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https://www.readbyqxmd.com/read/28441700/ultrasound-based-renal-sympathetic-denervation-for-the-treatment-of-therapy-resistant-hypertension-a-single-center-experience
#1
Karl Fengler, Robert Höllriegel, Thomas Okon, Thomas Stiermaier, Karl-Philipp Rommel, Stephan Blazek, Christian Besler, Max von Roeder, Martin Petzold, Gerhard Schuler, Philipp Lurz
INTRODUCTION: The effectiveness of renal sympathetic denervation (RDN) as a treatment for therapy-resistant hypertension has been doubted as the Simplicity-HTN-3 trial was unable to show any treatment benefit over sham procedure. This might partly be explained by a high procedural variability in treatment with radiofrequency-based catheters. Recently, newer systems for RDN, like ultrasound-based devices, have been introduced into practice. To date however, data on their effectiveness for the treatment of resistant hypertension are scarce...
June 2017: Journal of Hypertension
https://www.readbyqxmd.com/read/28396095/elderly-patients-with-chronic-myeloid-leukemia-benefit-from-a-dasatinib-dose-as-low-as-20-mg
#2
Hidekazu Itamura, Yasushi Kubota, Takero Shindo, Toshihiko Ando, Kensuke Kojima, Shinya Kimura
BACKGROUND: The clinical outcomes of patients with chronic myeloid leukemia (CML) treated with BCR-ABL tyrosine kinase inhibitors has improved markedly; however, the occurrence of adverse events (AEs) means that elderly patients often cannot be administered the standard dose. Nevertheless, some patients treated with low doses of tyrosine kinase inhibitor have achieved good molecular responses. PATIENTS AND METHODS: We retrospectively analyzed the efficacy and safety of low-dose dasatinib treatment of elderly CML patients...
March 18, 2017: Clinical Lymphoma, Myeloma & Leukemia
https://www.readbyqxmd.com/read/28370822/the-complexity-of-diuretic-resistance
#3
EDITORIAL
Doron Aronson
No abstract text is available yet for this article.
March 31, 2017: European Journal of Heart Failure
https://www.readbyqxmd.com/read/28349377/preferred-fourth-line-pharmacotherapy-for-resistant-hypertension-are-we-there-yet
#4
REVIEW
Hamish Cg Prosser, Cynthia Gregory, Dagmara Hering, Graham S Hillis, Greg Perry, Johan Rosman, Carl Schultz, Mark Thomas, Gerald F Watts, Markus P Schlaich
Resistant hypertension (RH) is defined as blood pressure (BP) that remains above target levels despite adherence to at least three different antihypertensive medications, typically including a diuretic. Epidemiological studies estimate that RH is increasing in prevalence, and is associated with detrimental health outcomes. The pathophysiology underlying RH is complex, involving multiple, overlapping contributors including activation of the renin-angiotensin aldosterone system and the sympathetic nervous system, volume overload, endothelial dysfunction, behavioural and lifestyle factors...
April 2017: Current Hypertension Reports
https://www.readbyqxmd.com/read/28327653/association-of-aldosterone-excess-and-apnea-hypopnea-index-in-patients-with-resistant-hypertension
#5
Xiao Ke, Wenyu Guo, Hu Peng, Chengheng Hu, Henghong Zhang, Changnong Peng, Xiaoqing Wang
The present study was to investigate the association of aldosterone excess and apnea-hypopnea index (AHI) in patients with resistant hypertension. Patients with resistant hypertension were enrolled and baseline characteristics including plasma aldosterone concentration (PAC) and 24 h-urine aldosterone levels were collected and compared between groups with different degrees of AHI as assessed by polysomnography. Association of key variables and AHI was then evaluated by univariate and multiple linear regression analysis...
March 22, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28302292/short-term-effects-of-tolvaptan-in-patients%C3%A2-with-acute-heart-failure-and%C3%A2-volume-overload
#6
Marvin A Konstam, Michael Kiernan, Arthur Chandler, Ravi Dhingra, Freny Vaghaiwalla Mody, Howard Eisen, W Herbert Haught, Lynne Wagoner, Divya Gupta, Richard Patten, Paul Gordon, Kenneth Korr, Russell Fileccia, Susan J Pressler, Douglas Gregory, Patricia Wedge, Douglas Dowling, Matthew Romeling, Jeremy M Konstam, Joseph M Massaro, James E Udelson
BACKGROUND: In patients with acute heart failure (AHF), dyspnea relief is the most immediate goal. Renal dysfunction, diuretic resistance, and hyponatremia represent treatment impediments. OBJECTIVES: It was hypothesized that the addition of tolvaptan to a background diuretic improved dyspnea early in patients selected for an enhanced vasopressin antagonism response. METHODS: In a double-blind trial, patients were randomized to tolvaptan 30 mg/day or placebo...
March 21, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28292320/addition-of-propranolol-in-resistant-arterial-hypertension-treatment-apropriate-study-study-protocol-for-a-randomized-double-blind-placebo-controlled-trial
#7
G R Constantine, P Ranasinghe, P Weeratunga, C Weeraratne, P Galappatthy, S Rajapakse, U Senarath, P Katulanda
BACKGROUND: Resistant hypertension is defined as an uncontrolled blood pressure despite treatment at best-tolerated doses with at least three antihypertensive agents including a diuretic. It is an emerging public health problem. At present clinical trial data on management of resistant hypertension is limited. Management is largely based on observational studies and expert opinions. Propranolol is a nonselective beta blocker. Several studies have confirmed that propranolol has a significant hypotensive action, both when used alone and as an adjuvant therapy...
March 14, 2017: Trials
https://www.readbyqxmd.com/read/28290895/-hemodynamic-predictors-of-clinical-deterioration-in-patients-with-pulmonary-arterial-hypertension-associated-with-systemic-scleroderma
#8
E V Nikolaeva, I A Kurmukov, N N Yudkina, S I Glukhova, A V Volkov
OBJECTIVE: to elucidate hemodynamic predictors of clinical deterioration (CD) in patients with pulmonary arterial hypertension (PAH) associated with systemic scleroderma (SSD). MATERIAL AND METHODS: We included into this study 48 patients with PAH-SSD consecutively admitted in 2004-2014. At inclusion all patients underwent right heart catheterization (RHC) and thereafter were under dynamic observation. CD deterioration was diagnosed in the presence of the following: >15% decline in 6-minute walk test distance; worsening of PAH functional class; intensification of symptoms of right ventricular failure; necessity in administration of parenteral diuretics...
October 2016: Kardiologiia
https://www.readbyqxmd.com/read/28266770/feasibility-of-catheter-ablation-renal-denervation-in-mild-resistant-hypertension
#9
Shaojie Chen, Marcio Galindo Kiuchi, Willem-Jan Acou, Michael Derndorfer, Jiazhi Wang, Ruotian Li, Georgios Kollias, Martin Martinek, Tetsuaki Kiuchi, Helmut Pürerfellner, Shaowen Liu
Renal denervation (RDN) has been proposed as a novel interventional antihypertensive technique. However, existing evidence was mainly from patients with severe resistant hypertension. The authors aimed to evaluate the efficacy of RDN in patients with resistant hypertension with mildly elevated blood pressure (BP). Studies of RDN in patients with mild resistant hypertension (systolic office BP 140-160 mm Hg despite treatment with three antihypertensive drugs including one diuretic, or mean systolic BP by 24-hour ambulatory BP measurement [ABPM] 135-150 mm Hg) were included...
March 7, 2017: Journal of Clinical Hypertension
https://www.readbyqxmd.com/read/28240682/visfatin-levels-are-increased-in-patients-with-resistant-hypertension-and-are-correlated-with-left-ventricular-hypertrophy
#10
Ender Ozal, Irfan Sahin, Ismail Bolat, Hamdi Pusuroglu, Ilhan Iker Avci, Ozgur Akgul, Vesile Ornek, Ozgür Sürgit, Aydin Yildirim
OBJECTIVE: The aim of this study was to investigate the possible correlation of serum visfatin levels with resistant hypertension (RHT). PATIENTS AND METHODS: Patients who had undergone ambulatory blood pressure measurements (ABPM) during the outpatient controls were prospectively recruited. Seventy-one patients with RHT and 94 patients with controlled hypertension (CHT) were included in the study. RHT was defined as 'uncontrolled blood pressure (BP) despite using three antihypertensive agents including a diuretic or need of four or more drugs to control BP'...
February 24, 2017: Blood Pressure Monitoring
https://www.readbyqxmd.com/read/28228405/inhibition-of-romk-blocks-macula-densa-tubuloglomerular-feedback-yet-causes-renal-vasoconstriction-in-anesthetized-rats
#11
Magali Araujo, William J Welch, Xiaoyan Zhou, Kathleen Sullivan, Shawn Walsh, Alexander Pasternak, Christopher S Wilcox
The Na+/K+/2Cl- cotransporter (NKCC2) on the loop of Henle is the site of action of furosemide. Since outer medullary potassium channel (ROMK) inhibitors prevent reabsorption by NKCC2, we tested the hypothesis that ROMK inhibition with a novel, selective ROMK inhibitor (Compound C) blocks tubuloglomerular feedback (TGF) and reduces vascular resistance. Loop perfusion of either ROMK inhibitor or furosemide caused dose-dependent blunting of TGF, but the response to furosemide was 10-fold more sensitive (IC50= 10-6M for furosemide and IC50=10-5M for Compound C)...
February 22, 2017: American Journal of Physiology. Renal Physiology
https://www.readbyqxmd.com/read/28228057/intravenous-chlorothiazide-versus-enteral-metolazone-to-augment-loop-diuretic-therapy-in-the-intensive-care-unit
#12
Christopher J Michaud, Kendall C Mintus
BACKGROUND: In cases of loop diuretic resistance in the intensive care unit (ICU), recommendations for a specific second-line thiazide agent are lacking. OBJECTIVE: To compare the effects of intravenous chlorothiazide (CTZ) and enteral metolazone (MET) on urine output (UOP) when added to furosemide monotherapy therapy in critically ill adults. METHODS: This was a retrospective cohort study conducted in the medical, surgical, and cardiothoracic ICUs of a quaternary medical center...
April 2017: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/28224192/serum-magnesium-and-the-risk-of-prediabetes-a-population-based-cohort-study
#13
Brenda C T Kieboom, Symen Ligthart, Abbas Dehghan, Steef Kurstjens, Jeroen H F de Baaij, Oscar H Franco, Albert Hofman, Robert Zietse, Bruno H Stricker, Ewout J Hoorn
AIMS/HYPOTHESIS: Previous studies have found an association between serum magnesium and incident diabetes; however, this association may be due to reverse causation, whereby diabetes may induce urinary magnesium loss. In contrast, in prediabetes (defined as impaired fasting glucose), serum glucose levels are below the threshold for urinary magnesium wasting and, hence, unlikely to influence serum magnesium levels. Thus, to study the directionality of the association between serum magnesium levels and diabetes, we investigated its association with prediabetes...
February 21, 2017: Diabetologia
https://www.readbyqxmd.com/read/28192112/multiple-blood-brain-barrier-transport-mechanisms-limit-bumetanide-accumulation-and-therapeutic-potential-in-the-mammalian-brain
#14
Kerstin Römermann, Maren Fedrowitz, Philip Hampel, Edith Kaczmarek, Kathrin Töllner, Thomas Erker, Douglas H Sweet, Wolfgang Löscher
There is accumulating evidence that bumetanide, which has been used over decades as a potent loop diuretic, also exerts effects on brain disorders, including autism, neonatal seizures, and epilepsy, which are not related to its effects on the kidney but rather mediated by inhibition of the neuronal Na-K-Cl cotransporter isoform NKCC1. However, following systemic administration, brain levels of bumetanide are typically below those needed to inhibit NKCC1, which critically limits its clinical use for treating brain disorders...
February 10, 2017: Neuropharmacology
https://www.readbyqxmd.com/read/28150289/relationship-between-gender-and-clinical-characteristics-associated-factors-and-hypertension-treatment-in-patients-with-resistant-hypertension
#15
Katarzyna Maria Hanus, Aleksander Prejbisz, Jerzy Gąsowski, Marek Klocek, Roman Topór-Mądry, Wiktoria Leśniak, Marek Kabat, Danuta Czarnecka, Kalina Kawecka-Jaszcz, Krzysztof Narkiewicz, Andrzej Januszewicz
BACKGROUND AND AIM: Recent meta-analysis indicate that the pooled prevalence of resistant hypertension (RHT) barely differed between sex. However differences between women and men with RHT in patients characteristics, associated factors and hypertension management are still not well-described. METHODS: In the cross-sectional questionnaire-based observational study we included 7306 hypertensive females and 5069 hypertensive males, ≥18 years old and treated for at least 12 months with antihypertensive drugs...
February 2, 2017: Kardiologia Polska
https://www.readbyqxmd.com/read/28134397/-review-update-on-magnesium-metabolism
#16
Pasquale Fatuzzo, Luca Zanoli, Viviana Scollo, Grazia Portale, Agostino Gaudio, Alessandra Pani, Antonio Granata
Magnesium is the second intracellular cation and the fourth most abundant mineral in the body. Low levels of magnesium have been associated with insulin resistance and type-2 diabetes mellitus, asthma, osteoporosis and chronic kidney disease (CKD). The use of proton pump inhibitors (PPIs) represents the most common cause of hypomagnesemia. The risk of hypomagnesemia, and consequently worsening of the renal function, is increased when diuretics are added to therapy in subjects treated with PPIs. Interestingly, diuretics and PPIs are two of the most used drugs in subjects with CKD...
November 2016: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
https://www.readbyqxmd.com/read/28124682/psychosocial-correlates-of-apparent-treatment-resistant-hypertension-in-the-jackson-heart-study
#17
A J Shallcross, M Butler, R M Tanner, A Bress, P Muntner, D Shimbo, G Ogedegbe, M Sims, T M Spruill
Apparent treatment-resistant hypertension (aTRH) is associated with adverse cardiovascular outcomes. aTRH is common and disproportionately affects African Americans. The objective of this study is to explore psychosocial correlates of aTRH in a population-based cohort of African Americans with hypertension. The sample included 1392 participants in the Jackson Heart Study with treated hypertension who reported being adherent to their antihypertensive medications. aTRH was defined as uncontrolled clinic BP (⩾140/90 mm Hg) with ⩾3 classes of antihypertensive medication or treatment with ⩾4 classes of antihypertensive medication, including a diuretic...
January 26, 2017: Journal of Human Hypertension
https://www.readbyqxmd.com/read/28123500/effects-of-low-dose-tolvaptan-on-electrolyte-abnormality-and-hemodynamic-parameters-in-a-liver-cirrhosis-associated-portopulmonary-hypertension-patient-a-case-report
#18
Yoshito Ogihara, Norikazu Yamada, Kaoru Dohi, Akimasa Matsuda, Satoshi Ota, Ken Ishikura, Mashio Nakamura, Masaaki Ito
The present study reported a case of portopulmonary hypertension (POPH) that was secondary to underlying liver cirrhosis in a 58-year-old woman, who was successfully treated with low-dose tolvaptan. The patient had suffered from refractory peripheral edema and electrolyte abnormalities, including severe hypokalemia, under the combination therapy of sildenafil, ambrisentan, furosemide and spironolactone. Subsequent to the initiation of low-dose tolvaptan at 3.75 mg/day with concurrent de-escalation of the dose of furosemide, the daily urine volume increased, peripheral edema improved and the serum potassium level increased immediately...
January 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28111410/who-needs-longer-tolvaptan-treatment
#19
MULTICENTER STUDY
Koichiro Kinugawa, Takayuki Inomata, Naoki Sato, Moriyoshi Yasuda, Toshiyuki Shimakawa, Kosuke Bando, Yasuhiko Fukuta
The vasopressin receptor 2 (V2) receptor antagonist tolvaptan is an aquaretic agent that has been approved for heart failure patients with volume overload in Japan. In this study (SMILE study), we investigated patient characteristics and effectiveness in both a 14 days and shorter treated group (14DS) and 15 days and longer treated group (15DL). The results showed that the patients in the 15DL group had low cardiac output with intensive diuretic administration (ie, diuretic resistance). The congestive symptoms were greatly improved within 14 days of treatment in both the 14DS and 15DL groups...
February 7, 2017: International Heart Journal
https://www.readbyqxmd.com/read/28105769/renal-tubular-resistance-is-the-primary-driver-for-loop-diuretic-resistance-in-acute-heart-failure
#20
Jozine M Ter Maaten, Veena S Rao, Jennifer S Hanberg, F Perry Wilson, Lavanya Bellumkonda, Mahlet Assefa, J Sam Broughton, Julie D'Ambrosi, W H Wilson Tang, Kevin Damman, Adriaan A Voors, David H Ellison, Jeffrey M Testani
BACKGROUND: Loop diuretic resistance is a common barrier to effective decongestion in acute heart failure (AHF), and is associated with poor outcome. Specific mechanisms underlying diuretic resistance are currently unknown in contemporary AHF patients. We therefore aimed to determine the relative importance of defects in diuretic delivery vs. renal tubular response in determining diuretic response (DR) in AHF. METHODS AND RESULTS: Fifty AHF patients treated with intravenous bumetanide underwent a 6-h timed urine collection for sodium and bumetanide clearance...
January 19, 2017: European Journal of Heart Failure
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