Evolution features of hypertensive patients with primary aldosteronism--prospective study.

BACKGROUND: Primary aldosteronism is the leading cause of secondary hypertension, the management of this disease requiring an interdisciplinary approach. OBJECTIVES: Evaluation of evolutionary features of patients with secondary hypertension and primary aldosteronism. METHODOLOGY: We have followed 26 patients diagnosed with secondary hypertension and primary aldosteronism, who were admitted consecutively to "C. I. Parhon" Endocrinology Institute between 2004-2009. Of the 26 patients, 17 had adenoma producer of aldosterone (APA), 8 had bilateral adrenal hyperplasia idiopathic (HIA) and one patient had adrenal carcinoma (with hypersecretion of aldosterone). The mean age of the cohort was of 49.3 years (44.9 years for adenomas and 52.6 years for bilateral hyperplasia). The evaluation of the patients included clinical examination, electrocardiogram, Holter BP, echocardiography and determination of plasma aldosterone and renin. RESULTS: The evolution of the patients with primary aldosteronism was different depending on the anatomoclinic type. In patients with idiopathic bilateral hyperplasia, medical treatment has improved control of hypertension and cardiac and cerebrovascular complications rate was moderate. In patients with unilateral adenoma producing aldosterone, blood pressure had higher values and more frequent complications, but surgical cure of adenomas significantly changed the prognosis of patients. In both cases, the presence of hypokalemia was an additional element of severity. CONCLUSIONS: Regardless of the primary aldosteronism, hypertension was directly involved in cardiac and cerebrovascular complications. Individualization of treatment according to the anatomoclinic type determined a significant improvement of the patients' prognosis.

The prognostic value of blood glucose level on admission in non-diabetic patients with acute myocardial infarction.

UNLABELLED: The diabetic patients represent a population with a high risk of morbidity and mortality because of vascular complications. Out of them, all the patients with acute ST-elevation myocardial infarction have a more reserved prognostic than those without diabetes mellitus. Moreover, the patients with impaired glucose tolerance have a more severe evolution in case of a myocardial infarction. AIM: We wondered about the progress of patients with myocardial infarction and high blood glucose levels in admittance who had not been previously diagnosed with diabetes mellitus. MATERIALS AND METHODS: We took 128 patients (who did not have diabetes) with acute ST-elevation myocardial infarction and divided them into three groups, according to the blood glucose level in admittance (<140 mg/dL, 140-200 mg/dL and > 200 mg/dL); we also analyzed a group of diabetics with acute myocardial infarction who were admitted in the same period in our clinic. We made a prospective analysis over a period of 30 days. We evaluated the mortality at 30 days (as primary objective), as well as the extent of the infarction and the change of the left ventricle systolic function (secondary objectives). RESULTS: Both mortality and the mass of myocardial necrosis grew relative to the blood glucose level in admittance; instead, the ejection fraction varied inversely to the initial blood glucose level. CONCLUSION: The admittance blood glucose level represents a useful and available marker for the initial stratification of risks in patients with acute myocardial infarction, even in those undiagnosed with diabetes mellitus.

Streptokinase-induced hypotension has no detrimental effect on patients with thrombolytic treatment for acute myocardial infarction. A substudy of the Romanian Study for Accelerated Streptokinase in Acute Myocardial Infarction (ASK-ROMANIA).

UNLABELLED: The Streptokinase (SK) regimen (1.5 MU/60 minutes) has remained unchanged for the past 20 years in patients with ST-segment elevation acute myocardial infarction (STEMI) due to fear of hypotension (a specific effect of this thrombolytic agent) and of hemorrhagic complications. OBJECTIVE: To evaluate the influence of the Streptokinase-induced hypotension (SK-hTA) on the rate of coronary reperfusion (CR), incidence of cardiogenic shock (CS), 30-day mortality and incidence of stroke in patients (pts.) with STEMI. The SK-hTA was defined as decrease of the systolic blood pressure with at least 20% within the first 20 min. after the start of the SK infusion. METHODS: A group of 837 pts. (age 20-90) with thrombolytic treatment, with three "accelerated" SK regimens within the first 6 hours after the onset of STEMI and enrolled in the Romanian open, prospective, non-randomised study for accelerated SK in STEMI (ASK-ROMANIA) have been included. The SK regimens consisted in infusing of the standard dose of 1.5 M.U. either in 30 min. (regimen SK1.5/30, 173 pts).) or in 20 min. (regimen SK1.5/20, 377 pts.) or of the half dose (0.75 M.U.) in 10 min. followed by a new infusion of 0.75 M.U. after 50 min. only if no bed-side signs of CR have been recorded (regimen SK 0.75/10, 287 pts.). The speed of the SK infusion was maintained in all pts. experiencing SK-hTA. All pts. received aspirin and heparin or enoxaparin if not contraindicated. Three noninvasive CR criteria have been used: 1. Rapid cessation of the chest pain. 2. Rapid decrease of the ST segment elevation by more than 50% of the initial value. 3. Rapid increase of the CK and CK-MB with a peak within the first 12 hrs. RESULTS: SK-hTA appeared in 372 pts. (44.55%) at 9+/-5 min after the start of the SK infusion. In this subgroup the rate of CR was 74.46%, non-significantly higher than the one of 68.81% registered in pts. without SK-hTA (p=0.071). SK-hTA disappeared in all patients after 16+/-6 minutes without a specific therapy. Fourteen pts. with SK-hTA (3.76%) and 16 pts. without SK-hTA (3.44%) developed CS after thrombolysis ( non-significant difference). The global in-hospital mortality was 10.21% in pts. with SK-hTA and 9.89% in pts. without this side effect (non-significant difference). The incidences of hemorrhagic and ischemic strokes were 0.26% (1 patient) respectively 0.52% (2 pts.) in the SK-hTA subgroup and 0.43% (2 pts.) respectively 0.64% (3 pts.) in the subgroup without SK-hTA. CONCLUSIONS: 1. Despite a very high incidence (44.55%) the SK-hTA has not a detrimental effect in pts. treated with accelerated SK regimens for STEMI. 2. Streptokinase can be rapidly administered without an increased risk.

Accelerated streptokinase--a new thrombolytic regimen in acute myocardial infarction.

Efficiency and safety of an accelerated regimen of streptokinase (1.5 M.U. over 20 min., 109 patients) has been compared with the standard regimen (1.5 M.U. over 60 min, 119 patients) in 218 patients admitted within the first 6 hours after the onset of the symptoms of acute myocardial infarction. Using the noninvasive criteria we found a coronary reperfusion rate of 77.04% in patients belonging to the accelerated regimen group and this value was significantly higher than the one of 57.14% registered in the standard group. No major hemorrhagic events were registered in both groups. Although the hypotension appeared to be more frequent in patients in whom the accelerated regimen was used, however this side effect proved to be transient and well controlled using the rapid infusion of natrium chloride solution. In conclusion, the accelerated regimen of streptokinase is safe and followed by a higher rate of coronary reperfusion as compared to the standard one.