[Takayasu's arteritis: underestimated cause of hypertension]. / Choroba takayasu--niedoceniana przyczyna nadcisnienia tetniczego.

UNLABELLED: Takaysu's arteritis (TA) is regarded to be a frequent cause of hypertension in Asian population. However some reports have recently informed about increasing frequency of its also in non Asian people. The aim of this study was to evaluated own experiences on diagnosis and treatment of TA as well as prevalence of TA in hypertensive patients in Caucasian population. MATERIALS AND METHODS: During last 15 years we examined 4190 hypertensive patients hospitalized in our department. Renovascular hypertension was recognized in 139 cases. The diagnosis of TA was based on angiographically proven vascular changes and its inflammatory phase on estimation increased (> 40 mm/h) sedimentation rate and immunoglobulins above normal level. The patients with acute phase of TA initially received typical immunosuppressive therapy (prednisone in monotherapy or combined with azatioprine or cyclophosphamide), followed by chronic administration of prednisone. In every case, if it was possible, we proposed angio-corrective procedure. All patients have received hypotensive and antiplatelet therapy. RESULTS: TA was recognized in 15 patients--4 men and 11 women, average age 36.3 +/- 9.8 y. The patients with TA represented 0.37% hypertensive and 10.9% cases of renovascular hypertension. Significant stenosis of renal artery and various degree of lesions in aorta and some arteries was discovered in all persons. In the observed group hypertension was effectively controlled with 2-3 hypotensive drugs, including ACE inhibitors, diuretics and Ca antagonists. The acute phase of TA was diagnosed in 11 patients and it was treated successfully (except one case) with immunosuppressive therapy. After discontinuation of the treatment (4 patients) progression of the disease was observed. In 6 patients, characterised by clinical and biochemical remission of acute phase percutaneous angioplasty renal artery was performed. A good result in long-term follow-up period was observed in 4 cases (in 2 after repeated procedure). Surgical procedure was performed in 4 cases--in 2 on carotid and in 1 on renal and the next one on coronary artery. In first 3 cases the procedures were unsuccessful (reocclusion ?). CONCLUSIONS: Our observation suggested that 1. The incidence of TA in hypertensive (especially renovascular hypertension) population is more frequent than expected. 2. Acute phase of the disease is indication to long-term the immunosuppressive therapy. 3. Angiocorrective procedure is necessary reflected in every case in period of remission of acute phase.

Clinical characteristics of patients with resistant hypertension: the RESIST-POL study.

Recent studies indicate that resistant hypertension (RHTN) is present in about 12% of the treated hypertensive population. However, patients with true RHTN (confirmed out of the office) have not been widely studied. We prospectively studied 204 patients (123 male, 81 female, mean age 48.4 years, range 19-65 years) with truly RHTN (ambulatory daytime mean blood pressure >135/85 mm Hg). We evaluated the frequency of obstructive sleep apnea (OSA), renal artery stenosis (RAS), primary aldosteronism (PA) and other secondary forms of hypertension (HTN) and conditions. Mild, moderate and severe OSA were present in 55 (27.0%), 38 (18.6%) and 54 (26.5%) patients, respectively. Secondary forms of HTN were diagnosed in 49 patients (24.0%), the most frequent being PA (15.7%) and RAS (5.4%). Metabolic syndrome (MS) was present in 65.7% of patients. Excessive sodium excretion was evident in 33.3% of patients and depression in 36.8% patients. In patients with RHTN, OSA and MS were the most frequent conditions, frequently overlapping with each other and also with PA. Our data indicate that in the vast majority of patients with truly RHTN, at least one of three co-morbidities-OSA, MS and PA-is present. Other conditions, even though less frequent, should also be taken into the consideration.

[2 cases of Sneddon syndrome]. / Dwa przypadki zespolu Sneddona.

Two cases of Sneddon syndrome (S.s.) in a 33 and 53-year-old women who developed arterial hypertension, cerebral ischaemic signs and who have livedo reticularis or livedo racemosa, are reported. The authors describe clinical, radiological and biological features of this rare disease, as well as diagnostic investigations including the measurements of the antiphospholipid antibodies (APA). The possible role of APA in the pathogenesis of S.s. is discussed.

[A difficult diagnostic case of malignant hypertension]. / Trudny diagnostycznie przypadek nadcisnienia zlosliwego.

A case of a 62-year old male with malignant hypertension was described. The clinical picture was dominated by the presence of cachexia, polyuria and polyneuropathy. Laboratory examinations revealed highly elevated sedimentation rate, hyponatremia and hypokalemia. Secondary hypertension as well as other diseases with similar clinical symptoms were excluded basing in diagnostic procedures. The authors discuss pathophysiological mechanisms on the base of abnormally elevated activity of the renin-angiotensin-aldosterone system. Unusual body weight loss (approximately 20 kgs), polyneuropathy and irreversible lesion of renal tubules without renal function impairment are emphasized.