Presentation
The patient was discharged and was lost to follow-up until he presented again in 2012 for 'resistant hypertension' in our outpatient clinic. [ncbi.nlm.nih.gov]
Entire Body System
- Fatigue
After the initial visit, the patient presented to the clinic with complaints of dizziness and fatigue and was found to be hypotensive. [ncbi.nlm.nih.gov]
He reports compliance with his medication regimen, and does not report any specific intolerances that he attributes to medications, but does note that he has a dry mouth, feels fatigued, and has excessive daytime sleepiness. Continue [clevelandclinicmeded.com]
As an aside, the fatigue and dry mouth were attributed to the β-blocker and the alpha 2 -agonist, supporting the adherence he claimed to his BP regimen. [cjasn.asnjournals.org]
Have your blood pressure and blood glucose levels tested regularly and see a kidney specialist if you experience fluid retention in your legs, ankles, feet or face; have unexplained fatigue, headache, nausea or vomiting. [mainlinehealth.org]
Martínez-Lavín, “Sympathetic nervous system dysfunction in fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and interstitial cystitis: a review of case-control studies.,” J. Clin. Rheumatol., vol. 20, no. 3, pp. 146–50, Apr. 2014. [acta.tums.ac.ir]
- Virilization
(11-β-OH deficiency); incomplete masculinization in males and primary amenorrhea in females (17-α-OH deficiency) Signs of virilization (11β) or incomplete masculinization (17α) Hypertension and hypokalemia with low or normal aldosterone and renin 11- [ahajournals.org]
Gastrointestinal
- Nausea
Have your blood pressure and blood glucose levels tested regularly and see a kidney specialist if you experience fluid retention in your legs, ankles, feet or face; have unexplained fatigue, headache, nausea or vomiting. [mainlinehealth.org]
Symptoms of a hypertensive crisis may include severe chest pain and headache, blurred vision, nausea, anxiety and shortness of breath. The affected person might also be unresponsive or have seizures. [idorsia.com]
Cardiovascular
- Femoral Bruit
The presence of carotid, abdominal, or femoral bruits increases the possibility that renal artery stenosis exists. [circ.ahajournals.org]
- Ejection Murmur
Physical exam revealed a systolic ejection murmur, and ECHO demonstrated moderate hypertrophy. [ncbi.nlm.nih.gov]
- Unequal Blood Pressure in the Arms
A focused physical exam should evaluate the patient for both secondary causes of hypertension (body mass index, unequal blood pressures on both arms, abdominal bruit, signs of Cushing's disease, thyroid exam) and for signs of target organ damage (retinal [renalandurologynews.com]
Face, Head & Neck
- Episodic Headache
If patient has symptoms of pheochromocytoma (episodic headaches, sweating, palpitations), check serum metanephrines. If patient is obese or has symptoms of sleep apnea, a formal sleep study is recommended. [renalandurologynews.com]
Psychiatrical
- Impulsivity
[…] to bilateral carotid sinus leads (CSLs). 26 Directional telemetry makes it possible to externally program the IPG, allowing adjustment of stimulation parameters. 26 These parameters include the amplitude of voltage and the frequency and duration of impulses [uscjournal.com]
Pulse and respiratory grouping of sympathetic impulses in human muscle-nerves. Acta Physiol Scand, 74 (1968), pp. 96-108 [13] M. Esler, G. Jackman, A. Bobik, et al. Determination of norepinephrine apparent release rate and clearance in humans. [revportcardiol.org]
Neurologic
- Headache
We report the case of a 34-year-old male patient who presented with generalized weakness, poorly controlled hypertension, nocturnal hypertension spikes, and morning headaches. [ncbi.nlm.nih.gov]
Symptoms include numbness in the arms and legs, blurred vision, confusion, chest pain, and headache. Resistant hypertension. [everydayhealth.com]
Such actions may include: Skipping your medication : When you take an aspirin and your headache goes away, you know the aspirin is working. [hopkinsmedicine.org]
Workup
Diagnostic workup and management of resistant hypertension were discussed in different clinical presentations. [ncbi.nlm.nih.gov]
At baseline, clinical data were collected and patients underwent echocardiographic measurements, routine blood testing and additional workup for exclusion of secondary causes of RHT (office-based uncontrolled hypertension under at least 3 drugs including [onlinejacc.org]
In addition, this paper will attempt to provide a rational for the workup and treatment of patients with resistant hypertension. 2. [hindawi.com]
X-Ray
- Small Kidney
An ultrasound for renal size will help to identify those with small kidneys typical of nondiabetic medical renal disease, or asymmetrical kidneys often seen in renovascular disease. [ncbi.nlm.nih.gov]
Chronic Kidney Disease Hypertension is commonly found in patients with chronic kidney disease (CKD), with 75% of CKD patients taking antihypertensive drugs [148]. [hindawi.com]
Serum
- Aldosterone Decreased
On administration of pioglitazone (30 mg/d) and nifedipine (40 mg/d), hypertension and hypokalemia improved and plasma aldosterone decreased for more than 6 months. [ncbi.nlm.nih.gov]
Treatment
INTRODUCTION: The effectiveness of renal sympathetic denervation (RDN) as a treatment for therapy-resistant hypertension has been doubted as the Simplicity-HTN-3 trial was unable to show any treatment benefit over sham procedure. [ncbi.nlm.nih.gov]
A total of 106 patients with resistant hypertension were randomly assigned to either RDN with medical treatment (treatment arm, n=52) or medical treatment alone (control arm, n=54). [revportcardiol.org]
Prognosis
CONCLUSIONS: ATRH entails a worse renal prognosis in T2D with hypertension. BP control is not associated with a more-favorable renal outcome in aTRH. [ncbi.nlm.nih.gov]
This article will describe how resistant hypertension is defined, its prevalence and prognosis, methods to diagnose it effectively in routine practice and strategies to effectively manage patients diagnosed with the condition. [heart.bmj.com]
Conclusions In treated hypertensive patients, among prospective RHT dynamic patterns, persistent RHT is frequent and independently associated with adverse cardiovascular prognosis. [onlinejacc.org]
Etiology
The etiology of resistance hypertension is multifactorial. [ncbi.nlm.nih.gov]
In the etiological study of hypertension, several analytical alterations were identified, and they are explained in table 1. [scielo.org.co]
Epidemiology
KEYWORDS: Epidemiology; pharmacology; resistant hypertension [ncbi.nlm.nih.gov]
Definitions of Resistant Hypertension and Epidemiology of Resistant Hypertension Ferro, Charles J. Pages 1-12 Definition and Characteristics of Hypertension Associated with Chronic Kidney Disease: Epidemiological Data Franczyk, Beata (et al.) [springer.com]
Pathophysiology
CONCLUSION: The renin-angiotensin-aldosterone system seems to play a cardinal role in the pathophysiology of resistant HT and requires appropriate management. [ncbi.nlm.nih.gov]
Prevention
Session Title: Prevention: Risk Predictors, Subclinical Atherosclerosis, and Resistent Hypertension Abstract Category: 21. Prevention: Hypertension Presentation Number: 1166M-363C 2014 American College of Cardiology Foundation [onlinejacc.org]
The contribution of carotid baroreceptor feedback in preventing or potentially contributing to the essential hypertensive cascade is poorly understood. [ncbi.nlm.nih.gov]
Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Vascular Medicine, Hypertension Keywords: Amiloride, Angiotensin Receptor Antagonists, Antihypertensive Agents, Angiotensin-Converting Enzyme Inhibitors, Arteriovenous Anastomosis, Blood [acc.org]
Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence: A scientific statement from the American Heart Association and the American Diabetes Association. [education.questdiagnostics.com]