scholarly journals High Blood Pressure Increases the Risk of Poor Outcome at Discharge and 12‐month Follow‐up in Patients with Symptomatic Intracranial Large Artery Stenosis and Occlusions: Subgroup analysis of the CICAS Study

2015 ◽  
Vol 21 (6) ◽  
pp. 530-535 ◽  
Author(s):  
Dan‐Dan Yu ◽  
Yue‐Hua Pu ◽  
Yue‐Song Pan ◽  
Xin‐Ying Zou ◽  
Yannie Soo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
High Blood Pressure ◽  
Subgroup Analysis ◽  
Artery Stenosis ◽  
Large Artery ◽  
Poor Outcome

MO233RENAL ARTERY STENOSIS: DO NOT FORGET INHERITED THROMBOPHILIA

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Marwa Omrane ◽  
Yosra Ben Ariba ◽  
Imen Ouertani ◽  
Jannet Labidi
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Renal Artery ◽  
High Blood Pressure ◽  
Protein C ◽  
Artery Bypass ◽  
Duplex Ultrasound ◽  
Protein S ◽  
Artery Stenosis ◽  
Inherited Thrombophilia

Abstract Background and Aims Inherited thrombophilia can be defined as a genetically determined predisposition to develop thromboembolic complications. Inherited prothrombotic risk factors include antithrombin deficiency, protein C and protein S deficiencies, activated protein C resistance due to Leiden factor V mutation, inherited hyperhomocysteinemia, prothrombin G20210A variant, dysfibrinogenemia and elevated factor VIII levels. Method We report the case of a patient with history of bilateral renal artery stenosis who presented with renal artery bypass thrombosis related to an inherited thrombophilia. Results We report a case of 40-year-old male patient who presented with extremely high blood pressure and hypokalemia without other biological abnormalities. The duplex ultrasound showed bilateral renal stenosis with chronic occlusion of the right renal artery and a tight stenosis of the left renal artery estimated at 50%. Renal angiography confirmed the bilateral stenosis, associated to a small right kidney. Renal scintigraphy with DMSA showed normal left renal function and right renal function estimated at 2%. The therapeutic decision was to perform an aorto-renal bypass surgery by the saphenous vein.After renal artery bypass the blood pressure improved markedly, maintaining this result at 12 months follow-up at clinical examination and duplex ultrasound. One year later, the patient presented with high blood pressure. The duplex ultrasound showed a stenosis of the bypass with a double stenosis of the left aorto renal bypass on renal angioscanner. The patient underwent angioplasty of the venous bridge with implantation of 2 stents with improvement of blood pressure after angioplasty. Six months later, the patient presented an unbalanced blood pressure, the ultrasound control with a vascular Doppler showed a stenosis at the stent. The antihypertensive treatment was increased, a thrombophilia balance was requested concluding a combined protein C and protein S deficiency. Conclusion An etiological assessment should be carried out systematically in the event of thrombosis occurring before the age of 40 or in the case of iterative venous or arterial thrombosis. A genetic study where appropriate and a family screening are then recommended.

scholarly journals High blood pressure in older subjects with cognitive impairment

2016 ◽  
Vol 84 (1-2) ◽  
Author(s):  
Enrico Mossello ◽  
David Simoni
Keyword(s):  
Blood Pressure ◽  
Cognitive Impairment ◽  
Old Age ◽  
High Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Cognitively Impaired ◽  
Blood Pressure Lowering ◽  
Pressure Lowering ◽  
Older Subjects

<p>High blood pressure and cognitive impairment often coexist in old age, but their pathophysiological association is complex. Several longitudinal studies have shown that high blood pressure at midlife is a risk factor for cognitive impairment and dementia, although this association is much less clear in old age. The effect of blood pressure lowering in reducing the risk of dementia is only borderline significant in clinical trials of older subjects, partly due to the insufficient follow-up time. Conversely, dementia onset is associated with a decrease of blood pressure values, probably secondary to neurodegeneration. Prognostic effect of blood pressure values in cognitively impaired older subjects is still unclear, with aggressive blood pressure lowering being potentially harmful in this patients category. Brief cognitive screening, coupled with simple motor assessment, are warranted to identify frail older subjects who need a more cautious approach to antihypertensive treatment. Values obtained with ambulatory blood pressure monitoring seem more useful than clinical ones to predict the outcome of cognitively impaired older subjects. Future studies should identify the most appropriate blood pressure targets in older subjects with cognitive impairment. </p><p><strong>Riassunto</strong></p><p>Ipertensione arteriosa e decadimento cognitivo spesso coesistono in età avanzata, sebbene la loro associazione sia complessa dal punto di vista fisiopatologico. Diversi studi longitudinali hanno mostrato che elevati valori pressori in età adulta rappresentano un fattore di rischio per decadimento cognitivo e demenza, sebbene tale associazione sia molto meno chiara in età avanzata. L’effetto della terapia antiipertensiva è risultato ai limiti della significatività statistica nel ridurre il rischio di demenza negli studi di intervento su soggetti anziani, in parte a causa della durata insufficiente del follow-up. D’altra parte, l’insorgenza di demenza è associata con una riduzione dei valori pressori, probabilmente secondaria alla neurodegenerazione. L’effetto prognostico dei valori pressori in anziani con decadimento cognitivo non è stato ancora chiarito, in presenza di un possibile effetto dannoso di un trattamento antiipertensivo aggressivo in questa categoria di pazienti. Un breve screening cognitivo, associato con una semplice valutazione motoria, è raccomandato per identificare gli anziani fragili, che necessitano di un approccio più cauto alla terapia antiipertensiva. I risultati del monitoraggio della pressione arteriosa nelle 24 ore sembrano più utili della misurazione clinica per predire la prognosi degli anziani cognitivamente compromessi. Studi futuri dovrebbero identificare gli obiettivi pressori più appropriati nel trattamento di anziani con decadimento cognitivo.</p>

scholarly journals Ischaemic stroke or TIA in older subjects associated with impaired dynamic blood pressure control in the absence of severe large artery stenosis

2015 ◽  
Vol 44 (4) ◽  
pp. 655-661 ◽  
Author(s):  
D. J. Ryan ◽  
R. A. Kenny ◽  
S. Christensen ◽  
J. F. M. Meaney ◽  
A. J. Fagan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischaemic Stroke ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Artery Stenosis ◽  
Large Artery ◽  
Older Subjects

Vascular smooth muscle Gq signaling is involved in high blood pressure in both induced renal and genetic vascular smooth muscle-derived models of hypertension

2007 ◽  
Vol 293 (5) ◽  
pp. H3072-H3079 ◽  
Author(s):  
David M. Harris ◽  
Heather I. Cohn ◽  
Stéphanie Pesant ◽  
Rui-Hai Zhou ◽  
Andrea D. Eckhart
Keyword(s):  
Blood Pressure ◽  
Smooth Muscle ◽  
Vascular Smooth Muscle ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Antihypertensive Therapy ◽  
High Blood Pressure ◽  
Vascular Function ◽  
Artery Stenosis ◽  
Ang Ii

More than 30% of the US population has high blood pressure (BP), and less than a third of people treated for hypertension have it controlled. In addition, the etiology of most high BP is not known. Having a better understanding of the mechanisms underlying hypertension could potentially increase the effectiveness of treatment. Because Gq signaling mediates vasoconstriction and vascular function can cause BP abnormalities, we were interested in determining the role of vascular smooth muscle (VSM) Gq signaling in two divergent models of hypertension: a renovascular model of hypertension through renal artery stenosis and a genetic model of hypertension using mice with VSM-derived high BP. Inhibition of VSM Gq signaling attenuated BP increases induced by renal artery stenosis to a similar extent as losartan, an ANG II receptor blocker and current antihypertensive therapy. Inhibition of Gq signaling also attenuated high BP in our genetic VSM-derived hypertensive model. In contrast, BP remained elevated 25% following treatment with losartan, and prazosin, an α1-adrenergic receptor antagonist, only decreased BP by 35%. Inhibition of Gq signaling attenuated VSM reactivity to ANG II and resulted in a 2.4-fold rightward shift in EC50. We also determined that inhibition of Gq signaling was able to reverse VSM hypertrophy in the genetic VSM-derived hypertensive model. These results suggest that Gq signaling is an important signaling pathway in two divergent models of hypertension and, perhaps, optimization of antihypertensive therapy could occur with the identification of particular Gq-coupled receptors involved.

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