Background-Nonadherence to antihypertensive treatment is a common problem in cardiovascular prevention and may influence prognosis. We explored predictors of adherence to antihypertensive treatment and the association of adherence with acute cardiovascular events.
The aim of this retrospective study was to evaluate the main independent prognostic factors of negative maternal and fetal outcomes in a relatively large sample of pregnant outpatients (N=906) who were normotensive or affected by chronic hypertension, gestational hypertension, or preeclampsia. Among the studied parameters, the ones significantly associated with negative maternal outcomes were a diagnosis of preeclampsia (vs other forms of hypertension or normotension) and higher serum uric acid level, while antihypertensive treatment, number of previous deliveries, and blood pressure (BP) control at deliveries seemed to be protective. Regarding negative fetal outcomes, the parameters significantly associated with a negative maternal outcome were a diagnosis of preeclampsia (vs other forms of hypertension or normotension) and mother pre‐pregnancy body mass index, while antihypertensive treatment and BP control at delivery seemed to be protective. Specific patient characteristics should help to predict the risk of negative maternal and fetal outcomes.
A therosclerotic disease and its complications, i.e., myocardial infarction and stroke, are one of the leading causes of morbidity and mortality among adults in Europe and North America. 1 Its overall prevalence is strongly related to that of different cardiovascular (CV) risk factors, including high blood pressure (BP), cigarette smoking, total plasma cholesterol (TC), low-and high-density lipoprotein (LDL and HDL) cholesterol, and diabetes. 2-5 Risk factor modification is an integral part of the optimal care of patients with and without cardiovascular disease. Data supporting this concept have been published in the fields of basic science, epidemiology, clinical medicine, and cost effectiveness analyses. Effective management of risk factors for CV diseases should be viewed as an integrated strategy of intervention to correct as many as possible of the modifiable risk factors. A combined approach to CV risk has been adopted as part of the framework for hypertension management programs (Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and the World Health Organization/International Society for Hypertension) and high plasma cholesterol treatment (National Cholesterol Education Program), in both the United States and Europe. [6][7][8] Data from large population studies have demonstrated that the long-term incidence of CV diseases can be significantly improved by using algorithms that take into account the impact of several risk factors, such as BP, smoking habits, TC and HDL cholesterol levels, diabetes, and left ventricular hypertrophy. 5 This suggests that CV risk could be better managed in the clinical setting by treatment strategies aimed at normalizing multiple CV risk factors.
Hypertension in pregnancy is a frequent disorder that includes a spectrum of conditions. We aimed at comparatively evaluating the hemodynamic, echocardiographic and biohumoral profile of a sample of pregnant Caucasian women with different form of pregnancy-related hypertension. We enrolled 39 non-hypertensive pregnant women (NP), 26 with Chronic HBP in pregnancy (CH), 24 with gestational hypertension (G-PIH), and 33 with pre-eclampsia. We recorded and compared blood pressure (BP), echocardiographic parameters, resting plasma renin activity (PRA) and plasma aldosterone (PA), Plasma levels of atrial (ANP) and brain natriuretic peptide (BNP). PE patients had a significantly higher BP than either G-PIH or NP patients. PE patients had also significantly lower cardiac output than NP, G-PIH and CH. In comparison to NP patients, the total peripheral vascular resistance was 61% higher in PE women and 38% higher in CH patients. All echographic parameters were significantly more altered in PE patients when compared with NP, in respect to any other form of hypertension. Either ANP (+35%) and BNP (+40%) were significantly higher in PE patients than in controls. The PRA was reduced in PE and CH patients when compared either with NP (-38 and -35%, respectively) or G-PIH (-47 and -43%, respectively). On the basis of our data, we can conclude that PE is the gestation associated hypertension with the largest anatomical, functional and biohumoral involvement, and so it has to be involved in a more intensive monitoring and evaluation.
Anterior epistaxis is commonly treated with Merocel nasal packing insertion. A 63-year-old male patient showed a cerebrospinal fluid rhinorrhea and pneumocephalus immediately after insertion of a Merocel tampon used for spontaneous right anterior epistaxis. He later developed fever and headache. This clinical report is to highlight how the nasal merocel should be positioned by specialized personnel and to describe how to manage this type of complication.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.