mass, heart rate, hyperlipidemia, and office SBP (P < .05). PBR had an additive value to PWV, CFR, and office SBP for the prediction of abnormal GLS (x 2  = 2.4-3.8, P for change = .03). Endothelial glycocalyx is impaired in untreated hypertensives and is related to arterial stiffness, coronary, and myocardial dysfunction. ©2018 Wiley Periodicals, Inc.

  20. Association of traditional risk factors with coronary artery disease in nonagenarians: the primary role of hypertension

    Directory of Open Access Journals (Sweden)

    Yayan J

    2014-11-01

    Full Text Available Josef YayanDepartment of Internal Medicine, Division of Pulmonary, Allergy and Sleep Medicine, Saarland University Medical Center, Homburg, Saarland, GermanyBackground: Previous studies have shown different relationships between traditional cardiovascular risk factors for coronary artery disease (CAD in very elderly people. Although new associations with CAD have been reported, there is also evidence of the possibility of new therapeutic strategies for the treatment or prevention of CAD. Design: This article retrospectively examines the possible association of traditional cardiovascular risk factors with CAD in very elderly people aged >90 years. This study represents the hypothesis that the elderly aged >90 years have a different cardiovascular profile with respect to CAD than patients <90 years old. Methods: Data on all patients aged >90 years who received a cardiac catheterization were collected from hospital charts from the Department of Internal Medicine, Saarland University Medical Center, Germany, within the study period of 2004–2013. The cardiovascular risk profiles were compared in patients aged >90 years with and without CAD after cardiac catheterization. Results: One hundred and six out of 67,976 (0.2%, mean age 91.6±1.8 years, 40 female [37.7%]; 95% confidence interval [CI]: 0.1–0.2, and out of a total of 114 of the very elderly patients, were found to have CAD. From the results of this study, the author could establish only a causal relationship between hypertension and CAD in very elderly people (P=0.005. At best, this is just an association with a higher risk of CAD in this age group. Several studies with similar outcomes are needed to establish causality. Conclusion: This study could find no link between CAD and traditional risk factors, except for hypertension.Keywords: aging, hypertension, diabetes, hypercholesterolemia, hyperlipidemia, obesity

  1. Identification of molecular markers in patients with hypertensive heart disease accompanied with coronary artery disease.

    Science.gov (United States)

    Pang, H; Han, B; Li, Z Y; Fu, Q

    2015-01-15

    We investigated the plasma hypersensitive C-reactive protein (hs-CRP), oxidized low-density lipoprotein (ox-LDL), and apelin levels in patients with hypertensive heart disease (HHD) plus coronary artery disease (CAD). Patients with hypertension hospitalized in Xuzhou Central Hospital were categorized into the HHD group and the HHD plus CAD group; 40 healthy subjects served as the control group. hs-CRP expression was determined with chemiluminescence. The expression of ox-LDL and apelin was analyzed with enzyme-linked immunosorbent assay. HHD was chiefly responsible for left atrial enlargement (P < 0.05) and left ventricle diastolic function insufficiency (P < 0.05). hs-CRP and ox-LDL were significantly higher in the HHD group than in the control group (P < 0.05). Compared with the control and HHD groups, significant increases in hs-CRP and ox-LDL levels were observed in the HHD plus CAD group. Apelin expression significantly decreased in the HHD group compared with that in controls (P < 0.05). Meanwhile, apelin expression significantly decreased in the HHD plus CAD group compared with that in the HHD (P < 0.05) and control (P < 0.05) groups. Logistic regression analysis for the binomial response variable indicated that high systolic pressure/diastolic pressure, increase in hs-CRP level, and decrease in apelin concentration were the risk factors for hypertension and cardiac impairments. HHD plus CAD has a greater influence on cardiac function than HHD alone. Increased inflammation and oxidative stress, as well as decreased secretion of cardiac protective factors, may be associated with the simultaneous onset of HHD and CAD.

  2. Hypertension

    Science.gov (United States)

    ... Hypertension Triglycerides Featured Resource Find an Endocrinologist Search Hypertension September 2017 Download PDFs English Espanol Editors Fady ... Additional Resources MedlinePlus (NIH) Mayo Clinic What is hypertension? Hypertension, or high blood pressure, is a leading ...

  3. Alcohol intake and risk of acute coronary syndrome and mortality in men and women with and without hypertension

    DEFF Research Database (Denmark)

    Lindschou Hansen, Jane; Tolstrup, Janne Schurmann; Jensen, Majken Karoline

    2011-01-01

    to moderate alcohol intake in relation to risk of ACS and overall mortality. We used data from 57,053 men and women, aged 50-64, who participated in the Danish Diet, Cancer and Health study. Information on alcohol intake (amount and frequency) was reported by the participants. Hypertension status was assessed......Although a light to moderate alcohol intake is associated with a lower risk of acute coronary syndrome (ACS), alcohol is also associated with risk of hypertension, which in turn is a strong risk factor of ACS. We examined whether middle-aged men and women with hypertension also benefit from a light...... at baseline by combining blood pressure measurements and self-reports. During follow-up, 860 and 271 ACS events occurred among men and women. Irrespective of alcohol intake, participants with hypertension had a higher risk than participants with normal blood pressure. Alcohol intake was associated...

  4. Hypertension.

    Science.gov (United States)

    Winter, Katherine H; Tuttle, Laura A; Viera, Anthony J

    2013-03-01

    Hypertension is the most common modifiable risk factor for cardiovascular disease. Antihypertensive treatment substantially reduces the risk of heart failure, stroke, and myocardial infarction. Current guidelines recommend screening all adults for high blood pressure (BP). Lifestyle modifications to help control high BP include weight loss, exercise, moderation of alcohol intake, and a diet low in sodium and saturated fats and high in fruits and vegetables. Out-of-office BP monitoring should be used to confirm suspected white coat effect, especially in patients with apparent resistant hypertension. Copyright © 2013 Elsevier Inc. All rights reserved.

  5. Correlation between Systemic Arterial Hypertension and Bone Morphogenetic Protein-2 in Central Obese Non-Diabetic Men with Evidence of Coronary Artery Calcification

    Directory of Open Access Journals (Sweden)

    Antonia Anna Lukito

    2011-12-01

    Full Text Available BACKGROUND: Previous studies have confirmed separately the relationship between obesity, insulin-resistance, hypertension and bone morphogenetic protein-2 (BMP-2 with coronary artery calcification, a parameter of subclinical atherosclerosis. It was also reported that BMPs may function as proinflammatory, prohypertensive and proatherogenic mediators. The study aimed to assess the correlation between systemic hypertension and BMP-2 plasma concentration in central-obese non-diabetic men with evidence of coronary artery calcification. METHODS: This was a cross sectional study on 60 central-obese non-diabetic men, of an average age of 55.2 years, with evidence of coronary calcification, who came for health check-up and met the inclusion criteria consecutively as defined by waist circumference >90 cm and fasting blood glucose <126 mg/dL. Coronary calcification was defined by coronary artery calcium (CAC score ≥10 Agatson-unit Dual Source 64 slice CT scan. RESULTS: There is positive correlation between hypertension and BMP-2 in central-obese non-diabetic men with evidence of coronary artery calcification. BMP-2 plasma concentration was higher in the hypertensive subjects. The correlation was stronger in younger (<55 years old subjects and subjects with insulin-resitance. KEYWORDS: hypertension, BMP-2, coronary calcification, central obesity, age, insulin resistance.

  6. Elevated plasma plasminogen activator inhibitor type-1 is an independent predictor of coronary microvascular dysfunction in hypertension

    International Nuclear Information System (INIS)

    Naya, Masanao; Tsukamoto, Takahiro; Inubushi, Masayuki; Morita, Koichi; Katoh, Chietsugu; Furumoto, Tomoo; Fujii, Satoshi; Tsutsui, Hiroyuki; Tamaki, Nagara

    2007-01-01

    Elevated plasma plasminogen activator inhibitor-1 (PAI-1) is related to cardiovascular events, but its role in subclinical coronary microvascular dysfunction remains unknown. Thus, in the present study it was investigated whether elevated plasma PAI-1 activity is associated with coronary microvascular dysfunction in hypertensive patients. Thirty patients with untreated essential hypertension and 10 age-matched healthy controls were studied prospectively. Myocardial blood flow (MBF) was measured by using 15 O-water positron emission tomography. Clinical variables associated with atherosclerosis (low-density lipoprotein-cholesterol, high-density lipoprotein (HDL)-cholesterol, triglyceride, homeostasis model assessment (HOMA-IR), and PAI-1 activity) were assessed to determine their involvement in coronary microvascular dysfunction. Adenosine triphosphate (ATP)-induced hyperemic MBF and coronary flow reserve (CFR) were significantly lower in hypertensive patients than in healthy controls (ATP-induced MBF: 2.77±0.82 vs 3.49±0.71 ml·g -1 ·min -1 ; p<0.02 and CFR: 2.95±1.06 vs 4.25±0.69; p<0.001). By univariate analysis, CFR was positively correlated with HDL-cholesterol (r=0.46, p<0.02), and inversely with HOMA-IR (r=-0.39, p<0.05) and PAI-1 activity (r=-0.61, p<0.001). By multivariate analysis, elevated PAI-1 activity remained a significant independent determinant of diminished CFR. Elevated plasma PAI-1 activity was independently associated with coronary microvascular dysfunction, which suggests that plasma PAI-1 activity is an important clue linking hypofibrinolysis to the development of atherosclerosis. (author)

  7. Homocysteine, Ischemic Stroke, and Coronary Heart Disease in Hypertensive Patients: A Population-Based, Prospective Cohort Study.

    Science.gov (United States)

    Han, Liyuan; Wu, Qunhong; Wang, Changyi; Hao, Yanhua; Zhao, Jinshun; Zhang, Lina; Fan, Rui; Liu, Yanfen; Li, Runhua; Chen, Zhongwei; Zhang, Tao; Chen, Sihan; Ma, Jianping; Liu, Shengyuan; Peng, Xiaolin; Duan, Shiwei

    2015-07-01

    Total homocysteine level (tHcy) is a risk factor of ischemic stroke (IS) and coronary heart disease. However, the results are conflicting and mainly focused on healthy individuals in developed countries. A prospective, population-based cohort study was conducted among 5935 participants from 60 communities in the city of Shenzhen, China. A Cox regression analysis was applied to evaluate the contribution of tHcy to the risk of IS and coronary heart disease. The effect of folic acid supplementation on tHcy levels was also evaluated among 501 patients with essential hypertension, who received an average of 2.5 years of folic acid supplementation. After adjustment for confounding factors, the hazard ratios (95% confidence intervals) of IS caused by hyperhomocysteinemia were 2.18 (1.65-2.89), 2.40 (1.56-3.67), and 2.73 (1.83-4.08) in the total, male, and female participants, respectively. Compared with normal levels of tHcy (disease. The 2.5 years of folic acid supplementation reduced tHcy levels by 6.7 μmol/L (27.92%) in patients with essential hypertension. Hyperhomocysteinemia in Chinese hypertensive patients is significantly associated with IS risk but not coronary heart disease susceptibility, and folic acid supplementation can efficiently reduce tHcy levels. © 2015 American Heart Association, Inc.

  8. Relationships Between Components of Blood Pressure and Cardiovascular Events in Patients with Stable Coronary Artery Disease and Hypertension.

    Science.gov (United States)

    Vidal-Petiot, Emmanuelle; Greenlaw, Nicola; Ford, Ian; Ferrari, Roberto; Fox, Kim M; Tardif, Jean-Claude; Tendera, Michal; Parkhomenko, Alexander; Bhatt, Deepak L; Steg, P Gabriel

    2018-01-01

    Observational studies have shown a J-shaped relationship between diastolic blood pressure (BP) and cardiovascular events in hypertensive patients with coronary artery disease. We investigated whether the increased risk associated with low diastolic BP reflects elevated pulse pressure (PP). In 22 672 hypertensive patients with coronary artery disease from the CLARIFY registry (Prospective Observational Longitudinal Registry of Patients With Stable Coronary Artery Disease), followed for a median of 5.0 years, BP was measured annually and averaged. The relationships between PP and diastolic BP, alone or combined, and the primary composite outcome (cardiovascular death or myocardial infarction) were analyzed using multivariable Cox proportional hazards models. Adjusted hazard ratios for the primary outcome were 1.62 (95% confidence interval [CI], 1.40-1.87), 1.00 (ref), 1.07 (95% CI, 0.94-1.21), 1.54 (95% CI, 1.32-1.79), and 2.34 (95% CI, 1.95-2.81) for PPhypertensive patients with coronary artery disease persists in patients within the lowest-risk PP range and is therefore unlikely to be solely the consequence of an increased PP reflecting advanced vascular disease. URL: http://www.clarify-registry.com. Unique identifier: ISRCTN43070564. © 2017 American Heart Association, Inc.

  9. Biochemical and genetic role of apelin in essential hypertension and acute coronary syndrome.

    Science.gov (United States)

    Gupta, Mohit D; Girish, M P; Shah, Dhaval; Rain, Manjari; Mehta, Vimal; Tyagi, Sanjay; Trehan, Vijay; Pasha, Qadar

    2016-11-15

    Apelin-APJ pathway has emerged as a potent regulator of blood pressure (BP) and blood flow in vasculature and heart. Variants in apelin gene may affect the vascular tone in peripheral circulation or heart, thereby predisposing to cardiovascular diseases. The aim of our study was to investigate the association of two apelin gene polymorphisms rs3761581 and rs2235312, and apelin levels in patients with essential hypertension (EH) and acute coronary syndrome (ACS). The study comprised of three groups namely, (1) 118 healthy control subjects, (2) 92 EH patients, and (3) 60 ACS patients. DNA was extracted from peripheral blood leukocytes and genotyping was performed by SNaPshot method. Plasma apelin 13 levels were estimated using ELISA. EH and ACS patients had a significantly lower level of apelin 13, regardless of gender (p=0.003, p=0.017, respectively). Interestingly, the female EH and ACS patients had lower levels of apelin 13 than their male counterparts. The G allele of rs3761581 was more apparent in patients especially in ACS than the controls. Reduced apelin levels may enhance vasoconstriction to influence high BP and heart's workload in EH and ACS. Genetic involvement of apelin needs to be established in well-defined larger sample size. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  10. [The assessment of the level of coping style and health locus of control in patients with coronary heart disease and hypertension].

    Science.gov (United States)

    Opuchlik, Katarzyna; Wrzesińska, Magdalena; Kocur, Józef

    2009-01-01

    The assessment of the level of coping style and health locus of control in patients with coronary heart disease and hypertension. The sample studied consisted of 112 patients (81 M, 31 F) at the age of 35-65 years. Two groups participated in the study; first with coronary heart disease and hypertension and second with hypertension without other diseases. The Coping Inventory for Stressful Situation and Multidimensional Health Locus of Control Scale were used in the study. Two groups of patients used the most frequent task-oriented coping style. The significant differences were seen between groups in the external health locus of control (t = 2.113; p locus of control. Patients with coronary heart disease and hypertension declare for external locus of control.

  11. [Biochemical markers of endothelial dysfunction in chronic obstructive pulmonary disease concurrent with hypertensive disease or coronary heart disease].

    Science.gov (United States)

    Akhmineeva, A Kh

    2014-01-01

    To evaluate the vascular endothelium in patients with cardiopulmonary disease, by studying the levels of endothelin-1 (ET-1) and C-type natriuretic peptide (CNP). Examinations were conducted in 212 dwellers of the Astrakhan Region, including 40 patients with chronic obstructive pulmonary disease (COPD) concurrent with hypertensive disease (HD), 40 patients with COPD concurrent with coronary heart disease (CHD), 27 somatically healthy individuals, 35 patients with Stage II HD, 35 patients with Functional Classes II and III CHD, and 35 patients with moderate and severe COPD. The patients with COPD concurrent with HD and CHD were found to have endothelial dysfunction manifesting itself in the overproduction of ET-1 and CNP. The level of CNP was statistically significantly higher in the COPD + HD group than in the HD and COPD groups whereas in the COPD + HD group the level of ET-1 remained comparable to that in the COPD and HD groups. This indicates that CNP is a more sensitive indirect marker of endothelial dysfunction and that nitric oxide deficiency is aggravated in the concurrence of COPD and HD as compared to a mononosological entity (HD, COPD). The concurrence of COPD and CHD is more unfavorable for the development and severity of endothelial dysfunction, which may lead to mutual aggravation syndrome, the rapider progression of the diseases, and the increased frequency of complications.

  12. Prognostic value of exercise-induced left ventricular systolic dysfunction in hypertensive patients without coronary artery disease.

    Science.gov (United States)

    Prada-Delgado, Oscar; Barge-Caballero, Eduardo; Peteiro, Jesús; Bouzas-Mosquera, Alberto; Estévez-Loureiro, Rodrigo; Barge-Caballero, Gonzalo; López-Pérez, Manuel; Vázquez-González, Nicolás; Castro-Beiras, Alfonso

    2015-02-01

    We sought to assess the prognostic value of exercise-induced left ventricular systolic dysfunction in hypertensive patients with normal resting echocardiography and absence of coronary artery disease. From our database of patients referred for treadmill exercise echocardiography, we identified 93 hypertensive patients with preserved resting left ventricular ejection fraction (≥ 50%), no evidence of structural heart disease, and absence of coronary artery disease on angiography. Overall, 39 patients developed exercise-induced left ventricular systolic dysfunction (defined as a decrease in left ventricular ejection fraction below 50% at peak exercise) and 54 exhibited a normal left ventricular ejection fraction response to exercise. The mean follow-up was 6.1 (3.7) years. End points were all-cause mortality, cardiac death, heart failure, and the composite event of cardiac death or heart failure. Patients who developed exercise-induced left ventricular systolic dysfunction were at higher risk of death from any cause (hazard ratio=3.4; 95% confidence interval, 1.1-10.3), cardiac death (hazard ratio=5.6; 95%CI, 1.1-29.4), heart failure (hazard ratio=8.9; 95% confidence interval, 1.8-44.2), and the composite end point (hazard ratio=5.7; 95% confidence interval, 1.7-19.0). In the multivariate analysis, exercise-induced left ventricular systolic dysfunction remained an independent predictor of both heart failure (hazard ratio=6.9; 95% CI, 1.3-37.4) and the composite event of cardiac death or heart failure (hazard ratio=4.5; 95% confidence interval, 1.2-16.0). In hypertensive patients with preserved resting left ventricular ejection fraction and absence of coronary artery disease, exercise-induced left ventricular systolic dysfunction is a strong predictor of cardiac events and may represent early hypertensive heart disease. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  13. Coronary artery disease and hypertension in a non-selected spinal cord injury patient population.

    Science.gov (United States)

    Aidinoff, E; Bluvshtein, V; Bierman, U; Gelernter, I; Front, L; Catz, A

    2017-03-01

    Retrospective observational comparative study. The objectives of this study were to assess the atherosclerosis diseases and risk factors prevalence after spinal cored injury (SCI). Loewenstein Rehabilitation Hospital, Israel. Data of 154 traumatic and non-traumatic SCI patients were retrospectively collected. Coronary artery disease (CAD), myocardial infarction (MI), hypertension (HT) and risk factors for atherosclerotic diseases were examined after SCI for prevalence and effects, and compared with published corresponding data of the general population. CAD, MI and HT were found in 11.7, 6.7 and 29.2% of 120 patients, aged 53.4±11.1 years, 83.3% males, who survived until the end of the follow-up. Corresponding values for the general population, adjusted for age, gender and years of education, are 8.5, 6.6 and 24.9% in Israel, and 10.2% for CAD and 40.3% for HT, in US. Body mass index>30 increased the odds of acquiring CAD (P=0.016). Hypercholesterolemia and older age at injury increased the hazard for HT (P=0.044; P=0.019, respectively). A steady partner decreased the risk of CAD (P=0.029). HT was more prevalent at T 4 -T 6 than above T 4 (52 vs 23.3%, P=0.02). Patients with SCI below T 6 had a higher rate of diabetes mellitus, hypercholesterolemia, and past smoking, and fewer years of education than those with SCI above T 7 (P=0.016; P=0.032; P=0.034; P=0.014, respectively). The prevalence of CAD, HT and some of their risk factors after SCI is generally, but not consistently and not statistically significant, slightly higher than in the corresponding general population. The challenge is to reduce the prevalence of atherosclerotic morbidity after SCI below that in the general population.

  14. Smoking associated with malignancy, hypertension, chronic obstructive pulmonary disease and concurrent coronary artery disease: report of nine cases.

    Science.gov (United States)

    Dwivedi, S; Srivastava, S; Dwivedi, G

    2006-01-01

    Tobacco smoking in any form is a major risk factor for coronary artery disease (CAD), hypertension (HTN), chronic obstructive pulmonary disease (COPD), oral, nasopharyngeal, bronchial and other visceral malignancies. Cessation of smoking exerts considerable beneficial effect on development, recurrence and prognosis of these diseases. Present communication is based on the study of nine cases who had concurrent CAD, HTN, COPD and mitotic and/or pre malignant lesions due to unabated smoking. The youngest patient was a 35-year-old male having a smoking index of 300, presenting with acute coronary syndrome, COPD, HTN and buccal leukoplakia. Associated genitourinary malignancies in two cases and osteosarcoma in one case was an unusual presentation. These cases highlight the prognosis and public health implications of continuous smoking.

  15. [Cardiovascular complications of hypertensive crisis].

    Science.gov (United States)

    Rosas-Peralta, Martín; Borrayo-Sánchez, Gabriela; Madrid-Miller, Alejandra; Ramírez-Arias, Erick; Pérez-Rodríguez, Gilberto

    2016-01-01

    It is inexorable that a proportion of patients with systemic arterial hypertension will develop a hypertensive crisis at some point in their lives. The hypertensive crises can be divided in hypertensive patients with emergency or hypertensive emergency, according to the presence or absence of acute end-organ damage. In this review, we discuss the cardiovascular hypertensive emergencies, including acute coronary syndrome, congestive heart failure, aortic dissection and sympathomimetic hypertensive crises (those caused by cocaine use included). Each is presented in a unique way, although some patients with hypertensive emergency report non-specific symptoms. Treatment includes multiple medications for quick and effective action with security to reduce blood pressure, protect the function of organs remaining, relieve symptoms, minimize the risk of complications and improve patient outcomes.

  16. Performance of recommended measures on risk factors control in patients with hypertension, coronary artery disease and chronic heart failure: the data from 2014 Russian registry

    Directory of Open Access Journals (Sweden)

    Posnenkova O.M.

    2015-03-01

    Full Text Available A report presents the results of evaluation of recommended measures on risk factors control in patients with hypertension, stable coronary artery disease (CAD and chronic heart failure (CHF. The performance of recommended measures was assessed with the help of specially developed system of clinical indicators on the basis of data of the year 2014 from patients enrolled in multicenter Russian registry of hypertension, CAD and CHF.

  17. Arterial hypertension in women at different ages

    OpenAIRE

    Pacheco-Romero, José

    2011-01-01

    Hypertension is associated to co-morbidities such as diabetes mellitus, coronary artery disease, stroke, peripheral vascular disease, chronic renal failure, entities that decrease life span. Peruvians suffer from arterial hypertension with characteristics similar to those of the general population. Early detection and treatment of hypertension should benefit them with years of quality of life. The occurrence of arterial hypertension in women from childhood through menopause, including reprodu...

  18. Alcohol Consumption and Risk for Coronary Heart Disease among Men with Hypertension

    NARCIS (Netherlands)

    Beulens, J.W.J.; Rimm, E.B.; Ascherio, A.; Spiegelman, D.; Hendriks, H.F.J.; Mukamal, K.J.

    2007-01-01

    Background: Heavy alcohol consumption increases risk for hypertension, which is in itself a strong risk factor for cardiovascular disease (CVD). However, data on the association between alcohol consumption and CVD among individuals with hypertension are scarce. Objective: To assess whether alcohol

  19. Alcohol consumption and risk for coronary heart disease among men with hypertension

    NARCIS (Netherlands)

    Beulens, J.W.J.; Rimm, E.B.; Ascherio, A.; Spiegelman, D.; Hendriks, H.F.J.; Mukamal, K.J.

    2007-01-01

    Background: Heavy alcohol consumption increases risk for hypertension, which is in itself a strong risk factor for cardiovascular disease (CVD). However, data on the association between alcohol consumption and CVD among individuals with hypertension are scarce. Objective: To assess whether alcohol

  20. QUALITY OF LIFE IN PATIENTS WITH HYPERTENSION, CORONARY HEART DISEASE, AND ATHEROSCLEROTIC LESION OF LOWER EXTREMITY ARTERIES IN THE SECONDARY PREVENTION OF COMPLICATIONS

    Directory of Open Access Journals (Sweden)

    A. A. Karlov

    2014-07-01

    Full Text Available Atherosclerotic lesion of lower extremity arteries frequently complicates the long-term course of hypertension and it is generally associated with coronary heart disease. Our study has attempted to evaluate the impact of combination antihypertensive therapy involving amlodipine, bisoprolol, and lisinopril on quality of life in this category of patients.

  1. Impact of abdominal obesity and systemic hypertension on risk of coronary heart disease in men and women: the EPIC-Norfolk Population Study

    NARCIS (Netherlands)

    Rhéaume, Caroline; Arsenault, Benoit J.; Després, Jean-Pierre; Faha, N. N.; Boekholdt, S. Matthijs; Wareham, Nicholas J.; Khaw, Kay-Tee; Chir, Mbb

    2014-01-01

    The objective of our study was to determine the respective contributions of waist circumference and systemic hypertension (HTN) to coronary heart disease (CHD) risk in a large population-based cohort representative of a contemporary European population. A total of 9580 men and 12 250 women aged

  2. QUALITY OF LIFE IN PATIENTS WITH HYPERTENSION, CORONARY HEART DISEASE, AND ATHEROSCLEROTIC LESION OF LOWER EXTREMITY ARTERIES IN THE SECONDARY PREVENTION OF COMPLICATIONS

    OpenAIRE

    A. A. Karlov; N. A. Karlova; E. A. Zolozova; E. V. Sayutina; V. V. Chigineva

    2013-01-01

    Atherosclerotic lesion of lower extremity arteries frequently complicates the long-term course of hypertension and it is generally associated with coronary heart disease. Our study has attempted to evaluate the impact of combination antihypertensive therapy involving amlodipine, bisoprolol, and lisinopril on quality of life in this category of patients.

  3. Hypertension

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — These datasets provide de-identified insurance data for hypertension hyperlipidemia. The data is provided by three managed care organizations in Allegheny County...

  4. Prognostic value of the increase in systolic blood pressure with exercise in patients with hypertension and known or suspected coronary artery disease.

    Science.gov (United States)

    Bouzas-Mosquera, Carmen; Bouzas-Mosquera, Alberto; Peteiro, Jesús

    2017-01-20

    The association of an exaggerated systolic blood pressure increase with exercise (EBPIE) with cardiovascular events remains controversial. Our aim was to determine the possible association of an EBPIE with survival and risk of serious cardiac events in patients with hypertension and known or suspected coronary artery disease (CAD). This is a retrospective observational study based on a sample of 5226 patients with a history of arterial hypertension and known or suspected CAD referred for exercise echocardiography. The EBPIE was defined as an increase in systolic blood pressure with exercise greater than or equal to the 95th percentile of this population (80mmHg). The end points were all-cause mortality, cardiac death and myocardial infarction (MI). During a mean follow-up of 4.7 years, there were 978 deaths (including 371 cardiac) and 798 MI. Annual rates of all-cause mortality, cardiac mortality and MI were 2.73, 0.83 and 2.63% in patients with EBPIE and 4.4, 1.58 and 3.98% in those without EBPIE (P<.001, P=.012, and P=.014, respectively). After multivariate analysis, an EBPIE remained independently associated with a lower risk of all-cause mortality (HR: 0.70, 95% CI: 0.52-0.95; P=.023) and MI (HR: 0.69, 95% CI: 0.50-0.95; P=.022) but was not significantly associated with cardiac mortality (HR: 0.72, 95% CI: 0.43-1.20; P=.2). EBPIE was associated with an increased likelihood of survival and lower rate of MI in hypertensive patients with known or suspected CAD. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  5. The effects of pay for performance on disparities in stroke, hypertension, and coronary heart disease management: interrupted time series study.

    Directory of Open Access Journals (Sweden)

    John Tayu Lee

    Full Text Available The Quality and Outcomes Framework (QOF, a major pay-for-performance programme, was introduced into United Kingdom primary care in April 2004. The impact of this programme on disparities in health care remains unclear. This study examines the following questions: has this pay for performance programme improved the quality of care for coronary heart disease, stroke and hypertension in white, black and south Asian patients? Has this programme reduced disparities in the quality of care between these ethnic groups? Did general practices with different baseline performance respond differently to this programme?Retrospective cohort study of patients registered with family practices in Wandsworth, London during 2007. Segmented regression analysis of interrupted time series was used to take into account the previous time trend. Primary outcome measures were mean systolic and diastolic blood pressure, and cholesterol levels. Our findings suggest that the implementation of QOF resulted in significant short term improvements in blood pressure control. The magnitude of benefit varied between ethnic groups with a statistically significant short term reduction in systolic BP in white and black but not in south Asian patients with hypertension. Disparities in risk factor control were attenuated only on few measures and largely remained intact at the end of the study period.Pay for performance programmes such as the QOF in the UK should set challenging but achievable targets. Specific targets aimed at reducing ethnic disparities in health care may also be needed.

  6. The effects of pay for performance on disparities in stroke, hypertension, and coronary heart disease management: interrupted time series study.

    Science.gov (United States)

    Lee, John Tayu; Netuveli, Gopalakrishnan; Majeed, Azeem; Millett, Christopher

    2011-01-01

    The Quality and Outcomes Framework (QOF), a major pay-for-performance programme, was introduced into United Kingdom primary care in April 2004. The impact of this programme on disparities in health care remains unclear. This study examines the following questions: has this pay for performance programme improved the quality of care for coronary heart disease, stroke and hypertension in white, black and south Asian patients? Has this programme reduced disparities in the quality of care between these ethnic groups? Did general practices with different baseline performance respond differently to this programme? Retrospective cohort study of patients registered with family practices in Wandsworth, London during 2007. Segmented regression analysis of interrupted time series was used to take into account the previous time trend. Primary outcome measures were mean systolic and diastolic blood pressure, and cholesterol levels. Our findings suggest that the implementation of QOF resulted in significant short term improvements in blood pressure control. The magnitude of benefit varied between ethnic groups with a statistically significant short term reduction in systolic BP in white and black but not in south Asian patients with hypertension. Disparities in risk factor control were attenuated only on few measures and largely remained intact at the end of the study period. Pay for performance programmes such as the QOF in the UK should set challenging but achievable targets. Specific targets aimed at reducing ethnic disparities in health care may also be needed.

  7. Atorvastatin, Losartan and Captopril Lead to Upregulation of TGF-β, and Downregulation of IL-6 in Coronary Artery Disease and Hypertension.

    Science.gov (United States)

    Sepehri, Zahra; Masoumi, Mohammad; Ebrahimi, Nazanin; Kiani, Zohre; Nasiri, Ali Akbar; Kohan, Farhad; Sheikh Fathollahi, Mahmood; Kazemi Arababadi, Mohammad; Asadikaram, Gholamreza

    2016-01-01

    Coronary artery disease (CAD) and hypertension are the main reasons of ischemic heart diseases (IHDs). Cytokines as the small glycoproteins are the main arm of immune system and manipulate all of the cardiovascular diseases. The aim of the current study was to examine the effects of treatment of hypertension and CAD on serum levels of IL-6, IL-8, TGF-β and TNF-α. This interventional study was performed on the patients with hypertension without CAD (group 1), hypertension and CAD (group 2), CAD but not hypertension (group 3) and without hypertension and CAD as controls (group 4). The patients received routine treatment for hypertension and CAD. Serum levels of IL-6, IL-8, TGF-β and TNF-α were analyzed in the groups treated with various drugs, using ELISA technique. With regard to the medications, Atorvastatin, Losartan and Captopril were administered more in patients (groups 1, 2 and 3) than the patients without hypertension and CAD. The results revealed that serum levels of TGF-β and IL-6 were significantly increased and decreased, respectively, in the groups 1, 2 and 3 when compared to group 4. Serum levels of TGF-β were also increased in females in comparison to males in the group 4. According to the results it seems that Atorvastatin, Losartan and Captopril have reduced inflammation in in vivo conditions via downregulation of IL-6 and upregulation of TGF-β.

  8. Hyperhomocysteinemia, coronary heart disease, and diabetes mellitus as predicted by various definitions for metabolic syndrome in a hypertensive Saudi population

    International Nuclear Information System (INIS)

    Al-Daghri, Nasser M.

    2007-01-01

    From the emergence of different definitions of metabolic syndrome (MS) we aim to determine the prevalence of such a condition among hypertensive Saudi population and to identify which definition can best assess the risk of hyperhomocysteinemia, coronary heart disease (CHD), and diabetes mellitus. In this cross-sectional study, we studied 581 hypertensive Saudis, aged 21-70, at the King Abdul-Aziz University Hospital, from June 2005 to December 2005 Each participant completed the questionnaire and underwent a complete physical examination. Metabolic parameters were measured using routine laboratory procedures and homocysteine using HPLC by the electrochemical detection method. According to the International Diabetes Federation (IDF) definition we diagnosed 222 males and 256 females. There is an increased risk for hyperhomocystenemia using the Adult Treatment Panel III (ATPIII) guidelines (odds ratio [OR] 3.30, 95% confidence interval [CI] 0.87-12.56; p=0.08) compared to IDF (OR 0.59, CI 0.17-2.10; p=0.41) and WHO (OR 0.45, CI 0.16-1.25; p=0.12); increased risk for probable CHD in patients with MS by WHO (OR 2.17, CI 1.11-4.25; p=0.02) compared to ATPIII (OR 2.14, CI 1.05-4.35; p=0.035) and IDF (OR 0.81, CI 0.37-1.78; p=0.6); risk of DM is highest with IDF (OR 13.07, CI 1.66-102.94; p=0.015). There is a high prevalence of MS among hypertensive Saudis regardless of definition used; it is most prevalent using the IDF definition as well as the risk for diabetes Patients diagnosed with ATPIII guidelines have greater risk of hyperhomocysteinemia. We recommend the WHO definition for Arabs since it predicts increased risk for CHD. (author)

  9. Detecting Restenosis after Percutaneous Coronary Intervention Using Exercise-Stress Electrocardiogram Findings Including QT Dispersion

    Directory of Open Access Journals (Sweden)

    Bonpei Takase, MD

    2006-01-01

    Full Text Available Despite the advent of drug-eluting stents in Japan, bare metal stents or conventional balloon angioplasty are still indicated in some patients needing elective percutaneous coronary intervention (PCI and in patients with acute coronary syndrome if these patients develop side effects while taking ticlopidine. In such patients, restenosis is a problem that is difficult to diagnose. To investigate the comparative diagnostic accuracy of the exercise-stress electrocardiogram (ECG for detecting restenosis after PCI, we measured conventional ST-segment changes and QT dispersion during exercise-stress testing in 173 patients with elective PCI (63 ± 10 years old. Exercise-stress testing was performed 3 to 6 months after successful PCI, and restenosis was confirmed by follow-up coronary angiogram. There were 98 patients with a prior myocardial infarction (prior MI group and 76 patients with no prior myocardial infarction (no MI group. Restenosis was found in 45 patients (46% in the prior MI group and 26 patients (34% in the no MI group. Conventional ST-segment depression (>1:0 mm, J 60 ms indicating exercise-induced myocardial ischemia had a sensitivity of around 50% and a specificity of around 70% for diagnosing restenosis in both groups. In the prior MI group, QT dispersion was increased by exercise-stress testing in both patients with and without restenosis, whereas in the no MI group, QT dispersion increased only in patients with restenosis. With a cut-off value of >60 ms, QT dispersion had a sensitivity of 54% and a specificity of 68% for detecting restenosis in the no MI group; these values were comparable to those seen with conventional ST-segment changes. In conclusion, due to its low cost, exercise-stress ECG remains useful for diagnosing restenosis following PCI if the clinician understands its limited sensitivity and specificity. The presence of a prior MI must be considered when QT dispersion during exercise-stress testing is used for

  10. Awareness of arterial hypertension, hyperlipidaemia and diabetes among patients admitted with acute coronary syndrome

    Czech Academy of Sciences Publication Activity Database

    Monhart, Z.; Reissigová, Jindra; Widimský, J.; Janský, P.; Zvárová, Jana; Grünfeldová, H.; Vojáček, J.

    2012-01-01

    Roč. 33, Suppl 1 (2012), s. 1077 ISSN 0195-668X. [ESC 2012. Congress of the European Society of Cardiology. 25.08.2012-29.08.2012, München] Institutional support: RVO:67985807 Keywords : hypertension * hyperlipidaemia * diabetes mellitus * cardiovascular diseases Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery

  11. Vascular effects of calcium antagonists: implications for hypertension and other risk factors for coronary heart disease

    NARCIS (Netherlands)

    van Zwieten, P. A.

    1989-01-01

    All calcium antagonists (CAs) so far developed are vasodilators, and this property is a most important component of their therapeutic potency in hypertension and angina pectoris. At a cellular level, the specific interaction of CAs with transmembranous calcium fluxes involves both potential and

  12. High performance of a risk calculator that includes renal function in predicting mortality of hypertensive patients in clinical application.

    Science.gov (United States)

    Ravera, Maura; Cannavò, Rossella; Noberasco, Giuseppe; Guasconi, Alessandro; Cabib, Ursula; Pieracci, Laura; Pegoraro, Valeria; Brignoli, Ovidio; Cricelli, Claudio; Deferrari, Giacomo; Paoletti, Ernesto

    2014-06-01

    The aim of this study was to assess the accuracy of a risk calculator that includes renal function as compared with that of the traditional Framingham Risk Score (FRS) in predicting the risk of mortality of hypertensive individuals managed in primary care. From the databases of British and Italian General Practitioners, we retrieved demographic and clinical data for 35 101 UK and 27 818 Italian individuals aged 35-74 years with a diagnosis of hypertension. Then, the 5-year incidence of cardiovascular events as well as all-cause and cardiovascular mortality were recorded for both samples. A comparison analysis of the performance of the Individual Data Analysis of Antihypertensive Intervention Trials (INDANA) calculator with that of FRS in predicting 5-year all-cause and cardiovascular mortality risk was made. The INDANA calculator was more accurate than the FRS in predicting all-cause [Δc 0.038, 95% confidence interval (CI) 0.026-0.051 for United Kingdom, and 0.018, 95% CI 0.010-0.027 for Italy, both P calculator, 20% of the UK and 10% of the Italian patients were reclassified to higher risk classes for all-cause mortality, and 25 and 28%, respectively were reclassified when cardiovascular mortality was assessed (P calculator proved to be more accurate than the FRS in predicting the risk of mortality in hypertensive patients and should be considered for systematic adoption for risk stratification of hypertensive individuals managed in primary care.

  13. Should mean arterial pressure be included in the definition of ambulatory hypertension in children?

    Science.gov (United States)

    Suláková, Terezie; Feber, Janusz

    2013-07-01

    The diagnosis of hypertension (HTN)/normotension (NT) on ambulatory blood pressure monitoring (ABPM) is usually based on systolic (SBP) or diastolic blood pressure (DBP). The goal of this study was to analyze whether inclusion of mean arterial pressure (MAP) improves the detection of HTN on ABPM. We retrospectively studied ABPM records in 229 children (116 boys, median age = 15.3 years) who were referred for evaluation of HTN. A diagnosis of HTN was made if: (A) MAP or SBP or DBP was ≥ 1.65 SDS (95th percentile); (B) SBP or DBP was ≥ 1.65 SDS (95th percentile), during 24-h or daytime or night-time in both definitions. Using definition A, 46/229 patients had HTN compared to definition B by which only 37/229 patients had HTN (p = 0.001). The level of agreement between the two definitions was very good (kappa = 0.86 ± 0.04), however nine patients (19.5 %) were missed by not using MAP in the definition of HTN. These nine patients had only mild HTN with a median Z score of 1.69. The inclusion of MAP in the definition of ambulatory HTN significantly increased the number of hypertensive patients. MAP may be very helpful in detecting mild HTN in patients with normal/borderline SBP and DBP.

  14. The interplay of exercise heart rate and blood pressure as a predictor of coronary artery disease and arterial hypertension.

    Science.gov (United States)

    Michaelides, Andreas P; Liakos, Charalampos I; Vyssoulis, Gregory P; Chatzistamatiou, Evangelos I; Markou, Maria I; Tzamou, Vanessa; Stefanadis, Christodoulos I

    2013-03-01

    Delayed blood pressure (BP) and heart rate (HR) decline at recovery post-exercise are independent predictors of incident coronary artery disease (CAD). Delayed BP recovery and exaggerated BP response to exercise are independent predictors of future arterial hypertension (AH). This study sought to examine whether the combination of two exercise parameters provides additional prognostic value than each variable alone. A total of 830 non-CAD patients (374 normotensive) were followed for new-onset CAD and/or AH for 5 years after diagnostic exercise testing (ET). At the end of follow-up, patients without overt CAD underwent a second ET. Stress imaging modalities and coronary angiography, where appropriate, ruled out CAD. New-onset CAD was detected in 110 participants (13.3%) whereas AH was detected in 41 former normotensives (11.0%). The adjusted (for confounders) relative risk (RR) of CAD in abnormal BP and HR recovery patients was 1.95 (95% confidence interval [CI], 1.28-2.98; P=.011) compared with delayed BP and normal HR recovery patients and 1.71 (95% CI, 1.08-2.75; P=.014) compared with normal BP and delayed HR recovery patients. The adjusted RR of AH in normotensives with abnormal BP recovery and response was 2.18 (95% CI, 1.03-4.72; P=.047) compared with delayed BP recovery and normal BP response patients and 2.48 (95% CI, 1.14-4.97; P=.038) compared with normal BP recovery and exaggerated BP response individuals. In conclusion, the combination of two independent exercise predictors is an even stronger CAD/AH predictor than its components. © 2012 Wiley Periodicals, Inc.

  15. 42. Hypertension: Morbidity review

    Directory of Open Access Journals (Sweden)

    Hamzullah khan

    2015-10-01

    Conclusions: hypertension is a major modifiable risk factor for coronary artery disease, stroke, eye abnormalities and end stage renal disease, which require proper counseling and management of patients.

  16. Which Costs Matter? Costs Included in Economic Evaluation and their Impact on Decision Uncertainty for Stable Coronary Artery Disease.

    Science.gov (United States)

    Lomas, James; Asaria, Miqdad; Bojke, Laura; Gale, Chris P; Richardson, Gerry; Walker, Simon

    2018-02-14

    Variation exists in the resource categories included in economic evaluations, and National Institute for Health and Care Excellence (NICE) guidance suggests the inclusion only of costs related to the index condition or intervention. However, there is a growing consensus that all healthcare costs should be included in economic evaluations for Health Technology Assessments (HTAs), particularly those related to extended years of life. We aimed to quantify the impact of a range of cost categories on the adoption decision about a hypothetical intervention, and uncertainty around that decision, for stable coronary artery disease (SCAD) based on a dataset comprising 94,966 patients. Three costing scenarios were considered: coronary heart disease (CHD) costs only, cardiovascular disease (CVD) costs and all costs. The first two illustrate different interpretations of what might be regarded as related costs. Employing a 20-year time horizon, the highest mean expected incremental cost was when all costs were included (£2468) and the lowest when CVD costs only were included (£2377). The probability of the treatment being cost effective, estimating health opportunity costs using a ratio of £30,000 per quality-adjusted life-year (QALY), was different for each of the CHD (70%) costs, CVD costs (73%) and all costs (56%) scenarios. The results concern a hypothetical intervention and are illustrative only, as such they cannot necessarily be generalised to all interventions and diseases. Cost categories included in an economic evaluation of SCAD impact on estimates of both cost effectiveness and decision uncertainty. With an aging and co-morbid population, the inclusion of all healthcare costs may have important ramifications for the selection of healthcare provision on economic grounds.

  17. High prevalence of severe coronary artery disease in elderly patients with non-operable chronic thromboembolic pulmonary hypertension referred for balloon pulmonary angioplasty

    Directory of Open Access Journals (Sweden)

    Marek Roik

    2016-11-01

    Full Text Available Introduction : Balloon pulmonary angioplasty (BPA is a new emerging catheter-based alternative treatment option for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH. Aim : To show that all elderly CTEPH patients referred for BPA are at higher risk of obstructive coronary artery disease and that, in daily practice, they should undergo invasive coronary angiography. Material and methods : Eleven patients at the age of at least 65 years (6 males, 5 females, 77.2 ±5.9 years with confirmed non-operable type II or type III CTEPH, considered for BPA, underwent elective coronary angiography. Severe obstructive coronary artery disease (CAD was diagnosed when stenosis of left main coronary artery ≥ 50% or stenosis of ≥ 70% of epicardial arteries was angiographically confirmed. We also screened for CAD consecutive age- and sex-matched 114 PE survivors (52 males, 62 females, 74.8 ±7.2 years with excluded CTEPH. Results : Severe CAD was more frequent in elderly patients with non-operable type II or type III CTEPH candidates for BPA than in elderly acute PE survivors with excluded CTEPH (54.5% vs. 16.7%, p < 0.01, and therefore elderly CTEPH patients referred for BPA were at higher risk of CAD (OR = 5.9, 95% CI: 1.64–21.46, p = 0.007 when compared to elderly survivors after acute PE with excluded CTEPH. Conclusions : All elderly CTEPH patients referred for BPA are at higher risk of severe CAD and should routinely undergo invasive coronary angiography before BPA.

  18. Types of Pulmonary Hypertension

    Science.gov (United States)

    ... Home / Hypertension Pulmonary Hypertension What Is Pulmonary hypertension (PULL-mun-ary HI- ... are called pulmonary hypertension.) Group 1 Pulmonary Arterial Hypertension Group 1 PAH includes: PAH that has no ...

  19. Living with Pulmonary Hypertension

    Science.gov (United States)

    ... Home / Hypertension Pulmonary Hypertension What Is Pulmonary hypertension (PULL-mun-ary HI- ... are called pulmonary hypertension.) Group 1 Pulmonary Arterial Hypertension Group 1 PAH includes: PAH that has no ...

  20. How should we manage heart failure developing in patients already treated with angiotensin-converting enzyme inhibitors and beta-blockers for hypertension, diabetes or coronary disease?

    DEFF Research Database (Denmark)

    Gustafsson, Finn; Segura, Julian; Ruilope, Luis M

    2010-01-01

    An increasing number of patients in the community are being treated with angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and beta-blockers for hypertension, coronary disease or diabetic renal and vascular complications. Some of these patients will develop heart...... failure despite such treatment. Based on data from hypertension trials it can be estimated that approximately 5% of treated patients will develop heart failure over 5 years. It is unclear whether patients developing heart failure on and off ACE-inhibitors or beta-blockers, respectively, at the time...... of heart failure diagnosis have similar prognosis.Treatment options for patients developing heart failure while already treated with ACE inhibitors/ARBs and beta-blockers are very limited if current heart failure guidelines are followed. In this review possible strategies are outlined and important areas...

  1. Evaluation of coronary blood flow reserve by {sup 13}N-NH{sub 3} positron emission computed tomography (PET) with dipyridamole in the treatment of hypertension with the ACE inhibitor (Cilazapril)

    Energy Technology Data Exchange (ETDEWEB)

    Masuda, Daisuke; Nohara, Ryuji [Kyoto Univ. (Japan). Graduate School of Medicine; Tamaki, Nagara (and others)

    2000-10-01

    The purpose of this study was to evaluate the effect of treatment with an angiotensin-converting enzyme (ACE) inhibitor (Cilazapril) for early hypertensive patients in terms of coronary blood flow reserve evaluated by {sup 13}NH{sub 3}-positron emission tomography (PET). Before and after 12 weeks of ACE inhibitor treatment, {sup 13}NH{sub 3}-PET with dipyridamole provocation test was performed, and definite myocardial perfusion and coronary flow reserve (CFR) were calculated. Compared to our normal subjects previously reported (2.61{+-}0.74), average coronary flow reserve was decreased (1.70{+-}0.64 in hypertensive patients), and improved after treatment (1.77{+-}0.52), but not significantly. Of 12 patients, five (42%) showed improved coronary flow reserve from 1.34 to 1.99 without a significant change in the resting flow. Only one patient (8%) showed deterioration after the ACE inhibitor treatment. The coronary vascular resistance (CVR) after ACE inhibitor treatment of the patients with CFR <2.0 decreased significantly compared with those with CFR {>=}2.0 (p<0.03). These results indicate that hypertensive patients at the early stage show decreased coronary flow reserve despite having normal resting flow. Treatment with an ACE inhibitor (Cilazapril) for 12 weeks improved coronary flow reserve in 42% of our patients. The CVR of the patients with CFR <2.0 showed improvement compared to those with CFR {>=}2.0. This result indicates that an ACE inhibitor (e.g., Cilazapril) should be one of the choices for improving CFR if hypertensive patients in early stage show signs of ischemia or diastolic dysfunction, which may be one of the sequels of reserve restriction. (author)

  2. Evaluation of coronary blood flow reserve by 13N-NH3 positron emission computed tomography (PET) with dipyridamole in the treatment of hypertension with the ACE inhibitor (Cilazapril)

    International Nuclear Information System (INIS)

    Masuda, Daisuke; Nohara, Ryuji; Tamaki, Nagara

    2000-01-01

    The purpose of this study was to evaluate the effect of treatment with an angiotensin-converting enzyme (ACE) inhibitor (Cilazapril) for early hypertensive patients in terms of coronary blood flow reserve evaluated by 13 NH 3 -positron emission tomography (PET). Before and after 12 weeks of ACE inhibitor treatment, 13 NH 3 -PET with dipyridamole provocation test was performed, and definite myocardial perfusion and coronary flow reserve (CFR) were calculated. Compared to our normal subjects previously reported (2.61±0.74), average coronary flow reserve was decreased (1.70±0.64 in hypertensive patients), and improved after treatment (1.77±0.52), but not significantly. Of 12 patients, five (42%) showed improved coronary flow reserve from 1.34 to 1.99 without a significant change in the resting flow. Only one patient (8%) showed deterioration after the ACE inhibitor treatment. The coronary vascular resistance (CVR) after ACE inhibitor treatment of the patients with CFR <2.0 decreased significantly compared with those with CFR ≥2.0 (p<0.03). These results indicate that hypertensive patients at the early stage show decreased coronary flow reserve despite having normal resting flow. Treatment with an ACE inhibitor (Cilazapril) for 12 weeks improved coronary flow reserve in 42% of our patients. The CVR of the patients with CFR <2.0 showed improvement compared to those with CFR ≥2.0. This result indicates that an ACE inhibitor (e.g., Cilazapril) should be one of the choices for improving CFR if hypertensive patients in early stage show signs of ischemia or diastolic dysfunction, which may be one of the sequels of reserve restriction. (author)

  3. Risk stratification in hypertension: new insights from the Framingham Study.

    Science.gov (United States)

    Kannel, W B

    2000-01-01

    Five decades of epidemiologic research have established that blood pressure elevation is a common and powerful contributor to all of the major cardiovascular diseases, including coronary disease, stroke, peripheral artery disease, renal disease, and heart failure. The common variety of hypertension designated benign essential hypertension was not shown to be either benign or essential. Although clinicians favor the diagnosis and treatment of hypertension in terms of diastolic blood pressure elevation and categoric cut points, epidemiologic data show a more important influence of systolic blood pressure, and a continuous, graded influence of blood pressure even within what is regarded as the normotensive range. An important revelation in epidemiologic hypertension research is that hypertension usually occurs in conjunction with other metabolically linked risk factors; therefore, less than 20% occurs in isolation. The other risk factors that tend to accompany hypertension include glucose intolerance, obesity, left ventricular hypertrophy, and dislipidemia (elevated total, LDL, and small dense LDL cholesterol levels, raised triglyceride, and reduced HDL cholesterol levels). Clusters of three or more of these additional risk factors occur at four times the rate expected by chance. This clustering is attributed to an insulin resistance syndrome promoted by abdominal obesity. The amount of risk factor clustering accompanying elevated blood pressure was observed to increase with weight gain. Based on Framingham Study data the prevalence of insulin resistance syndrome in the general population could be as high as 22% in men and 27% in women. Risk of coronary disease, the most common and most lethal sequel to hypertension, increased stepwise with the extent of risk factor clustering. Among persons with hypertension, about 40% of coronary events in men and 68% in women are attributable to the presence of two or more additional risk factors. Only 14% of coronary events in

  4. Elevated lipoprotein(a), hypertension and renal insufficiency as predictors of coronary artery disease in patients with genetically confirmed heterozygous familial hypercholesterolemia.

    Science.gov (United States)

    Chan, Dick C; Pang, Jing; Hooper, Amanda J; Burnett, John R; Bell, Damon A; Bates, Timothy R; van Bockxmeer, Frank M; Watts, Gerald F

    2015-12-15

    Familial hypercholesterolemia (FH) is characterized by elevated LDL-cholesterol and increased risk of premature coronary artery disease (CAD). Lipoprotein(a) [Lp(a)] increases CAD in FH, although the independence of this association relative to other CAD risk factors remains unclear. In this study, we examined the association between Lp(a) and other cardiovascular risk factors and prevalent CAD in patients with FH. A cross-sectional study of 390 patients with genetically confirmed FH were studied. Clinical and biochemical parameters of FH patients with and without CAD were compared. FH patients with CAD were older and more often male and had a higher prevalence of hypertension, smoking, diabetes, obesity, reduced eGFR, and elevated plasma Lp(a) and pre-treatment LDL-cholesterol and triglyceride (or low HDL-cholesterol) than FH patients without CAD (P<0.05 for all). In univariate analyses, age, male gender, smoking, hypertension, reduced eGFR, diabetes, obesity, plasma creatinine, Lp(a) and pretreatment LDL-cholesterol, triglycerides and HDL-cholesterol levels were significant predictors of CAD in the FH patients (P<0.05 for all). Elevated LDL-cholesterol, raised Lp(a), hypertension and reduced eGFR remained significant independent predictors of CAD (P<0.05 for all) in FH after adjusting for other modifiable risk factors. Elevated Lp(a), hypertension and renal insufficiency are independent risk factors beyond elevated pretreatment LDL-cholesterol which predict CAD in patients with FH. In spite of the cross-sectional design of our study, we propose the need for identifying and managing these abnormalities to reduce excess CAD risk in FH patients. However, this proposal remains to be formally tested in a prospective study. Copyright © 2015. Published by Elsevier Ireland Ltd.

  5. Calcium antagonist induced vasodilation in peripheral, coronary and cerebral vasculature as important factors in the treatment of elderly hypertensives

    OpenAIRE

    Erne, P.; Conen, D.; Kiowski, W.; Bolli, P.; Müller, F. B.; Bühler, F. R.

    2017-01-01

    Increased arteriolar tone is the pathophysiological hallmark of essential hypertension and is determined by the intracellular free calcium concentration in the vascular smooth muscle cell. Calcium influx is an important determinant of vasoconstriction and excess calcium influx-dependent vasoconstriction has been shown by plethysmographical studies in patients with essential hypertension. Calcium antagonists acutely lower BP by reducing calcium influx, calcium concentration and peripheral resi...

  6. Long-term effect of prazosin administration on blood pressure, heart and structure of coronary artery of young spontaneously hypertensive rats.

    Science.gov (United States)

    Kristek, F; Koprdova, R

    2011-06-01

    The sympathetic nervous system belongs to the essential systems participating in blood pressure (BP) regulation. Inhibitory intervention into the key point of its operation (alfa 1 adrenoceptors) in the prehypertensive period of spontaneously hypertensive rats (SHR) might affect the development of the hypertension in later ontogenic periods. We studied the long-term effect of prazosin administration on the cardiovascular system of young Wistar rats and SHR. Four-week-old animals were used: Wistar rats, SHR, and Wistar rats and SHR receiving prazosin (10 mg/kg/day in tap water) by gavage. Blood pressure (BP) was measured weekly by the plethysmographic method. After six weeks under anaesthesia, the carotid artery was cannulated for BP registration, and the jugular vein was cannulated for administration of drugs. Afterwards, the animals were perfused with a glutaraldehyde fixative at a pressure of 120 mmHg. The septal branch of the left descending coronary artery was processed using electron microscopy. The prazosin administration evoked the following results in both groups: a decrease of BP and heart/body weight ratio, enhancement of hypotensive responses to acetylcholine (0.1 μg, 1 μg, and 10 μg), and an increase in the inner diameter of the coronary artery without changes in wall thickness, cross sectional area (CSA) (tunica intima+media), CSA of smooth muscle cells, and extracellular matrix. In the SHR group, a reduction was observed in BP increase after noradrenaline (1 μg) application. CSA of endothelial cells which was decreased in the SHR (compared to the control Wistar rats) was increased after prazosin treatment (up to control value). Long-term prazosin administration from early ontogeny partially prevented some pathological alterations in the cardiovascular system of SHR.

  7. A Type A and Type D Combined Personality Typology in Essential Hypertension and Acute Coronary Syndrome Patients: Associations with Demographic, Psychological, Clinical, and Lifestyle Indicators.

    Directory of Open Access Journals (Sweden)

    Patrizia Steca

    Full Text Available Many studies have focused on Type A and Type D personality types in the context of cardiovascular diseases (CVDs, but nothing is known about how these personality types combine to create new profiles. The present study aimed to develop a typology of Type A and Type D personality in two groups of patients affected by and at risk for coronary disease. The study involved 711 patients: 51.6% with acute coronary syndrome, 48.4% with essential hypertension (mean age = 56.4 years; SD = 9.7 years; 70.7% men. Cluster analysis was applied. External variables, such as socio-demographic, psychological, lifestyle, and clinical parameters, were assessed. Six groups, each with its own unique combined personality profile scores, were identified: Type D, Type A-Negatively Affected, Not Type A-Negatively Affected, Socially Inhibited-Positively Affected, Not Socially Inhibited, and Not Type A-Not Type D. The Type A-Negatively Affected cluster and, to a lesser extent, the Type D cluster, displayed the worst profile: namely higher total cardiovascular risk index, physical inactivity, higher anxiety and depression, and lower self-esteem, optimism, and health status. Identifying combined personality profiles is important in clinical research and practice in cardiovascular diseases. Practical implications are discussed.

  8. How Is Pulmonary Hypertension Treated?

    Science.gov (United States)

    ... Home / Hypertension Pulmonary Hypertension What Is Pulmonary hypertension (PULL-mun-ary HI- ... are called pulmonary hypertension.) Group 1 Pulmonary Arterial Hypertension Group 1 PAH includes: PAH that has no ...

  9. Comparison of dobutamine stress echocardiography and technetium-99m sestamibi single-photon emission tomography for the diagnosis of coronary artery disease in hypertensive patients with and without left ventricular hypertrophy

    International Nuclear Information System (INIS)

    Elhendy, A.; Geleijnse, M.L.; Van Domburg, R.T.; Bax, J.J.; Nierop, P.R.; Beerens, S.A.M.; Mohsen Ibrahim, M.; Roelandt, J.R.T.C.; Valkema, R.; Krenning, E.P.

    1998-01-01

    The aim of this study was to compare the accuracy of these two imaging modalities in conjunction with dobutamine stress test for the diagnosis of coronary artery disease in hypertensive patients with and without left ventricular hypertrophy. Dobutamine stress echocardiography in conjunction with sestamibi (MIBI) SPET was performed in 84 patients with the diagnosis of systemic hypertension who had been referred for evaluation of myocardial ischaemia. Significant coronary artery disease (≥50% luminal diameter stenosis) was detected in 66 patients (79%). The sensitivity, specificity and accuracy of the ischaemic pattern at echocardiography for the diagnosis of coronary artery disease were 73% (CI 63%-82%), 83% (CI 75%-91%) and 75% (CI 66%-84%), those for MIBI were 67% (CI 57%-77%), 83% (CI 75%-91%) and 70% (CI 60%-80%) respectively (P = NS vs echocardiography). Significant stenosis was detected in 123 (49%) of the 252 analysed coronary arteries. The sensitivity, specificity and accuracy of echocardiography for the regional diagnosis of coronary artery disease were 63% (CI 56%-69%), 90% (CI 86%-94%) and 77% (CI 72%-82%). Those for MIBI were 58% (CI 51%-64%), 91% (CI 87%-94%) and 75% (CI 69%-80) respectively (P = NS vs echocardiography). Left ventricular hypertrophy was detected in 59 patients (70%) by echocardiography and did not influence the overall or regional specificity of echocardiography or MIBI SPET.(orig./MG) (orig.)

  10. Vitamin D supplementation reduces some AT1-AA-induced downstream targets implicated in preeclampsia including hypertension.

    Science.gov (United States)

    Faulkner, Jessica L; Amaral, Lorena M; Cornelius, Denise C; Cunningham, Mark W; Ibrahim, Tarek; Heep, Autumn; Campbell, Nathan; Usry, Nathan; Wallace, Kedra; Herse, Florian; Dechend, Ralf; LaMarca, Babbette

    2017-01-01

    Autoantibodies to the ANG II type I receptor (AT 1 -AA) are associated with preeclampsia (PE). We found that vitamin D supplementation reduced AT 1 -AA and blood pressure (MAP) in the RUPP rat model of PE. However, it was undetermined whether the decrease in AT 1 -AA was the mechanism whereby vitamin D lowered MAP or if it were through factors downstream of AT 1 -AA. Uterine artery resistance index, placental ET-1, and soluble FMS-like tyrosine kinase-1 are increased with AT 1 -AA-induced hypertension and are considered markers of PE in pregnant women. Therefore, we hypothesized that vitamin D would reduce PE factors during AT 1 -AA-induced hypertension and could lower blood pressure in a model of hypertension during pregnancy without PE features. Either ANG II (50 ng·kg -1 ·day) or AT 1 -AA (1:40) was infused from gestational day (GD) 12-19. vitamin D 2 (VD2, 270 IU/day) or vitamin D 3 (VD3, 15 IU/day) was administered orally from GD14-GD18. MAP (mmHg) increased in AT 1 -AA (121 ± 4) and ANG II (113 ± 1)-infused pregnant rats compared with normal pregnant rats (NP) (101 ± 2) but was lower in AT 1 -AA+VD2 (105 ± 2), AT 1 -AA+VD3 (109 ± 2), ANG II+VD2 (104 ± 4), and ANG II+VD3 (104 ± 3). VD2 and/or VD3 improved PE features associated with AT 1 -AA during pregnancy, while ANG II did not induce such features, supporting the hypothesis that AT 1 -AA induces PE features during pregnancy, and these are improved with vitamin D. In this study, we demonstrate that vitamin D improved many factors associated with PE and reduced blood pressure in a hypertensive model without PE features, indicating that vitamin D could be beneficial for various hypertensive disorders of pregnancy. Copyright © 2017 the American Physiological Society.

  11. Right versus left radial artery access for coronary procedures: an international collaborative systematic review and meta-analysis including 5 randomized trials and 3210 patients.

    Science.gov (United States)

    Biondi-Zoccai, Giuseppe; Sciahbasi, Alessandro; Bodí, Vicente; Fernández-Portales, Javier; Kanei, Yumiko; Romagnoli, Enrico; Agostoni, Pierfrancesco; Sangiorgi, Giuseppe; Lotrionte, Marzia; Modena, Maria Grazia

    2013-07-01

    Radial artery access is a mainstay in the diagnosis and treatment of coronary artery disease. However, there is uncertainty on the comparison of right versus left radial access for coronary procedures. We thus undertook a systematic review and meta-analysis comparing right versus left radial access for coronary diagnostic and interventional procedures. Pertinent studies were searched in CENTRAL, Google Scholar, MEDLINE/PubMed, and Scopus, together with international conference proceedings. Randomized trials comparing right versus left radial (or ulnar) access for coronary diagnostic or interventional procedures were included. Risk ratios (RR) and weighted mean differences (WMD) were computed to generate point estimates (95% confidence intervals). A total of 5 trials (3210 patients) were included. No overall significant differences were found comparing right versus left radial access in terms of procedural time (WMD=0.99 [-0.53; 2.51]min, p=0.20), contrast use (WMD=1.71 [-1.32; 4.74]mL, p=0.27), fluoroscopy time (WMD=-35.79 [-3.54; 75.12]s, p=0.07) or any major complication (RR=2.00 [0.75; 5.31], p=0.49). However, right radial access was fraught with a significantly higher risk of failure leading to cross-over to femoral access (RR=1.65 [1.18; 2.30], p=0.003) in comparison to left radial access. Right and left radial accesses appear largely similar in their overall procedural and clinical performance during transradial diagnostic or interventional procedures. Nonetheless, left radial access can be recommended especially during the learning curve phase to reduce femoral cross-overs. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  12. Nuclear cardiology and coronary surgery

    DEFF Research Database (Denmark)

    Eckardt, R.; Andersen, L.I.; Hesse, B.

    2008-01-01

    Rising age, repeated percutaneous coronary revascularizations, and co-morbidity such as overweight, diabetes, and hypertension, characterize a change over the last 20-30 years in coronary patients referred to coronary artery bypass grafting (CABG). This patient group represents a great part of to...

  13. [The influence of carbon dioxide baths differing in the total mineralization levels on the functional state of the cardiovascular system of the patients presenting with hypertensive disease associated with coronary heart disease].

    Science.gov (United States)

    L'vova, N V; Tupitsyna, Iu Iu; Badalov, N G; Krasnikov, V E; Lebedeva, O D

    2013-01-01

    The results of the study on the influence of carbon dioxide baths differing in the total mineralization levels on the clinical course of hypertensive disease associated with coronary heart disease and on various functional systems of the body. The data obtained provide an insight into the role of salt concentrations (10 and 20 g/l) in carbon dioxide bath water (1.2 g/l) applied for the traditional treatment of the patients with hypertensive disease associated with concomitant coronary heart disease and musculoskeletal pathology. Highly mineralized bath water has a greater influence on the functional state of the cardiovascular system by causing a more pronounced decrease in peripheral vascular resistance and hypotensive effect. Baths with a salt concentration of 20 g/l markedly reduced pain and had anti-inflammatory effect in the patients with pathology of support and locomotor organs.

  14. Adherence to Treatment, Safety, Tolerance, and Effectiveness of Perindopril/Amlodipine Fixed-Dose Combination in Greek Patients with Hypertension and Stable Coronary Artery Disease: A Pan-Hellenic Prospective Observational Study of Daily Clinical Practice.

    Science.gov (United States)

    Liakos, Charalampos I; Papadopoulos, Dimitrios P; Kotsis, Vasilios T

    2017-10-01

    Initiation of antihypertensive therapy with a two-drug fixed-dose combination (FDC) in a single tablet may be recommended in patients at high risk of cardiovascular events to improve adherence and effectiveness. Preferred combinations include an angiotensin-converting enzyme inhibitor with a dihydropyridine calcium antagonist. This study assessed adherence to and the safety, tolerance, and effectiveness of the perindopril/amlodipine FDC in Greek patients with hypertension and stable coronary artery disease (CAD) over a 4-month period. A total of 1907 patients with hypertension and CAD (59.1% males) who had recently (≤2 weeks) commenced treatment with the perindopril/amlodipine FDC (5/5, 5/10, 10/5, or 10/10 mg) were studied at baseline and at 1 and 4 months. Adherence to treatment was assessed with the Morisky Medication-taking Adherence Scale (MMAS). Seven patients (0.4%) did not attend the scheduled visits. In total, 1607 (84.6%) patients received a constant treatment dose throughout the study. High adherence (MMAS score = 0) was reported by 1592 (83.6%), 1628 (85.7%), and 1477 (77.7%) patients at the second and the third visit and at both visits, respectively. Adverse reactions were reported by only 13 (0.7%) patients, were all minor, and did not result in treatment discontinuation. Office blood pressure (BP) was significantly decreased at the third visit (130.8 ± 8.4/78.2 ± 6.4 mmHg) compared with baseline (156.5 ± 15.0/89.9 ± 9.6 mmHg; p < 0.001), regardless of previous antihypertensive treatment. Patients with grade 1, 2, and 3 hypertension at baseline showed a reduction in BP of 19.3/9.4, 31.5/13.5, and 47.8/22.2 mmHg, respectively (p < 0.001). Uncontrolled hypertension (≥140/90 mmHg) was notably reduced from 90.3% at baseline to 18.5% at the third visit. The perindopril/amlodipine FDC is characterized by high adherence and effectiveness, regardless of previous treatment. Degree of BP reduction was related to baseline BP levels

  15. Hypertension og hyperlipidaemi

    DEFF Research Database (Denmark)

    Hansen, Henrik Steen; Larsen, Mogens Lytken

    2009-01-01

    Hypertension and hyperlipidemia are well-established and partially overlapping risk factors for cardiovascular disease. Analyses of cardiovascular morbidity in relationship to changes in blood pressure and in serum cholesterol levels have shown that combined reduction of both risk factors...... are important to achieve a reduction in morbidity. Statins have been shown to be effective in preventing both coronary and cerebrovascular events in both hypertensive and normotensive cases. Consequently, most recent guidelines recommend that statin treatment be considered in hypertensive patients aged less...

  16. Resistant and Refractory Hypertension: Antihypertensive Treatment Resistance vs Treatment Failure

    Science.gov (United States)

    Siddiqui, Mohammed; Dudenbostel, Tanja; Calhoun, David A.

    2017-01-01

    Resistant or difficult to treat hypertension is defined as high blood pressure that remains uncontrolled with 3 or more different antihypertensive medications, including a diuretic. Recent definitions also include controlled blood pressure with use of 4 or more medications as also being resistant to treatment. Recently, refractory hypertension, an extreme phenotype of antihypertensive treatment failure has been defined as hypertension uncontrolled with use of 5 or more antihypertensive agents, including a long-acting thiazide diuretic and a mineralocorticoid receptor antagonist. Patients with resistant vs refractory hypertension share similar characteristics and comorbidities, including obesity, African American race, female sex, diabetes, coronary heart disease, chronic kidney disease, and obstructive sleep apnea. Patients with refractory vs resistant hypertension tend to be younger and are more likely to have been diagnosed with congestive heart failure. Refractory hypertension might also differ from resistant hypertension in terms of underlying cause. Preliminary evidence suggests that refractory hypertension is more likely to be neurogenic in etiology (ie, heightened sympathetic tone), vs a volume-dependent hypertension that is more characteristic of resistant hypertension in general. PMID:26514749

  17. Resistant Hypertension.

    Science.gov (United States)

    Doroszko, Adrian; Janus, Agnieszka; Szahidewicz-Krupska, Ewa; Mazur, Grzegorz; Derkacz, Arkadiusz

    2016-01-01

    Resistant hypertension is a severe medical condition which is estimated to appear in 9-18% of hypertensive patients. Due to higher cardiovascular risk, this disorder requires special diagnosis and treatment. The heterogeneous etiology, risk factors and comorbidities of resistant hypertension stand in need of sophisticated evaluation to confirm the diagnosis and select the best therapeutic options, which should consider lifestyle modifications as well as pharmacological and interventional treatment. After having excluded pseudohypertension, inappropriate blood pressure measurement and control as well as the white coat effect, suspicion of resistant hypertension requires an analysis of drugs which the hypertensive patient is treated with. According to one definition - ineffective treatment with 3 or more antihypertensive drugs including diuretics makes it possible to diagnose resistant hypertension. A multidrug therapy including angiotensin - converting enzyme inhibitors, angiotensin II receptor blockers, beta blockers, diuretics, long-acting calcium channel blockers and mineralocorticoid receptor antagonists has been demonstrated to be effective in resistant hypertension treatment. Nevertheless, optional, innovative therapies, e.g. a renal denervation or baroreflex activation, may create a novel pathway of blood pressure lowering procedures. The right diagnosis of this disease needs to eliminate the secondary causes of resistant hypertension e.g. obstructive sleep apnea, atherosclerosis and renal or hormonal disorders. This paper briefly summarizes the identification of the causes of resistant hypertension and therapeutic strategies, which may contribute to the proper diagnosis and an improvement of the long term management of resistant hypertension.

  18. Intracranial Hypertension Research Foundation

    Science.gov (United States)

    ... PARTNERSHIPS Meet our Fundraising Partners Tweet Welcome Intracranial hypertension (IH) is the general term for the neurological ... high. (Old names for IH include Benign Intracranial Hypertension and Pseudotumor Cerebri). The Intracranial Hypertension Research Foundation ...

  19. Practice size, caseload, deprivation and quality of care of patients with coronary heart disease, hypertension and stroke in primary care: national cross-sectional study

    Directory of Open Access Journals (Sweden)

    Soljak Michael

    2007-06-01

    Full Text Available Abstract Background Reports of higher quality care by higher-volume secondary care providers have fuelled a shift of services from smaller provider units to larger hospitals and units. In the United Kingdom, most patients are managed in primary care. Hence if larger practices provide better quality of care; this would have important implications for the future organization of primary care services. We examined the association between quality of primary care for cardiovascular disease achieved by general practices in England and Scotland by general practice caseload, practice size and area based deprivation measures, using data from the New General Practitioner (GP Contract. Methods We analyzed data from 8,970 general practices with a total registered population of 55,522,778 patients in England and Scotland. We measured practice performance against 26 cardiovascular disease (coronary heart disease, left ventricular disease, and stroke Quality and Outcomes Framework (QOF indicators for patients on cardiovascular disease registers and linked this with data on practice characteristics and census data. Results Despite wide variations in practice list sizes and deprivation, the prevalence of was remarkably consistent, (coronary heart disease, left ventricular dysfunction, hypertension and cerebrovascular disease was 3.7%; 0.45%; 11.4% and 1.5% respectively. Achievement in quality of care for cardiovascular disease, as measured by QOF, was consistently high regardless of caseload or size with a few notable exceptions: practices with larger list sizes, higher cardiovascular disease caseloads and those in affluent areas had higher achievement of indicators requiring referral for further investigation. For example, small practices achieved lower scores 71.4% than large practices 88.6% (P Conclusion The volume-outcome relationship found in hospital settings is not seen between practices in the UK in management of cardiovascular disorders in primary care

  20. Practice size, caseload, deprivation and quality of care of patients with coronary heart disease, hypertension and stroke in primary care: national cross-sectional study.

    Science.gov (United States)

    Saxena, Sonia; Car, Josip; Eldred, Darren; Soljak, Michael; Majeed, Azeem

    2007-06-27

    Reports of higher quality care by higher-volume secondary care providers have fuelled a shift of services from smaller provider units to larger hospitals and units. In the United Kingdom, most patients are managed in primary care. Hence if larger practices provide better quality of care; this would have important implications for the future organization of primary care services. We examined the association between quality of primary care for cardiovascular disease achieved by general practices in England and Scotland by general practice caseload, practice size and area based deprivation measures, using data from the New General Practitioner (GP) Contract. We analyzed data from 8,970 general practices with a total registered population of 55,522,778 patients in England and Scotland. We measured practice performance against 26 cardiovascular disease (coronary heart disease, left ventricular disease, and stroke) Quality and Outcomes Framework (QOF) indicators for patients on cardiovascular disease registers and linked this with data on practice characteristics and census data. Despite wide variations in practice list sizes and deprivation, the prevalence of was remarkably consistent, (coronary heart disease, left ventricular dysfunction, hypertension and cerebrovascular disease was 3.7%; 0.45%; 11.4% and 1.5% respectively). Achievement in quality of care for cardiovascular disease, as measured by QOF, was consistently high regardless of caseload or size with a few notable exceptions: practices with larger list sizes, higher cardiovascular disease caseloads and those in affluent areas had higher achievement of indicators requiring referral for further investigation. For example, small practices achieved lower scores 71.4% than large practices 88.6% (P < 0.0001) for referral for exercise testing and specialist assessment of patients with newly diagnosed angina. The volume-outcome relationship found in hospital settings is not seen between practices in the UK in

  1. COMPARATIVE EVALUATION OF THE ANTIHYPERTENSIVE EFFECT OF PERINDOPRIL AND LOSARTAN POTASSIUM IN PATIENTS WITH ARTERIAL HYPERTENSION AND STENOTIC CORONARY ATHEROSCLEROSIS BEFORE REVASCULARIZATION: AN OPEN RANDOMIZED COMPARATIVE STUDY

    Directory of Open Access Journals (Sweden)

    O. A. Osipova

    2011-01-01

    Full Text Available Aim. To compare effects of perindopril and losartan potassium on the parameters of the ambulatory blood pressure (BP monitoring (ABPM and circadian BP profile in patients with arterial hypertension (HT and stenotic coronary atherosclerosis before myocardium revascularization. Material and methods. 59 patients with HT degree 2-3 at the age of 35-69 were examined. ABPM was performed in all patients. Daily profile was assessed by the degree of nocturnal BP reduction. Patients were randomized to receive perindopril or losartan potassium. Perindopril was administered at dose of 4 mg/day with subsequent rising up to 8 mg/day in next 7 days. The initial dose of losartan potassium was 25 mg with subsequent rising up to 50 mg 2 times a day. Duration of observation was 8 weeks. Results. Perindopril reduced 24-hour and daytime systolic BP (SBP by 17.2% (p<0.0001, nighttime SBP - by 22.5% (p<0.0001, 24-hour and daytime diastolic BP (DBP - by 18.3% and 17.6% (p<0.0001, respectively , nighttime DBP - by 27.2% (p<0.0001. Losartan potassium reduced 24-hour SBP by 25.7% (p<0.0001, daytime SBP - by 23.6% (p<0.0001, night-time SBP – by 25.5% (p<0.0001, 24-hour DBP - by 27.4%, daytime DBP - by 26.3%, nighttime DBP - by 18.5% (p=0.003. Perindopril decreased in number of non-dippers by 24,3% and night-peakers by 5.4% as well as increased in number of dippers by 27% and over-dippers by 2.7%. A number of patients with SAD profile corresponding to non-dipper type was 45.5% more in losartan taking than this when perindopril receiving (p=0.027. Conclusion. In patients with HT and stenotic coronary atherosclerosis perindopril therapy increases a number of patients with normal BP profile before myocardium revascularization.

  2. A study on body mass index (BMI) and some biochemical parameters of the medicos with family history of diabetes mellitus, hypertension and coronary heart disease.

    Science.gov (United States)

    Bhattacharyya, S; Mukhopadhyay, M; Bhattacharyya, I; Lahiri, S K; Mitra, P K; Dutta, U K

    2007-07-01

    Increasing prevalence of diabetes mellitus (DM), hypertension (HT), coronary heart disease (CHD) is alarming; risk factors are fairly stable, passing fairly well from childhood to adulthood; genetic factors play a role. This is important to know the status of some biochemical parameters viz, fasting plasma glucose level, fasting serum insulin (FI), serum triglyceride (STG), total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL) among the medicos with family history (FH) of DM, HT or CHD and the relationship of biochemical parameters with body mass index (BMI). Mean age of the sample (n=67) was 22 years with 76.12% males and 23.88% females; 44.78%, 29.85% and 19.40% had FH of DM, HT and CHD respectively; 8.96% had the FH of three diseases. High BMI was seen in 62.69% cases; it was significantly high among those with FH of DM (p0.05) or CHD (p>0.05). All had normal fasting plasma glucose level. Positive association existed (a) between BMI with FI, LDL and HDL, FI with LDL and HDL, TG with TC, TC with LDL and HDL, LDL with HDL among those with FH of DM; (b) between BMI with FI, STG and HDL, FI with LDL and HDL, TC with LDL and HDL, LDL with HDL among those with FH of HT; (c) between BMI with FI, STG and HDL, FI with TC, LDL and HDL, TC with LDL and HDL, LDL with HDL among those with FH of CHD. Multiple correlation coefficients (R) also indicated moderate association.

  3. Mineralocorticoid hypertension

    Directory of Open Access Journals (Sweden)

    Vishal Gupta

    2011-01-01

    Full Text Available Hypertension affects about 10 - 25% of the population and is an important risk factor for cardiovascular and renal disease. The renin-angiotensin system is frequently implicated in the pathophysiology of hypertension, be it primary or secondary. The prevalence of primary aldosteronism increases with the severity of hypertension, from 2% in patients with grade 1 hypertension to 20% among resistant hypertensives. Mineralcorticoid hypertension includes a spectrum of disorders ranging from renin-producing pathologies (renin-secreting tumors, malignant hypertension, coarctation of aorta, aldosterone-producing pathologies (primary aldosteronism - Conns syndrome, familial hyperaldosteronism 1, 2, and 3, non-aldosterone mineralocorticoid producing pathologies (apparent mineralocorticoid excess syndrome, Liddle syndrome, deoxycorticosterone-secreting tumors, ectopic adrenocorticotropic hormones (ACTH syndrome, congenitalvadrenal hyperplasia, and drugs with mineraocorticoid activity (locorice, carbenoxole therapy to glucocorticoid receptor resistance syndromes. Clinical presentation includes hypertension with varying severity, hypokalemia, and alkalosis. Ratio of plasma aldosterone concentraion to plasma renin activity remains the best screening tool. Bilateral adrenal venous sampling is the best diagnostic test coupled with a CT scan. Treatment is either surgical (adrenelectomy for unilateral adrenal disease versus medical therapy for idiopathic, ambiguous, or bilateral disease. Medical therapy focuses on blood pressure control and correction of hypokalemia using a combination of anti-hypertensives (calcium channel blockers, angiotensin converting enzyme inhibitors, or angiotensin receptor blockers and potassium-raising therapies (mineralcorticoid receptor antagonist or potassium sparing diuretics. Direct aldosterone synthetase antagonists represent a promising future therapy.

  4. Study on the un-conformable results between myocardial perfusion SPECT and coronary angiography

    International Nuclear Information System (INIS)

    Yao Zhiming; Liu Xiujie; Yu Quanjun

    1997-01-01

    PURPOSE: To analyze the un-conformable results between myocardial perfusion SPECT and coronary angiography (CAG). METHODS: The data of 408 in-patients who underwent myocardial perfusion SPECT and CAG were analyzed. RESULTS: Among them, twenty five patients, 22 males and 3 females (average age 51.7 +- 10.5 years old) had un-conformable results of SPECT and CAG. Group A included 15 cases with myocardial defect on SPECT and normal coronary artery or coronary stenosis<50% on CAG, which were 3 old myocardial infarction, 7 X syndrome, 1 30%∼40% coronary stenosis, 1 essential hypertension, 1 dilated cardiomyopathy, 1 cardiac tumor and 1 sleep dyspnea syndrome. Group B included 10 cases with normal SPECT and coronary stenosis≥50% on CAG. There were 5 coronary artery stenosis between 50%∼60%, 5 right coronary artery stenosis, 5 terminal branches stenosis, 2 collateral circulation, and 1 insufficient exercise involved in 10 patients. CONCLUSION: It can not be considered that all abnormal SPECT without significant coronary stenosis is false positive; while all normal SPECT with significant coronary stenosis is truly negative, probably due to terminal branch stenosis, coronary stenosis between 50%∼60% on right coronary artery stenosis

  5. The human coronary collateral circulation: development and clinical importance.

    Science.gov (United States)

    Seiler, Christian; Stoller, Michael; Pitt, Bertram; Meier, Pascal

    2013-09-01

    Coronary collaterals are an alternative source of blood supply to myocardium jeopardized by ischaemia. In comparison with other species, the human coronary collateral circulation is very well developed. Among individuals without coronary artery disease (CAD), there are preformed collateral arteries preventing myocardial ischaemia during a brief vascular occlusion in 20-25%. Determinants of such anastomoses are low heart rate and the absence of systemic arterial hypertension. In patients with CAD, collateral arteries preventing myocardial ischaemia during a brief occlusion are present in every third individual. Collateral flow sufficient to prevent myocardial ischaemia during coronary occlusion amounts to one-fifth to one-fourth the normal flow through the open vessel. Myocardial infarct size, the most important prognostic determinant after such an event, is the product of coronary artery occlusion time, area at risk for infarction, and the inverse of collateral supply. Well-developed coronary collateral arteries in patients with CAD mitigate myocardial infarcts and improve survival. Approximately one-fifth of patients with CAD cannot be revascularized by percutaneous coronary intervention or coronary artery bypass grafting. Therapeutic promotion of collateral growth is a valuable treatment strategy in those patients. It should aim at growth of large conductive collateral arteries (arteriogenesis). Potential arteriogenic approaches include the treatment with granulocyte colony-stimulating factor, physical exercise training, and external counterpulsation.

  6. Correlation of regional wall motion and fatty acid metabolism in coronary artery disease, hypertension, and hypertrophic cardiomyopathy; Assessment by dual-isotope SPECT with thallium-201 and iodine-123 [beta]-methyl fatty acid analogue

    Energy Technology Data Exchange (ETDEWEB)

    Hase, Mamoru; Nakata, Tomoaki; Yonekura, Shuji (Sapporo Medical Coll. (Japan)) (and others)

    1993-05-01

    In order to investigate the correlation between cardiac fatty acid metabolism and regional wall motion, dual-isotope tomography using thallium-201 and iodine-123 labeled 15-(p-iodophenyl)-3-R, S-methylpentadecanoic acid (BMIPP), was performed in 15 patients with coronary artery disease (CAD), hypertension, or hypertrophic cardiomyopathy (HCM). The uptake of thallium and BMIPP was scored and compared with left ventricular regional wall motion assessed by 2-dimensional echocardiography and radionuclide ventriculography. The incidence of a complete agreement of thallium and BMIPP scores was significantly higher in hypertension (64%) and CAD (63%) groups compared to HCM patients (24%), while a lower BMIPP uptake compared to that of thallium (mismatching) was observed more frequently in HCM (65%) than in hypertension (31%) or CAD (33%). Only 3 infarct patients had regional wall motion abnormality which was detected in 20 (95%) of 21 segments with a low BMIPP uptake. Furthermore, compared to thallium perfusion, decreased BMIPP uptake much more corresponded to reduced wall motion in 8 of 11 segments with mismatching. Thus, metabolic abnormality assessed by BMIPP is well associated with asynergy in CAD patients, whereas the discrepancy of fatty acid metabolism and contraction is more dominant in HCM, suggesting that the combined assessment of thallium perfusion, BMIPP uptake, and regional wall motion might contribute to better understanding of the pathogenesis of various cardiac disorders. (author).

  7. Hypertension and cardiac arrhythmias

    DEFF Research Database (Denmark)

    Lip, Gregory Y H; Coca, Antonio; Kahan, Thomas

    2017-01-01

    Hypertension (HTN) is a common cardiovascular risk factor leading to heart failure (HF), coronary artery disease (CAD), stroke, peripheral artery disease and chronic renal failure. Hypertensive heart disease can manifest as many types of cardiac arrhythmias, most commonly being atrial fibrillation......) Council on Hypertension convened a Task Force, with representation from the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE), with the remit of comprehensively reviewing the available evidence...

  8. [Pregnancy and coronary artery dissection].

    Science.gov (United States)

    Martínez-Quintana, Efrén; Rodríguez-González, Fayna

    2015-01-01

    Acute myocardial infarction during pregnancy is associated with high maternal and fetal mortality. Coronary atherosclerosis is the most common cause due to an increase in the age of the patients and the association with cardiovascular risk factors such as smoking, hypertension, diabetes mellitus, preeclampsia, and the existence of family history of coronary disease. However, thrombosis, coronary dissection or coronary vasospasms are other causes that may justify it. We report the case of a 33 weeks pregnant first-time mother, without cardiovascular risk factors, who presented an acute coronary event in the context of atherosclerotic disease and coronary dissection after percutaneous coronary intervention. Copyright © 2014 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

  9. THE PLURAL LESION CORONARY AND CYTOKINES DISBALANCE IN PATIENTS WITH CORONARY ATHEROSCLEROSIS

    Directory of Open Access Journals (Sweden)

    Martynov AV

    2012-12-01

    Full Text Available The aim of the study was to examine the levels of the main pro-inflammatory and anti-inflammatory cytokines in patients with ischemic heart disease, and the study of the possible impact of persistent herpes virus infection plural lesion coronary arteries. A total of 57 patients (mean age 49,3 ± 3,7 years IHD s hemodynamically significant stenoses of the coronary vessels. Conducted virological examination, including the definition of hypertension HSV1, HSV2, HHV6, SMV, VZV and VEB immunofluorescent and cytokines ІL-1β, ІL-6 ІL-8, TNF by ELISA in serum. Found increased levels of proinflammatory cytokines ІL-1β, ІL-6 and FNPα of IHD patients who had hemodynamically significant stenoses of coronary vessels. ІL-6 level in patients with 2 or more significant coronary artery lesions exceeded the rate of patients with a damaged coronary artery in 1.67 TNFα, ІL-8 - 1.37 ІL-1β and 1.28 times respectively. In patients with plural coronary vascular damage was the most common combination of CMV, VEB and HHV6. Since CMV was detected in more than 60% of patients with injuries of two spacecraft and nearly 76% from three spacecraft, VEB was detected in 72% and 88%, respectively.

  10. Coronary Artery Anomalies in Animals.

    Science.gov (United States)

    Scansen, Brian A

    2017-04-12

    Coronary artery anomalies represent a disease spectrum from incidental to life-threatening. Anomalies of coronary artery origin and course are well-recognized in human medicine, but have received limited attention in veterinary medicine. Coronary artery anomalies are best described in the dog, hamster, and cow though reports also exist in the horse and pig. The most well-known anomaly in veterinary medicine is anomalous coronary artery origin with a prepulmonary course in dogs, which limits treatment of pulmonary valve stenosis. A categorization scheme for coronary artery anomalies in animals is suggested, dividing these anomalies into those of major or minor clinical significance. A review of coronary artery development, anatomy, and reported anomalies in domesticated species is provided and four novel canine examples of anomalous coronary artery origin are described: an English bulldog with single left coronary ostium and a retroaortic right coronary artery; an English bulldog with single right coronary ostium and transseptal left coronary artery; an English bulldog with single right coronary ostium and absent left coronary artery with a prepulmonary paraconal interventricular branch and an interarterial circumflex branch; and a mixed-breed dog with tetralogy of Fallot and anomalous origin of all coronary branches from the brachiocephalic trunk. Coronary arterial fistulae are also described including a coronary cameral fistula in a llama cria and an English bulldog with coronary artery aneurysm and anomalous shunting vessels from the right coronary artery to the pulmonary trunk. These examples are provided with the intent to raise awareness and improve understanding of such defects.

  11. Pharmacotherapy for mild hypertension

    Directory of Open Access Journals (Sweden)

    Diana Diao

    2012-01-01

    Full Text Available BACKGROUND: People with no previous cardiovascular events or cardiovascular disease represent a primary prevention population. The benefits and harms of treating mild hypertension in primary prevention patients are not known at present. This review examines the existing randomized controlled trial (RCT evidence. OBJECTIVE: Primary objective: To quantify the effects of antihypertensive drug therapy on mortality and morbidity in adults with mild hypertension (systolic blood pressure (BP 140-159 mmHg and/or diastolic BP 90-99 mmHg and without cardiovascular disease. METHODS: Search: We searched CENTRAL (2011, Issue 1, MEDLINE (1948 to May 2011, EMBASE (1980 to May 2011 and reference lists of articles. The Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effectiveness (DARE were searched for previous reviews and meta-analyses of anti-hypertensive drug treatment compared to placebo or no treatment trials up until the end of 2011. Selection criteria: RCTs of at least 1 year duration. Data collection and analysis: The outcomes assessed were mortality, stroke, coronary heart disease (CHD, total cardiovascular events (CVS, and withdrawals due to adverse effects. MAIN RESULTS: Of 11 RCTs identified 4 were included in this review, with 8,912 participants. Treatment for 4 to 5 years with antihypertensive drugs as compared to placebo did not reduce total mortality (RR 0.85, 95% CI 0.63, 1.15. In 7,080 participants treatment with antihypertensive drugs as compared to placebo did not reduce coronary heart disease (RR 1.12, 95% CI 0.80, 1.57, stroke (RR 0.51, 95% CI 0.24, 1.08, or total cardiovascular events (RR 0.97, 95% CI 0.72, 1.32. Withdrawals due to adverse effects were increased by drug therapy (RR 4.80, 95% CI 4.14, 5.57, ARR 9%. AUTHORS' CONCLUSIONS: Antihypertensive drugs used in the treatment of adults (primary prevention with mild hypertension (systolic BP 140-159 mmHg and/or diastolic BP 90-99 mmHg have not been

  12. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial--Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial

    DEFF Research Database (Denmark)

    Sever, Peter S; Dahlöf, Björn; Poulter, Neil R

    2003-01-01

    The lowering of cholesterol concentrations in individuals at high risk of cardiovascular disease improves outcome. No study, however, has assessed benefits of cholesterol lowering in the primary prevention of coronary heart disease (CHD) in hypertensive patients who are not conventionally deemed...

  13. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial--Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial

    DEFF Research Database (Denmark)

    Sever, Peter S; Dahlöf, Björn; Poulter, Neil R

    2004-01-01

    The lowering of cholesterol concentrations in individuals at high risk of cardiovascular disease improves outcome. No study, however, has assessed benefits of cholesterol lowering in the primary prevention of coronary heart disease (CHD) in hypertensive patients who are not conventionally deemed...

  14. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial--Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial

    DEFF Research Database (Denmark)

    Sever, Peter S; Dahlöf, Björn; Poulter, Neil R

    2003-01-01

    The lowering of cholesterol concentrations in individuals at high risk of cardiovascular disease improves outcome. No study, however, has assessed benefits of cholesterol lowering in the primary prevention of coronary heart disease (CHD) in hypertensive patients who are not conventionally deemed ...

  15. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial--Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial

    DEFF Research Database (Denmark)

    Sever, Peter S; Dahlöf, Björn; Poulter, Neil R

    2004-01-01

    The lowering of cholesterol concentrations in individuals at high risk of cardiovascular disease improves outcome. No study, however, has assessed benefits of cholesterol lowering in the primary prevention of coronary heart disease (CHD) in hypertensive patients who are not conventionally deemed ...

  16. Therapeutic Exercise and Hypertension

    African Journals Online (AJOL)

    Nekky Umera

    Little's syndrome and aldosteronism. (Kamide, 2003). Hypertension is probably the most common cardiovascular disease, and major health problem all over the world (Gumells, 1974). It is a strong and independent risk factor for coronary heart diasease. (National High Blood Pressure Education Programme, 1993) and the.

  17. Dosagem de microalbuminúria em hipertensos e em pacientes portadores de doença coronariana Determination of microalbuminuria in hypertensive patients and in patients with coronary artery disease

    Directory of Open Access Journals (Sweden)

    Ricardo Pereira Silva

    2008-02-01

    Full Text Available FUNDAMENTO: A taxa normal de excreção de albumina em 24 horas é de 20 mg. A taxa persistente de 30 a 300 mg/dia é chamada de microalbuminúria (MA e está relacionada com maior prevalência de doença cardiovascular. OBJETIVO: Determinar a prevalência de microalbuminúria em um grupo de hipertensos e em um grupo de portadores de doença coronariana; e determinar a relação da presença de microalbuminúria com hipertensão arterial, diabete melitus, dislipidemia, tabagismo e obesidade. MÉTODOS:: Determinamos a presença de microalbuminúria num grupo de hipertensos (73 indivíduos e num grupo de coronariopatas (39 indivíduos, e comparamos com um grupo-controle (43 indivíduos. Considerou-se como microalbuminúria a relação albumina/creatinina maior que 30 e menor que 300 em amostra isolada de urina matinal. Na análise estatística, foram utilizados os testes do qui-quadrado e o teste exato de Fisher. RESULTADOS: A microalbuminúria esteve presente em 9,5% dos hipertensos, em 33% dos coronariopatas e não esteve presente em nenhum indivíduo do grupo-controle. Ao analisar a ocorrência de microalbuminúria segundo os diversos parâmetros clínicos, independentemente do grupo a que pertenciam, verificamos correlação estatisticamente significativa com idade, diabete e dislipidemia. CONCLUSÃO: 1 A prevalência de microalbuminúria em indivíduos hipertensos é elevada, sendo ainda mais elevada em portadores de doença coronariana; 2 existe correlação da presença de microalbuminúria com idade, diabete e dislipidemia.BACKGROUND: The normal 24-hour albumin excretion rate is of 20 mg. A persistent rate of 30 to 300 mg/day is called microalbuminuria and is related to a higher prevalence of cardiovascular disease. OBJECTIVE: 1 To determine the prevalence of microalbuminuria in a group of hypertensive patients and in a group of patients with coronary artery disease; 2 To determine the relationship between the presence of microalbuminuria

  18. Metabolic syndrome and mortality in stable coronary heart disease: relation to gender

    DEFF Research Database (Denmark)

    Kragelund, Charlotte; Køber, Lars; Faber, Jens

    2007-01-01

    is unknown. METHODS: 1041 patients with stable coronary heart disease, referred for elective coronary angiography were included in this study. At baseline, history of hypertension, body mass index, lipids, fasting plasma glucose, and insulin were recorded. All-cause mortality was determined after a median...... follow-up of 9.2 years. RESULTS: At follow-up 296 (28%) patients had died. 315 (30%) patients had MS based on the definition by the World Health Organization. Patients with MS more frequently had diabetes and three-vessel disease of the coronary arteries. Men had a more severe risk profile than women...

  19. Outcome of Triple Antiplatelet Therapy Including Cilostazol in Elderly Patients with ST-Elevation Myocardial Infarction who Underwent Primary Percutaneous Coronary Intervention: Results from the INTERSTELLAR Registry.

    Science.gov (United States)

    Jang, Ho-Jun; Park, Sang-Don; Park, Hyun Woo; Suh, Jon; Oh, Pyung Chun; Moon, Jeonggeun; Lee, Kyounghoon; Kang, Woong Chol; Kwon, Sung Woo; Kim, Tae-Hoon

    2017-06-01

    Compared with dual antiplatelet therapy including aspirin and clopidogrel, triple antiplatelet therapy including cilostazol has a mortality benefit in patients with ST-segment elevation myocardial infarction. However, whether the mortality benefit persists in elderly patients is not clear. From 2007 to 2014, 1278 patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention were retrospectively analyzed. The patients were divided into four groups by age (elderly, respectively) and antiplatelet strategy (triple or dual antiplatelet therapy). We compared the mortality rates between the triple and dual antiplatelet therapy groups. There were 1052 (male, 85%; mean age, 56.3 ± 10.4 years) patients in the young group and 241 (male, 52.7%; mean age, 80.3 ± 4.5 years) patients in the elderly group. In the young and elderly groups, 220 (20.9%) and 28 (12.3%) patients were treated with triple antiplatelet therapy. During a 1-year follow-up period, 80 patients died (4.2% in the young group vs. 15.5% in the elderly group). Kaplan-Meier survival analysis revealed that triple antiplatelet therapy was associated with a lower mortality rate in the young group (log-rank, p = 0.005). Although there were more angiographic high-risk patients in the elderly group, similar mortality rates were reported (log-rank, p = 0.803) without increased bleeding rates (1 vs. 3.6% in the elderly group, p = 0.217). Triple antiplatelet therapy might be a better antiplatelet regimen than dual antiplatelet therapy for patients with ST-segment elevation myocardial infarction. Although this benefit was strong in patients aged elderly patients (aged ≥75 years).

  20. Development of new risk score for pre-test probability of obstructive coronary artery disease based on coronary CT angiography.

    Science.gov (United States)

    Fujimoto, Shinichiro; Kondo, Takeshi; Yamamoto, Hideya; Yokoyama, Naoyuki; Tarutani, Yasuhiro; Takamura, Kazuhisa; Urabe, Yoji; Konno, Kumiko; Nishizaki, Yuji; Shinozaki, Tomohiro; Kihara, Yasuki; Daida, Hiroyuki; Isshiki, Takaaki; Takase, Shinichi

    2015-09-01

    Existing methods to calculate pre-test probability of obstructive coronary artery disease (CAD) have been established using selected high-risk patients who were referred to conventional coronary angiography. The purpose of this study is to develop and validate our new method for pre-test probability of obstructive CAD using patients who underwent coronary CT angiography (CTA), which could be applicable to a wider range of patient population. Using consecutive 4137 patients with suspected CAD who underwent coronary CTA at our institution, a multivariate logistic regression model including clinical factors as covariates calculated the pre-test probability (K-score) of obstructive CAD determined by coronary CTA. The K-score was compared with the Duke clinical score using the area under the curve (AUC) for the receiver-operating characteristic curve. External validation was performed by an independent sample of 319 patients. The final model included eight significant predictors: age, gender, coronary risk factor (hypertension, diabetes mellitus, dyslipidemia, smoking), history of cerebral infarction, and chest symptom. The AUC of the K-score was significantly greater than that of the Duke clinical score for both derivation (0.736 vs. 0.699) and validation (0.714 vs. 0.688) data sets. Among patients who underwent coronary CTA, newly developed K-score had better pre-test prediction ability of obstructive CAD compared to Duke clinical score in Japanese population.

  1. Sleep apnoea, hypertension and vascular disease: where are we now?

    Directory of Open Access Journals (Sweden)

    B. Buyse

    2007-12-01

    Full Text Available The objective of the present article was to explore the relationship between obstructive sleep apnoea (OSA and hypertension (HT and/or arterial vascular disease (VD, including stroke and ischaemic coronary disease. Epidemiological and interventional studies on these relationships provide compelling evidence that OSA is causally related to HT. The causal relationship between OSA and VD other than HT has not been firmly established. A number of pathophysiological mechanisms that could potentially provide a causal link between obstructive sleep apnoea and hypertension, as well as vascular disease, have been identified. Available data on such mechanisms include sustained daytime sympathetic activation, oxidative stress, promotion of vascular inflammation and endothelial dysfunction.

  2. Effects of telmisartan combined with nifedipine controlled release tablet on inflammatory factors, vascular endothelial function and left ventricular function in patients with coronary heart disease with mild to moderate hypertension

    Directory of Open Access Journals (Sweden)

    Feng Guo

    2017-10-01

    Full Text Available Objective: To investigate the effect of telmisartan combined with Nifedipine Controlled Release Tablet on inflammatory factors, vascular endothelial function and left ventricular function in patients with coronary heart disease with mild to moderate hypertension. Methods: A total of 92 cases of patients with coronary heart disease with mild to moderate hypertension were selected as the object of observation, according to the random data table, they were divided into the control group (n=46 and observation group (n=46, and patients in the control group were treated with Nifedipine Controlled Release Table therapy, on this basis, the observation group patients were given telmisartan treatment, two groups were treated for 6 months. The levels of the blood pressure, inflammatory factors, vascular endothelial function and left ventricular function compared between the two groups before and after treatment. Results: There were no significant differences in the levels of SBP, DBP, hs-CRP, TNF-α, NO, ET-1, LVEF, LVEDD and LVESD in the two groups before treatment. After treatment, two groups of SBP, DBP, hs-CRP, TNF-α, ET-1, LVEDD and LVESD levels were significantly lower than those in the same group before treatment, and after treatment, the levels of SBP, DBP, hs-CRP, TNF-α, ET-1 and LVESD in the observation group were significantly lower than those in the control group, while there were no significant difference in the level of LVEDD between the two groups after treatment; Compared with level in the group before treatment, the levels of NO and LVEF in the two groups were significantly increased, and the observation group [(82.13±19.01 µmol/L, (52.83±7.45%] was significantly higher than the control group [(67.37±13.08 µmol/L, (49.47±6.96%]. Conclusion: Telmisartan combined with Nifedipine Controlled Release Table in treating coronary heart disease with mild to moderate hypertension, can effectively control blood pressure, reduce the

  3. Severity of coronary artery disease in obese patients undergoing coronary angiography

    International Nuclear Information System (INIS)

    Javed, A.; Ali, J.; Kayani, A.M.

    2012-01-01

    Objective: To assess the relationship of severity of coronary artery disease with obesity in patients undergoing coronary angiography. Design: Cross sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology - National Institute of Heart Diseases (AFIC-NIHD), 1st February 2010 to 31st August 2010 Patients and Methods: The study population included 468 patients undergoing coronary angiography. Obesity was classified according to the BMI using the National Institutes of Health (NIH) criteria as normal (BMI 21-24 kg/m2), overweight (BMI 25-29 kg/m2), obesity class I (BMI 30-34 kg/m2), obesity class II (BMI 35 to 39 kg/m2 and obesity class III (BMI 40 or above kg/m2). Coronary angiography data were obtained from the Siemens Queries software system, which maintains the database including detailed angiographic findings of all patients at this institution. Significant lesions were defined as those with >70% diameter narrowing of coronary arteries (>50% for the left main coronary artery). We attempted to quantify the 'severity of CAD' by ascertaining the prevalence of High-Risk Coronary Anatomy (HRCA). Results: Insignificant difference was observed in traditional risk factors i.e. age, diabetes mellitus and smoking except hypertension and gender. Statistically significantly low prevalence of HRCA was encountered in the obese group (57.7%) as compared to normal/overweight group (75.8%) (p < 0.05). Conclusion: We conclude that obesity is associated with less severe coronary artery disease. (author)

  4. Thallium-201 stress imaging in hypertensive patients

    International Nuclear Information System (INIS)

    Schulman, D.S.; Francis, C.K.; Black, H.R.; Wackers, F.J.

    1987-01-01

    To assess the potential effect of hypertension on the results of thallium-201 stress imaging in patients with chest pain, 272 thallium-201 stress tests performed in 133 hypertensive patients and 139 normotensive patients over a 1-year period were reviewed. Normotensive and hypertensive patients were similar in age, gender distribution, prevalence of cardiac risk factors (tobacco smoking, hyperlipidemia, and diabetes mellitus), medications, and clinical symptoms of coronary disease. Electrocardiographic criteria for left ventricular hypertrophy were present in 16 hypertensive patients. Stepwise probability analysis was used to determine the likelihood of coronary artery disease for each patient. In patients with mid to high likelihood of coronary disease (greater than 25% probability), abnormal thallium-201 stress images were present in 54 of 60 (90%) hypertensive patients compared with 51 of 64 (80%) normotensive patients. However, in 73 patients with a low likelihood of coronary disease (less than or equal to 25% probability), abnormal thallium-201 stress images were present in 21 patients (29%) of the hypertensive group compared with only 5 of 75 (7%) of the normotensive patients (p less than 0.001). These findings suggest that in patients with a mid to high likelihood of coronary artery disease, coexistent hypertension does not affect the results of thallium-201 exercise stress testing. However, in patients with a low likelihood of coronary artery disease, abnormal thallium-201 stress images are obtained more frequently in hypertensive patients than in normotensive patients

  5. ASSESSMENT OF THE CHANGES IN BLOOD PRESSURE CIRCADIAN PROFILE AND VARIABILITY IN PATIENTS WITH CHRONIC HEART FAILURE AND ARTERIAL HYPERTENSION DURING COMBINED THERAPY INCLUDING IVABRADINE

    Directory of Open Access Journals (Sweden)

    M. V. Surovtseva

    2012-01-01

    Full Text Available Aim. To assess the changes in blood pressure (BP circadian profile and variability in patients with chronic heart failure (CHF of ischemic etiology and arterial hypertension (HT due to the complex therapy including ivabradine. Material and methods. Patients (n=90 with CHF class II–III NYHA associated with stable angina II-III class and HT were examined. The patients were randomized into 3 groups depending on received drugs: perindopril and ivabradine - group 1; perindopril, bisoprolol and ivabradine - group 2; perindopril and bisoprolol - group 3. The duration of therapy was 6 months. Ambulatory BP monitoring (ABPM was assessed at baseline and after treatment. Results. More significant reduction in average 24-hours systolic BP was found in groups 1 and 2 compared to group 3 (Δ%: -19.4±0,4; -21.1±0.4 and -11.8±0.6, respectively as well as diastolic BP (Δ%: -10.6±0.6; -12.9±0.4 and -4,3±0.3, respectively and other ABPM indicators. Improvement of BP circadian rhythm was found due to increase in the number of «Dipper» patients (p=0.016. More significant reduction in average daily and night systolic and diastolic BP (p=0.001, as well as daily and night BP variability (p=0.001 was also found in patients of group 2 compared to these of group 1. Conclusion. Moderate antihypertensive effect (in respect of both diastolic and systolic BP was shown when ivabradine was included into the complex therapy of patients with ischemic CHF and HT. The effect was more pronounced when ivabradine was combined with perindopril and bisoprolol. This was accompanied by reduction in high BP daily variability and improvement of the BP circadian rhythm. 

  6. ASSESSMENT OF THE CHANGES IN BLOOD PRESSURE CIRCADIAN PROFILE AND VARIABILITY IN PATIENTS WITH CHRONIC HEART FAILURE AND ARTERIAL HYPERTENSION DURING COMBINED THERAPY INCLUDING IVABRADINE

    Directory of Open Access Journals (Sweden)

    M. V. Surovtseva

    2015-12-01

    Full Text Available Aim. To assess the changes in blood pressure (BP circadian profile and variability in patients with chronic heart failure (CHF of ischemic etiology and arterial hypertension (HT due to the complex therapy including ivabradine. Material and methods. Patients (n=90 with CHF class II–III NYHA associated with stable angina II-III class and HT were examined. The patients were randomized into 3 groups depending on received drugs: perindopril and ivabradine - group 1; perindopril, bisoprolol and ivabradine - group 2; perindopril and bisoprolol - group 3. The duration of therapy was 6 months. Ambulatory BP monitoring (ABPM was assessed at baseline and after treatment. Results. More significant reduction in average 24-hours systolic BP was found in groups 1 and 2 compared to group 3 (Δ%: -19.4±0,4; -21.1±0.4 and -11.8±0.6, respectively as well as diastolic BP (Δ%: -10.6±0.6; -12.9±0.4 and -4,3±0.3, respectively and other ABPM indicators. Improvement of BP circadian rhythm was found due to increase in the number of «Dipper» patients (p=0.016. More significant reduction in average daily and night systolic and diastolic BP (p=0.001, as well as daily and night BP variability (p=0.001 was also found in patients of group 2 compared to these of group 1. Conclusion. Moderate antihypertensive effect (in respect of both diastolic and systolic BP was shown when ivabradine was included into the complex therapy of patients with ischemic CHF and HT. The effect was more pronounced when ivabradine was combined with perindopril and bisoprolol. This was accompanied by reduction in high BP daily variability and improvement of the BP circadian rhythm. 

  7. Study protocol: Cost effectiveness of two strategies to implement the NVOG guidelines on hypertension in pregnancy: An innovative strategy including a computerised decision support system compared to a common strategy of professional audit and feedback, a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Luitjes Susanne HE

    2010-09-01

    Full Text Available Abstract Background Hypertensive disease in pregnancy remains the leading cause of maternal mortality in the Netherlands. Seventeen percent of the clinical pregnancies are complicated by hypertension and 2% by preeclampsia. The Dutch Society of Obstetrics and Gynaecology (NVOG has developed evidence-based guidelines on the management of hypertension in pregnancy and chronic hypertension. Previous studies showed a low adherence rate to other NVOG guidelines and a large variation in usual care in the different hospitals. An explanation is that the NVOG has no general strategy of practical implementation and evaluation of its guidelines. The development of an effective and cost effective implementation strategy to improve adherence to the guidelines on hypertension in pregnancy is needed. Methods/Design The objective of this study is to assess the cost effectiveness of an innovative implementation strategy of the NVOG guidelines on hypertension including a computerised decision support system (BOS compared to a common strategy of professional audit and feedback. A cluster randomised controlled trial with an economic evaluation alongside will be performed. Both pregnant women who develop severe hypertension or pre-eclampsia and professionals involved in the care for these women will participate. The main outcome measures are a combined rate of major maternal complications and process indicators extracted from the guidelines. A total of 472 patients will be included in both groups. For analysis, descriptive as well as regression techniques will be used. A cost effectiveness and cost utility analysis will be performed according to the intention-to-treat principle and from a societal perspective. Cost effectiveness ratios will be calculated using bootstrapping techniques.

  8. Blood pressure control status and relationship between salt intake and lifestyle including diet in hypertensive outpatients treated at a general hospital.

    Science.gov (United States)

    Ohta, Yuko; Kimura, Yorio; Kitaoka, Chie; Sakata, Tomoko; Abe, Isao; Kawano, Yuhei

    2017-01-01

    The purpose of the present study was to investigate blood pressure (BP) control and salt intake in hypertensive outpatients treated at a general hospital and to examine the relationship between their lifestyles and amount of salt intake. Subjects comprised 429 hypertensive patients (206 males, 223 females, and average age of 71 ± 11 years). We estimated 24-hour salt excretion using spot urine samples and assessed lifestyle using a self-description questionnaire. Average clinic BP and the number of antihypertensive drugs were 132 ± 11/73 ± 8 mmHg and 1.8 ± 0.9, respectively. In all subjects, average estimated salt intake was 9.2 ± 2.8 g/day and the rate of achievement of the estimated salt intake of hospital. It may be important to provide data on actual salt intake and guide salt restriction in the individual management of hypertension.

  9. Comparative efficacy and safety of the left versus right radial approach for percutaneous coronary procedures: a meta-analysis including 6870 patients

    Directory of Open Access Journals (Sweden)

    S.L. Xia

    2015-08-01

    Full Text Available The radial approach is widely used in the treatment of patients with coronary artery disease. We conducted a meta-analysis of published results on the efficacy and safety of the left and right radial approaches in patients undergoing percutaneous coronary procedures. A systematic search of reference databases was conducted, and data from 14 randomized controlled trials involving 6870 participants were analyzed. The left radial approach was associated with significant reductions in fluoroscopy time [standardized mean difference (SMD=-0.14, 95% confidence interval (CI=-0.19 to -0.09; P<0.00001] and contrast volume (SMD=-0.07, 95%CI=-0.12 to -0.02; P=0.009. There were no significant differences in rate of procedural failure of the left and the right radial approaches [risk ratios (RR=0.98; 95%CI=0.77-1.25; P=0.88] or procedural time (SMD=-0.05, 95%CI=0.17-0.06; P=0.38. Tortuosity of the subclavian artery (RR=0.27, 95%CI=0.14-0.50; P<0.0001 was reported more frequently with the right radial approach. A greater number of catheters were used with the left than with the right radial approach (SMD=0.25, 95%CI=0.04-0.46; P=0.02. We conclude that the left radial approach is as safe as the right radial approach, and that the left radial approach should be recommended for use in percutaneous coronary procedures, especially in percutaneous coronary angiograms.

  10. What Are the Signs and Symptoms of Pulmonary Hypertension?

    Science.gov (United States)

    ... Home / Hypertension Pulmonary Hypertension What Is Pulmonary hypertension (PULL-mun-ary HI- ... are called pulmonary hypertension.) Group 1 Pulmonary Arterial Hypertension Group 1 PAH includes: PAH that has no ...

  11. Premature cardiovascular disease following a history of hypertensive disorder of pregnancy.

    Science.gov (United States)

    McDonald, Emily G; Dayan, Natalie; Pelletier, Roxanne; Eisenberg, Mark J; Pilote, Louise

    2016-09-15

    Following an episode of hypertensive disorder of pregnancy (HDP) women have an increased risk of cardiovascular disease over their lifetime. At the time of acute coronary syndrome we compared clinical information between women with and without a history of hypertension in pregnancy to gain further insight into the pathophysiology of cardiovascular disease in this population. GENESIS-PRAXY (GENdEr and Sex determInantS of cardiovascular disease: from bench to beyond-PRemature Acute Coronary SYdrome) is a prospective multicenter study, with recruitment between January 2009 and April 2013, including 242 parous women with premature acute coronary syndrome. The median age was 50years (IQR 6) and HDP was common; 43 (17.8%) women had prior gestational hypertension, 33 (13.6%) preeclampsia and 166 (68.6%) a prior normotensive pregnancy. Women with a history of HDP commonly had chronic hypertension and diabetes and those presenting with ST-elevation myocardial infarction were more likely to have a history of preeclampsia (aOR 3.12, 95% CI 1.22-8.01) than were women with prior normotensive pregnancies. Neither gestational hypertension (aOR 1.40, 95% CI 0.60-3.26) nor preeclampsia (aOR 0.63, 95% CI 0.23-1.74) was associated with a higher composite risk of three-vessel, left main or proximal left anterior descending coronary disease. In this study of women with premature cardiovascular disease, ST-elevation myocardial infarction was associated with a history of preeclampsia possibly because of persistent endothelial dysfunction. High-risk coronary lesions on angiography did not appear to have an association with preeclampsia or gestational hypertension despite a high burden of traditional risk factors. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  12. Human chromosome 17 in essential hypertension.

    Science.gov (United States)

    Knight, J; Munroe, P B; Pembroke, J C; Caulfield, M J

    2003-03-01

    Hypertension affects up to 30% of the adult population in Western societies and is a major risk factor for kidney disease, stroke and coronary heart disease. It is a complex trait thought to be influenced by a number of genes and environmental factors, although the precise aetiology remains unknown at this time. A number of methods have been successfully used to identify mutations that cause Mendelian traits and these are now being applied to the investigation of complex diseases. This review summarises the data gathered, using such approaches, that suggest there is a gene or genes on chromosome 17 causing human essential hypertension. Studies in rodent models are discussed first, followed by studies of human hypertension that include the investigation of pseudohypoaldosteronism type II, a monogenic trait that manifests with hypertension alongside other phenotypic variables. In addition, candidate gene studies, genome screens and linkage studies based on comparative mapping are outlined. To date no gene has been identified on human chromosome 17 that influences blood pressure and causes human essential hypertension. However, results of ongoing fine mapping and candidate gene studies in both rodents and man are eagerly awaited.

  13. Hypertension and cardiac arrhythmias

    DEFF Research Database (Denmark)

    Lip, Gregory Y H; Coca, Antonio; Kahan, Thomas

    2017-01-01

    Hypertension is a common cardiovascular risk factor leading to heart failure (HF), coronary artery disease, stroke, peripheral artery disease and chronic renal insufficiency. Hypertensive heart disease can manifest as many cardiac arrhythmias, most commonly being atrial fibrillation (AF). Both...... supraventricular and ventricular arrhythmias may occur in hypertensive patients, especially in those with left ventricular hypertrophy (LVH) or HF. Also, some of the antihypertensive drugs commonly used to reduce blood pressure, such as thiazide diuretics, may result in electrolyte abnormalities (e.g. hypokalaemia......, hypomagnesemia), further contributing to arrhythmias, whereas effective control of blood pressure may prevent the development of the arrhythmias such as AF. In recognizing this close relationship between hypertension and arrhythmias, the European Heart Rhythm Association (EHRA) and the European Society...

  14. Lung Transplantation in Patients with Pulmonary Hypertension

    Science.gov (United States)

    ... with related complications in other organs, significant coronary artery disease or cancer (other than localized skin cancers) ... Address and Privacy Pulmonary Hypertension Association 801 Roeder Road, Ste. 1000 Silver Spring, MD 20910 Patient-to- ...

  15. Ocular Hypertension

    Science.gov (United States)

    ... Español Eye Health / Eye Health A-Z Ocular Hypertension Sections What Is Ocular Hypertension? Ocular Hypertension Causes ... Hypertension Diagnosis Ocular Hypertension Treatment What Is Ocular Hypertension? Leer en Español: ¿Qué es la hipertensión ocular? ...

  16. Renovascular hypertension

    International Nuclear Information System (INIS)

    Thomsen, H.S.; Sos, T.A.; Nielsen, S.L.; Koebenhavns Amts Sygehus, Herlev; Cornell Univ., New York

    1989-01-01

    Hypertension constitutes a major health problem and the challenge is to identify patients having 'surgically' curable renal vascular disease among the majority with so-called essential hypertension. The best of unsatisfactory diagnostic tests are renography and plasma renin activity both before and during angiotensin II blockade. The necessity of better screening tests has increased because of the recent advances in surgical techniques and especially percutaneous transluminal renal angioplasty. The latter has definitely become the method of choice for correction of suspected hemodynamically significant artery stenoses whenever technically feasible. With improved angioplasty techniques the risk of treating renal artery stenosis without hemodynamic and clinical importance (so-called cosmetic repair) has increased. Unfortunately randomized trials including surgery versus angioplasty are not available. It should be kept in mind that only after correction of the stenosis is achieved and the blood pressure has become normal, can the diagnosis of renovascular hypertension be made with certainty. (orig.)

  17. Implications of Public Reporting of Risk-Adjusted Mortality Following Percutaneous Coronary Intervention: Misperceptions and Potential Consequences for High-Risk Patients Including Nonsurgical Patients.

    Science.gov (United States)

    Gupta, Anuj; Yeh, Robert W; Tamis-Holland, Jacqueline E; Patel, Shalin H; Guyton, Robert A; Klein, Lloyd W; Rab, Tanveer; Kirtane, Ajay J

    2016-10-24

    Assessment of clinical outcomes such as 30-day mortality following coronary revascularization procedures has historically been used to spur quality improvement programs. Public reporting of risk-adjusted outcomes is already mandated in several states, and proposals to further expand public reporting have been put forward as a means of increasing transparency and potentially incentivizing high quality care. However, for public reporting of outcomes to be considered a useful surrogate of procedural quality of care, several prerequisites must be met. First, the reporting measure must be truly representative of the quality of the procedure itself, rather than be dominated by other underlying factors, such as the overall level of illness of a patient. Second, to foster comparisons among physicians and institutions, the metric requires accurate ascertainment of and adjustment for differences in patient risk profiles. This is particularly relevant for high-risk clinical patient scenarios. Finally, the potential deleterious consequences of public reporting of a quality metric should be considered prior to expanding the use of public reporting more broadly. In this viewpoint, the authors review in particular the characterization of high-risk patients currently treated by percutaneous coronary interventional procedures, assessing the adequacy of clinical risk models used in this population. They then expand upon the limitations of 30-day mortality as a quality metric for percutaneous coronary intervention, addressing the strengths and limitations of this metric, as well as offering suggestions to enhance its future use in public reporting. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  18. Metabolic syndrome in acute coronary syndrome

    International Nuclear Information System (INIS)

    Bhalli, M.A.; Aamir, M.; Mustafa, G.

    2011-01-01

    Objective: To determine the frequency of metabolic syndrome in male patients presenting with acute coronary syndrome Study design: A Descriptive study Place and duration of study: Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, from October 2007 to September 2008 Patients and Methods: Male patients with acute coronary syndrome (ACS) were included. Patients having angioplasty (PCI), coronary artery bypass surgery in the past and other co-morbid diseases were excluded. All patients were assessed for the presence of five components of metabolic syndrome including hypertension, HDL-Cholesterol and triglycerides, glucose intolerance and abdominal obesity. Systolic, diastolic blood pressures, waist circumference (WC) and body mass index (BMI) were measured. ECG, cardiac enzymes, fasting glucose and lipid profile were also done. Results: A total of 135 male patients of ACS were studied with a mean age of 54.26 +- 11 years. Metabolic syndrome (MS) was present in 55 (40.7%) patients. MS with all five components was documented in 4 (7.27%) while MS with four and three components was seen in 23 (41.81%) and 28 (50.90%) patients respectively. Only 24 (43.63%) patients with MS had diabetes mellitus, remaining 31(56.36%) were non diabetic. Frequencies of diabetes, hypertension and family history of CAD were significantly higher (p<0.05) in patients with metabolic syndrome as compared to patients with normal metabolic status. Conclusion: Metabolic syndrome is fairly common and important risk factor in patients of IHD. Other risk factors like smoking, dyslipidemia, hypertension and diabetes were also frequently found. Public awareness to control the risk factors can reduce the prevalence of CAD in our country. (author)

  19. The Artery of Percheron Infarction after Coronary Angiography

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    Haitham Mazek

    2016-01-01

    Full Text Available Coronary angiography is the golden choice for coronary artery disease evaluation and management. However, as with any invasive procedures, there is a risk of complications. We are reporting a case of 69-year-old male with past medical history of cardiac bypass surgery, CHF, hypertension, and hyperlipidemia who was admitted to the hospital to evaluate his chest pain. He had treadmill stress test that showed ischemic induced exercise. Patient underwent coronary angiography that showed proximal complete occlusion of the RCA with a patent graft. At the end of the procedure, the patient did not wake up and remained minimally responsive. An urgent brain MRI was ordered and showed infarctions consistent with an artery of Percheron infarction. Later, patient has improved slowly and was discharged home. We briefly here discuss this rare complication including the risk factor, clinical presentation, and the management.

  20. LB01.02: MORNING HOME BLOOD PRESSURE IS A STRONG PREDICTOR OF CORONARY ARTERY DISEASE EVENTS AS WELL AS STROKE EVENTS IN HYPERTENSIVE PATIENTS ON ANTIHYPERTENSIVE TREATMENT. THE HONEST STUDY.

    Science.gov (United States)

    Kario, K; Saito, I; Kushiro, T; Teramukai, S; Tomono, Y; Okuda, Y; Shimada, K

    2015-06-01

    Previous studies indicated that clinic blood pressure (CBP) is a strong predictor of stroke events, but CBP does not predict coronary artery disease (CAD) events so strongly. Morning home blood pressure (HBP) is more closely associated with stroke risk than CBP. However, few studies have investigated the relationship between morning HBP and CAD risk. We investigated the relationship between morning HBP and incidence of stroke events and CAD events, respectively, using data from the HONEST study. HONEST was a prospective observational study of hypertensive outpatients on olmesartan-based antihypertensive treatment. All the ischemic and hemorrhagic cerebrovascular events expect transient ischemic attack were defined as stroke events, and myocardial infarction and angina pectoris with coronary revascularization procedure were defined as CAD events. In 21591 participants (mean age, 64.9 years; mean follow-up, 2.02 years), 127 (2.92/1000 patient years) stroke events and 121 (2.78/1000 patient years) CAD events occurred. The incidence of stroke events was significantly increased in morning HBP >=145 to =155 mmHg compared with =150 to =160 mmHg compared with morning HBP >155 mmHg was 6.01 (95% CI, 2.85-12.68) compared with =160 mmHg, it was 5.82 (3.17-10.67) compared with morning HBP predicted stroke events similarly to CBP. The incidence of CAD events was significantly increased in morning HBP>=145 to =155 mmHg compared with =160 mmHg compared with =150 to morning HBP >=155 mmHg was 6.24 (2.82-13.84). In contrast, the HR in CBP >=160 mmHg was 3.51 (1.71-7.20), indicating that CBP underestimated CAD risk compared to morning HBP. Morning HBP predicted CAD events similarly to stroke events. In contrast, CBP is more likely to underestimate CAD risk than morning HBP. Morning SBP-guided approach for managing hypertension may be more effective in predicting future risk of CAD events than CBP-based one.

  1. [Hypertrophy and coronary reserve].

    Science.gov (United States)

    Motz, W; Scheler, S

    2008-12-01

    Left ventricular hypertrophy represents the structural mechanism of adaptation of the left ventricle as the answer of a chronic pressure overload in arterial hypertension. Initially an increment in left ventricular wall thickness occurs. In this stadium of "concentric hypertrophy" LV systolic wall stress, LV ejection fraction and myocardial oxygen consumption per weight unit myocardium remain unchanged. In the further time course of disease LV dilatation will be present. In this phase of "excentric hypertrophy" LV systolic wall stress and myocardial oxygen consumption per weight unit myocardium rise and LV ejection fraction decreases. Patients with arterial hypertension frequently complain of angina pectoris. Angina pectoris and the positive exercise tolerance test or the positive myocardial scintigraphy are the consequence of the impaired coronary flow reserve. The coronary flow reserve is diminished due to structural and functional changes of the coronary circulation. ACE-inhibitors and AT1-receptor blockers cause a significant improvement of coronary flow reserve and regression of both left ventricular hypertrophy and myocardial fibrosis.

  2. Left Main Coronary Artery Aneurysm

    Directory of Open Access Journals (Sweden)

    Hossein Doustkami

    2016-07-01

    Full Text Available Aneurysms of the left main coronary artery are exceedingly rare clinical entities, encountered incidentally in approximately 0.1% of patients who undergo routine angiography. The most common cause of coronary artery aneurysms is atherosclerosis. Angiography is the gold standard for diagnosis and treatment. Depending on the severity of the coexisting coronary stenosis, patients with left main coronary artery aneurysms can be effectively managed either surgically or pharmacologically. We herein report a case of left main coronary artery aneurysm in a 72-year-old man with a prior history of hypertension presenting to our hospital because of unstable angina. The electrocardiogram showed ST-segment depression and T-wave inversion in the precordial leads. All the data of blood chemistry were normal. Echocardiography showed akinetic anterior wall, septum, and apex, mild mitral regurgitation and ejection fraction of 45%. Coronary angiography revealed a saccular aneurysm of the left main coronary artery with significant stenosis in the left anterior descending, left circumflex, and right coronary artery. The patient immediately underwent coronary artery bypass grafting and ligation of the aneurysm. At six months’ follow-up, he remained asymptomatic.

  3. SECONDARY (ENDOCRINE HYPERTENSION: LECTURE

    Directory of Open Access Journals (Sweden)

    M. Yu. Yukina

    2016-01-01

    Full Text Available Hypertension is a  very common disease with high morbidity and reduction in quality of life. Endocrine disorders are the most common cause of secondary hypertension affecting ~3% of the population. Primary aldosteronism can be the cause of endocrine hypertension more often than other endocrine disorders. Other less common causes of endocrine hypertension include Cushing syndrome, pheochromocytoma, thyroid disorders, and hyperparathyroidism. Endocrine hypertension is potentially curable if the underlying cause is identified and treated accordingly. Younger age at manifestation of resistance to multiple antihypertensive drugs, together with other clinical signs of an endocrine disorder, should raise the suspicion and prompt the appropriate evaluation.

  4. Sex-specific assessment of reduced coronary sinus flow in non ...

    African Journals Online (AJOL)

    Background: Access to data on the coronary flow in the coronary sinus (CS) can aid in the diagnosis of coronary artery disease (CAD). We tested the hypothesis that assessing the CS flow by transthoracic Doppler echocardiography (TTE) at rest can detect coronary artery stenosis in non-hypertensive patients. Methods: The ...

  5. Coronary Artery Anomalies in Animals

    Directory of Open Access Journals (Sweden)

    Brian A. Scansen

    2017-04-01

    Full Text Available Coronary artery anomalies represent a disease spectrum from incidental to life-threatening. Anomalies of coronary artery origin and course are well-recognized in human medicine, but have received limited attention in veterinary medicine. Coronary artery anomalies are best described in the dog, hamster, and cow though reports also exist in the horse and pig. The most well-known anomaly in veterinary medicine is anomalous coronary artery origin with a prepulmonary course in dogs, which limits treatment of pulmonary valve stenosis. A categorization scheme for coronary artery anomalies in animals is suggested, dividing these anomalies into those of major or minor clinical significance. A review of coronary artery development, anatomy, and reported anomalies in domesticated species is provided and four novel canine examples of anomalous coronary artery origin are described: an English bulldog with single left coronary ostium and a retroaortic right coronary artery; an English bulldog with single right coronary ostium and transseptal left coronary artery; an English bulldog with single right coronary ostium and absent left coronary artery with a prepulmonary paraconal interventricular branch and an interarterial circumflex branch; and a mixed-breed dog with tetralogy of Fallot and anomalous origin of all coronary branches from the brachiocephalic trunk. Coronary arterial fistulae are also described including a coronary cameral fistula in a llama cria and an English bulldog with coronary artery aneurysm and anomalous shunting vessels from the right coronary artery to the pulmonary trunk. These examples are provided with the intent to raise awareness and improve understanding of such defects.

  6. Clinical presentation of hypertensive crises in emergency medical services.

    Science.gov (United States)

    Salkic, Sabina; Batic-Mujanovic, Olivera; Ljuca, Farid; Brkic, Selmira

    2014-02-01

    The objective of this study is to evaluate the incidence and clinical presentation of hypertensive crises in the Emergency medical services of the Community Health Centre "Dr. Mustafa Šehović" Tuzla in relation to age, sex, duration and severity of hypertension, as well as the prevalence of accompanying symptoms and clinical manifestations. The study was conducted between November 2009 and April 2010 and included 180 subjects of both sexes, aged 30-80 with a diagnosis of arterial hypertension. All subjects were divided into two groups: a control group, which consisted of subjects without hypertensive crisis (95 subjects) and an experimental group that consisted of subjects with hypertensive crisis (85 subjects). The study results indicate that female subjects were significantly over- represented compared to men (60% vs. 40 %, p=0.007). The average age of the male subjects was 55.83±11.06 years, while the female subjects' average age was 59.41±11.97 years. The incidence of hypertensive crisis was 47.22%, with hypertensive urgency significantly more represented than emergency (16.47% vs. 83.53%, phypertensive subjects were headache (75%), chest pain (48.33%), vertigo (44.44%), shortness of breath (38.88%) and nausea (33.89%). The most common symptoms in subjects with hypertensive crisis were headache (74.11%), chest pain and shortness of breath (62.35%), vertigo (49.41%), and nausea and vomiting (41.17%). Chest pain, shortness of breath, nausea and vomiting were significantly over-represented in subjects with hypertensive crisis (phypertensive emergencies in almost all subjects included acute coronary syndrome, and only one subject had acute pulmonary edema.

  7. Hypertension in a rural South African white population and the effect ...

    African Journals Online (AJOL)

    density lipoprotein cholesterol level, a high body mass index, a high uric acid level, a high prevalence of coronary heart disease and, in men, high alcohol consumption. Treated hypertensives had a greater risk of coronary heart disease than ...

  8. Myocardial damage in successful vessel coronary angioplasty as assessed by creatinine kinase and its myocardium band isoenzyme levels

    International Nuclear Information System (INIS)

    Abbas, S.; Samor, N.A.; Kayani, A.M.

    2008-01-01

    To determine the frequency of myocardial damage in elective, successful, single vessel percutaneous coronary angioplasty by assessing myocardial band (MB), creatinine kinase levels and to find out the association of common modifiable risk factors with myocardial damage in patients undergoing single vessel coronary angioplasty. Fifty patients undergoing elective and successful single vessel percutaneous coronary angioplasty were evaluated with creatinine kinase and creatinine kinase MB levels before and after 8 hours and 1st day following coronary angioplasty. Studied variables included the length of stent deployed, maximum deployment pressure and total balloon inflation time, apart from hypertension, cholesterol level, smoking and diabetes mellitus. Out of 50 patients, 9 had raised creatinine kinase at 8 hours (18%) and 10 had raised creatinine kinase (20%) on 1st day following coronary angioplasty, 7 (14%) patients and 8 (16%) patients had raised creatinine kinase MB levels at 8 hours and 1st day following coronary angioplasty respectively. The rise of either was equal to or more than 3 times the normal limits. Modifiable risk factors, significantly associated with myocardial damage, were diabetes mellitus (p=0.006) and LDL levels (p=0.009) in patients undergoing single vessel coronary angioplasty. Successful elective, uncomplicated, single vessel coronary angioplasty resulted in some myocardial damage evident by mild rise in cardiac enzymes but rise of creatinine kinase MB above 3 times of normal, which signifies percutaneous coronary angioplasty-related myocardial infarction, was not seen. There was a significant association between diabetes mellitus, LDL levels and myocardial damage in patients undergoing coronary angioplasty but no significant association was found between hypertension, smoking and myocardial damage. (author)

  9. [Hypertension in females].

    Science.gov (United States)

    Cífková, Renata

    2015-05-01

    Hypertension is the most common cardiovascular disorder affecting more males in younger age groups; in the age group of 45-64, it is equally frequent in both genders, it is more common in elderly females. Blood pressure increases more in females around the menopause. Use of hormonal replacement therapy is not associated with an BP increase but, because of increased risk of coronary events, stroke, and thromboembolic events, HRT is not re-commended in CVD prevention. There is a similar decrease in BP by antihypertensive drugs in both genders as well as benefit from antihypertensive treatment. Women report about a double rate of adverse events of antihypertensive drugs. Oral contraception use is associated with a mild BP increase in most women and development of overt hypertension in about 5 %. Pre-eclampsia is associated with increased risk of developing CVD later in life (more frequent development of hypertension, myocardial infarction, and stroke).

  10. Efficacy of Patient Selection for Diagnostic Coronary Angiography in Suspected Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Francisco Flávio Costa Filho

    2015-11-01

    Full Text Available AbstractBackground:Guidelines recommend that in suspected stable coronary artery disease (CAD, a clinical (non-invasive evaluation should be performed before coronary angiography.Objective:We assessed the efficacy of patient selection for coronary angiography in suspected stable CAD.Methods:We prospectively selected consecutive patients without known CAD, referred to a high-volume tertiary center. Demographic characteristics, risk factors, symptoms and non-invasive test results were correlated to the presence of obstructive CAD. We estimated the CAD probability based on available clinical data and the incremental diagnostic value of previous non-invasive tests.Results:A total of 830 patients were included; median age was 61 years, 49.3% were males, 81% had hypertension and 35.5% were diabetics. Non-invasive tests were performed in 64.8% of the patients. At coronary angiography, 23.8% of the patients had obstructive CAD. The independent predictors for obstructive CAD were: male gender (odds ratio [OR], 3.95; confidence interval [CI] 95%, 2.70 - 5.77, age (OR for 5 years increment, 1.15; CI 95%, 1.06 - 1.26, diabetes (OR, 2.01; CI 95%, 1.40 - 2.90, dyslipidemia (OR, 2.02; CI 95%, 1.32 - 3.07, typical angina (OR, 2.92; CI 95%, 1.77 - 4.83 and previous non-invasive test (OR 1.54; CI 95% 1.05 - 2.27.Conclusions:In this study, less than a quarter of the patients referred for coronary angiography with suspected CAD had the diagnosis confirmed. A better clinical and non-invasive assessment is necessary, to improve the efficacy of patient selection for coronary angiography.

  11. Hypertension management in primary care: study protocol for a cluster randomized controlled trial.

    Science.gov (United States)

    Weltermann, Birgitta; Viehmann, Anja; Kersting, Christine

    2015-03-21

    Studies worldwide show insufficient blood pressure control rates, and effective management of hypertension remains a challenge in general practice. Although structured forms of care improved blood pressure in randomized controlled trials, little is known about their effects under routine primary care. This cluster randomized trial (CRT) evaluates the effects of a modern interactive medical education series for general practitioners on hypertension management, including practice redesign strategies. For this CRT, 24 primary care academic teaching practices of the University of Duisburg-Essen, Germany, are randomized into two study arms. With the objective of improving hypertension control, general practitioners of the intervention group participate in a three-session medical education program on structured hypertension management. The program aims at changing physician awareness and practice design. Various practice tools are provided: for example, checklists on valid blood pressure readings, medication selection, detection of secondary hypertension, and patient education. General practitioners of both study groups include hypertensive patients with and without hypertension-related diseases such as angiographically proven coronary disease, and peripheral or cerebral vascular disease. Blood pressure is measured by 24-hour readings. Analyses will focus on differences in blood pressure control and changes of practice management between intervention and control group. The study will determine the effectiveness of our practice redesign intervention on hypertension control. The intervention addresses general practitioners and practice assistants, while aiming at benefits on the patient level. Therefore, the cluster design is used to evaluate the effects. DRKS00006315 (date of registration: 14 July 2014).

  12. The relationship between coronary artery calcification detected by non-gated multi-detector CT in patients with suspected ischemic heart disease and myocardial ischemia detected by thallium exercise stress testing.

    Science.gov (United States)

    Nishida, Chikako; Okajima, Kaoru; Kudo, Takashi; Yamamoto, Takashi; Hattori, Ryuichi; Nishimura, Yasumasa

    2005-12-01

    To examine whether we could predict myocardial ischemia when coronary artery calcification is detected by non-gated multidetector CT in patients with suspected ischemic heart disease. Eighty-three patients suspected of having ischemic heart disease (55 men, 28 women; age range 36-83 years; mean age 68 years) underwent multidetector CT and T1-201 single photon emission computed tomography. Prediction of myocardial ischemia by coronary arterial calcification detected on CT was evaluated by comparing the coronary artery territories that showed calcification with the area of myocardial ischemia determined by SPECT. The sensitivity, specificity, positive predictive value, and negative predictive value of multidetector CT for predicting myocardial ischemia were calculated. Coronary angiography was also examined and compared with multidetector CT. Risk factors, including hypertension, smoking, hyperlipidemia, diabetes, and family history, were compared for evidence of coronary artery calcification detected by multidetector CT and myocardial ischemia detected by thallium nuclear scans. For analysis by patients, the sensitivity, specificity, positive predictive value, and negative predictive value of coronary artery calcification for myocardial ischemia detection were 65, 63, 56, and 71%, respectively. Similarly, for analysis by coronary arterial territories, those values were 56, 77, 41 and 86%, respectively. Coronary stenosis on CAG was also related to the ischemia determined by SPECT and calcification on multidetector CT. Ischemia was better influenced by risk factors than was coronary arterial calcification. For analysis by coronary arterial territories, the specificity and negative predictive value of coronary arterial calcification seen by multidetector CT are relatively high.

  13. Coronary Microvascular Function and Cardiovascular Risk Factors in Women With Angina Pectoris and No Obstructive Coronary Artery Disease: The iPOWER Study.

    Science.gov (United States)

    Mygind, Naja Dam; Michelsen, Marie Mide; Pena, Adam; Frestad, Daria; Dose, Nynne; Aziz, Ahmed; Faber, Rebekka; Høst, Nis; Gustafsson, Ida; Hansen, Peter Riis; Hansen, Henrik Steen; Bairey Merz, C Noel; Kastrup, Jens; Prescott, Eva

    2016-03-15

    The majority of women with angina-like chest pain have no obstructive coronary artery disease when evaluated with coronary angiography. Coronary microvascular dysfunction is a possible explanation and associated with a poor prognosis. This study evaluated the prevalence of coronary microvascular dysfunction and the association with symptoms, cardiovascular risk factors, psychosocial factors, and results from diagnostic stress testing. After screening 3568 women, 963 women with angina-like chest pain and a diagnostic coronary angiogram without significant coronary artery stenosis (<50%) were consecutively included. Mean age (SD) was 62.1 (9.7). Assessment included demographic and clinical data, blood samples, questionnaires, and transthoracic echocardiography during rest and high-dose dipyridamole (0.84 mg/kg) with measurement of coronary flow velocity reserve (CFVR) by Doppler examination of the left anterior descending coronary artery. CFVR was successfully measured in 919 (95%) women. Median (IQR) CFVR was 2.33 (1.98-2.76), and 241 (26%) had markedly impaired CFVR (<2). In multivariable regression analysis, predictors of impaired CFVR were age (P<0.01), hypertension (P=0.02), current smoking (P<0.01), elevated heart rate (P<0.01), and low high-density lipoprotein cholesterol (P=0.02), but these variables explained only a little of the CFVR variation (r(2)=0.09). CFVR was not associated with chest pain characteristics or results from diagnostic stress testing. Impaired CFVR was detected in a substantial proportion, which suggests that coronary microvascular dysfunction plays a role in the development of angina pectoris. CFVR was associated with few cardiovascular risk factors, suggesting that CFVR is an independent parameter in the risk evaluation of these women. Symptom characteristics and results from stress testing did not identify individuals with impaired CFVR. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley

  14. Randomized comparison of deliverability and in-hospital complications in implantation of BxSonic(R), Express(R), and Flexmaster(R) coronary stents

    DEFF Research Database (Denmark)

    Thuesen, Leif; Galløe, Anders; Thayssen, Per

    2005-01-01

    in a native coronary artery were included in the study. There were 494 (664) patients (treated lesions) in the BxSonic(R), 499 (657) in the Express(R) and 500 (658) in the Flexmaster(R) groups. The groups were well matched with regard to age, sex, diabetes, smoking, hypercholesterolemia, hypertension...

  15. Frequency of significant three vessel coronary artery disease and left main stem disease in acute coronary syndrome patients having high LDL cholesterol level

    International Nuclear Information System (INIS)

    Zeb, S.; Achakzai, A.S.; Zeb, J.; Zeb, R.; Adil, M.; Jan, H.

    2017-01-01

    Objective: To calculate the frequency of significant three-vessel coronary artery and left main stem disease in patients presenting with acute coronary syndrome having high LDL cholesterol level. Methodology: This observational study was performed in Lady Reading Hospital, Peshawar, Pakistan from June 1, 2013 to December 31, 2013. All consecutive patients undergoing coronary angiography admitted with acute coronary syndrome within past 30 days and having LDL cholesterol more than 130mg/dl were included in the study. Demographic data was noted. The data was analyzed by using software SPSS version 16. Results: A total number of 206 patients were included in the study. Mean age was 51.25+-8.4 years. Of them, 139(67.5%) were male and 67(32.5%) female. Hypertension was found in 87(42.2%) patients, diabetes was found in 71(34.5%) patients, 56(27.2%) were smokers, family history of CAD was present in 39(18.9%) patients. The incidence of significant three vessel coronary artery disease was 52(25.2%) and left main stem disease were present in 15(7.2%). Out of 67(32.4%) with severe triple vessel and Left main stem disease, males were 51(76.1%) and females were 16(23.9%). Patients with significant three vessel and left main stem disease were more frequently males and younger. Conclusion: Patients having acute coronary syndrome with High LDL levels are more frequently have significant three vessel and Left main stem disease.

  16. Coronary artery calcifications in renal graft recipients at the time of transplantation.

    Science.gov (United States)

    Serafin, Zbigniew; Nawrocka, Elzbieta; Thabit, Sinjab A; Lasek, Władysław; Włodarczyk, Zbigniew

    2007-05-01

    Coronary artery calcifications (CACs) represent an important risk factor of coronary artery disease in the general population. The purpose of the study was to determine the amount of CAC, including calcium mass, in renal graft recipients early after transplantation. Forty-nine patients aged 43.7+/-9.8 years underwent CAC determination with multi-detector row computed tomography within two weeks after transplantation. The calcium scores were compared with the clinical and laboratory data of the subjects. CACs were detected in 73% of the subjects. The mean calcium score (CS) was 500.8+/-1100.4 and the mean calcium mass (CM) 127.0+/-228.6 mg. Presence of diabetes, duration of hypertension, and diastolic blood pressure (DBP) were significantly associated with the presence of CAC in univariate analysis. CS and CM positively correlated with duration of hypertension, time on dialysis, and pulse pressure (PP) and negatively with DBP. In multiple regression analysis the duration of hypertension, DBP, and PP were identified as independent predictors of CAC presence (p<0.01), while the time on dialysis and DBP were independent predictors of CAC severity (p<0.02). The results suggest that hypertension may play a crucial role in the development of coronary artery calcifications in end-stage renal disease patients, but the nature of the relation between CAC and blood pressure needs further investigation.

  17. Evidence for somatic gene conversion and deletion in bipolar disorder, Crohn's disease, coronary artery disease, hypertension, rheumatoid arthritis, type-1 diabetes, and type-2 diabetes.

    Science.gov (United States)

    Ross, Kenneth Andrew

    2011-02-03

    During gene conversion, genetic information is transferred unidirectionally between highly homologous but non-allelic regions of DNA. While germ-line gene conversion has been implicated in the pathogenesis of some diseases, somatic gene conversion has remained technically difficult to investigate on a large scale. A novel analysis technique is proposed for detecting the signature of somatic gene conversion from SNP microarray data. The Wellcome Trust Case Control Consortium has gathered SNP microarray data for two control populations and cohorts for bipolar disorder (BD), cardiovascular disease (CAD), Crohn's disease (CD), hypertension (HT), rheumatoid arthritis (RA), type-1 diabetes (T1D) and type-2 diabetes (T2D). Using the new analysis technique, the seven disease cohorts are analyzed to identify cohort-specific SNPs at which conversion is predicted. The quality of the predictions is assessed by identifying known disease associations for genes in the homologous duplicons, and comparing the frequency of such associations with background rates. Of 28 disease/locus pairs meeting stringent conditions, 22 show various degrees of disease association, compared with only 8 of 70 in a mock study designed to measure the background association rate (P conversion could be a significant causative factor in each of the seven diseases. The specific genes provide potential insights about disease mechanisms, and are strong candidates for further study.

  18. Migraine and hypertension

    Directory of Open Access Journals (Sweden)

    G. R. Tabeeva

    2015-01-01

    Full Text Available Investigations of a relationship between migraine and hypertension are being continued. In spite of numerous studies, the association of some types of migraine (migraine with aura and migraine without aura with hypertension has not been fully elucidated. This issue is particularly relevant since these forms differ both clinically and pathophysiologically. Of even greater importance are the analysis and prediction of associations between migraine and cardiovascular diseases (ischemic stroke, myocardial infarction, coronary heart disease. The review deals with the clinical and pathophysiological features of the relationship between hypertension and migraine. There is evidence for the anatomic and functional correlation between the antinociceptive system and blood pressure (BP regulation control. It has been speculated that the increase in pain threshold is not the result of just hypertension as a disease, but it is caused by elevated BP-related hypalgesia. The efficacy of antihypertensive drugs is the fact that supports the association between hypertension and endothelial dysfunction. Identification of groups of patients having migraine and a high cardiovascular risk will allow timely early primary prevention and therapy. Introduction of a stratification approach at diagnostic stages may cause a reduction in cardiovascular morbidity and mortality rates.

  19. [Registry of non-ST elevation acute coronary syndromes in a tertiary hospital (RESCATA-SEST registry)].

    Science.gov (United States)

    González-Pliego, José Angel; Gutiérrez-Díaz, Gonzalo Israel; Celis, Alfredo; Gudiño-Amezcua, Diego Armando

    2014-01-01

    To describe the clinical-epidemiologic profile and the process of care of the non-ST elevation acute coronary syndromes in a tertiary hospital. We analyzed the clinical information, the risk stratification and diagnostic methods, the revascularization therapy and the prescription trends at discharge, of patients with non-ST elevation acute coronary syndromes cared for in one year. Two hundred and eighty-three patients with mean age of 58 years were included (63% men). The largest number of non-ST elevation acute coronary syndromes (88.6%) was found between 50 to 59 years of age. The most common risk factor was hypertension; 82.5% of the patients had a low-intermediate TIMI score; residual ischemia was demonstrated in 37% and coronary obstructions were seen in 80 patients (70%). In 90%, a percutaneous coronary intervention was performed, mainly with drug-eluting Stents (87.5%). At discharge, even though antiplatelet agents and statins were prescribed in more than 90%, other drugs were indicated in a few more than 50% of patients. In this population, non-ST elevation acute coronary syndromes predominates in relatively young men, often with hypertension. To stratify risk, to look for residual ischemia and to revascularize with drug-eluting stents are common practices, but the evidence-based guidelines compliance is still suboptimal. Copyright © 2013 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

  20. Hypertension in Danish seafarers

    DEFF Research Database (Denmark)

    Tu, Mingshan; Jepsen, Jørgen Riis

    2016-01-01

    Background: Due to the high prevalence of arterial hypertension and its role in the development of athe- rosclerosis, myocardial infarction and stroke, hypertension is a major public health challenge worldwide. There is limited knowledge of the prevalence of hypertension among seafarers who......, however, are known to have an excess morbidity and mortality from these disorders. This article addresses the prevalence of hypertension among Danish seafarers and discusses potential risk factors for hypertension in maritime settings. Materials and methods: A representative sample of 629 Danish seafarers...... who had statutory medical examinations was studied from the beginning of October 2011 to the end of June 2012. The medical examination included measurements of blood pressure. The prevalence of hypertension in the study po- pulation was stratified by age, work place on board, smoking status, alcohol...

  1. The degree of hair graying as an independent risk marker for coronary artery disease, a CT coronary angiography study

    Directory of Open Access Journals (Sweden)

    Amr Abdel Aziz ElFaramawy

    2018-03-01

    Full Text Available Background: Cardiovascular disease is a leading cause of death worldwide. Aging is an unavoidable coronary risk factor and is associated with dermatological signs that could be a marker for increased coronary risk. We tested the hypothesis that hair graying as a visible marker of aging is associated with risk of coronary artery disease (CAD independent of chronological age. Methods: This cross-sectional study included 545 males who underwent a computed tomography coronary angiography (CTCA for suspicious of CAD, patients were divided into subgroups according to the percentage of gray/white hairs (Hair Whitening Score, HWS: 1–5 and to the absence or presence of CAD. Results: CAD was prevalent in 80% of our studied population, 255 (46.8% had 3 vessels disease with mean age of 53.2 ± 10.7 yrs. Hypertension, diabetes and dyslipidemia were more prevalent in CAD group (P = 0.001, P = 0.001, and P = 0.003, respectively. Patients with CAD had statistically significant higher HWS (32.1% vs 60.1%, p < 0.001 and significant coronary artery calcification (<0.001. Multivariate regression analysis showed that age (odds ratio (OR: 2.40, 95% confidence interval (CI: [1.31–4.39], p = 0.004, HWS (OR: 1.31, 95% CI: [1.09–1.57], p = 0.004, hypertension (OR: 1.63, 95% CI: [1.03–2.58], p = 0.036, and dyslipidemia (OR: 1.61, 95% CI: [1.02–2.54], p = 0.038 were independent predictors of the presence of atherosclerotic CAD, and only age (p < 0.001 was significantly associated with HWS. Conclusions: Higher HWS was associated with increased coronary artery calcification and risk of CAD independent of chronological age and other established cardiovascular risk factors. Keywords: Hair graying, Male gender, Coronary artery disease, Computed tomography coronary angiography

  2. Hypertensive Crisis

    Science.gov (United States)

    ... Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More Hypertensive Crisis: When You Should Call 9-1-1 for ... the Facts About HBP • Know Your Numbers Introduction Hypertensive Crisis Monitoring Your Blood Pressure At Home • Understand Symptoms ...

  3. [Menopause: Hypertension and vascular disease].

    Science.gov (United States)

    Zilberman, J M

    Hypertension is the main cardiovascular risk factor affecting 25% of women. Hormone changes and hypertension after menopause may lead to higher target organ damage and cardiovascular disease such as increased arterial stiffness, coronary diseases, chronic heart failure and stroke. The physiopathological mechanisms involved in the development of hypertension and cardiovascular diseases in menopausal women are controversial. There are pharmacokinetic and pharmacodynamic differences in both sexes, the women have more coughing when using the converting-enzyme inhibitors, more cramps when using thiazide diuretics and more oedema in the inferior limbs when using calcium antagonists. The aim of this review is to analyse possible physiopathological mechanisms involved in hypertension after menopause and to gain a better understanding of the biological effects mediated by vascular ageing in women when the level of oestrogen protective effect decreases over the vascular system. Copyright © 2017 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Acute Arterial Hypertension in Acute Pulmonary Edema: Mostly a Trigger or an Associated Phenomenon?

    Science.gov (United States)

    Figueras, Jaume; Bañeras, Jordi; Peña-Gil, Carlos; Masip, Josep; Barrabés, José A; Rodriguez Palomares, Jose; Garcia-Dorado, David

    2016-10-01

    The role of acute arterial hypertension in acute pulmonary edema (APE) as an associated or triggering phenomenon has been poorly investigated and is relevant to patient management. This was a prospective observational study of clinical, electrocardiographic, and echocardiographic characteristics of patients with APE. Potential triggers, including acute coronary syndrome (ACS), rapid atrial fibrillation (AF) (≥ 120 bpm in AF), fever > 38°C or volume overload, isolated acute hypertension (systolic blood pressure ≥ 170 mm Hg), and unknown factors were investigated. There were 742 patients, 578 with coronary artery disease (78%), 116 with valvular heart disease or cardiomyopathy (16%), and 47 without identifiable heart disease (6%). ACS was present in 482 (65%) patients (silent in 154 of them), AF was present in 76 (10%) patients, fever/volume overload was present in 62 (8%) patients, acute hypertension was present in 50 (7%) patients, and no apparent trigger was seen in 72 (10%) patients. Admission hypertension occurred in 260 patients (35%): 155 (60%) with ACS (silent in 49 [32%]), 36 (14%) with AF, 19 (7%) with fever/volume overload, and 59 (19%) as an isolated trigger. Similar results were obtained when analyzing patients using coronary angiography (467 patients [63%]). Acute hypertension was present more frequently in patients with severe hypoventilation (arterial Pco 2 > 60 mm Hg) than in those without (57% vs 29%; P acute hypertension is often present but mainly as an associated/reactive phenomenon and seems favoured by severe hypoventilation. Silent myocardial ischemia/necrosis deserves systematic investigation because it is not rare that it may be the underlying cause of APE. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  5. Assessment of waist/hip ratio and its relationship with coronary heart disease in community hospital of district swat

    International Nuclear Information System (INIS)

    Ahmad, R.; Ahmad, A.; Jan, S.; Rehman, I.U.

    2007-01-01

    To evaluate the relationship between central obesity (Abdominal adiposity), measured by Waist/Hip ratio and the development of Coronary Heart Disease in adult population of district Swat. The study comprised of 100 subjects, 34 Control, 33 Hypertensive subjects and 33 subjects with Coronary Heart Disease. Weight, Height, Waist/Hip ratio and Blood Pressure of subjects with Coronary Heart Disease (CHD) were compared with Hypertensive subjects and Control subjects. Patients with Coronary Heart Disease had higher Waist/Hip ratio and Blood Pressure than Hypertensive subjects, which in turn had higher values than control subjects. Waist/hip ratio is the dominant risk factor predicting Coronary Heart Disease. (author)

  6. Prediction of coronary artery disease in patients undergoing operations for mitral valve degeneration

    Science.gov (United States)

    Lin, S. S.; Lauer, M. S.; Asher, C. R.; Cosgrove, D. M.; Blackstone, E.; Thomas, J. D.; Garcia, M. J.

    2001-01-01

    OBJECTIVES: We sought to develop and validate a model that estimates the risk of obstructive coronary artery disease in patients undergoing operations for mitral valve degeneration and to demonstrate its potential clinical utility. METHODS: A total of 722 patients (67% men; age, 61 +/- 12 years) without a history of myocardial infarction, ischemic electrocardiographic changes, or angina who underwent routine coronary angiography before mitral valve prolapse operations between 1989 and 1996 were analyzed. A bootstrap-validated logistic regression model on the basis of clinical risk factors was developed to identify low-risk (coronary atherosclerosis was defined as 50% or more luminal narrowing in one or more major epicardial vessels, as determined by means of coronary angiography. RESULTS: One hundred thirty-nine (19%) patients had obstructive coronary atherosclerosis. Independent predictors of coronary artery disease include age, male sex, hypertension, diabetes mellitus,and hyperlipidemia. Two hundred twenty patients were designated as low risk according to the logistic model. Of these patients, only 3 (1.3%) had single-vessel disease, and none had multivessel disease. The model showed good discrimination, with an area under the receiver-operating characteristic curve of 0.84. Cost analysis indicated that application of this model could safely eliminate 30% of coronary angiograms, corresponding to cost savings of $430,000 per 1000 patients without missing any case of high-risk coronary artery disease. CONCLUSION: A model with standard clinical predictors can reliably estimate the prevalence of obstructive coronary atherosclerosis in patients undergoing mitral valve prolapse operations. This model can identify low-risk patients in whom routine preoperative angiography may be safely avoided.

  7. Prevalence of conventional risk factors and lipid profiles in patients with acute coronary syndrome and significant coronary disease

    Directory of Open Access Journals (Sweden)

    González-Pacheco H

    2014-10-01

    Full Text Available Héctor González-Pacheco,1 Jesús Vargas-Barrón,2 Maite Vallejo,2 Yigal Piña-Reyna,3 Alfredo Altamirano-Castillo,1 Pedro Sánchez-Tapia,1 Carlos Martínez-Sánchez1 1Coronary Care Unit, National Institute of Cardiology in Mexico City, Mexico City, Mexico; 2Department of Clinical Research, National Institute of Cardiology in Mexico City, Mexico City, Mexico; 3Catheterization Laboratory, National Institute of Cardiology in Mexico City, Mexico City, Mexico Background: Among patients with coronary artery disease (CAD, 80%–90% present at least one conventional risk factor. On the other hand, lipid profile modification after a cardiovascular event related to acute coronary syndrome (ACS has been recognized. The prevalence of conventional risk factors and the lipid profile at the time of admission in patients with ACS and significant CAD (stenosis ≥50% determined through coronary angiography is not well described. Methods: We studied 3,447 patients with a diagnosis of ACS and significant CAD with stenosis ≥50%, as shown on angiography. We recorded the presence of conventional risk factors, including smoking, hypertension, dyslipidemia, and diabetes. In addition, we analyzed the lipid profiles within the first 24 hours of admission. We analyzed the studied population and compared findings according to sex.Results: Most patients (81.7% were male. ST-elevation myocardial infarction was present in 51.3% of patients, and non-ST-elevation acute coronary syndrome was present in 48.7%. The most frequent risk factor was smoking, which was present in 68% of patients, followed by hypertension (57.8%, dyslipidemia (47.5%, and diabetes (37.7%. In women, the most frequent risk factors were hypertension, diabetes, and dyslipidemia, whereas in men, smoking was the most frequent. We identified at least one risk factor in 95.7% of all patients, two or three risk factors in 62%, and four risk factors in 8.6% of patients. The lipid profile analysis revealed that

  8. Distinctive Risk Factors and Phenotype of Younger Patients With Resistant Hypertension: Age Is Relevant.

    Science.gov (United States)

    Ghazi, Lama; Oparil, Suzanne; Calhoun, David A; Lin, Chee Paul; Dudenbostel, Tanja

    2017-05-01

    Resistant hypertension, defined as blood pressure >140/90 mm Hg despite using ≥3 antihypertensive medications, is a well-recognized clinical entity. Patients with resistant hypertension are at an increased risk of cardiovascular disease compared with those with more easily controlled hypertension. Coronary heart disease mortality rates of younger adults are stagnating or on the rise. The purpose of our study was to characterize the phenotype and risk factors of younger patients with resistant hypertension, given the dearth of data on cardiovascular risk profile in this cohort. We conducted a cross-sectional analysis with predefined age groups of a large, ethnically diverse cohort of 2170 patients referred to the Hypertension Clinic at the University of Alabama at Birmingham. Patients (n=2068) met the inclusion criteria and were classified by age groups, that is, ≤40 years (12.7% of total cohort), 41 to 55 years (32.1%), 56 to 70 years (36.1%), and ≥71 years (19.1%). Patients aged ≤40 years compared with those aged ≥71 years had significantly earlier onset of hypertension (24.7±7.4 versus 55.0±14.1 years; P hypertension, younger individuals have a distinct phenotype characterized by overlapping risk factors and comorbidities, including obesity, high aldosterone, and high dietary sodium intake compared with elderly. © 2017 American Heart Association, Inc.

  9. Elevated troponin predicts long-term adverse cardiovascular outcomes in hypertensive crisis: a retrospective study.

    Science.gov (United States)

    Pattanshetty, Deepak J; Bhat, Pradeep K; Aneja, Ashish; Pillai, Dilip P

    2012-12-01

    Hypertensive crisis is associated with poor clinical outcomes. Elevated troponin, frequently observed in hypertensive crisis, may be attributed to myocardial supply-demand mismatch or obstructive coronary artery disease (CAD). However, in patients presenting with hypertensive crisis and an elevated troponin, the prevalence of CAD and the long-term adverse cardiovascular outcomes are unknown. We sought to assess the impact of elevated troponin on cardiovascular outcomes and evaluate the role of troponin as a predictor of obstructive CAD in patients with hypertensive crisis. Patients who presented with hypertensive crisis (n = 236) were screened retrospectively. Baseline and follow-up data including the event rates were obtained using electronic patient records. Those without an assay for cardiac Troponin I (cTnI) (n = 65) were excluded. Of the remaining 171 patients, those with elevated cTnI (cTnI ≥ 0.12 ng/ml) (n = 56) were compared with those with normal cTnI (cTnI hypertensive crisis, pulmonary edema, stroke or transient ischemic attack). At 2 years, MACCE occurred in 40 (71.4%) patients with elevated cTnI compared with 44 (38.3%) patients with normal cTnI [hazard ratio: 2.77; 95% confidence interval (CI): 1.79-4.27; P hypertensive crisis, elevated cTnI confers a significantly greater risk of long-term MACCE, and is a strong predictor of obstructive CAD.

  10. Increased prevalence of coronary artery disease risk markers in patients with chronic hepatitis C

    DEFF Research Database (Denmark)

    Roed, Torsten; Kristoffersen, Ulrik Sloth; Knudsen, Andreas

    2014-01-01

    OBJECTIVE: Chronic hepatitis C is a global health problem and has been associated with coronary artery disease. Our aim was to examine the prevalence of coronary artery disease risk markers including endothelial biomarkers in patients with chronic hepatitis C and matched comparisons without...... manifest cardiovascular disease or diabetes in a cross-sectional design. METHODS: Sixty patients with chronic hepatitis C (mean age 51 years) were recruited from the Department of Infectious Diseases at Copenhagen University Hospital, and compared with 60 age-matched non-hepatitis C virus......-infected individuals from a general population survey. We examined traditional coronary artery disease risk factors, metabolic syndrome, carotid intima media thickness, and a range of endothelial biomarkers. RESULTS: Patients with chronic hepatitis C had more hypertension (40% versus 25%, prevalence ratio [PR] 1.6; 95...

  11. Acute coronary syndromes amongst type 2 diabetics with ischaemic ...

    African Journals Online (AJOL)

    Majority had three coronary artery disease (CAD) risk factors: obesity 86%, elevated LDL 73% and hypertension 60%. Therapy in use was OHA 43%, insulin 42%, insulin and OHA 1%; prophylactic aspirin 14.7% and statins 8.4%. Thirty four (35.8%) were classified as acute coronary syndrome (ACS); 29 ( 30.5%) acute ...

  12. Physiologic assessment of coronary artery fistula

    Energy Technology Data Exchange (ETDEWEB)

    Gupta, N.C.; Beauvais, J. (Creighton Univ., Omaha, NE (USA))

    1991-01-01

    Coronary artery fistula is an uncommon clinical entity. The most common coronary artery fistula is from the right coronary artery to the right side of the heart, and it is less frequent to the pulmonary artery. The effect of a coronary artery fistula may be physiologically significant because of the steal phenomenon resulting in coronary ischemia. Based on published reports, it is recommended that patients with congenital coronary artery fistulas be considered candidates for elective surgical correction to prevent complications including development of congestive heart failure, angina, subacute bacterial endocarditis, myocardial infarction, and coronary aneurysm formation with rupture or embolization. A patient is presented in whom treadmill-exercise thallium imaging was effective in determining the degree of coronary steal from a coronary artery fistula, leading to successful corrective surgery.

  13. Physiologic assessment of coronary artery fistula

    International Nuclear Information System (INIS)

    Gupta, N.C.; Beauvais, J.

    1991-01-01

    Coronary artery fistula is an uncommon clinical entity. The most common coronary artery fistula is from the right coronary artery to the right side of the heart, and it is less frequent to the pulmonary artery. The effect of a coronary artery fistula may be physiologically significant because of the steal phenomenon resulting in coronary ischemia. Based on published reports, it is recommended that patients with congenital coronary artery fistulas be considered candidates for elective surgical correction to prevent complications including development of congestive heart failure, angina, subacute bacterial endocarditis, myocardial infarction, and coronary aneurysm formation with rupture or embolization. A patient is presented in whom treadmill-exercise thallium imaging was effective in determining the degree of coronary steal from a coronary artery fistula, leading to successful corrective surgery

  14. Hypertension and cognitive impairment

    Directory of Open Access Journals (Sweden)

    Su-hang SHANG

    2015-08-01

    Full Text Available As a leading risk factor for stroke, hypertension is also an important risk factor for cognitive impairment. Midlife hypertension doubles the risk of dementia later in life and accelerates the progression of dementia, but the correlation between late-life blood pressure and cognitive impairment is still unclear. Beside blood pressure, the effect of pulse pressure, blood pressure variability and circadian rhythm of blood pressure on cognition is currently attracting more and more attention. Hypertension induces alterations in cerebrovascular structure and functions, which lead to brain lesions including cerebral atrophy, stroke, lacunar infarcts, diffuse white matter damage, microinfarct and microhemorrhage, resuling in cognitive impairment. Hypertension also impairs the metabolism and transfer of amyloid-β protein (Aβ, thus accelerates cognitive impairment. Individualized therapy, focusing on characteristics of hypertensive patients, may be a good choice for prevention and treatment of cognitive impairment. DOI: 10.3969/j.issn.1672-6731.2015.08.004

  15. Overweight, adipocytokines and hypertension

    DEFF Research Database (Denmark)

    Seven, Ekim; Husemoen, Lise L N; Wachtell, Kristian

    2014-01-01

    OBJECTIVE: The adipocytokines, leptin, adiponectin, and interleukin-6, which stimulate liver C-reactive protein (CRP) production, are regarded as potential candidate intermediates between adipose tissue and overweight-induced hypertension. METHODS: We examined the associations between leptin......, adiponectin, and CRP levels with both prevalent and 5-year incident hypertension (IHT) in a general population of Danish adults (n = 5,868, 51.3% women, mean age 45.8 ± 7.9 years). RESULTS: We recorded 2195 prevalent and 379 incident cases of hypertension. In models including leptin, CRP, adiponectin, sex.......023) in the fully adjusted model. The population attributable risk estimate of IHT owing to overweight was 31%. CONCLUSION: Leptin, but not adiponectin or CRP, may play a mediating role in overweight-induced hypertension. However, as BMI was a strong independent predictor of hypertension, other factors than leptin...

  16. Overweight, adipocytokines and hypertension

    DEFF Research Database (Denmark)

    Seven, Ekim; Husemoen, Lise L N; Wachtell, Kristian

    2014-01-01

    OBJECTIVE:: The adipocytokines, leptin, adiponectin, and interleukin-6, which stimulate liver C-reactive protein (CRP) production, are regarded as potential candidate intermediates between adipose tissue and overweight-induced hypertension. METHODS:: We examined the associations between leptin......, adiponectin, and CRP levels with both prevalent and 5-year incident hypertension (IHT) in a general population of Danish adults (n = 5868, 51.3% women, mean age 45.8 ± 7.9 years). RESULTS:: We recorded 2195 prevalent and 379 incident cases of hypertension. In models including leptin, CRP, adiponectin, sex.......023) in the fully adjusted model. The population attributable risk estimate of IHT owing to overweight was 31%. CONCLUSION:: Leptin, but not adiponectin or CRP, may play a mediating role in overweight-induced hypertension. However, as BMI was a strong independent predictor of hypertension, other factors than leptin...

  17. Epigenomics of hypertension.

    Science.gov (United States)

    Liang, Mingyu; Cowley, Allen W; Mattson, David L; Kotchen, Theodore A; Liu, Yong

    2013-07-01

    Multiple genes and pathways are involved in the pathogenesis of hypertension. Epigenomic studies of hypertension are beginning to emerge and hold great promise of providing novel insights into the mechanisms underlying hypertension. Epigenetic marks or mediators including DNA methylation, histone modifications, and noncoding RNA can be studied at a genome or near-genome scale using epigenomic approaches. At the single gene level, several studies have identified changes in epigenetic modifications in genes expressed in the kidney that correlate with the development of hypertension. Systematic analysis and integration of epigenetic marks at the genome-wide scale, demonstration of cellular and physiological roles of specific epigenetic modifications, and investigation of inheritance are among the major challenges and opportunities for future epigenomic and epigenetic studies of hypertension. © 2013 Elsevier Inc. All rights reserved.

  18. Influence of the coronary calcium score on the ability to rule out coronary artery stenoses by coronary CT angiography in patients with suspected coronary artery disease.

    Science.gov (United States)

    Schuhbaeck, Annika; Schmid, Jasmin; Zimmer, Thomas; Muschiol, Gerd; Hell, Michaela M; Marwan, Mohamed; Achenbach, Stephan

    2016-01-01

    Recent guidelines for the workup of patients with chest pain and suspected coronary artery disease include coronary computed tomography angiography (CTA). However, its diagnostic value may be limited in patients with severe coronary calcification. We investigated the relationship between the extent of coronary calcium and the ability of coronary CTA to rule out significant stenoses in a series of consecutive patients with suspected coronary artery disease. 2614 consecutive patients with suspected coronary artery disease in whom coronary calcium scoring and coronary CTA had been performed by Dual Source CT were analyzed. The ability of coronary CTA to rule out coronary artery stenoses (fully evaluable coronary arteries and absence of any luminal stenosis >75%) was analyzed relative to the coronary calcium score. The median coronary calcium score was 12, with calcium present in 60.5% of all patients. Coronary CTA ruled out stenoses in 82% of patients, while in 18% of patients at least one stenosis was found or could not be excluded. The threshold above which coronary CTA permitted to rule out stenoses in less than 50% of patients was an "Agatston Score" of 287. This threshold was significantly lower for male patients (213 vs. 330), for patients with a heart rate >65 beats/min (157 vs. 317) and for patients with a body mass index ≥25 kg/m(2) (208 vs. 392). The evaluability of coronary arteries decreased with increasing amounts of calcium and differed significantly between heart rates ≤65 beats/min and >65 beats/min (p coronary CTA permits to rule out coronary artery stenoses in less than 50% of cases. Copyright © 2016 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  19. Coronary CT Angiography in the Quantitative Assessment of Coronary Plaques

    Directory of Open Access Journals (Sweden)

    Zhonghua Sun

    2014-01-01

    Full Text Available Coronary computed tomography angiography (CCTA has been recently evaluated for its ability to assess coronary plaque characteristics, including plaque composition. Identification of the relationship between plaque composition by CCTA and patient clinical presentations may provide insight into the pathophysiology of coronary artery plaque, thus assisting identification of vulnerable plaques which are associated with the development of acute coronary syndrome. CCTA-generated 3D visualizations allow evaluation of both coronary lesions and lumen changes, which are considered to enhance the diagnostic performance of CCTA. The purpose of this review is to discuss the recent developments that have occurred in the field of CCTA with regard to its diagnostic accuracy in the quantitative assessment of coronary plaques, with a focus on the characterization of plaque components and identification of vulnerable plaques.

  20. Spontaneous Coronary Artery Dissection: A Rare Manifestation of Alport Syndrome

    Science.gov (United States)

    Sethi, Prince; Steffen, Kelly; Jonsson, Orvar; Petrasko, Marian

    2017-01-01

    Alport syndrome (AS) is a genetic disorder due to inheritance of genetic mutations which lead to production of abnormal type IV collagen. AS has been associated with renal, auditory, and ocular diseases due to the presence of abnormal alpha chains of type IV collagen in the glomerulus, cochlea, cornea, lens, and retina. The resulting disorder includes hereditary nephritis, corneal opacities, anterior lenticonus, fleck retinopathy, temporal retinal thinning, and sensorineural deafness. Aortic and aortic valve pathologies have been described as extrarenal manifestations of AS in multiple case reports. One case report described intramural hematoma of the coronary artery. We report the first case of true spontaneous coronary artery dissection (SCAD) with an intimal flap as a very rare manifestation of AS. The patient is a 36-year-old female with history of AS with chronic kidney disease, hypertension, and obesity who presented to the emergency room with acute onset of substernal chest pain radiating to her neck and arms. Troponin was elevated, and ECG showed transient 1 mm ST-segment elevation in the inferior leads. Subsequent coronary angiography revealed localized dissection of the left circumflex artery. Percutaneous coronary angioplasty was performed and her symptoms improved. This case illustrates that SCAD may be a manifestation of AS patients with chest pain. PMID:28884028

  1. Spontaneous Coronary Artery Dissection: A Rare Manifestation of Alport Syndrome

    Directory of Open Access Journals (Sweden)

    Amornpol Anuwatworn

    2017-01-01

    Full Text Available Alport syndrome (AS is a genetic disorder due to inheritance of genetic mutations which lead to production of abnormal type IV collagen. AS has been associated with renal, auditory, and ocular diseases due to the presence of abnormal alpha chains of type IV collagen in the glomerulus, cochlea, cornea, lens, and retina. The resulting disorder includes hereditary nephritis, corneal opacities, anterior lenticonus, fleck retinopathy, temporal retinal thinning, and sensorineural deafness. Aortic and aortic valve pathologies have been described as extrarenal manifestations of AS in multiple case reports. One case report described intramural hematoma of the coronary artery. We report the first case of true spontaneous coronary artery dissection (SCAD with an intimal flap as a very rare manifestation of AS. The patient is a 36-year-old female with history of AS with chronic kidney disease, hypertension, and obesity who presented to the emergency room with acute onset of substernal chest pain radiating to her neck and arms. Troponin was elevated, and ECG showed transient 1 mm ST-segment elevation in the inferior leads. Subsequent coronary angiography revealed localized dissection of the left circumflex artery. Percutaneous coronary angioplasty was performed and her symptoms improved. This case illustrates that SCAD may be a manifestation of AS patients with chest pain.

  2. CT coronary angiography vs. invasive coronary angiography in CHD

    Directory of Open Access Journals (Sweden)

    Anja Hagen

    2012-04-01

    Full Text Available Scientific background: Various diagnostic tests including conventional invasive coronary angiography and non-invasive computed tomography (CT coronary angiography are used in the diagnosis of coronary heart disease (CHD. Research questions: The present report aims to evaluate the clinical efficacy, diagnostic accuracy, prognostic value cost-effectiveness as well as the ethical, social and legal implications of CT coronary angiography versus invasive coronary angiography in the diagnosis of CHD. Methods: A systematic literature search was conducted in electronic data bases (MEDLINE, EMBASE etc. in October 2010 and was completed with a manual search. The literature search was restricted to articles published from 2006 in German or English. Two independent reviewers were involved in the selection of the relevant publications. The medical evaluation was based on systematic reviews of diagnostic studies with invasive coronary angiography as the reference standard and on diagnostic studies with intracoronary pressure measurement as the reference standard. Study results were combined in a meta-analysis with 95 % confidence intervals (CI. Additionally, data on radiation doses from current non-systematic reviews were taken into account. A health economic evaluation was performed by modelling from the social perspective with clinical assumptions derived from the meta-analysis and economic assumptions derived from contemporary German sources. Data on special indications (bypass or in-stent-restenosis were not included in the evaluation. Only data obtained using CT scanners with at least 64 slices were considered. Results: No studies were found regarding the clinical efficacy or prognostic value of CT coronary angiography versus conventional invasive coronary angiography in the diagnosis of CHD. Overall, 15 systematic reviews with data from 44 diagnostic studies using invasive coronary angiography as the reference standard (identification of obstructive

  3. Understanding idiopathic intracranial hypertension

    DEFF Research Database (Denmark)

    Markey, Keira A; Mollan, Susan P; Jensen, Rigmor H

    2016-01-01

    Idiopathic intracranial hypertension is a disorder characterised by raised intracranial pressure that predominantly affects young, obese women. Pathogenesis has not been fully elucidated, but several causal factors have been proposed. Symptoms can include headaches, visual loss, pulsatile tinnitus...

  4. Pulmonary Hypertension Overview

    Science.gov (United States)

    ... a tank can help relieve shortness of breath. Medicines that can be used to treat pulmonary hypertension include the following: Endothelin receptor antagonists Phosphodiesterase-5 inhibitors Prostacyclins Anticoagulants (blood-thinning medicine) ...

  5. The burden of erectile dysfunction in hypertensive men attending a ...

    African Journals Online (AJOL)

    Background: Hypertension is often cited as a cause of erectile dysfuntion (ED) which is currently known to be a risk factor for coronary artery disease (CAD). Both ED and CAD lower the quality of life of affected men. Objectives: To study the characteristics of men with hypertension-associated ED and to determine the ED ...

  6. Antihypertensive Medications Awareness Level of Patients with Hypertensive Crisis

    Directory of Open Access Journals (Sweden)

    Mona Dastgheib

    2012-10-01

    Full Text Available Antihypertensive medications awareness level of patients with crisis of hypertension. Hypertension is an important public health challenge in industrial and developing countries. It has an important role in the occurrence of coronary diseases, myocardial infarction, heart failure and kidney incompetency [1]. It has been shown that there is a positive correlation between medications awareness level and treatment success [2].

  7. Hypertension in Chronic Kidney Disease.

    Science.gov (United States)

    Hamrahian, Seyed Mehrdad; Falkner, Bonita

    2017-01-01

    Hypertension, a global public health problem, is currently the leading factor in the global burden of disease. It is the major modifiable risk factor for heart disease, stroke and kidney failure. Chronic kidney disease (CKD) is both a common cause of hypertension and CKD is also a complication of uncontrolled hypertension. The interaction between hypertension and CKD is complex and increases the risk of adverse cardiovascular and cerebrovascular outcomes. This is particularly significant in the setting of resistant hypertension commonly seen in patient with CKD. The pathophysiology of CKD associated hypertension is multi-factorial with different mechanisms contributing to hypertension. These pathogenic mechanisms include sodium dysregulation, increased sympathetic nervous system and alterations in renin angiotensin aldosterone system activity. Standardized blood pressure (BP) measurement is essential in establishing the diagnosis and management of hypertension in CKD. Use of ambulatory blood pressure monitoring provides an additional assessment of diurnal variation in BP commonly seen in CKD patients. The optimal BP target in the treatment of hypertension in general and CKD population remains a matter of debate and controversial despite recent guidelines and clinical trial data. Medical therapy of patients with CKD associated hypertension can be difficult and challenging. Additional evaluation by a hypertension specialist may be required in the setting of treatment resistant hypertension by excluding pseudo-resistance and treatable secondary causes. Treatment with a combination of antihypertensive drugs, including appropriate diuretic choice, based on estimated glomerular filtration rate, is a key component of hypertension management in CKD patients. In addition to drug treatment non-pharmacological approaches including life style modification, most important of which is dietary salt restriction, should be included in the management of hypertension in CKD patients.

  8. Overview of the i-SEARCH Global Study : Cardiovascular Risk Factors and Microalbuminuria in Hypertensive Individuals.

    Science.gov (United States)

    Böhm, Michael; Thoenes, Martin; Danchin, Nicolas; Reil, Jan C; Volpe, Massimo

    2008-10-01

    Microalbuminuria (MAU) is a highly predictive, sensitive, inexpensive and easily repeatable marker of cardiovascular risk and all-cause mortality in hypertensive patients. The international, observational, practice-based study i-SEARCH (Survey for Evaluating Microalbuminuria Routinely by Cardiologists in patients with Hypertension) was designed to assess the frequency with which MAU occurred in a large outpatient population who were currently treated or newly diagnosed with hypertension and were under professional care. The primary aim of the study was to define the prevalence of MAU in hypertensive outpatients attending a cardiologist or internist (i-SEARCH A) and to compare hypertensive outpatients with or without coronary artery disease (i-SEARCH B). A secondary objective was to establish a correlation between MAU and known cardiovascular risk factors. A total of 21 050 patients from 26 countries were included in the primary analysis. Overall, this study demonstrated a very high worldwide prevalence (58.4%) of MAU in high-risk cardiovascular patients, but with a considerable variation across countries. MAU was more prevalent in patients with coronary artery disease than in those without. It was also significantly related to the presence of specific predictors, including male gender, abnormally high waist circumference, increased blood pressure levels (systolic ≥120 mmHg, diastolic ≥100 mmHg), creatinine clearance ≥50 mL/min, or clinical conditions such as diabetes mellitus, congestive heart failure, history of cerebral pathology, and peripheral arterial disease. Since the presence of MAU reflects long-term detrimental effects on the cardiovascular system, these results indicate the high, and in many cases hidden, burden of cardiovascular diseases among the hypertensive patients seen by cardiologists. This article discusses the main results of the study and the potential implications of ongoing analyses included in the core clinical study programme.

  9. The 2017 Focused Update of the Guidelines of the Taiwan Society of Cardiology (TSOC) and the Taiwan Hypertension Society (THS) for the Management of Hypertension

    Science.gov (United States)

    Chiang, Chern-En; Wang, Tzung-Dau; Lin, Tsung-Hsien; Yeh, Hung-I; Liu, Ping-Yen; Cheng, Hao-Min; Chao, Ting-Hsing; Chen, Chen-Huan; Shyu, Kou-Gi; Ueng, Kwo-Chang; Chen, Chung-Yin; Chu, Pao-Hsien; Sung, Shih-Hsien; Wang, Kang-Ling; Li, Yi-Heng; Wang, Kuo-Yang; Chiang, Fu-Tien; Lai, Wen-Ter; Chen, Jyh-Hong; Chen, Wen-Jone; Yeh, San-Jou; Chen, Ming-Fong; Lin, Shing-Jong; Lin, Jiunn-Lee

    2017-01-01

    Hypertension (HT) is the most important risk factor for cardiovascular diseases. Over the past 25 years, the number of individuals with hypertension and the estimated associated deaths has increased substantially. There have been great debates in the past few years on the blood pressure (BP) targets. The 2013 European Society of Hypertension and European Society of Cardiology HT guidelines suggested a unified systolic BP target of 140 mmHg for both high-risk and low-risk patients. The 2014 Joint National Committee report further raised the systolic BP targets to 150 mmHg for those aged ≥ 60 years, including patients with stroke or coronary heart disease, and raised the systolic BP target to 140 mmHg for diabetes. Instead, the 2015 Hypertension Guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society suggested more aggressive BP targets of Cardiology and the Taiwan Hypertension Society convened and finalized the revised BP targets for management of HT. We suggested a new systolic BP target to < 120 mmHg for patients with coronary heart disease, chronic kidney disease with an eGFR of 20-60 ml/min/1.73 m2, and elderly patients aged ≥ 75 years, using unattended automated office BP measurement. When traditional office BP measurement is applied, we suggested BP target of < 140/90 mmHg for elderly patients with an age ≥ 75 years. Other BP targets with traditional office BP measurement remain unchanged. With these more aggressive BP targets, it is foreseeable that the cardiovascular events will decrease substantially in Taiwan. PMID:28559651

  10. Comparison of clinical outcomes of coronary artery stent implantation in patients with end-stage chronic kidney disease including hemodialysis for three everolimus eluting (EES) stent designs: Bioresorbable polymer-EES, platinum chromium-EES, and cobalt chrome-EES.

    Science.gov (United States)

    Sato, Takao; Hatada, Katsuharu; Kishi, Syohei; Fuse, Koichi; Fujita, Satoshi; Ikeda, Yoshio; Takahashi, Minoru; Matsubara, Taku; Okabe, Masaaki; Aizawa, Yoshifusa

    2017-11-22

    New-generation bioresorbable polymer-everolimus eluting stents (BP-EES) are available. This study aimed to compare the clinical outcomes for BP-EES compared to more established stent designs, namely the platinum chromium-EES (PtCr-EES) and cobalt chrome-EES(CoCr-EES) in patients with the end-stage chronic kidney disease (CKD) including hemodialysis (HD). One-hundred-forty-one consecutive stents (BP-EES [n = 44], PtCr-EES [n = 45], and CoCr-EES [n = 52]) were implanted in 104 patients with CKD. All patients underwent a follow-up coronary angiography at 12 months after implantation. End-stage CKD was defined as an estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m 2 , or the need for HD. The following outcome variables were compared among the three stent groups after implantation and the 12-month follow-up: target lesion revascularization (TLR), stent thrombosis (ST), and major adverse cardiac event (MACE). Minimal stent diameter (MSD) and %diameter-stenosis (%DS) were measured using quantitative coronary angiography. The overall rate of TLR and MACE was 14.6% and 30.8%, respectively, with no incidence of ST. Immediately after implantation, the MSD (P = 0.22) and %DS (P = 0.42) were equivalent among the three groups. However, at the 12-month follow-up, a tendency towards higher TLR was observed for the BP-EES group (22.7%) compared with the PtCr-EES (8.8%) and CoCr-EES (9.6%) groups (P = 0.07). Late loss in lumen diameter was also significantly greater for the BP-EES (0.51 ± 0.64 mm) group than either the PtCr-EES (0.20 ± 0.61 mm) and CoCr-EES (0.25 ± 0.70 mm) groups (P = 0.03). BP-EES might increase the risk of in-stent restenosis in patients with end-stage of CKD or the need for HD. © 2017, Wiley Periodicals, Inc.

  11. Coronary microvascular function and myocardial fibrosis in women with angina pectoris and no obstructive coronary artery disease: the iPOWER study.

    Science.gov (United States)

    Mygind, Naja Dam; Michelsen, Marie Mide; Pena, Adam; Qayyum, Abbas Ali; Frestad, Daria; Christensen, Thomas Emil; Ghotbi, Adam Ali; Dose, Nynne; Faber, Rebekka; Vejlstrup, Niels; Hasbak, Philip; Kjaer, Andreas; Prescott, Eva; Kastrup, Jens

    2016-11-04

    Even in absence of obstructive coronary artery disease women with angina pectoris have a poor prognosis possibly due to coronary microvascular disease. Coronary microvascular disease can be assessed by transthoracic Doppler echocardiography measuring coronary flow velocity reserve (CFVR) and by positron emission tomography measuring myocardial blood flow reserve (MBFR). Diffuse myocardial fibrosis can be assessed by cardiovascular magnetic resonance (CMR) T1 mapping. We hypothesized that coronary microvascular disease is associated with diffuse myocardial fibrosis. Women with angina, a clinically indicated coronary angiogram with <50 % stenosis and no diabetes were included. CFVR was measured using dipyridamole (0.84 mg/kg) and MBFR using adenosine (0.84 mg/kg). Focal fibrosis was assessed by 1.5 T CMR late gadolinium enhancement (0.1 mmol/kg) and diffuse myocardial fibrosis by T1 mapping using a modified Look-Locker pulse sequence measuring T1 and extracellular volume fraction (ECV). CFVR and CMR were performed in 64 women, mean (SD) age 62.5 (8.3) years. MBFR was performed in a subgroup of 54 (84 %) of these women. Mean native T1 was 1023 (86) and ECV (%) was 33.7 (3.5); none had focal fibrosis. Median (IQR) CFVR was 2.3 (1.9; 2.7), 23 (36 %) had CFVR < 2 indicating coronary microvascular disease, and median MBFR was 2.7 (2.2; 3.0) and 19 (35 %) had a MBFR value below 2.5. No significant correlations were found between CFVR and ECV or native T1 (R 2  = 0.02; p = 0.27 and R 2  = 0.004; p = 0.61, respectively). There were also no correlations between MBFR and ECV or native T1 (R 2  = 0.1; p = 0.13 and R 2  = 0.004, p = 0.64, respectively). CFVR and MBFR were correlated to hypertension and heart rate. In women with angina and no obstructive coronary artery disease we found no association between measures of coronary microvascular disease and myocardial fibrosis, suggesting that myocardial ischemia induced by coronary

  12. Usefulness of coronary artery calcium for detecting significant coronary artery disease in asymptomatic individuals.

    Science.gov (United States)

    Descalzo, M; Vidal-Pérez, R; Leta, R; Alomar, X; Pons-Lladó, G; Carreras, F

    2014-01-01

    To confirm the value of the coronary artery calcium (CAC) score as an indicator of significant coronary artery disease (CAD) in the asymptomatic Spanish population, using noninvasive coronary angiography by multidetector computed tomography (MDCT). This was a retrospective study of 232 asymptomatic individuals, referred for a cardiovascular health checkup that included CAC and MDCT. Participants' mean age was 54.6 years (SD ± 12.8); 73.3% of them were men. The mean CAC value was 117.8 (SD ± 277). The individuals with arterial hypertension, diabetes mellitus, smoking and 3 or more risk factors had significantly greater CAC scores. Some 16.4% of the participants were in the ≥75 percentile population for CAC. The MDCT identified 148 individuals (63.8%) with CAD; the coronary lesions were not significant in 116 individuals (50%) and were significant (>50% stenosis) in 32 (13.8%). The participants with diabetes, smoking and ≥3 risk vascular factors had a greater prevalence of significant stenosis. The individuals with >50% stenosis had higher CAC values (352.5 vs. 1; P300 (OR=10.9; 95% CI 3.35-35.8; P=.0001), belonging to the ≥75 percentile (OR=5.65; 95% CI 1.78-17.93; P=.03) and having 3 or more vascular risk factors (OR=4.19; 95% CI 1.44-12.14; P=.008). CAC quantification is an effective method for determining the extent and magnitude of CAD and delimiting the predictive capacity of traditional risk factors. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  13. Coronary Arteries

    Science.gov (United States)

    ... called coronary circulation. The aorta (the main blood supplier to the body) branches off into two main ... Daily Conferences For the Public Heart Information Center Project Heart Women’s Heart Health Clinical Trials 6770 Bertner ...

  14. Myocardial indium-111-antimyosin uptake in essential hypertension

    Energy Technology Data Exchange (ETDEWEB)

    Uenlue, M.; Temiz, N.H. [Dept. of Nuclear Medicine, Dept. of Nuclear Medicine, Ankara (Turkey); Cengel, A. [Dept. of Cardiology, Gazi Univ. School of Medicine, Dept. of Nuclear Medicine, Ankara (Turkey)

    2003-06-01

    Aim: Evaluation of myocardial uptake of {sup 111}In-antimyosin antibodies in patients with essential hypertension for the verification of our hypothesis that it may increase in stage 1 in the left ventricle as a result of myocardial damage. Patients, methods: Twelve men (mean age: 59 {+-} 2.4 years) suffering from angina like symptoms and essential hypertension in clinical stage 1 according to the JNC-VI criteria were included into the study. These patients showed normal perfusion as revealed by thallium-201 myocardial study and coronary angiography. Left ventricular mass index was determined in echocardiography. Planar antimyosin images were obtained 48 h after the intravenous injection of the tracer. Heart to lung ratios were calculated as a parameter of myocardial tracer uptake using appropriate region of interests; values >1.52 were considered as abnormal. Results: We observed increased antimyosin uptake (mean: 1.71 {+-} 0.12) consistent with myocardial damage in 11 of 12 patients. Nine of 12 patients had a left ventricular hypertrophy with left ventricular mass index values (mean: 131 g/m{sup 2} {+-} 9.48) above 115 g/m{sup 2}. Heart to lung ratio was correlated significantly to left ventricular mass index (r = 0.902, p <0.001) and duration of hypertension (r = 0.948, p <0.001). Conclusion: Our results suggest that {sup 111}In-antimyosin imaging may indicate myocyte damage in early phases of hypertensive heart disease. (orig.)

  15. Management of hypertension in 2017: targets and therapies.

    Science.gov (United States)

    Ahluwalia, Monica; Bangalore, Sripal

    2017-07-01

    Approximately one-fourth of the adult population is diagnosed with hypertension, which has been associated with increased cardiovascular morbidity and mortality including cardiovascular death, myocardial infarction, heart failure and stroke. Early detection and treatment is key and can lead to a significant reduction in cardiovascular morbidity and mortality. In this review, we discuss the management and treatment strategies in patients with hypertension in the current era. Blood pressure (BP) targets will be reviewed in accordance with the recent literature and current guidelines. There is a controversy about lower BP target in patients with coronary artery disease with some studies showing a J-curve relationship but a recent randomized trial (SPRINT) showing a benefit, albeit with controversy as to how BP was measured in the trial. Nevertheless, lower BP targets come with a price of needing more medication (thus impacting cost and compliance) and increases in medication-related adverse effects. There is a growing recognition that angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, calcium antagonists or thiazide diuretics can be used a first-line therapy for hypertension. Evidence also supports the use of combination drug therapy as opposed to monotherapy for more synergistic effect on lowering of BP, offsetting side effects and for improved adherence to a drug regimen. Overall, we aim to review BP targets and medical therapies for hypertension in the current era, recognizing varying clinical characteristics such as comorbidities and patient-risk profile.

  16. Prognostic Value of Coronary Computed Tomography Imaging in Patients at High Risk Without Symptoms of Coronary Artery Disease.

    Science.gov (United States)

    Dedic, Admir; Ten Kate, Gert-Jan R; Roos, Cornelis J; Neefjes, Lisan A; de Graaf, Michiel A; Spronk, Angela; Delgado, Victoria; van Lennep, Jeanine E Roeters; Moelker, Adriaan; Ouhlous, Mohamed; Scholte, Arthur J H A; Boersma, Eric; Sijbrands, Eric J G; Nieman, Koen; Bax, Jeroen J; de Feijter, Pim J

    2016-03-01

    At present, traditional risk factors are used to guide cardiovascular management of asymptomatic subjects. Intensified surveillance may be warranted in those identified as high risk of developing cardiovascular disease (CVD). This study aims to determine the prognostic value of coronary computed tomography (CT) angiography (CCTA) next to the coronary artery calcium score (CACS) in patients at high CVD risk without symptoms suspect for coronary artery disease (CAD). A total of 665 patients at high risk (mean age 56 ± 9 years, 417 men), having at least one important CVD risk factor (diabetes mellitus, familial hypercholesterolemia, peripheral artery disease, or severe hypertension) or a calculated European systematic coronary risk evaluation of >10% were included from outpatient clinics at 2 academic centers. Follow-up was performed for the occurrence of adverse events including all-cause mortality, nonfatal myocardial infarction, unstable angina, or coronary revascularization. During a median follow-up of 3.0 (interquartile range 1.3 to 4.1) years, adverse events occurred in 40 subjects (6.0%). By multivariate analysis, adjusted for age, gender, and CACS, obstructive CAD on CCTA (≥50% luminal stenosis) was a significant predictor of adverse events (hazard ratio 5.9 [CI 1.3 to 26.1]). Addition of CCTA to age, gender, plus CACS, increased the C statistic from 0.81 to 0.84 and resulted in a total net reclassification index of 0.19 (p value and risk reclassification benefit beyond CACS in patients without CAD symptoms but with high risk of developing CVD. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. What does my patient's coronary artery calcium score mean? Combining information from the coronary artery calcium score with information from conventional risk factors to estimate coronary heart disease risk

    Directory of Open Access Journals (Sweden)

    Pletcher Mark J

    2004-08-01

    Full Text Available Abstract Background The coronary artery calcium (CAC score is an independent predictor of coronary heart disease. We sought to combine information from the CAC score with information from conventional cardiac risk factors to produce post-test risk estimates, and to determine whether the score may add clinically useful information. Methods We measured the independent cross-sectional associations between conventional cardiac risk factors and the CAC score among asymptomatic persons referred for non-contrast electron beam computed tomography. Using the resulting multivariable models and published CAC score-specific relative risk estimates, we estimated post-test coronary heart disease risk in a number of different scenarios. Results Among 9341 asymptomatic study participants (age 35–88 years, 40% female, we found that conventional coronary heart disease risk factors including age, male sex, self-reported hypertension, diabetes and high cholesterol were independent predictors of the CAC score, and we used the resulting multivariable models for predicting post-test risk in a variety of scenarios. Our models predicted, for example, that a 60-year-old non-smoking non-diabetic women with hypertension and high cholesterol would have a 47% chance of having a CAC score of zero, reducing her 10-year risk estimate from 15% (per Framingham to 6–9%; if her score were over 100, however (a 17% chance, her risk estimate would be markedly higher (25–51% in 10 years. In low risk scenarios, the CAC score is very likely to be zero or low, and unlikely to change management. Conclusion Combining information from the CAC score with information from conventional risk factors can change assessment of coronary heart disease risk to an extent that may be clinically important, especially when the pre-test 10-year risk estimate is intermediate. The attached spreadsheet makes these calculations easy.

  18. What does my patient's coronary artery calcium score mean? Combining information from the coronary artery calcium score with information from conventional risk factors to estimate coronary heart disease risk

    Science.gov (United States)

    Pletcher, Mark J; Tice, Jeffrey A; Pignone, Michael; McCulloch, Charles; Callister, Tracy Q; Browner, Warren S

    2004-01-01

    Background The coronary artery calcium (CAC) score is an independent predictor of coronary heart disease. We sought to combine information from the CAC score with information from conventional cardiac risk factors to produce post-test risk estimates, and to determine whether the score may add clinically useful information. Methods We measured the independent cross-sectional associations between conventional cardiac risk factors and the CAC score among asymptomatic persons referred for non-contrast electron beam computed tomography. Using the resulting multivariable models and published CAC score-specific relative risk estimates, we estimated post-test coronary heart disease risk in a number of different scenarios. Results Among 9341 asymptomatic study participants (age 35–88 years, 40% female), we found that conventional coronary heart disease risk factors including age, male sex, self-reported hypertension, diabetes and high cholesterol were independent predictors of the CAC score, and we used the resulting multivariable models for predicting post-test risk in a variety of scenarios. Our models predicted, for example, that a 60-year-old non-smoking non-diabetic women with hypertension and high cholesterol would have a 47% chance of having a CAC score of zero, reducing her 10-year risk estimate from 15% (per Framingham) to 6–9%; if her score were over 100, however (a 17% chance), her risk estimate would be markedly higher (25–51% in 10 years). In low risk scenarios, the CAC score is very likely to be zero or low, and unlikely to change management. Conclusion Combining information from the CAC score with information from conventional risk factors can change assessment of coronary heart disease risk to an extent that may be clinically important, especially when the pre-test 10-year risk estimate is intermediate. The attached spreadsheet makes these calculations easy. PMID:15327691

  19. Hypertension hos gravide

    DEFF Research Database (Denmark)

    Mathiesen, Elisabeth R; Johansen, Marianne; Kamper, Anne Lise

    2009-01-01

    There are four major hypertensive disorders in pregnancy: chronic hypertension, gestational hypertension, preeclampsia and chronic hypertension with superimposed preeclampsia. The indications and efficacy of antihypertensive treatment of the different hypertensive disorders are assessed. Advantages...

  20. [Hypertension during pregnancy

    DEFF Research Database (Denmark)

    Mathiesen, E.R.; Johansen, M.; Kamper, A.L.

    2009-01-01

    There are four major hypertensive disorders in pregnancy: chronic hypertension, gestational hypertension, preeclampsia and chronic hypertension with superimposed preeclampsia. The indications and efficacy of antihypertensive treatment of the different hypertensive disorders are assessed. Advantages...

  1. Neuropeptide Y signal peptide Pro7 substitution protects against coronary artery atherosclerosis: the Helsinki Sudden Death Study.

    Science.gov (United States)

    Ilveskoski, Erkki; Viiri, Leena E; Mikkelsson, Jussi; Pörsti, Ilkka; Lehtimäki, Terho; Karhunen, Pekka J

    2008-08-01

    Neuropeptide Y (NPY) has a single nucleotide polymorphism at T1128C, leading to change of Leucine7 to Proline7. The Leu7Pro substitution has been linked to cardiovascular disease, but it is unknown whether the Pro7 allele is associated with increased or decreased risk of coronary heart disease (CHD). The aim of the present study was to investigate the association of the Leu7Pro polymorphism with coronary atherosclerosis and its consequences. We studied two autopsy series comprising 700 unselected middle-aged Caucasian men (Helsinki Sudden Death Study) who had died suddenly out of hospital. Areas of coronary artery atherosclerosis, narrowings of coronary arteries, and presence of myocardial infarction and/or coronary thrombosis were analyzed. All information including CHD risk factor data was obtained from 410 men. NPY genotype distribution was Leu7/Leu7=89.8%, Leu7/Pro7=10.0% and Pro7/Pro7=0.2%). Although the Pro7 allele was associated with reported hypertension (p=0.03), the men carrying Pro7 allele had lower area of fatty streaks (p=0.04), fibrotic lesions (p=0.07) and complicated lesions (p=0.004) in the left anterior descending (LAD) coronary artery and also less severe LAD narrowings (p=0.04) than men with the Leu7/Leu7 genotype. Supporting a protective role for the Pro7 allele against atherosclerosis, only 1 out of 46 men (2%) with coronary thrombosis carried the Pro7 allele (p=0.08 compared to men dying of other causes). This association weakened (OR 0.18 for Pro7 versus Leu7/Leu7, p=0.16) when adjusted for all available CHD risk factors. NPY Pro7 substitution protects middle-aged men from coronary artery atherosclerosis and might decrease the risk of acute coronary events.

  2. Definition and classification of pulmonary hypertension.

    Science.gov (United States)

    Humbert, Marc; Montani, David; Evgenov, Oleg V; Simonneau, Gérald

    2013-01-01

    Pulmonary hypertension is defined as an increase of mean pulmonary arterial pressure ≥25 mmHg at rest as assessed by right heart catheterization. According to different combinations of values of pulmonary wedge pressure, pulmonary vascular resistance and cardiac output, a hemodynamic classification of pulmonary hypertension has been proposed. Of major importance is the pulmonary wedge pressure which allows to distinguish pre-capillary (pulmonary wedge pressure ≤15 mmHg) and post-capillary (pulmonary wedge pressure >15 mmHg) pulmonary hypertension. Pre-capillary pulmonary hypertension includes the clinical groups 1 (pulmonary arterial hypertension), 3 (pulmonary hypertension due to lung diseases and/or hypoxia), 4 (chronic thrombo-embolic pulmonary hypertension) and 5 (pulmonary hypertension with unclear and/or multifactorial mechanisms). Post-capillary pulmonary hypertension corresponds to the clinical group 2 (pulmonary hypertension due to left heart diseases).

  3. Weight control in the management of hypertension. World Hypertension League.

    OpenAIRE

    1989-01-01

    This article, which includes a brief description of the mechanisms and some epidemiological findings in obesity and high blood pressure, sums up present knowledge on a complex subject and provides guidance to medical practitioners on the management of obese hypertensive patients. Weight reduction, together with drug therapy in severe and moderate hypertension, and other non-pharmacological methods and continuing observation in mild hypertension are the essential measures to be applied. In add...

  4. Periodontal disease, tooth loss and coronary heart disease assessed by coronary angiography: a cross-sectional observational study.

    Science.gov (United States)

    Zanella, S M; Pereira, S S; Barbisan, J N; Vieira, L; Saba-Chujfi, E; Haas, A N; Rösing, C K

    2016-04-01

    To evaluate the association between periodontal disease, tooth loss and coronary heart disease (CHD). There is still controversy about the relationship between periodontal disease and tooth loss with vessel obstruction assessed using coronary angiography. This cross-sectional study included 195 patients that underwent coronary angiography and presented with at least six teeth. Patients were classified into three categories of coronary obstruction severity: absence; one or more vessels with ≤ 50% obstruction; and one or more vessels with ≥ 50% obstruction. The extent of coronary obstruction was dichotomized into 0 and ≥ 1 affected vessels. A periodontist blinded to patient CHD status conducted a full mouth examination to determine mean clinical attachment loss, mean periodontal probing depth and tooth loss. Multiple logistic regression models were applied adjusting for age, gender, hypertension, smoking, body mass index, low-density lipoprotein cholesterol and C-reactive protein. Most patients were males (62.1%) older than 60 years (50.8%), and 61% of them had CHD. Mean periodontal probing depth, clinical attachment loss and tooth loss were 2.64 ± 0.72 mm, 4.40 ± 1.31 mm and 12.50 ± 6.98 teeth respectively. In the multivariable models, tooth loss was significantly associated with a higher chance of having at least one obstructed vessel (odds ratio = 1.04; 95% confidence interval 1.01-1.09) and with vessel obstruction ≥ 50% (odds ratio = 1.06; 95% confidence interval 1.01-1.11). No significant associations were found between periodontal variables and vessel obstruction. Tooth loss was found to be a risk indicator for CHD. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  5. Evaluation and management of pediatric hypertensive crises: hypertensive urgency and hypertensive emergencies

    Directory of Open Access Journals (Sweden)

    Patel NH

    2012-11-01

    Full Text Available Nirali H Patel,1 Sarah K Romero,2 David C Kaelber31Division of Emergency Medicine, Akron Children's Hospital, Akron, OH, USA; 2Division of Emergency Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH, USA; 3Departments of Information Services, Internal Medicine, Pediatrics, and Epidemiology and Biostatistics, The Center for Clinical Informatics Research and Education, The MetroHealth System and School of Medicine, Case Western Reserve University, Cleveland OH, USAAbstract: Hypertension (HTN in the pediatric population is estimated to have a world-wide prevalence of 2%-5%. As with adults, pediatric patients with HTN can present with hypertensive crises include hypertensive urgency and hypertensive emergencies. However, pediatric blood pressure problems have a greater chance of being from secondary causes of HTN, as opposed to primary HTN, than in adults. Thorough evaluation of a child with a hypertensive emergency includes accurate blood pressure readings, complete and focused symptom history, and appropriate past medical, surgical, and family history. Physical exam should include height, weight, four-limb blood pressures, a general overall examination and especially detailed cardiovascular and neurological examinations, including fundoscopic examination. Initial work-up should typically include electrocardiography, chest X-ray, serum chemistries, complete blood count, and urinalysis. Initial management of hypertensive emergencies generally includes the use of intravenous or oral antihypertensive medications, as well as appropriate, typically outpatient, follow-up. Emergency department goals for hypertensive crises are to (1 safely lower blood pressure, and (2 treat/minimize acute end organ damage, while (3 identifying underlying etiology. Intravenous antihypertensive medications are the treatment modality of choice for hypertensive emergencies with the goal of reducing systolic blood pressure by 25% of the original value over an 8

  6. Assessing outcomes to determine whether symptoms related to hypertension justify renal artery stenting.

    Science.gov (United States)

    Modrall, J Gregory; Rosero, Eric B; Timaran, Carlos H; Anthony, Thomas; Chung, Jayer; Valentine, R James; Trimmer, Clayton

    2012-02-01

    The goal of the study was to determine the blood pressure (BP) response to renal artery stenting (RAS) for patients with hypertension urgency, hypertension emergency, and angina with congestive heart failure (angina/congestive heart failure [CHF]). Patients who underwent RAS for hypertension emergencies (n = 13), hypertension urgencies (n = 25), and angina/CHF (n = 14) were included in the analysis. By convention, hypertension urgency was defined by a sustained systolic BP ≥ 180 mm Hg or diastolic BP ≥ 120 mm Hg, while the definition of hypertension emergency required the same BP parameters plus hypertension-related symptoms prompting hospitalization. Patient-specific response to RAS was defined according to modified American Heart Association reporting guidelines. The study cohort of 52 patients had a median age of 66 years (interquartile range 58-72). The BP response to RAS varied significantly according to the indication for RAS. Hypertension emergency provided the highest BP response rate (85%), while the response rate was significantly lower for hypertension urgency (52%) and angina/CHF (7%; P = .03). Only 1 of 14 patients with angina/CHF was a BP responder. Multivariate analysis showed that hypertension urgency or emergency were not independent predictors of BP response to RAS. Instead, the only independent predictor of a favorable BP response was the number of preoperative antihypertensive medications (odds ratio 7.5; 95% confidence interval 2.5-22.9; P = .0004), which is another indicator of the severity of hypertension. Angina/CHF was an independent predictor of failure to respond to RAS (odds ratio 118.6; 95% confidence interval 2.8-999.9; P = .013). Hypertension urgency and emergency are clinical manifestations of severe hypertension, but the number of preoperative antihypertensive medications proved to be a better predictor of a favorable BP response to RAS. In contrast, angina/CHF was a predictor of failure to respond to stenting, providing further

  7. Profile of conventional risk factors in patients presenting for coronary angiography in a tertiary care hospital

    International Nuclear Information System (INIS)

    Qureshi, N.S.

    2014-01-01

    The conventional risk factors for coronary artery disease (CAD) include hypertension, diabetes mellitus, hyperlipidaemia and cigarette smoking(1). There is a large body of evidence, which implicates these factors in the causation of coronary artery disease. Objective: To study the attern of the above-mentioned as well as additional risk factors including age, gender, family history, obesity and hepatitis B and C seropositivity in the population of patients undergoing coronary angiography at our tertiary care hospital.Methodology:In this cross-sectional survey, 465 patients undergoing coronary angiography were studied using a questionnaire as well as clinical and laboratory data. The information obtained included age, sex, clinical presentation, past medical history, family history, the presence or absence of previous ischemic heart disease, diabetes, hypertension and a history of smoking. A history of duration of diabetes and hypertension, their treatment and the presence or absence of complications was also noted. A proportion of patients had their fasting blood lipid levels measured. Height, weight and waist circumference as well as HepBsAg and anti-HCV levels were also determined.Results: The 465 patients studied included 383 males and 82 females. The mean age of all patients was 49.68 +- 0.464 years and the difference between genders was not significant. A past history of ischaemic heart disease was present in 31% of patients. Diabetes mellitus was present in 23% of males and 45% of females. A history of hypertension was present in 30.8% males and 70.7% of the females. Of the patients who could be studied, the mean LDL was 110.29 +- 1.706 mg/dL, the mean HDL was 41.01 +- 0.319 mg/dL and the mean TG was 189.67 +- 4.21 mg/dL. The difference in lipid profile values between male and female patients was not significant (p-value >0.05). Waist circumference was increased in 69.7% males and 93.9% females and here the difference between genders was significant, Hep

  8. Pulmonary Hypertension

    Science.gov (United States)

    Pulmonary hypertension (PH) is high blood pressure in the arteries to your lungs. It is a serious condition. If you have ... that carry blood from your heart to your lungs become hard and narrow. Your heart has to ...

  9. Hypertension screening

    Science.gov (United States)

    Foulke, J. M.

    1975-01-01

    An attempt was made to measure the response to an announcement of hypertension screening at the Goddard Space Center, to compare the results to those of previous statistics. Education and patient awareness of the problem were stressed.

  10. Traditional cardiovascular risk factors and coronary collateral circulation: Protocol for a systematic review and meta-analysis of case-control studies.

    Science.gov (United States)

    Xing, Zhenhua; Pei, Junyu; Tang, Liang; Hu, Xinqun

    2018-04-01

    Well-developed coronary collateral circulation usually results in fewer infarct size, improved cardiac function, and fewer mortality. Traditional coronary risk factors (diabetes, hypertension, and smoking) have some effects on coronary collateral circulation. However, the association between these risk factors and coronary collateral circulation are controversial. Given the confusing evidences regarding traditional cardiovascular risk factors on coronary collateral circulation, we performed this meta-analysis protocol to investigate the relationship between traditional risk factors of coronary artery disease and coronary collateral circulation. MEDINE, EMBASE, and Science Citation Index will be searched to identify relevant studies. The primary outcomes of this meta-analysis are well-developed coronary collateral circulation. Meta-analysis was performed to calculate the odds ratio (OR) and 95% confidence interval (CI) of traditional coronary risk factors (diabetes, smoking, hypertriton). Pooled ORs were computed as the Mantel-Haenszel-weighted average of the ORs for all included studies. Sensitivity analysis, quality assessment, publication bias analysis, and the Grading of Recommendations Assessment, Development and Evaluation approach (GRADE) will be performed to ensure the reliability of our results. This study will provide a high-quality synthesis of current evidence of traditional risk factors on collateral circulation. This conclusion of our systematic review and meta-analysis will provide evidence to judge whether traditional risk factors affects coronary collateral circulation.Ethics and dissemination: Ethical approval is not required because our systematic review and meta-analysis will be based on published data without interventions on patients. The findings of this study will be published in a peer-reviewed journal.

  11. Hypertension og det metaboliske syndrom

    DEFF Research Database (Denmark)

    Olsen, Michael Hecht; Jeppesen, Jørgen; Larsen, Mogens Lytken

    2009-01-01

    The metabolic syndrome is a relatively prevalent condition characterized by co-existence of several metabolic and cardiovascular risk factors including hypertension. Patients with hypertension have an increased risk of developing the metabolic syndrome which, in turn, increases the cardiovascular...... syndrome is of clinical importance as it makes the treating physician test for other elements of the syndrome in patients with one of the elements, e.g. hypertension. Udgivelsesdato: 2009-Jun-15...

  12. Hypertension og det metaboliske syndrom

    DEFF Research Database (Denmark)

    Olsen, Michael Hecht; Jeppesen, Jørgen; Larsen, Mogens Lytken

    2009-01-01

    The metabolic syndrome is a relatively prevalent condition characterized by co-existence of several metabolic and cardiovascular risk factors including hypertension. Patients with hypertension have an increased risk of developing the metabolic syndrome which, in turn, increases the cardiovascular...... syndrome is of clinical importance as it makes the treating physician test for other elements of the syndrome in patients with one of the elements, e.g. hypertension. Udgivelsesdato: 2009-Jun...

  13. Endokrin hypertension

    DEFF Research Database (Denmark)

    Poulsen, Per Løgstrup; Ibsen, Hans

    2009-01-01

    Endocrine hypertension is rare, but frequently refractory. Adenomas are common incidental findings. Biochemical tests confirm the diagnosis. Primary aldosteronism is the most common form. Hypokalaemia is an important sign, but 50% of patients may be normokalaemic. The plasma-aldosterone-to-renin ......Endocrine hypertension is rare, but frequently refractory. Adenomas are common incidental findings. Biochemical tests confirm the diagnosis. Primary aldosteronism is the most common form. Hypokalaemia is an important sign, but 50% of patients may be normokalaemic. The plasma...

  14. Hypertension and cardiac arrhythmias : A consensus document fromthe European Heart RhythmAssociation (EHRA) and ESC Council on Hypertension, endorsed by the Heart RhythmSociety (HRS), Asia-Pacific Heart RhythmSociety (APHRS) and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLEACE)

    NARCIS (Netherlands)

    Lip, Gregory Y. H.; Coca, Antonio; Kahan, Thomas; Boriani, Giuseppe; Manolis, Antonis S.; Olsen, Michael Hecht; Oto, Ali; Potpara, Tatjana S.; Steffel, Jan; Marin, Francisco; de Oliveira Figueiredo, Marcio Jansen; de Simone, Giovanni; Tzou, Wendy S.; Chiang, Chern-En; Williams, Bryan; Dan, Gheorghe-Andrei; Gorenek, Bulent; Fauchier, Laurent; Savelieva, Irina; Hatala, Robert; van Gelder, Isabelle; Brguljan-Hitij, Jana; Erdine, Serap; Lovic, Dragan; Kim, Young-Hoon; Salinas-Arce, Jorge; Field, Michael

    2017-01-01

    Hypertension is a common cardiovascular risk factor leading to heart failure (HF), coronary artery disease, stroke, peripheral artery disease and chronic renal insufficiency. Hypertensive heart disease can manifest as many cardiac arrhythmias, most commonly being atrial fibrillation (AF). Both

  15. [Management of arterial hypertension].

    Science.gov (United States)

    Groha, P; Schunkert, H

    2015-09-01

    Arterial hypertension is one of the most frequent diseases in the western world and is one of the three most important risk factors for heart diseases. The 2013 guidelines of the European Societies of Hypertension and Cardiology (ESH/ESC) provide a clear action plan for evidence-based diagnostics and therapeutic measures in hypertensive subjects and simplify target blood pressures across various patient groups. Non-pharmacological options play a central role in the treatment of arterial hypertension. The indications for drug therapy arise from three criteria including the level of hypertension, risk profile of the patient, as well as response to non-pharmacological therapy. For the first choice monotherapy five substance groups are available: diuretics, beta blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin (AT) 1 receptor antagonists and calcium antagonists. By combination therapy, the responder rate can be significantly increased with respect to a normalization of blood pressure. A true treatment resistance, in which the therapeutic goal is not reached in spite of a triple combination with maximum dosage, is extremely rare. Further treatment options are combinations of four drug classes and changes of medication. Hypertensive emergencies require a rapid intervention; nevertheless, the magnitude of blood pressure lowering can greatly vary depending on the individual clinical picture.

  16. The VITRO Score (Von Willebrand Factor Antigen/Thrombocyte Ratio as a New Marker for Clinically Significant Portal Hypertension in Comparison to Other Non-Invasive Parameters of Fibrosis Including ELF Test.

    Directory of Open Access Journals (Sweden)

    Stephanie Hametner

    Full Text Available Clinically significant portal hypertension (CSPH, defined as hepatic venous pressure gradient (HVPG ≥10 mmHg, causes major complications. HVPG is not always available, so a non-invasive tool to diagnose CSPH would be useful. VWF-Ag can be used to diagnose. Using the VITRO score (the VWF-Ag/platelet ratio instead of VWF-Ag itself improves the diagnostic accuracy of detecting cirrhosis/ fibrosis in HCV patients.This study tested the diagnostic accuracy of VITRO score detecting CSPH compared to HVPG measurement.All patients underwent HVPG testing and were categorised as CSPH or no CSPH. The following patient data were determined: CPS, D'Amico stage, VITRO score, APRI and transient elastography (TE.The analysis included 236 patients; 170 (72% were male, and the median age was 57.9 (35.2-76.3; 95% CI. Disease aetiology included ALD (39.4%, HCV (23.4%, NASH (12.3%, other (8.1% and unknown (11.9%. The CPS showed 140 patients (59.3% with CPS A; 56 (23.7% with CPS B; and 18 (7.6% with CPS C. 136 patients (57.6% had compensated and 100 (42.4% had decompensated cirrhosis; 83.9% had HVPG ≥10 mmHg. The VWF-Ag and the VITRO score increased significantly with worsening HVPG categories (P<0.0001. ROC analysis was performed for the detection of CSPH and showed AUC values of 0.92 for TE, 0.86 for VITRO score, 0.79 for VWF-Ag, 0.68 for ELF and 0.62 for APRI.The VITRO score is an easy way to diagnose CSPH independently of CPS in routine clinical work and may improve the management of patients with cirrhosis.

  17. Risk factors and incidence of contrast induced nephropathy following coronary intervention

    Directory of Open Access Journals (Sweden)

    Yoga Yuniadi

    2008-06-01

    Full Text Available Contrast induced nephropathy (CIN is one of important complication of contrast media administration. Its incidence and risk factors among Indonesian patients undergoing coronary intervention has not been reported yet. CIN was defined as increasing of serum creatinine by 0.5 mg/dl or more in the third day following contrast media exposure. Of 312 patients undergoing coronary intervention, 25% developed CIN. Patient-related risk factors comprised of hypertension, diabetes mellitus, NYHA class, proteinuria, serum creatinine > 1.5 mg/dl and ejection fraction ≤ 35%. Contrast-related risk factors comprised of contrast media volume > 300 ml, contrast media type. However, our final model demonstrated that only hypertension [Hazard ratio (HR = 2.89, 95% confidence intrval (CI = 1.78 to 4.71, P = 0.000], diabetes mellitus (HR = 3.09, 95% CI = 1.89 to 5.06, P = 0.000, ejection fraction (EF ≤ 35% (HR = 2.92; 95% CI = 1.72 to 4.96; P = 0.000, total contrast volume > 300 ml (HR = 7.73; 95% CI = 3.09 to 19.37; P = 0.000 and proteinuria (HR = 14.96; 95% CI = 3.45 to 64.86; P = 0.000 were independent risk factors of CIN. In conclusion, CIN developed in 25% of patients undergoing coronary intervention. The independent risk factors of CIN included hypertension, diabetes mellitus, EF ≤ 35%, contrast volume > 300 ml and proteinuria. (Med J Indones 2008; 17: 131-7Keywords: contrast induced nephropathy, coronary intervention

  18. Model of the coronary circulation based on pressure dependence of coronary resistance and compliance

    NARCIS (Netherlands)

    Bruinsma, P.; Arts, T.; Dankelman, J.; Spaan, J. A.

    1988-01-01

    The effect of pressure-dependent changes in vascular volume, resistance and capacitance in the coronary micro-circulation, has been studied by a distributed mathematical model of the coronary micro-vasculature in the left ventricular wall. The model does not include regulation of coronary blood flow

  19. A 53 Years Old Woman with Hypertension Grade I and Diabetes Mellitus Type 2

    OpenAIRE

    BR, Medikanto

    2014-01-01

    Hypertension is one of the diseases that result in high morbidity. Hypertension would give symptoms that may cause a target organ's failure such as the brain (stroke), heart blood vessels (coronary heart disease),and heart muscle (left ventricular hypertrophy). Miss (E), female, 53 years old, with hypertension and diabetes mellitus. Searched causes hypertension and diabetes mellitus and their affected family members. Analysis of causes, such as underlying disease or other risk factors that ca...

  20. Perioperative hypertension

    Directory of Open Access Journals (Sweden)

    G. Pinna

    2013-05-01

    Full Text Available BACKGROUND Perioperative hypertension is a situation whose management is suggested by the clinical judgement much more than clinical evidences. JNC 7 guidelines give a classification of blood pressure (BP, without any mention specifically dedicated to patients undergoing surgery. The ACC/AHA guidelines recommend deferring surgery if diastolic BP is above 110 mmHg and systolic BP is above 180 mmHg. AIM OF THE STUDY In this review we considered pathogenetic, clinical and therapeutic factors related to perioperative management of hypertensive patients. DISCUSSION In actual trend of the preoperative evaluation, alone hypertension is considered as a minor risk factor. BP values ≤ 180/110 mmHg do not influence the outcomes in patients who underwent noncardiac surgery. Therefore, in these conditions it’s not necessary to delay surgery. Hypertensive picks are possible during the operation, mostly because of the intubation, but, much more dangerous, falls of pressure are possible. The intraoperative arterial pressure should be maintained within 20% of the best estimated preoperative arterial pressure, especially in patients with markedly elevated preoperative pressures. After surgery the arterial BP can increase for stress factors, pain, hypoxia and hypercapnia, hypothermia and infusional liquids overload. For all these reasons a careful monitoring is mandatory. Anti-hypertensive medication should be continued during the postoperative period in patients with known and treated hypertension, as unplanned withdrawal of treatment can result in rebounded hypertension. The decision to give anti-hypertensive drugs must be made for each patient, taking into account their normal BP and their postoperative BP. With regard to the optimal treatment of the patient with poorly or uncontrolled hypertension in the perioperative evaluation, recent guidelines suggest that the best treatment may consider cardioselective β-blockers therapy, but also clonidin by

  1. Coronary Computed Tomography Angiography (CTA)

    Science.gov (United States)

    ... coronary artery disease, including patients who have chest pain and normal, non-diagnostic or unclear lab and ECG results. low to intermediate risk atypical chest pain in the emergency department. non-acute chest pain. ...

  2. The relationship between metabolic syndrome and target organ damage in Ghanaian with stage-2 hypertension.

    Science.gov (United States)

    Bello-Rodriguez, B M; Sanchez-Cruz, G; Delgado-Bustillo, F; Asiama, G

    2013-12-01

    To determine the frequency of Metabolic syndrome (MetS) in stage-2 hypertension and to assess the influence of MetS components over target organ damage (TOD) in Ghanaian patients. Forty adult patients with stage-2 hypertension were enrolled in a cross-sectional study developed at the Police Hospital, Accra, between 1st February 2009 and 31st January 2010. Diagnosis of MetS was based on The National Cholesterol Education Program in Adult Treatment Panel Revised in 2005 criteria. The alterations on the heart, aortic and carotid arteries, retina, and kidneys were evaluated through the clinical examination including retinal funduscopy, chest X-Ray, ECG, and serum creatinine quantification. The Brain CT-scan was performed on the patients with clinical cerebrovascular disease manifestations. MetS was diagnosed in 25 cases (62.5%); female sex revealed significant association with MetS (OR, 4.88; 95% CI, 1.19-19.94; P=0.027). Ninety-five percent of patients had TOD. Coronary disease was associated with MetS (OR, 4.43; 95% CI, 1.026-19,27; P=0.047) and diabetes mellitus as single MetS component (OR, 14.00; 95% CI, 1.56-125.61; P=0.018). A positive significant correlation was shown of age with cerebrovascular disease (r=0.381; P=0.015) and coronary disease (r=0.623; P=0.000). Non-significant correlation or association (P>0.05) was shown between number of MetS components and number of TOD. In stage-2 hypertension patients a high frequency of MetS with a risk increase in female sex was observed. This stage hypertension is for itself an individual risk to develop cardiovascular disease with high frequency none related with MetS, although coronary disease risk was increased in diabetic patients.

  3. Hipertensão pulmonar secundária à fístulas coronarianas para tronco da pulmonar Pulmonary hypertension secondary to coronary-to-pulmonary artery fistula

    Directory of Open Access Journals (Sweden)

    José Ramos Filho

    2008-08-01

    Full Text Available A fístula coronariana é uma anomalia caracterizada por comunicação entre uma artéria coronária e uma câmara cardíaca, artéria pulmonar, seio coronariano e veias pulmonares. Representa 0,2% a 0,4 % das cardiopatias congênitas e 0,1% a 0,2% da população adulta submetida a angiografia coronariana. Relatamos o caso clínico de uma paciente com 64 anos, cuja anomalia foi diagnosticada durante investigação clínica por desconforto torácico, dispnéia e síncope, sendo indicada correção cirúrgica com abertura da artéria pulmonar através de circulação extracorpórea.The coronary fistula is an anomaly characterized by the communication between a coronary artery and a cardiac chamber, pulmonary artery, coronary sinus and pulmonary veins. It represents 0.2 to 0.4% of the congenital cardiopathies and 0.1% to 0.2% of the adult population submitted to coronary angiography. We report the clinical case of a 64-year-old female patient, whose anomaly was diagnosed during a clinical investigation due to chest discomfort, dyspnea and syncope; the surgical correction was indicated, with opening of the pulmonary artery through extracorporeal circulation.

  4. Blood Transfusion and the Risk of Acute Kidney Injury Among Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention.

    Science.gov (United States)

    Karrowni, Wassef; Vora, Amit Navin; Dai, David; Wojdyla, Daniel; Dakik, Habib; Rao, Sunil V

    2016-09-01

    Acute kidney injury (AKI) complicating percutaneous coronary intervention (PCI) is associated with adverse clinical outcomes. To date, no studies have evaluated the association of blood transfusion with AKI in patients undergoing PCI. We used a retrospective cohort study of all patients with acute coronary syndrome undergoing PCI from CathPCI Registry (n=1 756 864). The primary outcome was AKI defined as the rise in serum creatinine post procedure ≥0.5 mg/dL or ≥25% above baseline values. AKI developed in 9.0% of study sample. Patients with AKI were older, more often women, and had high prevalence of comorbidities, including diabetes mellitus, hypertension, and advanced stages of chronic kidney disease at baseline. Blood transfusion was utilized in 2.2% of patients. In the overall sample, AKI developed in 35.1% of patients who received transfusion versus 8.4% of patients without transfusion (adjusted odds ratio, 4.87 [4.71-5.04]). In the subgroup of patients who sustained bleeding event and received transfusion, the rate of AKI was significantly increased across all preprocedure hemoglobin levels versus no blood transfusion. Similar findings were seen in the subgroup of patients with no bleeding event. Blood transfusion is strongly associated with AKI in patients with acute coronary syndrome undergoing PCI. Further investigation is needed to determine whether a restrictive blood transfusion strategy might improve PCI outcomes by reducing the risk of AKI. © 2016 American Heart Association, Inc.

  5. Evaluation and management of pediatric hypertensive crises: hypertensive urgency and hypertensive emergencies

    Science.gov (United States)

    Patel, Nirali H; Romero, Sarah K; Kaelber, David C

    2012-01-01

    Hypertension (HTN) in the pediatric population is estimated to have a world-wide prevalence of 2%–5%. As with adults, pediatric patients with HTN can present with hypertensive crises include hypertensive urgency and hypertensive emergencies. However, pediatric blood pressure problems have a greater chance of being from secondary causes of HTN, as opposed to primary HTN, than in adults. Thorough evaluation of a child with a hypertensive emergency includes accurate blood pressure readings, complete and focused symptom history, and appropriate past medical, surgical, and family history. Physical exam should include height, weight, four-limb blood pressures, a general overall examination and especially detailed cardiovascular and neurological examinations, including fundoscopic examination. Initial work-up should typically include electrocardiography, chest X-ray, serum chemistries, complete blood count, and urinalysis. Initial management of hypertensive emergencies generally includes the use of intravenous or oral antihypertensive medications, as well as appropriate, typically outpatient, follow-up. Emergency department goals for hypertensive crises are to (1) safely lower blood pressure, and (2) treat/minimize acute end organ damage, while (3) identifying underlying etiology. Intravenous antihypertensive medications are the treatment modality of choice for hypertensive emergencies with the goal of reducing systolic blood pressure by 25% of the original value over an 8-hour period. PMID:27147865

  6. Hypertension and renovascular disease

    DEFF Research Database (Denmark)

    Hasbak, P; Ibsen, H; Jensen, Lars Thorbjørn

    2002-01-01

    The clinical value of renal vein renin sampling (RVRS) as a prognostic tool in the treatment of renovascular hypertension was evaluated. One hundred consecutive patients were included over a 4-year period of time. About half of the patients (49%) were treated interventionally by PTRA (21%), nephr......The clinical value of renal vein renin sampling (RVRS) as a prognostic tool in the treatment of renovascular hypertension was evaluated. One hundred consecutive patients were included over a 4-year period of time. About half of the patients (49%) were treated interventionally by PTRA (21...

  7. Dutch guideline for the management of hypertensive crisis -- 2010 revision.

    Science.gov (United States)

    van den Born, B J H; Beutler, J J; Gaillard, C A J M; de Gooijer, A; van den Meiracker, A H; Kroon, A A

    2011-05-01

    Hypertensive crises are divided into hypertensive urgencies and emergencies. Together they form a heterogeneous group of acute hypertensive disorders depending on the presence or type of target organs involved. Despite better treatment options for hypertension, hypertensive crisis and its associated complications remain relatively common. In the Netherlands the number of patients starting renal replacement therapy because of 'malignant hypertension' has increased in the past two decades. In 2003, the first Dutch guideline on hypertensive crisis was released to allow a standardised evidence-based approach for patients presenting with a hypertensive crisis. In this paper we give an overview of the current management of hypertensive crisis and discuss several important changes incorporated in the 2010 revision. These changes include a modification in terminology replacing 'malignant hypertension' with 'hypertensive crisis with retinopathy and reclassification of hypertensive crisis with retinopathy under hypertensive emergencies instead of urgencies. With regard to the treatment of hypertensive emergencies, nicardipine instead of nitroprusside or labetalol is favoured for the management of perioperative hypertension, whereas labetalol has become the drug of choice for the treatment of hypertension associated with pre-eclampsia. For the treatment of hypertensive urgencies, oral administration of nifedipine retard instead of captopril is recommended as first-line therapy. In addition, a section on the management of hypertensive emergencies according to the type of target organ involved has been added. Efforts to increase the awareness and treatment of hypertension in the population at large may lower the incidence of hypertensive crisis and its complications.

  8. Treatment-Resistant Hypertension and Outcomes Based on Randomized Treatment Group in ALLHAT.

    Science.gov (United States)

    Bangalore, Sripal; Davis, Barry R; Cushman, William C; Pressel, Sara L; Muntner, Paul M; Calhoun, David A; Kostis, John B; Whelton, Paul K; Probstfield, Jeffrey L; Rahman, Mahboob; Black, Henry R

    2017-04-01

    Although hypertension guidelines define treatment-resistant hypertension as blood pressure uncontrolled by ≥3 antihypertensive medications, including a diuretic, it is unknown whether patient prognosis differs when a diuretic is included. Participants in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) were randomly assigned to first-step therapy with chlorthalidone, amlodipine, or lisinopril. At a Year 2 follow-up visit, those with average blood pressure ≥140 mm Hg systolic or ≥90 mm Hg diastolic on ≥3 antihypertensive medications, or blood pressure heart disease or nonfatal myocardial infarction) and secondary (all-cause mortality, stroke, heart failure, combined coronary heart disease, and combined cardiovascular disease) outcomes were identified for each treatment group. Of participants assigned to chlorthalidone, amlodipine, or lisinopril, 9.6%, 11.4%, and 19.7%, respectively, had treatment-resistant hypertension. During mean follow-up of 2.9 years, primary outcome incidence was similar for those assigned to chlorthalidone compared with amlodipine or lisinopril (amlodipine- vs chlorthalidone-adjusted hazard ratio [HR] 0.86; 95% confidence interval [CI], 0.53-1.39; P = .53; lisinopril- vs chlorthalidone-adjusted HR = 1.06; 95% CI, 0.70-1.60; P = .78). Secondary outcome risks were similar for most comparisons except coronary revascularization, which was higher with amlodipine than with chlorthalidone (HR 1.86; 95% CI, 1.11-3.11; P = .02). An as-treated analysis based on diuretic use produced similar results. In this study, which titrated medications to a goal, participants assigned to chlorthalidone were less likely to develop treatment-resistant hypertension. However, prognoses in those with treatment-resistant hypertension were similar across treatment groups. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. ADVANCIS Score Predicts Acute Kidney Injury After Percutaneous Coronary Intervention for Acute Coronary Syndrome.

    Science.gov (United States)

    Fan, Pei-Chun; Chen, Tien-Hsing; Lee, Cheng-Chia; Tsai, Tsung-Yu; Chen, Yung-Chang; Chang, Chih-Hsiang

    2018-01-01

    Acute kidney injury (AKI), a common and crucial complication of acute coronary syndrome (ACS) after receiving percutaneous coronary intervention (PCI), is associated with increased mortality and adverse outcomes. This study aimed to develop and validate a risk prediction model for incident AKI after PCI for ACS. We included 82,186 patients admitted for ACS and receiving PCI between 1997 and 2011 from the Taiwan National Health Insurance Research Database and randomly divided them into a training cohort (n = 57,630) and validation cohort (n = 24,656) for risk model development and validation, respectively. Risk factor analysis revealed that age, diabetes mellitus, ventilator use, prior AKI, number of intervened vessels, chronic kidney disease (CKD), intra-aortic balloon pump (IABP) use, cardiogenic shock, female sex, prior stroke, peripheral arterial disease, hypertension, and heart failure were significant risk factors for incident AKI after PCI for ACS. The reduced model, ADVANCIS, comprised 8 clinical parameters (age, diabetes mellitus, ventilator use, prior AKI, number of intervened vessels, CKD, IABP use, cardiogenic shock), with a score scale ranging from 0 to 22, and performed comparably with the full model (area under the receiver operating characteristic curve, 87.4% vs 87.9%). An ADVANCIS score of ≥6 was associated with higher in-hospital mortality risk. In conclusion, the ADVANCIS score is a novel, simple, robust tool for predicting the risk of incident AKI after PCI for ACS, and it can aid in risk stratification to monitor patient care.

  10. Knowing hypertension and diabetes

    DEFF Research Database (Denmark)

    Whyte, Susan Reynolds

    2016-01-01

    In Uganda, hypertension and diabetes have only recently been included in the health policy agenda. As they become treatable disorders, they take on more distinct contours in people's minds. This article relates knowledge about these two conditions to health institutions and technology for diagnos......In Uganda, hypertension and diabetes have only recently been included in the health policy agenda. As they become treatable disorders, they take on more distinct contours in people's minds. This article relates knowledge about these two conditions to health institutions and technology...... for diagnosing and treating them. The response to the AIDS epidemic in Uganda provides an important context for, and contrast with, the emergence of hypertension and diabetes as social phenomena. Ethnographic fieldwork shows the interplay between experience of these conditions and the political economy...

  11. Peripheral Reactive Hyperemia Index and Coronary Microvascular Function in Women With no Obstructive CAD

    DEFF Research Database (Denmark)

    Michelsen, Marie Mide; Mygind, Naja Dam; Pena, Adam

    2016-01-01

    and the endothelial-independent aspect of CMD assessed as a coronary flow velocity reserve (CFVR). METHODS: We included 339 women with chest pain suggestive of angina pectoris and a diagnostic invasive coronary angiogram without significant coronary artery stenosis (

  12. Vascular inflammatory cells in hypertension

    Directory of Open Access Journals (Sweden)

    David G. Harrison

    2012-05-01

    Full Text Available Hypertension is a common disorder with uncertain etiology. In the last several years, it has become evident that components of both the innate and adaptive immune system play an essential role in hypertension. Macrophages and T cells accumulate in the perivascular fat, the heart and the kidney of hypertensive patients and in animals with experimental hypertension. Various immunosuppressive agents lower blood pressure and prevent end-organ damage. Mice lacking lymphocytes are protected against hypertension, and adoptive transfer of T cells, but not B cells in the animals restores their blood pressure response to stimuli such as angiotensin II or high salt. Recent studies have shown that mice lacking macrophages have blunted hypertension in response to angiotensin II and that genetic deletion of macrophages markedly reduces experimental hypertension. Dendritic cells have also been implicated in this disease. Many hypertensive stimuli have triggering effects on the central nervous system and signals arising from the circumventricular organ seem to promote inflammation. Studies have suggested that central signals activate macrophages and T cells, which home to the kidney and vasculature and release cytokines, including IL-6 and IL-17, which in turn cause renal and vascular dysfunction and lead to blood pressure elevation. These recent discoveries provide a new understanding of hypertension and provide novel therapeutic opportunities for treatment of this serious disease.

  13. ACE (I/D polymorphism and response to treatment in coronary artery disease: a comprehensive database and meta-analysis involving study quality evaluation

    Directory of Open Access Journals (Sweden)

    Kitsios Georgios

    2009-06-01

    Full Text Available Abstract Background The role of angiotensin-converting enzyme (ACE gene insertion/deletion (I/D polymorphism in modifying the response to treatment modalities in coronary artery disease is controversial. Methods PubMed was searched and a database of 58 studies with detailed information regarding ACE I/D polymorphism and response to treatment in coronary artery disease was created. Eligible studies were synthesized using meta-analysis methods, including cumulative meta-analysis. Heterogeneity and study quality issues were explored. Results Forty studies involved invasive treatments (coronary angioplasty or coronary artery by-pass grafting and 18 used conservative treatment options (including anti-hypertensive drugs, lipid lowering therapy and cardiac rehabilitation procedures. Clinical outcomes were investigated by 11 studies, while 47 studies focused on surrogate endpoints. The most studied outcome was the restenosis following coronary angioplasty (34 studies. Heterogeneity among studies (p ACE I/D polymorphism on the response to treatment for the rest outcomes (coronary events, endothelial dysfunction, left ventricular remodeling, progression/regression of atherosclerosis, individual studies showed significance; however, results were discrepant and inconsistent. Conclusion In view of available evidence, genetic testing of ACE I/D polymorphism prior to clinical decision making is not currently justified. The relation between ACE genetic variation and response to treatment in CAD remains an unresolved issue. The results of long-term and properly designed prospective studies hold the promise for pharmacogenetically tailored therapy in CAD.

  14. Extent of Coronary Stenosis and Anxiety Symptoms among Patients Undergoing Coronary Angiography.

    Science.gov (United States)

    Assari, Shervin; Zandi, Hassan; Ahmadi, Khodabakhsh; Kazemi Saleh, Davoud

    2017-10-01

    Background: The association between coronary angiographic findings and the level of anxiety symptoms among patients who undergo coronary angiography is not known. The aim of this study was to investigate the association between the extent of coronary stenosis and anxiety symptoms in patients who undergo coronary angiography. Methods: In a cross-sectional study, 106 patients who underwent coronary angiography and had varying degrees of coronary artery disease were enrolled. Demographic characteristics (i.e., age and gender), socioeconomic status (i.e., educational attainment, income, and marital status), and traditional risk factors (i.e., hypertension, diabetes mellitus, hyperlipidemia, and smoking) were measured. The independent variable was the extent of coronary stenosis shown by coronary angiography, coded as single-vessel disease (n = 19), 2-vessel disease (n = 28), or 3-vessel disease (n = 59). The main outcome was symptoms of anxiety measured using the Hospital Anxiety Depression Scale (HADS). The Kruskal-Wallis test was used for bivariate analysis, and linear regression was applied for multivariable analysis. Results: Participants were mostly men (n = 78, 73%), at a mean age of 50.14 ± 10.60 years. We found an inverse association between the extent of coronary stenosis and anxiety symptoms in our samples. Anxiety symptoms were lowest in the patients with 3-vessel disease and highest in those with single-vessel disease. The above association remained significant in a linear regression model, controlled for the demographic, socioeconomic, and traditional risk factors. Conclusion: An inverse association may exist between the extent of coronary stenosis and the severity of anxiety symptoms in patients who undergo coronary angiography. Patients who undergo angiography and have fewer angiographic findings require screening for anxiety symptoms.

  15. Extent of Coronary Stenosis and Anxiety Symptoms among Patients Undergoing Coronary Angiography

    Science.gov (United States)

    Assari, Shervin; Zandi, Hassan; Ahmadi, Khodabakhsh; Kazemi Saleh, Davoud

    2017-01-01

    Background: The association between coronary angiographic findings and the level of anxiety symptoms among patients who undergo coronary angiography is not known. The aim of this study was to investigate the association between the extent of coronary stenosis and anxiety symptoms in patients who undergo coronary angiography. Methods: In a cross-sectional study, 106 patients who underwent coronary angiography and had varying degrees of coronary artery disease were enrolled. Demographic characteristics (i.e., age and gender), socioeconomic status (i.e., educational attainment, income, and marital status), and traditional risk factors (i.e., hypertension, diabetes mellitus, hyperlipidemia, and smoking) were measured. The independent variable was the extent of coronary stenosis shown by coronary angiography, coded as single-vessel disease (n = 19), 2-vessel disease (n = 28), or 3-vessel disease (n = 59). The main outcome was symptoms of anxiety measured using the Hospital Anxiety Depression Scale (HADS). The Kruskal–Wallis test was used for bivariate analysis, and linear regression was applied for multivariable analysis. Results: Participants were mostly men (n = 78, 73%), at a mean age of 50.14 ± 10.60 years. We found an inverse association between the extent of coronary stenosis and anxiety symptoms in our samples. Anxiety symptoms were lowest in the patients with 3-vessel disease and highest in those with single-vessel disease. The above association remained significant in a linear regression model, controlled for the demographic, socioeconomic, and traditional risk factors. Conclusion: An inverse association may exist between the extent of coronary stenosis and the severity of anxiety symptoms in patients who undergo coronary angiography. Patients who undergo angiography and have fewer angiographic findings require screening for anxiety symptoms. PMID:29576782

  16. 36. Clinical profile of coronary slow flow phenomena – A cardiac Y syndrome

    Directory of Open Access Journals (Sweden)

    Toufiqur Rahman

    2015-10-01

    Conclusion: CSFP was prevalent in wide spectrum if Ischemic Heart Disease presenting as CSA and Acute Coronary Syndrome. Most of the patients presented with CSFP were smokers and had uncontrolled Hypertension.

  17. Prevalence of optimal treatment regimens in patients with apparent treatment-resistant hypertension based on office blood pressure in a community-based practice network.

    Science.gov (United States)

    Egan, Brent M; Zhao, Yumin; Li, Jiexiang; Brzezinski, W Adam; Todoran, Thomas M; Brook, Robert D; Calhoun, David A

    2013-10-01

    Hypertensive patients with clinical blood pressure (BP) uncontrolled on ≥3 antihypertensive medications (ie, apparent treatment-resistant hypertension [aTRH]) comprise ≈28% to 30% of all uncontrolled patients in the United States. However, the proportion receiving these medications in optimal doses is unknown; aTRH is used because treatment adherence and measurement artifacts were not available in electronic record data from our >200 community-based clinics Outpatient Quality Improvement Network. This study sought to define the proportion of uncontrolled hypertensives with aTRH on optimal regimens and clinical factors associated with optimal therapy. During 2007-2010, 468 877 hypertensive patients met inclusion criteria. BP hypertension doses). Among 468 877 hypertensives, 147 635 (31.5%) were uncontrolled; among uncontrolled hypertensives, 44 684 were prescribed ≥3 BP medications (30.3%), of whom 22 189 (15.0%) were prescribed optimal therapy. Clinical factors independently associated with optimal BP therapy included black race (odds ratio, 1.40 [95% confidence interval, 1.32-1.49]), chronic kidney disease (1.31 [1.25-1.38]), diabetes mellitus (1.30 [1.24-1.37]), and coronary heart disease risk equivalent status (1.29 [1.14-1.46]). Clinicians more often prescribe optimal therapy for aTRH when cardiovascular risk is greater and treatment goals lower. Approximately 1 in 7 of all uncontrolled hypertensives and 1 in 2 with uncontrolled aTRH are prescribed ≥3 BP medications in optimal regimens. Prescribing more optimal pharmacotherapy for uncontrolled hypertensives including aTRH, confirmed with out-of-office BP, could improve hypertension control.

  18. Portal Hypertension

    Science.gov (United States)

    ... of Liver Disease .) Portal hypertension is abnormally high blood pressure in the portal vein (the large vein that brings blood from the ... imaging (MRI), or liver biopsy. Drugs can reduce blood pressure in the portal vein, but if bleeding in the digestive tract occurs, ...

  19. Idiopathic intracranial hypertension

    DEFF Research Database (Denmark)

    Yri, Hanne M; Jensen, Rigmor H

    2015-01-01

    AIMS: The aims of this article are to characterize the headache in idiopathic intracranial hypertension (IIH) and to field-test the ICHD diagnostic criteria for headache attributed to IIH. MATERIALS AND METHODS: We included 44 patients with new-onset IIH. Thirty-four patients with suspected but u...... tinnitus may suggest intracranial hypertension. Based on data from a well-defined IIH cohort, we propose a revision of the ICDH-3 beta diagnostic criteria with improved clinical applicability and increased sensitivity and specificity....

  20. Coronary artery calcium score using electron beam tomography in the patients with acute obstructive coronary arterial disease : comparative study within asymptomatic high-risk group of atherosclerosis and chronic obstructive coronary arterial disease group

    International Nuclear Information System (INIS)

    Ryu, Seok Jong; Choi, Byoung Wook; Choe, Kyu Ok

    2001-01-01

    To compare, through analysis of the coronary artery calcium (CAC) score and the risk factors for atherosclerosis, the characteristics of acute coronary syndrome between an asymptomatic high-risk group of atherosclerosis patients and a chronic coronary arterial obstructive disease(CAOD) group. The CAC scores of an asymptomatic high-risk group of atherosclerosis patients (group I, n=284), a chronic CAOD croup (group II, n=39) and an acute coronary syndrome group (group III, n=21) were measured by electron beam tomography. Forty-seven patients with CAOD from groups II and III underwent coronary angiography, and we scrutinized age, sex and risk factors including diabetes mellitus, hypertension, obesity, smoking, hypercholesterolemia and low high-density lipoproteinemia. The numbers of stenotic coronary arterial branches and degree of stenosis revealed by coronary angiography were also recorded. We determined the differences between the three groups in terms of CAC score and the risk factors, the relationship between CAC score and risk factors, and the characteristic features of each type of CAOD group. The mean CA score of group III (135.1) was not statistically different from that of group I (135.7) or group II (365.8). Among patients aged below 50, the mean CAC score of group III (127.4) was significantly higher than that of group I (6.2), (p=0.0006). The mean CAC score at the sixth decade was also significantly different between group I(81.5) and group II (266.9). The mean age of group III (54.2 years) was significantly lower than that of group I (58.1 years) (p=0.047) and of group II (60.1) (p=0.022). There was significant correlation between the number of stenotic coronary arterial branches and log(CAC +1) (p<.01). The square root of the CAC score and the maximal degree of stenosis was also well correlated (p<.01). There was no difference in the mean number of risk factors among the three groups, though the incidence of smoking in group III was significantly

  1. Coronary artery calcium score using electron beam tomography in the patients with acute obstructive coronary arterial disease : comparative study within asymptomatic high-risk group of atherosclerosis and chronic obstructive coronary arterial disease group

    Energy Technology Data Exchange (ETDEWEB)

    Ryu, Seok Jong; Choi, Byoung Wook; Choe, Kyu Ok [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

    2001-04-01

    To compare, through analysis of the coronary artery calcium (CAC) score and the risk factors for atherosclerosis, the characteristics of acute coronary syndrome between an asymptomatic high-risk group of atherosclerosis patients and a chronic coronary arterial obstructive disease(CAOD) group. The CAC scores of an asymptomatic high-risk group of atherosclerosis patients (group I, n=284), a chronic CAOD croup (group II, n=39) and an acute coronary syndrome group (group III, n=21) were measured by electron beam tomography. Forty-seven patients with CAOD from groups II and III underwent coronary angiography, and we scrutinized age, sex and risk factors including diabetes mellitus, hypertension, obesity, smoking, hypercholesterolemia and low high-density lipoproteinemia. The numbers of stenotic coronary arterial branches and degree of stenosis revealed by coronary angiography were also recorded. We determined the differences between the three groups in terms of CAC score and the risk factors, the relationship between CAC score and risk factors, and the characteristic features of each type of CAOD group. The mean CA score of group III (135.1) was not statistically different from that of group I (135.7) or group II (365.8). Among patients aged below 50, the mean CAC score of group III (127.4) was significantly higher than that of group I (6.2), (p=0.0006). The mean CAC score at the sixth decade was also significantly different between group I(81.5) and group II (266.9). The mean age of group III (54.2 years) was significantly lower than that of group I (58.1 years) (p=0.047) and of group II (60.1) (p=0.022). There was significant correlation between the number of stenotic coronary arterial branches and log(CAC +1) (p<.01). The square root of the CAC score and the maximal degree of stenosis was also well correlated (p<.01). There was no difference in the mean number of risk factors among the three groups, though the incidence of smoking in group III was significantly

  2. Interesting images: Multiple coronary artery aneurysms.

    Science.gov (United States)

    Howard, Jonathon M; Viswanath, Omar; Armas, Alfredo; Santana, Orlando; Rosen, Gerald P

    2017-01-01

    We present the case of a 65-year-old male who presented with stable angina and dyspnea on exertion. His initial workup yielded a positive treadmill stress test for reversible apical ischemia, and transthoracic echocardiogram demonstrated impaired systolic function. Cardiac catheterization was then performed, revealing severe atherosclerotic disease including multiple coronary artery aneurysms. As a result, the patient was advised to and subsequently underwent a coronary artery bypass graft. This case highlights the presence of multiple coronary artery aneurysms and the ability to appreciate these pathologic findings on multiple imaging modalities, including coronary angiogram, transesophageal echocardiography, and direct visualization through the surgical field.

  3. Depression following acute coronary syndrome

    DEFF Research Database (Denmark)

    Joergensen, Terese Sara Hoej; Maartensson, Solvej; Ibfelt, Else Helene

    2016-01-01

    .8 % developed a recurrent depression. Most patient characteristics (demographic factors, socioeconomic status, psychosocial factors, health-related behavioural factors, somatic comorbidities, and severity of acute coronary syndrome) were significantly associated with increased HRs for both early and later......PURPOSE: Depression is common following acute coronary syndrome, and thus, it is important to provide knowledge to improve prevention and detection of depression in this patient group. The objectives of this study were to examine: (1) whether indicators of stressors and coping resources were risk...... factors for developing depression early and later after an acute coronary syndrome and (2) whether prior depression modified these associations. METHODS: The study was a register-based cohort study, which includes 87,118 patients with a first time diagnosis of acute coronary syndrome during the period...

  4. [Progression of gestational hypertension to chronic hypertension].

    Science.gov (United States)

    Romero Gutiérrez, Gustavo; Muro Barragán, Sergio Alejandro; Ponce de León, Ana Lilia Ponce

    2009-09-01

    The gestational hypertension is the most frequent cause of hypertension during the pregnancy. The gestational hypertension is a provisional diagnosis only during the pregnancy; it is unknown the number of women with gestational hypertension who progress to chronic hypertension. To determine the number of women with gestational hypertension who progress to chronic hypertension. A cohort prospective study was carried out; we includedl96 patients with the diagnosis of gestational hypertension at the time of the interruption of the pregnancy; after 12 weeks, a follow up appointment was scheduled in order to measure the blood pressure and to determine how many patients progressed to chronic hypertension. The data were analyzed with arithmetic mean, standard error and percentage values. For the comparison of variables, the Chi2 test and a logistic regression analysis were used; an alpha value was set at 0.05. Thirteen patients (6.6%) with diagnosis of gestational hypertension progressed to chronic hypertension. It was found that advanced age (p = 0.007), high body mass index (p = 0.013) and the antecedent of hypertensive disease in a previous pregnancy (p = 0.048) were significantly associated with the progression to chronic hypertension. The overweight, advanced maternal age and the antecedent of hypertensive disorder in a previous pregnancy are the variables associated with the progression from gestational hypertension to chronic hypertension.

  5. The immunology of hypertension.

    Science.gov (United States)

    Norlander, Allison E; Madhur, Meena S; Harrison, David G

    2018-01-02

    Although systemic hypertension affects a large proportion of the population, its etiology remains poorly defined. Emerging evidence supports the concept that immune cells become activated and enter target organs, including the vasculature and the kidney, in this disease. Mediators released by these cells, including reactive oxygen species, metalloproteinases, cytokines, and antibodies promote dysfunction of the target organs and cause damage. In vessels, these factors enhance constriction, remodeling, and rarefaction. In the kidney, these mediators increase expression and activation of sodium transporters, and cause interstitial fibrosis and glomerular injury. Factors common to hypertension, including oxidative stress, increased interstitial sodium, cytokine production, and inflammasome activation promote immune activation in hypertension. Recent data suggest that isolevuglandin-modified self-proteins in antigen-presenting cells are immunogenic, promoting cytokine production by the cells in which they are formed and T cell activation. Efforts to prevent and reverse immune activation may prove beneficial in preventing the long-term sequelae of hypertension and its related cardiovascular diseases. © 2018 Norlander et al.

  6. Control of drug treatment of chronic coronary artery disease: possibilities of a regional registry

    Directory of Open Access Journals (Sweden)

    Rachkova S.A.

    2016-03-01

    Full Text Available The article describes the results of the Register of hypertension, coronary artery disease, chronic heart failure (Register of AH, CAD, HF in the Ivanovo region in 2015. The frequency of prescribing of the main groups of drugs in patients with coronary artery disease was estimated.

  7. ESSENTIAL ARTERIAL HYPERTENSION AND RISK FACTORS ASSOCIATED WITH HYPERTENSIVE NEPHROPATHY

    Directory of Open Access Journals (Sweden)

    Boban Milojković

    2014-12-01

    Full Text Available Arterial hypertension is a major risk factor that predisposes to cardiovascular disorders and is responsible for most of the morbidity and mortality in patients. Hypertension is closely associated with the kidney, because kidney disease can be both the cause and consequence of increased blood pressure. Elevation of blood pressure is a strong independent risk factor for hypertensive nephropathy and development of ESRD. The pathogenesis of ischemic hypertensive nephropathy (IHN is multifactoral, and in addition to blood pressure other factors contribute to the development of this renal pathology and its progression to end-stage renal disease. These include obesity, smoking, male gender and other still unknown risk factors. The aim of this paper was to analyse the association between essential arterial hypertension and renal hypertensive disease and prevalence of other atherosclerotic risk factors in patients with developed hypertensive renal disease. In this prospective cross sectional study 283 patients of both genders with diagnosed essential hypertension and hypertensive renal disease were analysed. The anamnestic data related to age, duration of hypertension, history of smoking, presence of hypertensive retinopathy, hypertrophy of the left chamber and data about previous renal diseases were collected through conversation and medical documentation. The clinical examination comprise determination of blood pressure, body mass index (BMI, lipid parameters (total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides, serum urea and creatinine, urine, albumin and protein concentration. The total number of 283 patients (185 males and 98 females with HN was analyzed. The analysis revealed significantly higher proportion of males aged over 60 years with IHN. The mean age of examined hypertensive patients with IHN is 62.6±8.8 years with duration of hypertension 19.8±5.9 years. All examined patients had hypertensive retinopathy and

  8. Resistant Hypertension and Cardiorenovascular Risk

    Directory of Open Access Journals (Sweden)

    Prkacin Ingrid

    2017-06-01

    Full Text Available Studies have documented independent contribution of sympathetic activation to the cardiovascular disease continuum. Hypertension is one of the leading modifiable factors. Most if not all the benefit of antihypertensive treatment depends on blood pressure lowering, regardless how it is obtained. Resistant hypertension is defined as blood pressure that remains uncontrolled in spite of the concurrent use of three antihypertensive drugs of different classes. Ideally, one of the three drugs should be a diuretic, and all drugs should be prescribed at optimal dose amounts. Poor adherence to antihypertensive therapy, undiscovered secondary causes (e.g. obstructive sleep apnea, primary aldosteronism, renal artery stenosis, and lifestyle factors (e.g. obesity, excessive sodium intake, heavy alcohol intake, various drug interactions are the most common causes of resistant hypertension. Cardio(renovascular morbidity and mortality are significantly higher in resistant hypertensive than in general hypertensive population, as such patients are typically presented with a long-standing history of poorly controlled hypertension. Early diagnosis and treatment is needed to avoid further end-organ damage to prevent cardiorenovascular remodeling. Treatment strategy includes lifestyle changes, adding a mineralocorticoid receptor antagonist, treatment adherence in cardiovascular prevention and, in case of failure to control blood pressure, renal sympathetic denervation or baroreceptor activation therapy. The comparative outcomes in resistant hypertension deserve better understanding. In this review, the most current approaches to resistant hypertension and cardiovascular risk based on the available literature evidence will be discussed.

  9. Hypertension Subtypes among Hypertensive Patients in Ibadan

    OpenAIRE

    Abiodun M. Adeoye; Adewole Adebiyi; Bamidele O. Tayo; Babatunde L. Salako; Adesola Ogunniyi; Richard S. Cooper

    2014-01-01

    Background. Certain hypertension subtypes have been shown to increase the risk for cardiovascular morbidity and mortality and may be related to specific underlying genetic determinants. Inappropriate characterization of subtypes of hypertension makes efforts at elucidating the genetic contributions to the etiology of hypertension largely vapid. We report the hypertension subtypes among patients with hypertension from South-Western Nigeria. Methods. A total of 1858 subjects comprising 76% fema...

  10. Resistant hypertension.

    Science.gov (United States)

    Armario, P; Oliveras, A; de la Sierra, A

    2013-11-01

    A 53 year old woman with hypercholesterolemia treated with statins, with no history of cardiovascular disease, was referred to the Hypertension and Vascular Risk Unit for management of hypertension resistant to 4 antihypertensive agents at full doses. The patient had obesity, with a body mass index of 36.3kg/m(2) and office blood pressure 162/102mm Hg. Physical examination showed no data of interest. glucose 120mg/dl, glycated Hb: 6.4%, albuminuria 68mg/g, kidney function and study of the renin angiotensin system and other biochemical parameters were normal. Echocardiography: left ventricular mass, 131g/m(2) (normal, <110g/m(2)). True resistant hypertension was confirmed by ambulatory monitoring of blood pressure during 24h (153/89mm Hg). Spironolactone treatment (25mg/day) was added and was well tolerated, with no change in renal function and kaliemia within normal (4.1mmol/l) following the treatment. After 8 weeks, blood pressure was well controlled: office blood pressure 132/86mm Hg and 24h-ambulatory blood pressure: 128/79mm Hg. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  11. Prevalence of Hypertension and Association of Obesity with Hypertension in School Ggoing Children of Surat City, Western India

    Directory of Open Access Journals (Sweden)

    Salvi S. Shah

    2013-08-01

    Full Text Available Purpose: The association of obesity with hypertension has been recognized for the decades which are the important risk factors for the cardiovascular disease. So the purpose of the present study was to determine association of obesity with hypertension in school going children of Surat. Methodology: School going children aged between 12-18 years, of five schools in Surat were selected for the study. Height and weight were measured and BMI was calculated. Blood pressure measurements were taken as per recommendation of American heart society and family history of hypertension has also been assessed. Hypertension was considered if blood pressure is more than 95th percentile according to the update of task force report and Obesity was diagnosed by BMI for age. Results: Of 682 children, 8.94% were obese and 20.09% were hypertensive. Conclusion: Obesity is strongly associated with hypertension in children and both together may risk factors for later coronary disease.

  12. Hypertension Subtypes among Hypertensive Patients in Ibadan

    Directory of Open Access Journals (Sweden)

    Abiodun M. Adeoye

    2014-01-01

    Full Text Available Background. Certain hypertension subtypes have been shown to increase the risk for cardiovascular morbidity and mortality and may be related to specific underlying genetic determinants. Inappropriate characterization of subtypes of hypertension makes efforts at elucidating the genetic contributions to the etiology of hypertension largely vapid. We report the hypertension subtypes among patients with hypertension from South-Western Nigeria. Methods. A total of 1858 subjects comprising 76% female, hypertensive, aged 18 and above were recruited into the study from two centers in Ibadan, Nigeria. Hypertension was identified using JNCVII definition and was further grouped into four subtypes: controlled hypertension (CH, isolated systolic hypertension (ISH, isolated diastolic hypertension (IDH, and systolic-diastolic hypertension (SDH. Results. Systolic-diastolic hypertension was the most prevalent. Whereas SDH (77.6% versus 73.5% and IDH (4.9% versus 4.7% were more prevalent among females, ISH (10.1% versus 6.2% was higher among males (P=0.048. Female subjects were more obese (P<0.0001 and SDH was prevalent among the obese group. Conclusion. Gender and obesity significantly influenced the distribution of the hypertension subtypes. Characterization of hypertension by subtypes in genetic association studies could lead to identification of previously unknown genetic variants involved in the etiology of hypertension. Large-scale studies among various ethnic groups may be needed to confirm these observations.

  13. Pulmonary Hypertension

    Science.gov (United States)

    Kim, John S.; McSweeney, Julia; Lee, Joanne; Ivy, Dunbar

    2015-01-01

    Objective Review the pharmacologic treatment options for pulmonary arterial hypertension (PAH) in the cardiac intensive care setting and summarize the most-recent literature supporting these therapies. Data Sources and Study Selection Literature search for prospective studies, retrospective analyses, and case reports evaluating the safety and efficacy of PAH therapies. Data Extraction Mechanisms of action and pharmacokinetics, treatment recommendations, safety considerations, and outcomes for specific medical therapies. Data Synthesis Specific targeted therapies developed for the treatment of adult patients with PAH have been applied for the benefit of children with PAH. With the exception of inhaled nitric oxide, there are no PAH medications approved for children in the US by the FDA. Unfortunately, data on treatment strategies in children with PAH are limited by the small number of randomized controlled clinical trials evaluating the safety and efficacy of specific treatments. The treatment options for PAH in children focus on endothelial-based pathways. Calcium channel blockers are recommended for use in a very small, select group of children who are responsive to vasoreactivity testing at cardiac catheterization. Phosphodiesterase type 5 inhibitor therapy is the most-commonly recommended oral treatment option in children with PAH. Prostacyclins provide adjunctive therapy for the treatment of PAH as infusions (intravenous and subcutaneous) and inhalation agents. Inhaled nitric oxide is the first line vasodilator therapy in persistent pulmonary hypertension of the newborn, and is commonly used in the treatment of PAH in the Intensive Care Unit (ICU). Endothelin receptor antagonists have been shown to improve exercise tolerance and survival in adult patients with PAH. Soluble Guanylate Cyclase Stimulators are the first drug class to be FDA approved for the treatment of chronic thromboembolic pulmonary hypertension. Conclusions Literature and data supporting the

  14. Contrast nephropathy in high-risk patients undergoing coronary angiography and intervention

    International Nuclear Information System (INIS)

    Uddin, M.A.; Rabbani, M.A.; Jafary, F.H.; Bhatti, M.A.; Islam, M.

    2005-01-01

    Objective: To determine the incidence of contrast nephropathy in high-risk patients undergoing coronary angiography and percutaneous coronary intervention (PCI), and to define the characteristics of this cohort. Design: Descriptive study. Place and Duration of Study: The Aga Khan University Hospital, Karachi from January to December 2002. Patients and Methods: One hundred and fifteen patients with serum creatinine greater than 1.4mg/dl who underwent coronary angiography or PCI were included. All patients received non-ionic contrast dye. Acute contrast nephropathy was defined as rise in serum creatinine of >0.5mg/dl within 48 hours following the index procedure. Means and standard deviations were calculated for continuous variables and frequencies for categorical variables. Results: Mean age of patients was 62.3 year + 8.83. Mean pre-contrast creatinine was 1.9+0.9mg/dl. Eleven (9.65%) patients developed contrast nephropathy. 4.4% of patients with serum creatinine 4.0(p-value 0.001). 11.9% diabetic patients developed nephropathy compared to 6.3% of non-diabetics (p-value 0.355). 11.4% of hypertensive and 3.7% of non-hypertensive patients developed contrast-nephropathy (p-value 0.454). 12.9% of low dose group ( 100ml) developed nephropathy (p-value 0.188). Mean serum creatinine in low dose group was higher (3.0mg/dl vs. 1.7 mg/dl). Conclusion: The incidence of contrast nephropathy in this study was similar to that reported in literature. Risk of CIN was found to be significantly proportional to the severity of baseline renal disease. Trends towards higher risk of CIN were seen in patients with diabetes and hypertension. Higher incidence of CIN in patients receiving low-dose contrast was confounded by higher baseline serum creatinine in that group. (author)

  15. Hypertension hos gravide

    DEFF Research Database (Denmark)

    Mathiesen, Elisabeth R; Johansen, Marianne; Kamper, Anne Lise

    2009-01-01

    There are four major hypertensive disorders in pregnancy: chronic hypertension, gestational hypertension, preeclampsia and chronic hypertension with superimposed preeclampsia. The indications and efficacy of antihypertensive treatment of the different hypertensive disorders are assessed. Advantag...... and disadvantages of different classes of antihypertensive drugs during pregnancy and lactation are described....

  16. Contribution of KV7 Channels to Basal Coronary Flow and Active Response to Ischemia

    DEFF Research Database (Denmark)

    Khanamiri, Saereh; Soltysinska, Ewa; Jepps, Thomas A

    2013-01-01

    in the presence of a KV7 inhibitor. The expression levels of KCNQ1-5 and their known accessory KCNE1-5 subunits in coronary arteries were similar in normotensive and hypertensive rats as measured by quantitative polymerase chain reaction. However, KV7.4 protein expression was reduced in hypertensive rats...

  17. Risk of Myocardial Infarction Attributable to Elevated Levels of Total Cholesterol Among Hypertensives

    NARCIS (Netherlands)

    Glazer, Nicole L.; Smith, Nicholas L.; Heckbert, Susan R.; Doggen, Catharina Jacoba Maria; Lemaitre, Rozenn N.; Psaty, Bruce M.

    2005-01-01

    Background Although cholesterol is an important risk factor for coronary heart disease (CHD) among hypertensives, the burden of CHD among hypertensives that may be due to elevated cholesterol has not been well documented. This study aimed to estimate the proportion of incident myocardial infarction

  18. Masked Hypertension and Incident Clinic Hypertension among African Americans in the Jackson Heart Study

    Science.gov (United States)

    Abdalla, Marwah; Booth, John N.; Seals, Samantha R.; Spruill, Tanya M.; Viera, Anthony J.; Diaz, Keith M.; Sims, Mario; Muntner, Paul; Shimbo, Daichi

    2016-01-01

    Masked hypertension, defined as non-elevated clinic blood pressure and elevated out-of-clinic blood pressure may be an intermediary stage in the progression from normotension to hypertension. We examined the associations of out-of-clinic blood pressure and masked hypertension using ambulatory blood pressure monitoring with incident clinic hypertension in the Jackson Heart Study, a prospective cohort of African Americans. Analyses included 317 participants with clinic blood pressure hypertension was defined as mean daytime blood pressure ≥135/85mmHg; masked nighttime hypertension as mean nighttime blood pressure ≥120/70mmHg; and masked 24-hour hypertension as mean 24-hour blood pressure ≥130/80mmHg. Incident clinic hypertension, assessed at study visits in 2005–2008 and 2009–2012, was defined as the first visit with clinic systolic/diastolic blood pressure ≥140/90mmHg or antihypertensive medication use. During a median follow-up of 8.1 years, there were 187 (59.0%) incident cases of clinic hypertension. Clinic hypertension developed in 79.2% and 42.2% of participants with and without any masked hypertension, 85.7% and 50.4% with and without masked daytime hypertension, 79.9% and 43.7% with and without masked nighttime hypertension and 85.7% and 48.2% with and without masked 24-hour hypertension, respectively. Multivariable-adjusted hazard ratios (95% CI) of incident clinic hypertension for any masked hypertension and masked daytime, nighttime, and 24-hour hypertension were 2.13 (1.51–3.02), 1.79 (1.24–2.60), 2.22 (1.58–3.12), and 1.91 (1.32–2.75), respectively. These findings suggest that ambulatory blood pressure monitoring can identify African Americans at increased risk for developing clinic hypertension. PMID:27185746

  19. Resistant hypertension, patient characteristics, and risk of stroke.

    Directory of Open Access Journals (Sweden)

    Chen-Ying Hung

    Full Text Available Little is known about the prognosis of resistant hypertension (RH in Asian population. This study aimed to evaluate the impacts of RH in Taiwanese patients with hypertension, and to ascertain whether patient characteristics influence the association of RH with adverse outcomes.Patients aged ≥45 years with hypertension were identified from the National Health Insurance Research Database. Medical records of 111,986 patients were reviewed in this study, and 16,402 (14.6% patients were recognized as having RH (continuously concomitant use of ≥3 anti-hypertensive medications, including a diuretic, for ≥2 years. Risk of major adverse cardiovascular events (MACE, a composite of all-cause mortality, acute coronary syndrome, and stroke [included both fatal and nonfatal events] in patients with RH and non-RH was analyzed. A total of 11,856 patients experienced MACE in the follow-up period (average 7.1±3.0 years. There was a higher proportion of females in the RH group, they were older than the non-RH (63.1 vs. 60.5 years patients, and had a higher prevalence of cardiovascular co-morbidities. Overall, patients with RH had higher risks of MACE (adjusted HR 1.17; 95%CI 1.09-1.26; p<0.001. Significantly elevated risks of stroke (10,211 events; adjusted HR 1.17; 95%CI 1.08-1.27; p<0.001, especially ischemic stroke (6,235 events; adjusted HR 1.34; 95%CI 1.20-1.48; p<0.001, but not all-cause mortality (4,594 events; adjusted HR 1.06; 95%CI 0.95-1.19; p = 0.312 or acute coronary syndrome (2,145 events; adjusted HR 1.17; 95%CI 0.99-1.39; p = 0.070 were noted in patients with RH compared to those with non-RH. Subgroup analysis showed that RH increased the risks of stroke in female and elderly patients. However, no significant influence was noted in young or male patients.Patients with RH were associated with higher risks of MACE and stroke, especially ischemic stroke. The risks were greater in female and elderly patients than in male or young

  20. White coat hypertension in definition of metabolic syndrome.

    Science.gov (United States)

    Helvaci, Mehmet Rami; Kaya, Hasan; Seyhanli, Mahmut; Yalcin, Atilla

    2008-07-01

    Although white coat hypertension (WCH) is believed to have an effect on health, there is no term defining WCH in metabolic syndrome. Consecutive patients 20 years old or older who underwent a check-up were included. The study included 1068 cases. The prevalences of hyperbetalipoproteinemia, hypertriglyceridemia, dyslipidemia, impaired glucose tolerance (IGT), and WCH were similar to excess weight in that they increased significantly until the seventh decade of life and decreased thereafter significantly (P hypertension (HT), diabetes mellitus (DM), and coronary heart disease (CHD) always increased significantly with age without any decrease (P definition of metabolic syndrome should include reversible metabolic risk factors such as excess weight (overweight and obesity), hyperbetalipoproteinemia, hypertriglyceridemia, dyslipidemia, IGT, and WCH, instead of irrevesible diseases such as DM, HT, CHD, and stroke that have already developed and require drug therapy. After development of one of the final metabolic diseases, the term metabolic syndrome probably loses most of its significance, since from that point on, nonpharmaceutical approaches such as lifestyle changes, diet, and exercise will provide little benefit to prevent development of the others, most likely due to the cumulative effects of the risk factors on body systems over a long period of time.

  1. Integral diagnosis of coronary atherosclerosis by coronary multidetector computed tomography and by invasive coronary angiography

    International Nuclear Information System (INIS)

    Llerena Rojas, Luis Roberto; Llerena Rojas, Lorenzo D; Mendoza Rodriguez, Vladimir

    2013-01-01

    Coronary angiography by multidetector computed tomography (CMDCT) visualizes the wall and lumen of coronary arteries. Invasive coronary angiography (INVCA) only visualizes the arterial lumen but with better resolution

  2. Coronary atherosclerosis in indigenous South American Tsimane: a cross-sectional cohort study.

    Science.gov (United States)

    Kaplan, Hillard; Thompson, Randall C; Trumble, Benjamin C; Wann, L Samuel; Allam, Adel H; Beheim, Bret; Frohlich, Bruno; Sutherland, M Linda; Sutherland, James D; Stieglitz, Jonathan; Rodriguez, Daniel Eid; Michalik, David E; Rowan, Chris J; Lombardi, Guido P; Bedi, Ram; Garcia, Angela R; Min, James K; Narula, Jagat; Finch, Caleb E; Gurven, Michael; Thomas, Gregory S

    2017-04-29

    Conventional coronary artery disease risk factors might potentially explain at least 90% of the attributable risk of coronary artery disease. To better understand the association between the pre-industrial lifestyle and low prevalence of coronary artery disease risk factors, we examined the Tsimane, a Bolivian population living a subsistence lifestyle of hunting, gathering, fishing, and farming with few cardiovascular risk factors, but high infectious inflammatory burden. We did a cross-sectional cohort study including all individuals who self-identified as Tsimane and who were aged 40 years or older. Coronary atherosclerosis was assessed by coronary artery calcium (CAC) scoring done with non-contrast CT in Tsimane adults. We assessed the difference between the Tsimane and 6814 participants from the Multi-Ethnic Study of Atherosclerosis (MESA). CAC scores higher than 100 were considered representative of significant atherosclerotic disease. Tsimane blood lipid and inflammatory biomarkers were obtained at the time of scanning, and in some patients, longitudinally. Between July 2, 2014, and Sept 10, 2015, 705 individuals, who had data available for analysis, were included in this study. 596 (85%) of 705 Tsimane had no CAC, 89 (13%) had CAC scores of 1-100, and 20 (3%) had CAC scores higher than 100. For individuals older than age 75 years, 31 (65%) Tsimane presented with a CAC score of 0, and only four (8%) had CAC scores of 100 or more, a five-fold lower prevalence than industrialised populations (p≤0·0001 for all age categories of MESA). Mean LDL and HDL cholesterol concentrations were 2·35 mmol/L (91 mg/dL) and 1·0 mmol/L (39·5 mg/dL), respectively; obesity, hypertension, high blood sugar, and regular cigarette smoking were rare. High-sensitivity C-reactive protein was elevated beyond the clinical cutoff of 3·0 mg/dL in 360 (51%) Tsimane participants. Despite a high infectious inflammatory burden, the Tsimane, a forager-horticulturalist population of the

  3. Hypertension and Spina Bifida

    Science.gov (United States)

    SBA National Resource Center: 800-621-3141 Hypertension A disease that often goes undetected. What is hypertension? Hypertension, also called high blood pressure , is a condition in which the arteries of ...

  4. The Role of Infection in the Development of Acute Coronary Syndrome

    Directory of Open Access Journals (Sweden)

    Hala Awadalla

    2011-12-01

    Full Text Available AIM: A potential link between infectious agents and atherosclerosis has been suggested. Data obtained from several seroepidemiological studies have suggested that infection with Chlamydophila pneumoniae, Helicobacter pylori, and Cytomegalovirus can initiate or maintain the atherosclerotic process. Aim of this study is to evaluate the probable relationship between serum titers of some various infectious agents and the development of acute coronary syndrome and to investigate the relationship between these infectious agents and other risk factors of acute coronary syndrome (smoking, hypertension, dyslipidemia, diabetes, and family history of CVD. METHOD: This is a hospital based case- control study was conducted on two groups: patients group included 86 patients, cases were collected from patients admitted to Cardiac Care Unit (CCU of Cleopatra hospital, and Ain Shams University hospital with acute myocardial infarction between January 2010 and June 2010 and control group included 86 apparently healthy individuals. A questionnaire was designed to determine conventional coronary artery risk factors. The sero-prevalence of Chlamydia pneumoniae (C. pneumoniae, Cytomegalovirus and Helicobacter pylori (H. pylori IgG antibodies were evaluated using quantitative enzyme-linked immunosorbent assay (ELISA. RESULTS: The results showed that there was an increased level of serum IgG antibodies of C. pneumoniae, Cytomegalovirus and Helicobacter pylori among patients with acute coronary syndrome compared to control subjects CONCLUSION: C. pneumoniae, Cytomegalovirus and Helicobacter pylori were expected to be predictors for the development of coronary artery disease, as there was significant elevation of the serum level of IgG antibodies against them. [TAF Prev Med Bull 2011; 10(6.000: 715-722

  5. Neonatal hypertension.

    Science.gov (United States)

    Sharma, Deepak; Farahbakhsh, Nazanin; Shastri, Sweta; Sharma, Pradeep

    2017-03-01

    Neonatal hypertension (HT) is a frequently under reported condition and is seen uncommonly in the intensive care unit. Neonatal HT has defined arbitrarily as blood pressure more than 2 standard deviations above the base as per the age or defined as systolic BP more than 95% for infants of similar size, gestational age and postnatal age. It has been diagnosed long back but still is the least studied field in neonatology. There is still lack of universally accepted normotensive data for neonates as per gestational age, weight and post-natal age. Neonatal HT is an important morbidity that needs timely detection and appropriate management, as it can lead to devastating short-term effect on various organs and also poor long-term adverse outcomes. There is no consensus yet about the treatment guidelines and majority of treatment protocols are based on the expert opinion. Neonate with HT should be evaluated in detail starting from antenatal, perinatal, post-natal history, and drug intake by neonate and mother. This review article covers multiple aspects of neonatal hypertension like definition, normotensive data, various etiologies and methods of BP measurement, clinical features, diagnosis and management.

  6. Dermatoglyphics in hypertension: a review.

    Science.gov (United States)

    Wijerathne, Buddhika T B; Meier, Robert J; Agampodi, Thilini C; Agampodi, Suneth B

    2015-08-12

    Hypertension is a major contributor to the global burden of disease and mortality. A major medical advancement would be a better means to ascertain which persons are at higher risk for becoming hypertensive beforehand. To that end, there have been a number of studies showing that certain dermatoglyphic markers are associated with hypertension. This association could be explained if the risk toward developing hypertension later on in life is somehow connected with fetal development of dermatoglyphics. It would be highly valuable from a clinical standpoint if this conjecture could be substantiated since dermatoglyphic markers could then be used for screening out individuals who might be at an elevated risk of becoming hypertensive. The aim of this review was to search for and appraise available studies that pertain to the association between hypertension and dermatoglyphics.A systematic literature search conducted using articles from MEDLINE (PubMed), Trip, Cochran, Google scholar, and gray literature until December 2014. Of the 37 relevant publications, 17 were included in the review. The review performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement.This review showed a fairly consistent finding of an increased frequency of whorl patterns along with a higher mean total ridge count in digital dermatoglyphic results in hypertensive samples compared to controls. However, it was imperative to discuss several limitations found in the studies that could make this association as yet unsettled.

  7. Does exercise pulmonary hypertension exist?

    Science.gov (United States)

    Lau, Edmund M; Chemla, Denis; Whyte, Kenneth; Kovacs, Gabor; Olschewski, Horst; Herve, Philippe

    2016-09-01

    The exercise definition of pulmonary hypertension using a mean pulmonary artery pressure threshold of greater than 30 mmHg was abandoned following the 4th World Pulmonary Hypertension Symposium in 2008, as this definition was not supported by evidence and healthy individuals frequently exceed this threshold. Meanwhile, the clinical value of exercise pulmonary hemodynamic testing has also been questioned. Recent data support the notion that an abnormal pulmonary hemodynamic response during exercise (or exercise pulmonary hypertension) is associated with symptoms and exercise limitation. Pathophysiologic mechanisms accounting for the development of exercise pulmonary hypertension include increased vascular resistance, excessive elevation in left atrial pressure and/or increased volume of trapped air during exercise, resulting in a steep rise in pulmonary artery pressure relative to cardiac output. Recent evidence suggests that exercise pulmonary hypertension may be defined by a mean pulmonary artery pressure surpassing 30 mmHg together with a simultaneous total pulmonary resistance exceeding 3 WU. Exercise pulmonary hypertension is a clinically relevant entity and an improved definition has been suggested based on new evidence. Exercise pulmonary hemodynamics may help unmask early or latent disease, particularly in populations that are at high risk for the development of pulmonary hypertension.

  8. Pulmonary hypertension in patients with chronic myeloproliferative disorders

    Directory of Open Access Journals (Sweden)

    Yochai Adir

    2015-09-01

    Full Text Available Pulmonary hypertension (PH is a major complication of several haematological disorders. Chronic myeloproliferative diseases (CMPDs associated with pulmonary hypertension have been included in group five of the clinical classification for pulmonary hypertension, corresponding to pulmonary hypertension for which the aetiology is unclear and/or multifactorial. The aim of this review is to discuss the epidemiology, pathogenic mechanism and treatment approaches of the more common forms of pulmonary hypertension in the context of CMPD's: chronic thromboembolic pulmonary hypertension, precapillary pulmonary hypertension and drug-induced PH.

  9. Volumetric analysis of central body fat accurately predicts incidence of diabetes and hypertension in adults.

    Science.gov (United States)

    Gibby, Jacob T; Njeru, Dennis K; Cvetko, Steven T; Merrill, Ray M; Bikman, Benjamin T; Gibby, Wendell A

    2015-01-01

    Central adipose tissue is appreciated as a risk factor for cardiometabolic disorders. The purpose of this study was to determine the efficacy of a volumetric 3D analysis of central adipose tissue in predicting disease. Full body computerized tomography (CT) scans were obtained from 1225 female (518) and male (707) subjects, aged 18-88. Percent central body fat (%cBF) was determined by quantifying the adipose tissue volume from the dome of the liver to the pubic symphysis. Calcium score was determined from the calcium content of coronary arteries. Relationships between %cBF, BMI, and several cardiometabolic disorders were assessed controlling for age, sex, and race. Higher %cBF was significantly greater for those with type 2 diabetes and hypertension, but not stroke or hypercholesterolemia. Simple anthropometric determination of BMI equally correlated with diabetes and hypertension as central body fat. Calcium scoring significantly correlated with all measurements of cardiovascular health, including hypertension, hypercholesterolemia, and heart disease. Central body fat and BMI equally and highly predict incidence of hypertension and type 2 diabetes.

  10. Risk factors for coronary heart disease in patients below 45 years of age

    Science.gov (United States)

    Nadeem, Mansoor; Ahmed, Syed Shahzad; Mansoor, Sarah; Farooq, Sidra

    2013-01-01

    Objective: To examine the traditional risk factors and biochemical profile of patients with established CAD (coronary artery disease), and compare the trends of these in specified age groups of different populations as depicted in various studies. Methodology: All consecutive patients below 45 years of age, having classical history of Ischemic heart disease and also having definite ECG changes consistent with coronary artery disease were enrolled. These patients were admitted to CCU/Intermediate Coronary Care Unit of Pakistan Ordinance Factories (POF) Hospital Wah Cantonment from April 2007 to December 2011. Patients who had doubtful history as regards CHD and those having ECG changes not classically consistent with CAD were excluded. Information collected through Performa included history including family history and details of risk factors. Clinical examination was carried out and relevant investigations including the serial ECG changes were recorded. Blood samples were collected after an overnight fast of 14 hours and tests were done for total cholesterol and HDL cholesterol by using Pioneer-USA, linear chemical kits by cholesterol oxidase and enzymatic calometric method. Results: A total of 109 cases were included. Cigarette smoking (46%) Family history (43%), Hypertension (37%), Dyslipidemia (33%), Diabetes mellitus (18%) and above normal BMI (63.3%) are the most common risk factors in our patients. Increased abdominal girth has appeared to be an important risk factor and at occasions is documented to be independent of obesity. Casual dietary habits and sedentary life style are the other less important risk factors. The majority of risk factors were equally prevalent in males as well as females except smoking which was less prevalent in females. Conclusions: Our study shows that Family history, Smoking, Hypertension, increased BMI, increased Abdominal girth, Dyslipidemia and Diabetes Mellitus are the main risk factors. Considering the increasing incidence of

  11. Comparison of modifiable coronary artery disease risk factors ...

    African Journals Online (AJOL)

    Objective: The aim of the present study was to compare the incidence of the following coronary artery disease (CAD) risk factors in urban (westernised) Black and White females: physical inactivity, hypertension, cigarette smoking, hypercholesterolaemia, obesity and multiple risk factors. Subjects: Subjects for this study were ...

  12. Childhood Antecedents to Adult Coronary Artery Diseases. Special Reference Briefs.

    Science.gov (United States)

    Winick, Myron

    This reference brief deals with the childhood antecedents to atherosclerosis and hypertension. While diet is related to the development of coronary artery diseases, there is some disagreement about what dietary changes are necessary or desirable in children to prevent their development, and at what age such changes should be made. Fifty-five…

  13. Research Article Gene expression profiling for coronary artery ...

    Indian Academy of Sciences (India)

    Shiridhar Kashyap

    pressure, neither was any significant difference noticed in risk factors like hypertension, smoking status, and tobacco chewing. The clinical. 8 variables like ESR, LFTs, CRP, haemoglobin, ..... Peripheral blood gene expression profile of atherosclerotic. 2 coronary artery disease in patients of different ethnicity in Malaysia.

  14. heart disease of coronary population (CRISIC study) The ...

    African Journals Online (AJOL)

    1990-07-21

    Jul 21, 1990 ... A cross-sectional study of risk factors for coronary heart disease in a random sample of 976 people from a South. African coloured population revealed this group to be at great risk. The prevalences of individual and of coexisting reversible risk factors - hypercholesterolaemia, hypertension and smoking ...

  15. Prevalence of Risk Factors for Coronary Artery Disease in Southern ...

    African Journals Online (AJOL)

    Prevalence of Risk Factors for Coronary Artery Disease in Southern Punjab, Pakistan. ... History of hypertension, diabetes mellitus (DM) or its treatment was recorded after observing their medical reports. Results: The proportion of females and males was 65.53 and 34.46 %, respectively. Of the 200 patients, the mean age of ...

  16. Restenosis after coronary angioplasty.

    Science.gov (United States)

    Anderson, H V; Vignale, S J; Benedict, C R; Willerson, J T

    1993-09-01

    Coronary angioplasty is used to treat coronary atherosclerotic disease in many patients. One problem with coronary angioplasty is the phenomenon of restenosis. Restenosis appears to be a universal response to arterial wall injury. The biological events that underlie restenosis are characterized by: platelet adhesion and aggregation at sites of damaged endothelium, and within dissections into the medial layers, release of platelet derived growth-promoting substances, inflammation of the injured medial zone, transformation, migration, and proliferation of smooth muscle cells of the media following their activation by growth-promoting substances, secretion of copious amounts of extracellular matrix material, and finally, termination of the growth process following regrowth of endothelium over the damaged area. More than a decade of research work has helped identify clinical correlates of restenosis after coronary angioplasty. Patient-related correlates include male gender, unstable angina, diabetes, and continued smoking after angioplasty. Lesion-related correlates include multilesion and multivessel procedures, higher post-angioplasty residual stenosis, proximal vessel location, location in the left anterior descending coronary artery, location in a vein graft, long lesions, and total occlusions. However, for the purposes of individual patient care, clinical correlates are not particularly helpful. No group of variables has predicted complete freedom from restenosis, and conversely no group of variables has reliably indicated its presence. All patients undergoing angioplasty will require some form of follow-up evaluation. Symptom status by itself has not been found to be useful for predicting restenosis. However, when symptom status is combined with exercise thallium-201 scintigraphy, performed 4-6 months after angioplasty, it is less than ideal, but has a negative predictive value of over 90%. This means that over 90% of patients who are asymptomatic and have no

  17. Dietary nitrite supplementation attenuates cardiac remodeling in l-NAME-induced hypertensive rats.

    Science.gov (United States)

    Sonoda, Kunihiro; Ohtake, Kazuo; Uchida, Hiroyuki; Ito, Junta; Uchida, Masaki; Natsume, Hideshi; Tamada, Hazuki; Kobayashi, Jun

    2017-07-01

    Loss of nitric oxide (NO) bioavailability underlies the development of hypertensive heart disease. We investigated the effects of dietary nitrite on N G -nitro-l-arginine methyl ester (l-NAME)-induced hypertension. Sprague-Dawley rats were divided into five groups: an untreated control group, an l-NAME-treated group, and three other l-NAME-treated groups supplemented with 10 mg/L or 100 mg/L of nitrite or 100 mg/L of captopril in drinking water. After the 8-week experimental period, mean arterial blood pressure was measured, followed by sampling of blood and heart tissue for assessment of nitrite/nitrate levels in the plasma and heart, the plasma level of angiotensin II (AT II), and the heart transcriptional levels of AT II type 1 receptor (AT 1 R), transforming growth factor-β1 (TGF-β1), and connective tissue proteins such as type 1 collagen and fibronectin. Heart tissue was analyzed by histopathological morphometry, including assessments of ventricular and coronary vascular hypertrophy and fibrosis, as well as immunohistochemistry analyses of myocardial expression of AT 1 R. l-NAME treatment reduced the plasma nitrate level and led to the development of hypertension, with increased plasma levels of AT II and increased heart transcriptional levels of AT 1 R and TGF-β1-mediated connective tissue proteins, showing myocardial and coronary arteriolar hypertrophy and fibrosis. However, dietary nitrite supplementation inhibited TGF-β1-mediated cardiac remodeling by suppressing AT II and AT 1 R. These results suggest that dietary nitrite levels achievable via a daily high-vegetable diet could improve hypertensive heart disease by inhibiting AT II-AT 1 R-mediated cardiac remodeling. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Hypertension in goldminers | Maepe | South African Medical Journal

    African Journals Online (AJOL)

    Background. Reliable information about the prevalence of hypertension, which is a major contributor to cardiovascular disease in general and to coronary heart disease in particular, in different geographical regions is essential for its prevention and optimal control. In the mining industry, which comprises mainly urbanised ...

  19. Prognosis of non-significant coronary atherosclerotic disease detected by coronary artery tomography

    Energy Technology Data Exchange (ETDEWEB)

    Barros, Marcio Vinicius Lins; Siqueira, Bruna Pinto; Guimaraes, Carolina Camargos Braichi; Cruz, David Filipe Silva; Guimaraes, Leiziane Assuncao Alves; Lima, Maicom Marcio Perigolo, E-mail: marciovlbarros@gmail.com [Faculdade de Saude e Ecologia Humana, Vespasiano, MG (Brazil); Nunes, Maria do Carmo Pereira [Universidade de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Faculdade de Medicina; Siqueira, Maria Helena Albernaz [Hospital Materdei, Belo Horizonte, MG (Brazil)

    2015-07-15

    Introduction: Although studies have shown high diagnostic accuracy of coronary tomography (CT) in detecting coronary artery disease (CAD), data on the prognostic value of this method in patients with no significant coronary obstruction are limited. Objective: To evaluate the value of CT in predicting adverse events in patients with suspected CAD and no significant coronary obstruction. Methods: We prospectively evaluated 440 patients between January 2008 and July 2013 by MDCT, diagnosed with no significant obstruction or no atherosclerotic coronary obstruction with an average follow-up of 33 months. The outcomes evaluated were: cardiac death, myocardial infarction, unstable angina associated with hospitalization or coronary artery bypass grafting. Results: Of the 440 patients studied, 295 (67%) were men with mean age 55.9 ± 12.0 years. Non-significant obstruction was found in 152 (35%) of the patients and there were 49 (11%) outcomes. In the multivariate analysis using the Cox regression model, the predictors of clinical outcomes were non-significant obstruction on CT (hazard ratio 3.51; 95% CI 1.73 - 7.8; p <0.01), age and hypertension. Non-significant obstruction on CT was associated with adverse clinical outcomes and survival analysis showed a significant difference (log-rank 24.6; p <0.01) in predicting these outcomes. Conclusion: The detection of non-significant atherosclerotic obstruction by CT was associated with the presence of adverse events in patients with suspected CAD, which may prove useful in the risk stratification of these patients. (author)

  20. Updates in management of coronary artery disease

    International Nuclear Information System (INIS)

    Yang, Dong Heon; Chae, Shung Chull

    2005-01-01

    Coronary artery disease (CAD) has been increasing during the last decade and is the one of major causes of death. The management of patients with coronary artery disease has evolved considerably. There are two main strategies in the management of CAD, complementary, not competitive, each other; the pharmacologic therapy to prevent and treat CAD and the percutaneous coronary intervention (PCI) to restore coronary flow. Antiplatelet drugs and cholesterol lowering drugs have central roles in pharmacotherapy. Drug eluting stent (DES) bring about revolutional changes in PCL in the management of patients with ST segment elevation acute myocardial infarction (AMI), there has been a debate on the better strategy for the restoration of coronary flow. Thrombolytic therapy is widely available and easy to administer, whereas primary PCI is less available and more complex, but more complete. Recently published evidences in the pharmacologic therapy including antiplatelet and statin, and PCI including DES and reperfusion therapy in patients with ST segment elevation AMI were reviewed

  1. Updates in management of coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Dong Heon; Chae, Shung Chull [Kyungpook National University Medical School, Daegu (Korea, Republic of)

    2005-02-15

    Coronary artery disease (CAD) has been increasing during the last decade and is the one of major causes of death. The management of patients with coronary artery disease has evolved considerably. There are two main strategies in the management of CAD, complementary, not competitive, each other; the pharmacologic therapy to prevent and treat CAD and the percutaneous coronary intervention (PCI) to restore coronary flow. Antiplatelet drugs and cholesterol lowering drugs have central roles in pharmacotherapy. Drug eluting stent (DES) bring about revolutional changes in PCL in the management of patients with ST segment elevation acute myocardial infarction (AMI), there has been a debate on the better strategy for the restoration of coronary flow. Thrombolytic therapy is widely available and easy to administer, whereas primary PCI is less available and more complex, but more complete. Recently published evidences in the pharmacologic therapy including antiplatelet and statin, and PCI including DES and reperfusion therapy in patients with ST segment elevation AMI were reviewed.

  2. The risk of acute coronary syndrome in Ramadan.

    Science.gov (United States)

    Sriha Belguith, Asma; Baccouche, Houda; Grissa, Mohamed Habib; Boubaker, Hamdi; Bouida, Wahid; Beltaief, Kaouthar; Sekma, Adel; Fredj, Nizar; Bzeouiche, Nasri; Zina, Zied; Boukef, Riadh; Soltani, Mohamed; Nouira, Semir

    2016-10-01

    Data on the effect of fasting on coronary disease are rare and controversial. The aim of our study was to investigate the influence of Ramadan on the prevalence of acute coronary syndrome among chest pain patients in the emergency department of Monastir. It was a prospective study, performed in the emergency department of Fattouma Bourguiba University Hospital of Monastir, during the 3 months before, during and after Ramadan from 2012 to 2014. We included all patients with non-traumatic chest pain during the study period. Data were collected using a standardized form. The uniformity chi 2 test, ANOVA test, Kruskal-Wallis test were performed at the 5% level. Binary logistic regression model was used for multivariate analysis. The SCA prevalence was 17% a month before Ramadan, 22% during Ramadan and 28% one month after Ramadan (p = 0.007). According to the results of the multivariate analysis, the period of Ramadan is not associated with increase of risk of SCA whereas the risk doubles after Ramadan in all group (p = 0.001). In subgroups analysis, the period of R was associated with an amplification of risk in men aged more than 55 years and women older than 65 years (OR: 2.1; p = 0.020) and among subjects with hypertension (OR: 2.4, p = 0.007). Ramadan and Shawwal were not associated with an increase of risk among subjects without CVX risk factor. We have demonstrated that the risk of SCA has increased in Ramadan only among the elderly and patient with hypertension. The increased risk in Shawwal can be explained by the lifting of dietary restriction.

  3. Coronary artery rupture during high-pressure post-dilatation of coronary stent in a heavily calcified lesion of an ectatic right coronary artery

    Directory of Open Access Journals (Sweden)

    Sina Ali

    2016-06-01

    Full Text Available Coronary artery perforation (CAP is a rare but feared complication of percutaneous coronary intervention. With the use of novel instruments, including hydrophilic and ultrarigid guidewires, rotablator devices, and cutting balloons, the success rate of intervention for coronary artery chronic total occlusion (CTOs and calcified lesions has increased. Along with these changes, the risk of CAP has also increased. In this case report, we present a tip III CAP due to high-pressure postdilatation of coronary stent in a heavily calcified lesion of an ectatic right coronary artery.

  4. Spontaneous coronary artery dissections: Four cases and literature review

    Directory of Open Access Journals (Sweden)

    Necmettin Çolak

    2009-01-01

    Full Text Available Spontaneous coronary artery dissection(SCAD is a very rare cause of acute coronary syndrome. SCAD can cause stable angina, unstable angina, acute myocardial infarction, cardiogenic shock and sudden cardiac death. Predisposing factors include atherosclerosis, the peripar-tum period, structural and inflammatory conditions affect-ing the arterial wall. The diagnosis is usually made by coronary angiography. The clinical presentation is similar to the atherosclerotic coronary artery disease. Prompt diagnosis and treatment of patients improves survival. Therapeutic options include medical therapy, percutane-ous coronary intervention and surgery. The four cases were presented an discussed with review of the pertinent literature.

  5. Sex differences in primary hypertension

    Science.gov (United States)

    2012-01-01

    Men have higher blood pressure than women through much of life regardless of race and ethnicity. This is a robust and highly conserved sex difference that it is also observed across species including dogs, rats, mice and chickens and it is found in induced, genetic and transgenic animal models of hypertension. Not only do the differences between the ovarian and testicular hormonal milieu contribute to this sexual dimorphism in blood pressure, the sex chromosomes also play a role in and of themselves. This review primarily focuses on epidemiological studies of blood pressure in men and women and experimental models of hypertension in both sexes. Gaps in current knowledge regarding what underlie male-female differences in blood pressure control are discussed. Elucidating the mechanisms underlying sex differences in hypertension may lead to the development of anti-hypertensives tailored to one's sex and ultimately to improved therapeutic strategies for treating this disease and preventing its devastating consequences. PMID:22417477

  6. Management of Hypertension in Pregnancy

    Directory of Open Access Journals (Sweden)

    Nurike S Mudjari

    2015-03-01

    Full Text Available Hypertension-related maternal mortality reaches 16% when it is compared to other causes of maternal mortality such as sepsis, bleeding or abortus. Pregnant women with hypertension disorder are at increased risk for experiencing numerous complications including disseminated intravascular coagulation (DIC, cerebral hemorrhage, liver dysfunction and acute renal failure; while to the fetus, it may cause intrauterine growth retardation, prematurity and perinatal mortality. Hypertension in pregnancy should be managed appropriately to reduce maternal and fetal morbidity and mortality rate, i.e. by preventing women from getting the risks of increased blood pressure, preventing disease progression and preventing the development of seizure and considering termination of pregnancy in lifethreatening situation for maternal and fetal health. Key words: blood pressure, hypertension, eclampsia, preeclampsia, pregnant women, gestational.

  7. First-line drugs for hypertension.

    Science.gov (United States)

    Wright, James M; Musini, Vijaya M; Gill, Rupam

    2018-04-18

    This is the first update of a review published in 2009. Sustained moderate to severe elevations in resting blood pressure leads to a critically important clinical question: What class of drug to use first-line? This review attempted to answer that question. To quantify the mortality and morbidity effects from different first-line antihypertensive drug classes: thiazides (low-dose and high-dose), beta-blockers, calcium channel blockers, ACE inhibitors, angiotensin II receptor blockers (ARB), and alpha-blockers, compared to placebo or no treatment.Secondary objectives: when different antihypertensive drug classes are used as the first-line drug, to quantify the blood pressure lowering effect and the rate of withdrawal due to adverse drug effects, compared to placebo or no treatment. The Cochrane Hypertension Information Specialist searched the following databases for randomized controlled trials up to November 2017: the Cochrane Hypertension Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (from 1946), Embase (from 1974), the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. We contacted authors of relevant papers regarding further published and unpublished work. Randomized trials (RCT) of at least one year duration, comparing one of six major drug classes with a placebo or no treatment, in adult patients with blood pressure over 140/90 mmHg at baseline. The majority (over 70%) of the patients in the treatment group were taking the drug class of interest after one year. We included trials with both hypertensive and normotensive patients in this review if the majority (over 70%) of patients had elevated blood pressure, or the trial separately reported outcome data on patients with elevated blood pressure. The outcomes assessed were mortality, stroke, coronary heart disease (CHD), total cardiovascular events (CVS), decrease in systolic and diastolic blood pressure, and

  8. Clinical correlation between N-terminal pro-b-type natriuretic peptide and angiographic coronary atherosclerosis

    Directory of Open Access Journals (Sweden)

    Demóstenes G.L. Ribeiro

    2014-06-01

    Full Text Available OBJECTIVES:This study aimed to investigate the clinical correlation between angiographic coronary atherosclerosis and N-terminal pro-B-type natriuretic peptide along with other known correlated factors.METHODS:In total, 153 patients with a diagnostic hypothesis of stable angina, unstable angina or acute myocardial infarction were classified as group A (patients with angiographically normal coronary arteries or group B (patients with angiographic coronary atherosclerosis. The two groups were analyzed with respect to the following factors: gender, age, body mass index, abdominal circumference, smoking, diabetes mellitus, arterial hypertension, early family history of atherosclerosis, statin use, the presence of metabolic syndrome, clinical presentation and biochemical factors, including cholesterol, creatinine and fibrinogen plasma concentrations, monocyte counts and N-terminal pro-B-type natriuretic peptide.RESULTS:Univariate analyses comparing the two groups revealed that group B patients more frequently had diabetes, used statins and had systolic dysfunction, N-terminal pro-B-type natriuretic peptide levels ≥250 pg/mL, fibrinogen levels >500 mg/dL and ≥501 monocytes/mm3 compared with group A patients (p<0.05. Nevertheless, multivariate logistic regression analysis demonstrated that the independent predictors of angiographic coronary atherosclerosis were an N-terminal pro-B-type natriuretic peptide level ≥250 pg/mL, diabetes mellitus and increased monocyte numbers and fibrinogen plasma concentration, regardless of the creatinine level or the presence of systolic dysfunction.CONCLUSIONS:An N-terminal pro-B-type natriuretic peptide plasma concentration of ≥250 pg/mL is an independent predictor of angiographic coronary atherosclerosis.

  9. Coronary CT angiography in coronary artery disease: Opportunities and challenges

    Directory of Open Access Journals (Sweden)

    Zhonghua Sun

    2016-06-01

    Full Text Available Coronary CT angiography is widely recognised as a reliable imaging modality for the diagnosis of coronary artery disease. Coronary CT angiography not only provides excellent visualisation of anatomical changes in the coronary artery with high diagnostic value in the detection of lumen stenosis or occlusion, but also offers quantitative characterisation of coronary plaque components. Furthermore, coronary CT angiography allows myocardial perfusion imaging with diagnostic value comparable to the reference standard method. Coronary CT angiography-derived haemodynamic analysis has the potential to evaluate functional significance of coronary lesions. This review article aims to provide an overview of clinical applications of coronary CT angiography in coronary artery disease.

  10. Genetics of essential hypertension.

    Science.gov (United States)

    Mein, Charles A; Caulfield, Mark J; Dobson, Richard J; Munroe, Patricia B

    2004-04-01

    Essential hypertension affects 1 billion people worldwide and its genetic basis is well established. For this review we surveyed the literature on the genetics of hypertension during the past 18 months and we now report the highlights. There has been publication of the two largest genome scans for blood pressure and new loci including significant linkage to chromosome 6q have been reported. The molecular basis of Gordon's syndrome has been partially unravelled with a dual function for WNK4 in ion transport regulation being discovered. There has also been progress in narrowing rodent quantitative trait loci using congenic approaches and several linkage peaks have now been demonstrated to have more than one loci. We also report some of the initial findings from pharmacogenetic studies.

  11. Coronary artery disease (image)

    Science.gov (United States)

    ... through these arteries is critical for the heart. Coronary artery disease usually results from the build-up of fatty material and plaque, a condition called atherosclerosis. As the coronary arteries narrow, the flow of blood to the ...

  12. Coronary heart disease

    Science.gov (United States)

    Heart disease, Coronary heart disease, Coronary artery disease; Arteriosclerotic heart disease; CHD; CAD ... more calcium, the higher your chance for CHD. Exercise stress test . Heart CT scan . Nuclear stress test .

  13. Assessment of antioxidant enzyme activities in erythrocytes of pre-hypertensive and hypertensive women

    Directory of Open Access Journals (Sweden)

    Farshad Amirkhizi

    2010-01-01

    Full Text Available Background: Few studies that have investigated hypertension have considered a state of oxidative stress that can contribute to the development of atherosclerosis and other hypertension induced organ damage. The aim of this study was to investigate whether pre-hypertension and hypertension status is associated with activities of erythrocyte antioxidant enzymes in a random sample of cardiovascular disease-free women. Methods: In this case-control study, 53 pre-hypertensive women, 32 hypertensive women and 75 healthy controls were included. General information was gathered using questionnaires and face-to-face interviews. Blood pressure and anthropometric measurements were measured for each subject. Venous blood samples were drawn from subjects and plasma was separated. Activities of erythrocyte antioxidant enzymes were also evaluated by measuring activities of copper zinc-superoxide dismutase (CuZn-SOD, glutathione peroxidase (GPX and catalase (CAT in selected subjects. Results: Fifty-three (33.1% and 32 (20% participants were pre-hypertensive and hypertensive, respectively. The hypertensive and pre-hypertensive women had lower CuZn-SOD (p < 0.001 and GPX (p < 0.01 activities compared to normotensives. Furthermore, hypertensive women had lower CAT activity compared to pre-hypertensive and normotensive women (p < 0.001. Moreover, significant differences were also observed between hypertensive and pre-hypertensive women in erythrocyte CAT activity (p < 0.01. Conclusions: The present findings show that activities of erythrocyte antioxidant enzymes decrease in pre-hypertensive and hypertensive women, which may eventually lead to atherosclerosis and other high blood pressure related health problems.

  14. Role of angiotensin II type 1 receptor antagonists in the treatment of hypertension in patients aged >or=65 years.

    Science.gov (United States)

    Gradman, Alan H

    2009-01-01

    Systolic blood pressure (SBP) increases with age, and hypertension affects approximately two-thirds of adults in the US aged >60 years. Blood pressure (BP) increases as a consequence of age-related structural changes in large arteries, which lead to loss of elasticity and reduced vascular compliance. Increased pulse wave velocity augments SBP, resulting in a high prevalence of isolated systolic hypertension. Because age itself elevates cardiovascular risk, effective treatment of hypertension in an older (aged >or=65 years) patient population prevents many more events per 1000 patients treated than treatment of younger hypertensive patients. Recommendations for treating hypertension are similar in older patients compared with the general population. The Seventh Report of the Joint National Committee on Detection, Prevention, Evaluation, and Treatment of High Blood Pressure recommends target BP goals of hypertension, and treatment goals to include patients with coronary artery disease, other types of vascular disease and heart failure. Randomized clinical trials have demonstrated the efficacy of calcium channel antagonists (calcium channel blockers [CCBs]), low-dose diuretics, ACE inhibitors and angiotensin II type 1 receptor antagonists (angiotensin receptor blockers [ARBs]) in reducing the risk of stroke and other adverse cardiovascular outcomes in older patients; beta-adrenoceptor antagonists are less effective in terms of endpoint reduction. The majority of older patients require two or more drugs to achieve BP goals. Despite active treatment, half of these patients do not achieve target BP, in part because of the reluctance of physicians to intensify treatment, a phenomenon referred to as 'clinical inertia'. ARBs are effective antihypertensive agents in older patients and have been shown to reduce cardiovascular endpoints in patients with hypertension, diabetic nephropathy, cerebrovascular disease and heart failure. ARBs produce additive BP reduction when

  15. Regulation of the renin–angiotensin system in coronary atherosclerosis: A review of the literature

    Directory of Open Access Journals (Sweden)

    Ramadan A Hammoud

    2008-01-01

    Full Text Available Ramadan A Hammoud, Christopher S Vaccari, Sameer H Nagamia, Bobby V KhanEmory University School of Medicine, Division of Cardiology, Grady Memorial Hospital Vascular Research Laboratory, Atlanta, Georgia, USAAbstract: Activation of the renin–angiotensin system (RAS is significant in the pathogenesis of cardiovascular disease and specifically coronary atherosclerosis. There is strong evidence that the RAS has effects on the mechanisms of action of atherosclerosis, including fibrinolytic balance, endothelial function, and plaque stability. Pharmacological inhibition of the renin angiotensin system includes angiotensin converting enzyme (ACE inhibitors, angiotensin receptor blockers (ARBs, and renin inhibitors. These agents have clinical benefits in reducing morbidity and mortality in the management of hypertension. In addition, ACE inhibitors and ARBs have shown to be effective in the management of congestive heart failure and acute myocardial infarction. This review article discusses the biochemical and molecular mechanisms involving the RAS in coronary atherosclerosis as well as the effects of RAS inhibition in clinical studies involving coronary atherosclerosis.Keywords: angiotensin II, atherosclerosis, endothelium, inflammation, vasculature

  16. Managing hypertension in the newborn infants

    Directory of Open Access Journals (Sweden)

    Azar Nickavar

    2014-01-01

    Full Text Available Hypertension in newborn infants, particularly those requiring intensive care, is becoming increasingly recognized, with prevalence of 0.2-3%. Recent studies have established normative tables for blood pressure (BP in both term and pre-term infants based on the gestational age, postnatal age, gender, weight and height, identifying the neonates at increased risk for early-onset cardiovascular disease. Common causes of neonatal hypertension include thromboembolic complications secondary to umbilical artery catheterization, congenital renal structural malformation, renovascular disease, aortic coarctation, as well as acute kidney injury and certain medications. A careful diagnostic evaluation should lead to identification of the underlying cause of hypertension in most infants. Treatment options should be tailored to the severity; and underlying cause of hypertension, including intravenous and/or oral therapy. This review summarizes recent work in these areas, focusing on optimal BP measurement, definition, evaluation and management of hypertension as well as advances in drug therapy of neonatal hypertension.

  17. Coronary Artery Bypass in Octogenarians

    Directory of Open Access Journals (Sweden)

    Chen-Yen Chien

    2012-09-01

    Full Text Available Prevalence of coronary artery disease (CAD has increased with the expansion of life span among the elderly population in the world. Hence, the issue of the coronary artery bypass in octogenarians has attracted more attention. Recent literature about the topic revealed nearly the same excellent results as those in the younger population under the newly developed operative techniques and improving concept in perioperative management and postoperative care. In this article, we review the current status of the procedure that was thought to be dangerous in the earlier era, including its risk factors, result, and benefit.

  18. Coronary Artery Disease in critical patients of Iran

    International Nuclear Information System (INIS)

    Zahra, P.M.; Azizollah, A.S.; Masoud, R.; Hamed, S.

    2012-01-01

    Objective: To identify the risk factors for Coronary Artery Diseases (CAD), such as hypertension, hyperlipidaemia, smoking, age, obesity, immobility and diabetes mellitus, in critical patients of Sistan-Baluchistan (SB), Iran. Methods: This cross-sectional research was performed in 2006. The sampling method was convenience, and involved 616 hospitalised patients in the CCUs of hospitals of Sistan-Baluchistan province. Data was collected by structured interview and a checklist which included personal characteristics and risk factors like lifestyles as well as biochemical and physiological factors for CAD. SPSS software, Chi-square and exact fisher tests were used for analysis. Results: Frequency of risk factors among patients with CAD was found to be high in the study area. Also, the results showed that the prevalence of some risk factors, such as diabetes mellitus 198 (32.5%), hypertension 266 (43.7%) and obesity 131 (22.9%), was significantly higher in women than men. Besides, there was a significant relationship between smoking, 317(52.3%) and low mobility 503 (83.3%), with gender (p=0.001). Conclusion: Clinical and para-clinical data indicated that the adult population has a high level of CAD risk factors in the Sistan-Baluchistan province which may require urgent steps to address national control measures regarding CAD. Implementation of a prevention programme is necessary in order to reduce the risk factors. Also, health education is necessary, specially for women. (author)

  19. Noninvasive Diagnostic Technique in Stenotic Coronary Atherosclerosis

    Directory of Open Access Journals (Sweden)

    A. Yu. Vasilyev

    2005-01-01

    Full Text Available Objective: to determine the sensitivity and specificity of combined stress echocardiography (EchoCG using dipyri-damole and dobutamine in diagnosing and defining the extent of stenotic coronary lesions in coronary heart disease (CHD in a group of critically ill patients who are unable to perform a physical exercise.Materials and methods: the study included 57 male patients with suspected acute coronary syndrome who underwent stress EchoCG using dipyridamole in high doses in combination with dobutamine, as well as coronary angiography.Results: stress EchoCG could bring up to the diagnostic criteria in all the patients, of whom 9 patients were found at coronary angiography to have no coronary lesion, 34 and 14 patients had one- and many-vessel lesions, respectively. The sensitivity and specificity of combined stress EchoCG were significantly higher than those of EchoCG used in the diagnosis of CHD.Conclusion: stress EchoCG using dipyridamole in combination with dobutamine is a highly informative safe noninvasive technique for diagnosing CHD, its helps to identify patients with atypical acute coronary syndrome and to form a group of patients to be subject to urgent coronarography and angiosurgical intervention. The pattern of segmental contractile disorders at the height of exercise during combined stress Echo-CG makes it possible to define the site of stenotic coronary atherosclerosis with 97.3% sensitivity and to diagnose many-vessel lesion with 100% sensitivity and 100%specificity.

  20. Comparison of Myocardial Perfusion Scintigraphy and Coronary Angiography Results

    Directory of Open Access Journals (Sweden)

    Umut Elboga

    2017-05-01

    Full Text Available Aim: Coronary artery disease (CAD is one of the most frequent causes of mortality and morbidity worldwide. Coronary angiography is the gold standard for the anatomical diagnosis of coronary artery stenosis. Myocardial Perfusion Scintigraphy (MPS is a non-invasive imaging modality used for the diagnosis of CAD. In this study, we aimed to compare the findings of MPS and coronary angiogram. Material and Method: Eighty-one patients (37 males, 44 females; mean age 55 ± 10.95 years with angina and detected perfusion defects on MPS were included in this study. All of the patients underwent coronary angiogram. A narrowing %u2265 50% was considered pathological on the coronary angiography. Results: Findings of the coronary angiogram and MPS were compared and found consistent in 51 (63% patients. A coronary narrowing < 50% was detected by coronary angiogram in 4 (5% of the remaining patients. Coronary angiogram was found to be normal in the remaining 26 patients (32% and these patients were evaluated as cardiac syndrome X (CSX known as microvascular angina (MA. Discussion: The findings showed that MPS is superior to coronary angiogram in the early diagnosis of myocardial perfusion disorders at the microvascular level. Therefore, we concluded that MPS should be the primary diagnostic tool to begin treatment before an anatomically large narrowing occurs in the coronaries.

  1. Risk factors of coronary heart disease among medical diagnostic X-ray workers

    International Nuclear Information System (INIS)

    Zhang Wei; Wang Jixian; Zhao Yongcheng; Li Benxiao; Fan Tiqiang; Zhao Zhigang; Lin Zhidong

    2002-01-01

    Objective: To investigate risk factors of coronary heart disease (CHD) in medical diagnostic X-ray workers in China, especially the relationship of CHD with occupational irradiation. Methods: A 1:2 matched case-control study was carried out. The study subjects consisted of 112 pair-matched cases and controls coming from different hospitals in China. Information about occupational and non-occupational risk factors obtained by interviewing every subjects personally. Individual doses were estimated by normalized work load method. SAS 6.12 software conditional Logistic regression method was applied to data analysis. Results: Variables such as family history of CHD (OR=17.298, P = 0.0001), history of hypertension (OR = 6.172, P = 0.0003), overweight (OR = 2.679, P = 0.0150), physical exercises (OR = 0.421, P0.0333), diabetes (OR = 7.823, P = 0.0200), radiation protection condition (OR = 3.992, P 0.0027), and accumulated radiation dose (OR = 1.612, P 0.0454) were included in the last model. Conclusions: For the medical diagnostic X-ray workers, family history of coronary heart disease, history of hypertension, diabetes, etc. are the main risk factors of CHD, and occupational exposure may be a potential risk factor. As for the mechanism, further studies are needed

  2. Hypertension in women

    OpenAIRE

    Hage, Fadi G; Mansur, Sulaf J; Xing, Dongqi; Oparil, Suzanne

    2013-01-01

    Hypertension is the most common modifiable risk factor for cardiovascular disease, the leading cause of death in both men and women. The prevalence and severity of hypertension rise markedly with age, and blood pressure control becomes more difficult with aging in both genders, particularly in women. In addition, there are forms of hypertension that occur exclusively in women, e.g., hypertension related to menopause, oral contraceptive use, or pregnancy (e.g., chronic hypertension, gestationa...

  3. CMR diagnosis of coronary graft fistula

    Directory of Open Access Journals (Sweden)

    Bengt Johansson

    2014-01-01

    Full Text Available The patient is a 54-year old man with a previous history of cerebral aqueduct stenosis and hydrocephalus resulting in malignant hypertension who had surgery for permanent ventriculo-peritoneal shunt. At age 41, he had coronary artery bypass graft (CABG surgery with the right internal mammary artery anastomosed to the posterior descending artery and a saphenous vein graft to the first obtuse marginal branch. The patient was recently admitted with pneumonia that rapidly deteriorated and he went in respiratory failure requiring mechanical ventilation. A thoracic CT investigation showed massive bilateral pulmonary infiltrates, pulmonary artery embolism and a large vein graft aneurysm with a maximal diameter of 40 mm (Figure 1 A-B. The management course was complicated with prolonged respiratory failure, persistent infection, despite negative cultures and extended hospital stay. After 50 days of slow recovery the patient was discharged with a need for home oxygen therapy. Ten days later, he was re-admitted with chest pain requiring admission to the coronary care unit where severe pulmonary hypertension was diagnosed with Doppler echocardiography. Troponin-T was mildly elevated, 1,3 ug/L (ref <0,01, CRP was 50 mg/L and chest X-ray showed bilateral lung infiltrates and wide pulmonary vessels. At this point a systo-diastolic murmur was heard at the left lower sternal edge. With a view of potential coronary reintervention and to evaluate the pulmonary hypertension, a coronary angiogram and a pulmonary artery cathetherisation were performed. This showed a new stenosis in the left anterior descending coronary artery and the pulmonary catheterisation showed a “step-up” in oxygen saturation in the pulmonary artery, suggesting a left-to-right shunt. The vein graft aneurysm did not contribute to the coronary circulation. A cardiovascular magnetic resonance scan revealed a communication between the vein graft aneurysm and the left branch pulmonary artery

  4. The carotid intima media thickness: a predictor of the clincal coronary events.

    Science.gov (United States)

    George, Jinzy Mariam; Bhat, Raghavendra; Pai, K Mohan; S, Arun; Jeganathan, Jayakumar

    2013-06-01

    The Carotid Intima-Media Thickness (CIMT) is a simple and an inexpensive tool which can be used to assess the cumulative effect of atherosclerotic risk factors and it is also an independent predictor of the future cardiovascular risk. Nevertheless, criticism has been raised throughout the scientific community, based on the observations which indicated a weak correlation between CIMT and coronary atherosclerosis. It has been suggested by the International Atherosclerosis Project, that the atherosclerotic process occurs at the same time in the carotid, cerebral and the coronary arteries. Measurement of the Carotid Intima-Media Thickness (CIMT) of the Common Carotid Artery (CCA) by B-mode ultrasound was found to be a suitable non-invasive method, to visualize the arterial walls and to monitor the early stages of the atherosclerotic process. This study sought to determine the usefulness of B-mode ultrasound as a non-invasive marker to examine the association between CIMT and the extent and the severity of coronary artery disease and its association with the cardiovascular risk factors, if any. A cross-sectional study was done among hundred cases and hundred age and sex matched controls who were in the age group of 30-65 years. The cases included those who had undergone coronary angiography. The controls included non-diabetic non-hypertensives with no cardiovascular risk factors. The CIMT was assessed by using a 7MHz linear array transducer. Fasting blood samples were collected for measuring the blood sugar and the lipid profiles. The statistical analysis was done by using the Student's t test and ANOVA and a p value of Media Thickness (AVCIMT) was higher in the cases (0.90 vs 0.47 in controls, p<0.001, very highly significant). The AVCIMT was found to be higher in those with triple vessel disease (1.00mm) coronaries (0.65mm). The easy applicability and the non invasive nature of B

  5. Potential association between coronary artery disease and the inflammatory biomarker YKL-40 in asymptomatic patients with type 2 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Kim Hyun

    2012-07-01

    Full Text Available Abstract Background Inflammation plays an important role in coronary artery disease from the initiation of endothelial dysfunction to plaque formation to final rupture of the plaque. In this study, we investigated the potential pathophysiological and clinical relevance of novel cytokines secreted from various cells including adipocytes, endothelial cells, and inflammatory cells, in predicting coronary artery disease (CAD in asymptomatic subjects with type 2 diabetes mellitus. Methods We enrolled a total of 70 asymptomatic type 2 diabetic patients without a documented history of cardiovascular disease, and determined serum levels of chemerin, omentin-1, YKL-40, and sCD26. We performed coronary computed tomographic angiography (cCTA in all subjects, and defined coronary artery stenosis ≥ 50 % as significant CAD in this study. Results Subjects were classified into two groups: patients with suspected coronary artery stenosis on cCTA (group I, n = 41 and patients without any evidence of stenosis on cCTA (group II, n = 29. Group I showed significantly higher YLK-40 levels and lower HDL-C levels than group II (p = 0.038, 0.036, respectively. Levels of chemerin, omentin-1, and sCD26 were not significantly different between the two groups. Serum YKL-40 levels were positively correlated with systolic/diastolic BP, fasting/postprandial triglyceride levels, and Framingham risk score. Furthermore, YKL-40 levels showed moderate correlation with the degree of coronary artery stenosis and the coronary artery calcium score determined from cCTA. In multivariate logistic analysis, after adjusting for age, gender, smoking history, hypertension, and LDL-cholesterol, YLK-40 levels showed only borderline significance. Conclusions YKL-40, which is secreted primarily from inflammatory cells, was associated with several CVD risk factors and was elevated in type 2 diabetic patients with suspected coronary artery stensosis on cCTA. These results suggest

  6. Correlation between religion and hypertension.

    Science.gov (United States)

    Meng, Qingtao; Zhang, Xin; Shi, Rufeng; Liao, Hang; Chen, Xiaoping

    2018-01-25

    The objectives of the study were to investigate the relationship between religion and hypertension, as well as the theoretical mechanism through which religion exerts effect on hypertension. A MEDLINE literature search was performed on articles describing religion and hypertension (N = 543) excluding unqualified ones such as those without expected information, those neither correcting confounding factors nor matching the comparison groups and those reporting repeated trials. Eight extra articles from references of reviews were added to the included studies. Finally, 79 articles were formerly evaluated. Briefly, there are limited trials on correlation between religion and hypertension and their results are inconsistent. First of all, longitudinal investigations, especially the high-quality ones, are deficient. Secondly, studies evaluating religion as an integral are scarce, although they can assess religions most comprehensively. Third, few studies use several religious measurements that represent distinct dimensions of religion. Moreover, divergence exists among diverse populations, even if they are assessed by the same indicator. In addition, 59% studies are concerned with an unspecified species of religion, and Christianity is studied the most among those with a specific category of religion. Finally, the possible mechanism underlying religion and hypertension is complex, which can partially explain the different results among various populations. Comprehensive evaluation of a specific religion should be encouraged. In addition, for a specific population, the correlation between religion and hypertension should be examined particularly, even if similar investigations in other populations have been conducted. Finally, more evidence focused on the effects of distinct religions/sects is also required.

  7. [Resistant hypertension: An update].

    Science.gov (United States)

    Renna, N F

    2018-01-31

    An estimated 10% to 20% of hypertensive patients could be considered resistant to treatment (RH). These are patients who are not controlled using three drugs, at the maximum tolerated doses, including a diuretic, as well as those with high blood pressure controlled using four or more drugs. The term is used to identify patients that might benefit from special diagnostic and/or therapeutic consideration. The term 'refractory hypertension' has recently been proposed as a novel phenotype of antihypertensive failure. It refers to patients whose blood pressure cannot be controlled with maximum treatment. The first studies of this phenotype indicate that it is rare and affects less than 5% of patients with RH. Adherence to or compliance with medical treatment is key to defining resistant hypertension. Closer attention has been paid to clinical and experimental research since the first scientific statement for the diagnosis, assessment and treatment of RH from the American Heart Association, and in the European guidelines, was published in 2008. This review will set out the concepts relating to prevalence, prognosis and compliance and cover the latest developments on this subject. Copyright © 2018 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Low-intensity isometric handgrip exercise has no transient effect on blood pressure in patients with coronary artery disease.

    Science.gov (United States)

    Goessler, Karla; Buys, Roselien; Cornelissen, Véronique A

    2016-08-01

    Hypertension is highly prevalent among patients with coronary artery disease (CAD). Exercise-based cardiac rehabilitation reduces blood pressure (BP). However, less is known about the transient effect of a single bout of exercise on BP. Isometric handgrip exercise has been proposed as a new nonpharmacologic tool to lower BP. We aimed to investigate the acute effect of isometric handgrip exercise on BP in CAD patients. Twenty-one male CAD patients were included. All patients completed two experimental sessions in random order: one control and one low-intensity isometric handgrip session. BP was measured by means of a 24-hour ambulatory BP monitor preintervention, for 1 hour in the office and subsequently for 24 hours. Our results suggest that isometric handgrip exercise performed at low intensity is safe in patients with CAD but does not induce a transient reduction in BP. Copyright © 2016 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.

  9. [Hypertensive crisis: urgency and hypertensive emergency].

    Science.gov (United States)

    Sobrino Martínez, Javier; Doménech Feria-Carot, Mónica; Morales Salinas, Alberto; Coca Payeras, Antonia

    2016-11-18

    Hypertensive crises lumped several clinical situations with different seriousness and prognosis. The differences between hypertensive urgency and hypertensive emergency depends on if this situation involves a vital risk for the patient. This risk is defined more by the severity of the organ damage than for the higher values of blood pressure. The hypertensive urgency not involves an immediately risk for the patient, for these reason, the treatment can be completed after discharged. Otherwise, the hypertensive emergency is a critical clinical condition that requires hospital assistance. Faced with a patient, with severe hypertension, asymptomatic or with unspecific symptoms we must be careful. First, we need to confirm the values of blood pressure, with several measures of blood pressure and investigate and treat factors, which triggered this situation. The objective of medical treatment for hypertensive urgency is to reduce blood pressure values (at least 20% of baseline values) but to avoid sudden reduction of these values. In hypertensive urgencies rapid acting drug should not be used because of the risk of ischemic stroke and use drugs with longer half-life. The cardiovascular risk of these patients is higher than that do not suffer hypertensive crisis. The treatment must be personalized in each hypertensive emergency and intravenous it’s the best route to treat these patients.

  10. Systolic hypertension in adult nigerians with hypertension

    International Nuclear Information System (INIS)

    Opadijo, O.G.; Salami, T.A.T.; Sanya, E.O.; Omotoso, A.B.O.

    2007-01-01

    To determine the prevalence of both systolic and diastolic hypertensions in relation to age and their impacts on target organ among adult Nigerians with hypertension. Newly diagnosed adult hypertensives, with blood pressure 140/90mm Hg, taken twice with mercury column sphygmomanometer at 3 weeks interval, were studied. The total number of hypertensive patients treated over this period was also taken into consideration. The newly diagnosed hypertensives were classified using JNC VI classification. The frequency of occurrence of target organ damage such as Left Ventricular Hypertrophy (LVH), heart failure, renal impairment etc. was charted according to systolic and or diastolic pressures. The occurrence of systolic or diastolic blood pressure was also related with the age of the patients. Blood metabolic parameters were compared in both systolic and diastolic blood pressures for their possible contributory role. Two thousand seven hundred and ninety-two adult hypertensive patients were managed over the study period. Of them, 218 (7.8%) were newly diagnosed and studied. There were 94 males and 124 females. Seventy-seven (35.3%) were aged 60 years and above with equal frequency in the gender. One hundred and seventy-eight (81.7%) cases had combined systolic and diastolic pressures. Twenty-nine (13.3%) patients had systolic hypertension. Twenty-five (86.2%) of these 29 were aged 50 years and above and 20 (69.0%) were aged 60 years and above. Eleven (5.0%) patients had isolated diastolic hypertension and they were all in the age bracket 40-49 years. Systolic blood pressure was found to be rising with advancing age while diastolic blood pressure peaked at mid 40's and declined. Target organ damage occurred more frequently with systolic hypertension and advancing age than with diastolic hypertension. Systolic hypertension occurred more frequently in this series of adult Nigerians with hypertension. It was higher with advancing age and associated with more target organ

  11. Pregnancy risks in women with pre-existing coronary artery disease, or following acute coronary syndrome

    NARCIS (Netherlands)

    Burchill, Luke J.; Lameijer, Heleen; Roos-Hesselink, Jolien W.; Grewal, Jasmine; Ruys, Titia P. E.; Kulikowski, Julia D.; Burchill, Laura A.; Oudijk, M. A.; Wald, Rachel M.; Colman, Jack M.; Siu, Samuel C.; Pieper, Petronella G.; Silversides, Candice K.

    2015-01-01

    Objective The objective of this study was to determine outcomes in pregnant women with pre-existing coronary artery disease (CAD) or following an acute coronary syndrome (ACS) including myocardial infarction (MI). Background The physiological changes of pregnancy can contribute to myocardial

  12. Subclinical coronary atherosclerosis identified by coronary computed tomographic angiography in asymptomatic morbidly obese patients

    Directory of Open Access Journals (Sweden)

    Peter A. McCullough

    2010-09-01

    Full Text Available Obesity is a common public health problem and obese individuals in particular have a disproportionate incidence of acute coronary events. This study was undertaken to identify coronary artery lesions as well as associated clinical features, risk factors and demographics in patients with a body mass index (BMI >40 kg/m2 without known coronary artery disease (CAD. Morbidly obese subjects were prospectively recruited to undergo coronary computed tomographic angiography (CCTA using a dual-source computed tomography (CT system. CAD was defined as the presence of any atherosclerotic lesion in any one coronary artery segment. The presence, location, and severity of atherosclerosis were related to patient characteristics. Forty-one patients (28 women, mean age, 50.4±10.0 years, mean BMI, 43.8±4.8 kg/m2 served as the study population. Of these, 25 patients (61% had at least one coronary stenosis. All but 2 patients within the CAD cohort had coronary artery calcium (CAC scores >0, and most plaques identified (75.4% were non-calcified. There was a predilection of calcified and non-calcified atherosclerosis involving the left anterior descending (LAD coronary artery compared with other coronary segments. Univariate predictors of CAD included older age, dyslipidemia, and diabetes. In this preliminary study of young morbidly obese patients, CCTA detected a high prevalence of calcified and non-calcified CAD, although the later predominated.

  13. [All-cause mortality and incidence of major cardiovascular events in hypertensive patients with ASCOT-type profile in a Spanish population setting].

    Science.gov (United States)

    Sicras-Mainar, Antoni; Fernández de Bobadilla, Jaime; Navarro-Artieda, Ruth; Rejas-Gutiérrez, Javier

    2010-08-01

    Mediterranean populations are traditionally considered to be associated with lower incidence of cardiovascular events (CVE). However, this might not be homogeneous throughout different patient strata. The goal was to compare the incidence of CVE and all-causes mortality in hypertensive patients with an ASCOT-type profile with that of the rest hypertensive subjects. A retrospective analysis was carried out using a claim database. Hypertensive patients without known cardiovascular disease on antihypertensive therapy included during year 2006 were followed up for two consecutive years to ascertain the incidence of all-causes mortality and any CVE. CVE included any of the following: coronary heart disease, acute myocardial infarction (AMI), angina, stroke, transient ischemic attack (TIA) and peripheral artery disease. Patients with ASCOT and ASCOT-LLA type profiles were identified and compared with non-ASCOT-type profile hypertensive subjects. A total of 11,104 were included in the analysis; 68.0+/-11.4 years, 41.6% males. More than 73% of subjects fulfilled criteria for ASCOT-type profile. All-causes mortality were numerically higher in ASCOT and ASCOT-LLA subjects compared with non-ASCOT-type; hazard ratio (95% CI)=1.3 (0.8-1.9) and 1.6 (0.9-2.8), respectively. However, any-coronary event rate was significantly higher in ASCOT-type [2.3 (1.8-2.8), plikely to have any cardiovascular event than those hypertensive patients without ASCOT profile in a Mediterranean setting in Spain. Copyright 2009 Elsevier España, S.L. All rights reserved.

  14. Hypertensive crisis during pregnancy and postpartum period.

    Science.gov (United States)

    Too, Gloria T; Hill, James B

    2013-08-01

    Hypertension affects 10% of pregnancies, many with underlying chronic hypertension, and approximately 1-2% will undergo a hypertensive crisis at some point during their lives. Hypertensive crisis includes hypertensive urgency and emergency; the American College of Obstetricians and Gynecologists describes a hypertensive emergency in pregnancy as persistent (lasting 15 min or more), acute-onset, severe hypertension, defined as systolic BP greater than 160 mmHg or diastolic BP >110 mmHg in the setting of pre-eclampsia or eclampsia. Pregnancy may be complicated by hypertensive crisis, with lower blood pressure threshold for end-organ damage than non-pregnant patients. Maternal assessment should include a thorough history. Fetal assessment should include heart rate tracing, ultrasound for growth and amniotic assessment, and Doppler evaluation if growth restriction is suspected. Initial management of hypertensive emergency (systolic BP >160 mmHg or diastolic BP >110 mmHg in the setting of pre-eclampsia or eclampsia) generally includes the rapid reduction of blood pressure through the use of intravenous antihypertensive medications, with goal systolic blood pressure between 140 mmHg and 150 mmHg and diastolic pressure between 90 mmHg and 100 mmHg. First-line intravenous drugs include labetalol and hydralazine, but other agents may be used, including esmolol, nicardipine, nifedipine, and, as a last resort, sodium nitroprusside. Among patients with hypertensive urgency, slower blood pressure reduction can be provided with oral agents. The objective of this article is to review the current understanding, diagnosis, and management of hypertensive crisis during pregnancy and the postpartum period. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Anatomical studies of the coronary system in elasmobranchs: II. Coronary arteries in hexanchoid, squaloid, and carcharhinoid sharks.

    Science.gov (United States)

    De Andrés, A V; Muñoz-Chápuli, R; Sans-Coma, V; García-Garrido, L

    1992-07-01

    Coronary artery anatomy was studied in 16 shark species belonging to 9 families of the orders Hexanchiformes, Squaliformes, and Carcharhiniformes. The study included 101 specimens and used an injection-corrosion technique that obtained internal casts of the main trunks and coronary arterial branches. The results showed 2 main patterns of coronary arterial arrangement: the dorsoventral coronary trunk pattern, shared by lamnoid and advanced carcharhinoid sharks, and the lateral coronary trunk pattern, shown by hexanchoid and squaloid sharks. Scyliorhinus and Galeus had intermediate arrangements of their vessels.

  16. 201Tl myocardial imaging in patients with pulmonary hypertension

    International Nuclear Information System (INIS)

    Cohen, H.A.; Baird, M.G.; Rouleau, J.R.; Fuhrmann, C.F.; Bailey, I.K.; Summer, W.R.; Strauss, H.W.; Pitt, B.

    1976-01-01

    The appearance of the right ventricular myocardium on thallium 201 myocardial perfusion images was evaluated in patients with chronic pulmonary hypertension and compared to patients without pulmonary hypertension. Four groups of patients were studied: (1) eight normals, (2) five patients with angiographically documented coronary artery disease and normal pulmonary artery pressures, (3) ten patients with moderate to severe pulmonary parenchymal or vascular disease and documented pulmonary hypertension and (4) eight patients with chronic left ventricular dysfunction and pulmonary hypertension discovered during cardiac catheterization. The right ventricular free wall was visualized on the thallium 201 myocardial perfusion image in only one of eight normals (group 1) and in only one of the five patients with coronary artery disease (group 2) and measured 0.5 cm and 0.9 cm in thickness, respectively. In patients with documented pulmonary hypertension the right ventricle was visualized on low contrast thallium 201 myocardial perfusion image in all patients. The apparent right ventricular free wall thickness measured from the ungated thallium 201 myocardial perfusion images was 1.7 +- 0.3 cm in group 3 and 1.5 +- 0.2 cm in group 4. Right ventricular hypertrophy was detected by electrocardiography in only five of ten patients in group 3 and only one of eight patients in group 4. Thallium 201 myocardial perfusion imaging appears to be a useful technique for assessing the effects of chronic pulmonary hypertension on the right ventricular myocardium

  17. Hypertension and appraisal of physical and psychological stressors

    NARCIS (Netherlands)

    Nyklicek, I.; Vingerhoets, A.J.J.M.; van Heck, G.L.

    2001-01-01

    Objective: In the operant conditioning of hypertension hypothesis, it is assumed that the frequently found diminished sensitivity to painful stimuli in hypertensives can be generalized to sensitivity to other stressors, including psychological stressors. The validity of this assumption is examined

  18. Spontaneous Coronary Artery Dissection: Clinical Outcomes and Risk of Recurrence.

    Science.gov (United States)

    Saw, Jacqueline; Humphries, Karin; Aymong, Eve; Sedlak, Tara; Prakash, Roshan; Starovoytov, Andrew; Mancini, G B John

    2017-08-29

    Spontaneous coronary artery dissection (SCAD) is underdiagnosed and an important cause of myocardial infarction (MI), especially in young women. Long-term cardiovascular outcomes, including recurrent SCAD, are inadequately reported. This study sought to describe the acute and long-term cardiovascular outcomes and assess the predictors of recurrent SCAD. Nonatherosclerotic SCAD patients were prospectively followed at Vancouver General Hospital systematically to ascertain baseline, predisposing and precipitating stressors, angiographic features, revascularization, use of medication, and in-hospital and long-term cardiovascular events. Clinical predictors for recurrent de novo SCAD were tested using univariate and multivariate Cox regression models. The authors prospectively followed 327 SCAD patients. Average age was 52.5 ± 9.6 years, and 90.5% were women (56.9% postmenopausal). All presented with MI; 25.7% had ST-segment elevation MI, 74.3% had non-ST-segment elevation MI, and 8.9% had ventricular tachycardia/ventricular fibrillation. Precipitating emotional stressors were reported in 48.3% and physical stressors in 28.1%. Fibromuscular dysplasia was present in 62.7%, connective tissue disorder in 4.9%, and systemic inflammatory disease in 11.9%. The majority (83.1%) were initially treated medically, with only 16.5% or 2.2% undergoing in-hospital percutaneous coronary intervention or coronary artery bypass graft surgery, respectively. The majority of SCAD patients were taking aspirin and beta-blocker therapy at discharge and at follow-up. Median hospital stay was 3.0 days, and the overall major adverse event rate was 7.3%. Median long-term follow-up was 3.1 years, and overall major adverse cardiac event rate was 19.9% (death rate: 1.2%; recurrent MI: 16.8%; stroke/transient ischemic attack: 1.2%; revascularization: 5.8%). Recurrent SCAD occurred in 10.4% of patients. In multivariate modeling, only hypertension increased (hazard ratio: 2.46; p = 0.011) and

  19. "Risk factors in mortality after coronary artery bypass graft - Imam Hospital (1996-1999 "

    Directory of Open Access Journals (Sweden)

    "Radmehr H

    2002-08-01

    Full Text Available Introduction: Ischemic heart disease is the most common cause of mortality in developed countries. CABG (Coronary Artery Bypass Graft is one of the therapeutic methods in ischemic heart disease. Methods and Materials: Considering the increased incidence of coronary artery disease in Iran, and with increased rate of CABG, we performed a cross sectioned study (1996-1999. In 635 patients 467 male (73.5 percent, 168 female (26.5 percent about risk factors of mortality after CABG in cardiac surgery department "Imam Khomeini hospital. 20 risk factors were included in our study: age, gender, smoking, family history, diabetes mellitus, morbid obesity, hypercholesterolemia, hypertension, palpitation, renal failure COPD, (chronic obstructive pulmonary disease, history of myocardial infarction, CHF, angina, cerebral vascular disease, pace maker, Ejection fraction<40 percent, history of PTCA, history of CPR, and coronary endarterectomy. Results: Cigarette smoking (P=0.40, CHF in female (P=0.003. Endarterectomy in both gender (P=0.0001. Pace maker in both gender (P=0.00006, palpitation in both gender (P=0.0001. CPR in both gender (P=0.0000001, were associated with increased risk of mortality after CABG. Conclusion: We found that, endarterctomy, cigarette smoking, CHF. Pace maker, CPR, and palpitation are important risk factors for mortality after CABG.

  20. Contribution of nursing to risk factor management as perceived by patients with established coronary heart disease.

    Science.gov (United States)

    Scholte op Reimer, Wilma J M; Jansen, Chris H; de Swart, Esther A M; Boersma, Eric; Simoons, Maarten L; Deckers, Jaap W

    2002-06-01

    Guidelines stress the importance of risk factor management in patients with coronary heart disease (CHD). To evaluate whether guidelines on patient education in risk factor management are followed in clinical practice and to assess the contribution of nursing to risk factor management as perceived by patients with established CHD. Within three Dutch hospitals consecutive patients were identified after a first coronary-artery bypass graft, a first percutaneous transluminal coronary angioplasty or hospital admission for acute myocardial infarction or ischaemia (n=357). Data were collected through patient interviews at least 6 months after hospital admission. Among smokers, overweight patients, patients with hypertension, high cholesterol, and sedentary lifestyle, respectively 75, 36, 67, 61 and 49% reported that information on presence or management of these risk factors was provided. The proportion of patients informed by nurses ranged from 14% (lowering cholesterol) to 23% (increasing physical activity), while 55% (lowering cholesterol) to 71% (stop smoking) were informed by physicians. Many patients with established CHD and cardiovascular risk factors do not remember ever having received information about management of their risk factors. Clearly, there is a substantial potential to improve professionals' compliance to guidelines on risk factor management, including those on patient education. The perceived contribution of nurses to risk factor management is small compared to that of physicians and other caregivers. If risk factor management is felt to be a main responsibility of nurses, current nursing activities in this area should be reconsidered within an improved organisational structure.

  1. Relationship between framingham risk score and coronary artery calcium score in asymptomatic Korean individuals

    Energy Technology Data Exchange (ETDEWEB)

    Heo, So Young; Park, Noh Hyuck; Park, Chan Sub; Seong, Su Ok [Dept. of Radiology, Myongji Hospital, Seonam University College of Medicine, Goyang (Korea, Republic of)

    2016-02-15

    We explored the association between Framingham risk score (FRS) and coronary artery calcium score (CACS) in asymptomatic Korean individuals. We retrospectively analyzed 2216 participants who underwent routine health screening and CACS using the 64-slice multidetector computed tomography between January 2010 and June 2014. Relationship between CACS and FRS, and factors associated with discrepancy between CACS and FRS were analyzed. CACS and FRS were positively correlated (p < 0.0001). However, in 3.7% of participants with low coronary event risk and high CACS, age, male gender, smoker, hypertension, total cholesterol, diabetes mellitus, and body mass index (BMI; ≥ 35) were associated with the discrepancy. In the diagnostic prediction model for discrepancy, the receiver operating characteristic curve including factors associated with FRS, diastolic blood pressure (≥ 75 mm Hg), diabetes mellitus, and BMI (≥ 35) showed that the area under the curve was 0.854 (95% confidence interval, 0.819–0.890), indicating good sensitivity. Diabetes mellitus or obesity (BMI ≥ 35) compensate for the weakness of FRS and may be potential indicators for application of CACS in asymptomatic Koreans with low coronary event risk.

  2. Do diabetes mellitus and systemic hypertension predispose to left ventricular free wall rupture in acute myocardial infarction?

    DEFF Research Database (Denmark)

    Melchior, T; Hildebrant, P; Køber, L

    1997-01-01

    Diabetes and systemic hypertension had no influence on left ventricular free wall rupture complicating acute myocardial infarction. Age <65 years and a history of coronary artery disease offers some protection from protection.......Diabetes and systemic hypertension had no influence on left ventricular free wall rupture complicating acute myocardial infarction. Age artery disease offers some protection from protection....

  3. Common Secondary Causes of Resistant Hypertension and Rational for Treatment

    Directory of Open Access Journals (Sweden)

    Charles Faselis

    2011-01-01

    Full Text Available Resistant hypertension is defined as uncontrolled blood pressure despite the use of three antihypertensive drugs, including a diuretic, in optimal doses. Treatment resistance can be attributed to poor adherence to antihypertensive drugs, excessive salt intake, physician inertia, inappropriate or inadequate medication, and secondary hypertension. Drug-induced hypertension, obstructive sleep apnoea, primary aldosteronism, and chronic kidney disease represent the most common secondary causes of resistant hypertension. Several drugs can induce or exacerbate pre-existing hypertension, with non-steroidal anti-inflammatory drugs being the most common due to their wide use. Obstructive sleep apnoea and primary aldosteronism are frequently encountered in patients with resistant hypertension and require expert management. Hypertension is commonly found in patients with chronic kidney disease and is frequently resistant to treatment, while the management of renovascular hypertension remains controversial. A step-by-step approach of patients with resistant hypertension is proposed at the end of this review paper.

  4. Noninvasive Demonstration of Dual Coronary Artery Fistulas to Main Pulmonary Artery with 64-Slice Multidetector-Computed Tomography: A Case Report

    Directory of Open Access Journals (Sweden)

    Yoshiki Noda

    2010-01-01

    Full Text Available Coronary artery fistulas, including coronary pulmonary fistulas, are usually discovered accidently among the adult population when undergoing invasive coronary angiographies. We report here a 58-year-old woman with dual fistulas originating from the left anterior descending coronary artery and right coronary sinus to the main pulmonary artery, demonstrating noninvasively with multidetector-computed tomography (MDCT and transthoracic echocardiography (TTE.

  5. Prospective Coronary Heart Disease Screening in Asymptomatic Hodgkin Lymphoma Patients Using Coronary Computed Tomography Angiography: Results and Risk Factor Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Girinsky, Theodore, E-mail: girinsky.theodore@orange.fr [Department of Radiation Oncology, Institut Gustave Roussy, Villejuif (France); M’Kacher, Radhia [Laboratory of Radiobiology and Oncology, Institut de Radiobiologie Cellulaire et Moleculaire/Direction des Sciences Vivantes/Commissariat Energie Atomique, Fontenay aux Roses (France); Lessard, Nathalie [Department of Radiation Oncology, Institut Gustave Roussy, Villejuif (France); Koscielny, Serge [Biostatistics and Epidemiology Unit, Institut Gustave Roussy, Villejuif (France); Elfassy, Eric; Raoux, François [Department of Radiology, Marie Lannelongue, Chatenay-Malabry (France); Carde, Patrice [Department of Hematology, Institut Gustave Roussy, Villejuif (France); Santos, Marcos Dos [Department of Radiation Oncology, Institut Gustave Roussy, Villejuif (France); Margainaud, Jean-Pierre [Department of Head and Neck Surgery, Institut Gustave Roussy, Villejuif (France); Sabatier, Laure [Laboratory of Radiobiology and Oncology, Institut de Radiobiologie Cellulaire et Moleculaire/Direction des Sciences Vivantes/Commissariat Energie Atomique, Fontenay aux Roses (France); Ghalibafian, Mithra [Department of Radiation Oncology, Institut Gustave Roussy, Villejuif (France); Paul, Jean-François [Department of Radiology, Marie Lannelongue, Chatenay-Malabry (France)

    2014-05-01

    Purpose: To prospectively investigate the coronary artery status using coronary CT angiography (CCTA) in patients with Hodgkin lymphoma treated with combined modalities and mediastinal irradiation. Methods and Materials: All consecutive asymptomatic patients with Hodgkin lymphoma entered the study during follow-up, from August 2007 to May 2012. Coronary CT angiography was performed, and risk factors were recorded along with leukocyte telomere length (LTL) measurements. Results: One hundred seventy-nine patients entered the 5-year study. The median follow-up was 11.6 years (range, 2.1-40.2 years), and the median interval between treatment and the CCTA was 9.5 years (range, 0.5-40 years). Coronary artery abnormalities were demonstrated in 46 patients (26%). Coronary CT angiography abnormalities were detected in nearly 15% of the patients within the first 5 years after treatment. A significant increase (34%) occurred 10 years after treatment (P=.05). Stenoses were mostly nonostial. Severe stenoses were observed in 12 (6.7%) of the patients, entailing surgery with either angioplasty with stent placement or bypass grafting in 10 of them (5.5%). A multivariate analysis demonstrated that age at treatment, hypertension, and hypercholesterolemia, as well as radiation dose to the coronary artery origins, were prognostic factors. In the group of patients with LTL measurements, hypertension and LTL were the only independent risk factors. Conclusions: The findings suggest that CCTA can identify asymptomatic individuals at risk of acute coronary artery disease who might require either preventive or curative measures. Conventional risk factors and the radiation dose to coronary artery origins were independent prognostic factors. The prognostic value of LTL needs further investigation.

  6. Rationale, design, and baseline characteristics of the CLARIFY registry of outpatients with stable coronary artery disease.

    Science.gov (United States)

    Sorbets, Emmanuel; Greenlaw, Nicola; Ferrari, Roberto; Ford, Ian; Fox, Kim M; Tardif, Jean-Claude; Tendera, Michal; Steg, Philippe Gabriel

    2017-10-01

    Despite major advances in prevention and treatment, coronary artery disease (CAD) remains the leading cause of death worldwide. Whereas many sources of data are available on the epidemiology of acute coronary syndromes, fewer datasets reflect the contemporary management and outcomes of stable CAD patients. A worldwide contemporary registry would improve our knowledge about stable CAD. The main objectives are to describe the demographics, clinical profile, contemporary management and outcomes of outpatients with stable CAD; to identify gaps between evidence and treatment; and to investigate long-term prognostic determinants. CLARIFY (ProspeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease) is an ongoing international observational longitudinal registry. Stable CAD patients from 45 countries in Europe, Asia, America, Middle East, Australia and Africa were enrolled between November 2009 and June 2010. The inclusion criteria were previous myocardial infarction, evidence of coronary stenosis >50%, proven symptomatic myocardial ischemia or prior revascularization procedure. The main exclusion criteria were serious non-cardiovascular disease, conditions interfering with life expectancy or severe other cardiovascular disease (including advanced heart failure). Follow-up visits were planned annually for up to 5 years, interspersed with 6-month telephone calls. Of the 32,703 patients enrolled, most (77.6%) were male, age (mean ± SD) was 64.2 ± 10.5 years, and 71.0% were receiving treatment for hypertension; mean ± SD resting heart rate was 68.2 ± 10.6 bpm. Patients were enrolled based on a history of myocardial infarction >3 months earlier (57.7%), having at least one stenosis >50% on coronary angiography (61.1%), proven symptomatic myocardial ischemia on non-invasive testing (23.1%), or history of percutaneous coronary intervention or coronary artery bypass graft (69.8%). Baseline characteristics were similar across the four

  7. Risk factors for coronary heart disease and actual diagnostic criteria for diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Mitrović-Perišić Nataša

    2009-01-01

    Full Text Available Background/Aim. Recent studies indicate that the prevalence of diabetes mellitus (DM type 2 is increasing in the world. Chronic hyperglycemia in DM is associated with a long term damage, dysfunction and failure of various organs, especially retina, kidney, nerves and, in addition, with an increased risk of cardiovasclar disease. For a long time the illness has been unknown. Early diagnosis of diabetes could suspend the development of diabetic complications. The aim of the study was to establish risk for the development of coronary disease in the patients evaluated by the use of new diagnostic criteria for DM. Methods. The study included 930 participants without diagnosis of DM, hypertension, dyslipidemia, nor coronary heart disease two years before the study. The patients went through measuring of fasting plasma glycemia, erythrocytes, hematocrit, cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C, low-density lipoprotein cholesterol, aspartate aminotransferase and alanine aminotransferase. In the group with hyperglycemia the 2-hour oral glucose tolerance test was performed. We analyzed ECG and made blood pressure monitoring, and also measured body mass, height, waist and hip circumference. We analyzed life style, especially smoking, and exercise and family history. Results. Diabetes prevalence was 2.68%, and prevalences of impaired fasting glucose, impaired glucose tolerance and DM were 12.15%. Average age of males and females was 38 and 45 years, respectively. In the healthy population there was higher frequency of smokers (55% vs 42%, but in the population with hyperglycemia there were more obesity (23% vs 10.5%, hypertension (39% vs 9%, hypercholesterolemia (76% vs 44.1%, lower HDL-C (52.2% vs 25.7%. Cummulative risk factor in healthy subjects, and those with hyperglycemia were 5.6% and 14%, respectively. Conclusion. Subjects with hyperglicemia without diagnosis of DM have higher risk factors for coronary heart disease.

  8. Refractory Hypertension: Determination of Prevalence, Risk Factors and Comorbidities in a Large, Population-Based Cohort

    Science.gov (United States)

    Calhoun, David A.; Booth, John N.; Oparil, Suzanne; Irvin, Marguerite R.; Shimbo, Daichi; Lackland, Daniel T.; Howard, George; Safford, Monika M.; Muntner, Paul

    2014-01-01

    Refractory hypertension is an extreme phenotype of antihypertensive treatment failure. Participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study, a large (n=30,239), population-based cohort were evaluated to determine the prevalence of refractory hypertension and associated cardiovascular risk factors and comorbidities. Refractory hypertension was defined as uncontrolled blood pressure (systolic/diastolic ≥ 140/90 mm Hg) on ≥ 5 antihypertensive drug classes. Participants with resistant hypertension (systolic/diastolic ≥140/90 mm Hg on ≥ 3 orhypertensive participants served as comparator groups. Of 14,809 REGARDS participants receiving antihypertensive treatment, 78 (0.5%) had refractory hypertension. The prevalence of refractory hypertension was 3.6% among participants with resistant hypertension(n=2,144) and 41.7% among participants on 5 or more antihypertensive drug classes. Among all hypertensive participants, African American race, male gender, living in the stroke belt or buckle, higher body mass index, lower heart rate, reduced estimated glomerular filtration rate, albuminuria, diabetes and history of stroke and coronary heart disease were associated with refractory hypertension. Compared to resistant hypertension, prevalence ratios for refractory hypertension were increased for African Americans (3.00, 95% CI 1.68 – 5.37) and those with albuminuria (2.22, 95% CI 1.40 – 3.52) and diabetes (2.09, 95% CI 1.32 – 3.31). The median 10-year Framingham risk for coronary heart disease and stroke was higher among participants with refractory hypertension compared to either comparator group. These data indicate that while resistant hypertension is relatively common among treated hypertensive patients, true antihypertensive treatment failure is rare. PMID:24324035

  9. Hypertension Management in Primary Care.

    Science.gov (United States)

    Weltermann, Birgitta; Kersting, Christine; Viehmann, Anja

    2016-03-11

    To improve hypertension control, this cluster randomized trial evaluated the effectiveness of physician manager education about hypertension management. After randomization at practice level, primary care physicians of the intervention arm, whose practices collaborated with a university department, participated in a three-session education on evidence-based hypertensiology and practice implementation strategies. The primary outcome was blood pressure (BP) control (ambulatory blood pressure [ABP] hypertension management. Following an intention-to-treat approach, data analyses included crude and adjusted generalized mixed models and sensitivity analyses. These took into account sex, age, ≥ hypertension-related disease and resistant hypertension (RH). The analysis included 103 of 169 patients from 22 practices. Overall, BP decrease was -8.2 systolic and -4.1 mmHg diastolic. The intervention had no effect on BP control (odds ratio 0.84 [95% CI 0.29-2.43]) and BP changes (interventional effect: systolic -2.48 mmHg [95% CI -7.24 to 2.29], diastolic -0.25 mmHg [95% CI 3.31 to 2.82]). Sensitivity analysis indicated effect modification in patients with RH. Intervention practices requested educational input on difficult cases, and newly implemented 3 practice strategies (14.5±2.6 versus 11.4±2.2; P=0.005). After the short follow-up of 5 months, the intervention had no impact on BP control but improved the use of practice strategies.

  10. Detection of blood vessels on coronary cineangiograms

    International Nuclear Information System (INIS)

    Yanagihara, Yosio; Sugahara, Tetsuo; Uyama, Chikao

    1988-01-01

    To determine the most suitable filter for measuring blood vessel width on a coronary cineagiogram, several sizes of vessel phantoms were taken under different energies and contrast substance densities on cine film and the vessel widths were calculated by using several edge detection filters. Among the filters, the entropy and Gaussian filters were found to be twice as accurate as the derivative filters. The entropy filter was applied to one frame of a coronary angiogram, and the detected vessel edges were as accurate as the determined by a radiologist. This filter can be applied to coronary cineangiograms, including stenosed sites. (author)

  11. Portal hypertension.

    Science.gov (United States)

    Collini, F J; Brener, B

    1990-02-01

    The management of both acute and recurrent variceal bleeding continues to be a significant challenge to the clinician. The cause and pathogenesis of portal hypertension has been described. Alcoholic cirrhosis is the most common cause of intrahepatic sinusoidal and postsinusoidal obstruction in the United States. Long term survival depends on rapid institution of an established protocol of surgical management for variceal hemorrhage. A patient who presents with variceal bleeding must be rapidly stabilized with fluid resuscitation, and specific measures, such as the use of vasopressin and balloon tamponade, must be instituted to control hemorrhage so that endoscopy can be used to establish the diagnosis. Sclerotherapy achieves a high rate of success in the acute situation, but if hemorrhage cannot be controlled, percutaneous transhepatic embolization or emergent shunting must be performed, depending on the condition of the patient. Angiography, prior to surgical treatment, is necessary to define venous anatomy and determine portal hemodynamics, both of which provide information vital in choosing the type of shunt. If bleeding is massive and the patient is unstable, H-grafts are most appropriate, for they are technically easier and give excellent short term results. In a stable Child's A or B patient with minor ascites as well as suitable anatomy and hepatopedal flow, DSRS is the procedure of choice because it produces the smallest degree of HE postoperatively and increases the survival rate for nonalcoholics. If this is not feasible or if the surgeon lacks the technical expertise to perform DSRS, PCS is the logical alternative. In view of the data from the series observed in the United States, ablative procedures cannot be recommended at the present for the treatment of variceal bleeding. In the Child's C poor-risk patient, the operative mortality rate is prohibitive, and only nonsurgical means should be used to establish control of bleeding. In the elective

  12. Determinants of isolated systolic hypertension among diabetic ...

    African Journals Online (AJOL)

    Background: Hypertension and diabetes mellitus, two of the leading risk factors for atherosclerosis, are associated with numerous complications, including heart attacks and strokes. Aim: This study established the prevalence and determinants of isolated systolic hypertension (ISH) in diabetes mellitus patients visiting the ...

  13. Case study on hypertension, physical exercise and ...

    African Journals Online (AJOL)

    Hypertension is a serious stress related disorder, typically requiring pharmacology in combination with various methods of health promotion including diet, specific lifestyle and psychophysiological techniques. This case study describes the effective treatment of a hypertensive crisis in a 63 year old woman with special ...

  14. Clinical approach in treatment of resistant hypertension

    Directory of Open Access Journals (Sweden)

    Jennifer Frank

    2009-07-01

    Full Text Available Jennifer Frank, David SommerfeldUniversity of Wisconsin School of Medicine and Public Health, Department of Family Medicine, Appleton, WI, USAAbstract: Resistant hypertension, defined as failure to achieve target blood pressure despite the use of optimal or maximum doses of at least 3 agents, one of which is a diuretic, or requiring 4 or more medications to achieve blood pressure goal, is likely to affect up to 20% of all patients with hypertension. Apparent resistant hypertension may be caused by medication nonadherence, substances that either interfere with antihypertensive mediations or cause blood pressure elevation, and under- or inappropriate medication treatment. Certain patient characteristics are associated with the presence of resistant hypertension and include chronic kidney disease, diabetes, obesity, and presence of end-organ damage (microalbuminuria, retinopathy, left-ventricular hypertrophy. Secondary causes of resistant hypertension are not uncommon and include obstructive sleep apnea, chronic kidney disease, primary aldosteronism, renal artery stenosis, pheochromocytoma, and Cushing’s disease. Initial medication management usually includes adding or increasing the dose of a diuretic, which is effective in lowering the blood pressure of a large number of patients with resistant hypertension. Additional management options include maximizing lifestyle modification, combination therapy of antihypertensive agents depending on individual patient characteristics, adding less-commonly used fourth- or fifth-line antihypertensive agents, and referral to a hypertension specialist.Keywords: resistant hypertension, blood pressure, diuretic

  15. Frequency of depression among hypertensive patients who ...

    African Journals Online (AJOL)

    The purpose of this study is therefore to determine the frequency of major depression among patients who developed stroke from hypertension. Methods: This is a retrospective study. Thirty four patients who developed stroke from severe hypertension were included. Using Diagnostic Statistical Manual (DSM) IV criteria, the ...

  16. Remote reading of coronary CTA exams using a tablet computer: utility for stenosis assessment and identification of coronary anomalies.

    Science.gov (United States)

    Zimmerman, Stefan L; Lin, Cheng T; Chu, Linda C; Eng, John; Fishman, Elliot K

    2016-06-01

    The feasibility of remote reading of coronary CT examinations on tablet computers has not been evaluated. The purpose of this study is to evaluate the accuracy of coronary CT angiography reading using an iPad compared to standard 3D workstations. Fifty coronary CT angiography exams, including a spectrum of coronary artery disease and anatomic variants, were reviewed. Coronary CT angiography exams were interpreted by two readers independently on an iPad application (Siemens Webviewer) and a clinical 3D workstation at sessions 2 weeks apart. Studies were scored per vessel for severity of stenosis on a 0-3 scale (0 none, 1  0.05). Both readers identified 100 % of coronary anomalies using each technique. Reading of coronary CT angiography examinations on the iPad had no influence on stenosis assessment compared to the standard clinical workstation.

  17. Gender inequality in the clinical outcomes of equally treated acute coronary syndrome patients in Saudi Arabia.

    Science.gov (United States)

    Hersi, Ahmad; Al-Habib, Khalid; Al-Faleh, Husam; Al-Nemer, Khalid; Alsaif, Shukri; Taraben, Amir; Kashour, Tarek; Abuosa, Ahmed Mohamed; Al-Murayeh, Mushabab Ayedh

    2013-01-01

    Gender associations with acute coronary syndrome (ACS), remain inconsistent. Gender-specific data in the Saudi Project for Assessment of Coronary Events registry, launched in December 2005 and currently with 17 participating hospitals, were explored. A prospective multicenter study of patient with ACS in secondary and tertiary care centers in Saudi Arabia were included in this analysis. Patients enrolled from December 2005 until December 2007 included those presented to participating hospitals or transferred from non-registry hospitals. Summarized data were analyzed. Of 5061 patients, 1142 (23%) were women. Women were more frequently diagnosed with non ST-segment elevation myocardial infarction (NSTEMI [43%]) than unstable angina (UA [29%]) or ST-segment elevation myocardial infarction (STEMI [29%]). More men had STEMI (42%) than NSTEMI (37%) or UA (22%). Men were younger than women (57 vs 63 years) who had more diabetes, hypertension, and hyperlipidemia. More men had a history of coronary artery disease. More women received angiotensin receptor blockers (ARB) and fewer had percutaneous coronary intervention (PCI). Gender differences in the subset of STEMI patients were similar to those in the entire cohort. However, gender differences in the subset of STEMI showed fewer women given b-blockers, and an insignificant PCI difference between genders. Thrombolysis rates between genders were similar. Overall, in-hospital mortality was significantly worse for women and, by ACS type, was significantly greater in women for STEMI and NSTEMI. However, after age adjustment there was no difference in mortality between men and women in patients with NSTEMI. The multivariate-adjusted (age, risk factors, treatments, door-to-needle time) STEMI gender mortality difference was not significant (OR=2.0, CI: 0.7-5.5; P=.14). These data are similar to other reported data. However, differences exist, and their explanation should be pursued to provide a valuable insight into understanding

  18. Psychological factors and coronary heart disease

    Directory of Open Access Journals (Sweden)

    Hadži-Pešić Marina

    2007-01-01

    Full Text Available Coronary heart disease (CAD results from an interaction of different somatic, environmental and behavioral risk factors. Commonly, development of CAD is associated with arterial hypertension, dyslipidemia, diabetes mellitus, smoking, sedentary life style and the like. Psychological factors in their own sake or in combination with other risk factors are also important for genesis of CAD. In this study, 170 people that were diagnosed with CAD and 170 healthy controls of corresponding sex and age were compared for anxiety, aggressiveness and Eysenck's two personality dimension. The data indicate that patients with CAD have very low level of anxiety and aggressiveness and very high level of neuroticism relative to the controls. .

  19. New therapies for arterial hypertension.

    Science.gov (United States)

    Pagliaro, Beniamino; Santolamazza, Caterina; Rubattu, Speranza; Volpe, Massimo

    2016-03-01

    Arterial hypertension is the most common chronic disease in developed countries and it is the leading risk factor for stroke, ischemic heart disease, congestive heart failure, chronic renal failure and peripheral artery disease. Its prevalence appears to be about 30-45% of the general population. Recent European guidelines estimate that up to 15-20% of the hypertensive patients are not controlled on a dual antihypertensive combination and they require three or more different antihypertensive drug classes to achieve adequate blood pressure control. The guidelines confirmed that diuretics, beta-blockers, calcium-channel blockers, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are suitable for the initiation and maintenance of antihypertensive treatment, either as monotherapy or in combination therapy. Very few antihypertensive agents have reached the market over the last few years, but no new therapeutic class has really emerged. The long-term adherence to cardiovascular drugs is still low in both primary and secondary prevention of cardiovascular diseases. In particular, the issue of compliance is persistently high in hypertension, despite the fixed-dose combination therapy. As a consequence, a cohort of high-risk hypertensive population, represented by patients affected by refractory and resistant hypertension, can be identified. Therefore, the need of controlling BP in high-risk patients may be addressed, in part, by the development of new drugs, devices and procedures that are designed to treat hypertension and comorbidities. In this review we will comprehensively discuss the current literature on recent therapeutic advances in hypertension, including both medical therapy and interventional procedures.

  20. Thermolabile defect of methylenetetrahydrofolate reductase in coronary artery disease.

    Science.gov (United States)

    Kang, S S; Passen, E L; Ruggie, N; Wong, P W; Sora, H

    1993-10-01

    proven coronary artery stenosis. The traditional risk factors--age, sex, diabetes, smoking, hypercholesterolemia, and hypertension--were not significantly associated with the presence of thermolabile methylenetetrahydrofolate reductase. Thermolabile methylenetetrahydrofolate reductase is a risk factor for coronary artery disease and is unrelated to other risk factors.

  1. [Hypertension in the elderly].

    Science.gov (United States)

    Handschin, Anja; Henny-Fullin, Katja; Buess, Daniel; Leuppi, Jörg; Dieterle, Thomas

    2015-06-01

    Arterial hypertension remains the most important risk factor for cardiovascular and renal diseases. In view of an increasing prevalence with older age and an increasingly aging population, the treatment of elderly patients with arterial hypertension will become increasingly important in daily practice. Arterial hypertension in the elderly differs in many aspects from arterial hypertension in younger patients. For example, isolated systolic hypertension is the predominant form of arterial hypertension in the elderly. In comparison to younger patients, treatment of hypertension in the elderly is less well investigated. However, available data suggest that lowering of blood pressure in the elderly and very elderly reduces the risk of heart failure, stroke, and even mortality. The best evidence for the treatment of hypertension in the elderly exists for diuretics and calcium antagonists. However, the primary choice of antihypertensive therapy should be guided by the presence of existing cardiovascular and/or renal comorbidities.

  2. Prevalence and characteristics of coronary artery anomalies in children with congenital heart disease diagnosed with coronary angiography.

    Science.gov (United States)

    Temel, Münevver Tuğba; Coşkun, Mehmet Enes; Başpınar, Osman; Demiryürek, Abdullah Tuncay

    2017-09-01

    Aim of the present study was to determine the prevalence of coronary artery anomalies in children with congenital heart disease. Data of 1138 consecutive patients who were referred for cardiac catheterization and angiography for assessment of coronary anomaly between January 2005 and December 2009 were retrospectively analyzed. Total of 515 patients whose coronary arteries could be examined through left ventricle and aortic root injection were included in the study. Of 515 angiograms with visible coronaries, 42 patients (20 males, 22 females; mean age: 5.3±2.0 years) were found to have final diagnosis of coronary anomaly. Prevalence of coronary artery anomalies was 8.16% in this study. It was determined that 38 (90.4%) were anomalies of origination, 2 (4.8%) were anomalies of intrinsic coronary arterial anatomy, and 2 (4.8%) were anomalies of coronary termination. Most common coronary artery abnormality was anomalous origin of the right coronary artery from the left aortic sinus (16 patients; 38.1%), and the most common congenital heart disease was tetralogy of Fallot (18 patients; 42.9%). Recognizing variability of coronary artery anomalies is critical when considering surgical or interventional therapies in children with congenital heart disease.

  3. [THE INFLUENCE OF MONO- AND MULTIVASCULAR LESIONS OF CORONARY ARTERIES ON THE COURSE OF CORONARY HEART DISEASE IN PATIENTS WITH DIABETES MELLITUS TYPE 2].

    Science.gov (United States)

    Sypalo, A; Kravchun, P; Kadykova, O

    2017-03-01

    The article assesses the influence of mono- and multivascular lesions of coronary arteries on the course of coronary heart disease at patients with diabetes mellitus type 2. For this purpose, a comprehensive survey of 75 patients with coronary heart disease and diabetes mellitus type 2 was arranged. Depending on the number of vascular lesions of the coronary arteries, according to the data of coronary arteries computer tomography, all patients were divided into two subgroups. The first subgroup included 27 patients with coronary heart disease and diabetes mellitus type 2 with monovascular lesions of coronary arteries. To the second subgroup were included 48 patients with coronary heart disease and diabetes mellitus type 2 with multivascular lesions of coronary arteries. During the analysis of carbohydrate metabolism in cases of coronary heart disease and diabetes mellitus type 2 the HOMA index increase by 25.40% and insulin level increase by 17.05% were revealed at patients with multivascular lesions of coronary arteries in comparison with patients with monovascular lesions of coronary arteries, respectively. The combination of coronary heart disease and diabetes mellitus type 2 with multivascular lesions of coronary arteries was associated with an increase of sortilin level (233,47±47,85 ng/l). A significant increase in triglycerides, lipoprotein cholesterol of very low density influences greatly on the progression of coronary atherosclerosis with lesions of greater number of coronary arteries at patients surveyed. At patients with coronary heart disease and diabetes mellitus type 2 with multivascular lesions of coronary arteries the left ventricle myocardial re-modeling occurred through the increase of left ventricle's size and cavity.

  4. The Prevalence and Awareness of Cardiometabolic Risk Factors in Southern Chinese Population with Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Xinrui Li

    2013-01-01

    Full Text Available Background. Cardiometabolic risk factors significantly accelerate the progression of coronary artery disease (CAD; however, whether CAD patients in South China are aware of the prevalence of these risk factors is not clear yet. Methods. The study consisted of 2312 in-admission CAD patients from 2008 to 2011 in South China. Disease history including hypertension, dyslipidemia, and diabetes was relied on patients' self-reported records. Physical and clinical examinations were tested to assess the real prevalence of the cardiometabolic risk factors. Results. 57.9% of CAD patients had more than 3 cardiometabolic risk factors in terms of the metabolic syndrome. The self-known and real prevalence of hypertension, diabetes, and dyslipidemia were 56.6%, 28.3%, and 25.1% and 91.3%, 40.9%, and 92.0%, respectively. The awareness rates were 64.4%, 66.3%, and 28.5% for hypertension, diabetes, and dyslipidemia. The prevalence of cardiometabolic risk factors was significantly different among gender and among disease status. Conclusions. Most CAD patients in South China had more than three cardiometabolic risk factors. However, the awareness rate of cardiometabolic diseases was low, especially for dyslipidemia. Strategies of routine physical examination programs are needed for the early detection and treatment of cardiometabolic risk factors in order to prevent CAD progression and prognosis.

  5. Effects of dance movement therapy on selected cardiovascular parameters and estimated maximum oxygen consumption in hypertensive patients.

    Science.gov (United States)

    Aweto, H A; Owoeye, O B A; Akinbo, S R A; Onabajo, A A

    2012-01-01

    Objective:Arterial hypertension is a medical condition associated with increased risks of of death, cardiovascular mortality and cardiovascular morbidity including stroke, coronary heart disease, atrial fibrillation and renal insufficiency. Regular physical exercise is considered to be an important part of the non-pharmacologictreatment of hypertension. The purpose of this study was to investigate the effects of dance movement therapy (DMT) on selected cardiovascular parameters and estimated maximum oxygen consumption in hypertensive patients. Fifty (50) subjects with hypertension participated in the study. They were randomly assigned to 2 equal groups; A (DMT group) and B (Control group). Group A carried out dance movement therapy 2 times a week for 4 weeks while group B underwent some educational sessions 2 times a week for the same duration. All the subjects were on anti-hypertensive drugs. 38 subjects completed the study with the DMTgroup having a total of 23 subjects (10 males and 13 females) and the control group 15 subjects (6 males and 9 females). Descriptive statistics of mean, standard deviation and inferential statistics of paired and independentt-testwere used for data analysis. Following four weeks of dance movement therapy, paired t-test analysis showed that there was a statistically significant difference in the Resting systolic blood pressure (RSBP) (p 0.05). Independent t-test analysis between the differences in the pre and post intervention scores of groups A and B also showed statistically significant differences in all the outcome variables (p <0.05). DMT was effective in improving cardiovascular parameters and estimated maximum oxygen consumption in hypertensive patients.

  6. Risk indicators in coronary cardiac disease and occlusive disease of the peripheral arteries

    International Nuclear Information System (INIS)

    Roth, H.

    1982-01-01

    In 160 patients with clinically confirmed coronary heart diseases, angiograms of the coronary vessels, the left ventricle, the abdominal aorta, the pelvic and femoral arteries and the supra-aortic vessels were taken. At the same time the incidence of the risk indicators overweight, hypercholesterinaemia, hypertriglyceridaemia, hyperuricaemia, diabetes mellitus, hypertension and cigarette smoking was established and compared with the angiograms. Hypercholesterinaemia, hypertriglyceridaemia, diabetes mellitus and hypertension are found to be in a clearly positive correlation with the frequency and severity of coronary and peripheral vascular diseases. For hyperuricaemia and overweight a relation to the frequency and severity of peripheral but not coronary vascular stenoses is outlined. Cigarette smoking, again, proves to be a clear risk indicator. (orig./MG) [de

  7. Genetik og hypertension

    DEFF Research Database (Denmark)

    Ellervik, Christina; Tarnow, Lisa; Pedersen, Erling Bjerregaard

    2009-01-01

    Monogenic forms of hypertension are very rare, but have a well-characterized heredity. Primary hypertension is very common with a complex and polygenic heredity. Primary hypertension arises due to an interaction between multiple genetic and environmental factors. Its heredity is unknown, although...

  8. Hypertension and sexual dysfunction

    African Journals Online (AJOL)

    Review Article: Hypertension and sexual dysfunction. 117. Vol 54 No 2. S Afr Fam Pract 2012. Introduction. Hypertension is a major independent cardiovascular risk factor, and also a marker of survival risk. Quality of life during the treatment of hypertension is an important health issue, as one in every five treated patients ...

  9. Spontaneous coronary artery dissection causing acute coronary syndrome in a young patient without risk factors

    Directory of Open Access Journals (Sweden)

    Parag Chevli

    2014-09-01

    Full Text Available Spontaneous coronary artery dissection (SCAD is a rare cause of acute myocardial infarction that is more common in younger patients (under age 50 and in women. Although the etiology is not known, some predisposing conditions to SCAD are well known and include Marfan syndrome, pregnancy and peripartum state, drug abuse, and some anatomical abnormalities of the coronary arteries such as aneurysms and severe kinking. We describe a case of SCAD in a young woman who presented with sudden onset of chest pain and was admitted for the treatment of acute coronary syndrome. The coronary angiography showed dissection of the left anterior descending artery. The patient underwent successful percutaneous transluminal coronary angioplasty and stent placement.

  10. Endothelial dysfunction and atherosclerosis in children with irreversible pulmonary hypertension due to congenital heart disease

    International Nuclear Information System (INIS)

    Çiftel, Murat; Şimşek, Ayse; Turan, Özlem; Kardelen, Firat; Akçurin, Gayaz; Ertuğ, Halil

    2012-01-01

    To assess endothelial dysfunction and the risk for coronary atherosclerosis in children with irreversible pulmonary hypertension due to congenital heart disease (CHD). The study included 18 cyanotic patients (the mean age was 12.28 ± 3.26 years) who developed irreversible pulmonary hypertension due to cyanotic and acyanotic CHDs, and 18 control patients (the mean age was 11.78 ± 3.00 years). Study groups were compared for flow-mediated dilatation (FMD), carotid intima media thickness (CIMT) and atherosclerotic risk factors. Compared to the control group, the mean FMD was significantly reduced in the cyanotic group (5.26 ± 2.42% and 9.48 ± 2.60%, respectively; P-value < 0.001). No significant difference was observed between the groups in CIMT (0.41 ± 0.08 mm and 0.39 ± 0.06 mm, respectively; P-value = 0.299). The levels of total cholesterol, low-density lipoprotein–cholesterol and very low-density lipoprotein–cholesterol were statistically significantly lower compared tothe control group (P-value = 0.001, 0.006 and 0.014, respectively), whereas no statistically significant difference was found in the levels of high-density lipoprotein–cholesterol and triglycerides (P-value = 0.113 and 0.975, respectively). Systemic endothelial dysfunction in children with irreversible pulmonary hypertension due to CHD was noted but there was no increased risk for atherosclerosis

  11. Dietary pattern, lifestyle and nutritional status of hypertensive ...

    African Journals Online (AJOL)

    Inappropriate eating habits and sedentary lifestyle predispose to hypertension. This study assessed dietary pattern, lifestyle and nutritional status of hypertensive outpatients attending Cardiology Clinic of University College Hospital, Ibadan. This research was descriptive and cross-sectional, including 92 hypertensive ...

  12. Nanomedicine in coronary artery disease.

    Science.gov (United States)

    Ambesh, Paurush; Campia, Umberto; Obiagwu, Chukwudi; Bansal, Rashika; Shetty, Vijay; Hollander, Gerald; Shani, Jacob

    Nanomedicine is one of the most promising therapeutic modalities researchers are working on. It involves development of drugs and devices that work at the nanoscale (10-9m). Coronary artery disease (CAD) is responsible for more than a third of all deaths in age group >35 years. With such a huge burden of mortality, CAD is one of the diseases where nanomedicine is being employed for preventive and therapeutic interventions. Nanomedicine can effectively deliver focused drug payload at sites of local plaque formation. Non-invasive strategies include thwarting angiogenesis, intra-arterial thrombosis and local inflammation. Invasive strategies following percutaneous coronary intervention (PCI) include anti-restenosis and healing enhancement. However, before practical application becomes widespread, many challenges need to be dealt with. These include manufacturing at the nanoscale, direct nanomaterial cellular toxicity and visualization. Copyright © 2017 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  13. Hotel Housekeeping Work Influences on Hypertension Management

    Science.gov (United States)

    Sanon, Marie-Anne

    2013-01-01

    Background Characteristics of hotel housekeeping work increase the risk for hypertension development. Little is known about the influences of such work on hypertension management. Methods For this qualitative study, 27 Haitian immigrant hotel housekeepers from Miami-Dade County, FL were interviewed. Interview transcripts were analyzed with the assistance of the Atlas. ti software for code and theme identification. Results Influences of hotel housekeeping work on hypertension management arose both at the individual and system levels. Factors at the individual level included co-worker dynamics and maintenance of transmigrant life. Factors at the system level included supervisory support, workload, work pace, and work hiring practices. No positive influences were reported for workload and hiring practices. Conclusions Workplace interventions may be beneficial for effective hypertension management among hotel housekeepers. These work influences must be considered when determining effective methods for hypertension management among hotel housekeepers. PMID:23775918

  14. Hotel housekeeping work influences on hypertension management.

    Science.gov (United States)

    Sanon, Marie-Anne

    2013-12-01

    Characteristics of hotel housekeeping work increase the risk for hypertension development. Little is known about the influences of such work on hypertension management. For this qualitative study, 27 Haitian immigrant hotel housekeepers from Miami-Dade County, FL were interviewed. Interview transcripts were analyzed with the assistance of the Atlas.ti software for code and theme identification. Influences of hotel housekeeping work on hypertension management arose both at the individual and system levels. Factors at the individual level included co-worker dynamics and maintenance of transmigrant life. Factors at the system level included supervisory support, workload, work pace, and work hiring practices. No positive influences were reported for workload and hiring practices. Workplace interventions may be beneficial for effective hypertension management among hotel housekeepers. These work influences must be considered when determining effective methods for hypertension management among hotel housekeepers. © 2013 Wiley Periodicals, Inc.

  15. Qigong for Hypertension

    Science.gov (United States)

    Xiong, Xingjiang; Wang, Pengqian; Li, Xiaoke; Zhang, Yuqing

    2015-01-01

    Abstract The purpose of this review was to evaluate the efficacy and safety of qigong for hypertension. A systematic literature search was performed in 7 databases from their respective inceptions until April 2014, including the Cochrane Library, EMBASE, PubMed, Chinese Scientific Journal Database, Chinese Biomedical Literature Database, Wanfang database, and Chinese National Knowledge Infrastructure. Randomized controlled trials of qigong as either monotherapy or adjunctive therapy with antihypertensive drugs versus no intervention, exercise, or antihypertensive drugs for hypertension were identified. The risk of bias was assessed using the tool described in Cochrane Handbook for Systematic Review of Interventions, version 5.1.0. Twenty trials containing 2349 hypertensive patients were included in the meta-analysis. The risk of bias was generally high. Compared with no intervention, qigong significantly reduced systolic blood pressure (SBP) (weighted mean difference [WMD] = −17.40 mm Hg, 95% confidence interval [CI] −21.06 to −13.74, P Qigong was inferior to exercise in decreasing SBP (WMD = 6.51 mm Hg, 95% CI 2.81 to 10.21, P = 0.0006), but no significant difference between the effects of qigong and exercise on DBP (WMD = 0.67 mm Hg, 95% CI −1.39 to 2.73, P = 0.52) was identified. Compared with antihypertensive drugs, qigong produced a clinically meaningful but not statistically significant reduction in SBP (WMD = −7.91 mm Hg, 95% CI −16.81 to 1.00, P = 0.08), but appeared to be more effective in lowering DBP (WMD = −6.08 mm Hg, 95% CI −9.58 to −2.58, P = 0.0007). Qigong plus antihypertensive drugs significantly lowered both SBP (WMD = −11.99 mm Hg, 95% CI −15.59 to −8.39, P qigong is an effective therapy for hypertension. However, more rigorously designed randomized controlled trials with long-term follow-up focusing on hard clinical outcomes are required to confirm the results. PMID

  16. Selective Coronary Arteriography

    Science.gov (United States)

    Parker, John O.; Challis, Thomas W.; West, Roxroy O.

    1966-01-01

    The technique of selective coronary arteriography, as described originally by Sones, was employed in 255 patients. Successful catheterization of both coronary arteries was carried out in 88% of these patients, and in the last 100 examinations both coronary arteries were entered in 95 patients. Selective coronary arteriography is a useful diagnostic tool but is a potentially hazardous form of examination as we encountered four episodes of ventricular fibrillation in the present series. ImagesFig. 1Fig. 2Figs. 3A-DFig. 3EFig. 3FFig. 4Fig. 5Fig. 6Fig. 7Fig. 8Fig. 9 PMID:5902704

  17. Factors influencing delay time and coronary arterial density during coronary angiography with DSCT

    International Nuclear Information System (INIS)

    Lijun Tang; Xiaomei Zhu; Yi Xu; Tongfu Yu; Hai Xu; Jinhua Tang; Dehang Wang; Dogra, Vikram

    2011-01-01

    Background: CT angiography (CTA) plays an important role in diagnosing coronary arterial disease. Delay time and density of the coronary arteries related with patient-specific factors are essential for getting an optimal CTA image. Purpose: To investigate various factors influencing delay time and coronary arterial density during coronary CTA with dual source CT. Material and Methods: One hundred and sixteen consecutive subjects who underwent cardiac DSCT with retrospective ECG-gating were included. Factors including gender, age, height, weight, transversal cardiac diameter (TCD), transversal thoracic diameter (TTD), heart rate (HR), body surface area (BSA = [weight x height/3600]1/2) and cardiothoracic ratio (CTR = TCD/TTD) were recorded, measured and calculated before administration of contrast media during coronary CT angiography. Delay time was determined as duration from the beginning of the injection to the density in the descending aorta at the level of right main pulmonary artery reaching a threshold of 100 HU. Coronary arterial density was measured at the mid portion of the right coronary artery. Regression analysis and stepwise regression analysis were used to investigate the influence of these factors on delay time and coronary arterial density. Results: Delay time decreased with an increasing HR and it was shorter in women than men. Delay time increased with an increasing TCD. Delay time could be predicted by the formula: DT = 16.651-0.110 x HR + 1.902 x gender + 0.394 x TCD (where DT is abbreviation for delay time, gender is 0 for women and 1 for men). Coronary arterial density decreased with an increasing HR and weight. Coronary arterial density could be predicted by the formula: CAD = 923.42-4.099 x HR-3.293 x weight (CAD = coronary arterial density). There was no relationship between the other factors mentioned above and delay time or coronary arterial density. Conclusion: Delay time is influenced by HR, gender and TCD. Coronary arterial density

  18. Hypertension og det metaboliske syndrom

    DEFF Research Database (Denmark)

    Olsen, Michael Hecht; Jeppesen, Jørgen; Larsen, Mogens Lytken

    2009-01-01

    The metabolic syndrome is a relatively prevalent condition characterized by co-existence of several metabolic and cardiovascular risk factors including hypertension. Patients with hypertension have an increased risk of developing the metabolic syndrome which, in turn, increases the cardiovascular...... risk associated with increased blood pressure. As the definition of the metabolic syndrome is based on dichotomization of cardiovascular risk factors with a continuously increasing risk, it cannot match risk stratification tools like the HeartScore for calculation of prognosis. However, the metabolic...... syndrome is of clinical importance as it makes the treating physician test for other elements of the syndrome in patients with one of the elements, e.g. hypertension. Udgivelsesdato: 2009-Jun...

  19. Hypertension og det metaboliske syndrom

    DEFF Research Database (Denmark)

    Olsen, Michael; Jeppesen, Jørgen; Larsen, Mogens

    2009-01-01

    The metabolic syndrome is a relatively prevalent condition characterized by co-existence of several metabolic and cardiovascular risk factors including hypertension. Patients with hypertension have an increased risk of developing the metabolic syndrome which, in turn, increases the cardiovascular...... risk associated with increased blood pressure. As the definition of the metabolic syndrome is based on dichotomization of cardiovascular risk factors with a continuously increasing risk, it cannot match risk stratification tools like the HeartScore for calculation of prognosis. However, the metabolic...... syndrome is of clinical importance as it makes the treating physician test for other elements of the syndrome in patients with one of the elements, e.g. hypertension. Udgivelsesdato: 2009-Jun-15...

  20. Role of coronary physiology in the contemporary management of coronary artery disease.

    Science.gov (United States)

    Ruparelia, Neil; Kharbanda, Rajesh K

    2015-02-16

    Coronary artery disease (CAD) remains the leading cause of death worldwide with approximately 1 in 30 patients with stable CAD experiencing death or acute myocardial infarction each year. The presence and extent of resultant myocardial ischaemia has been shown to confer an increased risk of adverse outcomes. Whilst, optimal medical therapy (OMT) forms the cornerstone of the management of patients with stable CAD, a significant number of patients present with ischaemia refractory to OMT. Historically coronary angiography alone has been used to determine coronary lesion severity in both stable and acute settings. It is increasingly clear that this approach fails to accurately identify the haemodynamic significance of lesions; especially those that are visually "intermediate" in severity. Revascularisation based upon angiographic appearances alone may not reduce coronary events above OMT. Technological advances have enabled the measurement of physiological indices including the fractional flow reserve, the index of microcirculatory resistance and the coronary flow reserve. The integration of these parameters into the routine management of patients presenting to the cardiac catheterization laboratory with CAD represents a critical adjunctive tool in the optimal management of these patients by identifying patients that would most benefit from revascularisation and importantly also highlighting patients that would not gain benefit and therefore reducing the likelihood of adverse outcomes associated with coronary revascularisation. Furthermore, these techniques are applicable to a broad range of patients including those with left main stem disease, proximal coronary disease, diabetes mellitus, previous percutaneous coronary intervention and with previous coronary artery bypass grafting. This review will discuss current concepts relevant to coronary physiology assessment, its role in the management of both stable and acute patients and future applications.

  1. Role of coronary physiology in the contemporary management of coronary artery disease

    Science.gov (United States)

    Ruparelia, Neil; Kharbanda, Rajesh K

    2015-01-01

    Coronary artery disease (CAD) remains the leading cause of death worldwide with approximately 1 in 30 patients with stable CAD experiencing death or acute myocardial infarction each year. The presence and extent of resultant myocardial ischaemia has been shown to confer an increased risk of adverse outcomes. Whilst, optimal medical therapy (OMT) forms the cornerstone of the management of patients with stable CAD, a significant number of patients present with ischaemia refractory to OMT. Historically coronary angiography alone has been used to determine coronary lesion severity in both stable and acute settings. It is increasingly clear that this approach fails to accurately identify the haemodynamic significance of lesions; especially those that are visually “intermediate” in severity. Revascularisation based upon angiographic appearances alone may not reduce coronary events above OMT. Technological advances have enabled the measurement of physiological indices including the fractional flow reserve, the index of microcirculatory resistance and the coronary flow reserve. The integration of these parameters into the routine management of patients presenting to the cardiac catheterization laboratory with CAD represents a critical adjunctive tool in the optimal management of these patients by identifying patients that would most benefit from revascularisation and importantly also highlighting patients that would not gain benefit and therefore reducing the likelihood of adverse outcomes associated with coronary revascularisation. Furthermore, these techniques are applicable to a broad range of patients including those with left main stem disease, proximal coronary disease, diabetes mellitus, previous percutaneous coronary intervention and with previous coronary artery bypass grafting. This review will discuss current concepts relevant to coronary physiology assessment, its role in the management of both stable and acute patients and future applications. PMID

  2. Hypertension in Asymptomatic, Young Medical Students with Parental History of Hypertension

    Directory of Open Access Journals (Sweden)

    Simran Sidhu

    2017-11-01

    Full Text Available Introduction: Family history of hypertension in medical students is an important, non-modifiable risk factor for hypertension in future. Aim: To determine the prevalence of sustained hypertension in young asymptomatic medical students with a parental history of hypertension. Materials and Methods: A cross-sectional study was conducted in a medical college of Dehradun. A total of 104 medical students with parental history of hypertension (Group A and 100 medical students without a parental history of hypertension (Group B were included. Electronically blood pressures were recorded on two separate occasions at an interval of 15 days. Comparison was done using Chi-square test/Likelihood ratio, Un-paired t-test and ANCOVA. Results: Overall, Group A had significantly higher percentage of prehypertensive (56.7% and hypertensive (17.3% students as compared to Group B which were 19% and 1%, respectively. Group A students had significantly higher Systolic Blood Pressure (SBP and Diastolic Blood Pressure (DBP as compared to Group B, even after controlling for the differences in Body Mass Index (BMI and gender (p<0.001. Conclusion: Hypertension was significantly higher in asymptomatic, healthy medical students with parental history of hypertension as compared to those with normotensive parents. We need to orient medical students to improve their knowledge, attitude and lifestyle practices early in life to prevent, treat hypertension and prevent its subsequent morbidity and mortality.

  3. Relationship between elevated serum gamma-glutamyltransferase activity and slow coronary flow

    DEFF Research Database (Denmark)

    Sen, Nihat; Ozlü, Mehmet F; Basar, Nurcan

    2009-01-01

    . The results were compared with those of a control group consisting of 86 age- and sex-matched patients who had normal coronary arteries and normal coronary flow. RESULTS: The three groups were similar with respect to body mass index, presence of hypertension and diabetes mellitus, lipid profiles, and fasting...... was found as the only independent predictor of the mean TFC (beta=0.309; pphysiopathologic role of serum GGT activity in SCF....

  4. Do we over treat mild hypertension?

    Science.gov (United States)

    Zanchetti, Alberto

    2015-06-01

    The important question whether 'mild' hypertension should or should not be treated by drugs is difficult to answer, because the only randomized controlled trials (RCTs) investigating this question were conducted when the definition of 'mild' hypertension was based on diastolic blood pressure only, whereas the present definition of grade 1 hypertension includes both systolic and diastolic values (SBP/DBP), and the concept of 'mild' hypertension also includes that of low-moderate cardiovascular risk (hypertension only on the basis of expert opinion. However, recent meta-analyses have provided some support to drug treatment intervention in low-moderate risk grade 1 hypertensives and have shown that, when treatment is deferred until organ damage or cardiovascular disease occur, absolute residual risk (events occurring despite treatment) markedly increases. Although evidence favoring therapeutic intervention in mild hypertension is nowadays stronger than expert opinion, meta-analyses are not substitutes for specific RCTs, and the wide BP spans defining grade 1 hypertension as well as the span defining low-moderate risk leave a wide space for individualized or personalized decisions.

  5. Coronary artery calcium score in high-risk asymptomatic women in Saudi Arabia.

    Science.gov (United States)

    Fathala, Ahmed; Alreshoodi, Saleh; Rujaib, Mashael Al; Shoukri, Mohamed; Sergani, Hani Al; Buriki, Jehad Al; Sugair, Abdulaziz Al

    2015-01-01

    Coronary artery calcification (CAC) is indicated by calcium deposits in the coronary artery wall. Calcification is a component of atherosclerosis and coronary artery disease. Currently, there are no data on calcification in Saudi women at high risk of coronary artery disease. The aim of this study was to investigate the prevalence and percentiles of CAC score in high-risk asymptotic women in Saudi Arabia with comparison of age-specific CAC percentiles derived from large population-based published study in the United States. Retrospective analysis of CAC scores (CACS) at a single tertiary care center. Between January 2011 and April 2015, women referred for CAC screening because of the presence of one or more CAD risk factors were enrolled in the study. CT scans were interpreted by an experienced radiographic technologist, and confirmed by a radiologist. The study sample consisted of 918 women, mean (SD) age of 55 (11) years. All patients were asymp.tomatic and referred by their primary care physician or cardiologist for CAC screening because presence of one or more CAD risks factors. CAD risk factors included diabetes, hypertension, hypercholesterolemia, family history of CAD, and obesity. Baseline CAD risk factors were remarkably higher than in the US comparator group. CACS for 25th, 50th, 75th, and 90th percentiles were calculated. The 75th and 90th CACS percentiles in Saudi women were significantly higher than the US percentiles. Age and diabetes are the most independent predictor of severity of CAC. A potential bias due to sample collection because data was from a single tertiary care center, the study was retrospective and the sample size was small. There are significantly higher CACS percentiles in Saudi women compared with international data. Application of available published percentiles to a local population is not applicable and underestimates the severity of subclinical atherosclerosis. A large local population-based study is warranted to establish local

  6. Sensibility and specificity of the stress echocardiography with Dobutamine for the detection of coronary disease

    International Nuclear Information System (INIS)

    Senior, Juan Manuel; Escobar, Carlos Ignacio; Jaramillo, Mario and others

    2001-01-01

    Dobutamine stress echocardiography has become a useful method for detecting coronary artery disease in the high prevalence population. The reported sensitivity varies between 76-90% and the specificity between 60-95%. 60-95% there have been few reports regarding sensitivity and specificity among our population. The aim of this study was to evaluate the sensitivity of dopamine stress echocardiography in a population with a high probability of coronary disease. This was a randomized retrospective-prospective study. Between February 1 of 1998 and February 1 of 1999. 409 patients underwent dopamine stress echocardiography and were analyzed according to established protocol. The Dobutamine stress echocardiography as well as the angiography was checked in a blind form by one of the participating researchers trained in those procedures. The diagnostic concordance was found to be greater than 90%. Significant coronary disease was considered to be present in those cases in which there was severe stenosis greater than 50% in a major epicardial artery or greater than 40 % in the left main artery. Coronary arteriography was performed within three months of Dobutamine stress echocardiography imaging. A sixteen-segment model was used as the index for the evaluation of systolic wall thickening and the results were classified as follows: normal (l), ischemia (ll), fixed abnormality (lll) and mixed (lV). 409 patients with an average age of 62.8 +/- 12) were included in the study at random. Six patients with mediocre technical examinations were excluded. 47 % were male. 29% had a history of myocardial infarction, 35 % had a history of arterial hypertension and 10% had diabetes mellitus. The average ejection fraction was 54 +/- 13%. The examination was prescribed in order to detect the presence of ischemia in 95.8% of the cases and as part of preoperative evaluation in 4.2 %. There were adverse effects in 40% of the cases; 15% of these were systemic and 25 % cardiac. The test was

  7. Idiopathic portal hypertension

    International Nuclear Information System (INIS)

    Han, Tae Kyun; Ryu, Dae Sik; Kim, Heung Chul; Hur, Hun; Eom, Kyeung Tae; Namkung, Sook; Park, Man Soo; Hwang, Woo Chul; Lee, Kwan Seop

    1996-01-01

    To describe the radiologic findings of idiopathic portal hypertension and to find the points of differentiation between idiopathic portal hypertension and liver cirrhosis. Four portograms in five patients who for four years had suffered from pathologically confirmed idiopathic portal hypertension were retrospectively analyzed and compared with a portogram obtained from a control subject with liver cirrhosis. Portographic finding s of idiopathic portal hypertension were paucity of medium-sized portal branches, irregular and obtuse-angled division of peripheral branches, abrupt interruption and an avascular area beneath the liver margin. A portogram of idiopathic portal hypertension may be useful in differentiation this and liver cirrhosis

  8. Association between Aspirin Therapy and Clinical Outcomes in Patients with Non-Obstructive Coronary Artery Disease: A Cohort Study.

    Science.gov (United States)

    Hwang, In-Chang; Jeon, Joo-Yeong; Kim, Younhee; Kim, Hyue Mee; Yoon, Yeonyee E; Lee, Seung-Pyo; Kim, Hyung-Kwan; Sohn, Dae-Won; Sung, Jidong; Kim, Yong-Jin

    2015-01-01

    Presence of non-obstructive coronary artery disease (CAD) is associated with increased prescription of cardiovascular preventive medications including aspirin. However, the association between aspirin therapy with all-cause mortality and coronary revascularization in this population has not been investigated. Among the cohort of individuals who underwent coronary computed tomography angiography (CCTA) from 2007 to 2011, 8372 consecutive patients with non-obstructive CAD (1-49% stenosis) were identified. Patients with statin or aspirin prescription before CCTA, and those with history of revascularization before CCTA were excluded. We analyzed the differences of all-cause mortality and a composite of mortality and late coronary revascularization (> 90 days after CCTA) between aspirin users (n = 3751; 44.8%) and non-users. During a median of 828 (interquartile range 385-1,342) days of follow-up, 221 (2.6%) mortality cases and 295 (3.5%) cases of composite endpoint were observed. Annualized mortality rates were 0.97% in aspirin users versus 1.28% in non-users, and annualized rates of composite endpoint were 1.56% versus 1.48%, respectively. Aspirin therapy was associated with significantly lower risk of all-cause mortality (adjusted HR 0.649; 95% CI 0.492-0.857; p = 0.0023), but not with the composite endpoint (adjusted HR 0.841; 95% CI 0.662-1.069; p = 0.1577). Association between aspirin and lower all-cause mortality was limited to patients with age ≥ 65 years, diabetes, hypertension, decreased renal function, and higher levels of coronary artery calcium score, low-density lipoprotein cholesterol and high-sensitivity C-reactive protein. Among the patients with non-obstructive CAD documented by CCTA, aspirin is associated with lower all-cause mortality only in those with higher risk.

  9. Association between Aspirin Therapy and Clinical Outcomes in Patients with Non-Obstructive Coronary Artery Disease: A Cohort Study.

    Directory of Open Access Journals (Sweden)

    In-Chang Hwang

    Full Text Available Presence of non-obstructive coronary artery disease (CAD is associated with increased prescription of cardiovascular preventive medications including aspirin. However, the association between aspirin therapy with all-cause mortality and coronary revascularization in this population has not been investigated.Among the cohort of individuals who underwent coronary computed tomography angiography (CCTA from 2007 to 2011, 8372 consecutive patients with non-obstructive CAD (1-49% stenosis were identified. Patients with statin or aspirin prescription before CCTA, and those with history of revascularization before CCTA were excluded. We analyzed the differences of all-cause mortality and a composite of mortality and late coronary revascularization (> 90 days after CCTA between aspirin users (n = 3751; 44.8% and non-users. During a median of 828 (interquartile range 385-1,342 days of follow-up, 221 (2.6% mortality cases and 295 (3.5% cases of composite endpoint were observed. Annualized mortality rates were 0.97% in aspirin users versus 1.28% in non-users, and annualized rates of composite endpoint were 1.56% versus 1.48%, respectively. Aspirin therapy was associated with significantly lower risk of all-cause mortality (adjusted HR 0.649; 95% CI 0.492-0.857; p = 0.0023, but not with the composite endpoint (adjusted HR 0.841; 95% CI 0.662-1.069; p = 0.1577. Association between aspirin and lower all-cause mortality was limited to patients with age ≥ 65 years, diabetes, hypertension, decreased renal function, and higher levels of coronary artery calcium score, low-density lipoprotein cholesterol and high-sensitivity C-reactive protein.Among the patients with non-obstructive CAD documented by CCTA, aspirin is associated with lower all-cause mortality only in those with higher risk.

  10. The role of comorbidities in patients' hypertension self-management.

    Science.gov (United States)

    Fix, Gemmae M; Cohn, Ellen S; Solomon, Jeffrey L; Cortés, Dharma E; Mueller, Nora; Kressin, Nancy R; Borzecki, Ann; Katz, Lois A; Bokhour, Barbara G

    2014-06-01

    We sought to understand barriers to hypertension self-management in patients with hypertension and comorbidities. We conducted semi-structured, qualitative interviews with 48 patients with uncontrolled hypertension and at least one comorbidity to learn about beliefs and behaviors that might affect hypertension self-management. Using a grounded theory strategy, we analyzed interview transcripts detailing patients' hypertension self-management behaviors vis-à-vis a framework including Explanatory Models-a patient's understanding of the pathophysiology, cause, course, treatment, and severity of an illness, such as hypertension. We identified four factors that interfered with hypertension self-management. (1) Interdependence: Participants saw hypertension as interconnected to their comorbidities and subsequently had difficulty separating information about their illnesses. (2) Low priority: Compared to other conditions, participants assigned hypertension a lower priority. (3) Conflicts: Participants struggled with conflicts between hypertension self-management practices and those for comorbidities. (4) Managing multiple medications: Polypharmacy led to patients' confusion and concern about taking medications as prescribed. Participants did not experience hypertension as a discreet clinical condition; rather, they self-managed hypertension concurrently with other conditions, leading to a breakdown in hypertension self-management. We provide strategies to address each of the four barriers to better equip providers in addressing their clinically salient concerns.

  11. Health literacy in rural areas of China: hypertension knowledge survey.

    Science.gov (United States)

    Li, Xia; Ning, Ning; Hao, Yanhua; Sun, Hong; Gao, Lijun; Jiao, Mingli; Wu, Qunhong; Quan, Hude

    2013-03-18

    We conducted this study to determine levels and correlates of hypertension knowledge among rural Chinese adults, and to assess the association between knowledge levels and salty food consumption among hypertensive and non-hypertensive populations. This face-to-face cross sectional survey included 665 hypertensive and 854 non-hypertensive respondents in the rural areas of Heilongjiang province, China. Hypertension knowledge was assessed through a 10-item test; respondents received 10 points for each correct answer. Among respondents, the average hypertension knowledge score was 26 out of a maximum of 100 points for hypertensive and 20 for non-hypertensive respondents. Hypertension knowledge was associated with marital status, education, health status, periodically reading books, newspapers or other materials, history of blood pressure measurement, and attending hypertension educational sessions. Hypertension knowledge is extremely low in rural areas of China. Hypertension education programs should focus on marginal populations, such as individuals who are not married or illiterate to enhance their knowledge levels. Focusing on educational and literacy levels in conjunction with health education is important given illiteracy is still a prominent issue for the Chinese rural population.

  12. Health Literacy in Rural Areas of China: Hypertension Knowledge Survey

    Directory of Open Access Journals (Sweden)

    Hude Quan

    2013-03-01

    Full Text Available We conducted this study to determine levels and correlates of hypertension knowledge among rural Chinese adults, and to assess the association between knowledge levels and salty food consumption among hypertensive and non-hypertensive populations. This face-to-face cross sectional survey included 665 hypertensive and 854 non-hypertensive respondents in the rural areas of Heilongjiang province, China. Hypertension knowledge was assessed through a 10-item test; respondents received 10 points for each correct answer. Among respondents, the average hypertension knowledge score was 26 out of a maximum of 100 points for hypertensive and 20 for non-hypertensive respondents. Hypertension knowledge was associated with marital status, education, health status, periodically reading books, newspapers or other materials, history of blood pressure measurement, and attending hypertension educational sessions. Hypertension knowledge is extremely low in rural areas of China. Hypertension education programs should focus on marginal populations, such as individuals who are not married or illiterate to enhance their knowledge levels. Focusing on educational and literacy levels in conjunction with health education is important given illiteracy is still a prominent issue for the Chinese rural population.

  13. Women's health in menopause with a focus on hypertension.

    Science.gov (United States)

    Maas, A H E M; Franke, H R

    2009-02-01

    In menopause transition many women have vasomotor symptoms which may affect their normal daily activities. With the decline in oestrogen levels, risk factors for coronary heart disease (CHD) become more apparent, especially hypertension. The onset of hypertension can cause a variety of complaints that are often attributed to the menopause. Risk factor identification is poorly managed in middle-aged women and should be the first step in the evaluation and treatment of women with perimenopausal symptoms. In women at low risk for CHD, there is still a window of opportunity for safe hormone prescription in the first years proximal to menopause. (Neth Heart J 2009;17:68-72.).

  14. Bariatric Surgery and Hypertension.

    Science.gov (United States)

    Owen, Jonathan G; Yazdi, Farshid; Reisin, Efrain

    2017-12-08

    Obesity continues to increase in prevalence worldwide. Hypertension has long been associated with obesity, and weight loss continues to be a first-line therapy in the treatment of hypertension. Lifestyle modification and pharmacologic therapy, however, often meet with treatment failure. Bariatric surgery continues to be the most successful approach to sustained weight loss. This review focuses on the underlying physiologic mechanisms of obesity-hypertension, and the impact of bariatric surgery on the treatment of hypertension. Current available literature on the physiologic mechanisms of obesity-hypertension, and the major trials, meta-analyses and systematic reviews of the impact of bariatric surgery procedures on hypertension are reviewed. Evidence suggests significant improvement in obesity-hypertension in patients who undergo surgical weight-reduction procedures. Malabsorptive techniques such as the Roux-en-Y gastric bypass or surgical resection techniques such as laparoscopic sleeve gastrectomy appear to offer superior results in regards to hypertension control over restrictive techniques such as Gastric Banding. Though long-term control of hypertension following surgery remains a concern, available follow-up post-operative data of up to 10 years suggests a sustained, if lessened, effect on hypertension control over time. © American Journal of Hypertension, Ltd 2017. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  15. Expanding the definition and classification of hypertension.

    Science.gov (United States)

    Giles, Thomas D; Berk, Bradford C; Black, Henry R; Cohn, Jay N; Kostis, John B; Izzo, Joseph L; Weber, Michael A

    2005-09-01

    Cardiovascular abnormalities are frequently the cause, as well as the effect, of elevated blood pressure. As such, early cardiovascular disease (CVD) may be established before identifiable blood pressure thresholds are crossed. To identify individuals at risk for CVD at an earlier point in the disease process, as well as to avoid labeling persons as hypertensive who are at low risk for CVD, the Hypertension Writing Group proposes incorporating the presence or absence of cardiovascular risk factors, early disease markers, and target organ damage into the definition and classification scheme of hypertension. To describe both the complexity and progressive nature of hypertension, the following definition is proposed: "Hypertension is a progressive cardiovascular syndrome arising from complex and interrelated etiologies. Early markers of the syndrome are often present before blood pressure elevation is observed; therefore, hypertension cannot be classified solely by discrete blood pressure thresholds. Progression is strongly associated with functional and structural cardiac and vascular abnormalities that damage the heart, kidneys, brain, vasculature, and other organs and lead to premature morbidity and death." Classification of hypertension must involve assessing global cardiovascular risk to situate an individual's risk for CVD and events along a continuum. As knowledge of early CVD continues to evolve, the approach to classifying individuals along that continuum can be expected to evolve accordingly. The four categories currently used to classify hypertension are normal, prehypertension, and stages 1 and 2 hypertension. The population identified with prehypertension includes a subgroup with early CVD. We believe it would be preferable to classify all individuals as either normal or hypertensive, based on their cardiovascular evaluation, using the four categories of normal and stages 1, 2, and 3 hypertension.

  16. Spontaneous Coronary Artery Dissection and Pregnancy.

    Science.gov (United States)

    Naderi, Sahar

    2017-09-01

    Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic, non-traumatic cause of coronary artery dissection. SCAD is the most common cause of myocardial infarction in pregnancy or the postpartum period and results in significant cardiovascular morbidity and mortality in the pregnant population. It is important to consider pregnancy-associated spontaneous coronary artery dissection (PASCAD) high on the differential for a pregnant woman who presents with symptoms consistent with acute coronary syndrome. Management of these patients requires a thoughtful, multidisciplinary approach, with consideration of conservative management if possible. Counseling regarding future pregnancies is also critical and requires compassionate care. Given our limited understanding of SCAD, including PASCAD, more data and research are needed to help guide diagnosis, management, and determination of prognosis.

  17. Morphological study on coronary ostial and clinicoangiographic analysis of isolated coronary ostial stenosis

    International Nuclear Information System (INIS)

    Kanoh, Tatsuji

    2007-01-01

    A morphological study of coronary ostia was performed in 70 autopsied human hearts, with particular attention being focused on the funnel-shaped structure, aging changes, and relation to atherosclerosis. The following results were obtained: The ostium is particularly well-defined and forms a funnel-shaped structure. The structure is predominantly a double circular shape on the right and comet-shaped on the left. The funnel-shaped structure of coronary ostia is characterized by a longitudinal smooth muscle arrangement in the inner layer and circular one in the outer layer. Including overhang formation, coronary sclerosis of the ostium appears mainly on the upper margin of the funnel-shaped structure of the right ostium and at the upper right margin of the left. In ischemic heart disease, along with changes in coronary arteries themselves, changes in the ostia of these arteries should be paid close attention. Ostial stenosis of the coronary artery in the absence of distal vessel obstructions, isolated ostial stenosis, is a rare form of coronary artery disease. In a previous review of the international literature, the incidence of coronary ostial stenosis varied between 0.13% and 2.7%. Among 7,500 patients undergoing selective coronary cineangiography at Juntendo University Hospital and Juntendo Urayasu Hospital from 1975 to 1990, five women (0.07%) were diagnosed as having ''isolated coronary ostial stenosis'', of which the cause is unknown. Atherosclerosis, particularly early premature atherome, congenital coronary anomaly, fibro-muscular dysplasia, Takayasu's aortitis, humoral factors, spasm, and iatrogenic events have been considered as its causes. In contrast to usual atherosclerotic coronary artery disease, patients with isolated coronary ostial stenosis of unknown etiology were characterized as being middle-aged, premenopausal, slender females having few coronary risk factors, experiencing severe angina pector is with marked ischemic electrocardiogram changes

  18. Tissue characterization of non-culprit intermediate coronary lesions in non ST elevation acute coronary syndromes

    Directory of Open Access Journals (Sweden)

    Helmy Hassan Elghawaby

    2018-03-01

    Full Text Available Background: Disruption of vulnerable plaques is the most common cause of acute coronary syndromes. Intravascular ultrasound facilitates cross-sectional imaging of coronary arteries. We aimed at using IVUS to investigate the morphology and tissue characteristics of atherosclerotic plaques of non-culprit intermediate coronary lesions in non-ST elevation ACS setting. Methods: IVUS assessment of sixty-one intermediate coronary lesions in twenty-eight patients with the diagnosis of Non ST elevation acute coronary syndromes. Ultrasound signals were obtained by an IVUS system using a 40-MHz catheter. Results: Mean age was 53.2 ± 9.1 years. Males = 20 (71.4%. Smoking in 17 (60.7%, hypertension in 16 (57.1%, Dyslipidemia in 12 (42.9% and DM in 8 (28.6%. Culprit vessels represent 42% of affected vessels. Sixty-one intermediate lesions were detected. Twenty-nine lesions in culprit vessels and thirty-two lesions in non-culprit vessels with higher lipidic content in lesions of culprit vessels (P < 0.001 while a higher calcific content in lesions of non-culprit vessels (P < 0.001. Higher calcific content of proximal more than distal lesions (P = 0.048. Negative remodeling in 55.7% of lesions. Conclusions: A higher lipidic content in lesions of culprit vessels, while the lesions of non-culprit vessels were more calcific. Higher calcific content of proximal more than distal lesions was defined as well. Keywords: ACS: Acute coronary syndrome, Intermediate lesions, IVUS: Intravascular ultrasound, Vulnerable plaques, MHz: Mega Hertz

  19. Pulmonary Hypertension

    Science.gov (United States)

    ... organs. Metabolic disorders, such as thyroid disease and glycogen storage disease. (In glycogen storage disease, the body's cells don't use ... also includes lean meats, poultry, fish, and fat-free or low-fat milk or milk products. A ...

  20. Coronary anomalies in Pakistani children with tetralogy of fallot

    International Nuclear Information System (INIS)

    Hussain, I.; Patel, N.

    2010-01-01

    To determine coronary artery anomalies in tetralogy of Fallot in Pakistani children as seen on angiography. Study Design: Case series. Place and Duration of Study: The National Institute of Cardiovascular Diseases, Karachi, Pakistan from July 2006 to July 2007. Methodology: Children under 15 years of age with echocardiographic diagnosis of tetralogy of Fallot were included in the study. All patients had pre-operative cardiac catheterization and angiography. Coronary arteries were studied with a nonselective aortic root angiogram in standard cranially tilted left anterior oblique view. The frequency of a normal and an anomalous coronary was determined. Results: Of the 83 patients, 78% were male and had a mean age of 8.9 years. Their mean weight was 14.3 kilograms. Seventy six (91.6%) had a normal coronary anatomy while 7 (8.4%) patients had anomalous coronary arteries. Among the patients with coronary anomalies, the commonest was a single origin coronary artery in 04 (57.14%) cases. Three (42.86%) had an anomalous origin of left anterior descending artery from the right coronary artery. Conclusion: Coronary artery anomalies were detected in 8.4% of the cases with tetralogy of Fallot. Single origin coronary artery anomaly was the commonest anomaly. (author)

  1. Complex Coronary Hemodynamics - Simple Analog Modelling as an Educational Tool.

    Science.gov (United States)

    Parikh, Gaurav R; Peter, Elvis; Kakouros, Nikolaos

    2017-01-01

    Invasive coronary angiography remains the cornerstone for evaluation of coronary stenoses despite there being a poor correlation between luminal loss assessment by coronary luminography and myocardial ischemia. This is especially true for coronary lesions deemed moderate by visual assessment. Coronary pressure-derived fractional flow reserve (FFR) has emerged as the gold standard for the evaluation of hemodynamic significance of coronary artery stenosis, which is cost effective and leads to improved patient outcomes. There are, however, several limitations to the use of FFR including the evaluation of serial stenoses. In this article, we discuss the electronic-hydraulic analogy and the utility of simple electrical modelling to mimic the coronary circulation and coronary stenoses. We exemplify the effect of tandem coronary lesions on the FFR by modelling of a patient with sequential disease segments and complex anatomy. We believe that such computational modelling can serve as a powerful educational tool to help clinicians better understand the complexity of coronary hemodynamics and improve patient care.

  2. Prevalence and predictors of coronary artery disease in adults with Kawasaki disease.

    Science.gov (United States)

    Garg, Jalaj; Krishnamoorthy, Parasuram; Palaniswamy, Chandrasekar; Paudel, Rajiv; Chatterjee, Saurav; Ahmad, Hasan; Snyder, Christopher

    2015-08-01

    Accelerated coronary atherosclerosis in patients with Kawasaki disease, in conjunction with coronary artery aneurysm and stenosis that characterise this disease, are potential risk factors for developing coronary artery disease in young adults. We aimed to determine the prevalence and predictors of coronary artery disease in adult patients with Kawasaki disease. All patients aged 18-55 years of age diagnosed with Kawasaki disease were sampled from Nationwide Inpatient Sample database using International Classification of Diseases 9th revision (ICD 9 code 446.1) from 2009 to 2010. Demographics, prevalence of coronary artery disease, and other traditional risk factors in adult patients with Kawasaki disease were analysed using ICD 9 codes. The prevalence of Kawasaki disease among adults was 0.0005% (n=215) of all in-hospital admissions in United States. The mean age was 27.3 years with women (27.6 years) older than men (27.1 years). Traditional risk factors were hypertension (21%), hyperlipidaemia (15.6%), diabetes (11.5%), tobacco use (8.8%), and obesity (8.8%), with no significant difference between men and women. Coronary artery disease (32.4%), however, was more prevalent in men (44.7%) than in women (12.1%; p=0.03). In multivariate regression analysis, after adjusting for demographics and traditional risk factors, hypertension (OR=13.2, p=0.03) was an independent risk factor of coronary artery disease. There was increased preponderance of coronary artery disease in men with Kawasaki disease. On multivariate analysis, hypertension was found to be the only independent predictor of coronary artery disease in this population after adjusting for other risk factors.

  3. [Hypertensive crisis in infancy and childhood].

    Science.gov (United States)

    Wirbelauer, J; Strotmann, J; Kirchhoff, A; Darge, K; Thomas, W

    2008-01-01

    The extended physical examination of a patient includes measurement of blood pressure. In infancy and childhood the blood pressure measurement may be difficult due to an uncooperative and restless patient. In a 16-month-old girl apparently unmeasurable blood pressure was a hypertensive crisis with systolic blood pressure of more than 200 mmHg. The cause of the hypertension was found to be a nephroblastoma. In the case of rapidly progressive arterial hypertension in another 16-month-old girl with left ventricular dilatation and reduced function was a consequence of kidney dysplasia. Headache attacks lead to diagnosis of a subtotal coarctation of the aortic isthmus in a 17-year-old boy. Hypertensive crisis in infancy, childhood and adolescence is discussed based on these case reports. Special features of blood pressure measurement in the pediatric age group, pathogenesis of hypertensive crisis and the potential therapies are discussed incorporating a brief review of the literature.

  4. Refractory versus resistant hypertension: Novel distinctive phenotypes

    Science.gov (United States)

    Dudenbostel, Tanja; Siddiqui, Mohammed; Gharpure, Nitin; Calhoun, David A.

    2017-01-01

    Resistant hypertension (RHTN) is relatively common with an estimated prevalence of 10-20% of treated hypertensive patients. It is defined as blood pressure (BP) >140/90 mmHg treated with ≥3 antihypertensive medications, including a diuretic, if tolerated. Refractory hypertension is a novel phenotype of severe antihypertensive treatment failure. The proposed definition for refractory hypertension, i.e. BP >140/90 mmHg with use of ≥5 different antihypertensive medications, including a diuretic and a mineralocorticoid receptor antagonist (MRA) has been applied inconsistently. In comparison to RHTN, refractory hypertension seems to be less prevalent than RHTN. This review focuses on current knowledge about this novel phenotype compared with RHTN including definition, prevalence, mechanisms, characteristics and comorbidities, including cardiovascular risk. In patients with RHTN excess fluid retention is thought to be a common mechanism for the development of RHTN. Recently, evidence has emerged suggesting that refractory hypertension may be more of neurogenic etiology due to increased sympathetic activity as opposed to excess fluid retention. Treatment recommendations for RHTN are generally based on use and intensification of diuretic therapy, especially with the combination of a long-acting thiazide-like diuretic and an MRA. Based on findings from available studies, such an approach does not seem to be a successful strategy to control BP in patients with refractory hypertension and effective sympathetic inhibition in such patients, either with medications and/or device based approaches may be needed. PMID:29034321

  5. Pulmonary hypertension associated with left-sided heart disease.

    Science.gov (United States)

    Maeder, Micha Tobias; Schoch, Otto D; Kleiner, Rebekka; Joerg, Lucas; Weilenmann, Daniel; Swiss Society For Pulmonary Hypertension

    2017-01-19

    Pulmonary hypertension associated with left-sided heart disease (PH-LHD) is the most common type of pulmonary hypertension. In patients with left-sided heart disease, the presence of pulmonary hypertension is typically a marker of more advanced disease, more severe symptoms, and worse prognosis. In contrast to pulmonary arterial hypertension, PH-LHD is characterised by an elevated pulmonary artery wedge pressure (postcapillary pulmonary hypertension) without or with an additional precapillary component (isolated postcapillary versus combined postcapillary and precapillary pulmonary hypertension). Transthoracic echocardiography is the primary nonin-vasive imaging tool to estimate the probability of pulmonary hypertension and to establish a working diagnosis on the mechanism of pulmonary hyperten-sion. However, right heart catheterisation is always required if significant pulmonary hypertension is sus-pected and exact knowledge of the haemodynamic constellation is necessary. The haemodynamic con-stellation (mean pulmonary artery pressure, mean pulmonary artery wedge pressure, left ventricular end-diastolic pressure) in combination with clinical infor-mation and imaging findings (mainly echocardiog-raphy, coronary angiography and cardiac magnetic resonance imaging) will usually allow the exact mech-anism underlying PH-LHD to be defined, which is a prerequisite for appropriate treatment. The general principle for the management of PH-LHD is to treat the underlying left-sided heart disease in an optimal man-ner using drugs and/or interventional or surgical ther-apy. There is currently no established indication for pulmonary arterial hypertension-specific therapies in PH-LHD, and specific therapies may even cause harm in patients with PH-LHD.

  6. Doença arterial obstrutiva periférica e índice tornozelo-braço em pacientes submetidos à angiografia coronariana Peripheral arterial occlusive disease and ankle-brachial index in patients who had coronary angiography

    Directory of Open Access Journals (Sweden)

    Sthefano Atique Gabriel

    2007-03-01

    Full Text Available OBJETIVO: Avaliar a prevalência de doença arterial obstrutiva periférica (DAOP em coronariopatas. Avaliar a relação entre Índice Tornozelo-Braço (ITB e doença coronariana, e sua correlação com fatores de risco cardiovascular. MÉTODO: ITB investigado com ultra-sonografia Doppler. Características clínicas pesquisadas: idade, sexo, diabetes mellitus, hipertensão arterial sistêmica, etilismo, tabagismo e obesidade. População: 113 pacientes submetidos à angiografia coronariana. Primeira análise: 2 grupos - ausência e presença de coronariopatia. Segunda análise: 3 grupos - Grupo 1 - ausência de lesão coronariana; Grupo 2 - estenose 70%. Terceira análise: 2 grupos - ausência e presença de DAOP. RESULTADOS: 90,76% dos coronariopatas apresentaram DAOP. Houve diferença significante quanto à faixa etária (pOBJECTIVE: To evaluate the prevalence of peripheral arterial disease (PAD in patients with coronary arterial disease. To evaluate the relation between ankle-brachial index (ABI and coronary arterial disease, and its correlation with cardiovascular risk factors. METHOD: ABI investigated with Doppler ultrasonic device. Clinical characteristics researched: age, gender, diabetes, hypertension, alcoholism, smoking and obesity. Population: 113 patients who had coronary angiography. First analyses: 2 groups - absence and presence of coronary arterial disease. Second analyses: 3 groups - Group 1 - absence of coronary lesion; Group 2 - stenosis 70%. Third analyses: 2 groups - absence and presence of PAD. RESULTS: 90.76% of patients with coronary arterial disease presented PAD. There were significant difference including age (p<0.001, hypertension (p<0.001. smoking (p<0.001, body mass index (BMI (p<0.001, systolic blood pressure (SBP (p<0.001, diastolic blood pressure (DBP (p<0.001 and pulse pressure (PP (p<0.001 and ABI (p<0.001 between patients with and without coronary lesion. There were significant difference including age (p<0

  7. Resistant hypertension: Current status, future challenges

    Directory of Open Access Journals (Sweden)

    Niloofar Hajizadeh

    2014-01-01

    Full Text Available Resistant hypertension in adolescents is increasing in frequency and is increasingly recognized as having significant short- and long-term health consequences. It may be seen in up to 30% of all hypertensive patients cared for. Adolescents with resistant hypertension are at higher cardiovascular (CV risk due to a long history of severe hypertension complicated by other CV risk factors such as obesity. Common causes of resistant hypertension include primary aldosteronism, sleep apnea, diabetes and chronic kidney disease. Careful blood pressure (BP measurement and thorough evaluation of patients with sustained BP elevation should make a possible early diagnosis of resistant hypertension. Successful treatment requires identification and reversal of life-style factors contributing to treatment resistant and diagnosis and appropriate treatment of causes of hypertension. Improved pharmacologic therapies may offer the potential for preventing or at least ameliorating early CV disease. This review highlights these and other important issues in the evaluation and management of adolescents with resistant hypertension and provides practical guidance to the practitioners involved in caring for such patients.

  8. [Severe hypertension: definition and patients profiles].

    Science.gov (United States)

    Mourad, Jean-Jacques

    2013-05-01

    Severe arterial hypertension gathers relatively different clinical situations explained by the heterogeneity of the definitions of this clinical setting. From a medical point of view, severe hypertension is a short course situation defined by very high values of blood pressure corresponding to grade 3 hypertension. In France, until 2011, the social security also included in the definition of severe HTA chronic situations characterized by moderate blood pressure values requiring at least triple anthihypertensive therapies associated with a clinical or infraclinical target organ damages. These clinical profiles, much more frequent than grade 3 hypertension, allowed the full reimbursement of care costs for these patients. In France, it is estimated that 10% of hypertensive patients present a severe form with an annual incidence of 50,000 patients. The patients with severe hypertension have an increased cardiovascular morbidity justifying a closer clinical monitoring. From an economic point of view, these severe forms of hypertension have a higher cost of care, explained primarily by a more frequent need of specialized referrals, radiological exams and hospitalizations. This excess cost justified the existence of a full coverage of induced costs by the social security, since the incidence of severe hypertension is more frequent in the low social categories, and in patients with economic fragility.

  9. Coexistent coronary artery disease or myocardial bridging in patients with hypertrophic cardiomyopathy using coronary CT angiography

    International Nuclear Information System (INIS)

    Lee, Jae Hwan; Chun, Eun Ju; Kim, Yeo Koon; Yoo, Jin Young; Choi, Sang Il; Choi, Dong Ju

    2015-01-01

    To evaluate the prevalence of coexistent coronary artery disease (CAD) or myocardial bridging (MB) in patients with hypertrophic cardiomyopathy (HCM) using coronary CT angiography (CCTA) and assess the role of CCTA. The prevalence of obstructive CAD (> 50% luminal reduction) and MB (partial and full encasement) were assessed in 150 patients with HCM diagnosed by clinical findings, electrocardiography, and echocardiography of 19588 consecutive patients who underwent CCTA for suspected CAD. The overall feasibility of coronary artery visualization was 98.9% with CCTA. In patients with HCM, the prevalence of obstructive CAD and MB (14.7% partial and 28.0% full encasement) were 23.3% and 42.7%, respectively. Age, hypertension, family history of premature CAD, Framingham risk score and severe chest pain were associated with CAD, whereas male gender and septal type were associated with MB (all p < 0.05). In comparison to invasive coronary angiography (n = 37), the diagnostic accuracy of CCTA for the detection of CAD and full encasement MB was 89.2% and 86.5%, respectively. One-quarter of patients with HCM had coexistent obstructive CAD or full encasement MB. CCTA can be a feasible and accurate noninvasive imaging modality for the detection of CAD and MB in patients with HCM

  10. Coexistent coronary artery disease or myocardial bridging in patients with hypertrophic cardiomyopathy using coronary CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jae Hwan; Chun, Eun Ju; Kim, Yeo Koon; Yoo, Jin Young; Choi, Sang Il; Choi, Dong Ju [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2015-07-15

    To evaluate the prevalence of coexistent coronary artery disease (CAD) or myocardial bridging (MB) in patients with hypertrophic cardiomyopathy (HCM) using coronary CT angiography (CCTA) and assess the role of CCTA. The prevalence of obstructive CAD (> 50% luminal reduction) and MB (partial and full encasement) were assessed in 150 patients with HCM diagnosed by clinical findings, electrocardiography, and echocardiography of 19588 consecutive patients who underwent CCTA for suspected CAD. The overall feasibility of coronary artery visualization was 98.9% with CCTA. In patients with HCM, the prevalence of obstructive CAD and MB (14.7% partial and 28.0% full encasement) were 23.3% and 42.7%, respectively. Age, hypertension, family history of premature CAD, Framingham risk score and severe chest pain were associated with CAD, whereas male gender and septal type were associated with MB (all p < 0.05). In comparison to invasive coronary angiography (n = 37), the diagnostic accuracy of CCTA for the detection of CAD and full encasement MB was 89.2% and 86.5%, respectively. One-quarter of patients with HCM had coexistent obstructive CAD or full encasement MB. CCTA can be a feasible and accurate noninvasive imaging modality for the detection of CAD and MB in patients with HCM.

  11. Women’s health in menopause with a focus on hypertension

    OpenAIRE

    Maas, A.H.E.M.; Franke, H.R.

    2009-01-01

    In menopause transition many women have vasomotor symptoms which may affect their normal daily activities. With the decline in oestrogen levels, risk factors for coronary heart disease (CHD) become more apparent, especially hypertension. The onset of hypertension can cause a variety of complaints that are often attributed to the menopause. Risk factor identification is poorly managed in middle-aged women and should be the first step in the evaluation and treatment of women with perimenopausal...

  12. Coronary arterial Disease associated with arteriosclerosis in lower extremity: Angiographic analysis

    International Nuclear Information System (INIS)

    Kim, Ji Hye; Chung, Jin Wook; Lee, Seon Kyu; Han, Joon Koo; Park, Jae Hyung; Kim, Jae Seung; Han, Man Chung

    1993-01-01

    We performed both peripheral and coronary angiographies in 52 patients with an arteriosclerosis in lower extremities. The severity of arteriosclerotic narrowing of the coronary and peripheral arteries were compared on angiographies. An angiographic vascular score(AVS, 0-5) reflecting the number and the degree of stenosis in 12 lower extremity arteries and three major coronary arteries was assigned to each angiogram and the sun of scores in the lower extremity arteries was compared with the incidence of significant coronary artery disease (more than grade 3) and coronary score. Relation of incidence and severity of vascular stenosis and risk factors (diabetes metallitus, hypertension, smoking, and hypercholesterolemia) was also analyzed. Thirty-four of 52 patients (65%) had an angiographically significant coronary artery disease. Thirteen of these 34 patients (38%) had no clinical symptom and sign of the ischemic heart disease. There was no statistically significant difference in the incidence and severity of coronary artery disease between high (more than 30) and low AVS group in lower extremity (p>0.14). All patients had at least one risk factor and 49 of 52 patients (94%) had multiple risk factors. Coronary angiography was normal in there patients with only one risk factors, and angiographically significant coronary artery disease existed in nine of 16 cases (56.3%) with two risk factors. 13 of 17 case (76.5%) with three risk factors, and 12 of 16 cases (75.0%) with all four risk factors. There were no significant correlations between individual risk factors and incidence, severity of arteriosclerosis in coronary and lower extremity arteries. In conclusion, angiographic evaluation of the coronary artery disease in patients with lower extremity arteriosclerosis is necessary because of the high chance of coronary artery disease and difficulty in the prediction of coronary artery disease with a severity of the peripheral arteriosclerosis, presence of various risk

  13. Acute Coronary Syndrome Due to Spontaneous Coronary Artery Dissection in a Middle-Aged Man

    Directory of Open Access Journals (Sweden)

    Davran Cicek

    2014-08-01

    Full Text Available True spontaneous coronary artery dissection (SCAD is an extremely rare but important cause of acute coronary syndrome, with only about 200 cases reported in the literature. Diagnosis is often made at autopsy. Risk factors include oral contraceptive use, atherosclerotic disease and the peripartum period. SCAD should be considered when a healthy young patient presents with the onset of acute myocardial ischemic syndrome. A timely diagnosis and intervention are mandatory as SCAD can cause sudden death. We present a case of SCAD with an uncommon clinical presentation of acute coronary syndrome and without identifiable risk factors, and successfully treated with non-invasive (medical therapy.

  14. Awareness and Practices of Non-Pharmacological Approaches for Management of Hypertension in a Geriatric Population

    OpenAIRE

    Debalina Sahoo; Harshida Gosai; Ujjwal Sahoo; J. M. Harsoda

    2014-01-01

    Background: There is an increase in the prevalence of hypertension all over the world, including India. Hypertension can be initially managed with non-pharmacological measures. This study aims to assess the knowledge of non-pharmacological measures to control hypertension and its application in a geriatric hypertensive population. Methods: The study was conducted at the Department of Physiology, SVU, Vadodara, India. A total 110 hypertensive patients were included in the study and a non-v...

  15. [Knowledge level of hypertensive patients about hypertension. Relationship between knowledge level and hypertension control].

    Science.gov (United States)

    Benítez Camps, M; Egocheaga Cabello, M Isabel; Dalfó Baqué, A; Bajo García, J; Vara González, L; Sanchis Doménech, C; Martín Rioboo, E; Ureña Fernández, T; Domínguez Sardiña, M; Bonet Pla, A

    2015-01-01

    To assess the knowledge of the hypertensive patients about their hypertension and their relation to its control. Cross-sectional study among 400 hypertensive patients, all over 18 years, selected from 50 primary-care centres, who responded to an hypertension-related survey. Included variables were survey items, age, gender, educational level, professional occupation, blood pressure data and antihypertensive treatment. The obtained differences were analyzed using the chi-square test, Kruskal-Wallis, Wilcoxon, Anova and Bonferroni methods. There were 323 valid surveys. 52.9% of respondents were women, the average age: 65.4 years (SD: 11.2), 54.8% of them had primary education. 39.6% were aware of the objectives of systolic BP control. Only 19.6% having knowledge of those for diastolic BP control, with no differences between controlled and uncontrolled (systolic BP: 39% vs 38.1%, P=.887; diastolic BP: 19.2% vs 21%, P=.721). Over 70% knew about lifestyle changes, without significant differences between controlled and uncontrolled respondents. 82% of controlled respondents, and 79% of those uncontrolled, recognized the chronical nature of the treatment (P=.548), but 15.1% of the controlled respondents and 12.4% of uncontrolled respondents did not see the relation between the treatment and hypertension control (P=.525). 31.1% believed to be well-controlled, but in fact was not. Our patients doesn't know blood pressure targets of control. There isn't relationship between this knowledge and control of hypertension. Copyright © 2014 SEHLELHA. Published by Elsevier Espana. All rights reserved.

  16. Persistence of cardiovascular risk factors in patients with coronary artery diseases after percutaneous coronary interventions

    Directory of Open Access Journals (Sweden)

    Fariba Heidari

    2016-02-01

    Full Text Available Introduction: Coronary artery disease (CAD is as a leading cause of death and disability all around the world. Multiple risk factors have a role in the development and progression of coronary heart disease (CHD. It is necessary to control risk factors, to achieve optimal results of treatment. The aim of present study was to evaluate the persistence of cardiovascular risk factors in patients with CADs after percutaneous cardiac interventions. Methods: In an analytical-descriptive study, 150 patient with CAD and percutaneous coronary intervention (PCI were performed for them, and referred to Cardiology Clinic of Shahid Madani Hospital of Tabriz University of Medical Sciences, Tabriz, Iran, from September 2013 to September 2015, were studied. The persistence of coronary risk factors, 12-24 months after performing PCI, was evaluated. Results: The mean age of patients at time of PCI performing was 57.90 ± 12.26 years. 72.7% of patients were male and 27.3% were female and male to female ratio was 1 to 0.37. Dyslipidemia in 52.0% of patients, hypertension in 51.3% patients, and diabetes mellitus (DM in 41.3% patients were the most common underlying comorbidities. In both before and after doing PCI, 26.7% were a smoker, and smoking rates after doing PCI also showed no significant change (P = 0.055, and also there were no significant changes in the physical activity of patients compared before and after performing PCI. Conclusion: Based on the findings of the present study, dyslipidemia, hypertension, and DM, was the most frequent underlying diseases in patients with CAD respectively. Risk factors such as smoking, and lack of exercise, had no significant changes after performing PCI.

  17. Localization strategy for magnetic resonance coronary angiography

    International Nuclear Information System (INIS)

    Cheng Liuquan; Gao Yuangui; Sun Wei; Sheng Fugeng; Cai Youquan

    2003-01-01

    Objective: To develop a localization strategy for magnetic resonance coronary angiography (MRCA). Methods: In 89 subjects, the standard 4-chamber view and long-axis view of left and right ventricle were acquired using Fast-Imaging-Employing-Steady-State-Acquisition (FIESTA) sequence in CINE mode, and the trigger-delay time for mid-diastolic phase was determined. Coronary vessels including right coronary artery (RCA), left main (LM), left anterior descending (LAD), and left circumflex (LCX) were localized and imaged using 3- dimensional fat-suppressed FIESTA sequence during end-expiration. The reproducibility of the localization strategy was evaluated by taking the standard of coronary segmentation system recommended by American Heart Association. Results: Eighty-six subjects completed the examination with full respiratory co-operation and the indication ratio was 96.63%. Nine planes were optimized as the standard to target the main branches of coronary arteries, and a comprehensive reproducibility reached 100% in demonstrating the proximal and middle segment of RCA (AHA-18, 19), LM (AHA-1, 2), proximal and middle segment of LAD (AHA-3, 5, 7), and proximal LCX (AHA-10). The reproducibility for the demonstration of distal segments of LAD, LCX, and RCA (AHA-9, 14, 21) was 94.19%, 72.09%, and 96.51%, respectively. Conclusion: This is a simple and practical localization strategy for MRCA. It could image the proximal and middle segments of the coronary arteries with good reproducibility, which indicates the potential for clinical application

  18. Hypertension in Pregnancy and Future Cardiovascular Event Risk in Siblings

    Science.gov (United States)

    Turner, Stephen T.; Mosley, Thomas H.; Kardia, Sharon L.R.; Hanis, Craig L.; Milic, Natasa M.; Garovic, Vesna D.

    2016-01-01

    Hypertension in pregnancy is a risk factor for future hypertension and cardiovascular disease. This may reflect an underlying familial predisposition or persistent damage caused by the hypertensive pregnancy. We sought to isolate the effect of hypertension in pregnancy by comparing the risk of hypertension and cardiovascular disease in women who had hypertension in pregnancy and their sisters who did not using the dataset from the Genetic Epidemiology Network of Arteriopathy study, which examined the genetics of hypertension in white, black, and Hispanic siblings. This analysis included all sibships with at least one parous woman and at least one other sibling. After gathering demographic and pregnancy data, BP and serum analytes were measured. Disease-free survival was examined using Kaplan–Meier curves and Cox proportional hazards regression. Compared with their sisters who did not have hypertension in pregnancy, women who had hypertension in pregnancy were more likely to develop new onset hypertension later in life, after adjusting for body mass index and diabetes (hazard ratio 1.75, 95% confidence interval 1.27–2.42). A sibling history of hypertension in pregnancy was also associated with an increased risk of hypertension in brothers and unaffected sisters, whereas an increased risk of cardiovascular events was observed in brothers only. These results suggest familial factors contribute to the increased risk of future hypertension in women who had hypertension in pregnancy. Further studies are needed to clarify the potential role of nonfamilial factors. Furthermore, a sibling history of hypertension in pregnancy may be a novel familial risk factor for future hypertension. PMID:26315531

  19. Supracristal ventricular septal defect with severe right coronary cusp prolapse

    International Nuclear Information System (INIS)

    Hussain, A.H.; Hanif, B.; Khan, G.; Hasan, K.

    2011-01-01

    The case of a 20 years old male, diagnosed as supracristal ventricular septal defect (VSD) for last 6 years is being presented. He came in emergency department with decompensated congestive cardiac failure. After initial stabilization, he underwent trans thoracic echocardiogram which showed large supracristal VSD, severely prolapsing right coronary cusp, severe aortic regurgitation and severe pulmonary hypertension. Right heart catheterization was performed which documented reversible pulmonary vascular resistance after high flow oxygen inhalation. He underwent VSD repair, right coronary cusp was excised and aortic valve was replaced by mechanical prosthesis. Post operative recovery was uneventful. He was discharged home in one week.The case of a 20 years old male, diagnosed as supracristal ventricular septal defect (VSD) for last 6 years is being presented. He came in emergency department with decompensated congestive cardiac failure. After initial stabilization, he underwent trans thoracic echocardiogram which showed large supracristal VSD, severely prolapsing right coronary cusp, severe aortic regurgitation and severe pulmonary hypertension. Right heart catheterization was performed which documented reversible pulmonary vascular resistance after high flow oxygen inhalation. He underwent VSD repair, right coronary cusp was excised and aortic valve was replaced by mechanical prosthesis. Post operative recovery was uneventful. He was discharged home in one week. (author)

  20. Hypertensive crisis in children.

    Science.gov (United States)

    Chandar, Jayanthi; Zilleruelo, Gastón

    2012-05-01

    Hypertensive crisis is rare in children and is usually secondary to an underlying disease. There is strong evidence that the renin-angiotensin system plays an important role in the genesis of hypertensive crisis. An important principle in the management of children with hypertensive crisis is to determine if severe hypertension is chronic, acute, or acute-on-chronic. When it is associated with signs of end-organ damage such as encephalopathy, congestive cardiac failure or renal failure, there is an emergent need to lower blood pressures to 25-30% of the original value and then accomplish a gradual reduction in blood pressure. Precipitous drops in blood pressure can result in impairment of perfusion of vital organs. Medications commonly used to treat hypertensive crisis in children are nicardipine, labetalol and sodium nitroprusside. In this review, we discuss the pathophysiology, differential diagnosis and recent developments in management of hypertensive crisis in children.

  1. Association between resting heart rate and coronary artery disease, stroke, sudden death and noncardiovascular diseases: a meta-analysis.

    Science.gov (United States)

    Zhang, Dongfeng; Wang, Weijing; Li, Fang

    2016-10-18

    Resting heart rate is linked to risk of coronary artery disease, stroke, sudden death and noncardiovascular diseases. We conducted a meta-analysis to assess these associations in general populations and in populations of patients with hypertension or diabetes mellitus. We searched PubMed, Embase and MEDLINE from inception to Mar. 5, 2016. We used a random-effects model to combine study-specific relative risks (RRs). We used restricted cubic splines to assess the dose-response relation. We included 45 nonrandomized prospective cohort studies in the meta-analysis. The multivariable adjusted RR with an increment of 10 beats/min in resting heart rate was 1.12 (95% confidence interval [CI] 1.09-1.14) for coronary artery disease, 1.05 (95% CI 1.01-1.08) for stroke, 1.12 (95% CI 1.02-1.24) for sudden death, 1.16 (95% CI 1.12-1.21) for noncardiovascular diseases, 1.09 (95% CI 1.06-1.12) for all types of cancer and 1.25 (95% CI 1.17-1.34) for noncardiovascular diseases excluding cancer. All of these relations were linear. In an analysis by category of resting heart rate ( 80 beats/min), the RRs were 0.99 (95% CI 0.93-1.04), 1.08 (95% CI 1.01-1.16) and 1.30 (95% CI 1.19-1.43), respectively, for coronary artery disease; 1.08 (95% CI 0.98-1.19), 1.11 (95% CI 0.98-1.25) and 1.08 (95% CI 0.93-1.25), respectively, for stroke; and 1.17 (95% CI 0.94-1.46), 1.31 (95% CI 1.12-1.54) and 1.57 (95% CI 1.39-1.77), respectively, for noncardiovascular diseases. After excluding studies involving patients with hypertension or diabetes, we obtained similar results for coronary artery disease, stroke and noncardiovascular diseases, but found no association with sudden death. Resting heart rate was an independent predictor of coronary artery disease, stroke, sudden death and noncardiovascular diseases over all of the studies combined. When the analysis included only studies concerning general populations, resting heart rate was not associated with sudden death. © 2016 Canadian Medical

  2. An investigation of correlation between left coronary bifurcation angle and hemodynamic changes in coronary stenosis by coronary computed tomography angiography-derived computational fluid dynamics.

    Science.gov (United States)

    Sun, Zhonghua; Chaichana, Thanapong

    2017-10-01

    To investigate the correlation between left coronary bifurcation angle and coronary stenosis as assessed by coronary computed tomography angiography (CCTA)-generated computational fluid dynamics (CFD) analysis when compared to the CCTA analysis of coronary lumen stenosis and plaque lesion length with invasive coronary angiography (ICA) as the reference method. Thirty patients (22 males, mean age: 59±6.9 years) with calcified plaques at the left coronary artery were included in the study with all patients undergoing CCTA and ICA examinations. CFD simulation was performed to analyze hemodynamic changes to the left coronary artery models in terms of wall shear stress, wall pressure and flow velocity, with findings correlated to the coronary stenosis and degree of bifurcation angle. Calcified plaque length was measured in the left coronary artery with diagnostic value compared to that from coronary lumen and bifurcation angle assessments. Of 26 significant stenosis at left anterior descending (LAD) and 13 at left circumflex (LCx) on CCTA, only 14 and 5 of them were confirmed to be >50% stenosis at LAD and LCx respectively on ICA, resulting in sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 100%, 52%, 49% and 100%. The mean plaque length was measured 5.3±3.6 and 4.4±1.9 mm at LAD and LCx, respectively, with diagnostic sensitivity, specificity, PPV and NPV being 92.8%, 46.7%, 61.9% and 87.5% for extensively calcified plaques. The mean bifurcation angle was measured 83.9±13.6º and 83.8±13.3º on CCTA and ICA, respectively, with no significant difference (P=0.98). The corresponding sensitivity, specificity, PPV and NPV were 100%, 78.6%, 84.2% and 100% based on bifurcation angle measurement on CCTA, 100%, 73.3%, 78.9% and 100% based on bifurcation angle measurements on ICA, respectively. Wall shear stress was noted to increase in the LAD and LCx models with significant stenosis and wider angulation (>80º), but

  3. Primary hypertension and special aspects of hypertension in older children and adolescents

    Directory of Open Access Journals (Sweden)

    Ellis D

    2011-07-01

    Full Text Available Demetrius Ellis, Yosuke MiyashitaChildren’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, PA, USAAbstract: The prevalence of hypertension has increased at an accelerated rate in older children and adolescents. This has raised great concern about premature development of cardiovascular disease, which has major long-term health and financial implications. While obesity and sedentary habits largely explain this phenomenon, there are other social and cultural influences that may unmask genetic susceptibility to hypertension in the pediatric population. While it is essential to exclude numerous causes of secondary hypertension in every child, these disorders are not discussed in this review. Rather, the aim of this review is to familiarize pediatricians with casual and ambulatory blood pressure measurement, epidemiology, pathophysiology, and management of several common conditions that play a role in the development of hypertension in children and adolescents. Besides primary hypertension and obesity-related hypertension, emphasis is given to epidemiology, measurement of blood pressure, including ambulatory blood pressure monitoring, hypertension associated with drug use, teenage pregnancy, and video and computer games. Lastly, because pediatricians are increasingly confronted with special issues concerning the management of the hypertensive athlete, this topic is also addressed.Keywords: hypertension, adolescents, obesity, drugs, pregnancy, athletes

  4. Pulmonary arterial hypertension

    Science.gov (United States)

    2013-01-01

    Pulmonary arterial hypertension (PAH) is a chronic and progressive disease leading to right heart failure and ultimately death if untreated. The first classification of PH was proposed in 1973. In 2008, the fourth World Symposium on PH held in Dana Point (California, USA) revised previous classifications. Currently, PH is devided into five subgroups. Group 1 includes patients suffering from idiopathic or familial PAH with or without germline mutations. Patients with a diagnosis of PAH should systematically been screened regarding to underlying mutations of BMPR2 gene (bone morphogenetic protein receptor type 2) or more rarely of ACVRL1 (activine receptor-like kinase type 1), ENG (endogline) or Smad8 genes. Pulmonary veno occusive disease and pulmonary capillary hemagiomatosis are individualized and designated as clinical group 1'. Group 2 'Pulmonary hypertension due to left heart diseases' is divided into three sub-groups: systolic dysfonction, diastolic dysfonction and valvular dysfonction. Group 3 'Pulmonary hypertension due to respiratory diseases' includes a heterogenous subgroup of respiratory diseases like PH due to pulmonary fibrosis, COPD, lung emphysema or interstitial lung disease for exemple. Group 4 includes chronic thromboembolic pulmonary hypertension without any distinction of proximal or distal forms. Group 5 regroup PH patients with unclear multifactorial mechanisms. Invasive hemodynamic assessment with right heart catheterization is requested to confirm the definite diagnosis of PH showing a resting mean pulmonary artery pressure (mPAP) of ≥ 25 mmHg and a normal pulmonary capillary wedge pressure (PCWP) of ≤ 15 mmHg. The assessment of PCWP may allow the distinction between pre-capillary and post-capillary PH (PCWP > 15 mmHg). Echocardiography is an important tool in the management of patients with underlying suspicion of PH. The European Society of Cardiology and the European Respiratory Society (ESC-ERS) guidelines specify its role

  5. The rationale and design of the PERindopril GENEtic association study (PERGENE): a pharmacogenetic analysis of angiotensin-converting enzyme inhibitor therapy in patients with stable coronary artery disease

    NARCIS (Netherlands)

    Brugts, J. J.; de Maat, M. P. M.; Boersma, E.; Witteman, J. C. M.; van Duijn, C.; Uitterlinden, A. G.; Bertrand, M.; Remme, W.; Fox, K.; Ferrari, R.; Danser, A. H. J.; Simoons, M. L.; Remme, W. J.; Aldershville, J.; Hildebrandt, P.; Bassand, J. P.; Cokkinos, D.; Toutouzas, P.; Eha, J.; Erhardt, L.; Erikssen, J.; Grybauskas, R.; Kalnins, U.; Karsch, K.; Sechtem, U.; Keltai, M.; Klein, W.; Luescher, T.; Mulcahy, D.; Nieminen, M.; Oto, A.; Ozsaruhan, O.; Paulus, W.; Providencia, L.; Riecansky, I.; Ruzyllo, W.; Santini, U.; Tavazzi, L.; Soler-Soler, J.; Widimsky, P.; Julian, D.; Dargie, H.; Kobler, W.; Duprez, D.; Steg, G.; Thygesen, K.; Drexel, H.; Gombotz, G.; Stoeckl, G.; Heyndrickx, G. H.; Legrand, V.; Materne, P.; van Mieghem, W.; Bocek, P.; Branny, M.; Cech, M.; Charouzek, J.; Drazka, J.; Fabik, L.; Florian, J.; Francek, L.; Groch, L.; Havranek, P.; Herman, A.; Hradec, J.; Jansky, P.; Jirmar, R.; Jokl, I.; Krejcova, H.; Kvasnak, M.; Maratka, T.; Marcinek, G.; Moravcova, J.; Nedbal, P.; Peterka, K.; Povolny, J.; Rosolova, H.; Semrad, B.; Sochor, K.; Spacek, R.; Spinar, J.; Stipal, R.; Stuchlik, K.; Sulda, M.; Ulman, J.; Vaclavicek, A.; Vojtisek, P.; Bjerregard Andersen, H.; Dorff, B.; Kristensen, K.; Madsen, J. K.; Markenvard, J.; Meibom, J.; Norgaard, A.; Scheibel, M.; Leht, A.; Teesalu, R.; Vahulaa, V.; Itkonen, A.; Juvonen, J.; Karmakoski, J.; Kilkki, E.; Koskela, E.; Kotila, M. J.; Melin, J.; Nieminen, M. S.; Savola, R.; Terho, T.; Voipio Pulkki, L. M.; Apffel, F.; Attali, P.; Baron, B.; Berthier, Y.; Dambrine, P.; Danchin, N.; Decoulx, E.; Deshayes, P.; Fouche, R.; Genest, M.; Godard, S.; Guillot, J. P.; Hanania, G.; Lelguen, C.; Leroy, F.; Mansourati, J.; Mery, D.; Michel, A. N.; Quiret, J. C.; Raynaud, P.; Rondepierre, D.; Roynard, J. L.; van Belle, E.; Veyrat, A.; Gaudron, P.; Karsch, K. R.; Lauer, B.; Rettig Stsrmer, G.; Riessen, R.; Rutsch, W.; Sigel, H. A.; Simon, R.; Stork, S.; von Schacky, C.; Winkelmann, B. R.; Christakos, S.; Feggos, S.; Geleris, P.; Georgiadis, S.; Gialafos, J.; Goudevenos, I.; Kardara, D.; Kardaras, F.; Karidis, C.; Kelesides, C.; Kyriakidis, M.; Koliopoulos, N.; Kremastinos, D.; Liberi, S.; Manolis, A. N.; Pyrgakis, V.; Papasteriadis, E.; Papazoglou, N.; Skoufas, P.; Stamatelopoulos, S.; Stambola, S.; Stavridis, A.; Syribeis, S.; Vardas, P.; Vassiliadis, I.; Voudris, V.; Zacharoulis, A.; Zobolos, S.; Zouras, C.; Berenyi, I.; Bocsa, Z.; Csendes, E.; Edes, I.; Gelesz, E.; Janosi, A.; Kalo, E.; Karpati, P.; Kornel, S.; Pap, I.; Pinter, I.; Polak, G.; Reiber, I.; Rusznak, M.; Simon, A.; Tarjan, J.; Tihanyi, L.; Timar, S.; Toth, K.; Veress, G.; Barton, J.; Crean, P.; Daly, K.; Kearney, P.; Meany, T. B.; Quigley, P.; Azzolini, P.; Barone, G.; Barsotti, A.; Bellone, E.; Borghetti, A.; Branzi, A.; Brunelli, C.; Capponi, E.; Capucci, A.; Casaccia, M.; Casali, G.; Cecchetti, E.; Ceci, V.; Celegon, L.; Chimini, C.; Colombo, A.; Corsini, G.; Cucchini, F.; Dalla Volta, S.; de Luca, I.; de Servi, S.; Delise, P.; Di Donato, M.; Di Giacomo, U.; Di Pasquale, G.; Fiorentini, C.; Gaddi, O.; Giannetto, M.; Giannuzzi, P.; Giordano, A.; Giovannini, E.; Iacono, A.; Inama, G.; Ippoliti, G.; Leghissa, R.; Lorusso, R.; Marzilli, M.; Minutiello, L.; Moretti, G.; Mosele, G. M.; Pasotti, C.; Pettinati, G.; Pezzano, A.; Polimeni, M. R.; Portaluppi, F.; Proto, C.; Riva, S.; Sanguinetti, M.; Santini, M.; Severi, S.; Sinagra, G.; Tantalo, L.; Vajola, S. F.; Vincenzi, M.; Volterrani, M.; Zavatteri, G.; Zogno, M.; Gailiss, E.; Gersamija, A.; Ozolina, M. A.; Skards, J.; Baubiniene, A.; Berukstis, E.; Grigoniene, L.; Grybauskas, A. N.; Kibarskis, A.; Kirkutis, A.; Marcinkus, R.; Milvidaite, I.; Vasiliauskas, D.; Aalders, J. C. A.; Bruggeling, W. A. J.; Bucx, J. J. J.; de Feyter, P. J.; de Leeuw, M. J.; de Waard, D. E. P.; de Weerd, G. J.; de Zwaan, C.; Dijkgraaf, R.; Droste, H. T.; Freericks, M. P.; Hagoort Kok, A. W.; Jap, W. T. J.; Jochemsen, G. M.; Kiemeney, K.; Kuijer, P. J. P.; Mannaerts, H. F. J.; Piek, J. J.; Saelman, J. P. M.; Slob, F. D.; Smits, W. C. G.; Spierenburg, H. A. M.; Suttorp, M. J.; Tan, T. B.; van Beek, G. J.; van Daele, M. E. R. M.; van den Merkhof, L. F. M.; van den Toren, E. W.; van Hessen, M. W. J.; van Langeveld, R. A. M.; van Loo, L. W. H.; van Nierop, P. R.; van Rey, F. J. W.; van Straalen, M. J.; Vos, J.; Werner, H. A.; Westendorp, J. J. C.; Zwiers, G.; Achremczyk, P.; Adamus, J.; Baska, J.; Bolinska Soltysiak, H.; Bubinski, R.; Ceremuzynski, L.; Cieslinski, A.; Dariusz, D.; Deptulski, T.; Drewla, P.; Drozdowski, P.; Dubiel, J. S.; Dudek, D.; Galewicz, M.; Ghlebus, K.; Halawa, B.; Jakubowska Majnigier, M.; Janion, M.; Jaworska, K.; Kaszewska, I.; Kleinrok, A.; Kornacewicz Jach, Z.; Krawczyk, W.; Krynicki, R.; Krzciuk, M.; Krzeminska Pakula, M.

    2009-01-01

    BACKGROUND: Angiotensin-converting enzyme (ACE) inhibitors reduce clinical symptoms and improve outcome in patients with hypertension, heart failure, and stable coronary artery disease (CAD) and are among the most frequently used drugs in these patient groups. For hypertension, treatment is guided

  6. Coronary Heart Disease in the Middle East and North Africa: Current Status and Future Goals.

    Science.gov (United States)

    Traina, Mahmoud I; Almahmeed, Wael; Edris, Ahmad; Murat Tuzcu, E

    2017-05-01

    The Middle East and North Africa has witnessed a dramatic transformation over the last 30 years caused by rapid urbanization and modernization and significant changes to diet and lifestyle. This review attempts to highlight recent data in regards to ischemic heart disease and its risk factors from the region. Ischemic heart disease is now the leading cause of death in the region. Age at presentation with myocardial infarction and acute coronary syndrome appears to be significantly younger than global averages. Increased rates of all major risk factors including diabetes, hypertension, hyperlipidemia, smoking, obesity, and sedentary lifestyle have been noted. Specifically, significant changes to dietary habits and growing epidemic of use of alternative tobacco products are noted. This review article highlights the growing epidemic of ischemic heart disease in the region led by dramatic increases in incidence of its risk factors. This epidemic will require a multipronged approach to address the varied issues and mitigate the growing prevalence of the disease.

  7. Selective coronary scintigraphy

    International Nuclear Information System (INIS)

    Gambini, D.-J.

    1975-01-01

    Isotopic techniques occupy a leading place amongst examinations practicable on coronary patients because of their reliability and the safety and simplicity of their use. The present work reviews the possible applications of selective coronary scintigraphy in pathology. After a brief discussion on scintigraphy, isotopic techniques for myocardium research, coronarography and other methods to study local myocardium perfusion the theoretical bases for the use of the exploration are studied, the techniques and methods employed are reported and the results discussed. Coronary scintigraphy consists of selective injection in the two coronary arteries previously catheterized during a coronarography, of two different populations of microspheres labelled with two physically short-lived indicators: 15μ 99m Tc-labelled serumalbumin microspheres, 10 to 15μ In-labelled siderophiline microspheres. Various studies have shown the complete harmlessness of the exploration when certain precautions are taken regarding the size and number of the spheres. The microspheres disperse into the downstream arterial territory proportionally to the number of capillaries present in the different parts of the irrigated region, and are temporarily stopped in the precapillaries. The preparation of the different images needed to interpret the Face and OAG examination for the left coronary, then for the right coronary, is carried out at the end of the coronarography and lasts about 45 minutes. It is also possible by selective injection in the aorta-coronary bridges to judge their functional condition by observation of the regions they irrigate. 56 patients of the Necker hospital cardiological clinic have been examined [fr

  8. Coronary artery fistulas

    Directory of Open Access Journals (Sweden)

    V. M. Subbotin

    2015-01-01

    Full Text Available Coronary artery fistulas are classified as abnormalities of termination and referred to as major congenital anomalies. Most coronary artery fistulas are small, unaccompanied by clinical symptoms, and diagnosed by echocardiography or coronarography performed for an unrelated cause. Such fistulas usually do not cause any complications and can spontaneously resolve. However, larger fistulas are usually >3 tones the size of a normal caliber of a coronary artery and may give rise to clinical symptoms in these cases. The clinical symptoms of coronary artery fistulas may mimic those of various heart diseases depending on which chamber a fistula drains into. Most fistulas are congenital. Congenital coronary artery fistulas may occur as an isolated malformation or be concurrent with other cardiac anomalies, more frequently with critical pulmonary stenosis or atresia with an intact interventricular septum and pulmonary stenoses, Fallot's tetralogy, aortic coarctation, and left heart hypoplasia. When choosing a treatment modality, one should take into account the number of fistula communications, the feeding vessel, localization of drainage, degree of myocardial damage, and hemodynamic relevance of the shunt caused by the presence of a fistula. The goal of treatment is to obliterate a fistula by preserving normal coronary blood flow. The risk for persisting fistula should be balanced with the potential risk of complications related to a procedure of coronarography and fistula occlusion. Percutaneous transcatheter coil occlusion of coronary artery fistulas is the modality of choice in children with the suitable anatomy of fistula communications and without concomitant congenital heart diseases.

  9. [Hypertension in women].

    Science.gov (United States)

    Tagle, Rodrigo; Tagle V, Rodrigo; Acevedo, Mónica; Valdés, Gloria

    2013-02-01

    The present review examines the types of hypertension that women may suffer throughout life, their physiopathological characteristics and management. In early life, the currently used low-dose oral contraceptives seldom cause hypertension. Pregnancy provokes preeclampsia, its main medical complication, secondary to inadequate transformation of the spiral arteries and the subsequent multisystem endothelial damage caused by deportation of placental factors and microparticles. Hypertension in preeclampsia is an epiphenomenon which needs to be controlled at levels that reduce maternal risk without impairing placental perfusion. The hemodynamic changes of pregnancy may unmask a hypertensive phenotype, may exacerbate a chronic hypertension, or may complicate hypertension secondary to lupus, renovascular lesions, and pheochromocytoma. On the other hand a primary aldosteronism may benefit from the effect of progesterone and present as a postpartum hypertension. A hypertensive pregnancy, especially preeclampsia, represents a risk for cardiac, vascular and renal disease in later life. Menopause may mimic a pheochromocytoma, and is associated to endothelial dysfunction and salt-sensitivity. Among women, non-pharmacological treatment should be forcefully advocated, except for sodium restriction during pregnancy. The blockade of the renin-angiotensin system should be avoided in women at risk of pregnancy; betablockers could be used with precautions during pregnancy; diuretics, ACE inhibitors and angiotensin receptor antagonists should not be used during breast feeding. Collateral effects of antihypertensives, such as hyponatremia, cough and edema are more common in women. Thus, hypertension in women should be managed according to the different life stages.

  10. The new hypertension guidelines.

    Science.gov (United States)

    Stern, Ralph H

    2013-10-01

    The Canadian Hypertension Education Program (CHEP) has published guidelines annually since 2000. The CHEP guidelines are a model of concise, comprehensive, up-to-date, evidence-rated guidelines for physicians who diagnose and treat hypertension. The guidelines address measurement of blood pressure and the definition of hypertension, secondary hypertension evaluation and treatment, and blood pressure targets and medication choices in patients with and without compelling indications. This review describes CHEP's process for developing guidelines and provides an overview of the 2013 recommendations. ©2013 Wiley Periodicals, Inc.

  11. Elevated serum leptin levels in patients with acute myocardial infarction; correlation with coronary angiographic and echocardiographic findings

    Directory of Open Access Journals (Sweden)

    Khafaji Hadi AR

    2012-05-01

    Full Text Available Abstract Background To assess the relationship between serial serum leptin levels in patients with acute myocardial infarction (AMI who received thrombolysis and the degree of coronary atherosclerosis, coronary reperfusion, echocardiographic findings, and clinical outcome. 51 consecutive patients presenting with AMI were studied. Clinical characteristics including age, sex, body mass index (BMI and cardiovascular risk factors were recorded. Serial serum leptin levels at the time of admission and subsequently at 0, 6, 12, 24, 36, 60 hours afterwards were obtained. Coronary angiography was performed in 34 patients; the relation between serum leptin levels and evidence of coronary reperfusion as well as the extent of coronary atherosclerosis according to the coronary artery surgery study classification (CASS were evaluated. Echocardiographic evaluation was performed in all patients. 36 matched patients were enrolled as control group who had serum leptin level 9.4 ± 6.5 ng/ml. Results The patients mean age was 50.5 ± 10.6 years. There were 47 males and 3 females. 37.1% were diabetics, 23.5% were hypertensive, 21.6% were dyslipidemic and 22.7% were obese (BMI ≥ 30. Leptin concentrations (ng/ml increased and peaked at the 4th sample (36 hrs after admission (mean ± SD sample (1 =9.55 ± 7.4, sample (2 =12.9 ± 8.4, sample (3 =13.8 ± 10.4, sample (4 =18.9 ± 18.1, sample (5 =11.4 ± 6.5, sample (6 =10.8 ± 8.9 ng/ml. There was a significant correlation between serum leptin and BMI (r = 0.342; p = 0.03. Leptin levels correlated significantly to creatine kinase level on the second day (r = 0.43, p ≤ 0.01. Significant correlation of mean serum leptin with the ejection fraction (P p = 0.8. There was a trend for an increase in the mean serum leptin levels with increasing number of diseased vessels. There was no correlation between serum leptin levels and outcome neither during the

  12. Auxetic coronary stent endoprosthesis

    DEFF Research Database (Denmark)

    Amin, Faisal; Ali, Murtaza Najabat; Ansari, Umar

    2014-01-01

    to determine the effects of fabrication processes on the topography of the auxetic stent. RESULTS AND CONCLUSIONS: The elastic recoil (3.3%) of the in vitro mechanical analysis showed that the auxetic stent design effectively maintained the luminal patency of the coronary artery. Also, the auxetic coronary...... was obtained via laser cutting, and surface treatment was performed with acid pickling and electropolishing, followed by an annealing process. In vitro mechanical analysis was performed to analyze the mechanical performance of the auxetic coronary stent. Scanning electronic microscopy (SEM) was used...

  13. Cardiac and renal damage in the elderly hypertensive

    Directory of Open Access Journals (Sweden)

    Jean Ribstein

    2002-03-01

    Full Text Available In the elderly patient with essential hypertension of long duration or de novo systolic hypertension, the prevalence of co-morbid conditions, be they apparent or not, the burden of associated diseases and the alteration in nutritional status and lifestyle, result in specific problems with regards to hypertension-related target organ damage. Accumulating data suggest that left ventricular (LV remodelling is a common finding in the nor-motensive elderly, and that LV hypertrophy (LVH will herald the development of heart failure in a fraction of patients with either systolic/diastolic or isolated systolic hypertension. Increased arterial stiffness, as well as impaired myocardial relaxation, reduced early diastolic filling and decreased ?-adrenergic responsiveness, contribute to the large prevalence of abnormalities in LV function in the elderly hypertensive. The response to exercise is clearly attenuated, and coronary heart disease, although highly prevalent, may be misdiagnosed because symptoms are altered. The elderly hypertensive is exquisitely sensitive to both volume depletion and excessive sodium intake, due to a marked sodium sensitivity of blood pressure (BP. A decline in renal blood flow and glomerular filtration rate (GFR is a common finding in the elderly. Although structural alterations attributed to age and hypertension may differ, hypertension is often looked upon as an accelerated form of ageing with regards to the heart and the kidney. Lifestyle modifications and initial monotherapy with a low-dose diuretic are warranted in the elderly hypertensive with no co-morbidity; a variety of specific approaches are considered when associated clinical conditions are present. Blockers of the renin-angiotensin system (RAS may be the preferred first-line agents in many patients with cardiac or renal damage.

  14. Effect of marital status on the outcome of patients undergoing elective or urgent coronary revascularization.

    Science.gov (United States)

    Barbash, Israel M; Gaglia, Michael A; Torguson, Rebecca; Minha, Sa'ar; Satler, Lowell F; Pichard, Augusto D; Waksman, Ron

    2013-10-01

    Marriage confers various health advantages in the general population. However, the added value of marriage among patients who undergo percutaneous coronary intervention (PCI) beyond the standard cardiovascular risk factors is not clear. This study aimed to assess the effects of marital status on outcomes of patients undergoing elective or urgent PCI. Clinical observational analysis of consecutive patients undergoing elective or urgent PCI from 1993 to 2011 was performed. Patients were stratified by marital status, comparing married to unmarried patients. Clinical outcome up to 12 months was obtained by telephone contact or office visit. A total of 11,216 patients were included in the present analysis; 55% were married and 45% unmarried. Significant differences in baseline characteristics were noted, including a lower prevalence of hypertension (86% vs 88%), diabetes (34% vs 38%), and smoking (19% vs 25%) among married vs unmarried patients, respectively (P < .001). However, married patients had a higher prevalence of hypercholesterolemia and family history of coronary artery disease. Early and late major adverse cardiac event rates were significantly lower for married vs unmarried patients up to 1 year (13.3% vs 8.2%, P < .001). Married status was independently associated with improved outcome in multivariable analysis (hazard ratio 0.7, 95% CI 0.6-0.9). Married patients who undergo urgent or elective PCI have superior short- and long-term outcomes up to 1 year when compared with unmarried patients. These benefits persist after adjustment for multiple traditional cardiovascular risk factors. © 2013.

  15. Right Ventricular Systolic Dysfunction Is Common in Hypertensive Heart Failure: A Prospective Study in Sub-Saharan Africa.

    Directory of Open Access Journals (Sweden)

    Dike B Ojji

    Full Text Available Right ventricular (RV systolic dysfunction is now recognized widely as a strong and independent predictor of adverse outcomes in patients with heart failure (HF. Reduction of RV systolic function more closely predicts impaired exercise tolerance and poor survival than does left ventricular (LV systolic function. In spite of this, there is a dearth of data on RV function in hypertensive HF which is the commonest form of HF in sub-Saharan Africa. We therefore conducted a prospective cohort study of hypertensive HF patients presenting to the University of Abuja Teaching Hospital, Abuja, Nigeria over an 8 year period.Each subject had transthoracic echocardiography performed on them according to the guidelines of American Society of Echocardiography. RV systolic function was defined as a tricuspid annular plane systolic excursion (TAPSE <15 mm using M-mode echocardiography.RV systolic dysfunction was identified in 272 (44.5% of the 611 subjects that were studied. Subjects with TAPSE less than 15 mm had worse prognosis compared to those with TAPSE ≥15 mm.There was a significant correlation between TAPSE and other adverse prognostic markers including left and right atrial area, LV size, LV mass, LV ejection fraction, restrictive mitral inflow and RV systolic pressure (RVSP. However, LV ejection fraction and right atrial area were the only independent determinants of RV systolic dysfunction.Hypertensive HF is a major cause of RV systolic dysfunction even in a population with a low prevalence of coronary artery disease, and RV systolic dysfunction is associated with poor prognosis in hypertensive HF. Detailed assessment of RV function should therefore be part of the echocardiography evaluation of patients with hypertensive HF.

  16. Genetics of coronary artery disease.

    Science.gov (United States)

    Roberts, Robert

    2014-06-06

    There is almost no data on the genetics of acute coronary syndromes, so this review discusses primarily the 50 genetic risk variants associated with coronary artery disease that are of genome-wide significance in the discovery population and replicated in an independent population. All of these risk variants are extremely common with more than half occurring in >50% of the general population. They increased only minimally the relative risk for coronary artery disease. The most striking finding is that 35 of the 50 risk variants act independently of known risk factors, indicating there are several pathways yet to be appreciated, contributing to the pathogenesis of coronary atherosclerosis and myocardial infarction. All of the genetic variants seem to act through atherosclerosis, except for the ABO blood groups, which show that A and B are associated with increased risk for myocardial infarction, mediated by a prolonged von Willebrand plasma half life leading to thrombosis. The potential molecular mechanisms of 9p21 are discussed, including cell cycle kinase inhibitors. Discovery of risk variants associated with PCSK9 has led to the development of novel treatment for plasma low-density lipoprotein cholesterol. A monoclonal antibody inhibiting PCSK9 has already undergone phase I and II clinical trials, showing it is a potent inhibitor of low-density lipoprotein cholesterol and is mediated through more rapid removal of low-density lipoprotein cholesterol from the plasma. This therapy complements that of statin therapy, which inhibits the synthesis of cholesterol. The benefits of Mendelian randomization to assess safety and efficacy and their limitations are discussed along with future directions. © 2014 American Heart Association, Inc.

  17. Recognition and Management of Resistant Hypertension.

    Science.gov (United States)

    Braam, Branko; Taler, Sandra J; Rahman, Mahboob; Fillaus, Jennifer A; Greco, Barbara A; Forman, John P; Reisin, Efrain; Cohen, Debbie L; Saklayen, Mohammad G; Hedayati, S Susan

    2017-03-07

    Despite improvements in hypertension awareness and treatment, 30%-60% of hypertensive patients do not achieve BP targets and subsequently remain at risk for target organ damage. This therapeutic gap is particularly important to nephrologists, who frequently encounter treatment-resistant hypertension in patients with CKD. Data are limited on how best to treat patients with CKD and resistant hypertension, because patients with CKD have historically been excluded from hypertension treatment trials. First, we propose a consistent definition of resistant hypertension as BP levels confirmed by both in-office and out-of-office measurements that exceed appropriate targets while the patient is receiving treatment with at least three antihypertensive medications, including a diuretic, at dosages optimized to provide maximum benefit in the absence of intolerable side effects. Second, we recommend that each patient undergo a standardized, stepwise evaluation to assess adherence to dietary and lifestyle modifications and antihypertensive medications to identify and reduce barriers and discontinue use of substances that may exacerbate hypertension. Patients in whom there is high clinical suspicion should be evaluated for potential secondary causes of hypertension. Evidence-based management of resistant hypertension is discussed with special considerations of the differences in approach to patients with and without CKD, including the specific roles of diuretics and mineralocorticoid receptor antagonists and the current place of emerging therapies, such as renal denervation and baroreceptor stimulation. We endorse use of such a systematic approach to improve recognition and care for this vulnerable patient group that is at high risk for future kidney and cardiovascular events. Copyright © 2017 by the American Society of Nephrology.

  18. Association of ACP1 gene polymorphisms and coronary artery ...

    Indian Academy of Sciences (India)

    Coronary artery disease (CAD) is the major cause of death in most countries including China (He et al. 2005). A num- ber of susceptible variants of candidate genes have been recognized as genetic risk factors that are associated with pathogenesis of coronary heart disease (Wu et al. 2001;. Achour et al. 2011; Zhou et al.

  19. Obesity paradox in patients undergoing coronary intervention: A review

    OpenAIRE

    Patel, Nirav; Elsaid, Ossama; Shenoy, Abhishek; Sharma, Abhishek; McFarlane, Samy I

    2017-01-01

    There is strong relationship exist between obesity and cardiovascular disease including coronary artery disease (CAD). However, better outcomes noted in obese patients undergoing percutaneous cardiovascular interventions for CAD, a phenomenon known as the obesity paradox. In this review, we performed extensive search for obesity paradox in obese patients undergoing percutaneous coronary intervention and discussed possible mechanism and disparities in different race and sex.

  20. Apolipoprotein E gene polymorphism in Egyptian acute coronary ...

    African Journals Online (AJOL)

    Background: Apolipoprotein E (apo E) gene polymorphism was found to be associated with coronary artery disease in several studies. In this investigation, we aimed to study the association between apo E gene polymorphism and acute coronary syndrome in Egyptian population. Subjects and methods: The study included ...

  1. Coronary artery calcium in breast cancer survivors after radiation therapy

    NARCIS (Netherlands)

    Takx, Richard A P; Vliegenthart, Rozemarijn; Schoepf, U Joseph; Pilz, Lothar R; Schoenberg, Stefan O; Morris, Pamela B; Henzler, Thomas; Apfaltrer, Paul

    The purpose of the current study is to investigate whether breast cancer survivors after radiation therapy have a higher burden of coronary artery calcium as a potential surrogate of radiation-induced accelerated coronary artery disease. 333 patients were included. 54 patients underwent chest CT ae

  2. Association of plasma protein C levels and coronary artery disease ...

    African Journals Online (AJOL)

    Several studies have shown the risk factor causes of coronary heart disease. In this study we tested the hypothesis that plasma protein C level might be used as a biomarker for coronary heart disease and myocardial infarction. The study included 60 men that were classified into 3 groups according to clinical examination; ...

  3. [Coronary angioplasty of moderate lesions (50 to 60%)].

    Science.gov (United States)

    Tanajura, L F; Sousa, A G; Feres, F; Mattos, L A; Maldonado, G; Cano, M N; Pinto, I M; Sousa, J E

    1991-04-01

    To assess the efficacy of transluminal coronary angioplasty in patients with moderate (50-60%) coronary lesions. One hundred and thirty nine patients, 108 (78%) male, mean age was 55 years, who underwent coronary angioplasty from August 1983 to January 1989. Clinical findings included stable angina in 91 (65%) and unstable angina in 48 (35%). Single vessel disease was the case for 117 (84%), whereas 22 (16%) had two vessel coronary artery disease. Primary success rate was 130 (94%). All patients with two vessel disease had complete revascularization. In the failure group there were 2 acute myocardial infarction (1.4%), and 4 (2.8%) emergency coronary artery by-pass surgery. There were no in-hospital deaths. Of the 130 patients with success, 119 (92%) had late follow-up (mean time 31 months). At the end of the follow-up period we found 85 (71%) asymptomatic, while 27 (23%) had recurrence of symptoms. There were 2 late cardiovascular deaths. Fifty four patients underwent late angiography and 42 (78%) had maintenance of the result while 12 (22%) had restenosis, with a mean degree more severe than pre-coronary angioplasty. Coronary angioplasty of moderate lesions has a high success rate (94%); nevertheless the rate of major complications and restenosis is very similar to that of coronary angioplasty for severe stenosis. Such findings led us to reserve the indication of coronary angioplasty for moderate lesions for patients at higher risk with clear evidence of myocardial ischemia.

  4. Clinical and angiographic characteristics of coronary artery disease in young adults: a single centre study.

    Science.gov (United States)

    Maroszyńska-Dmoch, Ewa M; Wożakowska-Kapłon, Beata

    2016-01-01

    Coronary artery disease (CAD) in young adults under 40 years of age is a growing medical, social, psychological and economical problem, related to the prevalence of civilization-related diseases and unhealthy lifestyle. The problem of CAD in young people has not been characterised as well as in older individuals, as the available data mostly come from case reports and small series, often related to genetic aspects and familial occurrence of the disease. To assess clinical and angiographic characteristics of young adults with CAD and to evaluate in-hospital and long-term mortality in this patient group. The study combined a retrospective and a prospective approach. A total of 239 patients aged 40 years or younger who underwent coronary angiography (CAG) in the Swietokrzyskie Centre of Cardiology in Kielce in 2001-2008 were included in this study. Demographic characteristics, risk factor profile, laboratory test results, electrocardiographic and echocardiographic findings, CAG findings, and in-hospital mortality were assessed retrospectively in the selected groups. During the second stage of the study, clinical and mortality data were obtained prospectively in 130 patients (54.4% of the study group) during up to 5 years of follow-up. The mean patient age was 35.1 ± 4.4 years. Men made up 86.2% of the study sample, and the proportion of rural area residents was 54.8%. Among young patients with acute coronary syndromes (ACS), the most common presentation (52.8%) was ST segment elevation myocardial infarction (STEMI). Angiographically normal coronary arteries were found in 37.2% of CAD patients and in 16.9% of patients with the diagnosis of ACS. The mean degree of coronary artery lumen stenosis was 75.4% in the group with significant atherosclerotic coronary lesions (50-90%) and 95.9% in the group demonstrating a critical coronary obstruction (≥ 90%). Single-vessel disease was identified in 61.9% of patients with a positive result of CAG (stenosis > 50%, CORO

  5. The elderly hypertensive population: what lies ahead of us?

    Directory of Open Access Journals (Sweden)

    Guillaume Bobrie

    2002-03-01

    Full Text Available In the next 25 years, the population aged 65 years and over will increase by 88%. Thus, postponing the adverse effects of old age for as long as possible will be a major social and economic issue. Hypertension is common in older people, with a prevalence rate of up to 60%, the majority having isolated systolic hypertension. Both isolated systolic hypertension and increased pulse pressure (PP are associated with a high cardiovascular (CV risk, and hypertension remains the biggest treatable risk factor for CV disease in the elderly and in the very old. Randomised, controlled trials have demonstrated the benefit of the treatment of hypertension in this population, such that treating just 43 subjects (95% CI: 31–69 for five years would prevent one cerebro-vascular event and treating 61 (95% CI: 39–141 would prevent one coronary event. It should be stressed that antihypertensive treatment reduces both fatal and nonfatal events and will probably prevent the onset of dementia. In other words, it reduces events that represent a major source of disability and handicap in old age and allows healthy ageing. Ongoing trials, which are addressing the preventive effect of treatment in the very elderly hypertensive, will provide further evidence as to the risk/benefit ratio in this ever increasing age group.

  6. Familial hypercholesterolaemic downsized pig with human-like coronary atherosclerosis: a model for preclinical studies

    DEFF Research Database (Denmark)

    Thim, Troels; Hagensen, Mette; Drouet, L.

    2010-01-01

    AIMS: A manageable and reproducible large animal model of human-like coronary atherosclerosis is lacking but highly needed for translational research in percutaneous coronary interventions and imaging. Farm pigs with familial hypercholesterolaemia develop advanced atherosclerosis in two to three......-prone (vulnerable) plaque in humans. Associated vulnerable plaque features included neovascularisation, intraplaque haemorrhage, and expansive remodelling. CONCLUSIONS: This human-like porcine model of coronary atherosclerosis is practical and highly relevant for translational research in percutaneous coronary...

  7. Arterial hypertension and associated factors in patients submitted to myocardial revascularization

    Directory of Open Access Journals (Sweden)

    Flávia Cortez Colósimo

    2015-04-01

    Full Text Available OBJECTIVE To identify the prevalence of arterial hypertension and associated factors in patients submitted to myocardial revascularization. METHOD Cross-sectional study using the database of a hospital in São Paulo (SP, Brazil containing 3010 patients with coronary artery disease submitted to myocardial revascularization. A multiple logistic regression was performed to identify variables independently associated with hypertension (statistical significance: p1.3: (OR=1.37;CI:1.09-1.72. CONCLUSION A high prevalence of arterial hypertension and association with both non-modifiable and modifiable factors was observed.

  8. Acute Coronary Syndrome

    Science.gov (United States)

    ... illustration of coronary arteries ). A stent, a wire mesh tube, may be permanently placed in the artery ... Changes Recovery FAQs • Heart Attack Tools & Resources • Support Network Heart Attack Tools & Resources My Cardiac Coach What ...

  9. Coronary Artery Bypass Surgery

    Science.gov (United States)

    ... t help, you may need coronary artery bypass surgery. The surgery creates a new path for blood to flow ... more than one bypass. The results of the surgery usually are excellent. Many people remain symptom-free ...

  10. Coronary Artery Disease

    Science.gov (United States)

    ... in some patients. Calcium channel blockers may cause constipation and leg swelling. Most patients don’t have ... stress test, cardiovascular, Chest Pain, coronary artery disease, elderly, electrocardiogram, older adults, senior, shortness of breath March ...

  11. ANALISYS OF RISK FACTORS IN HYPERTENSIVE PATIENTS IN BRANIK

    Directory of Open Access Journals (Sweden)

    Matjaž Klemenc

    2001-11-01

    Full Text Available Background. The goal of this cross sectional study was to determine the prevalence of hypertension among the habitants of Branik and the presence of other risk factors, connected with hypertension.Methods. Between December 1987 and December 1988 the authors examined 745 persons older than 20 years, 60% of whole population in Branik. Examination included history, clinical examination, blood pressure and other laboratory measurements.Results. 23.4% of examined persons take antihypertensive drugs or are on low salt diet. The percent of hypertensive patients rises with age: from 2.3% (age 20–29 to 60.6% (age 80– 89. Most of hypertensive patients have moderate hypertension – 44.3%. The percent of hypertensive patients with normal body weight (NBW is significantly lower than the percent of normotensive persons with NBW (p < 0.01. Among the persons with more than 130% of ideal body weight, there is significantly more hypertensive patients than normotensives (p < 0.01. The proportion of hypertensive patients, who never add salt to the food, is significantly greater than the proportion of normotensive patients of the same group (p < 0.01. There are more heavy drinkers among hypertensive patients than normotensive persons. There are less cigarette smokers among hypertensive persons than normotensive. 4% of examined persons have diabetes mellitus. 60% of diabetics have also hypertension. 10.3% of hypertensive persons have diabetes mellitus.Conclusions. The prevalence of arterial hypertension was relatively high – 23.4%. The percent of hypertensive patients, who are overweight, is also higher than the percent of normotensive participants. Surprisingly, salt intake habits are healthier in hypertensive patients than in normotensive participants

  12. Evolving Concepts of Pulmonary Hypertension Secondary to Left Heart Disease.

    Science.gov (United States)

    Ramu, Bhavadharini; Thenappan, Thenappan

    2016-04-01

    Pulmonary hypertension associated with left heart disease is the most common form of pulmonary hypertension. Although its pathophysiology remains incompletely understood, it is now well recognized that the presence of pulmonary hypertension is associated with a worse prognosis. Right ventricular failure has independent and additive prognostic value over pulmonary hypertension for adverse outcomes in left heart disease. Recently, several new terminologies have been introduced to better define and characterize the nature and severity of pulmonary hypertension. Several new treatment options including the use of pulmonary arterial hypertension specific therapies are being considered, but there is lack of evidence. Here, we review the recent advances in this field and summarize the diagnostic and therapeutic modalities of use in the management of pulmonary hypertension associated with left heart disease.

  13. Tissue characterization of non-culprit intermediate coronary lesions in non ST elevation acute coronary syndromes.

    Science.gov (United States)

    Elghawaby, Helmy Hassan; Shawky, Mohamed Ashraf; Mowafi, Ahmed Hossam; Abd-Elbary, Akram Mohamed; Faris, Farouk Mostafa

    2018-03-01

    Disruption of vulnerable plaques is the most common cause of acute coronary syndromes. Intravascular ultrasound facilitates cross-sectional imaging of coronary arteries. We aimed at using IVUS to investigate the morphology and tissue characteristics of atherosclerotic plaques of non-culprit intermediate coronary lesions in non-ST elevation ACS setting. IVUS assessment of sixty-one intermediate coronary lesions in twenty-eight patients with the diagnosis of Non ST elevation acute coronary syndromes. Ultrasound signals were obtained by an IVUS system using a 40-MHz catheter. Mean age was 53.2 ± 9.1 years. Males = 20 (71.4%). Smoking in 17 (60.7%), hypertension in 16 (57.1%), Dyslipidemia in 12 (42.9%) and DM in 8 (28.6%). Culprit vessels represent 42% of affected vessels. Sixty-one intermediate lesions were detected. Twenty-nine lesions in culprit vessels and thirty-two lesions in non-culprit vessels with higher lipidic content in lesions of culprit vessels ( P  < 0.001) while a higher calcific content in lesions of non-culprit vessels ( P  < 0.001). Higher calcific content of proximal more than distal lesions ( P  = 0.048). Negative remodeling in 55.7% of lesions. A higher lipidic content in lesions of culprit vessels, while the lesions of non-culprit vessels were more calcific. Higher calcific content of proximal more than distal lesions was defined as well.

  14. Impact of Genetic Defects on Coronary Atherosclerosis among Turkish Cypriots.

    Science.gov (United States)

    Conkbayir, Cenk; Fahrioglu Yamaci, Rezan; Gencer, Pinar; Barin, Burc; Yucel, Genco; Yildiz, Cenk Eray; Ugurlucan, Murat; Basak, A Nazli

    2017-10-30

    cholesterol (P cholesterol levels (P < .05). Conclusion: Turkish Cypriot patients with coronary artery disease may be more affected by secondary factors, such as diabetes, hypertension, obesity, and sedentary life style when compared with genetic factors, which may be responsible for coronary artery disease.

  15. Opium addiction as an independent risk factor for coronary microvascular dysfunction: A case-control study of 250 consecutive patients with slow-flow angina.

    Science.gov (United States)

    Esmaeili Nadimi, Ali; Pour Amiri, Farah; Sheikh Fathollahi, Mahmood; Hassanshahi, Gholamhossien; Ahmadi, Zahra; Sayadi, Ahmad Reza

    2016-09-15

    Approximately 20% to 30% of patients who undergo coronary angiography for assessment of typical cardiac chest pain display microvascular coronary dysfunction (MCD). This study aimed to determine potential relationships between baseline clinical characteristics and likelihood of MCD diagnosis in a large group of patients with stable angina symptoms, positive exercise test and angiographic ally normal epicardial coronary arteries. This cross-sectional study included 250 Iranian with documented evidence of cardiac ischemia on exercise testing, class I or II indication for coronary angiography, and either: (1) angiographically normal coronary arteries and diagnosis of MCD with slow-flow phenomenon, or (2) normal angiogram and no evidence of MCD. All patients completed a questionnaire designed to capture key data including clinical demographics, past medical history, and social factors. Data was evaluated using single and multivariable logistic regression models to identify potential individual patient factors that might help to predict a diagnosis of MCD. 125 (11.2% of total) patients were subsequently diagnosed with MCD. 125 consecutive control subjects were selected for comparison. The mean age was similar among the two groups (52.38 vs. 53.26%, p=ns), but there was a higher proportion of men in the study group compared to control (42.4 vs. 27.2%, p=0.012). No significant relationships were observed between traditional cardiovascular risk factors (diabetes, hypertension, and dyslipidemia) or body mass index (BMI), and likelihood of MCD diagnosis. However, opium addiction was found to be an independent predictor of MCD on single and multivariable logistic regression model (OR=3.575, 95%CI: 1.418-9.016; p=0.0069). We observed a significant relationship between opium addiction and microvascular angina. This novel finding provides a potential mechanistic insight into the pathogenesis of MCD with slow-flow phenomenon. Copyright © 2016 Elsevier Ireland Ltd. All rights

  16. Emerging issues in lifestyle, social, and environmental interventions to promote behavioral change related to prevention and control of hypertension in the African-American population.

    Science.gov (United States)

    Edwards, C H

    1995-08-01

    Prevention of hypertension must play a more prominent role in health care, in the education of young people, and in the public policy arena if we are committed to reduce mortality from cardiovascular disease. Some steps individuals can take to lessen the risk of stroke or coronary heart disease include: If you are obese and hypertensive, you should reduce total calories and lose weight. Substitute olive oil or canola oil for vegetable oils to increase your intake of monounsaturated fatty acids. Try the Mediterranean diet. Start a program of aerobic exercise or increase the amount you are currently doing. Reduce salt intake. Reduce alcohol consumption. Stop smoking. If you have hypertension and tend to overrespond to stress, try relaxation and biofeedback techniques, which according to some studies may produce a modest reduction in blood pressure in some individuals with mild hypertension. Increase the amount of fiber in the diet by increasing the amount of grains, fruit, and vegetables. Have your renin level tested. A "population" approach should be incorporated into medical school curricula to encourage and train caregivers to consider social, cultural, and economic factors affecting patients. Historically black colleges, public and private elementary and secondary schools, and churches can provide leadership in this nation for educating African Americans in the prevention and control of high blood pressure. In conclusion, we already have the information we need from research to close the mortality gap between whites and African Americans in cardiovascular disease.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. Maskeret hypertension i graviditeten

    DEFF Research Database (Denmark)

    Fischer, Margit Bistrup; Thingaard, Ebbe; Andersen, Anita Sylvest

    2018-01-01

    Hypertension during pregnancy is one of the leading causes of maternal and foetal morbidity and mortality. Monitoring of blood pressure is therefore an essential part of prenatal care. Masked hypertension, where blood pressure levels are elevated at home despite normal blood pressure levels...

  18. Hypertension og hjernen

    DEFF Research Database (Denmark)

    Christensen, Hanne; Strandgaard, Svend

    2009-01-01

    Hypertension is a major and modifiable risk factor of stroke and dementia. Hypertension causes remodelling of the cerebral resistance vessels, impairing their tolerance to very low blood pressure. In primary prevention of stroke, the effect of beta-blockers is inferior to other classes...

  19. Therapeutic Exercise and Hypertension

    African Journals Online (AJOL)

    Nekky Umera

    Beneficial effects of exercise training on human hypertension.Journal of Nig Soc of Physiotherapy. 10 (2): 28-30. ALLHAT Collaboration Research Group (2000) Major cardiovascular. Events in hypertensive patients randomized to doxagosin versus chlorthalidone: the antihypertensive and lipid lowering treatment to.

  20. Noncirrotisk intrahepatisk portal hypertension

    DEFF Research Database (Denmark)

    Dam Fialla, Annette; Havelund, Troels

    2007-01-01

    Non-cirrhotic intrahepatic portal hypertension is characterized by portal hypertension in the absence of liver cirrhosis or portal vein thrombosis. The disease is common in the East and rarely seen in the West. Two cases with oesophageal varices are described. The histopathology is heterogeneous...

  1. Hypertension and liver disease

    DEFF Research Database (Denmark)

    Henriksen, Jens H; Møller, Søren

    2004-01-01

    Arterial hypertension is a common disorder with a frequency of 10% to 15% in subjects in the 40- to 60-year age group. Yet most reports find the prevalence of arterial hypertension in patients with chronic liver disease (cirrhosis) much lower. In this review, we consider the alterations in systemic...

  2. [Hypertension and renal disease

    DEFF Research Database (Denmark)

    Kamper, A.L.; Pedersen, E.B.; Strandgaard, S.

    2009-01-01

    Renal mechanisms, in particular the renin-angiotensin system and renal salt handling, are of major importance in blood pressure regulation. Co-existence of hypertension and decreased renal function may be due to nephrosclerosis secondary to hypertension, or primary renal disease with secondary...

  3. Hypertension og nyresygdom

    DEFF Research Database (Denmark)

    Kamper, Anne-Lise; Pedersen, Erling B; Strandgaard, Svend

    2009-01-01

    Renal mechanisms, in particular the renin-angiotensin system and renal salt handling, are of major importance in blood pressure regulation. Co-existence of hypertension and decreased renal function may be due to nephrosclerosis secondary to hypertension, or primary renal disease with secondary...

  4. Uraemia from Benign Hypertension

    African Journals Online (AJOL)

    tance,' and the criteria for the recognition of malignant hypertension have become so well established that there is no dispute about the diagnosis when this condition ends in uraemia. By contrast, benign hypertension mani- fests itself mainly as cardiac or cerebrovascular disease,"" and although the occurrence of renal ...

  5. Large coronary intramural hematomas

    DEFF Research Database (Denmark)

    Antonsen, Lisbeth; Thayssen, Per; Jensen, Lisette Okkels

    2015-01-01

    coronary vessel wall pathology, with poorly understood underlying pathogenic mechanisms. Affected individuals may present with a broad spectrum of symptoms ranging from acute coronary syndromes (ACS) to cardiogenic shock or even sudden cardiac death. The disease entity causes challenges in terms of both......, no randomized, controlled trials exist to guide treatment, and no consensus regarding management is available. Currently, treatment strategies are based on a case-by-case clinical assessment, and experiences described in previous, limited retrospective studies and case reports....

  6. Coronary Fistulas: A Case Series

    Directory of Open Access Journals (Sweden)

    Nada Fennich

    2014-01-01

    Full Text Available Coronary artery fistula is an uncommon finding during angiographic exams. We report a case series of five patients with congenital coronary fistulas. The first patient was 56 years old and had a coronary fistula associated with a partial atrio ventricular defect, the second patient was 54 years old and had two fistulas originating from the right coronary artery with a severe atherosclerotic coronary disease, the third patient was 57 years old with a fistula originating from the circumflex artery associated with a rheumatic mitral stenosis, the fourth patient was 50 years old and had a fistulous communication between the right coronary artery and the right bronchial artery, and the last patient was 12 years old who had bilateral coronary fistulas draining into the right ventricle with an aneurismal dilatation of the coronary arteries. Angiographic aspects of coronary fistulas are various; management is controversial and depends on the presence of symptoms.

  7. Awareness, treatment and control of hypertension among Filipino immigrants.

    Science.gov (United States)

    Ursua, Rhodora; Aguilar, David; Wyatt, Laura; Tandon, Shiv Darius; Escondo, Kirklyn; Rey, Mariano; Trinh-Shevrin, Chau

    2014-03-01

    Filipino Americans have high rates of hypertension, yet little research has examined hypertension awareness, treatment, and control in this group. In a community-based sample of hypertensive Filipino American immigrants, we identify 1) rates of hypertension awareness, treatment, and control; and 2) factors associated with awareness, treatment, and control. Cross-sectional analysis of survey data from health screenings collected from 2006 to 2010. A total of 566 hypertensive Filipino immigrants in New York City, New York and Jersey City, New Jersey. Hypertension awareness, treatment, and control. Participants were included in analysis if they were hypertensive, based on: a past physician diagnosis, antihypertensive medication use, and/or high blood pressure (BP) screening measurements. Demographic variables included sex, age, time in the United States, location of residence, and English spoken language fluency. Health-related variables included self-reported health, insurance status, diabetes diagnosis, high cholesterol diagnosis, clinical measures (body mass index [BMI], glucose, and cholesterol), exercise frequency, smoking status, cardiac event history, family history of cardiac event, and family history of hypertension. Among the hypertensive individuals, awareness, treatment, and control rates were suboptimal; 72.1 % were aware of their status, 56.5 % were on medication, and only 21.7 % had controlled BP. Factors related to awareness included older age, worse self-reported health, family history of hypertension, and a diagnosis of high cholesterol or diabetes; factors related to treatment included older age, longer time lived in the United States, and being a non-smoker; having health insurance was found to be the main predictor of hypertension control. Many individuals had other cardiovascular disease (CVD) risk factors; 60.4 % had a BMI ≥25, 12.0 % had at-risk glucose measurements and 12.8 % had cholesterol ≥ 240. Hypertensive Filipinos exhibit poor

  8. Diabetes is associated with impaired myocardial performance in patients without significant coronary artery disease

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Gislason, Gunnar H; Weeke, Peter

    2010-01-01

    Patients with diabetes mellitus (DM) have high risk of heart failure. Whether some of the risk is directly linked to metabolic derangements in the myocardium or whether the risk is primarily caused by coronary artery disease (CAD) and hypertension is incompletely understood. Echocardiographic...

  9. CT Coronary angiography in clinical practice : Klinische toepassing van CT coronair angiografie

    NARCIS (Netherlands)

    A.C. Weustink (Annick)

    2010-01-01

    markdownabstract__Abstract__ Stable angina is a common and disabling disease with coronary artery disease (CAD) accounting for 68% of heart related deaths (I). Common risk factors for CAD 1nclude hypertension, h1gh cholesterol levels, cigarette smoking, obesity, and a family history of heart

  10. The coexistence of major coronary heart disease risk factors in the ...

    African Journals Online (AJOL)

    A cross-sectional study of risk factors for coronary heart disease in a random sample of 976 people from a South African coloured population revealed this group to be at great risk. The prevalences of individual and of coexisting reversible risk factors - hypercholesterolaemia, hypertension and smoking - were highest in the ...

  11. Hypertension and liver disease

    DEFF Research Database (Denmark)

    Henriksen, Jens H; Møller, Søren

    2004-01-01

    Arterial hypertension is a common disorder with a frequency of 10% to 15% in subjects in the 40- to 60-year age group. Yet most reports find the prevalence of arterial hypertension in patients with chronic liver disease (cirrhosis) much lower. In this review, we consider the alterations in systemic...... to increased arterial blood pressure. Subjects with established arterial hypertension (essential, secondary) may become normotensive during the development of cirrhosis, and arterial hypertension is rarely manifested in patients with cirrhosis, even in cases with renovascular disease and high circulating renin...... activity. There is much dispute as to the understanding of homeostatic regulation in cirrhotic patients with manifest arterial hypertension. This is a topic for future research....

  12. Hypertension in women.

    Science.gov (United States)

    Pimenta, Eduardo

    2012-02-01

    Hypertension is an important modifiable risk factor for cardiovascular (CV) morbidity and mortality, and a highly prevalent condition in both men and women. However, the prevalence of hypertension is predicted to increase more among women than men. Combined oral contraceptives (COCs) can induce hypertension in a small group of women and, increase CV risk especially among those with hypertension. Both COC-related increased CV risk and blood pressure (BP) returns to pretreatment levels by 3 months of its discontinuation. The effects of menopause and hormone replacement therapy (HRT) on BP are controversial, and COCs and HRT containing the new generation progestin drospirenone are preferred in women with established hypertension. Despite the high incidence of cancer in women, CV disease remains the major cause of death in women and comparable benefit of antihypertensive treatment have been demonstrated in both women and men.

  13. Cervical Spondylosis and Hypertension

    Science.gov (United States)

    Peng, Baogan; Pang, Xiaodong; Li, Duanming; Yang, Hong

    2015-01-01

    Abstract Cervical spondylosis and hypertension are all common diseases, but the relationship between them has never been studied. Patients with cervical spondylosis are often accompanied with vertigo. Anterior cervical discectomy and fusion is an effective method of treatment for cervical spondylosis with cervical vertigo that is unresponsive to conservative therapy. We report 2 patients of cervical spondylosis with concomitant cervical vertigo and hypertension who were treated successfully with anterior cervical discectomy and fusion. Stimulation of sympathetic nerve fibers in pathologically degenerative disc could produce sympathetic excitation, and induce a sympathetic reflex to cause cervical vertigo and hypertension. In addition, chronic neck pain could contribute to hypertension development through sympathetic arousal and failure of normal homeostatic pain regulatory mechanisms. Cervical spondylosis may be one of the causes of secondary hypertension. Early treatment for resolution of symptoms of cervical spondylosis may have a beneficial impact on cardiovascular disease risk in patients with cervical spondylosis. PMID:25761188

  14. Coronary tortuosity: a long and winding road.

    NARCIS (Netherlands)

    Zegers, E.S.; Meursing, B.T.J.; Oude Ophuis, A.J.M.

    2007-01-01

    Coronary tortuosity is a phenomenon often encountered by cardiologists performing coronary angiography. The aetiology and clinical importance of coronary tortuosity are still unclear. Coronary tortuosity without fixed atherosclerotic stenosis in patients with angina pectoris and an abnormal exercise

  15. Coronary flow reserve measurement in the coronary sinus in pre and post CABG status

    Directory of Open Access Journals (Sweden)

    M Hajaghaei

    2007-11-01

    Full Text Available Background: Coronary flow reserve (CFR is defined as a maximal(hyperemic to resting ratio of coronary blood flow. It is a physiologicparameter of coronary circulation and depends on the patency of the epicardialcoronary arteries and integrity of the microvascular circulation.CFR measurement has many clinical applications including functional assessmentof intermediate stenosis, detection of critical stenosis monitoring of coronaryflow in the post angioplasty period, assessment of post infarct blood flow andassessment of coronary graft patency. The aim of this study was to measure CFRin the coronary sinus through the transthoracic echocardiographic approach, inpatients who were candidate for coronary artery bypass graft surgery (CABGbefore and one month after operation.Patients and Methods: The present study included 19 patients (meanage=56±9.1 including 15 males and 4 females, admitted for CABG. All patientshad a sinus rhythm, normal wall thickness, normal RV systolic pressure, andtricuspid valvular regurgitation equal or less than grade 2. The antegrade phaseof coronary flow in the coronary sinus moving into the right atrium was analyzedin two phases (systolic and diastolic. Each wave was determined considering thepeak velocity and velocity time integral (VTI. The volumetric blood flow in thecoronary sinus calculated at the baseline and then in hyperemic phase was usedfor determination of CFR both before and after CABG.Results: There was a significant increase in the diameter of the coronarysinus after CABG (9.4±1.2mm compared with that of before CABG values (8.6±1.05mm. Also there was a trend of increasing the diameter in the hyperemicphase before and after CABG. The absolute increase in mean coronary sinusdiameter was 0.5 mm before and 1.5 mm after CABG. Coronary flow reserve (CFRwas significantly higher after surgery, despite a significant increase insystolic velocity ratio (hyperemic/baseline after CABG. This is also true forsystolic

  16. METOPROLOL VERSUS THIAZIDE DIURETICS IN HYPERTENSION - MORBIDITY RESULTS FROM THE MAPHY STUDY

    NARCIS (Netherlands)

    WIKSTRAND, J; WARNOLD, [No Value; TUOMILEHTO, J; OLSSON, G; BARBER, HJ; ELIASSON, K; ELMFELDT, D; JASTRUP, B; KARATZAS, NB; LEER, J; MARCHETTA, F; RAGNARSSON, J; ROBITAILLE, NM; VALKOVA, L; WESSELING, H; BERGLUND, G

    The present study in hypertensive men (40-64 years old) with untreated diastolic blood pressure above 100 mm Hg was aimed at investigating whether metoprolol (n = 1,609) given as initial treatment would lower the risk for coronary events (sudden death and myocardial infarction) more effectively than

  17. Variation between studies in reported relative risks associated with hypertension: time trends and other explanatory variables

    NARCIS (Netherlands)

    Marang-van de Mheen, P. J.; Gunning-Schepers, L. J.

    1998-01-01

    This study examined the variation in reported relative risks of coronary heart disease and stroke associated with hypertension and determined reasons for the interstudy variation. Studies published since 1970 were examined that reported the absolute number of events and person-years for men by age

  18. Enhanced interstitial fluid drainage in the hippocampus of spontaneously hypertensive rats

    NARCIS (Netherlands)

    Bedussi, Beatrice; Naessens, Daphne M. P.; de Vos, Judith; Olde Engberink, Rik; Wilhelmus, Micha M. M.; Richard, Edo; ten Hove, Malyssa; VanBavel, Ed; Bakker, Erik N. T. P.

    2017-01-01

    Hypertension is associated with cognitive decline and various forms of dementia, including Alzheimer's disease. In animal models of hypertension, many of Alzheimer's disease characteristics are recapitulated, including brain atrophy, cognitive decline, amyloid beta accumulation and blood brain

  19. Changes of TXA2 and PGI2 during postoperative hypertensive crisis in patients with hypertensive intracerebral hemorrhage.

    Science.gov (United States)

    Wang, Zhi; Wang, Chao; Zhang, Weiguang; Wang, Laizang; Lei, Ting

    2008-02-01

    In order to explore the changes and the roles of TXA2 and PGI2 during postoperative hypertensive crisis in patients with hypertensive intracerebral hemorrhage, 31 cases subject to craniotomy were divided into three groups: group A, 9 patients with postoperative hypertensive crisis; group B, 13 patients without postoperative hypertensive crisis; and group C, 9 patients without history of hypertension and hypertensive intracerebral hemorrhage. TXA2, TXB2, 6-keto-PGF1 alpha and PGI2 were measured after operation in the three groups respectively. The postoperative blood pressure in group A, including SBP and DBP, was elevated more obviously than that in the other two groups. TXA2 and PGI2 in group A were significantly higher than those in other two groups (Phypertensive crisis. And the increased value of TXB2 to 6-keto-PGF1 alpha could provide the basis for diagnosis of postoperative hypertensive crisis.

  20. Association Between Endometriosis and Hypercholesterolemia or Hypertension.

    Science.gov (United States)

    Mu, Fan; Rich-Edwards, Janet; Rimm, Eric B; Spiegelman, Donna; Forman, John P; Missmer, Stacey A

    2017-07-01

    An altered hormonal or chronic systemic inflammatory milieu characterizing endometriosis may result in a higher risk of hypercholesterolemia and hypertension. Conversely, elevated low-density lipoprotein in hypercholesterolemia and chronic systemic inflammation resulting from hypertension may increase the risk of endometriosis. We assessed the association of laparoscopically confirmed endometriosis with hypercholesterolemia and hypertension in a large prospective cohort study. In 1989, 116 430 registered female nurses aged 25 to 42 completed the baseline questionnaire and were followed for 20 years. Multivariable Cox proportional hazards models were applied. In 1989, there were 4244 women with laparoscopically confirmed endometriosis and 91 554 women without. After adjusting for demographic, anthropometric, family history, reproductive, dietary, and lifestyle risk factors prospectively, comparing women with laparoscopically confirmed endometriosis to women without, the relative risks were 1.25 (95% confidence interval, 1.21-1.30) for development of hypercholesterolemia and 1.14 (95% confidence interval, 1.09-1.18) for hypertension. Conversely, the relative risks of developing laparoscopically confirmed endometriosis were 1.22 (95% confidence interval, 1.15-1.31) comparing women with hypercholesterolemia to women without and 1.29 (95% confidence interval, 1.18-1.41) comparing women with hypertension to women without. The strength of associations of laparoscopically confirmed endometriosis with hypercholesterolemia or hypertension was strongest among women aged ≤40 and weakened as age increased ( P values for interaction endometriosis and hypercholesterolemia and hypertension could be accounted for by treatment factors after endometriosis diagnosis, including greater frequency of hysterectomy/oophorectomy and earlier age for this surgery. In this large cohort study, laparoscopically confirmed endometriosis was prospectively associated with increased risk of

  1. Distribution of coronary calcium score in healthy middle-aged Korean

    Energy Technology Data Exchange (ETDEWEB)

    Choe, Kyu Ok; Kim, Min Jung; Choi, Byoung Wook; Kim, Jung Ho; Noh, Ki Suh; Kim, Si Yon; Ko, Heung Kyu; Suh, Il [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

    1999-11-01

    To determine the prevalence and degree of CAC (coronary artery calcification) in appearently healthy middle-aged Koreans, and the relation of CAC to risk factors for atherosclerosis. A total of 289 apparently healthy personnel at Yonsei University (male: 170, female:119, age: mean(SD=54.9{+-}7.1 years)) underwent EBT (electron bean tomography). The risk factors for athero-sclerosis, which included diabetes mellitus, hypertension, smoking, a family history of precocious onset, obesity, hyperlipidemia, and high intraperitoneal fat, were scrutinized. One hundred and sixty-eight subjects (58%) had at least one risk factor. The CAC score was calculated for all subjects and for each coronary artery separately and was then analyzed by age and sex and in relation to the risk factors. The prevalence of CAC was 40% in men and 18.5% in women (mean score:29.7 vs. 9.9). The number of individuals who had one, two, or more than two risk factors was 141,41, and 19, respectively. The number of risk factors and the prevalence and score of CAC were significantly correlated (p=0.01, 0.02 respectively). The number of individuals with no risk factor, with without CAC, was 58(20.1%) and 103(35.6%), respectively, while the number with some risk factor, with or without CAC, was 38(13.1%) and 90(31.1%), respectively. The CAC score was significantly higher in the presence of hypertension, low HDL, or obesity(p=0.001, 0.049, and 0.068, respectively). Smoking appeared to have a borderline effect on the calcium score(p=0.118). This study should provide useful information for interpreting CAC scores and establishing a treatment strategy for Koreans. The comparison of our results with other studies will enable a better understanding of the process and risk factors of atherosclerosis in Koreans.

  2. Distribution of coronary calcium score in healthy middle-aged Korean

    International Nuclear Information System (INIS)

    Choe, Kyu Ok; Kim, Min Jung; Choi, Byoung Wook; Kim, Jung Ho; Noh, Ki Suh; Kim, Si Yon; Ko, Heung Kyu; Suh, Il

    1999-01-01

    To determine the prevalence and degree of CAC (coronary artery calcification) in appearently healthy middle-aged Koreans, and the relation of CAC to risk factors for atherosclerosis. A total of 289 apparently healthy personnel at Yonsei University (male: 170, female:119, age: mean(SD=54.9±7.1 years) underwent EBT (electron bean tomography). The risk factors for athero-sclerosis, which included diabetes mellitus, hypertension, smoking, a family history of precocious onset, obesity, hyperlipidemia, and high intraperitoneal fat, were scrutinized. One hundred and sixty-eight subjects (58%) had at least one risk factor. The CAC score was calculated for all subjects and for each coronary artery separately and was then analyzed by age and sex and in relation to the risk factors. The prevalence of CAC was 40% in men and 18.5% in women (mean score:29.7 vs. 9.9). The number of individuals who had one, two, or more than two risk factors was 141,41, and 19, respectively. The number of risk factors and the prevalence and score of CAC were significantly correlated (p=0.01, 0.02 respectively). The number of individuals with no risk factor, with without CAC, was 58(20.1%) and 103(35.6%), respectively, while the number with some risk factor, with or without CAC, was 38(13.1%) and 90(31.1%), respectively. The CAC score was significantly higher in the presence of hypertension, low HDL, or obesity(p=0.001, 0.049, and 0.068, respectively). Smoking appeared to have a borderline effect on the calcium score(p=0.118). This study should provide useful information for interpreting CAC scores and establishing a treatment strategy for Koreans. The comparison of our results with other studies will enable a better understanding of the process and risk factors of atherosclerosis in Koreans

  3. The relationship between hypertension and health-related quality of life: adjusted by chronic pain, chronic diseases, and life habits in the general middle-aged population in Japan.

    Science.gov (United States)

    Kitaoka, Masami; Mitoma, Junko; Asakura, Hiroki; Anyenda, Olando Enoch; Nguyen, Thao Thi Thu; Hamagishi, Toshio; Hori, Daisuke; Suzuki, Fumihiko; Shibata, Aki; Horii, Masae; Tsujiguchi, Hiromasa; Hibino, Yuri; Kambayashi, Yasuhiro; Hitomi, Yoshiaki; Shikura, Naoto; Hiroyuki, Nakamura

    2016-07-01

    The aim of this study was to examine the relationship between hypertension and health-related quality of life (HRQoL) adjusted by chronic pain, other chronic diseases, and life habits in the general middle-aged population in Japan. This study is a population-based cross-sectional study. In this study, 1117 participants aged 40-65 years and living in Shika Town completed a self-administered questionnaire including Short Form-36 (SF-36). The scores of SF-36 among hypertensives were compared with those of normotensives. The independent association of hypertension with each SF-36 subscale was analyzed using a multiple linear regression model adjusted by age, BMI, chronic pain, chronic diseases, sleep, exercise, and occupational status. We analyzed two groups; Group 1 which contained 846 participants completed the questionnaire without coronary heart disease and cerebral vascular disease, Group 2 which contained 686 participants without coronary heart disease, cerebral vascular disease, or diseases accompanied by chronic pain (gastroduodenal ulcer, fracture, osteoarthritis, osteoporosis, rheumatoid arthritis, and disc herniation). In Group 2, hypertensive women had a lower general health perception than normotensive women [unstandardized coefficients; B = -8.84, 95 % confidence interval (95 % CI) = -13.3 to -4.34, standardized coefficients; β = -0.200, p < 0.001], whereas hypertensive men had higher social functioning than normotensive men (B = 5.66, 95 % CI = 1.30-10.0, β = 0.149, p < 0.05) after adjusting by chronic pain and life habits. These results may be due to the sex difference in the light of the perception for health.

  4. Coronary Anomalies: Left Main Coronary Artery Aneurysm

    OpenAIRE

    Varda, Rajsekhar; Chitimilla, Santosh Kumar; Lalani, Aslam

    2012-01-01

    Coronary artery aneurysm is one of the rarest anomalies that we see in our medical practice and they are mostly associated with obstructive lesions due to atherosclerotic changes. Management of these aneurysm patients (conservative or surgical repair) usually depends on obstructive lesions and associated symptoms. We are presenting a case of left main aneurysm measuring around 1 4 × 2 8  mm with other obstructive leisons. It was treated with surgical repair in view of obstructive lesions and ...

  5. Coronary Anomalies: Left Main Coronary Artery Aneurysm

    Directory of Open Access Journals (Sweden)

    Rajsekhar Varda

    2012-01-01

    Full Text Available Coronary artery aneurysm is one of the rarest anomalies that we see in our medical practice and they are mostly associated with obstructive lesions due to atherosclerotic changes. Management of these aneurysm patients (conservative or surgical repair usually depends on obstructive lesions and associated symptoms. We are presenting a case of left main aneurysm measuring around 14×28 mm with other obstructive leisons. It was treated with surgical repair in view of obstructive lesions and symptoms.

  6. ACUTE CORONARY SYNDROME DUE TO CORONARY VASOSPASM – CASE REPORT

    Directory of Open Access Journals (Sweden)

    S. D. Klimovskiy

    2017-01-01

    Full Text Available Spasm of the coronary arteries is a dynamic narrowing of one or more coronary arteries, leading to significant restriction of the lumen. The leading role in coronary  artery spasm diagnostic belongs to coronary  angiography and its accompanying provocative tests. Mechanisms of coronary  artery spasm development remain incompletely clarified and it's considered as a multifactorial disease with its own specific risk factors.  Though pathophysiology is no longer a matter of dispute, further  efforts should be aimed at the practical application of the recommendations. Diagnosis of the coronary  artery spasm  has important practical significance, due to the prevailing benefit of calcium antagonists in the treatment and absence of benefit from percutaneous coronary  interventions in most cases. A clinical case of the patient with multivessel, multifocal coronary  artery spasm is presented.

  7. The Association between Androgenic Hormone Levels and the Risk of Developing Coronary Artery Disease (CAD).

    Science.gov (United States)

    Allameh, Farzad; Pourmand, Gholamreza; Bozorgi, Ali; Nekuie, Sepideh; Namdari, Farshad

    2016-01-01

    The aim of the study was to evaluate the relationship between the serum levels of androgens and Coronary Artery Disease (CAD) in an Iranian population. Male individuals admitted to Tehran Heart Center and Sina Hospital, Tehran, Iran from 2011-2012 were categorized into CAD and control groups based on selective coronary angiography. Baseline demographic data, including age, BMI, diabetes, and a history of hypertension were recorded. Patients were also assessed for their serum levels of total testosterone, free testosterone, estradiol, dehydroepi and rosterone sulfate (DHEA-S), and Sex Hormone Binding Globulin (SHBG). Data analysis was carried out chi-square and ANOVA tests as well as logistic regression analysis. Two hundred patients were in the CAD group and 135 individuals in control group. In the CAD group, 69 had single-vessel disease, 49 had two-vessel diseases, and 82 had three-vessel diseases. Statistically significant differences were observed between the individuals in the two groups with respect to age (PCAD group; however, the serum level of SHBG was higher in the CAD group than in the control group (P=0.007). Results of the logistic regression analysis indicated that only age (P=0.042) and diabetes (P=0.003) had significant relationships with CAD. Although the serum levels of some of the androgens were significantly different between the two groups, no association was found between androgenic hormone levels and the risk of CAD, due mainly to the effect of age and diabetes.

  8. PREVALENCE AND PREDICTORS OF CORONARY ARTERY DISEASE IN SEVERE AORTIC STENOSIS PATIENTS UNDERGOING SURGERY

    Directory of Open Access Journals (Sweden)

    Narayanapilai Jayaprasad

    2017-09-01

    Full Text Available BACKGROUND The present study is to find out the prevalence of CAD in severe Aortic Stenosis (AS patients undergoing aortic valve replacement and the relation between the conventional risk factors and CAD in them. Calcific aortic stenosis is associated with the same risk factors as coronary artery disease. Studies on calcific aortic stenosis and CAD are rarely reported from India. The aim of the study is to find out the predictive value of angina for presence of CAD in severe aortic stenosis. MATERIALS AND METHODS All cases of isolated severe aortic stenosis undergoing CAG before aortic valve replacement were included in the study. Data regarding various risk factors, symptoms, echocardiographic parameters and angiographic profile were collected. RESULTS Among a total of 94 patients who have undergone aortic valve replacement for severe AS 40 (42.6% had CAD. Risk factors like advanced age, hypertension, diabetes and smoking were more in patients with CAD compared to isolate AS. Mean gradient was more in the AS + CAD group compared with AS group. Presence of angina had a sensitivity of 82.5% and specificity of 51.85% for predicting coexisting CAD. CONCLUSION Among severe aortic stenosis, patients undergoing AVR 42.6% of patients had significant obstructive CAD. The conventional risk factors predict presence of coronary artery disease. Angina has got a fairly good sensitivity, but moderate specificity for CAD.

  9. Determinants of successful recanalization of chronic coronary arterial total occlusion by percutaneous intervention and the prognosis

    International Nuclear Information System (INIS)

    Zheng Xing; Qin Yongwen; Ding Jijun; Xu Rongliang; Zhang Zhenyuan; Chen Shaoping; Ma Liping; Chen Ling; Cui Jifu

    2004-01-01

    Objective: To evaluate the determinants of successful recanalization of chronic coronary arterial total occlusion (CTO) by percutaneous coronary intervention (PCI) as well as the effect of the recanalization on the prognosis of the patients. Methods: Fifty-two patients with CTO were treated by PCI. 30 patients (duration more than one month) were successfully recanalized with stent implantation. Their clinical features and prognosis were compared with those without successful recanalization. Results: Compared with patients without successful recanalization, patients with successful recanalization had a higher incidence of hypertension (53% vs 23%, P<0.05), shorter duration of the predicted occlusion (P<0.01), lower plasma concentration of total cholesterol [(4.8 ± 0.85) vs (5.6 ± 1.5) mmol/L, P<0.05], lower percentage of the lesions with clear out stump or with bridging collaterals or with a branch at orifice or of long segment (17% vs 45%, P<0.05); more frequently free of angina (73% vs 50%, P<0.05) and had lower combination end points including repeated PCI, CABG and hospilization (13% vs 36% P<0.05) during follow-up. Conclusions: Duration of occlusion, the length of occlusion, the occlusion with a missing stump or bridging collaterals are key factors for success or failure of recanalization of TCO by PCI. Patients with successful PCI of CTO have a better prognosis. (authors)

  10. Erectile dysfunction in healthy subjects predicts reduced coronary flow velocity reserve.

    Science.gov (United States)

    Borgquist, Rasmus; Gudmundsson, Petri; Winter, Reidar; Nilsson, Peter; Willenheimer, Ronnie

    2006-09-20

    Erectile dysfunction is associated with, and may be the first sign of coronary artery disease. We aimed to assess whether men with erectile dysfunction but without cardiovascular disease have reduced coronary flow reserve, as a sign of early coronary atherosclerosis. We investigated 12 men aged 68-73 years with erectile dysfunction, and 12 age-matched controls. Erectile function was evaluated using the validated IIEF-5 questionnaire. A score or = 21 was considered normal. Patients with neurological or psychological reasons for erectile dysfunction were excluded, as were patients with symptoms of or prescribed medication for cardiovascular disease, hypertension or diabetes. Coronary flow velocity reserve was measured non-invasively by Doppler in the left anterior descending artery, before and during adenosine infusion. Coronary flow velocity reserve was significantly reduced in subjects with erectile dysfunction: 2.36 versus 3.19; P=0.024. In logistic regression analysis, compared to control subjects, men with erectile dysfunction had significantly increased risk of reduced coronary flow velocity reserve (reduced coronary flow velocity reserve, P=0.016. Men with erectile dysfunction but without diabetes or clinical cardiovascular disease have early signs of coronary artery disease. Our findings suggest that a cardiac risk evaluation may be indicated in men with suspected vasculogenic erectile dysfunction, and these individuals should be considered for primary prevention measures regarding cardiovascular disease risk factors.

  11. Evaluation of myocardial bridging by coronary computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Barros, Marcio Vinicius Lins; Rabelo, Daniel Rocha; Siqueira, Maria Helena Albernaz, E-mail: marciovlbarros@uol.com.br [Hospital Mater Dei, Belo Horizonte, MG (Brazil); Garretto, Luiza Samarane; Paula, Marcela Mascarenhas De; Carvalho, Marina Oliveira; Alves, Marina Rangel Moreira Barros [Faculdade de Saude e Ecologia Humana (FASEH), Vespasiano, MG (Brazil)

    2013-01-15

    The myocardial bridge (MB) is defined as a segment of an epicardial coronary artery that has an intramural course in the myocardium. Although MB is clinically silent in most cases, has been associated with myocardial ischemia, arrhythmias and sudden death. Coronary conventional angiography is the gold standard for detection of MB, but is invasive and cannot be sufficiently sensitive compared to autopsy studies. Recently, multislice computed tomography of coronary arteries (MCTCA) has allowed the detection of coronary artery course, including PM. Objectives: to evaluate MB prevalence in patients with suspected coronary artery disease undergoing MCTCA and to evaluate the predictive value of this method at medium term. Methods: during the period 2008 to 2011, 498 consecutive patients were examined by TMC for the diagnosis of coronary artery disease, being conducted to evaluate the presence of BM and followed for a mean follow-up of 23 months for the occurrence of cardiovascular hard events (death, hospitalization or revascularization). Results: patients mean age was 55.3 ± 14.2, being male 71.1%. Among the patients, 7.6% (38 patients) showed MB. Main findings included angina pectoris in 40% and a positive stress test in 34%. 34.2% had atherosclerotic disease, and one patient had significant coronary stenosis. During follow-up, no patients showed adverse events. Conclusion: MCTCA is a noninvasive technique with high accuracy in anatomical evaluation of the coronary arteries and may be particularly useful to assess the incidence, location and morphology of myocardial bridging in vivo. (author)

  12. Spontaneous left main coronary artery dissection complicated by pseudoaneurysm formation in pregnancy: role of CT coronary angiography

    Directory of Open Access Journals (Sweden)

    Weintraub Nealw F

    2009-04-01

    Full Text Available Abstract We report a case of a 26-year-old female, who presented at 34 weeks of an uncomplicated pregnancy with an acute ST elevation anterior wall myocardial infarction. Cardiac catheterization suggested a left main coronary artery dissection with pseudoaneurysm formation. The patient's course was complicated by congestive heart failure. She was initially managed conservatively by a multidisciplinary team including heart failure specialists, obstetricians, and cardiovascular surgeons. 4 days after admission, her LMC was imaged by dual-source 64 slice Cardiac computed tomography, coronary dissection was identified extending to the lumen, and the presence of pseudoaneurysm was confirmed. She underwent subsequently a staged procedure, which included placement of an intra-aortic balloon pump, cesarean section, and coronary artery bypass grafting. This case illustrates the utility of coronary artery CT imaging to assess the complexity and stability of coronary artery dissections, thereby helping to determine the need for, and timing of revascularization procedures.

  13. Pulmonary hypertension CT imaging

    International Nuclear Information System (INIS)

    Nedevska, A.

    2013-01-01

    Full text: The right heart catheterization is the gold standard in the diagnosis and determines the severity of pulmonary hypertension. The significant technical progress of noninvasive diagnostic imaging methods significantly improves the pixel density and spatial resolution in the study of cardiovascular structures, thus changes their role and place in the overall diagnostic plan. Learning points: What is the etiology, clinical manifestation and general pathophysiological disorders in pulmonary hypertension. What are the established diagnostic methods in the diagnosis and follow-up of patients with pulmonary hypertension. What is the recommended protocol for CT scanning for patients with clinically suspected or documented pulmonary hypertension. What are the important diagnostic findings in CT scan of a patient with pulmonary hypertension. Discussion: The prospect of instantaneous complex - anatomical and functional cardiopulmonary and vascular diagnostics seems extremely attractive. The contrast enhanced multislice computed (CT ) and magnetic resonance imaging are very suitable methods for imaging the structures of the right heart, with the possibility of obtaining multiple projections and three-dimensional imaging reconstructions . There are specific morphological features that, if carefully analyzed, provide diagnostic information. Thus, it is possible to avoid or at least reduce the frequency of use of invasive diagnostic cardiac catheterization in patients with pulmonary hypertension. Conclusion: This review focuses on the use of contrast-enhanced CT for comprehensive evaluation of patients with pulmonary hypertension and presents the observed characteristic changes in the chest, lung parenchyma , the structures of the right half of the heart and pulmonary vessels

  14. Genes and hypertension.

    Science.gov (United States)

    Garcia, E A; Newhouse, S; Caulfield, M J; Munroe, P B

    2003-01-01

    The combination of investigation of rare Mendelian forms of hypertension, candidate gene studies, comparative mapping and genome-wide screening in both animal models and man has led to significant progress in determining new mechanisms of blood pressure control. In this review, the newly discovered blood pressure/cardiovascular genes, WNK kinases and angiotensin converting enzyme 2 and the development of a new anti-hypertensive agent PST2238 are discussed. Major genes causing essential hypertension have yet to be discovered, however, there are now over 20 published genome-wide screens for blood pressure controlling genes. Several regions demonstrate suggestive linkage to the trait and there is some overlap of regions between the different studies. It is hoped that new blood pressure genes will ultimately be discovered using this method. Pharmacogenetic studies in hypertension have only been initiated recently, some are described in this paper. Small studies upon single candidate genes, suggest that the contribution of genetics to the inter-individual variation in blood pressure response to anti-hypertensive therapy, is small, approximately 3-5%. Recently micro-arrays with multiple polymorphisms in multiple genes have been used. After accounting for the additive affects of multiple blood pressure loci, an individual's genetic profile appeared to explain up to 50% of the variation in blood pressure response to therapy. Knowledge of the genetic variants that cause hypertension and influence response to anti-hypertensive therapy will ultimately provide a greater understanding of the molecular mechanisms underlying blood pressure control.

  15. Fetal activity patterns in hypertensive pregnancies.

    Science.gov (United States)

    Rayburn, W F

    1982-01-01

    This prospective investigation attempts to determine whether the maternal recording of perceived fetal motion is useful for fetal assessment in pregnancies complicated by hypertension. During a 21 month period, 124 patients whose pregnancies were complicated by either chronic or pregnancy-induced hypertension participated. The number of perceived movements per hour (24 +/- 11, mean +/- S.D.) and evidence for fetal inactivity (7 cases, 6%) did not vary significantly from a control group of normotensive pregnancies (p greater than 0.05). Fetal inactivity was predictive of an unfavorable perinatal outcome in 6 of 7 cases, including the three stillborn infants. No perinatal deaths occurred among the 117 hypertensive pregnancies with active fetuses, and the 6 cases with an unfavorable outcome were associated with mild intrauterine growth delay, prematurity, or acute changes such as placental abruption or umbilical cord accidents. Realizing these limitations, a record of fetal inactivity is worthwhile in managing the pregnancy complicated by hypertension.

  16. Long-term prognosis and clinical characteristics of young adults (≤40 years old) who underwent percutaneous coronary intervention.

    Science.gov (United States)

    Konishi, Hirokazu; Miyauchi, Katsumi; Kasai, Takatoshi; Tsuboi, Shuta; Ogita, Manabu; Naito, Ryo; Katoh, Yoshiteru; Okai, Iwao; Tamura, Hiroshi; Okazaki, Shinya; Daida, Hiroyuki

    2014-09-01

    Limited data exist regarding the long-term prognosis of percutaneous coronary intervention (PCI) in young adults. The aim of this study was to retrospectively assess the long-term clinical outcomes in young patients who underwent PCI. Between 1985 and 2011, 7649 consecutive patients underwent PCI, and data from 69 young adults (age ≤40 years) and 4255 old adults (age ≧65 years) were analyzed. A Cox proportional hazards regression analysis was used to determine the independent predictors of a composite endpoint that included all-cause death and acute coronary syndrome (ACS) during the follow-up period. The mean age of the 69 young patients was 36.1±4.9 years, and 96% of them were men. Approximately 30% were current smokers, and their body mass index (BMI) was 26.7±5.0kg/m(2). The prevalence of diabetes and hypertension was 33% and 48%, respectively. All patients had ≥1 conventional cardiovascular risk factor. At a median follow-up of 9.8 years, the overall death rate was 5.8%, and new-onset ACS occurred in 8.7%. Current smoking was an independent predictor of the composite endpoint (hazard ratio 4.46, confidence interval 1.08-19.1, p=0.04) for young adults. Current smoking and obesity (high BMI) are the important clinical characteristics in young Japanese coronary heart disease patients who undergo PCI. The long-term prognosis in young patients is acceptable, but current smoking is a significant independent predictor of death and the recurrence of ACS in young Japanese coronary heart disease patients who are obese. Copyright © 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  17. Non-compliance to anti-hypertensive medication and its associated factors among hypertensives

    International Nuclear Information System (INIS)

    Bilal, A.; Riaz, M.; Shafiq, N.U.; Ahmed, M.; Sheikh, S.; Rasheed, S.

    2015-01-01

    Non-compliance to anti-hypertensive drugs can have negative impact on cardiovascular outcome. Various studies have been conducted on the issue but the factors are not yet explored properly, particularly in Pakistan. This study was conducted to determine the frequency and factors associated with non-compliance to anti-hypertensive medications in Karachi. Methods: This descriptive cross sectional study was conducted on 113 indoor hypertensive patients included by purposive sampling, aged 30 years and above diagnosed at least 6 months back in public sector tertiary care institutes of Karachi from March to October 2011. Data was collected through a questionnaire in Urdu. Demographic data, hypertension diagnosis, medical co-morbidity, current number of anti-hypertensive medicines, frequency of missing prescribed antihypertensive therapy and other factors affecting compliance pertaining to medicines, patient, physician and health care centre were included in the questionnaire. Results: This study revealed that 68.14% patients were non-compliant. Non-compliance was found to be associated with gender and socioeconomic status. Duration of hypertension, duration between follow up visits to physician, number of drugs, careless attitude, role of physician and limiting access to health care center are found to be important factors in non-compliance. Conclusions: Multiple factors including patients, medicine and health care system related, which can be prevented with simple measures, were found responsible for higher prevalence of non-compliance against anti-hypertensive medicines. (author)

  18. Acute coronary syndrome: a rare case of multiple endocrine neoplasia syndromes with pheochromocytoma and medullary thyroid carcinoma.

    Science.gov (United States)

    Maloberti, Alessadro; Meani, Paolo; Pirola, Roberto; Varrenti, Marisa; Boniardi, Marco; De Biase, Anna Maria; Vallerio, Paola; Bonacina, Edgardo; Mancia, Giuseppe; Loli, Paola; Giannattasio, Cristina

    2015-09-01

    Pheochromocytoma is a tumor arising from neuroectodermal chromaffin tissues in the adrenal gland or extra-adrenal paraganglia (paragangliomas). The prevalence of the tumor is 0.1%-0.6% in the hypertensive population, of which 10%-20% are malignant. Pheochromocytoma produces, stores, and secretes catecholamines, as well as leads to hypertensive crisis, arrhythmia, angina, and acute myocardial infarction without coronary artery diseases. We report a case of acute coronary syndrome (ACS) with a final diagnosis of multiple endocrine neoplasia with pheochromocytoma and medullary thyroid carcinoma (MTC).

  19. Spaceflight-Induced Intracranial Hypertension.

    Science.gov (United States)

    Michael, Alex P; Marshall-Bowman, Karina

    2015-06-01

    Although once a widely speculated about and largely theoretical topic, spaceflight-induced intracranial hypertension has gained acceptance as a distinct clinical phenomenon, yet the underlying physiological mechanisms are still poorly understood. In the past, many terms were used to describe the symptoms of malaise, nausea, vomiting, and vertigo, though longer duration spaceflights have increased the prevalence of overlapping symptoms of headache and visual disturbance. Spaceflight-induced visual pathology is thought to be a manifestation of increased intracranial pressure (ICP) because of its similar presentation to cases of known intracranial hypertension on Earth as well as the documentation of increased ICP by lumbar puncture in symptomatic astronauts upon return to gravity. The most likely mechanisms of spaceflight-induced increased ICP include a cephalad shift of body fluids, venous outflow obstruction, blood-brain barrier breakdown, and disruption to CSF flow. The relative contribution of increased ICP to the symptoms experienced during spaceflight is currently unknown, though other factors recently posited to contribute include local effects on ocular structures, individual differences in metabolism, and the vasodilator effects of carbon dioxide. This review article attempts to consolidate the literature regarding spaceflight-induced intracranial hypertension and distinguish it from other pathologies with similar symptomatology. It discusses the proposed physiological causes and the pathological manifestations of increased ICP in the spaceflight environment and provides considerations for future long-term space travel. In the future, it will be critical to develop countermeasures so that astronauts can participate at their peak potential and return safely to Earth.

  20. Ruthenium Complex Improves the Endothelial Function in Aortic Rings From Hypertensive Rats

    Science.gov (United States)

    Vatanabe, Izabela Pereira; Rodrigues, Carla Nascimento dos Santos; Buzinari, Tereza Cristina; de Moraes, Thiago Francisco; da Silva, Roberto Santana; Rodrigues, Gerson Jhonatan

    2017-01-01

    Background The endothelium is a monolayer of cells that extends on the vascular inner surface, responsible for the modulation of vascular tone. By means of the release of nitric oxide (NO), the endothelium has an important protective function against cardiovascular diseases. Objective Verify if cis- [Ru(bpy)2(NO2)(NO)](PF6)2 (BPY) improves endothelial function and the sensibility of conductance (aorta) and resistance (coronary) to vascular relaxation induced by BPY. Methods Normotensive (2K) and hypertensive (2K-1C) Wistar rats were used. For vascular reactivity study, thoracic aortas were isolated, rings with intact endothelium were incubated with: BPY(0.01 to10 µM) and concentration effect curves to acetylcholine were performed. In addition, cumulative concentration curves were performed to BPY (1.0 nM to 0.1 µM) in aortic and coronary rings, with intact and denuded endothelium. Results In aorta from 2K-1C animals, the treatment with BPY 0.1µM increased the potency of acetylcholine-induced relaxation and it was able to revert the endothelial dysfunction. The presence of the endothelium did not modify the effect of BPY in inducing the relaxation in aortas from 2K and 2K-1C rats. In coronary, the endothelium potentiated the vasodilator effect of BPY in vessels from 2K and 2K-1C rats. Conclusion Our results suggest that 0.1 µM of BPY is able to normalize the relaxation endothelium dependent in hypertensive rats, and the compound BPY induces relaxation in aortic from normotensive and hypertensive rats with the same potency. The endothelium potentiate the relaxation effect induced by BPY in coronary from normotensive and hypertensive rats, with lower effect on coronary from hypertensive rats. PMID:28678930