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Rebound Hypertension


Presentation

  • Whereas mild manifestations of these symptoms can occasionally be present at presentation in patients with intracranial hypotension, severe or continuous nausea, vomiting, and blurred vision are not common with low CSF pressure.[ajnr.org]
  • Every time a patient presents with a new disease or an exacerbation of an existing condition, someone needs to ask, “Could this be drug-related?”[books.google.de]
  • , University of Florida, Gainesville, Florida, USA Correspondence to Dr John Malaty, malaty{at}ufl.edu Summary A 46-year-old African-American man with a history of hypertension, end-stage kidney disease (on haemodialysis) and previous cocaine misuse presented[casereports.bmj.com]
  • Presented at: ASN Kidney Week; Oct. 23-28, 2018; San Diego. Disclosure: Healio Nephrology was unable to confirm relevant financial disclosures at the time of publication.[healio.com]
  • Renal biopsy is indicated if nephritic urinary sediment and/or nephrotic range proteinuria are present.[renalandurologynews.com]
Asymptomatic
  • […] drugs are known to have interaction and will need the involvement of your doctor before use together; Clonidine and Blocadren Diuretics and Beta Blockers Clonidine and Indreal Clonidine and Tenormin In terms of symptoms, rebound hypertension can be asymptomatic[hypertension-bloodpressure-center.com]
  • Second, because most patients who undergo epidural blood patching do not undergo routine subsequent CSF pressure evaluation, asymptomatic rises in CSF pressure in some patients could occur.[ajnr.org]
  • “We try to dissuade internists and surgeons from sending patients to the ED for high blood pressure that is asymptomatic.” Misuse of resources is another issue, added Dr.[acphospitalist.org]
  • Although there is not a strong basis in clinical trials, expert opinion also supports the use of beta-blockers in patients with asymptomatic reduction in ventricular function with the goal of improving ventricular function and prevention of the onset[thecardiologyadvisor.com]
Intravenous Administration
  • In a patient with hypertensive crisis following abrupt cessation of clonidine hydrochloride and metoprolol tartrate, intravenous administration of labetalol hydrochloride rapidly reduced blood pressure and heart rate to precrisis levels.[ncbi.nlm.nih.gov]
  • administration of clonidine may be preferable.[anesthesiology.pubs.asahq.org]
Upper Abdominal Pain
  • Despite chemotherapy with 5-fluorouracil and gencitabine, increased tumor growth resulted in complaints of upper abdominal pain radiating through to the back.[anesthesiology.pubs.asahq.org]
Paresthesia
  • Some patients may not be able to tolerate the side effects of acetazolamide, which include paresthesias of the digits, fatigue, and nausea. 19 If patients cannot tolerate acetazolamide, we have used topiramate as an alternative because it also demonstrates[ajnr.org]
  • Prodromal symptoms reported by either patients or witnesses included lightheadedness, dizziness, confusion, paresthesias, altered sensorium, and loss of balance.[innovationsincrm.com]
Morning Headache
  • Prolonged recumbent positioning at night may contribute to morning headaches, though other proposed mechanisms such as a rise in pCO 2 at night, decreased CSF reabsorption, and increased CSF production modulated by chemical factors such as melatonin,[ajnr.org]
Tremulousness
  • A further 2 h later, he became progressively diaphoretic and tremulous. Blood pressure was increased from 140/80 to 220/110 mmHg, and heart rate was 170 beats/min. During this period, the patient complained of chest tightness.[anesthesiology.pubs.asahq.org]

Treatment

  • Rebound high blood pressure can be driven by the patient themselves when they simply stop taking medication mid-way of ongoing treatment regimen.[hypertension-bloodpressure-center.com]
  • Pretreatment (ie, before EBP) and post-EBP clinical symptoms, CSF pressure measurements, and treatment details were recorded.[ajnr.org]
  • […] for severe cancer pain in patients for whom other treatments are ineffective. [11].[anesthesiology.pubs.asahq.org]
  • If long-term treatment with a β-blocker needs to be interrupted, the β-blocker 974284[paintballwpolsce.com.pl]
  • Although the adult literature has focused on the unpredictable decline in BP after SA-NIF treatment, these cases suggest that rapid increases in BP following the maximal SA-NIF effect may be associated with impaired cerebral autoregulation and encephalopathy[scite.ai]

Prognosis

  • This applies in particular to patients with lacunar infarction, whereas patients with POCI, who presented with the lowest blood pressure, had the poorest prognosis.[medscape.com]
  • “Some different types of essential hypertension: their course and prognosis.”. Am J Med Sci. vol. 268. 1974. pp. 336-345. Klijn, CJ, Hankey, GJ.[renalandurologynews.com]

Etiology

  • These symptoms mirror features of those patients with raised intracranial pressure caused by other etiologies. 7, 8 Jugular venous outflow is impaired in the recumbent position, 9 which probably accounts for the worsening of symptoms in some patients[ajnr.org]
  • Subtherapeutic treatment regimens, nonadherence, and drug-induced etiologies have been attributed to its development. 1,3,5,6 Being African American, elderly, male, and lacking a primary care physician have been identified as major risk factors for the[uspharmacist.com]
  • "Elevated Norepinephrine may be a Unifying Etiological Factor in the Abuse of a Broad Range of Substances: Alcohol, Nicotine, Marijuana, Heroin, Cocaine, and Caffeine". Substance Abuse. 7 : 171–83. doi : 10.4137/SART.S13019. PMC 3798293.[en.wikipedia.org]
  • Hypertension of virtually any etiology (essential or secondary) can enter into the crisis phase. The most common cause for a hypertensive crisis is chronic hypertension with an acute exacerbation resulting from medication noncompliance.[renalandurologynews.com]

Epidemiology

  • Hypertensive crises, including hypertensive emergency and urgency admissions to ER, were reported to be 4.6/1,000 in a recent multicenter Italian epidemiological study.[renalandurologynews.com]
Sex distribution
Age distribution

Pathophysiology

  • The frequency and pathophysiology of the clonidine withdrawal syndrome was studied in fourteen hypertensive patients on chronic clonidine therapy. 2.[ncbi.nlm.nih.gov]
  • "Role of norepinephrine in the pathophysiology and treatment of posttraumatic stress disorder". Biological Psychiatry. 46 (9): 1192–204. doi : 10.1016/S0006-3223(99)00219-X. PMID 10560025. Strawn, JR; Geracioti, TD, Jr (2008).[en.wikipedia.org]

Prevention

  • Drinking enough water is essential to prevent the negative effects of dehydration on your heart rate and blood pressure.[cellercise.com]
  • These cases underscore the need for frequent blood pressure determinations and therapy to prevent rebound hypertension.[scite.ai]
  • Now in its second edition, this popular and essential comprehensive resource provides a detailed analysis of how to identify, prevent, and manage drug-induced diseases. Edited by James E. Tisdale and Douglas A.[books.google.de]
  • This also explains our experience that adrenergic beta-receptor blocking drugs do not prevent the rise in BP, although they alleviate some of the symptoms. Full text Full text is available as a scanned copy of the original print version.[ncbi.nlm.nih.gov]
  • The best management for hypertensive crisis is prevention.[pharmacytimes.com]

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