Results of the trycort: Cohort study of add-on antihypertensives for treatment of resistant hypertension.

Although true treatment resistant hypertension is relatively rare (about 7.3% of all patients with hypertension), optimal control of blood pressure is not achieved in every other patient due to suboptimal treatment or nonadherence. The aim of this study was to compare effectiveness, safety and tolerability of various add-on treatment options in adult patients with treatment resistant hypertension The study was designed as multi-center, prospective observational cohort study, which compared effectiveness and safety of various add-on treatment options in adult patients with treatment resistant hypertension. Both office and home blood pressure measures were recorded at baseline and then every month for 6 visits. The study cohort was composed of 515 patients (268 females and 247 males), with average age of 64.7 ± 10.8 years. The patients were switched from initial add-on therapy to more effective ones at each study visit. The blood pressure measured both at office and home below 140/90 mm Hg was achieved in 80% of patients with add-on spironolactone, while 88% of patients taking this drug also achieved decrease of systolic blood pressure for more than 10 mm Hg from baseline, and diastolic blood pressure for more than 5 mm Hg from baseline. Effectiveness of centrally acting antihypertensives as add-on therapy was inferior, achieving the study endpoints in <70% of patients. Adverse drug reactions were reported in 9 patients (1.7%), none of them serious. Incidence rate of hyperkalemia with spironolactone was 0.44%, and gynecomastia was found in 1 patient (0.22%). In conclusion, the most effective and safe add-on therapy of resistant hypertension were spironolactone alone and combination of spironolactone and a centrally acting antihypertensive drug.

Effects of Knee Extension Joint Angle on Quadriceps Femoris Muscle Activation and Exerted Torque in Maximal Voluntary Isometric Contraction.

This study investigated the effects of knee joint angle on muscle activation, exerted torque, and whether the knee angle affects the muscle activation−torque ratio. Nine healthy adult male participants participated in the study. They performed maximal voluntary isometric contraction (MVIC) at six (80°, 90°, 100°, 110°, 120°, and 130°) different knee joint angles (i.e., angles between the thigh and shin bones). Their maximal torque was assessed utilizing an isokinetic chair, while their muscle activation (root mean square [RMS]) was assessed using an eight-channel single differential surface EMG sensor. For the purposes of the torque−knee angle relationship and muscle activation−knee angle relationship, the torque and RMS were normalized relative to the maximal value obtained by each participant. To evaluate the muscle activation−torque ratio in function of knee angle, RMS was normalized relative to the corresponding torque obtained at each knee angle. Repeated measure analysis of variance was used to investigate the effects of knee angle on muscle activation, torque, and muscle activation−torque ratio. There was a significant effect of knee joint angle on normalized torque (F = 27.521, p < 0.001), while the activation of vastus lateralis and vastus medialis remained unchanged. The changes in knee angle affected the muscle activation−torque ratio of vastus lateralis (Chi-square = 16.246, p = 0.006) but not the vastus medialis. These results suggest that knee joint angles from 80° to 130° provide a stable milieu for muscle electrification, while mechanical factor such as knee joint angle (i.e., lever arm length) affect the torque output when one needs to contract quadriceps maximally during the isometric contraction.

[The importance of echocardiography in diagnostics of idiopathic pulmonary arterial hypertension: a case report].

INTRODUCTION: Idiopathic pulmonary arterial hypertension (IPAH) is rare and difficult progressive disease with prevalence of approximately 15 cases per million residents, with predominant female cases. CASE OUTLINE: A 47-year-old female presented with symptoms and signs of the right heart chambers failure. Over prior seven years the patient had the feeling of suffocation and fatigue when walking, and received treatment for bronchial asthma. Physical examination revealed a marked loud second heart sound over the pulmonary artery. Electrocardiogram: right ventricular hypertrophy. Spirometric (pulmonary capacity) test, cardiac perfusion scan and spiral CT scanning excluded secondary pulmonary arterial hypertension. Blood testing for connective tissue diseases and HIV were within normal reference limits. Transthoracic colour Doppler echocardiography demonstrated a mild tricuspid regurgitation with high values of estimated maximal and middle systolic pressure of the right ventricle (135/110 mm Hg), and excluded previous heart disease. Cardiac catheterization confirmed IPAH diagnosis, with systolic right ventricular pressure of 101/47/66 mm Hg and pulmonary capillary pressure of 30/13/10 mm Hg. Basic therapy with sildenafil, nevertheless, considerable limitations of strain tolerance was still present. CONCLUSION: IPAH is a severe heart disease with non-specific signs and symptoms. Screening for IPAH is transthoracic colour Doppler echocardiography shows high correlation with cardiac catheterization.