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resistance to diuretics

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https://www.readbyqxmd.com/read/28192112/multiple-blood-brain-barrier-transport-mechanisms-limit-bumetanide-accumulation-and-therapeutic-potential-in-the-mammalian-brain
#1
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 9, 2017: Neuropharmacology
https://www.readbyqxmd.com/read/28150289/relationship-between-gender-and-clinical-characteristics-associated-factors-and-hypertension-treatment-in-patients-with-resistant-hypertension
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
https://www.readbyqxmd.com/read/28104016/-effect-of-the-obstructive-sleep-apnea-hypopnea-syndrome-treatment-on-blood-pressure-in-patients-with-resistant-hypertension
#8
H W Wang, H M Liu, Z Y Zheng, Y Z Jia, H R Li
Objective: To investigate the effect of the treatments for obstructive sleep apnea hypopnea syndrome (OSAHS) on the resistant hypertension (RH) of patients. Methods: Eighty patients with OSAHS and RH (blood pressure could not be controlled under 140/90 mmHg (1 mmHg=0.133 kPa) even with more than three kinds of antihypertensive drugs including diuretics) received surgery or continuous positive airway pressure (CPAP) treatment. The results of polysomnography monitoring, ambulatory blood pressure monitoring, and the dosage of antihypertensive medication were recorded before and six months after the treatment...
January 7, 2017: Zhonghua Er Bi Yan Hou Tou Jing Wai Ke za Zhi, Chinese Journal of Otorhinolaryngology Head and Neck Surgery
https://www.readbyqxmd.com/read/28038989/increased-plasma-rbp4-concentration-in-older-hypertensives-is-related-to-the-decreased-kidney-function-and-the-number-of-antihypertensive-drugs-results-from-the-polsenior-substudy
#9
Marcin Majerczyk, Piotr Choręza, Maria Bożentowicz-Wikarek, Aniceta Brzozowska, Habibullah Arabzada, Aleksander Owczarek, Małgorzata Mossakowska, Tomasz Grodzicki, Tomasz Zdrojewski, Andrzej Więcek, Magdalena Olszanecka-Glinianowicz, Jerzy Chudek
Increased plasma retinol-binding protein 4 (RBP4), a novel adipokine, has been associated in previous studies with obesity, type 2 diabetes, dyslipidemia, hypertension (HT), atherosclerosis, and coronary artery disease. This study aimed to analyze the relationship between HT occurrence and its treatment, and plasma RBP4 concentrations in the older polish population. The study sample consisted of 1728 (890 men and 838 women) PolSenior study participants aged 65 years and older with available plasma samples and NT-proBNP values below 2000 pg/mL...
December 7, 2016: Journal of the American Society of Hypertension: JASH
https://www.readbyqxmd.com/read/28027534/asymptomatic-hyperuricemia-is-a-strong-risk-factor-for-resistant-hypertension-in-elderly-subjects-from-general-population
#10
Alberto Mazza, Salvatore Lenti, Laura Schiavon, Alvise Del Monte, Danyelle M Townsend, Emilio Ramazzina, Domenico Rubello, Edoardo Casiglia
OBJECTIVE: In clinical practice, patient characteristics predicting resistant hypertension (RH) include higher blood pressure levels, left ventricular hypertrophy, older age, obesity, chronic kidney disease and diabetes. On the contrary little is known about the role of serum uric acid (SUA) as a risk factor for RH in subjects from general population. MATERIAL AND METHODS: 580 elderly subjects aged ≥65 years were enrolled in the Risk Of Vascular complications Impact of Genetics in Old people (ROVIGO) study...
February 2017: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
https://www.readbyqxmd.com/read/28003251/effect-of-arteriovenous-anastomosis-on-blood-pressure-reduction-in-patients-with-isolated-systolic-hypertension-compared-with-combined-hypertension
#11
Christian Ott, Melvin D Lobo, Paul A Sobotka, Felix Mahfoud, Alice Stanton, John Cockcroft, Neil Sulke, Eamon Dolan, Markus van der Giet, Joachim Hoyer, Stephen S Furniss, John P Foran, Adam Witkowski, Andrzej Januszewicz, Danny Schoors, Konstantinos Tsioufis, Benno J Rensing, Manish Saxena, Benjamin Scott, G André Ng, Stephan Achenbach, Roland E Schmieder
BACKGROUND: Options for interventional therapy to lower blood pressure (BP) in patients with treatment-resistant hypertension include renal denervation and the creation of an arteriovenous anastomosis using the ROX coupler. It has been shown that BP response after renal denervation is greater in patients with combined hypertension (CH) than in patients with isolated systolic hypertension (ISH). We analyzed the effect of ROX coupler implantation in patients with CH as compared with ISH...
December 21, 2016: Journal of the American Heart Association
https://www.readbyqxmd.com/read/27984005/treatment-resistant-hypertension-and-outcomes-based-on-randomized-treatment-group-in-allhat
#12
Sripal Bangalore, Barry R Davis, William C Cushman, Sara L Pressel, Paul M Muntner, David A Calhoun, John B Kostis, Paul K Whelton, Jeffrey L Probstfield, Mahboob Rahman, Henry R Black
BACKGROUND: Although hypertension guidelines define treatment-resistant hypertension as blood pressure uncontrolled by ≥3 antihypertensive medications, including a diuretic, it is unknown whether patient prognosis differs when a diuretic is included. METHODS: Participants in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) were randomly assigned to first-step therapy with chlorthalidone, amlodipine, or lisinopril. At a Year 2 follow-up visit, those with average blood pressure ≥140 mm Hg systolic or ≥90 mm Hg diastolic on ≥3 antihypertensive medications, or blood pressure <140/90 mm Hg on ≥4 antihypertensive medications were identified as having apparent treatment-resistant hypertension...
October 27, 2016: American Journal of Medicine
https://www.readbyqxmd.com/read/27903988/metabolic-syndrome-in-relation-to-risk-of-meningioma
#13
Corinna Seliger, Christoph R Meier, Claudia Becker, Susan S Jick, Martin Proescholdt, Ulrich Bogdahn, Peter Hau, Michael F Leitzmann
BACKGROUND: Meningioma is a frequent primary intracranial tumor, the etiology of which is potentially related to adiposity. Metabolic syndrome (MetS) is an increasingly common disease characterized by having at least three of the following conditions: central adiposity, arterial hypertension, dyslipidemia, and insulin resistance. Only one prior study investigated MetS in relation to meningioma risk and found a positive association between the two. RESULTS: Among 2,027 cases and 20,269 controls, body mass index was positively associated with meningioma (p-value for trend < 0...
January 10, 2017: Oncotarget
https://www.readbyqxmd.com/read/27895487/combination-therapy-with-lercanidipine-and-enalapril-in-the-management-of-the-hypertensive-patient-an-update-of-the-evidence
#14
REVIEW
Christina Antza, Stella Stabouli, Vasilios Kotsis
Hypertension is an important risk factor for premature death as it increases the probability of stroke, myocardial infarction, and heart failure. Antihypertensive drugs can decrease cardiovascular (CV) morbidity and mortality. The majority of hypertensive patients need more than one antihypertensive agent to attain blood pressure (BP) targets. Monotherapy can effectively reduce BP only in 20%-40% of patients. Multiple mechanisms including increased peripheral vascular resistance, increased cardiac work, and hypervolemia are involved in the pathogenesis of hypertension...
2016: Vascular Health and Risk Management
https://www.readbyqxmd.com/read/27895136/recognition-and-management-of-resistant-hypertension
#15
REVIEW
Branko Braam, Sandra J Taler, Mahboob Rahman, Jennifer A Fillaus, Barbara A Greco, John P Forman, Efrain Reisin, Debbie L Cohen, Mohammad G Saklayen, S Susan Hedayati
Despite improvements in hypertension awareness and treatment, 30%-60% of hypertensive patients do not achieve BP targets and subsequently remain at risk for target organ damage. This therapeutic gap is particularly important to nephrologists, who frequently encounter treatment-resistant hypertension in patients with CKD. Data are limited on how best to treat patients with CKD and resistant hypertension, because patients with CKD have historically been excluded from hypertension treatment trials. First, we propose a consistent definition of resistant hypertension as BP levels confirmed by both in-office and out-of-office measurements that exceed appropriate targets while the patient is receiving treatment with at least three antihypertensive medications, including a diuretic, at dosages optimized to provide maximum benefit in the absence of intolerable side effects...
November 28, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/27890630/arteriovenous-renal-replacement-therapy-in-end-stage-left-sided-heart-failure-patients-has-a-detrimental-effect-on-patients-with-impaired-right-ventricular-function
#16
Evangelos Repasos, Elisabeth Kaldara, Christos Pantsios, Chris Kapelios, Emmeleia Nana, Spiridon Vernadakis, Christina Melexopoulou, Konstantinos Malliaras, John Boletis, John N Nanas
OBJECTIVE: Chronic intermittent renal replacement therapy(RRT) is an alternate method of decongestion for patients presenting with diuretic-resistant, end-stage heart failure(HF) and cardiorenal syndrome. The optimal method of vascular access has not been confirmed. This study investigated the 6-month outcomes of patients with end-stage HF after the creation of arteriovenous communications (AVC) compared with other means of RRT. METHODS: We treated 40 patients with chronic, intermittent, ambulatory RRT, of whom 15 (37...
November 23, 2016: Hellenic Journal of Cardiology: HJC, Hellēnikē Kardiologikē Epitheōrēsē
https://www.readbyqxmd.com/read/27883326/renal-replacement-therapy-in-patients-with-heart-and-kidney-failure
#17
Dimitrios S Goumenos, Evangelos Papachristou, Marios Papasotiriou
The incidence of chronic kidney disease (CKD) in patients with chronic heart failure (CHF) is high as CKD and CHF share underlying risk factors such as arterial hypertension, diabetes mellitus and atherosclerosis. Cardiac failure leads to renal hypoperfusion and dysfunction and then fluid overload and need for aggressive diuretic therapy. However, development of diuretic resistance represents a significant problem in the management of these patients. The role of Renal Replacement Therapy (RRT) is important for patients who do not response to conservative management of fluid overload facilitating the failing heart to restore function...
November 1, 2016: Prilozi (Makedonska Akademija Na Naukite i Umetnostite. Oddelenie za Medicinski Nauki)
https://www.readbyqxmd.com/read/27873228/hypertension-in-chronic-kidney-disease
#18
Seyed Mehrdad Hamrahian, Bonita Falkner
Hypertension, a global public health problem, is currently the leading factor in the global burden of disease. It is the major modifiable risk factor for heart disease, stroke and kidney failure. Chronic kidney disease (CKD) is both a common cause of hypertension and CKD is also a complication of uncontrolled hypertension. The interaction between hypertension and CKD is complex and increases the risk of adverse cardiovascular and cerebrovascular outcomes. This is particularly significant in the setting of resistant hypertension commonly seen in patient with CKD...
November 22, 2016: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/27863352/ultrafiltration-for-acute-decompensated-cardiac-failure-a-systematic-review-and-meta-analysis
#19
Chun Shing Kwok, Chun Wai Wong, Claire A Rushton, Fozia Ahmed, Colin Cunnington, Simon J Davies, Ashish Patwala, Mamas A Mamas, Duwarakan Satchithananda
BACKGROUND: Ultrafiltration is a method used to achieve diuresis in acute decompensated heart failure (ADHF) when there is diuretic resistance, but its efficacy in other settings is unclear. We therefore conducted a systematic review and meta-analysis to evaluate the use of ultrafiltration in ADHF. METHODS: We searched MEDLINE and EMBASE for studies that evaluated outcomes following filtration compared to diuretic therapy in ADHF. The outcomes of interest were body weight change, change in renal function, length of stay, frequency of rehospitalization, mortality and dependence on dialysis...
February 1, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/27826971/predictors-of-blood-pressure-control-in-patients-with-resistant-hypertension
#20
J Pales, G Kamensky, J Payer
BACKGROUND: Uncontrolled resistant hypertension (RH) defined by the mean 24-hour ambulatory blood pressure (ABPM) represents an independent risk factor in hypertensive patients. Predictors of blood pressure (BP) control in RH are not yet clearly defined. OBJECTIVES: To evaluate the predictors of BP control in RH patients with repeated ABPM measurements. METHODS: 114 consecutive patients from outpatient cardiology office fulfilling criteria for RH (office BP ≥ 140 and/or 90 mmHg, with treatment of ≥ 3 antihypertensive drugs, including diuretic, or controlled BP with > 3 drugs), with two consecutive ABPM studies were compared in clinical characteristics according to BP control assessed by ABPM RESULTS: After the second ABPM, BP was controlled in 25...
2016: Bratislavské Lekárske Listy
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