Hypertension

SAN ANTONIO -- Uncontrolled hypertension in older patients increases the risk of cognitive impairment, researchers reported here.

MATSUMOTO, Japan -- Among patients in their 60s and older, fast walking is better than moderate strolling to improve systolic blood pressure and flexibility, researchers here have found.

BOSTON -- Medicare may be inheriting big expenses from the lengthy ravages of medical neglect faced by uninsured Americans who had been unable to afford treatment for hypertension, diabetes, or other chronic conditions.

MONTREAL -- Patients with high blood pressure may be at risk for episodes of silent ischemia because they have a decreased perception of the pain that would otherwise signal heart disease, researchers here said.

CLEVELAND -- Beta-blocker therapy can provide statistically significant regression of coronary artery plaque, found a review of intravascular ultrasound (IVUS) studies here.

COLOGNE, Germany -- Small doses of daily dark chocolate lowered blood pressure by an amount equivalent to established hypertension diet plans.

At a routine blood pressure check, a 63-year-old woman has 2 readings of 165/100 mm Hg. The patient has had essential hypertension since age 41 years. For more than a decade, it was easily controlled with a b-blocker; however, in recent years, her blood pressure has been more variable, with occasional readings of higher than 150/90 mm Hg.

Heart failure is prevalent in both primary care and cardiology practices. It develops in about 1 in 5 persons during their lifetime and in about 1 in 8 of those who have not sustained a myocardial infarction (MI). Heart failure is also the leading cause of hospitalization in the elderly.

Lp(a) is a fascinating variant of low-density lipoprotein (LDL). It is basically an LDL molecule that has been modified by the covalent addition of apoprotein(a). Elevated levels of Lp(a) correlate with increased risk of acute coronary syndromes, cerebrovascular accident, peripheral arterial disease, and coronary mortality. This Q&A session answers some curiosities about Lipoprotein(a).

A 67-year-old woman arrived via ambulance in ventricular tachycardia. She had been experiencing crushing substernal chest pain and shortness of breath that had worsened over the past several hours. She received oxygen (by mask) and lidocaine (100 mg intravenously) en route to the emergency department (ED), but there was no change in the rhythm.

A 60-year-old African American woman presented with an asymptomatic, nonpruritic lesion on the left temporal scalp that bled intermittently. She had noticed the lesion after she used a hair relaxant 5 to 6 months earlier. Since then, the lesion had slowly enlarged. She had a history of type 2 diabetes mellitus and hypertension. She denied alcohol consumption and tobacco use.

HONOLULU -- Medicare Part D formularies cover nearly all drug classes for treatment of hypertension, hyperlidemia, and depression, with generics accounting for most of the agents.

ROCKVILLE, Md. -- The FDA has approved ambrisentan (Letairis), an endothelin receptor antagonist, for treatment of pulmonary arterial hypertension (PAH).

BALTIMORE -- Mean arterial pressure declines during a coronary bypass surgery, but a mean drop of 27 mm Hg or more may increase the risk of post-operative cognitive dysfunction.

CHICAGO -- Initiating treatment with a combination of anti-hypertensive drugs gets 75% of patients' blood pressures under control, researchers reported here.

In patients presenting with severe hypertension, what constitutes a true emergency?

Is it necessary to prescribe lipid-lowering therapy for a patient with a mildly elevated total cholesterol level (240 mg/dL), a low-density lipoprotein (LDL) cholesterol level of 120 mg/dL, and a high high-density lipoprotein (HDL) cholesterol level of 100 mg/dL?

Torsades de pointes, or polymorphic ventricular tachycardia, seen on ECG includes wide complex QRS morphology tachycardia, axis deviation of the QRS complexes around baseline.

A 50-year-old man with end-stage renal disease secondary to long-standing hypertension had an elevated hematocrit and progressively increasing hemoglobin levels. For the past 7 years, he had been receiving hemodialysis 3 times a week. He denied headache, flushing, easy bruising, bleeding, nausea, vomiting, chest pain, dyspnea, and other symptoms. He was not receiving exogenous erythropoietin.

WINSTON-SALEM, N.C. -- A simple exercise test measuring the ratio of oxygen consumption to carbon dioxide production can predict mortality risks in systolic heart failure, said researchers here.

SAN FRANCISCO -- Pregnant women who have disordered breathing patterns during sleep may be at elevated risk of developing diabetes and high blood pressure -- including eclampsia and pre-eclampsia.

SAN DIEGO -- In utero exposure to selective serotonin reuptake inhibitors was not significantly associated with the risk for cardiac malformations or persistent pulmonary hypertension, researchers reported here.

CHICAGO -- Fixed combination doses of a calcium-channel blocker and an angiotensin-receptor blocker appear to improve hypertension treatment, researchers said here.

CHICAGO -- Obesity appears to be associated with an increased risk of diastolic rather than systolic hypertension subtypes, researchers said here.

CHICAGO -- For the lack of a convenient abbreviation, a diuretic with a good track record for hypertension is often spurned on prescription pads, said researchers here.

HELSINKI, Finland -- When babies born prematurely with a low birth weight become young adults, they are likely to have higher levels of insulin resistance, glucose intolerance, and higher blood pressure than those born at term, researchers here reported.

NEW YORK -- Aliskiren, the first oral antihypertensive agent in the renin-inhibitor class, is no better at reducing blood pressure than older agents, and in some patients may actually increase blood pressure, claimed two reviewers.

SEATTLE -- Lowering blood pressure with centrally active angiotensen enzyme inhibitors may have the added benefit of reducing the risk of cognitive decline, researchers here reported.

FLORENCE, Italy -- An ultrasound measurement of liver thickness predicted portal hypertension in patients with hepatitis C-related cirrhosis, researchers here found.

Patients with congenital heart disease and pulmonary arterial hypertension (PAH) are at risk for severe deterioration during pregnancy and delivery. We discuss the case of a 38-year-old woman who presented to the emergency department complaining of dyspnea 6 days after giving birth to her first child via cesare- an section. When PAH is untreated, maternal mortality may exceed 50%, but aggressive PAH treatment offers improved outcomes. Moreover, initial improvement in functional status made with parenteral prostanoids can be maintained with combination oral therapy.