Elderly men are underscreened for primary aldosteronism even in Hypertension Excellence Centre.

Purpose The Endocrine Society (ES) guidelines recommend screening for primary aldosteronism (PA) in high risk hypertensive patients presenting with at least one of seven criteria (resistant HTN, hypokalaemia, adrenal nodule, etc.) Although guidelines are clear and screening is simple, compliance rates among clinicians are extremely low. This results in underdiagnosis of early disease, leading to cadiovasculaer complications and the extra-burden of advanced chronic kidney disease. We aimed to evaluate the screening rates in our Nephrology and Hypertension clinics, as an example of a dedicated Hypertension Excellence Centre. Materials and methods Data on adult hypertensive patients was retrieved from January 2018 to December 2020. Included in the study were hypertensive patients who had at least one of the ES criteria for PA screening. Of all suitable patients, we compared those who were screened for PA to patients who were not screened. Univariate and multivariate cox regression analyses were used for comparison between groups. Results Of 661 patients with HTN, 218 patients (33%) met the ES guidelines for PA screening. Forty-six of them (21.1%) were referred for screening. Advanced age and male gender were associated with lower screening referral rates. Odds ratio for age was 0.945 for every year (95% CI 0.915 - 0.975). There was a trend towards decreased referral rate in advanced kidney disease. Conclusions A 21% screening rate, suggests that many cases of PA are likely missed, more often in older patients. We therefore advocate for PA screening of all hypertensive patients, especially elderly patients with CKD, in whom clinicians' awareness is low but the absolute risk is high.

Aldosterone is a hormone secreted from the adrenal gland.Oversecretion of aldosterone (Primary Aldosteronism [PA]) causes salt retention, urinary loss of potassium and difficult to control hypertension.Both hypertension and hyperaldosteronism act synergistically and cause, over time, severe cardiac, vascular and renal damage.Different guidelines support doctors' decision-making algorithm, suggesting who should be evaluated for aldosterone hypersecretion.Our study demonstrates that even in an expert hypertension centre, many candidates for screening are missed. Elderly men are specifically underscreened.Since PA is not as rare as once thought, and can have a devastating impact on patients' health, we suggest screening all hypertensive patients for autonomous hypersecretion of aldosterone.

Critical Stepwise Decline of Antibodies against SARS-CoV-2 among Chronic Hemodialysis Patients 180 Days Post Comirnaty Vaccine.

BACKGROUND: The reduced immune response of maintenance hemodialysis patients to coronavirus disease 2019 (COVID-19) vaccines is a major concern. OBJECTIVES: To analyze the late (6 months after full vaccination) antibody response and compare it to early post-vaccination titer. METHODS: We conducted a multicenter prospective study of 13 hemodialysis units in Israel. RESULTS: We demonstrated that the low titers observed among ESRD patients 2-3 months after vaccination with the Comirnaty vaccine (median 63.8 AU/ml) declined to critically lower values 6 months after full vaccination. (Mediananti S antibodies, 31 AU/ml). Seropositivity significantly declined among hemodialysis patients from 89% to 74% (P < 0.0001), although it did not significantly change among controls. CONCLUSIONS: We recommend all patients on hemodialysis receive a booster COVID-19 vaccine 6 months after the second dose.

The Relationship between Hypertension and Cancer.

BACKGROUND: Hypertension and cancer are both common due to the aging of the population and the advances in medical treatment which result in increased survival of cancer patients today. More patients with cancer; therefore, present with hypertension, which is attributed to different factors, including genetics and age as well as the type of tumor and cancer-related treatments. Given the increased cardiovascular and mortality risk related to hypertension, it is important to appropriately identify and treat hypertension, particularly in the population of vulnerable cancer patients. In this article we discuss the epidemiology, different etiologies, and approaches to the management of hypertension in cancer patients.

[HYPERTENSION IN A YOUNG WOMAN WITH ANXIETY DISORDER: THE CHICKEN OR THE EGG?]

INTRODUCTION: This is a case study of a thirty-five year old woman with a past medical history of anxiety disorder and hypertension which has been elevated up to 180/100 mmHg during the previous year. She had no cardiovascular risk factors or family history of hypertension. Her high blood pressure was initially attributed to emotional stress, however, she was later referred for additional evaluation for secondary causes of hypertension. Her lab test results demonstrated significantly elevated plasma aldosterone levels and suppressed renin levels. A computed tomography scan demonstrated a left adrenal mass consistent with adrenal adenoma, with a normal adrenal gland on the right. Immediately after left adrenalectomy, plasma aldosterone level normalized and blood pressure was controlled with only minimal pharmacotherapy. Approximately 10 days post-surgery, her blood pressure values were measured in a range of 125/90 and anxiety significantly improved, under treatment only with 12.5mg Atenolol.

[HYPERTENSION IN A PATIENT WITH AN ADEQUATELY TREATED COARCTATION OF THE AORTA - WHAT IS THE REASON FOR UNCONTROLLED HYPERTENSION?]

INTRODUCTION: A 35 year old patient, who had a successful surgical repair of coarctation of the aorta in early childhood, was referred for investigation regarding the cause for resistant hypertension. He underwent a full workup which was negative. Due to elevated renin levels his medications were altered with corresponding normalization of the renin levels. Symptomatic palpitations subsided after stopping treatment with a calcium channel blocker (lercanidipine), which implies reflex tachycardia secondary to lercanidipine. After all the investigations and interventions were performed, it appears that the etiology of resistant hypertension in his case is secondary to the coarctation, in spite of prior successful therapeutic interventions.