2022 January-March Volume 8 Issue 1
SARS-Cov-2 neuroinvasion – direct and indirect central nervous effects, behavioral consequences at the population level
Victor A. Voicu 1, 2 *, Octavian Vasiliu 3
1 Department of Pharmacology, Toxicology and Psychopharmacology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
2 Medical Sciences Section, Romanian Academy, Bucharest, Romania
3 Department of Psychiatry, Carol Davila Central Military Emergency University Hospital, Bucharest, Romania.
No abstract available.
J Hypertens Res (2022) 8(1):1–8 [download PDF]
Arterial hypertension – the timeline of a concept
Roxana Oana Darabont 1 *
1 Department of Carol Davila, University of Medicine and Pharmacy and Cardiovascular Surgery - University Emergency Hospital, Bucharest, Romania
Nowadays, it is well acknowledged that arterial hypertension is the leading global risk factor for cardiovascular diseases and the largest contributor to cardiovascular mortality in many parts of the world, including Europe. However, we rarely think about the evolution of its diagnosis, its changing definition, or the gradual understanding of its significance. In this paper, the milestones of the arterial hypertension concept will be presented, highlighting the decisive steps that led to the actual methods of blood pressure measurement in a clinical setting in the first part. The second part will reveal the contradictory evolution of the concept of hypertension until its current definition in relation to cardiovascular risk.
J Hypertens Res (2022) 8(1):9–13 [download PDF]
The continuum of inflammation – cardiovascular risk – rheumatic disease activity: where can we step in?
Claudia Cobilinschi 1, 3, Radu Țincu 2, 3, Flavia Dumitru 4, Daniela Opris-Belinski 1, 3
1 Department of Internal Medicine and Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania
2 Department of Anaesthesiology and Intensive Care II – Toxicology, Bucharest Clinical Emergency Hospital, Bucharest, Romania
3 Department of Internal Medicine and Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
4 Department of Radiotherapy, Coltea Clinical Hospital, Bucharest, Romania
Chronic inflammatory rheumatic conditions like rheumatoid arthritis, spondyloarthritis, or systemic lupus erythematosus have been linked to a higher cardiovascular disease risk when compared to the general population. Apart from chronic inflammation, which plays a central role, this increased risk is a consequence of traditional risk factors, disease-related factors, or prescribed antirheumatic drugs. Medications like non-steroidal anti-inflammatory drugs or corticosteroids should be used with caution in rheumatic patients with established heart disease because of the additional risk they might bring. Patients with cardiovascular disease should be regularly monitored, having a screening performed every five years. Assessment tools include the SCORE system, which should be multiplied by 1.5 in patients with rheumatoid arthritis. Management of this patient population should include lifestyle changing and pharmacological treatments according to available guidelines, but clinicians should also focus on achieving tight control of the rheumatic disease since lower or no disease activity has been shown to decrease patients’ cardiovascular disease risk.
J Hypertens Res (2022) 8(1):14–21 [download PDF]
The gray zone in severe hypertension – from uncontrolled to hypertensive emergencies: where one stops and the other begins
Claudia Nistor 1, Elisabeta Badila 2, 3, Emma Weiss 2, 3, Cristina Japie 2, 3, Daniela Bartos 2, 3, Ana-Maria Balahura 2, 3 *
1 Cardiology Department, Elias University Emergency Hospital, Bucharest, Romania
2 Department of Internal Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
3 Internal Medicine Department, Emergency Clinical Hospital Bucharest, Bucharest, Romania
Acutely increased blood pressure (BP) is a very common presentation in the emergency department (ED). However, not every high BP value represents a life-threatening condition; therefore, adjusting antihypertensive treatment and focusing on long-term BP control is often sufficient. Nonetheless, acute severe increase in BP associated with acute hypertensive-mediated organ damage (HMOD), the real hypertensive emergencies (HEs), require quick diagnosis and adequate therapy to prevent or diminish acute organ dysfunction. Easy in theory but hard in practice, a clear distinction between uncontrolled hypertension (UH) and HEs is not always readily apparent until evidence of organ damage appears, leaving the clinician in a “gray zone” of BP values and time of unknown approach to the intensity and rapidity of lowering BP and subsequent cardiovascular risk control. UH is the most frequent form of ED presentation for an acute increase in BP. In these patients, it is reasonable to lower BP with caution and within a few hours without aiming to get a BP within the normal range. The true aim is, however, to obtain long-term control of hypertension and risk factors. On the other hand, HE requires a supervised, tailoredapproach according to the acute HMOD. A customized timeline and magnitude of BP decrease is mandatory and the patients should be admitted for monitoring. Therefore, the cornerstone in the management of acute hypertensive disorders remains the accurate definition and risk stratification of the actual emergency and a tailored therapeutic strategy.
J Hypertens Res (2022) 8(1):22–30 [download PDF]
Secondary hypertension: an overview for the practitioner
Ana Maria Vrabie 1 #, Stefan Totolici 1 #, Ana Maria Balahura 2, 3, Emma Weiss 2, 3, Cristina Japie 3, Elisabeta Badila 2, 4
1 Prof. Dr. C. C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, Romania
2 Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
3 Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, Bucharest, Romania
4 Department of Cardiology, Colentina Clinical Hospital, Bucharest, Romania
# Equal contribution
As hypertension is a worldwide known cardiovascular risk factor, with secondary hypertension being accountable for 5-15% of the cases, this paper aims to summarize and simplify the diagnostic algorithm for the most frequent forms of secondary hypertension, with general principles regarding screening methods, clinical characteristics, pathophysiological mechanisms, and diagnostic tests. Bearing in mind that the prevalence of secondary forms of hypertension varies with age and is most frequently encountered among young adults, the diagnosis becomes of utmost importance, considering the multiple curable interventions available. Regarding elderly patients, who usually present with long-term hypertension leading to irreversible vascular remodeling, the procedures that target secondary causes of hypertension provide mainly a better control of blood pressure values with fewer antihypertensive drugs. Furthermore, essential and secondary hypertension can coexist, or, sometimes, several forms of secondary hypertension can be present in the same patient. Not all hypertensive patients should undergo screening evaluation, as this strategy is not cost-efficient, and many false-positive results occur. Hence, rigorous clinical judgment is essential in order to select patients who may benefit from screening procedures. As a result, early diagnosis and treatment of secondary hypertension can contribute to avoiding unnecessary complications and decreasing cardiovascular risk and mortality rates.
J Hypertens Res (2022) 8(1):31–45 [download PDF]
Late postpartum hypertension 8 weeks after delivery: a case report
Radu Andy Sascau 1, 2 #, Laura-Catalina Benchea 1 #, 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
# Equal contribution
We present the case of a 34-year-old female who was admitted to the department of cardiology for high blood pressure values accompanied by headache and dizziness. She gave birth to a boy by cesarean section 8 weeks a priori. At the time of admission, she was hemodynamically stable. Blood pressure was over 170/100 mmHg in both upper limbs, with no significant differences. The cardiac auscultation highlighted a systolic murmur (grade 2/6) at the level of the apex. The renal function was altered, but the electrocardiogram was normal. Transthoracic echocardiography revealed non-dilated cardiac chambers, good left and right ventricular global systolic function, and mild mitral regurgitation. When discussing the etiology of late postpartum hypertension, the following were taken into consideration: renal, endocrine, or neurological disorders.
J Hypertens Res (2022) 8(1):46–50 [download PDF]