Fathal pulmonary hypertension after distal splenorenal shunt in schistosomal portal hypertension

INTRODUCTIONMansonic schistosomiasis is the main cause of portalhypertension in Brazil.Hepatosplenic (HS) form is manifestedby hepatomegaly mainly on the left hepatic lobe associatedwith large splenomegaly and bleeding due to esophagealvarices with high mortality rates.Pulmonary hypertension in the HS form of mansonicschistosomiasis is described in association with both the acuteand chronic forms of the disease,with a prevalence of 5% andmay be a serious complication in the evolution of the disease.It can also be the triggering factor for serious complicationsassociated with any form of surgical approach.Surgical treatment is indicated for patients with a history ofbleeding due to esophageal varix rapture based on world previous     

What's new in portal hypertension?

Portal hypertension is defined as increased pressure in the portal venous system. The most common cause of portal hypertension is cirrhosis. In this setting, there is an increase in intrahepatic resistance leading to an increase in portal pressure. By increasing portal blood flow, splanchnic vasodilation further aggravates portal hypertension. New pathogenic pathways are being established which might result in new therapeutic strategies. The presence of varices at endoscopy and/or other abdominal portosystemic collaterals confirms the diagnosis of portal hypertension. The role of non‐invasive and imaging tests in the diagnosis and prognosis of portal hypertension has been clarified. Non‐selective beta‐blockers decrease both the risk of variceal haemorrhage and hepatic decompensation. Terlipressin, somatostatin or octreotide, in combination with early endoscopic therapy, are recommended for the treatment of acute variceal haemorrhage. Early Transjugular intrahepatic portosystemic shunt (TIPS) is effective as salvage therapy in acute variceal bleeding in selected patients and prevents rebleeding more effectively than endoscopic and medical therapy resulting in an increased survival.     

Mitochondrial DNA mutation in essential hypertension

Essential hypertension (EH) is an escalating problem for developed and developing countries.It is currently seen as a 'complex' genetic trait caused by multiple susceptibility genes which are modulated by gene-environment and gene-gene interactions.Over the past 10 years,mitochondrial defects have been implicated in a wide variety of degenerative diseases,aging,and cancer.Recently several studies showed that human essential hypertension has excess maternal transmission which suggests a possible mitochondrial involvement.However,the exact pathophysiology of mitochondrial DNA mutation (mtDNA) in essential hypertension still remains perplexing.With the application of a variety of imaging approaches and successive mouse model of mitochonddal diseases we convince that these problems will be resolved in the near future.(J Geriatr Cardiol 2008;5(1):60-64)     

Is there ileopathy in portal hypertension?

BACKGROUND AND AIMS: Portal hypertensive gastropathy and colopathy are well described endoscopic abnormalities in patients with portal hypertension. Endoscopic abnormalities in the ileum in patients with portal hypertension have not been well described. The aim of the present study was to evaluate endoscopic abnormalities in the ileum of patients with portal hypertension. METHODS: Patients with portal hypertension of various etiologies were included in the study. Upper gastrointestinal endoscopy was performed to record esophageal varices, gastric varices and portal hypertensive gastropathy. Colonoscopy with retrograde intubation of the ileum was performed and the presence of colorectal varices, colopathy and mucosal findings in the ileum were noted. RESULTS: Forty-one patients (age 16-80 years, 33 men) were studied. Esophageal varices were present in all. Portal hypertensive gastropathy was present in 27/41 (66%) patients. Rectal varices were noted in 22/41 (54%) patients and 17/41 (42%) patients had features suggestive of colopathy. Ileum could be intubated in 38 patients (93%). Endoscopic abnormalities in the ileum were noted in 13/38 (34%) patients. Ileopathy as evident by endoscopic mucosal abnormalities was observed in 10/38 (26%) patients. Ileal varices were present in 8/38 (21%) patients. Three of these had ileal varices alone while the remaining five patients also had associated ileopathy The presence of ileopathy was significantly associated with the presence of portal hypertensive gastropathy and colopathy but not with esophageal, gastric or rectal varices. CONCLUSIONS: Ileopathy occurs in one-third of patients with portal hypertension and is significantly associated with the presence of portal hypertensive gastropathy and colopathy.     

Refractory hypertension and multiple organ dysfunction in theelderly

Amalepatientaged 6 3withahistoryofhyper tensionfortenyearsandgoutfortwoyearswasad mittedtoourhospitalonDec 2 3rd,2 0 0 1.Tenyearsago ,hewasdiagnosedasessentialhyper tensionbecauseofrecurrentdizziness,chestdistressandthehighestbloodpressureof 2 6 0 / 15 0mmHg .Hehadre ceivedantihypertensivetherapy ,includingnifedipine ,metoprololandcaptopril,buthisbloodpressurewasstillabove 170 / 110mmHg .Twoandonehalfhoursbeforeadmission,hesuddenlydevelopeddyspnea ,orthopnea ,cyanosisandcoughwith profusewhite…     

Hydrogen sulfide system in the pathogenesis of renovascular hypertension in rats

Objective To investigate the role of hydrogen sulfide (H2S) synthases/H2S pathway in the pathogenesis of renovascular hypertension.Methods Wistar rats were subdivided into 4 groups:(1) 2-kidney,1-clip (2K-1C group,n=7),(2) control (n=7),(3)sham (n=7),and (4) 2K-1C plus sodium hydrosulfide (NariS) (NariS-treated group,n=7).The systolic blood pressure (SBP) was measured by a tail-cuff method using a pulse transducer once a week.Four weeks later,all rats were killed and the concentration of plasma hydrogen sulfide (H2S),the activity of the H2S syntha.ses in the kidneys on both sides,the plasma angiotensin Ⅱ concentration,and the left-to-whole heart weight ratio were measured.Results The SBP was significantly increased in the 2K-IC group (185.4± 14.0mmHg) comparing with those in the sham group (112.9±6.5mmHg,,or the NariS-treated group(134.8±9.5mmHg) (both P＜0.01).At 4 weeks,the angiotensin Ⅱ concentration in the plasma was increased in the 2K-1C and NariS-treated group,comparing with the control and the sham group (306.92±7.03 pg/ml and 240.73±13.22 pg/ml vs 122.6±25.49 pg/ml and 125.95±10.55 pg/ml,respectively,both P＜0.05).The plasma H2S concentration and the activity of H2S synthases in the left kidney were decreased in the 2K-1C group comparing with those in the sham and the control groups.There was no difference of the activity of the H2S synthases in the right kidneys among the 4 groups.The left-to-whole heart weight ratio was increased in the 2K-1C and the NariS-treated group camparing with that in the sham and natural control groups.Conclusions Dysfunction of the H2S synthases/H2S pathway was involved in the 2K-1C-induced renovascular hypertension in rat.Exogenous administration of H2S donor can attenuate the development of hypertension.These findings suggest that the H2S synthases/H2S pathway participates in the pathogenesis of renovascular hypertension.     

How to diagnose hypertension in the elderly?

The management of hypertension in the elderly requires careful diagnosis, which is not always easy in this population because of the increased variability of blood pressure. The practitioner is faced with three questions in this diagnostic approach: how to evaluate the patient's real blood pressure level, how to assess the degree of cardiovascular impairment and concomitant disease and finally how to evaluate the subject's global cardiovascular risk. Self-monitoring of blood pressure, which allows measurement of blood pressure by the patient himself in his usual environment, provides a better assessment of the elderly patient's real blood pressure level.     

What is new in the 2018 Chinese hypertension guideline and the implication for the management of hypertension in Asia?

The new Chinese hypertension guideline comprehensively covers almost all major aspects in the management of hypertension. In this new guideline, hypertension remains defined as a systolic/diastolic blood pressure of at least 140/90 mm Hg. For risk assessment, a qualitative approach is used similarly as in previous Chinese guidelines according to the blood pressure level and the presence or absence of other risk factors, target organ damage, cardiovascular complications, and comorbid diseases. The therapeutic target is 140/90 mm Hg in general, and if tolerated, especially in high‐risk patients, can be more stringent, that is, 130/80 mm Hg. However, a less stringent target, that is, 150/90 mm Hg, is used in the younger (65‐79 years, if tolerated, 140/90 mm Hg) and older elderly (≥80 years). Five classes of antihypertensive drugs, including β‐blockers, can be used either in initial monotherapy or combination. The guideline also provided information on the management of hypertension in several special groups of patients and in the presence of secondary causes of hypertension. To implement the guideline recommendations, several nationwide hypertension control initiatives are being undertaken with new technology. The new technological platforms hopefully will help improve the management of hypertension and generate scientific evidence for future hypertension guidelines, including a possible Asian hypertension guideline in the near future.     

Is an ephedrine caffeine treatment contraindicated in hypertension?

OBJECTIVES: To examine how the slimming drug, Letigen, containing ephedrine (E) 20 mg and caffeine (C) 200 mg (E + C), affects blood pressure in normotensive and hypertensive patients treated with adrenergic beta-receptor blocking drugs and/or other antihypertensive agents, during a period of six weeks. DESIGN: A double-blind, randomised, placebo controlled study of five parallel groups of overweight patients from general practices. SUBJECTS: One hundred and thirty-six patients with Body Mass Index (BMI) > 25 kg/m2 were included consecutively by 25 general practitioners in Denmark and randomized into five groups: (1) Hypertensive patients treated with betablockers and E + C; (2) Hypertensive patients treated with antihypertensive agents other than betablockers, and E + C; (3) Normotensive patients treated with E + C; (4) Hypertensive patients under any antihypertensive treatment + placebo; and (5) Normotensive patients + placebo. All patients were instructed in a 1200 kcal (= 5040 kj) diet. RESULTS: Of a total of 136 patients aged 20-74 y, 112 completed the study protocol. Fluctuations in systolic and diastolic blood pressure were seen in all groups. The systolic blood pressure was reduced significantly (5.5 mmHg) in the patients treated with antihypertensive agents other than betablockers, plus E + C. In the other hypertensive groups the reduction in blood pressure was not significant. In normotensive patients treated with E + C, the systolic and the diastolic blood pressure declined significantly (4.4/3.9 mmHg). At the end of the treatment period heart rate had increased significantly (4.9 beats/min) in the group of normotensive patients treated with E + C. Blood pressure and heart rate measured by the patient at home showed similar fluctuations from baseline prior to and during treatment with E + C or placebo. A mean loss of weight of approximately 4 kg in 6 weeks was significant for all the groups. There was no significant difference between the groups during this short period of treatment. In 56% of the patients treated with E + C complaints/side-effects related to the medical treatment were found at questioning. Corresponding complaints occurred in 21% of the placebo treated patients. In the E + C treated group 7% dropped out due to side-effects. In the placebo group there were no drop-outs. CONCLUSIONS: This study does not support the assumption that E + C should cause rises in blood pressure, acutely or during shortterm treatment, in either normotensive or hypertensive obese patients. The antihypertensive effect of the betablockers was not reversed by E + C.     

Is it time to measure microalbuminuria in hypertension?

Former guidelines on hypertension never made a commitment to the detection of microalbuminuria for screening or follow-up of hypertensive patients. On the other hand, growing evidence support the contributory role of microalbuminuria in the prediction of absolute cardiovascular risk in hypertension and document the potential relevance of this parameter to the initial choice of antihypertensive treatment. Upcoming new guidelines and diagnostic algorithms in hypertension need to underscore the clinical positioning of microalbuminuria for stratification of risk and follow-up purposes.