Hypertensive emergencies: still an emergency?
Christos Fragoulis 1, Emilia Lazarou 1, Konstantinos Tsioufis 1 *
1 First Cardiology Department, Medical School, University of Athens, Hippokration Hospital, Athens, Greece
Patients with an acute increase in blood pressure, often described as hypertensive crises, remain a worldwide burden despite the advances in antihypertensive medication in the past century. The presence or absence of hypertension-mediated organ damage divides patients into hypertensive emergencies and hypertensive urgencies, respectively, requiring a more urgent approach for the management of hypertensive emergencies. Few data have been published regarding patients’ long-term monitoring after the presenting episode. Therefore, further research is needed concerning the management and follow-up of these patients.
J Hypertens Res (2021) 7(4):119-123 [download PDF]
The neurocardiac axis in traumatic brain injury – an endless pathophysiological hot spot
Cristian Cobilinschi 1, 2 *, Radu Tincu 3, 4, Claudia Cobilinschi 5, 6, Ioana Grintescu 1, 2
1 Department of Anaesthesiology and Intensive Care I, Bucharest Clinical Emergency Hospital, Bucharest, Romania
2 Department of Anaesthesiology and Intensive Care II, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
3 Department of Anaesthesiology and Intensive Care II – Toxicology, Bucharest Clinical Emergency Hospital, Bucharest, Romania
4 Department of Toxicology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
5 Department of Internal Medicine, Sf Maria Clinical Hospital, Bucharest, Romania
6 Department of Internal Medicine and Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Traumatic brain injury (TBI) continues to be one of the leading causes of morbidity and mortality worldwide. Depending on the type of traumatic mechanical forces that act on the skull, primary polymorphic injuries may occur due to the direct impact. Secondary injuries are usually rapidly induced in the acute phase after the initial hit and are represented by neuroinflammation, cerebral edema, or ischemia. As in every acute stress condition, sympathetic activation is the primary and central pathophysiological alteration after TBI, being responsible for the more significant part of the systemic organ damage, systemic inflammation, and finally for the poor outcome. Massive catecholamine release translates into massive peripheral vasoconstriction and raised systemic vascular resistance, an entity frequently recognized as “neurogenic hypertension”. Catecholamine cardiotoxicity may induce stress cardiomyopathy, characterized by myocytolysis or contraction band necrosis, induced by accelerated myocardial necrosis in a hypercontracted state. If stress cardiomyopathy was reported to occur simultaneously with a stressful event, like TBI, another similar entity named neurogenic stunned myocardium was described to arise secondary to the primary neurologic pathology. A reversible microcirculatory dysfunction has also been identified. Considering the rationale of beta-blocker use in patients with concomitant TBI and stress cardiomyopathy, further homogenous trials are needed to establish benefits and safety.
J Hypertens Res (2021) 7(4):124-130 [download PDF]
The role of ambulatory blood pressure monitoring in the diagnosis of pheochromocytoma
Sofia Lider 1, 2, Corin Badiu 1, 2 *
1 Department of Endocrinology 2, CI Parhon National Institute of Endocrinology, Bucharest, Romania
2 Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Pheochromocytoma and paraganglioma (PPGL) represent a group of rare disorders associated with secondary hypertension. With more than 50% of cases with a genetic cause, the current management of these patients includes adrenal imaging, functional investigation, and surgical treatment. While some cases bring a full clinical picture, many patients are oligo- or asymptomatic. In order to bring catecholamine hypertension into focus, ambulatory monitoring of blood pressure (ABPM) is a useful approach. In this review, we discuss the role of ABPM in the management of PPGL in diagnosis, preparation for surgery and further follow-up. Cut-off levels for normal variations as well as response to pharmacological treatment are also debated.
J Hypertens Res (2021) 7(4):131-134 [download PDF]
Severe early-onset fetal growth restriction as the first sign of preeclampsia: a case report and literature review
Cristian Poalelungi 1, 2*, Oana Eliza Cretu 1, 2, Alina-Alexandra Dirlau 1, 2, 3, Adrian-Valeriu Neacsu 1, 2, Anne-Marie Dima 1, Dragos Dobritoiu 1, 2, Iuliana Ceausu 1, 2
1 Obstetrics and Gynecology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
2 Obstetrics and Gynecology Department, Dr. Ioan Cantacuzino Clinical Hospital, Bucharest, Romania
3 Obstetrics and Gynecology Department, Dr. N. Kretzulescu Medical Center for Diagnosis and Treatment, Bucharest, Romania
Early fetal growth restriction (IUGR/FGR) remains a challenging entity associated with an increased risk of perinatal morbidity and mortality and maternal complications. Placental dysfunction in the second trimester (early-onset FGR) is thought to arise from the inadequate remodeling of the spiral arteries in the first trimester, similar to preeclampsia. This paper aims to provide data regarding a rare case report of a patient with symptoms of early-onset severe FGR and preeclampsia during a singleton pregnancy in the 20th week of gestation obtained through in vitro fertilization (IVF). The patient had a history of severe preeclampsia, complicated by severe FGR, that imposed delivery at 27 weeks of gestation. This case was managed from the beginning with appropriate treatment to avoid complications and clinical symptoms related to preeclampsia. Despite the absence of proteinuria and adequate treatment of hypertension, severe FGR was revealed at 21 weeks of gestation. We suggested delivery at 27 weeks of gestation because of the severe alterations seen on Doppler velocimetry, but the patient refused. Intrauterine fetal demise occurred at 28 weeks of gestation, and the patient delivered a 470 g female fetus with no viability signs.
J Hypertens Res (2021) 7(4):135-142 [download PDF]
Hibernating kidney on bilateral renal artery stenosis – the relevance of a costly diagnosis
Emma Weiss 1, 2 *#, Elisabeta Badila 1, 2 #, Ana Maria Balahura 1, 2, Cristina Japie 2, Daniela Bartos 1, 2, Lucian Calmac 3, Costin Minoiu 1, 4, Laurentiu Gulie 4
1 Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
2 Internal Medicine Department, Emergency Clinical Hospital Bucharest, Bucharest, Romania
3 Cardiology Department, Emergency Clinical Hospital Bucharest, Bucharest, Romania,
4 Radiology Department, Emergency Clinical Hospital, Bucharest, Bucharest, Romania
# Equal contribution
We present the case of an elderly hypertensive, diabetic male patient with a ten-year history of chronic kidney disease and bilateral moderate atherosclerotic renal artery disease. During follow-up, the nephrologist observes a rapid worsening of kidney function and refers the patient to our clinic. Angiography describes severe (70–80%) bilateral renal artery stenosis and, in the setting of refractory hypertension confirmed by automatic 24hour blood pressure measurement and recent rapid progression of renal dysfunction, a decision for bilateral angioplasty with stent placement is taken. On follow-up, renal dysfunction is partially reversed, and blood pressure levels drop closer to target. Further, we discuss the rationale for interventional therapy in atherosclerotic renal artery disease and underline the key element in such a case – appropriate patient identification to select probable responders to treatment.
J Hypertens Res (2021) 7(4):143–149 [download PDF]
“Through the ears of the needle” – secondary hypertension in young women
Cristina Andreea Adam 1 #, Mara Cristina Boureanu 1, Delia Lidia Salaru 1, 2 #, Cristina Luca 1, 2, 3, Marius Traian Dragos Marcu 2 *, Radu Andy Sascau 1, 2, Cristian Statescu 1, 2
1 Prof. Dr. George I.M. Georgescu Institute of Cardiovascular Diseases, Iasi, Romania
2 Department of Internal Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
3 Department of Morpho-Functional Sciences I, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
# Equal contributio
We present the case of a 37-year-old female patient who was admitted on an outpatient basis for oscillating blood pressure values accompanied by headache and intermittent vertigo. At the time of admission, she was hemodynamically stable. The cardiac auscultation highlighted an apexian systolic murmur (grade 3/6) and as well as a systolic murmur (grade 2/6) under the scapula. The echocardiography revealed a progressive narrowing of the lumen in the proximal descending aorta. Chest radiography outlined rib notches at the level of rib arches 3–9 and a pathognomonic image of “3” secondary to pre- and post-stenotic dilations. The computed tomography scan identified progressive narrowing of the lumen with a minimum caliber of 1.7 mm at the insertion site of the ligamentum arteriosum in the proximal descending aorta and significant collateral circulation.
J Hypertens Res (2021) 7(4):150–154 [download PDF]