Guidelines for the Identification, Evaluation, and Management of Systemic Hypertension in Dogs and Cats

BackgroundPrimary hyperaldosteronism (PHA) in cats occurs as a consequence of excessive hormone production by an adrenocortical tumor. Median survival time, association between tumor type and prognosis, and the likelihood that cats require continued medical therapy after surgery have not been systematically evaluated.ObjectivesTo determine the median survival time of cats with PHA treated by unilateral adrenalectomy. To examine if tumor type, anesthesia time, or tumor location (left or right side) affect survival and if affected cats require continued postoperative treatment for persistent hypertension or hypokalemia.AnimalsTen client‐owned cats.MethodsRetrospective study. Cats were diagnosed with PHA based on clinical signs, increased plasma aldosterone concentration, and advanced imaging. Cats underwent unilateral adrenalectomy. Survival time (days alive after surgery) was determined for each cat. Factors affecting median survival time were investigated, including histopathology, anesthesia time, and location (side) of the tumor.ResultsEight of 10 cats survived to discharge from the hospital post adrenalectomy. Overall median survival was 1,297 days (range 2–1,582 days). The only significant factor affecting median survival time was anesthesia time >4 hours. Tumor type and location (side) did not significantly affect median survival time. No cats required continued medical treatment for PHA.Conclusions and Clinical ImportanceAlthough PHA in cats is still considered an uncommon condition, it should be considered in middle to older aged cats with hypokalemic polymyopathy and systemic hypertension. Surgical correction by unilateral adrenalectomy is a viable approach to definitive treatment of PHA with no need for continued medical management.

Section: Resultsmentioning

confidence: 99%

Treatment of Aldosterone‐Secreting Adrenocortical Tumors in Cats by Unilateral Adrenalectomy: 10 Cases (2002–2012)

Holt

Brown

et al. 2013

“…Dogs were allowed a 10‐minutes acclimation to the clinic environment, and indirect blood pressure measurement was the first diagnostic test performed on each sampling day based on previously described guidelines 32. Dogs were gently restrained in right lateral recumbency and measurements were obtained using a Doppler sphygmomanometry method (Doppler Flow Detector, Parks Medical Electronics, Inc, Aloha, Oregon) with a cuff size approximately 40% of the limb circumference on the left pelvic limb.…”

Section: Methodsmentioning

confidence: 99%

A prospective, randomized, double‐blind, placebo‐controlled pilot study of sacubitril/valsartan (Entresto) in dogs with cardiomegaly secondary to myxomatous mitral valve disease

Newhard

Jung

Winter

et al. 2018

BackgroundThe effects of sacubitril/valsartan (S/V) on the renin‐angiotensin‐aldosterone system (RAAS) in dogs with cardiomegaly secondary to myxomatous mitral valve disease (MMVD) are currently unknown.ObjectivesTo determine the pharmacodynamic effects of S/V on the RAAS, natriuretic peptide concentrations, systolic arterial pressure (SAP), tests of renal function, and serum electrolyte concentrations in dogs with cardiomegaly secondary to MMVD.AnimalsThirteen client‐owned dogs weighing 4‐15 kg with American College of Veterinary Internal Medicine (ACVIM) Stage B2 MMVD.MethodsProspective, randomized, double‐blind, placebo‐controlled pilot study of S/V in dogs with ACVIM Stage B2 MMVD.ResultsThirteen dogs were recruited: S/V (n = 7) and placebo (n = 6). The median percentage increase in urinary aldosterone to creatinine ratio (UAldo : C) between day 0 and day 30 was significantly lower in the S/V group (12%; P = .032) as compared with the placebo group (195%). The median percentage decrease of NT‐proBNP concentration from day 0 to day 30 was not statistically different between groups (P = .68). No statistical differences were seen in echocardiographic, thoracic radiographic, SAP, or serum biochemical test results measured at any time point between groups. No adverse events were observed for dogs in either group.Conclusion and Clinical ImportanceSacubitril/valsartan may provide a new pharmaceutical method to effectively inhibit the RAAS in dogs with ACVIM Stage B2 MMVD.

“…Urinary free IsoPs were compared among all groups by a Kruskal–Wallis test followed by Dunn's multiple‐comparison tests, with P < .05 considered significant. The IsoPs were compared in cats with and without pathologic systemic hypertension (defined as systolic blood pressure ≥160 mmHg)30 or clinically relevant proteinuria (UPC >0.40)31 by a Mann–Whitney test and also were tested for correlations with serum creatinine, blood pressure, UPC, and USG across all cats with CKD by Spearman correlation tests. Finally, because renal diets supplemented with antioxidants such as omega‐3 fatty acids might affect measures of oxidative stress,20 urinary IsoPs were compared in cats fed predominantly standard diets versus renal diets by a Mann–Whitney test, and 15‐F 2t ‐isoprostane:creatinine ratio (IsoP) data among CKD stages were reanalyzed with censoring of cats fed renal diets.…”

Section: Methodsmentioning

confidence: 99%

Urinary F₂‐Isoprostanes in Cats with International Renal Interest Society Stage 1–4 Chronic Kidney Disease

Whitehouse

Quimby

Wan

et al. 2017

BackgroundF2‐isoprostanes, a biomarker of oxidant injury, increase with advancing chronic kidney disease (CKD) in humans. In cats, the relationship between CKD and oxidative stress is poorly understood.ObjectivesTo determine whether cats with advancing CKD have increasing urinary F2‐isoprostanes.AnimalsControl cats without evidence of CKD (≥6 years old; n = 11), and cats with IRIS stage 1 (n = 8), 2 (n = 38), 3 (n = 21), and 4 (n = 10) CKD.MethodsThis was a prospective observational study. Urinary F2‐isoprostanes (specifically free 15‐F2t‐isoprostanes) normalized to urine creatinine (IsoPs) were compared among groups and tested for correlations with blood pressure, proteinuria, serum creatinine concentration, and urine specific gravity. The IsoPs also were compared between cats with and without hypertension or proteinuria, and in cats fed predominantly standard versus renal diets.ResultsUrinary IsoPs were increased, but not significantly, in cats with stage 1 CKD (median 263 pg/mg creatinine; range, 211–380) compared to controls (182 pg/mg; range, 80–348) and decreased significantly from stage 1 through advancing CKD (stage 2, 144 pg/mg; range, 49–608; stage 3, 102 pg/mg; range, 25–158; stage 4, 67 pg/mg; range, 26–117; P < .01). Urinary IsoPs were inversely correlated with serum creatinine (r = −0.66, P < .0001).Conclusion and Clinical ImportanceUrinary IsoPs are significantly higher in early CKD (stage 1) compared to cats with more advanced CKD. Additional studies are warranted to characterize oxidative stress in cats with stage 1 CKD and determine whether early antioxidant treatments have a protective effect on CKD progression.