Hypertension

VIENNA, Sept. 4 -- Even normotensive patients with diabetes can reduce their risk of heart attack, stroke, and renal failure by lowering of blood pressure, researchers reported here.

A 68-year-old woman with hypertension complains of intermittent dyspnea and light-headedness. She is asymptomatic during the evaluation. Vital signs are normal, but an irregularly irregular pulse is noted on examination as well as on the telemetry monitor. The 12-lead ECG is shown here; the ECG machine printout reads "atrial fibrillation." The patient has no history of this arrhythmia.

Current evidence suggests that out-of-office blood pressure measurements and 24-hour ambulatory blood pressure monitoring are better predictors of cardiovascular risk than routine office measurements. Is it time to make greater use of automated devices in my practice?

An 83-year-old man with a history of hypertension, hyperlipidemia, and diverticulosis was hospitalized because of painless hematochezia of 1 day's duration. Two years earlier, he had undergone surgical excision of a superficial spreading melanoma on his right thigh.

BOSTON -- Childhood hypertension is there, if only pediatricians would look for it. Most of the time, they don't, investigators here reported.

Lyon, France -- Residence in a nursing home and taking antihypertensive medications are among the factors that increase the risk of death following heatstroke, investigators here found.

My patient is an 82-year-old woman with a history of coronary artery bypass grafting (CABG), chronic obstructive pulmonary disease (COPD), pulmonary hypertension, and mild intermittent angina on exertion, which is relieved by sublingual nitroglycerin.

OKAYAMA, Japan -- When medical therapy flags for pulmonary artery hypertension (PAH), lung transplants from related living donors can be life-saving, researchers here said.

UTRECHT, Netherlands -- Exposure to tobacco smoke before birth may raise blood pressure substantially in infancy, which could have consequences later in life, researchers here said.

BIRMINGHAM, Ala.-- Combining two classes of renin inhibition led to significantly lowered blood pressures than did treatment with either alone.

GAINESVILLE, Fla. -- Hispanic women with coronary artery disease and hypertension achieved better blood pressure control than non-Hispanic white counterparts who were treated with the same antihypertensive drugs.

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.