بایگانی برچسب برای: Hypertension

Resistant.Hypertension.in.Chronic.Kidney.Disease.[taliem.ir]

Resistant Hypertension in Chronic Kidney Disease

Hypertension has long been known to be a signifcant cardiovascular risk factor and remains one of the most preventable causes of premature, especially cardiovascular and renal, morbidity and mortality in both developed and developing countries . Hypertension accounts for, or contributes to, 62% of all strokes and 49% of all cases of heart disease responsible for 7.1 million deaths per year: approximately 13% of total world deaths . Antihypertensive trials consistently demonstrate a signifcant risk reduction beneft from lowering blood pressure. A reduction of 5 mmHg in diastolic pressure over 5 years is associated with a 42% relative reduction in stroke and a 14% relative reduction in the risk of an ischemic heart disease event . At the start of the millennium, the estimated number of adults with hypertension worldwide was 972 million, with that number expected to rise to 1.56 billion by 2025 . Blood pressure is a continuous variable that is normally distributed . There is no natural “cutoff” above which hypertension defnitely exists and one below which it defnitely does not. Indeed, the risk of stroke and ischemic heart disease events is continuously associated with blood pressure , with no evidence of a threshold value down to at least 115/75 mmHg . Above 115/70 mmHg, the risk of cardiovascular disease doubles for every 20/10 mmHg rise in BP across all the blood pressure ranges for both men and women .
Pulmonary.Hypertension.and.Interstitial.Lung.[taliem.ir]

Pulmonary Hypertension and Interstitial Lung Disease

Interstitial lung diseases (ILD) is a heterogeneous group of over 200 different diseases of unknown and known cause with common functional characteristics (restrictive physiology and impaired gas exchange) and a common fnal pathway, eventually leading to irreversible fbrosis . In this chapter, the radiographic imaging of the more common conditions of ILD is reviewed, and in particular, Idiopathic Interstitial Pneumonias (IIP), in relation to the presence of pulmonary hypertension, is discussed. A special emphasis is placed on the role of high-resolution computed tomography (HRCT) fndings in association with Pulmonary Hypertension (PH) . In 2002, the ATS/ERS multidisciplinary panel proposed a classifcation of IIP that comprises clinical– pathological entities such as Idiopathic Pulmonary Fibrosis. (IPF), Nonspecifc Interstitial Pneumonia (NSIP), Respiratory Bronchiolitisassociated Interstitial Lung Disease (RB-ILD), Cryptogenic Organizing Pneumonia (COP), Acute Interstitial Pneumonia (AIP), Desquamative Interstitial Pneumonia .(DIP), and lymphoid interstitial pneumonia (LIP) IPF is the most common subset IIP occurring most frequently in patients older than 50 years of age, limited to the lower lungs, and associated with a histological pattern termed usual interstitial pneumonia (UIP). Symptoms include dry cough, progressive dyspnea, and fnger clubbing that usually precede presentation by 6 months [10–18]. Physiological examination shows crackles over the lower lungs specifc for IPF with a high level of accuracy near 100%. In our opinion, only two approaches would allow an earlier diagnosis of IPF: (a) assessment of Velcro crackles by lung auscultation and (b) screening using HRCT.
Diagnosis.and.Treatment.of.Pulmonary.Hypertension.[taliem.ir]

Diagnosis and Treatment of Pulmonary Hypertension

The clinical classifcation of pulmonary hypertension is intended to categorize in fve groups of multiple clinical conditions according to similar clinical presentation, pathological fndings, hemodynamic characteristics, and treatment strategy, as follows: (1) pulmonary arterial hypertension (PAH), (2) pulmonary hypertension due to left heart disease, (3) pulmonary hypertension due to lung diseases and/or hypoxia, (4) chronic thromboembolic pulmonary hypertension (CTEPH) and other pulmonary artery obstructions, and (5) pulmonary hypertension with unclear and/or multifactorial mechanisms.
Essentials of[taliem.ir]

Essentials of Hypertension

In the classic book The Principles and Practice of Medicine, Sir William Osler did not mention hypertension or its archaic name, hyperpiesis . He obviously could not address a disease still undiscovered at that time, when the available noninvasive method to measure blood pressure (BP)—the sphygmograph, which measured the amplifed radial pulse—was not reliable and practical for clinical use. Scipione Riva-Rocci opened up a new era, presenting the sphygmomanometer in 1896 . Pulse palpation measured only systolic BP. Nikolai Sergeyevich Korotkov, a Russian surgeon, identifed diastolic BP by auscultation in 1905 . For many decades, the only novelty in BP measurement was the misspelling of the name “Korotkov ,”which was changed to “Korotkoff” in some publications. Chapter 3 discusses the methods used for BP measurement Businesspersons were the frst people to identify the risks of high BP. In 1911, the medical director of the Northwestern Mutual Life Insurance Company determined that applicants for life insurance should have their BP measured with a sphygmomanometer . Sir William Osler, in a lecture given to the Royal College of Physicians and Surgeons of Glasgow in 1912, proposed that BP over 160 mmHg was high . He did not, however, suspect its importance in the pathogenesis of atherosclerosis.
Hypertension[taliem.ir]

Hypertension and Cardiac Organ Damage

A 71-year-old Caucasian male was admitted to the outpatient clinic for hypertension and palpitations. He referred history of essential hypertension persisting for more than 4 years, treated with nifedipine GITS 30 mg once a day. The average values of home blood pressure were 130/80 mmHg. Both parents and one brother (47 years old) have history of arterial hypertension. Former smoker (about 10–20 cigarettes daily) for more than 30 years until the age of 55, he does not present additional cardiovascular risk factors, associated clinical conditions or non-cardiovascular diseases.