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hypokalemia with stroke

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https://www.readbyqxmd.com/read/27754188/sp-05-1-should-the-target-for-blood-pressure-reduction-be-lower-in-adults-with-hypertension-and-a-history-of-cardiovascular-disease
#1
Paul Whelton
BACKGROUND: Choice of the optimal target for blood pressure (BP) reduction during treatment of patients with hypertension, including those with underlying co-morbid conditions, is an important challenge in clinical practice. The Systolic Blood Pressure Intervention Trial (SPRINT) was designed to provide guidance in selection of a Systolic BP target during treatment of hypertension. METHODS: Adults ≥50 years old with hypertension and at least one additional risk factor for cardiovascular disease (CVD), but excluding persons with diabetes mellitus, prior stroke, or advanced chronic kidney disease (CKD) were randomly assigned to intensive therapy (intensive), targeting a systolic BP (SBP) <120 mmHg, or standard therapy (standard), targeting a SBP <140 mmHg...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27754163/sy-11-3-hypertension-in-women-more-dangerous-than-in-men
#2
Suzanne Oparil
Heart disease, stroke, and kidney failure are leading causes of death worldwide, and hypertension is a significant risk factor for each. Hypertension is less common in women, compared to men, in those younger than 45 years of age. This trend is reversed in those 65 years and older. In the US between 2011-2014, the prevalence of hypertension in women and men by age group was 6% vs 8% (18-39 years), 30% vs 35% (40-59 years), and 67% vs 63% (60 years and over). Awareness, treatment, and control rates differ between genders with women being more aware of their diagnosis (85% vs 80%), more likely to take their medications (81% vs 71%) and more frequently having controlled hypertension (55% vs 49%)...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27643145/sp-05-1-should-the-target-for-blood-pressure-reduction-be-lower-in-adults-with-hypertension-and-a-history-of-cardiovascular-disease
#3
Paul Whelton
BACKGROUND: Choice of the optimal target for blood pressure (BP) reduction during treatment of patients with hypertension, including those with underlying co-morbid conditions, is an important challenge in clinical practice. The Systolic Blood Pressure Intervention Trial (SPRINT) was designed to provide guidance in selection of a Systolic BP target during treatment of hypertension. METHODS: Adults ≥50 years old with hypertension and at least one additional risk factor for cardiovascular disease (CVD), but excluding persons with diabetes mellitus, prior stroke, or advanced chronic kidney disease (CKD) were randomly assigned to intensive therapy (intensive), targeting a systolic BP (SBP) <120 mmHg, or standard therapy (standard), targeting a SBP <140 mmHg...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27643118/sy-11-3-hypertension-in-women-more-dangerous-than-in-men
#4
Suzanne Oparil
Heart disease, stroke, and kidney failure are leading causes of death worldwide, and hypertension is a significant risk factor for each. Hypertension is less common in women, compared to men, in those younger than 45 years of age. This trend is reversed in those 65 years and older. In the US between 2011-2014, the prevalence of hypertension in women and men by age group was 6% vs 8% (18-39 years), 30% vs 35% (40-59 years), and 67% vs 63% (60 years and over). Awareness, treatment, and control rates differ between genders with women being more aware of their diagnosis (85% vs 80%), more likely to take their medications (81% vs 71%) and more frequently having controlled hypertension (55% vs 49%)...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27315758/sfe-sfhta-afce-consensus-on-primary-aldosteronism-part-5-genetic-diagnosis-of-primary-aldosteronism
#5
Maria-Christina Zennaro, Xavier Jeunemaitre
While the majority of cases of primary aldosteronism (PA) are sporadic, four forms of autosomal-dominant inheritance have been described: familial hyperaldosteronism (FH) types I to IV. FH-I, also called glucocorticoid-remediable aldosteronism, is characterized by early and severe hypertension, usually before the age of 20 years. It is due to the formation of a chimeric gene between the adjacent CYP11B2 and CYP11B1 genes (coding for aldosterone synthase and 11β-hydroxylase, respectively). FH-I is often associated with family history of stroke before 40years of age...
July 2016: Annales D'endocrinologie
https://www.readbyqxmd.com/read/27267762/electrolyte-disturbances-and-risk-factors-of-acute-kidney-injury-patients-receiving-dialysis-in-exertional-heat-stroke
#6
Bancha Satirapoj, Suramanat Kongthaworn, Panbubpa Choovichian, Ouppatham Supasyndh
BACKGROUND: Exertional heat stroke (EHS) is a life-threatening illness and leads to multi-organ dysfunction including acute kidney injury (AKI). The clinical significance of abnormal electrolytes and renal outcomes in ESH patients has been poorly documented. We aim to exhibit the electrolyte abnormalities, renal outcomes and risk factors of patients with AKI receiving dialysis in EHS. METHODS: A retrospective cohort study in EHS patients between 2003 and 2014 were conducted...
2016: BMC Nephrology
https://www.readbyqxmd.com/read/26591287/medical-and-neurological-complications-among-stroke-patients-admitted-for-inpatient-care-in-addis-ababa-ethiopia
#7
Yared Mamushet, Guta Zenebe, Adamu Addissie
BACKGROUND AND PURPOSE: Medical and neurologic complications of acute stroke adversely impact patient outcome and in some cases can be preventable. There is scarcity of data in the African medical setup and none to date in our country to our knowledge. The current study aims to describe types and frequencies of neuro-medical complications occurring in hospitalized patients after an acute stroke and to identify risk factors for development of these complications and the role of these factors on mortality...
January 2015: Ethiopian Medical Journal
https://www.readbyqxmd.com/read/26093133/-hypokalemia-in-lennox-gastaut-syndrome
#8
Fabio Tattoli, Daniela Falconi, Ornella De Prisco, Maurizio Gherzi, Federico Marazzi, Marita Marengo, Ilaria Serra, Michela Tamagnone, Marco Formica
The Lennox-Gastaut Syndrome (LGS) is a childhood epileptic encephalopathy. Incidence: 1/1.000.000/year, prevalence: 15/100.000. LGS covers 5-10% of epileptic patients and 1-2% of childhood epilepsies. Also referred to as cryptogenic or symptomatic generalized epilepsy. LGS is characterized by: multiple seizures (atypical absences, axial tonic seizures and sudden atonic or myoclonic falls), diffuse slow cryptic EEG waves when awake (<3 Hz), fast rhythmic peaks (10 Hz) during sleep, mental retardation and personality disorders...
May 2015: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
https://www.readbyqxmd.com/read/25728846/changes-in-serum-potassium-levels-during-hospitalization-in-patients-with-worsening-heart-failure-and-reduced-ejection-fraction-from-the-everest-trial
#9
COMPARATIVE STUDY
Sadiya S Khan, Umberto Campia, Ovidiu Chioncel, Faiez Zannad, Patrick Rossignol, Aldo P Maggioni, Karl Swedberg, Marvin A Konstam, Michele Senni, Savina Nodari, Muthiah Vaduganathan, Haris Subacius, Javed Butler, Mihai Gheorghiade
Both hyperkalemia and hypokalemia may be related to heart failure (HF) therapy and are associated with adverse outcomes. Abnormalities in serum potassium levels in hospitalized patients with HF and reduced ejection fraction (EF) have not been previously investigated. A post hoc analysis was performed in 1,907 hospitalized patients with worsening HF and reduced EF in the placebo arm of the Efficacy of Vasopressin Antagonism in HF Outcome Study with Tolvaptan (EVEREST) trial. Serum potassium was measured at randomization and at discharge or day 7...
March 15, 2015: American Journal of Cardiology
https://www.readbyqxmd.com/read/25406305/regional-variation-in-patients-and-outcomes-in-the-treatment-of-preserved-cardiac-function-heart-failure-with-an-aldosterone-antagonist-topcat-trial
#10
RANDOMIZED CONTROLLED TRIAL
Marc A Pfeffer, Brian Claggett, Susan F Assmann, Robin Boineau, Inder S Anand, Nadine Clausell, Akshay S Desai, Rafael Diaz, Jerome L Fleg, Ivan Gordeev, John F Heitner, Eldrin F Lewis, Eileen O'Meara, Jean-Lucien Rouleau, Jeffrey L Probstfield, Tamaz Shaburishvili, Sanjiv J Shah, Scott D Solomon, Nancy K Sweitzer, Sonja M McKinlay, Bertram Pitt
BACKGROUND: Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) patients with heart failure and preserved left ventricular ejection fraction assigned to spironolactone did not achieve a significant reduction in the primary composite outcome (time to cardiovascular death, aborted cardiac arrest, or hospitalization for management of heart failure) compared with patients receiving placebo. In a post hoc analysis, an ≈4-fold difference was identified in this composite event rate between the 1678 patients randomized from Russia and Georgia compared with the 1767 enrolled from the United States, Canada, Brazil, and Argentina (the Americas)...
January 6, 2015: Circulation
https://www.readbyqxmd.com/read/25043707/sodium-lactate-for-fluid-resuscitation-the-preferred-solution-for-the-coming-decades
#11
Carole Ichai, Jean-Christophe Orban, Eric Fontaine
In a recent issue of Critical Care, 0.5 M sodium lactate infusion for 24 hours was reported to increase cardiac output in patients with acute heart failure. This effect was associated with a concomitant metabolic alkalosis and a negative water balance. Growing data strongly support the role of lactate as a preferential oxidizable substrate to supply energy metabolism leading to improved organ function (heart and brain especially) in ischemic conditions. Due to its sodium/chloride imbalance, this solution prevents hyperchloremic acidosis and limits fluid overload despite the obligatory high sodium load...
2014: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/24812304/incidence-predictors-and-outcomes-related-to-hypo-and-hyperkalemia-in-patients-with-severe-heart-failure-treated-with-a-mineralocorticoid-receptor-antagonist
#12
RANDOMIZED CONTROLLED TRIAL
Orly Vardeny, Brian Claggett, Inder Anand, Patrick Rossignol, Akshay S Desai, Faiez Zannad, Bertram Pitt, Scott D Solomon
BACKGROUND: Mineralocorticoid receptor antagonists reduce morbidity and mortality in patients with heart failure but can cause hyperkalemia, which contributes to reduced use of these drugs. Hypokalemia also leads to worse outcomes in patients with heart failure and may be attenuated by mineralocorticoid receptor antagonists. METHODS AND RESULTS: We assessed incidence and predictors of hyperkalemia (potassium ≥5.5 mmol/L) and hypokalemia (potassium <3.5 mmol/L) and the relationship to outcomes in 1663 patients with class III or IV heart failure and left ventricular ejection fraction <35% randomized to treatment with spironolactone 25 mg or placebo in the Randomized Aldactone Evaluation Study (RALES) trial...
July 2014: Circulation. Heart Failure
https://www.readbyqxmd.com/read/24716680/spironolactone-for-heart-failure-with-preserved-ejection-fraction
#13
RANDOMIZED CONTROLLED TRIAL
Bertram Pitt, Marc A Pfeffer, Susan F Assmann, Robin Boineau, Inder S Anand, Brian Claggett, Nadine Clausell, Akshay S Desai, Rafael Diaz, Jerome L Fleg, Ivan Gordeev, Brian Harty, John F Heitner, Christopher T Kenwood, Eldrin F Lewis, Eileen O'Meara, Jeffrey L Probstfield, Tamaz Shaburishvili, Sanjiv J Shah, Scott D Solomon, Nancy K Sweitzer, Song Yang, Sonja M McKinlay
BACKGROUND: Mineralocorticoid-receptor antagonists improve the prognosis for patients with heart failure and a reduced left ventricular ejection fraction. We evaluated the effects of spironolactone in patients with heart failure and a preserved left ventricular ejection fraction. METHODS: In this randomized, double-blind trial, we assigned 3445 patients with symptomatic heart failure and a left ventricular ejection fraction of 45% or more to receive either spironolactone (15 to 45 mg daily) or placebo...
April 10, 2014: New England Journal of Medicine
https://www.readbyqxmd.com/read/24526255/chlorthalidone-for-poorly-controlled-hypertension-in-chronic-kidney-disease-an-interventional-pilot-study
#14
Rajiv Agarwal, Arjun D Sinha, Maria K Pappas, Farah Ammous
To test the hypothesis that thiazide-type diuretics effectively lower blood pressure (BP) in moderate to advanced chronic kidney disease (CKD; estimated GFR 20-45 ml/min/ 1.73 m(2)), after confirming poorly controlled hypertension with 24-hour ambulatory BP monitoring, chlorthalidone was added to existing medications in a dose of 25 mg/day, and the dose doubled every 4 weeks if the BP remained elevated. The average age of the 14 subjects was 67.5 years, a median of 4 antihypertensive drugs were used and estimated GFR was 26...
2014: American Journal of Nephrology
https://www.readbyqxmd.com/read/24458168/accidental-mushroom-poisoning-mimicking-stroke-a-case-report-and-literature-review
#15
Ivan Comelli, Giuseppe Lippi, Attilio De Blasio, Gianfranco Cervellin
We describe here a paradigmatic case of mushroom poisoning mimicking a stroke. A 64-year old male was referred to the emergency department (ED) for a car accident. He was found diaphoretic, hypotensive, bradycardic, and slightly confused at presentation. No signs of trauma were observed on physical examination. The patient had weakness of the right limbs and bilateral severe myosis. The lab tests were normal, except for leukocytosis, mild hyperglycemia, mild hyperazotemia and moderate hypokalemia. The clinical picture, with the exception of miosis, was thereby suggestive for a stroke, which was also considered the cause of the car accident...
2013: Acta Bio-medica: Atenei Parmensis
https://www.readbyqxmd.com/read/24251163/ischemic-stroke-as-a-presenting-feature-of-vipoma-due-to-men-1-syndrome
#16
Rushikesh Raviraj Maheshwari, Madhav Desai, Vara Prasada G Rao, Radha Rani Palanki, Rajendra Prasad Namburi, Karthik T S Reddy, Amaresh P Reddy
INTRODUCTION: Presentation of the ischemic stroke due to vasoactive intestinal peptide producing tumor (VIPoma) or Verner Morrison syndrome is rare. This is first of its kind case which we are reporting here which was later turned out to be multiple endocrine neoplasia type 1 (MEN 1) syndrome with diagnosis of primary hyperparathyroidism in the same patient in follow-up. DESCRIPTION OF THE CASE: A 13-year-old girl presented to our emergency department with features of disorientation, weakness of left sided extremities...
October 2013: Indian Journal of Endocrinology and Metabolism
https://www.readbyqxmd.com/read/24191305/the-effect-of-ramipril-and-telmisartan-on-serum-potassium-and-its-association-with-cardiovascular-and-renal-events-results-from-the-ontarget-trial
#17
RANDOMIZED CONTROLLED TRIAL
Hiddo J Lambers Heerspink, Peggy Gao, Dick de Zeeuw, Catherine Clase, Gilles R Dagenais, Peter Sleight, Eva Lonn, Koon T Teo, Salim Yusuf, Johannes F Mann
AIMS: In the Ongoing Telmisartan Alone and in Combination with Ramipril Trial (ONTARGET), dual agent renin-angiotensin-aldosterone system (RAAS) blockade with angiotensin-converting-enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) did not reduce the risk of renal and cardiovascular outcomes compared with the single use of either agent. Dual therapy however increased the incidence of hyperkalemia. We examined risk factors for hyper- and hyokalemia and hypothesized that both would be associated with worse cardiovascular and renal outcomes...
March 2014: European Journal of Preventive Cardiology
https://www.readbyqxmd.com/read/23806550/low-diastolic-blood-pressure-was-one-of-the-independent-predictors-of-ischemia-like-findings-of-electrocardiogram-in-patients-who-underwent-coronary-angiography
#18
Shinichiro Fujishima, Noboru Murakami, Yoshie Haga, Eiji Nyuta, Yuuki Nakate, Shiro Ishihara, Shigeru Kaseda, Tokushi Koga, Takao Ishitsuka
BACKGROUND: The underlying cause of a high cardiovascular event rate in the population with low diastolic blood pressure (DBP) has not been fully elucidated. METHODS AND RESULTS: The relationship between DBP and ischemia-like findings on electrocardiography (ECG) was investigated in 187 patients who underwent coronary angiography. Patients with conditions affecting ECG (e.g. patients taking digitalis or those with old myocardial infarction, complete right bundle branch block, or hypokalemia) were excluded from the analyses...
October 2013: Journal of Cardiology
https://www.readbyqxmd.com/read/23552325/chlorthalidone-versus-hydrochlorothiazide-for-the-treatment-of-hypertension-in-older-adults-a-population-based-cohort-study
#19
COMPARATIVE STUDY
Irfan A Dhalla, Tara Gomes, Zhan Yao, Jeff Nagge, Navindra Persaud, Chelsea Hellings, Muhammad M Mamdani, David N Juurlink
BACKGROUND: Some evidence suggests that chlorthalidone may be superior to hydrochlorothiazide for the treatment of hypertension. OBJECTIVE: To compare the effectiveness and safety of chlorthalidone and hydrochlorothiazide in older adults. DESIGN: Propensity score-matched observational cohort study with up to 5 years of follow-up. SETTING: Ontario, Canada. PATIENTS: All individuals aged 66 years or older who were newly treated with chlorthalidone or hydrochlorothiazide and were not hospitalized for heart failure, stroke, or myocardial infarction in the prior year were eligible for inclusion...
March 19, 2013: Annals of Internal Medicine
https://www.readbyqxmd.com/read/23134903/electrolyte-changes-in-stroke
#20
M N Alam, M J Uddin, K M Rahman, S Ahmed, M Akhter, N Nahar, M K Swapan, M M Alam, N Sultana, M M Hallaz, M M Alam, M M Uddin, M S Bari, M A Israil
The present study was carried out in the department of Neurology and Medicine, Mymensingh Medical College Hospital, Bangladesh during the period of January 2009 to December 2010 to see the electrolyte changes in stroke. The serum concentration of Na⁺, K⁺, and Cl⁻ were measured in 110 cases during acute period of stroke (55 ischemic and 55 haemorrhagic strokes). Data were analyzed by computer with SPSS programme using 't' test and chi square test. In haemorrhagic stroke, out of 55 patients 29(52.72%) had abnormal sodium level, of them 23(41...
October 2012: Mymensingh Medical Journal: MMJ
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