ABSTRACT
A case is presented of a diabetic, hypertensive, female patient who suffers from a bleeding complication from application of an ambulatory blood pressure monitor. A recent literature search is referred to and practitioners are cautioned against this adverse reaction.
Subject(s)
Blood Pressure Monitors/adverse effects , Ecchymosis/etiology , Purpura/etiology , Diabetes Mellitus, Type 2/complications , Female , Humans , Middle AgedABSTRACT
It might be expected that the tremendous increase in available antihypertensives would eliminate resistant hypertension by allowing many alternatives to its treatment. In spite of this, resistant hypertension remains a common problem due, the authors feel, to a poor understanding of the pathophysiology of this condition, particularly an understanding of whether plasma volume expansion mediates resistance to antihypertensive therapy. The authors evaluated the status of plasma volume as a major determinant of response to therapy in nine patients with resistant hypertension. Measuring plasma volume using I125 radiolabeled albumin, they found eight patients with elevated plasma volumes and one patient with a contracted plasma volume at the time of presentation with resistant hypertension. In all eight patients with plasma volume expansion, aggressive diuretic therapy allowed goal blood pressure to be achieved. The patient with plasma volume contraction achieved goal blood pressure with vasodilator therapy. Plasma volume expansion is common in resistant hypertension and it mediates resistance to therapy. Measurement of plasma volume gives the clinician important insight into the pathophysiology of resistant hypertension and increases the likelihood of successful management of the resistant hypertensive patient.
Subject(s)
Hypertension/physiopathology , Adult , Aged , Antihypertensive Agents/therapeutic use , Blood Volume , Diastole , Drug Resistance , Female , Humans , Hypertension/drug therapy , Male , Middle Aged , SystoleABSTRACT
A 31-year-old obese man with essential hypertension developed progressive optic disc edema despite mild-to-moderate elevations of his blood pressure. Neurologic evaluation, including cranial axial tomography, nuclear magnetic resonance scan, and lumbar puncture, was unremarkable. Further evaluation revealed that the patient had sleep apnea syndrome. In contrast to the few patients reported with this syndrome, he had normal cerebrospinal fluid pressures and hypertension. The possible interplay of sleep apnea and hypertension in the development of optic disc edema is considered.
Subject(s)
Hypertension/complications , Obesity Hypoventilation Syndrome/complications , Papilledema/etiology , Sleep Apnea Syndromes/complications , Adult , Diagnosis, Differential , Humans , Male , Sleep Apnea Syndromes/diagnosisABSTRACT
Recent investigations suggest that calcium supplementation may cause a lower arterial pressure in hypertensive individuals. We studied 32 patients with mildly elevated arterial pressure (diastolic pressure 88-95 mmHg) and inadequate dietary calcium intake (less than 750 mm/day), who were randomly assigned to placebo or 1500 mg/day elemental calcium for 4 weeks. Baseline and post-treatment urinary calcium concentrations and 3 biweekly supine blood pressures were recorded. Supine systolic blood pressure in the calcium group rose during the first 2 weeks of treatment (delta systolic blood pressure +5.9 mmHg; P less than 0.025) compared with no change in supine blood pressure for the placebo group. Within the calcium group, seven out of 15 patients had decreased or unchanged supine blood pressure during treatment. A lower urinary calcium concentration and a lower dietary sodium intake were found in this subgroup compared with those whose supine blood pressure increased with calcium administration.
Subject(s)
Blood Pressure/drug effects , Calcium, Dietary/administration & dosage , Hypertension/diet therapy , Calcium Carbonate/administration & dosage , Calcium, Dietary/pharmacology , Clinical Trials as Topic , Double-Blind Method , Humans , Random AllocationABSTRACT
We studied the incidence of diuretic-induced hypokalemia (DIH) in two diuretic-treated hypertensive populations. Thirty-seven patients with mild hypertension were treated with HCTZ and monitored over 6 months. Group 1 (21 patients) was treated with 25 mg HCTZ q.d. in a public hypertension clinic. Group 2 (16 patients) was treated with 50 mg HCTZ q.d. in a private-practice setting. Group 1 was predominantly nonwhite (76% vs. 31% [p less than 0.002]). Baseline serum potassium levels were lower in group 1 (3.93 vs. 4.42 mEq/L [p less than 0.001]). Equivalent reductions in blood pressure and serum potassium were observed in both groups. Contrary to expectations, DIH (serum potassium less than 3.5 mEq/L) developed in 52% of group 1 and 19% of group 2 (p = 0.037). Black females were especially at risk for DIH. The higher incidence of DIH in group 1 appears to be related to lower baseline serum potassium levels.
