Diagnosis of pheochromocytoma in the setting of Parkinson disease.

Background: A 59-year-old man with a 7-year history of Parkinson disease (PD) presented with episodes of sudden, severe headaches with neck pain, tachycardia, sweating and pallor. During these episodes, the patient showed marked elevations in blood pressure, regardless of posture. This was unusual, given that he had no prior history of hypertension.

Now or never: optimal antihypertensive therapy in the elderly.

Hypertension control rates in the elderly, particularly for systolic hypertension, are poor and lower than control rates in other age groups. Older patients often require treatment with specific antihypertensive drugs because of concomitant conditions and usually need > or =2 drugs to control blood pressure. Combining drugs with complementary mechanisms of action may improve both blood pressure control and the tolerability of individual drugs.

Management of hypertension in patients with cardiac disease: use of renin-angiotensin blocking agents.

Inhibition of renin-angiotensin system (RAS) activity using angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ARBs) is beneficial in patient populations with left ventricular dysfunction or systolic heart failure (HF) and other forms of heart disease. In high-risk patients with coronary heart disease (CHD), treatment with these agents reduces the mortality rate and improves secondary outcomes. Individuals with stable CHD who are at lower risk benefit less from treatment.

Assessment of the validation of blood pressure monitors: a statistical reappraisal.

Protocols to determine the accuracy of noninvasive blood pressure monitors have been published by the Association for the Advancement of Medical Instrumentation, the British Hypertension Society, and the European Society of Hypertension (ESH). We compared the statistical basis for each of these protocols. Although the Association for the Advancement of Medical Instrumentation and British Hypertension Society protocols require a minimum of 85 participants, the ESH protocol requires only 33 participants.

Racial analysis of patients with myocardial infarction complicated by heart failure and/or left ventricular dysfunction treated with valsartan, captopril, or both.

Objectives: African Americans have a high incidence of heart failure (HF). Limited retrospective observational subgroup analyses of patients with left ventricular systolic dysfunction (LVSD) suggest marginal benefit of angiotensin-converting enzyme inhibitors in the prevention of HF hospitalizations or total mortality in African Americans.

Background: Very few data exist concerning the effectiveness of angiotensin receptor blockers in this population.

Nebivolol: pharmacologic profile of an ultraselective, vasodilatory beta1-blocker.

Beta-blockers are well-established therapeutic agents in the treatment of hypertension and cardiovascular disease. However, these agents are highly heterogeneous. Beta-blockers differ in their ancillary pharmacologic properties, which are clinically important.

Fibromuscular dysplasia: an uncommon cause of secondary hypertension.

Fibromuscular dysplasia is a noninflammatory vascular disease that commonly affects the distal two thirds of the renal artery and branch vessels, but occasionally involves other arteries. Progression of stenosis occurs in 16%-38% of renal arteries. Although the etiology is unknown, genetic studies suggest a relationship to the angiotensin-converting enzyme I allele.

Arterial elasticity and erectile dysfunction in hypertensive men.

Erectile dysfunction is a common symptom among hypertensive patients that impairs quality of life and adherence to antihypertensive pharmacologic therapy. It is also associated with cardiovascular risk factors and disease. The Sexual Health Inventory in Men (SHIM) was administered to 105 ambulatory hypertensive patients, and large and small artery elasticity indices were measured.

Obstructive sleep apnea syndrome.

Obstructive sleep apnea syndrome is caused by upper airway collapse during inspiration, causing intermittent hypoxemia, hypercapnia, acidosis, sympathetic nervous system activation, and arousal from sleep. Nighttime blood pressure is higher, but unexpectedly, daytime hypertension occurs. The prevalence of hypertension is very high and the incidence of hypertension increases as the number of apneic and hypopneic events per hour rises.

Hyperthyroidism: a secondary cause of isolated systolic hypertension.

Isolated systolic hypertension is the most common form of hypertension, especially among patients 50 years or older. What is not appreciated is that there are secondary causes of isolated systolic hypertension. Hyperthyroidism increases systolic blood pressure by decreasing systemic vascular resistance, increasing heart rate, and raising cardiac output.

Elevated endothelin-1 levels are associated with decreased arterial elasticity in hypertensive patients.

Endothelin-1 stimulates collagen synthesis and is increased in hypertension, but its effect on collagen degradation remains unknown. The current study tested the hypothesis that elevated endothelin-1 levels are associated with decreased collagenase activity, markers of collagen degradation, and arterial compliance in hypertensive patients. Normotensive (n = 10) and hypertensive (n = 13) patients who were not on any antihypertensive medication were recruited, and small and large artery elasticity index, systemic vascular resistance, pulse pressure, and blood pressure were determined using blood pressure waveform analysis.

Phosphodiesterase-5 inhibitors and their hemodynamic effects.

Erectile dysfunction occurs commonly in untreated and treated hypertensive patients, impairing adherence to treatment and quality of life. Furthermore, it is a marker for enhanced risk for cardiovascular disease. Phosphodiesterase type 5 (PDE5) inhibitors, sildenafil, vardenafil, and tadalafil, provide effective treatment of erectile dysfunction.

Relationship between glycosylated hemoglobin and arterial elasticity.

Arterial elasticity is decreased in diabetes, but it is unclear whether there is a relationship between glycosylated hemoglobin (HbA1c) and arterial elasticity. To evaluate this question, 111 subjects with diabetes mellitus had HbA1c and arterial elasticity determined in an academic outpatient setting. Three measurements of arterial elasticity indices were obtained supine using the HDI/PulseWave CR-2000 Research CardioVascular Profiling System (Hypertension Diagnostics Inc.

Antihypertensive pharmacobezoar.

Most antihypertensive drugs have known side effects that are elicited by the careful clinician taking care of hypertensive patients. However, many antihypertensive medications utilize drug delivery systems that prolong the duration of blood pressure reduction. The gastrointestinal therapeutic system that is used with nifedipine, isradipine, and verapamil has a unique side effect.

Ophthalmoscopic findings in malignant hypertension.

Malignant hypertension may present with retinopathy, choroidopathy, and optic neuropathy. Flame-shaped retinal hemorrhages, an early finding, are due to smooth muscle necrosis and bleeding along the nerve fiber layer. Cotton-wool spots, or cytoid bodies, are not exudates, but rather are retinal infarcts.

Polycystic kidney disease.

Polycystic kidney disease, an inherited systemic disorder, is characterized by the development of multiple cysts in the kidneys and other organs. Patients can present at any age, but more often come to clinical attention (unless there is a family history) after age 30. Patients who are diagnosed before age 30 have a worse renal survival.

Assessment of test repeatability of arterial stiffness index.

Background: Increased arterial stiffness is an early indicator of vascular disease. Several methods may be used to determine arterial stiffness. One method obtains an arterial stiffness index from the vascular dynamics of oscillometric-derived brachial artery pressure.

Aortic dissection.

Aortic root enlargement is generally asymptomatic, with few clinical clues, but may be observed as an incidental finding on a chest x-ray, echocardiogram, or contrast-enhanced computerized tomogram of the chest. Aortic dissection is one of the most feared complications of hypertension. A history of hypertension is commonly present, but the systolic blood pressure in type A dissection (proximal to the left subclavian artery) has been found to be less than 150 mm Hg in 64% of patients.

Gynecomastia and hypertension.

Palpable dense and mobile subareolar tissue in the male breast defines the presence of gynecomastia. For the hypertension specialist, breast enlargement in men provides a clue to a secondary cause of hypertension or an adverse antihypertensive drug reaction. Hyperthyroidism, chronic renal failure, adrenal hyperplasia or tumors, amphetamine, cyclosporine, and anabolic steroids are secondary causes of hypertension associated with gynecomastia.

Hypertensive heart disease.

Hypertensive heart disease encompasses anatomical changes and altered physiology of heart muscle, coronary arteries, and great vessels. Left ventricular hypertrophy is not only a target organ response to increased afterload, but is also the most potent cardiovascular risk factor. Regression of hypertrophy reduces morbidity and mortality.

Chronotherapeutics: a surge of ideas.

Chronotherapeutics is advancing hypertension treatments beyond once-daily dosing by synchronizing the maximum levels of medication during times when cardiovascular risk is highest. It has long been established that patients are at higher risk for cardiovascular events-including myocardial infarction, stroke, and sudden death-in the early morning hours. Using novel oral delivery methods, chronotherapeutic medication synchronizes the delivery of blood pressure drug within the period of rates risk, significantly reducing both absolute blood pressure numbers and, especially important, the rate of blood pressure increase.

Chronotherapeutic oral drug absorption system verapamil is effective in reducing morning blood pressure in African Americans: a post hoc analysis of the chrono trial.

Results of several clinical trials have shown that verapamil is effective in reducing blood pressure (BP) in African Americans, a population at high risk for hypertension and target-organ damage. Nonetheless, adequate control of BP is perceived as difficult to achieve in this population. A post hoc analysis of data from the community-based CHRONO trial (Controlling Hypertension in the moRning with a ChrONO medication) was undertaken to assess racial/ethnic differences in the safety and efficacy of the Chronotherapeutic Oral Drug Absorption System (CODAS) formulation of verapamil in a real-world setting.

Nonarteritic anterior ischemic optic neuropathy.

Nonarteritic anterior ischemic optic neuropathy is a common cause of sudden, painless loss of vision present commonly on awakening from sleep. It most commonly affects middle-aged and elderly Caucasian men and women. Involvement of the opposite eye occurs within 3 years in less than 43% of patients.