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diuretic titration

Rajkumar Bharatia, Manoj Chitale, Ganesh Narain Saxena, Raman Ganesh Kumar, Chikkalingaiah, Abhijit Trailokya, Kalpesh Dalvi, Suhas Talele
INTRODUCTION: Hypertension (HTN), being a major risk factor for cardiovascular diseases (CVDs), is an important issue of medical and public health. High blood pressure (BP) is ranked as the third most important risk factor for attributable burden of disease in south Asia (2010). Hypertension (HTN) exerts a substantial public health burden on cardiovascular health status and healthcare systems in India. Uncontrolled hypertension among adults with hypertension is associated with increased mortality...
July 2016: Journal of the Association of Physicians of India
Naomi Nakazawa, Keisuke Nakabayashi, Toshiaki Oka
Renal congestion contributes to the cardiorenal syndrome. There are some heart failure cases that are refractory to diuretic therapy. If the dose of diuretics is titrated, it leads to irreversible renal dysfunction. Early administration of tolvaptan is effective in treating fluid retention and congestion. However, in case of tolvaptan resistance, starting extracorporeal ultrafiltration (ECUM) at an early stage should be considered. Tolvaptan has been proven efficient, and we believe it should be incorporated with the classical method, ECUM...
October 4, 2016: BMJ Case Reports
Keziban Aslı Bala, Murat Doğan, Sultan Kaba, Sinan Akbayram, Oktay Aslan, Selami Kocaman, Gülsüm İclal Bayhan, Lokman Üstyol, Nihat Demir
BACKGROUND Our study aimed to demonstrate the frequency of the syndrome of inappropriate ADH secretion (SIADH) and associated factors during the course of brucellosis in children and adolescents. MATERIAL AND METHODS The study included children and adolescents aged 0-18 years old diagnosed with brucellosis between 2012 and 2014. The data were collected from patient charts. The diagnosis of brucellosis was made based on titrations >1:160 in standard Wright tube agglutination tests and/or positive culture tests...
2016: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Joseph L Izzo, Yan Jia, Dion H Zappe
The effects of race and age on 24-hour mean ambulatory systolic blood pressure (maSBP) responses to sequential 4-week periods of angiotensin receptor blocker therapy (valsartan [VAL] 160 mg/d then 320 mg/d and combination VAL/hydrochlorothiazide [HCTZ] 320/12.5 mg/d) were compared in 304 patients with stage 1 or 2 hypertension. There were lesser blood pressure (BP) responses from baseline with VAL monotherapy in black than Caucasian patients (-2.9 and -4.0 mm Hg vs -8.2 and -9.3 mm Hg, respectively; P<.001 each) but VAL/HCTZ BP responses were similar in both groups (-12 vs -15 mm Hg)...
September 1, 2016: Journal of Clinical Hypertension
Nasrien E Ibrahim, Hanna K Gaggin, Dustin J Rabideau, Parul U Gandhi, Aditi Mallick, James L Januzzi
OBJECTIVES: To assess prognostic meaning of worsening renal failure (WRF) occurring during management of chronic heart failure (HF) with reduced ejection fraction. BACKGROUND: When WRF develops during titration of HF medical therapy, it commonly leads to less aggressive care. METHODS: A total of 151 patients enrolled in a prospective, randomized study of standard of care (SOC) HF therapy versus SOC plus a goal N-terminal pro-B type natriuretic peptide (NT-proBNP) < 1000 pg/mL were examined...
July 25, 2016: Journal of Cardiac Failure
Jasmijn S J A van Campen, Karin de Boer, Mariëlle C van de Veerdonk, Cathelijne E E van der Bruggen, Cor P Allaart, Pieter G Raijmakers, Martijn W Heymans, J Tim Marcus, Hendrik J Harms, M Louis Handoko, Frances S de Man, Anton Vonk Noordegraaf, Harm-Jan Bogaard
While beta-blockers are considered contraindicated in pulmonary arterial hypertension (PAH), the prognostic significance of sympathetic nervous system over-activity suggests a potential benefit of beta-blocker therapy. The aim of this randomised, placebo-controlled, crossover, single centre study was to determine the effects of bisoprolol on right ventricular ejection fraction (RVEF) in idiopathic PAH (iPAH) patients. Additional efficacy and safety parameters were explored.Patients with optimally treated, stable iPAH (New York Heart Association functional class II/III) were randomised to placebo or bisoprolol...
September 2016: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
Eugenio Picano, Patricia A Pellikka
Extravascular lung water (EVLW) is a key variable in heart failure management and prognosis, but its objective assessment remains elusive. Lung imaging has been traditionally considered off-limits for ultrasound techniques due to the acoustic barrier of high-impedance air wall. In pulmonary congestion however, the presence of both air and water creates a peculiar echo fingerprint. Lung ultrasound shows B-lines, comet-like signals arising from a hyper-echoic pleural line with a to-and-fro movement synchronized with respiration...
July 14, 2016: European Heart Journal
Martin J Wolley, Michael Stowasser
Treatment-resistant hypertension is an increasingly recognised problem and is markedly over-represented in patients with chronic kidney disease (CKD). Recent evidence has clarified the heightened risk for both adverse renal and cardiovascular outcomes associated with resistant hypertension, even when blood pressure control is attained. The diagnosis of resistant hypertension in CKD is reliant on accurate blood pressure measurement, and out of office measurements are important due to the high prevalence of masked hypertension in these patients...
April 2016: Current Hypertension Reports
Alison Handley, Eric Lloyd, Andrew Roberts, Bruce Barger
This 56-week phase 3, open-label, treat-to-target study, involving 2 consecutive, non-randomized cohorts, evaluated the safety and tolerability of azilsartan medoxomil (AZL-M) in essential hypertension (mean baseline blood pressure [BP] 152/100 mmHg). All subjects (n = 669) initiated AZL-M 40 mg QD, force-titrated to 80 mg QD at week 4, if tolerated. From week 8, subjects could receive additional medications, starting with chlorthalidone (CLD) 25 mg QD (Cohort 1) or hydrochlorothiazide (HCTZ) 12...
2016: Clinical and Experimental Hypertension: CHE
Alexander J Kula, Jennifer S Hanberg, F Perry Wilson, Meredith A Brisco, Lavanya Bellumkonda, Daniel Jacoby, Steven G Coca, Chirag R Parikh, W H Wilson Tang, Jeffrey M Testani
BACKGROUND: Reduction in systolic blood pressure (SBP reduction) during the treatment of acute decompensated heart failure is strongly and independently associated with worsening renal function. Our objective was to determine whether SBP reduction or titration of oral neurohormonal antagonists during acute decompensated heart failure treatment negatively influences diuresis and decongestion. METHODS AND RESULTS: SBP reduction was evaluated from admission to discharge in consecutive acute decompensated heart failure admissions (n=656)...
January 2016: Circulation. Heart Failure
Phool Chandra, Kamal Kishore, Ashoke Kumar Ghosh
Fumaria indica is used for its anthelmintic, antidyspeptic, cholagogue, diaphoretic, diuretic, laxative, stomachic, tonic properties and claimed to possess various properties for the ailments of blood, skin, gastrointestinal systems and central nervous system. The present study was undertaken to evaluate antisecretory, gastroprotective and in-vitro antacid capacity of ethanol extract from F. indica in rats. Evaluation of F. indica extract as antisecretory was carried out by pyloric ligation induced ulcer model...
September 2015: Journal of Environmental Biology
M Seifert, C Butter
Heart failure is one of the most frequent diagnoses in hospital admissions in Germany. In the majority of these admissions acute decompensation of an already existing chronic heart failure is responsible. New mostly wireless and remote strategies for monitoring, titration, adaptation and optimization are the focus for improvement of the treatment of heart failure patients and the poor prognosis. The implantation of hemodynamic monitoring devices follows the hypothesis that significant changes in hemodynamic parameters occur before the occurrence of acute decompensation requiring readmission...
November 2015: Herz
Silviu Dovancescu, Jane S Saczynski, Chad E Darling, Jarno Riistama, Fatima Sert Kuniyoshi, Theo Meyer, Robert Goldberg, David D McManus
BACKGROUND: Recurrent hospital admissions are common among patients admitted for acute decompensated heart failure (ADHF), but identification of patients at risk for rehospitalization remains challenging. Contemporary heart failure (HF) management programs have shown modest ability to reduce readmissions, partly because they monitor signs or symptoms of HF worsening that appear late during decompensation. Detecting early stages of HF decompensation might allow for immediate application of effective HF therapies, thereby potentially reducing HF readmissions...
2015: JMIR Research Protocols
Mitja Lainscak, Francesco Pelliccia, Giuseppe Rosano, Cristiana Vitale, Michele Schiariti, Cesare Greco, Giuseppe Speziale, Carlo Gaudio
Spironolactone was first developed over 50 years ago as a potent mineralocorticoid receptor antagonist with undesirable side effects; it was followed a decade ago by eplerenone, which is less potent but much more mineralocorticoid receptor-specific. From a marginal role as a potassium-sparing diuretic, spironolactone has been shown to be an extraordinarily effective adjunctive agent in the treatment of progressive heart failure. Also, spironolactone is safe and protective in arterial hypertension, particularly in patients with so-called resistant hypertension...
December 1, 2015: International Journal of Cardiology
Michael C Scott, Michael E Winters
Patients with acute decompensated heart failure are usually critically ill and require immediate treatment. However, most are not volume overloaded. Emergency department (ED) management is based on rapid initiation of noninvasive positive-pressure ventilation and aggressive titration of nitrates. Afterload reduction with an angiotensin-converting enzyme inhibitor can be considered. A diuretic should not be administered before optimal preload and afterload reduction has been achieved. Short-term inotropic therapy can be considered in select patients with cardiogenic shock and acute decompensated heart failure (ADHF) who fail to respond to standard therapy...
August 2015: Emergency Medicine Clinics of North America
N Vakilzadeh, M Muller, V Forni, B Milani, M Piskunowicz, C Zweiacker, B Vogt, M Pruijm, M Burnier
OBJECTIVE: Renal tissue oxygenation may play an important role in the progression of renal diseases. Today, blockers of the renin-angiotensin system and diuretics are two major drug classes used to treat hypertension in patients with or without chronic kidney diseases. The purpose of the present study was to compare the direct renin inhibitor aliskiren to the diuretic hydrochlorothiazide (HCTZ) in their ability to modulate renal tissue oxygenation in hypertensive patients.(Figure is included in full-text article...
June 2015: Journal of Hypertension
Frederik H Verbrugge, Matthias Dupont, Philippe B Bertrand, Petra Nijst, Lars Grieten, Joseph Dens, David Verhaert, Stefan Janssens, W H Wilson Tang, Wilfried Mullens
AIMS: To study pulmonary vascular response patterns to exercise in heart failure with reduced ejection fraction (HFrEF) and pulmonary hypertension (PH). METHODS AND RESULTS: In this prospective single-centre cohort study, consecutive symptomatic HFrEF patients (n = 40) with mean pulmonary arterial pressure (MPAP) ≥25 mmHg, pulmonary artery wedge pressure (PAWP) >15 mmHg, and cardiac index <2.5 L/min.m(2) , received protocol-driven titrated sodium nitroprusside (SNP) and diuretics to reach mean arterial blood pressure 65-75 mmHg and PAWP ≤15 mmHg...
March 2015: European Journal of Heart Failure
Julio Núñez, Pilar Merlos, Lorenzo Fácila, Pau Llàcer, Maria José Bosch, Vicente Bertomeu-Martínez, Sergio García-Blas, Vicente Montagud, Valle Pedrosa, Andrea Mendizábal, Alberto Cordero, Gema Miñana, Juan Sanchis, Vicente Bertomeu-González
INTRODUCTION AND OBJECTIVES: Morbidity and mortality after admission for acute heart failure remain prohibitively high. In that setting, plasma levels of antigen carbohydrate 125 have shown to correlate with the severity of fluid overload and the risk of mortality and readmission. Preliminary data suggests a potential role of antigen carbohydrate 125 to guide therapy. The objective of this study is to evaluate the prognostic effect of an antigen carbohydrate 125-guided management strategy vs standard therapy in patients recently discharged for acute heart failure...
February 2015: Revista Española de Cardiología
Filippo M Sarullo, Giuseppe Vitale, Antonino Di Franco, Silvia Sarullo, Ylenia Salerno, Laura Vassallo, Emanuela Petrona Baviera, Stefania Marazia, Giorgio Mandalà, Gaetano A Lanza
BACKGROUND: Nemaline myopathy (NM) is a rare congenital myopathy characterized by muscle weakness, hypotonia and the presence in muscle fibers of inclusions known as nemaline bodies and a wide spectrum of clinical phenotypes, ranging from severe forms with neonatal onset to asymptomatic forms. The adult-onset form is heterogeneous in terms of clinical presentation and disease progression. Cardiac involvement occurs in the minority of cases and little is known about medical management in this subgroup of NM patients...
2015: BMC Cardiovascular Disorders
Piotr Rozentryt, Jolanta Nowak, Jacek Niedziela, Bartosz Hudzik, Wolfram Doehner, Ewa A Jankowska, Stephan von Haehling, Robert Partyka, Edyta Kawecka, Krzysztof Myrda, Tomasz Rywik, Bożena Szyguła, Danuta Kokocińska, Stefan D Anker, Piotr Ponikowski, Lech Poloński
Serum phosphorus abnormalities may pose a risk on the cardiovascular system. In heart failure (HF) phosphorus homeostatic mechanisms are altered and may be modified by modern HF therapy. The impact of therapy optimization on phosphorus abnormalities and related outcome remains unknown. In 722 patients with HF subjected to treatment up-titration we analyzed the prevalence of serum phosphorus abnormalities and their relation to HF severity on top of optimal treatment, and we assessed adjusted risk of phosphorus abnormalities at different stages of HF...
November 15, 2014: International Journal of Cardiology
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