RESUMO
Hypertension (HTN) and sudden cardiac death (SCD) constitute major public health problems accounting for millions of deaths each year worldwide. Both HTN and HTN-induced left ventricular hypertrophy (LVH) have been shown to be independent risk factors for SCD. However, the association between antihypertensive pharmacotherapy and risk of SCD has been under-investigated. Given that antihypertensive pharmacotherapy effectively reduces overall cardiovascular mortality, it would be expected to protect patients from SCD. Nevertheless, available data demonstrate that antihypertensive medications (primarily thiazide diuretics), while effective in reducing the incidence of myocardial infarction, do not confer protection from SCD. The purpose of this review was to present the relationship between HTN, LVH, and SCD and to describe the potential association between antihypertensive pharmacotherapy and risk of SCD.
Assuntos
Hipertensão , Infarto do Miocárdio , Anti-Hipertensivos/uso terapêutico , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Hipertrofia Ventricular Esquerda/tratamento farmacológico , Fatores de RiscoRESUMO
Masked hypertension (HTN) and white coat hypertension represent two reverse forms of clinical HTN with questionable prognostic significance. Recent evidence supports that low apelin and relaxin plasma levels contribute to vascular damage accelerating atherogenesis and predisposing to HTN and cardiovascular (CV) events. The aim of this study was to compare apelin and relaxin plasma levels between patients with masked hypertension (MH) and those with white coat HTN (WCH). Overall, 130 patients not receiving antihypertensive therapy were studied. All patients underwent 24-hour ambulatory BP monitoring (ABPM) and office BP measurements. Plasma apelin and relaxin levels were measured by ELISA method. According to BP recordings, 24 subjects had MH (group A) and 32 had WCH (group B). Apelin (200 ± 111 pg/mL vs 305 ± 127 pg/mL, P < 0.01) and relaxin (35.2 ± 6.7 pg/mL vs 46.8 ± 23.6 pg/mL, P < 0.01) plasma levels were significantly lower in patients with MH compared to those with WCH, respectively. In conclusion, our findings showed that patients with MH had significantly lower apelin and relaxin levels compared to those with WCH. This observation implies an additional prognostic role for adipokines supporting the concept that MH is closer to essential HTN whereas WCH is a more benign condition.
Assuntos
Apelina/sangue , Hipertensão Mascarada/metabolismo , Relaxina/sangue , Hipertensão do Jaleco Branco/metabolismo , Adipocinas/sangue , Adipocinas/farmacologia , Adulto , Apelina/farmacologia , Aterosclerose/complicações , Aterosclerose/epidemiologia , Monitorização Ambulatorial da Pressão Arterial/métodos , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Hipertensão Essencial/epidemiologia , Feminino , Humanos , Masculino , Hipertensão Mascarada/epidemiologia , Hipertensão Mascarada/fisiopatologia , Pessoa de Meia-Idade , Prevalência , Prognóstico , Relaxina/farmacologia , Fatores de Risco , Hipertensão do Jaleco Branco/epidemiologia , Hipertensão do Jaleco Branco/fisiopatologiaAssuntos
Fibrinolíticos/uso terapêutico , Inflamação/tratamento farmacológico , Infarto do Miocárdio/tratamento farmacológico , Placa Aterosclerótica/diagnóstico por imagem , Terapia Trombolítica/métodos , Remodelação Ventricular/fisiologia , Angiografia Coronária , Feminino , Humanos , Inflamação/diagnóstico , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Placa Aterosclerótica/diagnósticoRESUMO
Pulmonary embolism and thromboembolic disease carry a high mortality if not recognised and managed appropriately. Herein we illustrate the case of a dehydrated elderly female patient with recurrent syncope who proved to have high risk pulmonary embolism and a free floating right heart thrombus. The echocardiographic findings of right heart thrombus and possible thrombi 'in transit' within a low flow inferior vena cava, guided a life-saving treatment in this frail elderly patient.
