Spontaneous outer retinal layer recovery in a case of hypertensive choroidopathy secondary to pre-eclampsia: a multimodal evaluation / Recuperação espontânea das camadas externas da retina em um caso de coroidopatia hipertensiva secundária a pré-eclâmpsia: avaliação multimodal

ABSTRACT A 26-year-old woman presented at 28 weeks gestation with hypertensive choroidopathy associated with pre-eclampsia. Fundus photography, fundus autofluorescence, spectral-domain optical coherence tomography (SD-OCT), fluorescein angiography, and indocyanine green angiography were performed in both eyes in the immediate postoperative period. SD-OCT images were obtained before delivery and during a 3-month follow-up. Fundus autofluorescence exhibited patchy hyper- and hypoautofluorescent lesions; fluorescein and indocyanine green angiography revealed areas of choroidal ischemia; and SD-OCT showed disorganization of the outer retinal layers and disruption of the ellipsoid zone. After her blood pressure was stabilized, progressive recovery of the outer retinal layer was monitored on SD-OCT.

RESUMO Uma mulher de 26 anos de idade, com 28 semanas de gestação apresentando coroidopatia hipertensiva associada à pré-eclâmpsia. Retinografia, autofluorescência, tomografia de coerência óptica de domínio espectral, angiofluoresceínografia e angiografia com indocianina verde foram realizadas em ambos os olhos no período pós-operatório imediato do parto. Imagens da tomografia de coerência óptica de domínio espectral foram obtidas antes do parto e durante o seguimento de 3 meses. A autofluorescência apresentou lesões heterogêneas hiper e hipoautofluorescentes, a angiofluoresceínografia e angiografia com indocianina verde revelaram áreas de isquemia de coroide, e a tomografia de coerência óptica de domínio espectral apresentou desorganização das camadas externas da retina e interrupção da zona elipsóide. Após a estabilização da pressão sanguínea, a recuperação progressiva da camada externa da retina foi monitorada pela tomografia de coerência óptica de domínio espectral.

Diuretics are Similar to Losartan on Echocardiographic Target-Organ Damage in Stage I Hypertension. PREVER-Treatment Study / Diuréticos são Similares à Losartana na Avaliação Ecocardiográfica de Lesão a Órgãos-Alvo no Estágio I da Hipertensão. Estudo PREVER-Treatment

Abstract Blood pressure (BP)-lowering therapy improves left ventricular (LV) parameters of hypertensive target-organ damage in stage II hypertension, but whether there is a drug-class difference in echocardiographic parameters in stage I hypertension patients is less often studied. In the PREVER treatment study, where individuals with stage I hypertension were randomized for treatment with diuretics (chlorthalidone/amiloride) or losartan, 110 participants accepted to participate in a sub-study, where two-dimensional echocardiograms were performed at baseline and after 18 months of antihypertensive treatment. As in the general study, systolic BP reduction was similar with diuretics or with losartan. Echocardiographic parameters showed small but significant changes in both treatment groups, with a favorable LV remodeling with antihypertensive treatment for 18 months when target blood pressure was achieved either with chlorthalidone/amiloride or with losartan as the initial treatment strategy. In conclusion, even in stage I hypertension, blood pressure reduction is associated with improvement in echocardiographic parameters, either with diuretics or losartan as first-drug regimens.

Resumo A terapia de redução da pressão arterial (PA) melhora os parâmetros do ventrículo esquerdo (VE) na lesão a órgãos-alvo causada pela condição hipertensiva na hipertensão de estágio II; no entanto, se existem ou não diferenças relacionadas à classe de medicamentos nos parâmetros ecocardiográficos de pacientes com hipertensão estágio I é menos frequentemente estudado. No estudo PREVER-treatment, em que indivíduos com hipertensão estágio I foram randomizados para tratamento com diuréticos (clortalidona/amilorida) ou losartana, 110 participantes aceitaram participar de um subestudo, no qual foram realizados ecocardiogramas bidimensionais basais e após 18 meses de tratamento anti-hipertensivo. Como no estudo geral, a redução da PA sistólica foi semelhante com diuréticos ou com losartana. Os parâmetros ecocardiográficos mostraram pequenas mas significativas alterações em ambos os grupos de tratamento, com um remodelamento favorável do VE com tratamento anti-hipertensivo por 18 meses, quando a pressão arterial alvo foi atingida com clortalidona/amilorida ou com losartana como estratégia inicial de tratamento. Em conclusão, mesmo na hipertensão estágio I, a redução da pressão arterial está associada à melhora nos parâmetros ecocardiográficos tanto com o uso de diuréticos ou losartana como primeiro esquema de tratamento farmacológico.

Diagnosis and management of systemic hypertension due to renovascular and aortic stenosis in patients with Williams-Beuren syndrome

SUMMARY AIM To describe the incidence, diagnosis, and management of systemic arterial hypertension related to renal artery stenosis in patients with Williams-Beuren syndrome. METHODS Sixty-five patients with Williams-Beuren syndrome were evaluated for hypertension. Enrolled patients underwent Doppler sonography of the renal arteries and Doppler echocardiography. Those with Doppler sonography-detected lesions or with normal Doppler sonography but severe hypertension underwent computed tomography or gadolinium-enhanced magnetic resonance angiography of the aorta and renal vessels. Patients needing vascular therapeutic intervention underwent conventional angiography. RESULTS Systemic arterial hypertension was diagnosed in 21/65 patients with Williams-Beuren syndrome (32%; 13 male) with a mean age of 13.9 years (5mo-20yrs). In 8/21 patients renovascular hypertension was detected. Angioplasty was unsuccessful in five patients with renal artery stenosis, requiring additional treatment. Doppler echocardiography showed cardiac abnormalities in 16/21 (76%) hypertensive patients. CONCLUSION Cardiac abnormalities and hypertension in patients with Williams-Beuren syndrome are common. Thus, thorough evaluation and follow-up are necessary to reduce cardiovascular risks and mortality of these patients

RESUMO OBJETIVO Descrever a incidência, o diagnóstico e o tratamento da hipertensão arterial sistêmica relacionada com estenose da artéria renal em pacientes com síndrome de Williams-Beuren. MÉTODOS Sessenta e cinco pacientes com síndrome de Williams-Beuren foram avaliados quanto à presença de hipertensão. Os pacientes foram submetidos à ultrassonografia com Doppler das artérias renais e ecocardiograma Doppler. Aqueles com suspeita de hipertensão renovascular foram submetidos à tomografia computadorizada ou angiografia por ressonância magnética da aorta e vasos renais ou angiografia convencional. RESULTADOS A hipertensão arterial sistêmica foi diagnosticada em 21/65 pacientes com síndrome de Williams-Beuren (32%, 13 do sexo masculino), com idade média de 13,9 anos (5 meses-20 anos). Em 8/21 pacientes foi detectada a hipertensão renovascular. Angioplastia não teve sucesso em cinco pacientes com estenose da artéria renal, necessitando de tratamento adicional. O ecocardiograma Doppler mostrou anormalidades cardíacas em 16/21 (76%) pacientes hipertensos. CONCLUSÃO As anormalidades cardíacas e hipertensão arterial em pacientes com síndrome de Williams-Beuren são muito frequentes, sendo necessários uma avaliação minuciosa e seguimento para diminuir o risco cardiovascular e a morbimortalidade desses pacientes

Impact of Ambulatory Blood Pressure on Early Cardiac and Renal Dysfunction in Hypertensive Patients without Clinically Apparent Target Organ Damage

PURPOSE: Impaired left ventricular (LV) global longitudinal strain (GLS) and the presence of microalbuminuria indicate early cardiac and renal dysfunction. We aimed to determine the relationships among 24-h ambulatory blood pressure (BP) variables, LV GLS, and urine albumin creatinine ratio (UACR) in hypertensive patients. MATERIALS AND METHODS: A total of 130 hypertensive patients (mean age 53 years; 59 men) underwent 24-h ambulatory BP monitoring, measurements of peripheral and central BPs, and transthoracic echocardiography. Patients with apparent LV systolic dysfunction (LV ejection fraction < 50%) or chronic kidney disease were not included. LV GLS was calculated using two-dimensional speckle tracking, and UACR was analyzed from spot urine samples. RESULTS: In simple correlation analysis, LV GLS showed the most significant correlation with mean daytime diastolic BP (DBP) (r=0.427, p < 0.001) among the various BP variables analyzed. UACR revealed a significant correlation only with night-time mean systolic BP (SBP) (r=0.253, p=0.019). In multiple regression analysis, daytime mean DBP and night-time mean SBP were independent determinants for LV GLS (β=0.35, p=0.028) and log UACR (β=0.49, p=0.007), respectively, after controlling for confounding factors. Daytime mean DBP showed better diagnostic performance for impaired LV GLS than did peripheral or central DBPs, which were not diagnostic. Night-time mean SBP showed satisfactory diagnostic performance for microalbuminuria. CONCLUSION: There are different associations for daytime and night-time BP with early cardiac and renal dysfunction. Ambulatory BP monitoring provides more relevant BP parameters than do peripheral or central BPs regarding early cardiac and renal dysfunction in hypertensive patients.

Assessment of Carotid Intima-Media Thickness as an Early Marker Of Vascular Damage In Hypertensive Children / Avaliação da Espessura Médio-Intimal Carotídea como um Marcador Vascular Precoce em Crianças Hipertensas

Abstract Background: The increased carotid intima-media thickness (CIMT) correlates with the presence of atherosclerosis in adults and describes vascular abnormalities in both hypertensive children and adolescents. Objective: To assess CIMT as an early marker of atherosclerosis and vascular damage in hypertensive children and adolescents compared with non-hypertensive controls and to evaluate the influence of gender, age, and body mass index (BMI) on CIMT on each group. Methods: Observational cohort study. A total of 133 hypertensive subjects (male, n = 69; mean age, 10.5 ± 4 years) underwent carotid ultrasound exam for assessment of CIMT. One hundred and twenty-one non-hypertensive subjects (male, n = 64; mean age, 9.8 ± 4.1 years) were selected as controls for gender, age (± 1 year), and BMI (± 10%). Results: There were no significant difference regarding gender (p = 0.954) and age (p = 0.067) between groups. Hypertensive subjects had higher BMI when compared to control group (p = 0.004), although within the established range of 10%. Subjects in the hypertensive group had higher CIMT values when compared to control group (0.46 ± 0.05 versus 0.42 ± 0.05 mm, respectively, p < 0.001; one-way ANOVA). Carotid IMT values were not significantly influenced by gender, age, and BMI when analyzed in both groups separately (Student's t-test for independent samples). According to the adjusted determination coefficient (R²) only 11.7% of CIMT variations were accounted for by group variations, including age, gender, and BMI. Conclusions: Carotid intima-media thickness was higher in hypertensive children and adolescents when compared to the control group. The presence of hypertension increased CIMT regardless of age, gender, and BMI.

Resumo Fundamento: O aumento da espessura médio-intimal carotídea (EMIC) correlaciona-se com a presença de aterosclerose em adultos e descreve anormalidades vasculares em crianças e adolescentes hipertensos. Objetivo: Avaliar a EMIC como marcador precoce de aterosclerose e dano vascular em crianças e adolescentes hipertensos em comparação com um grupo controle e avaliar a influência do sexo, idade e índice de massa corporal (IMC) sobre a EMIC em cada grupo. Métodos: Estudo observacional de coorte. Um total de 133 indivíduos hipertensos (sexo masculino, n = 69; idade média 10.5 ± 4 anos) foi submetido à ultrassonografia das artérias carótidas para avaliação da EMIC. Cento e vinte e um indivíduos saudáveis (sexo masculino, n = 64; idade média, 9.8 ± 4.1 anos) foram selecionados como controles para as seguintes características: sexo, idade (± 1ano) e IMC (±10%). Resultados: Não houve diferenças significativas entre os grupos com relação ao sexo (p = 0,954) e idade (p = 0,067). Os indivíduos hipertensos apresentaram maior IMC (p = 0,004), porém dentro da faixa estabelecida de até 10%. Os indivíduos hipertensos apresentaram maiores valores de EMIC quando comparados ao grupo-controle (0,46 ± 0,05 versus 0,42 ± 0,05 mm, respectivamente, p < 0.001; ANOVA com um parâmetro). Os valores da EMIC não foram influenciados por sexo, idade e IMC quando analisados em ambos os grupos separadamente (Teste t de Student para amostras independentes). De acordo com o coeficiente de determinação (R²) ajustado, apenas 11.7% das variações da EMIC são devidas às variações em cada grupo, incluindo idade, sexo e IMC. Conclusões: A espessura médio-intimal das carótidas apresentou-se aumentada em crianças e adolescentes hipertensos quando comparados ao grupo controle. A presença de hipertensão aumentou a EMIC independentemente de idade, sexo e IMC.

Subtype of hypertension is evidence for preclinical atherosclerosis. A study of carotid artery ultrasonography and biochemical markers

To assess subclinical atherosclerosis in subtypes of hypertension using lipid profile as a biomarker and B mode ultrasonography of the carotid arteries. Ninety-six subjects [49 females and 47 males] aged 42-78 years were recruited from the vascular Doppler unit at Baghdad Teaching Hospital, Baghdad, Iraq from January to June 2008. They were grouped into normotensive [group I], isolated systolic hypertension [group II], isolated diastolic hypertension [group III], and combined systolic and diastolic hypertension [group IV]. Subclinical atherosclerosis was observed in groups III and IV in terms of significantly low levels of high-density lipoprotein, high levels of low-density lipoprotein, and high atherogenic index. The mean intima media thickness was significantly increased with transition from group I to group IV in all carotid arteries, and the mean resistive index value of each carotid artery in group IV was significantly higher than that of group I. Carotid plaque was demonstrated in a significantly higher percent in group IV [12 out of 15] followed by groups III [14 out of 31] and II [1 out of 30]. Lipid profile and high resolution B-mode ultrasonography of the carotids are good predictive measures of subclinical atherosclerosis. Isolated diastolic hypertension and combined systolic-diastolic hypertension accounts for early subclinical atherosclerosis compared with isolated systolic hypertension

Significant measurement of mean carotid intima-media thickness in sustained essential hypertension

To assess the significant association of atherosclerosis quantified by screening intima media thickness of bilateral common and internal carotid arteries in patients with asymptomatic and persistent hypertension with and without ischemic stroke. To assess the significant association of atherosclerosis quantified by screening intima media thickness of bilateral common and internal carotid arteries in patients with asymptomatic and persistent hypertension with and without ischemic stroke. The mean diameter as well as intima media thickness of common and internal carotid arteries was significantly higher in group IV than group II, II, and group I. These changes were associated with significant increased fasting serum cholesterol, lowdensity lipoprotein, and decreased high-density lipoprotein. Intima media thickness above one mm was significantly observed in hypertension with ischemic stroke [odd ratio 1.37]. The results support the importance of screening asymptomatic as well as sustained treated hypertension by carotid ultrasound Doppler

Real-time three-dimensional echocardiographic assessment of left ventricular remodeling index in patients with hypertensive heart disease and coronary artery disease / 华中科技大学学报（医学）（英德文版）

Left ventricular remodeling index (LVRI) was assessed in patients with hypertensive heart disease (HHD) and coronary artery disease (CAD) by real-time three-dimensional echocardiography (RT3DE). RT3DE data of 18 patients with HHD, 20 patients with CAD and 22 normal controls (NC) were acquired. Left ventricular end-diastolic volume (EDV) and left ventricular end-diastolic epicardial volume (EDVepi ) were detected by RT3DE and two-dimensional echocardiography Simpson biplane method (2DE). LVRI (left ventricular mass /EDV) was calculated and compared. The results showed that LVRI measurements detected by RT3DE and 2DE showed significant differences inter-groups (P0.05), but significant difference in HHD and CAD intra-group (P0.05). It was concluded that LVRI derived from RT3DE as a new index for evaluating left ventricular remodeling can provide more superiority to LVRI derived from 2DE.

[Assessment of right ventricular function among hypertensive patients using pulse tissue doppler]

Classically, one's heart function is mostly based upon its systolic function, whereas the diastolic function steps on second order. In recent years it has been revealed that diastolic function plays an important role in both cardiac mortality and cardiac morbidity. On the other hand is hypertension which due to increasing the afterload, interferes with these functions of heart. In this study we assessed the diastolic function of hypertensive patients using pulse tissue Doppler. 30 patients with high blood pressure that had not consumed anti-hypertensive agents and along with 30 healthy control ones enrolled in our survey, all of whom had normal sinus rhythm without detectable symptoms corresponding to congestive heart failure, ischemia, valvular diseases and pulmonary problems. 2D echocardiography was performed in both groups as well as M Mode and Doppler ech. The PTD echo was performed by the lateral annulus of both tricuspid and mitral valves. Systolic and diastolic findings were measured by PTD. Hypertensive patients had negative diastolic findings but no negative systolic ones. PTS illustrated that E/A ratio [early peak velocity / late peak velocity] in right ventricle had significantly decreases [P<0.01] among these patients. In right ventricle, both RT [relaxation time] [P<0.01], DT [decelation time] [P<0.04] and Am [Late Peak Velocity] [P<0.03] were converesly increased. Right ventricular E/A ratio had a significant correlation with that of left ventricle [P<0.005, r =0.5]. It seems that hypertension is longitudinally related with diastolic disfunction of right ventricle. This disturbance would be represented by the lengthened RT and decreasing of E/A ratio which are both resulted from interfering of two ventricle's function and increased pressure of left ventricle. Therefore, PTD can be applied to evaluate the right ventricular diastolic function among patients with high blood pressure

Characterisation of left ventricular function by tissue Doppler imaging technique in newly diagnosed, untreated hypertensive subjects

BACKGROUND:Hypertension results in structural and functional changes in the heart. Early detection of abnormalities of cardiac structure and function is important in the assessment and treatment of hypertensive subjects. The aim of this study was to evaluate the utility of the tissue Doppler echocardiographic technique in characterising diastolic and systolic functions in untreated native black African hypertensive subjects.MATERIALS AND METHODS:Forty consecutive, newly diagnosed, untreated hypertensives with adequate conventional echocardiographic (2-D, M-mode, transmitral and pulmonary Doppler flow velocities) and tissue Doppler echocardiographic images were recruited into the study. The control subjects were apparently normal individuals. Each arm of the study consisted of 21 male and 19 female subjects.RESULTS:The two groups were comparable by age (48.6 +/- 11.35 years in the hypertensives vs 48.1 +/- 11.33 years in the controls; p = 0.844) and gender distribution (M/F: 21/19 in both groups). Other baseline characteristics, except for blood pressure parameters, which were predictably higher in the hypertensive subjects, were comparable between the two groups. The hypertensive subjects had a lower systolic myocardial velocity (Sm) and early diastolic myocardial velocity (Em) in comparison with the controls (p = 0.033 and p = 0.018, respectively). The late diastolic myocardial velocity (Am) was comparable in the two groups (p = 0.430). CONCLUSIONS:Tissue Doppler echocardiography demonstrates diastolic dysfunction relatively early in native African hypertensives and may be useful for detecting subtle deterioration in systolic function

Incidence of mandibular nutrient canals in hypertensive patients: a radiographic study.

Hypertension, also called a 'silent killer,' is one of the most common medical problems seen in our profession. A prospective study was conducted in the Department of Oral Medicine and Radiology to determine the incidence of the appearance of nutrient canals in the periapical radiographs of the mandibular anterior region of patients with high blood pressure. A total of 100 patients, between 10-80 years, were examined. After taking a proper history, systemic and oral examinations were done and the findings were recorded under two categories, hypertensive patients and normotensive patients. They were further subdivided according to their periodontal status. Intraoral periapical radiographs of the lower anterior region were then taken. Radiographs were interpreted with a good X-ray viewer and the use of a magnifying glass. Findings were recorded on a prepared format.

Assessment of effect of angiotensin II receptor antagonist losartan on aortic distensibility in patients with essential hypertension by echocardiography / 华中科技大学学报（医学）（英德文版）

The effects of angiotensin II receptor antagonist losartan on elastic properties of aorta in patients with mild to moderate essential hypertension were assessed. The ascending aortic distensibility in 26 patients (48 +/- 3 years) with mild to moderate essential hypertension before and after 12 weeks of treatment with losartan (50 mg/day) was evaluated by using two-dimensional echocardiography. M-mode measurements of aortic systolic (Ds) and diastolic diameter (Dd) were taken at a level approximately 3 cm above the aortic valve. Simultaneously, cuff brachial artery systolic (SBP) and diastolic (DBP) pressures were measured. Aortic pressure-strain elastic modulus (Ep) was calculated as Dd x (SBP-DBP)/(Ds-Dd) x 1333 and stiffness index beta (beta) was defined as Dd x Ln (SBP/DBP)/(Ds-Dd). Blood pressure significantly decreased from 148 +/- 13/95 +/- 9 mmHg to 138 +/- 12/88 +/- 8 mmHg (systolic blood pressure, P = 0.001; diastolic blood pressure, P = 0.003). There was no significant difference in pulse pressure before and after treatment with losartan (53 +/- 10 mmHg vs 50 +/- 7 mmHg). The distensibility of ascending aorta increased significantly as showed by the significant decrease in pressure-strain elastic modulus from 4.42 +/- 5.79 x 10(6) dynes/cm2 to 1.99 +/- 1.49 x 10(6) dynes/cm2 (P = 0.02) and stiffness index beta from 27.4 +/- 32.9 to 13.3 +/- 9.9 (P = 0.02). Although there was a weak correlation between the percent changes in pressure-strain elastic modulus and stiffness index beta and that in diastolic blood pressure after losartan treatment (r = 0.40, P = 0.04 and r = 0.55, P = 0.004, respectively), no correlation was found between the percent changes in pressure-strain elastic modulus and stiffness index beta and that in systolic blood pressure (r = 0.04, P = 0.8 and r = 0.24, P = 0.2, respectively). Our study demonstrated that angiotensin II receptor antagonist losartan has a beneficial effect on aortic distensibility in patients with mild to moderate essential hypertension and this effect is partly independent of blood pressure reduction.

Index of myocardial performance using Doppler-derived parameters in the evaluation of left ventricular function in patients with essential hypertension

We analyzed Doppler echocardiographic data in 120 subjects with normal sinus rhythm; normals (NL, n=60, ages 54.1 15.1) and essential hypertensive patients (HT, n=60, ages 57.3 10.2). The IMP was calculated as follows: IMP=(ICT+IRT)/ET, ICT; isovolumic contraction time, IRT; isovolumic relaxation time, ET; ejection time. There were no significant differences in ejection fraction (EF), stroke volume index (SVI), cardiac index (CI), ET and ICT between NL and HT. There were, however, significant differences in deceleration time (DT), E/A ratio, IRT and the IMP between the two groups (199.5 45.6 msec vs 222.3 54.3 msec, p0.05; 138.4 21.2 mmHg vs 131.3 19.9 mmHg, p>0.05). These data suggest that the IMP may be a useful parameter and an early indicator of left ventricular dysfunction in essential hypertensive patients with normal systolic function.

Changes of the carotid artery Doppler flow velocity pattern after sublingual nitroglycerin in patients with hypertension

OBJECTIVE: To evaluate the applicability of carotid Doppler echography for the assessment of changes of peripheral hemodynamics in the hypertensives. SUBJECTS: 28 hypertensives (17 males, 11 females), mean age of 64 yrs and 40 normal controls (24 males, 16 females) mean age of 49 yrs. METHODS: We recorded the right common carotid arterial Doppler flow velocity (BFV) pattern and measured the peak velocities of the percussion wave (P) and late rising tidal wave (T), the ratio of the two (P/T), the time interval between the two peaks corrected by heart rate (P-Tc), systolic flow velocity integral (FVI) and carotid artery diameter (CAD) before and after 0.4 mg dose of subligual nitroglycerin (NTG). RESULTS: 1) In hypertensives, the P wave velocity showed lower and P-Tc interval shorter than those of the normal controls at baseline. 2) After NTG, the P-Tc and P/T increased, but the T and FVI decreased significantly in both groups of subjects. 3) The P/T ratio was less significantly increased after NTG in the hypertensives than in the controls. These results suggest that NTG might have been involved in concomitant reduction and delay of the wave reflection from the peripheral vessels, preferentially in the normal subjects than in hypertensives. CONCLUSIONS: The carotid Doppler echography can be useful for the evaluation of the changes of hemodynamics in the peripheral vessel such as carotid artery in hypertensive subjects.

The role of hypertension in dilated cardiomyopathy: an echocardiographic assessment

Follow-up and radiological studies have been carried out in the past speculating on the interlationship between hypertension and dilated cardiomyopathy; and what proportion of the later would be predominantly blamed on the former. Follow-up studies have the problem of time and drop-out rate to contend with; while radiological features pathognomonic of hypertension. A 2-D echocardiographic study of cases of biventricular failure due to hypertension and dilated cardiomyopathy (because at point of admission; no cause was evident) was undertaken to see what if any relationship exists. Certain echo indices were found to be indicative of significant hypertension in patients diagnosed as having biventricular failure due to dilated cardiomyopathy. Using this method it would be possible to tell the dilated cardiomyopathy patient who will benefit at onset from some form of antihypertensive therapy

Les complications cardiaques de l'hypertension arterielle chez 392 Noirs Africains

Les auteurs evaluent les complications cardiaques de l'hypertension arterielle a la lumiere des donnees cliniques; electrocardiographiques et radiologiques a partir de 392 admissions pour HTA au service de cardiologie du CHU Ignace Deen de Conakry (R. Guinee) de 1981 a 1988. Trois cent cinquante quatre cas de complications cardiaques (90 pour cent) ont ete colliges. Chez 38 patients (10 pour cent); la maladie n'etait pas compliquee. Les complications cardiaques ont ete diagnostiquees chez 228 hommes (64 pour cent) et 126 femmes (36 pour cent). Le pic de preference est observe a 51-60 ans pour les deux sexes (44 pour cent des cas). La cardiopathie hypertensive avec insuffisance cardiaque decomposee (349 cas) est la forme clinique la plus frequente

A study of the effect of nifedipine in reversing left ventricular hypertrophy in hypertensive patients

Using WHO hypertensive criteria; 184 patients with hypertension were chosen (102 male; 82 female); aged 58-78 years old. Other heart diseases were ruled out by physical examination; electrocardiographic examination; chest-ray and echocardiography. All the cases had one or more criteria of left ventricular hypertrophy (LVH): Interventricular septal thickness at diastole; left ventricular posterior wall thickness at end diastole and left ventricular mass index. The findings in this study imply that it is good practise to include nifedipine in the treatment regimen of patients whose hypertension is complicated with LVH and (or) ischaemic heart disease

An arteriographic assessment of renal vasculature in young patients with essential hypertension.

Twenty-five patients below the age of 40 years with Uncomplicated hypertension underwent selective renal arteriography to assess the involvement of interlobar and arcuate arteries. Renal vasculature was abnormal in all 25 patients. Patients with severe hypertension had markedly abnormal renal vasculature. None of the patients with mild hypertension had severe vascular involvement. Functional significance of these arteriographic abnormalities is discussed.