| Unrecognized secondary causes of hypertension in patients with hypertensive urgency/emergency: prevalence and co-prevalence. | |
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MedLine Citation:
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PMID: 20361196 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Hypertensive urgency/emergency occurs frequently, yet no prospective data on common secondary causes, including sleep apnea (SA), renal artery stenosis (RAS), and hyperaldosteronism, are available. METHODS: Patients presenting to the emergency room for over 1 year with systolic blood pressure > or =180 mmHg and/or diastolic blood pressure > or =100 mmHg and typical symptoms were included. RAS was diagnosed by direct duplex/Doppler ultrasound of the renal artery, resistance index, and imaging. The aldosterone/renin ratio (ARR) was determined from morning blood samples taken with the patients supine after > or =2 h of rest. A positive ARR (>50) was followed by saline infusion to exclude primary hyperaldosteronism. SA was evaluated by nasal breathing flow screening; when positive [apnea/hypopnea index (AHI) >5/h], complete polysomnography was performed. RESULTS: Of 161 patients (age, 66.0 +/- 13.1 years; BMI, 28.6 +/- 5.1 kg), 131 had previously identified hypertension (duration, 12.7 +/- 11.5 years; 1.9 +/- 1.5 antihypertensive medications). SA was found in 114 (70.8%) patients [18% mild (AHI: 5-15/h), 26.8% moderate (15.1-30/h), and 24.2% severe (>30/h)]. Aldosterone levels exceeded 160 pg/ml in 22 of 23 patients with hyperaldosteronism; 4 had primary and 12 had secondary hyperaldosteronism. Thirteen (8.1%) patients had RAS. Three secondary causes were found in 1 patient (0.6%), > or =2 in 25 (15.5%), and > or =1 in 124 patients (77.0%). Of 150 detected secondary causes, only 5 were recognized previously. CONCLUSIONS: Secondary causes of hypertension are common and predominantly unrecognized in patients with hypertensive urgency/emergency. Co-prevalence of secondary causes occurs in about 15% and should be considered before therapeutic intervention. |
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Authors:
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Jan Börgel; Stephanie Springer; Jasmin Ghafoor; Daniel Arndt; Hans-Werner Duchna; Andreas Barthel; Sibylle Werner; Josef Van Helden; Christoph Hanefeld; Horst Neubauer; Daniel Bulut; Andreas Mügge |
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Publication Detail:
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Type: Journal Article Date: 2010-04-02 |
Journal Detail:
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Title: Clinical research in cardiology : official journal of the German Cardiac Society Volume: 99 ISSN: 1861-0692 ISO Abbreviation: Clin Res Cardiol Publication Date: 2010 Aug |
Date Detail:
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Created Date: 2010-07-29 Completed Date: 2010-12-22 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101264123 Medline TA: Clin Res Cardiol Country: Germany |
Other Details:
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Languages: eng Pagination: 499-506 Citation Subset: IM |
Affiliation:
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Department of Cardiology and Angiology, University Clinic St. Josef Hospital, Heart Center, University of Bochum, Germany. jan.boergel@rub.de |
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Causality Comorbidity Emergency Service, Hospital / statistics & numerical data* False Positive Reactions Female Germany / epidemiology Humans Hyperaldosteronism / diagnosis, epidemiology* Hypertension / diagnosis, epidemiology* Male Prevalence Renal Artery Obstruction / diagnosis, epidemiology* Risk Assessment Risk Factors Sleep Apnea Syndromes / diagnosis, epidemiology* |
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