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diuretic resistance

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https://www.readbyqxmd.com/read/28105769/renal-tubular-resistance-is-the-primary-driver-for-loop-diuretic-resistance-in-acute-heart-failure
#1
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
#2
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
#3
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
#4
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...
December 24, 2016: 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
#5
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
#6
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 to Prevent Heart Attack Trial were randomly assigned to first-step therapy with chlorthalidone, amlodipine, or lisinopril. At a Year 2 follow-up visit, those with average BP≥140 mmHg systolic or ≥90 mmHg diastolic on ≥3 antihypertensive medications, or BP<140/90 mmHg 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
#7
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...
November 26, 2016: 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
#8
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
#9
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-detrimental-effect-on-patients-with-impaired-right-ventricular-function
#10
Evangelos Repasos, Elisabeth Kaldara, Christos Pantsios, Chris Kapelios, Emmeleia Nana, Spiridon Vernadakis, Christina Melexopoulou, Konstantinos Malliaras, John Boletis, John N Nanas
INTRODUCTION: 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 compared the 6-month outcomes of patients with end-stage HF after the creation of arteriovenous communications (AVC) versus 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
#11
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
#12
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
#13
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
#14
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
https://www.readbyqxmd.com/read/27815337/development-of-original-metabolically-stable-apelin-17-analogs-with-diuretic-and-cardiovascular-effects
#15
Romain Gerbier, Rodrigo Alvear-Perez, Jean-Francois Margathe, Adrien Flahault, Pierre Couvineau, Ji Gao, Nadia De Mota, Hubert Dabire, Bo Li, Emilie Ceraudo, Annette Hus-Citharel, Lucie Esteoulle, Cynthia Bisoo, Marcel Hibert, Alain Berdeaux, Xavier Iturrioz, Dominique Bonnet, Catherine Llorens-Cortes
Apelin, a (neuro)vasoactive peptide, plays a prominent role in controlling cardiovascular functions and water balance. Because the in vivo apelin half-life is in the minute range, we aimed to identify metabolically stable apelin-17 (K17F) analogs. We generated P92 by classic chemical substitutions and LIT01-196 by original addition of a fluorocarbon chain to the N terminus of K17F. Both analogs were much more stable in plasma (half-life >24 h for LIT01-196) than K17F (4.6 min). Analogs displayed a subnanomolar affinity for the apelin receptor and behaved as full agonists with regard to cAMP production, ERK phosphorylation, and apelin receptor internalization...
November 4, 2016: FASEB Journal: Official Publication of the Federation of American Societies for Experimental Biology
https://www.readbyqxmd.com/read/27814935/diuretic-resistance
#16
Ewout J Hoorn, David H Ellison
Diuretic resistance is defined as a failure to achieve the therapeutically desired reduction in edema despite a full dose of diuretic. The causes of diuretic resistance include poor adherence to drug therapy or dietary sodium restriction, pharmacokinetic issues, and compensatory increases in sodium reabsorption in nephron sites that are not blocked by the diuretic. To illustrate the pathophysiology and management of diuretic resistance, we describe a patient with nephrotic syndrome. This patient presented with generalized pitting edema and weight gain despite the use of oral loop diuretics...
January 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/27798457/refractory-versus-resistant-hypertension
#17
Mohammed Siddiqui, David A Calhoun
PURPOSE OF REVIEW: Refractory hypertension is a recently proposed phenotype of antihypertensive treatment failure. As such it represents an extreme subtype of resistant or difficult-to-treat hypertension. Resistant hypertension is relatively common with an estimated prevalence of 10-20% of treated hypertensive patients. It is typically defined as having an uncontrolled blood pressure on three or more antihypertensive medications, including a diuretic. Refractory hypertension is rare with a prevalence of approximately 5% of patients with uncontrolled resistant hypertension...
January 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/27777360/trends-in-antihypertensive-medication-use-among-us-patients-with-resistant-hypertension-2008-to-2014
#18
Andrew Y Hwang, Chintan Dave, Steven M Smith
Little is known of US trends in antihypertensive drug use for patients with treatment-resistant hypertension (TRH). We analyzed antihypertensive use among patients with TRH (treated with ≥4 antihypertensive drugs concurrently) from July 2008 through December 2014 using Marketscan administrative data. We included adults aged 18 to 65 years, with ≥6 months of continuous enrollment, a hypertension diagnosis, and ≥1 episode of overlapping use of ≥4 antihypertensive drugs; patients with heart failure were excluded...
December 2016: Hypertension
https://www.readbyqxmd.com/read/27774268/permanent-catheter-drainage-system-for-palliation-of-diuretic-resistant-cardiac-ascites
#19
Jonathan Bevan, Lee-Anne Penn, Andrew R J Mitchell
We report the case of a 69-year-old man with dilated cardiomyopathy treated with a permanent catheter drainage system for diuretic resistant cardiac ascites. At 1 year follow-up, the patient had no heart failure related hospitalisations, displayed improved quality of life measures and had incurred no complications related to the catheter. Permanent tunnelled catheters are widely used to treat malignant ascites but may also be considered for palliation of cardiac ascites.
March 2016: ESC Heart Failure
https://www.readbyqxmd.com/read/27759337/management-practices-in-indian-patients-with-uncontrolled-hypertension
#20
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
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