How to Explore an Endocrine Cause of Hypertension

Hypertension (HTN) is the most frequent modifiable risk factor in the world, affecting almost 30 to 40% of the adult population in the world. Among hypertensive patients, 10 to 15% have so-called “secondary” HTN, which means HTN due to an identified cause. The most frequent secondary causes of HTN are renal arteries abnormalities (renovascular HTN), kidney disease, and endocrine HTN, which are primarily due to adrenal causes. Knowing how to detect and explore endocrine causes of hypertension is particularly interesting because some causes have a cure or a specific treatment available. Moreover, the delayed diagnosis of secondary HTN is a major cause of uncontrolled blood pressure. Therefore, screening and exploration of patients at risk for secondary HTN should be a serious concern for every physician seeing patients with HTN. Regarding endocrine causes of HTN, the most frequent is primary aldosteronism (PA), which also is the most frequent cause of secondary HTN and could represent 10% of all HTN patients. Cushing syndrome and pheochromocytoma and paraganglioma (PPGL) are rarer (less than 0.5% of patients). In this review, among endocrine causes of HTN, we will mainly discuss explorations for PA and PPGL.

ASSOCIATION OF DIETARY AND LIFESTYLE FACTORS ON BLOOD PRESSURE CONTROL AMONG ADULT HYPERTENSIVE PATIENTS ATTENDING A UGANDAN TERTIARY HOSPITAL

Hypertension is an important worldwide public-health challenge due to its high prevalence and being a risk factor for cerebrovascular, cardiovascular, and chronic renal diseases. Despite these risk factors, blood pressure control among hypertensive patients is still poor. The main objective was to assess dietary and lifestyle factors associated with uncontrolled blood pressure control among Ugandan hypertensive patients at Kiruddu hospital. Materials and methods: A cross-sectional study involving 271 adult hypertensive patients attending the outpatient hypertensive clinic was enrolled. Data were obtained on dietary, lifestyle factors (alcohol intake, smoking status, and level of physical activity), social demographics, Body Mass Index (BMI), comorbidities, and adherence to hypertensive medication. An average of the current and previous two Blood pressure readings was recorded. Factors associated with uncontrolled blood pressure were assessed using a multivariate logistic regression model. Results: The mean age of study participants was 57 ± 0.76 years, with female dominance (77.9%). Among the study participants, 121 (44.7%) had uncontrolled BP. Dietary factors that were associated with uncontrolled blood pressure with adjusted OR (95%CI) included consumption of raw salt: 4.18 (1.32-13.24) and inadequate fruit consumption: 2.18 (1.26-3.75) while clinical factors included being overweight: 2.51 (1.27-4.95) and poor adherence to antihypertensive medications prescribed: 1.82 (1.03-3.21). Conclusion: The proportion of hypertensive patients with uncontrolled Blood Pressure was high (44.7%). Consumption of raw salt, inadequate fruit consumption, being overweight and poor adherence to antihypertensive medication were significantly associated with uncontrolled BP. From these findings, factors that were associated with the control of blood pressure are modifiable.

PENINGKATAN PENGETAHUAN PENCEGAHAN HIPERTENSI PADA MASA PANDEMI COVID-19

Uncontrolled blood pressure can cause fatal complications for the patients. The high number of hypertension patients in Indonesia, especially in Jakarta is caused by a lack of self-awareness and low motivation from families. Those encourage the team to conduct education activities related to preventing high blood pressure and tips so that blood pressure can be controlled. The team coordinated with West Jakarta Tomang sub-district citizens in the implementation of community service so that health education activities can be realized. This activity is carried out by providing health education related to the ways in preventing hypertension and the benefits of it during this pandemic situation. The target people of the activity is young adults in West Jakarta area, especially those with risk factors related to hypertension, hypertension patients and their families. The activity was attended by 38 participants in accordance with the target of counseling activities. The result of the average pre-test score was 35.09 and the post-test average score was 62.28; there was an increase in the knowledge of participants who attended this education about 77.5%. This activity and other similar activities need to be carried out routinely so that the people can apply healthy life habits consistently.Tekanan darah yang tidak terkontrol dapat menimbulkan komplikasi dan berakibat fatal bagi penderitanya. Masih tingginya angka kejadian hipertensi di Indonesia terutama di Jakarta, disebabkan karena kurangnya kesadaran diri serta rendahnya motivasi dari keluarga. Hal tersebut mendorong tim pengabdian melakukan edukasi terkait pencegahan tekanan darah tinggi serta kiat-kiat agar tekanan darah dapat terkontrol. Tim pengabdian berkoordinasi dengan kader kelurahan Tomang Jakarta Barat dalam pelaksanaan pengabdian masyarakat agar kegiatan edukasi kesehatan dapat terealisasi. Pelaksanaan pengabdian kepada masyarakat dilakukan dengan memberikan edukasi kesehatan terkait informasi cara pencegahan hipertensi serta manfaat pencegahan hipertensi pada masa pandemi. Sasaran dari kegiatan adalah dewasa muda di daerah Jakarta Barat terutama yang memiliki faktor resiko terkait hipertensi, penderita hipertensi dan keluarganya. Kegiatan dihadiri 38 peserta yang sesuai dengan target sasaran kegiatan penyuluhan. Hasil nilai rata-rata pre-tets adalah 35,09 dan nilai rata-rata post-test adalah 62,28, terjadi peningkatan pengetahuan peserta yang mengikuti edukasi dengan materi pencegahan hipertensi sebesar 77,5%. Kegiatan pengabdian ini dan kegiatan serupa perlu dilaksanakan secara rutin agar perubahan gaya hidup dapat diterapkan secara konsisten oleh masyarakat.

Reasons for Uncontrolled Blood Pressure Among US Adults: Data From the US National Health and Nutrition Examination Survey

Identifying subgroups of the population with different reasons for uncontrolled blood pressure (BP) can inform where to direct interventions to increase hypertension control. We determined characteristics associated with not being aware of having hypertension and being aware but not treated with antihypertensive medication among US adults with uncontrolled BP using the 2015 to 2018 National Health and Nutrition Examination Surveys (N=2282). Among US adults with uncontrolled BP, systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, 38.0% were not aware they had hypertension, 15.6% were aware but not treated and 46.4% were aware and treated with antihypertensive medication. After multivariable adjustment, US adults who were 18-39 versus ≥70 years old were more likely (prevalence ratio, 1.49 [95% CI, 1.11–1.99]) and those who had a health care visit in the past year were less likely (prevalence ratio, 0.61 [95% CI, 0.48–0.77]) to be unaware they had hypertension. Among US adults with uncontrolled BP who were aware they had hypertension, those 18 to 39, 40 to 49, 50 to 59, and 60 to 69 versus ≥70 years old were more likely to not be treated versus being treated with antihypertensive medication. Not being treated with antihypertensive medication versus being treated and having uncontrolled BP was less common among those with versus without a usual source of health care (prevalence ratio, 0.69 [95% CI, 0.51–0.94]) and who reported having versus not having a health care visit in past year (prevalence ratio, 0.46 [95% CI, 0.35–0.61]). In conclusion, to increase BP control, interventions should be directed towards populations in which hypertension awareness is low and uncontrolled BP is common despite antihypertensive medication use.

Risk factors associated with uncontrolled blood pressure among patients with non-dialysis chronic kidney disease in Vietnam

Background: Uncontrolled blood pressure rates are high in patients with non-dialysis chronic kidney disease, worsening the disease progression and leading to end-stage renal disease. However, studies on uncontrolled blood pressure in patients with non-dialysis chronic kidney disease and its associated factors in Vietnam are scarce. Objectives: This study aimed at identifying uncontrolled blood pressure rates and risk factors associated with uncontrolled blood pressure among Vietnamese patients with non-dialysis chronic kidney disease. Results: 63.2% of the participants could not control their BP less than 130/80 mmHg. Poor sleep quality (OR 2.076, 95%CI 1.059-4.073, p=.034) and severe comorbidities (OR 2.926, 95%CI 1.248-6.858, p=.013) were risk factors associated with uncontrolled blood pressure among Vietnamese patients with non-dialysis chronic kidney disease. Interestingly, the study found a high rate of awareness toward the importance of blood pressure control but a low rate of known blood pressure targets. Conclusion: Uncontrolled blood pressure rates among Vietnamese patients with non-dialysis chronic kidney disease were high. Sleep quality and comorbidity severity were significantly associated with uncontrolled blood pressure in this population. To achieve blood pressure targets, nurses and other healthcare providers should pay more attention to the patients with poor sleep quality and severe comorbidities. Funding: The “2018 Mahidol Postgraduate Scholarship”.

Hard bilateral syphilitic testes with vasculitis: a case report and literature review

Background We report the case of a patient with syphilitic testicular gumma and vasculitis with adrenal failure due to chronic steroid use. Case presentation A 63-year-old male presented with hard right eye swelling and very firm bilateral testes on palpation, which he had for 2 years. Testicular tumor markers were negative; syphilis test was positive. Radiological examination suggested aortitis and bilateral testicular malignancy. The patient received ampicillin for the infection and prednisolone for vasculitis. Left orchidectomy was performed to confirm the presence of testicular tumor; histological examinations revealed granulomatous orchitis. The prednisolone doses were adjusted because of relapses and adverse effects of steroid use. Unfortunately, the patient died in the intensive care unit because of uncontrolled blood pressure and pneumonia. Conclusions This is a rare case of syphilis with testicular involvement and vasculitis. This report shows the importance of broadening the differential diagnoses of testicular firmness.