Management of posaconazole-induced pseudohyperaldosteronism

2020 ◽  
Vol 75 (12) ◽  
pp. 3688-3693
Author(s):  
Matthew R Davis ◽  
Minh-Vu H Nguyen ◽  
Thomas J Gintjee ◽  
Alex Odermatt ◽  
Brian Y Young ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Dose Reduction ◽  
Serum Potassium ◽  
Continuous Monitoring ◽  
Therapeutic Interventions ◽  
Serum Concentrations ◽  
Average Decrease ◽  
Before And After ◽  
Repeat Assessment

Abstract Background Posaconazole-induced pseudohyperaldosteronism (PIPH) has been associated with elevated posaconazole serum concentrations. Clinicians are faced with the difficult task of managing patients with PIPH while maintaining the efficacy of antifungal therapy. Commonly, modifications to posaconazole therapy are utilized in managing PIPH, including dosage reduction of posaconazole or switch to an alternative antifungal. Objectives To characterize the management of patients diagnosed with PIPH and their response to various therapeutic interventions. Methods We retrospectively reviewed 20 consecutive adult patients diagnosed with PIPH. Patient data collected included blood pressure, electrolytes, endocrine laboratory values and posaconazole serum concentrations collected before and after therapeutic intervention. Results Of 20 patients included, 17 patients (85%) underwent therapeutic modification, with posaconazole dose reduction (n = 11) as the most common change. Other modifications included discontinuation (n = 3), switch to an alternative antifungal (n = 2) and addition of spironolactone (n = 1). Clinical improvement (decrease in systolic blood pressure and increase in serum potassium) was observed in 9 of 17 patients (52.9%). An average decrease in systolic blood pressure of 7.1 mmHg and increase in serum potassium of 0.22 mmol/L was observed following therapeutic modification. Conclusions We report our experience with PIPH management, for which there is no universally effective strategy. We utilized a stepwise approach for management, starting with posaconazole dose reduction and repeat assessment of clinical and laboratory parameters. If resolution of PIPH is not achieved, an alternative triazole antifungal or the addition of an aldosterone antagonist are additional potential interventions. It is possible for PIPH to persist after therapeutic modification despite these interventions. Thus, early diagnosis and continuous monitoring is warranted.

scholarly journals 752. Management of 20 Patients Diagnosed with Posaconazole-Induced Pseudohyperaldosteronism

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S423-S424
Author(s):  
Thomas J Gintjee ◽  
Matthew R Davis ◽  
Minh-Vu Hoang Nguyen ◽  
Brian Young ◽  
Alex Odermatt ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Dose Reduction ◽  
Dosage Reduction ◽  
Case Series ◽  
Antifungal Prophylaxis ◽  
Close Monitoring ◽  
Serum Concentrations ◽  
Stepwise Approach ◽  
Before And After ◽  
Repeat Assessment

Abstract Background Posaconazole-induced pseudohyperaldosteronism (PIPH) has been associated with elevated posaconazole serum concentrations. Clinicians are faced with the difficult task of managing patients with PIPH while not compromising the efficacy of antifungal prophylaxis or treatment. Commonly, modifications to posaconazole therapy are utilized in managing PIPH including dosage reduction of posaconazole or therapeutic switch to an alternative antifungal. Methods We retrospectively reviewed 20 consecutive adult patients diagnosed with PIPH in this case series. Patient data including blood pressure, electrolytes, endocrine laboratory values, and posaconazole serum concentrations collected before and after therapeutic intervention. Results Out of 20 patients included, 17 patients (85%) underwent therapeutic modification with posaconazole dose reduction (N=11) as the most common change. Other modifications included posaconazole discontinuation (N=3), switch to an alternative antifungal (N=2), and addition of spironolactone (N=1). Clinical improvement (a decrease in systolic blood pressure and increase in serum potassium) was observed in 9 of 17 patients (52.9%). Table 1. Management of Posaconazole-Induced Pseudohyperaldosteronism - p1 Table 1. Management of Posaconazole-Induced Pseudohyperaldosteronism - p2 Table 1. Management of Posaconazole-Induced Pseudohyperaldosteronism - p3 Conclusion We report our experience with PIPH management, for which there is currently no universally effective strategy. We suggest a stepwise approach for PIPH management, starting with posaconazole dose reduction and repeat assessment of clinical and laboratory parameters. If resolution of PIPH is not achieved, an alternative triazole antifungal or the addition of an aldosterone antagonist are additional potential interventions. Even with this approach, it is possible for PIPH to persist after therapeutic modification. Thus, early diagnosis and continuous, close monitoring of patients is warranted. Disclosures All Authors: No reported disclosures

scholarly journals Systolic blood pressure of dogs at hospital and domestic environment

2012 ◽  
Vol 42 (7) ◽  
pp. 1242-1248
Author(s):  
Frederico Aécio Carvalho Soares ◽  
Elisa Barp Neuwald ◽  
Verônica Santos Mombach ◽  
Ana Elize Ribeiro D'Avila ◽  
Francisco de Oliveira Conrado ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Doppler Ultrasonography ◽  
Serum Cortisol ◽  
Serum Concentrations ◽  
Pathological Conditions ◽  
Healthy Dogs ◽  
The Mean ◽  
Veterinary Hospital ◽  
At Home

The measurement of blood pressure (BP) is an important assessment of the cardiovascular system, being influenced by physical and pathological conditions. Certain situations of stress and anxiety during BP measurement can lead to elevated values in small animals, known in medicine as "white coat effect". The aim of this research was to compare systolic blood pressure (SBP) measurement using Doppler ultrasonography in 45 adult healthy dogs in two environments, at a veterinary hospital and at home. Comparison of heart rate, serum concentrations of cortisol and glucose intended to help the evaluation of the stress level of the animals. The mean of SBP at the veterinary hospital was 154.7mmHg and it was significantly (P<0.01) higher than at home (136.3mmHg). It was also observed that HR (mean=122.7bpm), and serum cortisol (median=4.5µg dL-1) and glucose (mean=95.9mg dL-1) concentrations were significantly higher (P<0.01) at the hospital, when compared with values obtained at home (109.6bpm; 1.5µg dL-1 and 85.5mg dL-1, respectively). In conclusion, the environment can influence SBP in dogs, due to factors related to stress.

scholarly journals Dental anxiety in patients undergoing oral surgery and its effects on blood pressure and heart rate

2020 ◽  
Vol 9 (8) ◽  
pp. e316985536
Author(s):  
Jaqueline Oliveira Barreto ◽  
Julliana Cariry Palhano Freire ◽  
Arthur Willian de Lima Brasil ◽  
Cristian Statkievicz ◽  
Francisley Ávila Souza ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Systolic Blood Pressure ◽  
Oral Surgery ◽  
Dental Anxiety ◽  
Waiting Room ◽  
Demographic Questionnaire ◽  
Significant Difference ◽  
Before And After ◽  
Evaluation Anxiety

Objective: To assess dental anxiety in patients undergoing oral surgery, as well as its impact on blood pressure and heart rate. Material and Methods: A total of 233 patients answered a socio-demographic questionnaire and another one based on the Corah dental anxiety scale. Blood pressure and heart rate were assessed at three moments while: patients were in the waiting room, immediately before and after the procedure. Results: This study revealed a prevalence of anxiety of 77.3%. There was a statistically significant difference in mean systolic blood pressure and heart rate at the three moments of the evaluation. Anxiety was prevalent in the sample and was observed from the time in the waiting room until the time when local anesthesia was performed, causing variations in systolic blood pressure and heart rate, anxiety levels decreased after the end of the service. In conclusion, we observed that oral surgery is directly related to increased anxiety, and anxiety is mainly related to the change in heart rate.

scholarly journals Heart Rate, Systolic Blood Pressure and Autonomic Nerve Activity Before and After High Intensity Resistance Exercise

2010 ◽  
Vol 25 (6) ◽  
pp. 899-903 ◽  
Author(s):  
Akira SYOUBO ◽  
Toshio SUSAKI ◽  
Noboru HIROSE ◽  
Toshiro OKU ◽  
Kstsuhiko TACHINO
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Resistance Exercise ◽  
Systolic Blood Pressure ◽  
High Intensity ◽  
Autonomic Nerve ◽  
Nerve Activity ◽  
Before And After ◽  
Autonomic Nerve Activity

scholarly journals Effect of the consumption of a food based on fruits and natural additives in patients with cardiovascular risk

Revista Vitae ◽  
2019 ◽  
Vol 26 (2) ◽  
pp. 68-77
Author(s):  
Maria Camila FRANCO LONDOÑO ◽  
Adrián ISAZA ◽  
Gladys POSADA ◽  
Maria Elena MALDONADO CELIS
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Inflammatory Markers ◽  
Fruits And Vegetables ◽  
Psidium Guajava ◽  
Passion Fruit ◽  
Human Consumption ◽  
Diabetic Patients ◽  
Before And After ◽  
Characterization Test

Background: cardiovascular diseases (CVD), a group of disorders of the heart and blood vessels are the main cause of morbidity and mortality worldwide. Strategies for its prevention have been proposed, such as modifying life habits, including increasing the consumption of fruits and vegetables associated with the decrease in the probability of suffering CVD. Objective: to evaluate the effects of a base compote of guava (Psidium guajava) and passion fruit (Passiflora ligularis) on blood pressure and metabolic and inflammatory biomarkers in hypertensive type two diabetic patients. Methods: food characterization test (microbiological, proximal, sensorial, antioxidant activity and total phenols). The compote was administered for 21 days to 8 adults (30 to 65 years old); glycaemia, blood pressure, inflammatory markers, and BMI and waist circumference before and after the intervention were measured. Results: the sensory test showed: 66% acceptance and all attributes a value >3, indicating that it was well evaluated. The microbiological aspects comply with the safety for human consumption and nutritionally it stands out that the contribution of carbohydrates (12.3%) is adequate for these patients. The hydrophilic ORAC value was 98.570 μmol ET/g sample. In the patients at the end of the study, a statistically significant decrease in systolic blood pressure was observed (127 mmHg, p 0.041) and the pro-inflammatory markers TNFα, IL-1β and IL6 (31.9 pg/mL, p 0.012, 31.9 pg/mL, p 0.012, and 3.5 pg/mL, p 0.017 respectively) and glycaemia increase (157.5 mg/dL, p 0.036). Conclusions: the medium-term consumption of a compote based on guava, passion fruit, cinnamon and flaxseed oil improves systolic blood pressure and the proinflammatory markers TNFα, IL-1β and IL6 in diabetic and hypertensive patients.

scholarly journals DOES GENDER INFLUENCE RISK FOR ORTHOSTATIC HYPOTENSION IN OLDER ADULTS WITH SARCOPENIA?

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S682-S682
Author(s):  
Melissa J Benton ◽  
Amy L Silva-Smith ◽  
Jefferson M Spicher
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Systolic Blood Pressure ◽  
Orthostatic Hypotension ◽  
Lean Mass ◽  
Bioelectrical Impedance ◽  
Early Morning ◽  
Postural Changes ◽  
Before And After ◽  
Pressure Changes

Abstract Older adults with sarcopenia may be at risk for unstable postural blood pressure due to diminished lean mass that plays a role in maintaining fluid volume. Males have greater lean mass, so risk may be mediated by gender. We compared postural blood pressure changes in older men (77.1 ± 2.0 years; n = 15) and women (79.6 ± 2.0 years; n = 13) with sarcopenia before and after an overnight fast. Sarcopenia was defined using the Lean Mass Index (males ≤ 19.0 kg/m2; females ≤ 15.0 kg/m2). Body composition was measured using multi-frequency bioelectrical impedance, and blood pressure was measured lying, sitting, and standing. On Day 1 (normally hydrated) there were significant drops in systolic blood pressure, with an overall decrease of -9.1 ± 2.2 mmHg (p &lt; 0.001) between lying and standing. On Day 2 (overnight fast), postural changes were more profound, with an overall decrease of -14.1 ± 2.8 mmHg (p &lt; 0.001). However, when compared by gender, postural changes between lying and standing remained significant but did not differ between men and women (Day 1: men -8.9 ± 2.5 vs. women -9.3 ± 2.5 mmHg; Day 2: men -14.6 ± 4.6 vs. women -13.6 ± 3.1 mmHg). On both days diastolic blood pressure remained stable. In this group of older adults, significant decreases in postural systolic blood pressure were observed in the early morning fasted condition, increasing the risk for orthostatic hypotension (drop in systolic blood pressure -20.0 mmHg). Interestingly, gender did not influence risk.

scholarly journals PENGARUH REBUSAN BUNGA ROSELLA TERHADAP PENURUNAN TEKANAN DARAH (HIPERTENSI) PADA PASIEN DI WILAYAH KERJA PUKESMAS SUKAMERINDU BENGKULU

2019 ◽  
Vol 26 (2) ◽  
pp. 53-60
Author(s):  
Vellyza Colin ◽  
Buyung Keraman ◽  
Evan Aditya Pratama
Keyword(s):  
Public Health ◽  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Health Center ◽  
Rank Test ◽  
P Value ◽  
Wilcoxon Sign Rank Test ◽  
Before And After ◽  
Wilcoxon Sign Rank ◽  
Sign Rank Test

The Effect of Rosella Stew to Decreasing of Blood Pressure (Hypertension) in Patients at Working Area of  Sukamerindu Public Health Center BengkuluABSTRAKPengaruh rebusan bunga rosella terhadap penurunan tekanan darah (Hipertensi) pada pasien diwilayah kerja Puskesmas Sukamerindu Bengkulu. Hipertensi adalah peningkatan tekanan darah sistolik lebih dari 140 mmHg dan diastolik lebih dari 90 mmHg. Penelitian ini bertujuan untuk mempelajari pengaruh rebusan bunga rosella digunakan untuk menurunkan tekanan darah oleh sebagian masyarakat. Penelitian ini merupakan penelitian kuantiatif dengan desain pra exsprimental. Populasi dalam penelitian ini pasien hipertensi yang berobat di Puskesmas Sukamerindu Kota Bengkulu pada bulan Januari-Desember 2018 sebanyak 52 orang dewasa yang terkena hipertensi. Teknik pengambilan sample dengan total sampling dengan kriteria inkulasi dan ekslusi sehingga sample yang diambil 30 orang yang memenuhi kriteria dalam pemberian rebusan bunga rosella dan 22 orang yang tidak memenuhi kriteria dalam pemberian bunga rosella untuk penurunan tekanan darah hipertensi. Pengumpulan data dalam penelitian ini menggunakan data sekunder dengan melihat cacatan dokumentasi di Poli Umum Di Puskesmas Sukamerindu Bengkulu.Hasil penelitian didapatkan: uji statistik Wilcoxon Sign Rank Test Hasil tekanan darah sistolik sebelum dan sesudah perlakuan didapatkan nilai  Z = -4,293 dengan p=value=0,0000,05 berarti signifikan, maka Ho ditolak dan Ha diterima. Jadi Ada pengaruh pemberian rebusan bunga rosella terhadap penurunan tekanan darah sistolik pada pasien diwilayah kerja Puskesmas Sukamerindu Kota Bengkulu. Hasil tekanan darah diastol sebelum dan sesudah perlakuam didapatkan nilai  Z = -3,075 dengan p=value=0,0020,05 berarti signifikan, maka Ho ditolak dan Ha diterima. Jadi Ada pengaruh pemberian rebusan bunga rosella terhadap penurunan tekanan darah diastolik pada pasien diwilayah kerja Puskesmas Sukamerindu Kota Bengkulu. Kata Kunci : hipertensi,  tekanan darah, rebusan rosella ABSTRACT Effect of rosella stew on blood pressure (hypertension) reduction in patients in the Pukesmas area Sukamerindu Bengkulu. Hypertension is an increase in systolic blood pressure of more than 140 mmHg and diastolic of more than 90 mmHg. This study discusses the benefits of rosella stew used for reducing blood pressure by most people. This research is a quantitative research with pre-exemplary design. The population in this study were hypertensive patients seeking treatment at the Sukamerindu Public Health Center in Bengkulu City in January-December 2018 as many as 52 adults affected by hypertension. Sampling technique with total sampling with inclusion and exclusion criteria so that the samples taken were 30 people who met the criteria in the provision of rosella stew and 22 people who did not meet the criteria for rosella stew for decreasing hypertension. Data collection in this study uses secondary data by looked at documentation records at Puskesmas Sukamerindu Bengkulu.The results of this study showed: Wilcoxon Sign Rank Test statistical test Results of systolic blood pressure before and after treatment obtained a value of Z = -4.293 with p = value = 0.000 0.05 means significant, then Ho is rejected and Ha is accepted. So there is Effect of rosella stew to Decreasing of blood pressure (hypertension) in patients at area of Pukesmas Sukamerindu Bengkulu. The results of diastolic blood pressure before and after the treatment showed that the value of Z = -3.075 with p = value = 0.002 0.05 means significant, then Ho was rejected and Ha was accepted. So there is Effect of rosella stew to Decreasing of blood pressure (hypertension) in patients at area of Pukesmas Sukamerindu Bengkulu. Keywords: blood pressure, hypertension, rosella stew

scholarly journals Blood pressure pattern following a combined exercise session in hypertensive older women

2019 ◽  
Vol 22 (6) ◽  
Author(s):  
Matheus Pamplona Fachini ◽  
Guilherme Tadeu de Barcelos ◽  
Juliana Cavestré Coneglian ◽  
Paulo Ricardo de Oliveira Medeiros ◽  
Aline Mendes Gerage
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Sedentary Behavior ◽  
Older Women ◽  
Exercise Session ◽  
Low Light ◽  
Post Exercise ◽  
Combined Exercise ◽  
Hemodynamic Variables ◽  
Before And After

Abstract Objective: The aim of the present study was to verify the behavior of hemodynamic variables in hypertensive older women following a combined exercise session and to identify the intensity of effort achieved in this session. Method: The study included 14 hypertensive older women (72.0±6.7 years old) who regularly practiced physical activities. The participants underwent a one-hour combined exercise session performed in a group, with intensity of effort monitored by accelerometry (Actigraph, model GT3X+). The hemodynamic parameters (systolic blood pressure, diastolic blood pressure, heart rate, stroke volume, cardiac output and peripheral vascular resistance) were individually measured by finger photoplethysmography (Finometer) before and after (60 min) the exercise session. Results: The sessions consisted predominantly of low-light intensity activities (60%) and 20% of class time was spent on sedentary behavior. None of the evaluated variables exhibited changes when the pre and post-exercise values were compared (p>0.05). Systolic blood pressure behavior correlated positively with time spent in sedentary behavior (r=0.541; p=0.045). Conclusion: The combined exercise sessions, as conducted, did not generate post-exercise hypotension. In addition, the time spent in typically sedentary activities during the classes positively correlated with changes in blood pressure, suggesting that combined exercise programs, applied in the form of collective aerobic exercises, should be composed of higher intensity activities.

scholarly journals PENGARUH THERAPY BEKAM BASAH TERHADAP TEKANAN DARAH PASIEN HIPERTENSI

2018 ◽  
Vol 6 (2) ◽  
pp. 102-105
Author(s):  
Leli Mulyati
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Cupping Therapy ◽  
Control Group ◽  
Pressure Measurements ◽  
Hypertensive Patients ◽  
Average Systolic Blood Pressure ◽  
Before And After ◽  
Post Test ◽  
Quasi Experimental

This study aims to determined the effected of wet cupping therapy on blood pressure in hypertensive patients. The study used a quasi-experimental method with one group pre-test and post-test without a control group. The study subjects total 30 respondents consisting of patients with hypertension. All subjects are given wet cupping treatment twice with an interval of 2 weeks. Blood pressure measurements made ​​before and after wet cupping. The results of analysis used a t-dependent, decrease in average systolic blood pressure was 13 333 ± 12 042 wet cupping mmHg and diastolic 4667 ± 3294 mmHg. At week 2 a decrease in average systolic blood pressure mmHg while the 8667 ± 8308 6667 ± 5525 mmHg diastolic. Decrease in average systolic and diastolic blood pressure there were significant differences (p <0.05) in the first wet cupping and second wet cupping. This shows that wet cupping therapy affects blood pressure in hypertension patients.

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