Document Detail


Paradoxical hypertension after reversal of heart failure in patients treated with intensive vasodilator therapy.
MedLine Citation:
PMID:  9752888     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Hypertension is a major cause of heart failure, evolving from left ventricular hypertrophy to systolic and diastolic dysfunction. Although effective heart failure therapy has been associated with a lowering or no change in systemic arterial blood pressure in long-term follow-up, this study describes the symptomatic, clinical, and left ventricular functional response of a subgroup of heart failure patients with a prior history of hypertension who demonstrated a paradoxical hypertensive response despite high-dose vasodilator therapy. We prospectively identified 45 patients with a past history of hypertension who had become normotensive with symptomatic heart failure. Of these 45 heart failure patients, 12 became hypertensive while receiving therapy in follow-up, with systolic blood pressure > or = 140 mm Hg (Group A). The remaining 33 patients did not have a hypertensive response to therapy (Group B). In the 12 Group A patients, 60+/-10 years old, with symptomatic heart failure for 6.3+/-4.3 years, vasodilator therapy was intensified in the 2.0+/-0.5 years of follow-up, achieving final doses of enalapril 78+/-19 mg and isosorbide dinitrate 293 +/-106 mg per day. New York Heart Association classification improved from 2.9+/-0.8 to 1.3+/-0.5 (P < or = .0001), with a reduction in heart-failure-related hospitalizations. Left ventricular ejection fraction increased from 17+/-6% to 40+/-10% (P < .0001). Follow-up blood pressure at 1 to 3 months was unchanged. However, both systolic and diastolic blood pressure increased at final follow-up, rising from 116+/-14 to 154+/-13 mm Hg (P = .0001) and from 71+/-9 to 85+/-14 mm Hg (P = .004), respectively. Renal function remained unchanged. Although both groups had similar clinical responses, there were more blacks and women in the hypertensive Group A. Effectively, 12 of 45 (27%) heart failure patients with an antecedent history of hypertension demonstrated a paradoxical hypertensive response to vasodilator therapy. The recurrence of hypertension in a significant portion of patients successfully treated for heart failure has important clinical implications.
Authors:
T B Levine; A B Levine; M Kathawala; B Narins; P Kaminski
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of hypertension     Volume:  11     ISSN:  0895-7061     ISO Abbreviation:  Am. J. Hypertens.     Publication Date:  1998 Sep 
Date Detail:
Created Date:  1998-11-24     Completed Date:  1998-11-24     Revised Date:  2009-02-24    
Medline Journal Info:
Nlm Unique ID:  8803676     Medline TA:  Am J Hypertens     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1041-7     Citation Subset:  IM    
Affiliation:
Michigan Institute for Heart Failure & Transplant Care, Botsford General Hospital, Farmington Hills 48336, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Blood Pressure
Female
Heart Failure / complications*,  drug therapy*
Humans
Hypertension / etiology*,  physiopathology
Male
Middle Aged
Vasodilator Agents / adverse effects,  therapeutic use*
Ventricular Function, Left
Chemical
Reg. No./Substance:
0/Vasodilator Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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