The diagnostic approach and management of hypertension in the emergency department.

Hypertension urgency and emergency represents a challenging condition in which clinicians should determine the assessment and/or treatment of these patients. Whether the elevation of blood pressure (BP) levels is temporary, in need of treatment, or reflects a chronic hypertensive state is not always easy to unravel. Unfortunately, current guidelines provide few recommendations concerning the diagnostic approach and treatment of emergency department patients presenting with severe hypertension. Target organ damage determines: the timeframe in which BP should be lowered, target BP levels as well as the drug of choice to use. It's important to distinguish hypertensive emergency from hypertensive urgency, usually a benign condition that requires more likely an outpatient visit and treatment.

Uric acid blood levels and relationship with the components of metabolic syndrome in hypertensive patients.

Associations between high serum uric acid (SUA) levels and high blood pressure (BP), as well as between SUA levels and metabolic syndrome (MetS) have already been reported. The aim of the study was to investigate the relationship between the components of MetS with the SUA levels as also between SUA and apolipoproteins A1 and B (apoA1 and apoB) ratio in hypertensive patients. A total of 2577 consecutive hypertensive patients (1193 male and 1384 female) aged 57.5±13.3 years, were enrolled in our research. Samples were taken to measure SUA, glucose, triglycerides, high density lipoprotein (HDL-C), components of the MetS and apoA1 and apoB. The study population was divided into two groups: group A: SUA levels above normal range (men ⩾7 mg dl(-1), women ⩾6 mg dl(-1)) and group B: SUA levels within normal range. In the overall study population, SUA levels showed a statistically significant correlation with waist circumference (WC; r=0.293, P<0.000), triglycerides (r=0.197, P<0.000), glucose (r=0.085, P<0.000), apoB/apoA1 (r=0.136, P<0.000) and HDL-C (r=-0.235, P<0,001). In newly diagnosed untreated hypertensive patients there was also a statistically significant correlation of SUA levels with WC (r=0.331, P<0.001), triglycerides (r=0.228, P<0.001) apoB/apoA1 ratio (r=0.202, P<0.001) and HDL-C (r=-0.278, P<0.001). In hyperurecemic hypertensives there was a statistically significant correlation between SUA levels with WC (r=0.168, P=0.007), apoB/apoA1 ratio (r=0.256, P=0.003) and HDL-C (r=-0.202, P<0.001). SUA levels correlate significantly with all the components of MetS, as well as with the risk factor apoB/apoA1 ratio, in hypertensive patients.

Effects of regular exercise on blood pressure and left ventricular hypertrophy in African-American men with severe hypertension.

BACKGROUND: The prevalence of hypertension and its cardiovascular complications is higher in African Americans than in whites. Interventions to control blood pressure in this population are particularly important. Regular exercise lowers blood pressure in patients with mild-to-moderate hypertension, but its effects in patients with severe hypertension have not been studied. We examined the effects of moderately intense exercise on blood pressure and left ventricular hypertrophy in African-American men with severe hypertension. METHODS: We randomly assigned 46 men 35 to 76 years of age to exercise plus antihypertensive medication (23 men) or antihypertensive medication alone (23 men). A total of 18 men in the exercise group completed 16 weeks of exercise, and 14 completed 32 weeks of exercise, which was performed three times per week at 60 to 80 percent of the maximal heart rate. RESULTS: After 16 weeks, mean (+/- SD) diastolic blood pressure had decreased from 88 +/- 7 to 83 +/- 8 mm Hg in the patients who exercised, whereas it had increased slightly, from 88 +/- 6 to 90 +/- 7 mm Hg, in those who did not exercise (P = 0.002). Diastolic blood pressure remained significantly lower after 32 weeks of exercise, even with substantial reductions in the dose of antihypertensive medication. In addition, the thickness of the interventricular septum (P = 0.03), the left ventricular mass (P = 0.02), and the mass index (P = 0.04) had decreased significantly after 16 weeks in the patients who exercised, whereas there was no significant change in the nonexercisers. CONCLUSIONS: Regular exercise reduced blood pressure and left ventricular hypertrophy in African-American men with severe hypertension.

Cardiorespiratory fitness and coronary heart disease risk factor association in women.

OBJECTIVES: The purpose of this study was to examine the association between cardiorespiratory fitness and coronary risk factors in healthy, nonsmoking adult women. BACKGROUND: A sedentary life-style is recognized as an independent risk factor for coronary heart disease, and increasing physical activity is strongly recommended to reduce this risk. However, studies examining the effects of increased physical activity on coronary heart disease risk factors in women are relatively few, and the findings have been equivocal. METHODS: Subjects provided written informed consent, completed a questionnaire on medical history and performed an exercise tolerance test. Blood chemistry and lipid levels were determined from fasting blood samples. Three fitness categories were established on the basis of treadmill time to exhaustion and were adjusted for age. RESULTS: The women in the lowest fitness category had less favorable lipid profiles, blood glucose levels, blood pressures and anthropometric indexes than those in the moderate and high fitness categories. CONCLUSIONS: Moderate fitness (equivalent to 10 metabolic equivalents [METs]) is required to improve the coronary risk profile in women.

Effect of acute ventricular pressure changes on QRS duration.

The effect of acute changes in ventricular pressure is examined on the QRS duration to clarify the mechanism of ventricular pressure-related arrhythmogenesis. Ventricular pressure was changed acutely by arterial transfusion-bleeding into an open-air ventricular pressure reservoir that was either off or on a metaraminol intravenous drip. While maintaining ventricular pressure at several levels, the QRS duration was measured at 200 mm/s paper speed. The QRS duration correlated significantly with the left ventricular pressure in all 14 dogs examined. An average change in ventricular by 100 mmHg was associated with a change of about 18% in the QRS duration. An acute ventricular pressure elevation impairs the ventricular conduction, which may contribute to ventricular pressure-related arrhythmogenicity.