Hypertension

For several months, a 16-year-old girl has had an asymptomatic papulosquamousdescending linear eruption on 1 leg.

A 34-year-old man has had Crohn disease for 12years. He presented initially with ileitis and has had 3surgeries for obstructive complications. Ileum resectionhas resulted in bile salt and fat malabsorption. Recently,the Crohn disease has spread to the large bowel. For thelast 2 years, he has also had seronegative spondyloarthropathy-another complication of Crohn disease.

For 3 months, a 57-year-old woman has had a persistent green nail that is occasionallyslightly sore; the nail plate has lifted. Another physician prescribed a7-day course of levofloxacin for a suspected Pseudomonas infection; the treatmenthad no effect on the nail. A subsequent 7-day course of norfloxacin wasalso unsuccessful. The patient is otherwise healthy.

A 24-year-old woman complains ofa pruritic rash that erupted after shesoaked in a hot tub a few days earlier.The patient is otherwise healthy;her only medication is an oralcontraceptive.

A 67-year-old woman who is being treated as an inpatient for head traumacomplains of vague tenderness during an abdominal examination. Othercomplaints are difficult to assess. She had been placed on an oxygen ventilator;however, her cognitive function and pulmonary function are improving, andher cerebral edema is diminished.

A vigorous 61-year-old man presents for a preemployment physical examination.He has no symptoms of angina pectoris or congestive heart failure (CHF).

For 3 days, a 42-year-old man has had episodic dullchest pain. The anterior precordial and retrosternalpain intensifies with inspiration and movement. He has nohistory of recent viral infection, hypertension, coronaryartery disease, cardiac surgery, diabetes mellitus, or hyperlipidemia.There is no family history of cardiovasculardisease.

A 76-year-old woman presents with chest pain-which she describes as“muscle tightness”- that began when she awoke in the morning. Thepain is constant, exacerbated by deep inspiration, and accompanied by asubjective sense of slight dyspnea; she rates its severity as 3 on a scale of1 to 10. She denies pain radiation, nausea, diaphoresis, palpitations, andlight-headedness. Her only cardiac risk factors are hypertension and a distanthistory of smoking.

In their article, “Hypertensive Emergencies and Urgencies: Update on Management”(CONSULTANT, March 2004, page 341), Drs Iris Reyes and Rex Mathewwrite that labetalol is specifically indicated for most hypertensive emergencies,“especially stroke and acute cocaine intoxication.” In fact, labetalol is potentiallydeadly and is contraindicated in acute hypertension and/or concomitant chestpain related to cocaine intoxication.

ANN ARBOR, Mich. -- Surgery for renovascular hypertension in children is nearly always successful in curing or improving the high blood pressure, researchers here reported.

HOLLYWOOD, Fla. -- Without any fanfare or intention, the use of some drugs for high blood pressure may be silently protecting against Alzheimer's disease, suggest in vitro and animal studies presented here today.

An 81-year-old woman presented with a widespread pruritic eruption of 1 month's duration. She had hypertension but was otherwise healthy and was taking no new medications.

SAN DIEGO -- High blood pressure during pregnancy may be a warning sign for stroke or other cardiovascular events later in life, reported researchers here.

ROCHESTER, Minn. -- Mortality rates for heart failure patients with preserved left ventricular ejection fraction (non-systolic) are similar to those for patients with a reduced ejection fraction (systolic). However, a higher systolic pressure on admission was a marker of better prognosis.

WINSTON-SALEM, N.C. -- High serum levels of uric acid are strongly associated with risk for hypertension, particularly among blacks, reported researchers here.

Abstract: Our understanding of the pathobiology of pulmonary arterial hypertension (PAH) has evolved considerably over the past 2 decades, with increasing recognition of the important role that aberrant vasoproliferative responses play in conjunction with disordered vasoconstriction. Classification of the many forms of PAH into categories sharing a similar pathophysiology and clinical presentations help the practicing clinician approach a complex differential diagnosis. Noninvasive tests can be used to narrow this differential but must be applied with an appreciation for their limitations. Transthoracic echocardiography is the screening tool of choice; the workup should also include chest radiography and electrocardiography. However, right heart catheterization is ultimately required to establish the diagnosis. While PAH remains a progressive and generally fatal disease, existing therapies have a significant impact on survival and new therapeutic targets offer great hope for improving the prognosis. (J Respir Dis. 2006;27(11):487-493)

An 84-year-old man with a history of stable angina, type 2 diabetes, hyperlipidemia, and hypertension presents to the emergency department with worsening dyspnea and peripheral edema.

An asymptomatic loss of pigment around the eyelids of several weeks' duration prompts a 53-year-old woman to seek evaluation. She has not started wearing any new eye makeup; her only medication is an antihypertensive.

SAN ANTONIO -- Children with high blood pressure are more likely to snore and have other sleep disordered breathing problems than normotensive peers, researchers reported here.

A previously healthy 56-year-old woman presented to her primary care physician with progressive dyspnea and pleuritic chest pain. She was afebrile and had a heart rate of 83 beats per minute, blood pressure of 104/70 mm Hg, and respiration rate of 20 breaths per minute. Her oxygen saturation was 87% on room air and 92% while receiving 3 L of oxygen via nasal cannulae.

Q: What is the lowest acceptable diastolic blood pressure (DBP) in a patient with systolic hypertension who is older than 65 years?

What is the lowest acceptable diastolic blood pressure (DBP) in a patient with systolic hypertension who is older than 65 years?

An 87-year-old woman complained of a red tinge in the vision of her right eye. She also felt that the vision in the right eye was just not right. She was pseudophakic in both eyes from previous cataract surgery. She had diet-controlled diabetes and took atenolol for hypertension.

Acute parotiditis is characterized by unilateral swelling of the parotid gland with associated erythema and tenderness. Purulent secretions from the Stensen duct may be noted in more than 50% of the cases.

COPENHAGEN -- The ACE-inhibitor Altace (ramipril) does not prevent type 2 diabetes in patients with impaired glucose metabolism, found DREAM trial researchers.

COPENHAGEN -- The ACE-inhibitor Altace (ramipril) does not prevent type 2 diabetes in patients with impaired glucose metabolism, found DREAM trial researchers.

ABSTRACT: Our knowledge of chronic diseases has advanced significantly in recent decades, but patient outcomes have not kept pace. This is largely because the traditional acute care model does not adequately address the needs of patients with chronic disease. Patients play an active role in the management of chronic disease, and successful outcomes are highly dependent on adherence to treatment. Thus, clinicians need to have skills in coaching and encouraging as well as an awareness of factors in patients' backgrounds that are likely to affect their ability or willingness to follow treatment plans. Provider- and system-related factors, such as lack of reimbursement for counseling and high copayments, can also act as barriers to compliance. Among the strategies that can improve adherence are the use of community resources, multidisciplinary approaches, and regular follow-up.

The term "prehypertension" was introduced in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines to describe blood pressures (BPs) of 120/80 mm Hg to 139/89 mm Hg.1

A 64-year-old woman presents with persistent, progressively worsening chest pain and dyspnea of 1 month's duration. She also reports orthopnea, bilateral leg swelling, and weight gain. She denies any history of similar symptoms.

Over the past few decades, the management of chronic disease has assumed a greater role in health care. Diseases such as diabetes, chronic obstructive pulmonary disease, and depression have replaced acute disorders as the leading cause of morbidity, mortality, and health care expenditures.