Resistant hypertension.

PURPOSE OF REVIEW: Resistant hypertension (RH) is characterized by persistently elevated blood pressure despite the concurrent use of three antihypertensive medications, including a diuretic, at optimal doses. This clinical phenomenon poses a significant burden on healthcare systems worldwide due to its association with increased cardiovascular disease morbidity and mortality. RECENT FINDINGS: Ongoing studies on device-based treatment of RH, with aim to reduce sympathetic nervous system outflow, have shown promising evidence in management of RH which may in turn decrease the incidence of composite cardiovascular outcome faced by the affected population. SUMMARY: This paper aims to provide a comprehensive overview of RH, and review some of the diagnostic and therapeutic approaches in management of RH.

Cardiovascular effects of preeclampsia.

PURPOSE OF REVIEW: Preeclampsia complicates 3-5% of first and 15% of subsequent pregnancies. This study reviews the evidence of increase cardiovascular risk in these women. RECENT FINDINGS: Women with preeclampsia are at two-fold higher risk for development of coronary artery disease, stroke and death, and four-fold increased risk of heart failure. Preeclampsia developed in early part of pregnancy confers greater risk than later in pregnancy. Common factors that predispose women to preeclampsia also confer high risk for developing cardiovascular disease include obesity, metabolic abnormalities, dyslipidaemia, insulin resistance, heightened inflammatory responses, hypercoagulable states and endothelia dysfunction. SUMMARY: Patients with preeclampsia should be screened at regular intervals by a preventive cardiologist and treated accordingly.

Preimplant Hyponatremia Does Not Predict Adverse Outcomes in Patients With Left Ventricular Assist Devices.

Hyponatremia is a well-established marker of adverse outcomes in chronic heart failure (HF) but not well studied in patients with left ventricular assist device (LVAD). This is a retrospective study, single center study of HM3 [Abbott, USA] LVAD implants. We divided our population based on their sodium prior to LVAD implantation - hyponatremia if <135 mEq/L and normal sodium if 135-145 mEq/L. We compared postoperative and long-term outcomes. A total of 195 patients were included, preimplant hyponatremia was present in 40% with a sodium of 132.1 ± 2.1 vs 137.8 ± 1.9 mEq/L in the normal sodium group. No differences were observed in the postoperative or long-term outcomes. Preimplant hyponatremia was not associated with mortality or HF admissions, likely due to adequate left ventricular unloading and resolution of the mechanisms that lead to hyponatremia. These results suggest that optimization of mild hyponatremia may not be critical and should not delay LVAD placement.

A Simplified Diagnostic and Therapeutic Approach to Pulmonary Hypertension.

Pulmonary hypertension remains a common but complex disorder that physicians face in their daily practice. Pulmonary hypertension has been classified by the World Health Organization into five major categories according to etiology, pathophysiology, and hemodynamic properties. The clinical course and overall prognosis varies by etiology, therefore making the correct diagnosis is paramount to avoid delay in treatment and improve outcomes. This review aims to provide clinicians with a simplified diagnostic approach to pulmonary hypertension. We also provide a guide to risk stratification and when to refer patient to a pulmonary hypertension expert center.

Development and Validation of a Multivariable Risk Prediction Model for COVID-19 Mortality in the Southern United States.

OBJECTIVE: To evaluate clinical characteristics of patients admitted to the hospital with coronavirus disease 2019 (COVID-19) in Southern United States and development as well as validation of a mortality risk prediction model. PATIENTS AND METHODS: Southern Louisiana was an early hotspot during the pandemic, which provided a large collection of clinical data on inpatients with COVID-19. We designed a risk stratification model to assess the mortality risk for patients admitted to the hospital with COVID-19. Data from 1673 consecutive patients diagnosed with COVID-19 infection and hospitalized between March 1, 2020, and April 30, 2020, was used to create an 11-factor mortality risk model based on baseline comorbidity, organ injury, and laboratory results. The risk model was validated using a subsequent cohort of 2067 consecutive hospitalized patients admitted between June 1, 2020, and December 31, 2020. RESULTS: The resultant model has an area under the curve of 0.783 (95% CI, 0.76 to 0.81), with an optimal sensitivity of 0.74 and specificity of 0.69 for predicting mortality. Validation of this model in a subsequent cohort of 2067 consecutively hospitalized patients yielded comparable prognostic performance. CONCLUSION: We have developed an easy-to-use, robust model for systematically evaluating patients presenting to acute care settings with COVID-19 infection.