Multimodality imaging for the assessment of hypertensive heart disease
Dan Andrei Radu, Maria Dorobantu
Cardiology Department, Clinical Emergency Hospital, Bucharest, Romania
Cardiology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Left ventricular hypertrophy is one of the complications of systemic hypertension. However, it can be caused by several other conditions such as valvular, genetic, or infiltrative heart diseases. In clinical practice, it is important to establish the etiology of left ventricular hypertrophy accurately, but this is frequently challenging due to phenotype overlap. Multimodality imaging is currently employed in clinical practice, and echocardiography and cardiovascular magnetic resonance (CMR) provide valuable information in the case of left ventricular hypertrophy. Because of its tissue characterization capabilities, CMR can inform about myocardial fibrosis, edema, or infiltration; thus, it should be indicated whenever clinical or echocardiographic red flags indicate an alternative etiology of the left ventricular hypertrophy, other than hypertensive heart disease.
J Hypertens Res (2021) 7(2):41–45 [download PDF]
Orthostatic hypotension in hypertensive older patients
Roxana-Maria Stanica, Andreea Catarina Popescu
Department of Cardiology, Elias Emergency University Hospital, Bucharest, Romania
Orthostatic hypotension (OH) has a significant prevalence in the general population, which increases exponentially with age and determines considerable morbidity and mortality. The older population is prone to frailty and comorbidities, including hypertension requiring treatment, whilst certain antihypertensive classes are proven to precipitate OH. At the same time, OH treatment may determine exacerbation of hypertension, making the therapeutical management of this group of patients a significant challenge. OH can be neurogenic or non-neurogenic. This review summarizes data from current literature on the epidemiology, precipitating medication, prognostic, and treatment of OH in elderly hypertensive patients.
J Hypertens Res (2021) 7(2):46–54 [download PDF]
Efficacy and safety of torasemide in patients with advanced renal insufficiency
Michael Doumas, Anna Varouktsi, Konstantinos Imprialos, Konstantinos Stavropoulos, Dimitrios Patoulias, Fotios Siskos, Maria Mavridou, Nikoleta Chatzipapa, Maria Toumpourleka, Eleni Georgianou, Elisavet Simoulidou, Ioanna Zografou
2nd Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece
Arterial hypertension and chronic kidney disease are major public health problems and closely interconnected. Thiazide and thiazide-like diuretics become less effective in advanced renal insufficiency and should be replaced by loop diuretics. However, studies negating that dogma exist in the literature. We conducted an observational retrospective study to evaluate the efficacy and safety of torasemide in patients with stage 3b chronic kidney disease who had uncontrolled blood pressure while receiving thiazide or thiazide-like diuretics. Thiazides were withdrawn, patients were administered torasemide, and follow-up was performed at 8-12 weeks post-torasemide initiation. Data were retrieved from medical records and analyzed retrospectively. A total of 24 patients (aged 67.1±6.1 years; 11 females) fulfilled all study criteria and were included in the analysis. Systolic blood pressure was substantially reduced following torasemide therapy (from 154.3±5.6 to 140.2±6.6 mmHg), and the reduction was statistically significant (p<0.001). There were no severe or clinically significant adverse events during the study follow-up period; neither electrolyte abnormalities nor renal function deterioration was observed. Torasemide was both effective and safe in patients with stage 3b chronic kidney disease and uncontrolled hypertension. This finding supports current recommendations to substitute thiazide and thiazide-like with loop diuretics in patients with advanced renal insufficiency.
J Hypertens Res (2021) 7(2):55–59 [download PDF]
The combined effect of alcohol consumption and smoking on blood pressure and the achievement of blood pressure target values in treated hypertensive patients
Ede Kékes, András Paksy, Viktória Baracsi-Botos, Vince Bertalan Szőke, Zoltán Járai
1st Department of Internal Medicine, Department of Cardiology and Angiology, University of Pécs Clinical Center, Pécs, Hungary
School of PhD Studies, Aesculap Academy, Budapest, Hungary
Department of Cardiology, Szent Imre University Teaching Hospital, Budapest, Hungary
Hungarian Society of Hypertension, Budapest, Hungary
The combined effect of alcohol consumption and smoking on hypertension in hypertensive patients is still not completely clear, although both are known to be cardiovascular risk factors. The aim of our study was to compare the blood pressures and the achievement of target blood pressure as well as heart rate values of middle-aged, non-smoking, and non-drinking hypertensive patients with those who smoke and drink regularly. From the Hungarian Hypertension Registry database, 12,615 patients (6,341 men and 6,274 women) aged 45-64 years were included in the current analysis, who self-reported a smoking habit and regular alcohol consumption. The mean age of the patients was 55.8±5.7 years (males) and 56.1±5.5 years (females). The percentage of regular smokers was 40.8% and 27.2% in men and women, respectively. 38.1% of males and 12.5% of females were regular alcohol drinkers. The ratio of patients reaching goal blood pressure values was higher in all investigated groups of females than in males (p<0.001). Regular smokers and drinkers have a lower percentage of reaching goal blood pressure values: 31.1% versus 46.6% in males (p<0.001) and 41.1% versus 49.8% in females (p<0.01), respectively. The mean pulse rate was higher in patients who are both smokers and regular drinkers. Regular alcohol consumption and smoking decrease the chance of reaching blood pressure goal values in treated hypertensive patients of middle-age.
J Hypertens Res (2021) 7(2):60–68 [download PDF]
Cardio-ankle vascular index (CAVI) as a marker for arterial stiffness predicts outcome of renal sympathetic denervation in patients with resistant arterial hypertension
Arman Postadzhiyan, Sotir Tochev, Lora Andreeva, Nizar Rifai, Bojidar Finkov
Department of Cardiology, Medical University of Sofia, Sofia, Bulgaria
Department of Cardiology, St Anne University Hospital, Sofia, Bulgaria
This study aimed to examine arterial stiffness using the cardio-ankle vascular index (CAVI) in patients with resistant arterial hypertension and to assess the predictive value of the parameter in the identification of responders from renal denervation. The study included 62 patients with treatment-resistant hypertension; after out-of-office blood pressure measurement and intensification of therapy, renal denervation was performed in 32 cases. Patients with increased arterial stiffness were older, with a larger waist circumference and previous cardiovascular events. Despite similar baseline out-of-office and office blood pressure and concomitant antihypertensive therapy, patients with lower arterial stiffness had a more significant blood pressure effect after renal denervation, a result that persisted within 12 months of follow-up. In contrast, the effect of the procedure was clinically insignificant among patients with baseline CAVI values above 8.3.
J Hypertens Res (2021) 7(2):69–78 [download PDF]