ABSTRACT
Introducción: La hipertensión arterial es una de las enfermedades más prevalentes en atención primaria y el principal factor de riesgo para enfermedad cardivoascular. La hipertensión arterial secundaria es frecuente entre los pacientes con diagnóstico de hipertensión arterial, con una prevalencia del 10 % que puede incrementar hasta 20 % o 40 % en pacientes con hipertensión refractaria al tratamiento. Su identificación temprana se asocia con mejores desenlaces. Objetivo: Evaluar en la literatura las principales causas de hipertensión arterial secundaria e identificar el abordaje diagnóstico inicial de las patologías asociadas. Métodos: Selección y lectura de artículos de bases de datos Pubmed y Google Scholar y de revisiones de UpToDate que trataran el tema de hipertensión arterial secundaria. Conclusiones: Es importante reconocer aquellos pacientes que puedan estar cursando con hipertensión arterial de causa secundaria, ya que esto modifica el enfoque terapéutico, facilita el tratamiento y mejora los desenlaces; incluso puede llegar a la cura y resolución.
Hypertension is one of the most common diseases encountered in primary care settings and a major risk. factor for cardiovascular disease. Secondary hypertension is common in patients with hypertension diagnosis; its prevalence is about 10% and can be as high as 40% in patients whom are resistant to treatment. Its early recognition and treatment allows for better outcomes. Objective: To evalúate and identify the main causes for secondary' hypertension and to identify the diagnosis and evaluation of related conditions. Nfethods: Selection and review of articles from Pubmed and Google scholar and Iiterature reviews from Uptodate. Conclusions: It is important to identify secondary hypertension since this will modify treatment, outcomes and in some scenarios might be curable.
Subject(s)
Sleep Apnea, Obstructive/pathology , Hyperaldosteronism , Hypertension/diagnosis , Aortic Coarctation/diagnosis , Hypertension, Renal/diagnosisABSTRACT
The aim of this study was to observe the effects of uric acid lowering therapy (UALT), febuxostat and allopurinol, on blood pressure (BP) and serum creatinine level. Post-hoc data were derived from a phase-III, randomised, double-blind, 4-week trial of male gouty patients that compared the safety and efficacy of febuxostat and allopurinol in adults with gout. The subjects were randomly assigned to one of five groups, 35-37 in each group (febuxostat: 40, 80, 120 mg/d; allopurinol: 300 mg/d; control group: placebo). Blood pressure and serum creatinine level were measured at baseline and at weeks 2 and 4. Diastolic BP and creatinine level had decreased significantly in the UALT groups compared to the control group at week 4. Diastolic BP had decreased significantly in the allopurinol group and serum creatinine level had decreased significantly in the febuxostat groups at week 4. After adjusting for confounding variables, serum uric acid changes were found to be significantly correlated with changes in serum creatinine level but were not associated with changes in systolic or diastolic BP. UALT in gouty subjects significantly decreased diastolic BP and serum creatinine level. Changes in uric acid were significantly correlated with those in serum creatinine level, suggesting the feasibility of renal function improvement through UALT in gouty men.
Subject(s)
Humans , Male , Middle Aged , Allopurinol/administration & dosage , Biomarkers/blood , Blood Pressure/drug effects , Creatinine/blood , Dose-Response Relationship, Drug , Gout/drug therapy , Gout Suppressants/administration & dosage , Hypertension, Renal/diagnosis , Reproducibility of Results , Sensitivity and Specificity , Thiazoles/administration & dosage , Treatment OutcomeABSTRACT
After a thorough dinical examination and laboratory investigations, ultrasonography (USG) followed by minute sequence urography (MSU) and aortography and/or selective renal angiography were done in 108 patients, clinically suspected of having renal hypertension of which 32 patients (29.6%) were found to be positive for renal/renovascular disease. Out of 82 patients, who were only young hypertensives, a definite diagnosis of renal/renovascular disease could be made in only 15 cases (18.3%), whereas the pick up rate increased to 65.4% in the rest of the 26 patients who had some other clinical criteria besides hypertension and it further increased up to 92.3% (out of these 26 patients) who had 2 or more than 2 clinical criteria of selection of patients besides hypertension. USG was useful in diagnosing renal parenchymal disease/ suggesting renal abnormalities in 30 cases and MSU was able to detect renal changes in 31 patients. Aortography and/or selective renal angiography could make a definite diagnosis of renovascular disease in 17 cases and renal agenesis in one case.
Subject(s)
Adult , Age Factors , Angiography , Blood Chemical Analysis , Cohort Studies , Comorbidity , Female , Humans , Hypertension/diagnosis , Hypertension, Renal/diagnosis , Hypertension, Renovascular/diagnosis , India/epidemiology , Kidney Diseases/diagnosis , Male , Prevalence , Prospective Studies , Risk Assessment , Sex Factors , Urogenital Abnormalities/diagnosis , UrographyABSTRACT
Se realiza una revisión de diversos procederes diagnósticos utilizados en el estudio de la hipertensión arterial debido a la elevaba morbimortalidad que se observa en la actualidad por esta afección. Un mejor conocimiento de su utilidad relativa permitirá la búsqueda de casos secundarios de hipertensión potencialmente curables. Se señalan las principales alteraciones informadas en el pielograma minutado, el renograma isotópico y la arteriografía renal. Se hacen algunas consideraciones sobre otros métodos de estudio más novedosos, como la digital substraction angiography, (DSA) y las técnicas angiográficas de angulación combinada
Subject(s)
Humans , Male , Female , Angiography/methods , Hypertension, Renal/diagnosis , Hypertension, Renovascular/diagnosis , Hypertension/diagnosisABSTRACT
Se realiza un estudio prospectivo de 54 pacientes hipertensos de menos de 55 años de edad, quienes fueron sometidos a una metodología de estudio de la hipertensión arterial que incluyó entre otras investigaciones, el renograma isotópico, el pielograma minutado y la arteriografía renal. Se analizan comparativamente estas tres pruebas para el diagnóstico de la hipertensión secundaria, fundamentalmente renal y renovascular. Resulta el pielograma minutado la prueba de mayor sensibilidad diagnóstica