Effectiveness of telemedicine-guided home blood pressure compared to 24 h-ambulatory blood pressure monitoring in patients with and without chronic kidney disease.

Background. Only few direct comparative studies evaluated the effectiveness of telemedicine-guided home blood pressure (tele-HBPM) compared to 24 h ambulatory blood pressure monitoring (ABPM) in assessing blood pressure (BP) and BP control. Material and methods. This prospective clinical trial included patients with arterial hypertension, with (n = 23) and without (n = 18) chronic kidney disease and normal volunteers (n = 16). All subjects underwent with a 1-month interval twice one-week of BP monitoring with office BP (3 measurements at 2 visits), 24 h-ABPM and tele-HBPM during 7 consecutive days. Results. Mean (SD) BP levels were 128/77 [19/11] mm Hg and 126/75 [14/9] mm Hg for tele-HBPM, 129/78 [17/11] mm Hg and 127/75 [14/9] mm Hg for daytime-ABPM, and 133/77 [23/12] mm Hg and 130/74 [17/11] mm Hg for office BP, all respectively at the first and the second measurement periods. Blood pressure and BP control were comparable between the two out-of-office techniques. Conclusion. Both out-of-office techniques (tele-HBPM and 24h-ABPM) show good agreement for systolic as well as diastolic BP, and are equally effective in assessing BP and BP control, explicitly during daytime

Fibromuscular dysplasia: its various phenotypes in everyday practice in 2021

Fibromuscular dysplasia (FMD) is a non-atherosclerotic vascular disease that may involve medium-sized muscular arteries throughout the body. The pathogenesis of FMD remains poorly understood, but a combination of genetic and environmental factors may be involved. The majority of FMD patients are women, but men may have a more progressive disease, especially when smoking. Besides the classical phenotype of string of beads or focal stenosis, arterial aneurysms, dissections, and tortuosity are frequent manifestations of the disease. However, the differential diagnosis of FMD is extensive and includes imaging artefacts as well as other arterial diseases. Diagnosis is based on CT-, MR-, or conventional catheter-based angiography during work-up of clinical manifestations, but clinically silent lesions may be found incidentally. Arterial hypertension and neurological symptoms are the most frequent clinical presentations, as renal and cerebrovascular arteries are the most commonly involved. However, involvement of most arteries throughout the body has been reported, resulting in a variety of clinical symptoms. The management of FMD depends on the vascular phenotype as well on the clinical picture. Ongoing FMD-related research will elaborate in depth the current progress in improved understandings of the disease’s clinical manifestations, epidemiology, natural history and pathogenesis. This review is focused on the clinical management of adult FMD in daily practice

Renal replacement therapy is an independent risk factor for mortality in critically ill patients with acute kidney injury

INTRODUCTION: Outcome studies in patients with acute kidney injury (AKI) have focused on differences between modalities of renal replacement therapy (RRT). The outcome of conservative treatment, however, has never been compared with RRT. METHODS: Nine Belgian intensive care units (ICUs) included all adult patients consecutively admitted with serum creatinine >2 mg/dl. Included treatment options were conservative treatment and intermittent or continuous RRT. Disease severity was determined using the Stuivenberg Hospital Acute Renal Failure (SHARF) score. Outcome parameters studied were mortality, hospital length of stay and renal recovery at hospital discharge. RESULTS: Out of 1,303 included patients, 650 required RRT (58% intermittent, 42% continuous RRT). Overall results showed a higher mortality (43% versus 58%) as well as a longer ICU and hospital stay in RRT patients compared to conservative treatment. Using the SHARF score for adjustment of disease severity, an increased risk of death for RRT compared to conservative treatment of RR = 1.75 (95% CI: 1.4 to 2.3) was found. Additional correction for other severity parameters (Acute Physiology And Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA)), age, type of AKI and clinical conditions confirmed the higher mortality in the RRT group. CONCLUSIONS: The SHARF study showed that the higher mortality expected in AKI patients receiving RRT versus conservative treatment can not only be explained by a higher disease severity in the RRT group, even after multiple corrections. A more critical approach to the need for RRT in AKI patients seems to be arrante

Long-term cardiovascular outcome after renal revascularization.

Percutaneous stenting of the renal artery for the treatment of presumed renovascular hypertension due to atherosclerotic renal artery stenosis (RAS) remains a controversial issue. From dilating and stenting every renal stenosis in the 1990s, the approach changed to conservative therapy following the landmark trials in the field. Indeed, both the CORAL (Cardiovascular Outcomes in Renal Atherosclerotic Lesions) and ASTRAL (Angioplasty and Stent for Renal Artery Lesions) trials, and some other randomized controlled trials failed to show improvement in blood pressure (BP) control as well as renal function.1 However, all these trials have been criticized for lack of power, nonstandardized inclusion criteria, also with the inclusion of patients with only mild stenosis, and inadequate selection of patients that led to the exclusion of high-risk individuals.1,2 On the other hand, clinical experience and observational studies do show a beneficial effect of revascularization on BP, renal function, and even cardiovascular (CV) events in patients with progressive but reversible renal failure, resistant or refractory hypertension, or circulatory fluid overload. [...

Ambulatory blood pressure lowering effects of butizide/potassium canrenoate in hypertensive patients

A double-blind, randomized, balanced, placebo-controlled study was conducted to assess the hypotensive and metabolic effects of a fixed combination of 5 mg of butizide and 50 mg of potassium canrenoate in 20 patients with mild-to-moderate essential hypertension. This treatment significantly reduced both clinic and ambulatory blood pressure and was well tolerated. Hypokalemia developed in only one patient. There were no other clinically significant metabolic side effects.SCOPUS: NotDefined.jinfo:eu-repo/semantics/publishe