305 research outputs found
Vasoregulation and renal function in essential hypertension
It is well known from population studies that blood pressure tends to increase
with age (Master et al., 1950; Hamilton et al., 1954; Zinner et al., 1971; Kahn
et al., 1972; Buck, 1973; Kimura, 1973; Miall and Chinn, 1973), at least in
Western society. Any upward deviation from this "normal" trend can thus be
considered to represent a development into the hypertensive range. A hypertensive
individual distinguishes himself by an earlier or steeper increase in
blood pressure.
Once a diagnosis of essential hypertension has been established by excluding
known causes of elevated blood pressure, the follow-up of these patients is
mainly based on repetitive blood pressure readings.
Many studies have been carried out with respect to the epidemiology of
hypertension. Such investigations provide information about the incidence
and end-points of hypertension but this concerns only the easily accessible part
of the disorder
Life-threatening hypokalaemia and quadriparesis in a patient with ureterosigmoidostomy
We report quadriparesis as a result of severe hypokalaemia and acidosis in
a 50-year-old man who had undergone ureterosigmoidostomy for bladder
extrophy 48 years earlier. Aggressive suppletion with intravenous
potassium and bicarbonate combined with potassium-sparing diuretics and
ACE inhibitors resulted in complete restoration of the serum potassium and
resolution of the neurological symptoms. The underlying mechanism as well
as the treatment of hypokalaemia and hyperchloraemic metabolic acidosis
after ureterosigmoidostomy are briefly discussed
Interactions between five candidate genes and antihypertensive drug therapy on blood pressure
Despite the availability of effective antihypertensive drugs, there is a large variation in response to these drugs. This study investigates whether polymorphisms in the angi
Recruitment of participants through community pharmacies for a pharmacogenetic study of antihypertensive drug treatment
Objective To describe the design, recruitment and baseline characteristics of participants in a community pharmacy based pharmacogenetic study of antihypertensive drug treatment. Setting: Participants enrolled from the population-based Pharmaco-Morbidity Record Linkage System. Method We designed a nested case-control study in which we will assess whether specific genetic polymorphisms modify the effect of antihypertensive drugs on the risk of myocardial infarction. In this study, cases (myocardial infarction) and controls were recruited through community pharmacies that participate in PHARMO. The PHARMO database comprises drug dispensing histories of about 2,000,000 subjects from a representative sample of Dutch community pharmacies linked to the national registrations of hospital discharges. Results In total we selected 31010 patients (2777 cases and 28233 controls) from the PHARMO database, of whom 15973 (1871 cases, 14102 controls) were approached through their community pharmacy. Overall response rate was 36.3% (n = 5791, 794 cases, 4997 controls), whereas 32.1% (n = 5126, 701 cases, 4425 controls) gave informed consent to genotype their DNA. As expected, several cardiovascular risk factors such as smoking, body mass index, hypercholesterolemia, and diabetes mellitus were more common in cases than in controls. Conclusion Furthermore, cases more often used beta-blockers and calcium-antagonists, whereas controls more often used thiazide diuretics, ACE-inhibitors, and angiotensin-II receptor blockers. We have demonstrated that it is feasible to select patients from a coded database for a pharmacogenetic study and to approach them through community pharmacies, achieving reasonable response rates and without violating privacy rules
New diagnostic and treatment strategies in renal artery stenosis: a promising pursuit or disappointment foretold?
Clinical management of renal artery stenosis has seen a major shift, after randomised clinical trials have shown no group benefit of endovascular intervention relative to optimal medical control. However, the inclusion criteria of these trials have been criticised for focusing on a subset of patients with atherosclerotic renal artery stenosis where intervention was unlikely to be beneficial. Moreover, new imaging and computational techniques have become available, which have the potential to improve identification of patients that will respond to interventional treatment. This review addresses the challenges associated with clinical decision making in patients with renal artery stenosis. Opportunities for novel diagnostic techniques to improve patient selection are discussed, along with ongoing Dutch studies and network initiatives that investigate these strategies
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