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Horst Neubauer - One of the best experts on this subject based on the ideXlab platform.

  • Unrecognized secondary causes of hypertension in patients with Hypertensive Urgency/emergency: prevalence and co-prevalence
    Clinical Research in Cardiology, 2010
    Co-Authors: Jan Börgel, Stephanie Springer, Jasmin Ghafoor, Daniel Arndt, Hans-werner Duchna, Andreas Barthel, Sibylle Werner, Josef Helden, Christoph Hanefeld, Horst Neubauer
    Abstract:

    Background Hypertensive Urgency/emergency occurs frequently, yet no prospective data on common secondary causes, including sleep apnea (SA), renal artery stenosis (RAS), and hyperaldosteronism, are available. Methods Patients presenting to the emergency room for over 1 year with systolic blood pressure ≥180 mmHg and/or diastolic blood pressure ≥100 mmHg and typical symptoms were included. RAS was diagnosed by direct duplex/Doppler ultrasound of the renal artery, resistance index, and imaging. The aldosterone/renin ratio (ARR) was determined from morning blood samples taken with the patients supine after ≥2 h of rest. A positive ARR (>50) was followed by saline infusion to exclude primary hyperaldosteronism. SA was evaluated by nasal breathing flow screening; when positive [apnea/hypopnea index (AHI) >5/h], complete polysomnography was performed. Results Of 161 patients (age, 66.0 ± 13.1 years; BMI, 28.6 ± 5.1 kg), 131 had previously identified hypertension (duration, 12.7 ± 11.5 years; 1.9 ± 1.5 antiHypertensive medications). SA was found in 114 (70.8%) patients [18% mild (AHI: 5–15/h), 26.8% moderate (15.1–30/h), and 24.2% severe (>30/h)]. Aldosterone levels exceeded 160 pg/ml in 22 of 23 patients with hyperaldosteronism; 4 had primary and 12 had secondary hyperaldosteronism. Thirteen (8.1%) patients had RAS. Three secondary causes were found in 1 patient (0.6%), ≥2 in 25 (15.5%), and ≥1 in 124 patients (77.0%). Of 150 detected secondary causes, only 5 were recognized previously. Conclusions Secondary causes of hypertension are common and predominantly unrecognized in patients with Hypertensive Urgency/emergency. Co-prevalence of secondary causes occurs in about 15% and should be considered before therapeutic intervention.

  • unrecognized secondary causes of hypertension in patients with Hypertensive Urgency emergency prevalence and co prevalence
    Clinical Research in Cardiology, 2010
    Co-Authors: Jan Börgel, Stephanie Springer, Jasmin Ghafoor, Daniel Arndt, Hans-werner Duchna, Andreas Barthel, Sibylle Werner, Josef Helden, Christoph Hanefeld, Horst Neubauer
    Abstract:

    Hypertensive Urgency/emergency occurs frequently, yet no prospective data on common secondary causes, including sleep apnea (SA), renal artery stenosis (RAS), and hyperaldosteronism, are available. Patients presenting to the emergency room for over 1 year with systolic blood pressure ≥180 mmHg and/or diastolic blood pressure ≥100 mmHg and typical symptoms were included. RAS was diagnosed by direct duplex/Doppler ultrasound of the renal artery, resistance index, and imaging. The aldosterone/renin ratio (ARR) was determined from morning blood samples taken with the patients supine after ≥2 h of rest. A positive ARR (>50) was followed by saline infusion to exclude primary hyperaldosteronism. SA was evaluated by nasal breathing flow screening; when positive [apnea/hypopnea index (AHI) >5/h], complete polysomnography was performed. Of 161 patients (age, 66.0 ± 13.1 years; BMI, 28.6 ± 5.1 kg), 131 had previously identified hypertension (duration, 12.7 ± 11.5 years; 1.9 ± 1.5 antiHypertensive medications). SA was found in 114 (70.8%) patients [18% mild (AHI: 5–15/h), 26.8% moderate (15.1–30/h), and 24.2% severe (>30/h)]. Aldosterone levels exceeded 160 pg/ml in 22 of 23 patients with hyperaldosteronism; 4 had primary and 12 had secondary hyperaldosteronism. Thirteen (8.1%) patients had RAS. Three secondary causes were found in 1 patient (0.6%), ≥2 in 25 (15.5%), and ≥1 in 124 patients (77.0%). Of 150 detected secondary causes, only 5 were recognized previously. Secondary causes of hypertension are common and predominantly unrecognized in patients with Hypertensive Urgency/emergency. Co-prevalence of secondary causes occurs in about 15% and should be considered before therapeutic intervention.

  • Unrecognized secondary causes of hypertension in patients with Hypertensive Urgency/emergency: prevalence and co-prevalence
    Clinical Research in Cardiology, 2010
    Co-Authors: Jan Börgel, Stephanie Springer, Jasmin Ghafoor, Daniel Arndt, Hans-werner Duchna, Andreas Barthel, Sibylle Werner, Josef Helden, Christoph Hanefeld, Horst Neubauer
    Abstract:

    Hypertensive Urgency/emergency occurs frequently, yet no prospective data on common secondary causes, including sleep apnea (SA), renal artery stenosis (RAS), and hyperaldosteronism, are available. Patients presenting to the emergency room for over 1 year with systolic blood pressure ≥180 mmHg and/or diastolic blood pressure ≥100 mmHg and typical symptoms were included. RAS was diagnosed by direct duplex/Doppler ultrasound of the renal artery, resistance index, and imaging. The aldosterone/renin ratio (ARR) was determined from morning blood samples taken with the patients supine after ≥2 h of rest. A positive ARR (>50) was followed by saline infusion to exclude primary hyperaldosteronism. SA was evaluated by nasal breathing flow screening; when positive [apnea/hypopnea index (AHI) >5/h], complete polysomnography was performed. Of 161 patients (age, 66.0 ± 13.1 years; BMI, 28.6 ± 5.1 kg), 131 had previously identified hypertension (duration, 12.7 ± 11.5 years; 1.9 ± 1.5 antiHypertensive medications). SA was found in 114 (70.8%) patients [18% mild (AHI: 5–15/h), 26.8% moderate (15.1–30/h), and 24.2% severe (>30/h)]. Aldosterone levels exceeded 160 pg/ml in 22 of 23 patients with hyperaldosteronism; 4 had primary and 12 had secondary hyperaldosteronism. Thirteen (8.1%) patients had RAS. Three secondary causes were found in 1 patient (0.6%), ≥2 in 25 (15.5%), and ≥1 in 124 patients (77.0%). Of 150 detected secondary causes, only 5 were recognized previously. Secondary causes of hypertension are common and predominantly unrecognized in patients with Hypertensive Urgency/emergency. Co-prevalence of secondary causes occurs in about 15% and should be considered before therapeutic intervention.

Ilgin Karaca - One of the best experts on this subject based on the ideXlab platform.

  • The Relation Between Left Ventricular Wall Stress and QT Dispersion in Hypertensive Urgency Patients
    Turkish journal of emergency medicine, 2020
    Co-Authors: Polat Durukan, Ilgin Karaca, Murat Pekdemir, Yılmaz Özbay, Mustafa Yildiz, Mehmet Akbulut, Cemil Kavalci, Ali Rahman
    Abstract:

    6 SUMMARY O b j e c t i v e s : Mortality of Hypertensive patients is due to systolic and diastolic dysfunction and hypertrophy of left ventricle, coronary artery disease, arrhythmias and sudden death. Measurement of QT dispersion (QTD) is a non- invasive method for evaluation of heterogenity of myocardial repolarization and it is thought to accompany arrhyth- mogenic events. Left ventricular hypertrophy is accepted to be the major factor affecting QTD in Hypertensive patients. Aim of this study is to investigate the relation between QTD and left ventricular wall stress caused by an increase in afterload independant from left ventricular hypertrophy in Hypertensive Urgency patients. Materials and Methods: Standart 12-lead surface electrocardiographic records of 76 patients matching inclu- sion criteria were taken in Hypertensive period and period in which mean blood pressure lowered 10% by Na-nitro- prussid and then QTD and corrected QT dispersion (QTcD) were calculated. Left ventricular geometric patterns were determined by echocardiographic measurements. Results: Mean age of the patients was 57.29±11.3 and 68.4% of them were women. In the Hypertensive period mean systolic blood pressure (SBP), QTD and QTcD were 192.11±20.2 mmHg, 45.79±14.90 msec and 54.78±17.96 msec and in lowered blood pressure (LBP) period they are 149.08±11.9 mmHg, 29.47±13.65 msec and 34.06±15.73 msec respectively (p

  • the effect of rapid blood pressure control on p wave dispersion in Hypertensive Urgency
    Advances in Therapy, 2008
    Co-Authors: Ilgin Karaca, Polat Durukan, Necati Dagli, Mustafa Yavuzkir, Ibrahim Ikizceli, Mehmet Balin
    Abstract:

    INTRODUCTION: A sharp increase in blood pressure, increase in atrial pressure and atrial strain, left ventricular diastolic dysfunction, and left ventricular hypertrophy (LVH) lead to heterogeneity and instability in atrial conduction. The resulting physiopathological situation may elevate maximum Pwave duration (P(max)) and P-wave dispersion (PWD) in electrocardiography. The objective of our study was to explore the effect of the sudden change in atrial hemodynamics on P(max) and PWD, which may indicate the risk of atrial fibrillation (AF) development in Hypertensive Urgency. METHODS: The study included patients diagnosed as Hypertensive Urgency (systolic blood pressure > or =180 mmHg, diastolic blood pressure > or =110 mmHg). Nitroprusside was started at a dose of 0.2 microg/kg/min, and the ensuing dose was arranged according to blood pressure. Echocardiography and electrocardiography were used to noninvasively measure changes in diastolic function and PWD and P(max), respectively. RESULTS: The study enrolled 102 patients (mean age 57.9+/-11.6 years; 32 [31.4%] males, and 70 [68.6%] females). P(max) decreased from 99.9+/-11.1 msec (95% confidence intervals [CI] 97.7, 102) to 88.5+/-9.3 msec (95% CI 86.6, 90.3) (P<0.001), while PWD decreased from 60.1+/-7.4 msec (95% CI 58.7, 61.6) to 43.9+/-6.7 msec (95% CI 42.5, 45.2) (P<0.001). In addition, most patients had LVH and diastolic dysfunction. After nitroprusside treatment improvements in indicators of diastolic functions such as E/A ratio, deceleration time, and isovolumetric relaxation time were observed. CONCLUSION: The change observed in P(max) and PWD in Hypertensive Urgency may be associated with the rapid change in blood pressure and atrial strain, sympathetic nervous system activation, relative myocardial ischemia, and left ventricular diastolic dysfunction. Rapid regulation of blood pressure with nitroprusside brought about a marked decrease in P(max) and PWD in our patients. This improvement was interpreted as atrial conduction acquiring a stable and homogeneous character, which may reduce the risk of AF development in Hypertensive Urgency.

  • The effect of rapid blood pressure control on P-wave dispersion in Hypertensive Urgency
    Advances in Therapy, 2008
    Co-Authors: Ilgin Karaca, Polat Durukan, Necati Dagli, Mustafa Yavuzkir, Ibrahim Ikizceli, Mehmet Balin
    Abstract:

    Introduction A sharp increase in blood pressure, increase in atrial pressure and atrial strain, left ventricular diastolic dysfunction, and left ventricular hypertrophy (LVH) lead to heterogeneity and instability in atrial conduction. The resulting physiopathological situation may elevate maximum Pwave duration (P_max) and P-wave dispersion (PWD) in electrocardiography. The objective of our study was to explore the effect of the sudden change in atrial hemodynamics on P_max and PWD, which may indicate the risk of atrial fibrillation (AF) development in Hypertensive Urgency. Methods The study included patients diagnosed as Hypertensive Urgency (systolic blood pressure ≥180 mmHg, diastolic blood pressure ≥110 mmHg). Nitroprusside was started at a dose of 0.2 μg/kg/min, and the ensuing dose was arranged according to blood pressure. Echocardiography and electrocardiography were used to noninvasively measure changes in diastolic function and PWD and P_max, respectively. Results The study enrolled 102 patients (mean age 57.9±11.6 years; 32 [31.4%] males, and 70 [68.6%] females). P_max decreased from 99.9±11.1 msec (95% confidence intervals [CI] 97.7, 102) to 88.5±9.3 msec (95% CI 86.6, 90.3) ( P

  • The effect of rapid blood pressure control on P-wave dispersion in Hypertensive Urgency
    Advances in Therapy, 2008
    Co-Authors: Ilgin Karaca, Polat Durukan, Necati Dagli, Mustafa Yavuzkir, Ibrahim Ikizceli, Mehmet Balin
    Abstract:

    Introduction A sharp increase in blood pressure, increase in atrial pressure and atrial strain, left ventricular diastolic dysfunction, and left ventricular hypertrophy (LVH) lead to heterogeneity and instability in atrial conduction. The resulting physiopathological situation may elevate maximum Pwave duration (Pmax) and P-wave dispersion (PWD) in electrocardiography. The objective of our study was to explore the effect of the sudden change in atrial hemodynamics on Pmax and PWD, which may indicate the risk of atrial fibrillation (AF) development in Hypertensive Urgency.

  • the relation between left ventricular wall stress and qt dispersion in Hypertensive Urgency patients
    Turkish journal of emergency medicine, 2007
    Co-Authors: Polat Durukan, Ilgin Karaca, Murat Pekdemir, Yılmaz Özbay, Mustafa Yildiz, Mehmet Akbulut, Cemil Kavalci, Ali Rahman
    Abstract:

    6 SUMMARY O b j e c t i v e s : Mortality of Hypertensive patients is due to systolic and diastolic dysfunction and hypertrophy of left ventricle, coronary artery disease, arrhythmias and sudden death. Measurement of QT dispersion (QTD) is a non- invasive method for evaluation of heterogenity of myocardial repolarization and it is thought to accompany arrhyth- mogenic events. Left ventricular hypertrophy is accepted to be the major factor affecting QTD in Hypertensive patients. Aim of this study is to investigate the relation between QTD and left ventricular wall stress caused by an increase in afterload independant from left ventricular hypertrophy in Hypertensive Urgency patients. Materials and Methods: Standart 12-lead surface electrocardiographic records of 76 patients matching inclu- sion criteria were taken in Hypertensive period and period in which mean blood pressure lowered 10% by Na-nitro- prussid and then QTD and corrected QT dispersion (QTcD) were calculated. Left ventricular geometric patterns were determined by echocardiographic measurements. Results: Mean age of the patients was 57.29±11.3 and 68.4% of them were women. In the Hypertensive period mean systolic blood pressure (SBP), QTD and QTcD were 192.11±20.2 mmHg, 45.79±14.90 msec and 54.78±17.96 msec and in lowered blood pressure (LBP) period they are 149.08±11.9 mmHg, 29.47±13.65 msec and 34.06±15.73 msec respectively (p<0.001). In 50% of patients concentric hypertrophy and in 11.8% of patients nor- mal ventricular geometry were detected. According to left ventricular geometry mean QTD and QTcD were similar between the groups in Hypertensive and LBP periods. Although mean QTDs were similar (p=0.058) in normal left ventricular geometry group in both Hypertensive and LBP periods, mean QTcDs were different (p=0.036). In patient groups having other left ventricular geometric patterns mean QTD and QTcD were different in Hypertensive and LBP periods (for each p<0.05). In Hypertensive patients when blood pressure is high, due to an increase in afterload ven- tricular wall stress increases and due to myocardial ischemia QTD and QTcD lengthen, when the blood pressure comes to normal QTD and QTcD shorten. Conclusion: As a result it is thought that when blood pressure changes acutely, QTD and QTcD change due to left

Mehmet Balin - One of the best experts on this subject based on the ideXlab platform.

  • the effect of rapid blood pressure control on p wave dispersion in Hypertensive Urgency
    Advances in Therapy, 2008
    Co-Authors: Ilgin Karaca, Polat Durukan, Necati Dagli, Mustafa Yavuzkir, Ibrahim Ikizceli, Mehmet Balin
    Abstract:

    INTRODUCTION: A sharp increase in blood pressure, increase in atrial pressure and atrial strain, left ventricular diastolic dysfunction, and left ventricular hypertrophy (LVH) lead to heterogeneity and instability in atrial conduction. The resulting physiopathological situation may elevate maximum Pwave duration (P(max)) and P-wave dispersion (PWD) in electrocardiography. The objective of our study was to explore the effect of the sudden change in atrial hemodynamics on P(max) and PWD, which may indicate the risk of atrial fibrillation (AF) development in Hypertensive Urgency. METHODS: The study included patients diagnosed as Hypertensive Urgency (systolic blood pressure > or =180 mmHg, diastolic blood pressure > or =110 mmHg). Nitroprusside was started at a dose of 0.2 microg/kg/min, and the ensuing dose was arranged according to blood pressure. Echocardiography and electrocardiography were used to noninvasively measure changes in diastolic function and PWD and P(max), respectively. RESULTS: The study enrolled 102 patients (mean age 57.9+/-11.6 years; 32 [31.4%] males, and 70 [68.6%] females). P(max) decreased from 99.9+/-11.1 msec (95% confidence intervals [CI] 97.7, 102) to 88.5+/-9.3 msec (95% CI 86.6, 90.3) (P<0.001), while PWD decreased from 60.1+/-7.4 msec (95% CI 58.7, 61.6) to 43.9+/-6.7 msec (95% CI 42.5, 45.2) (P<0.001). In addition, most patients had LVH and diastolic dysfunction. After nitroprusside treatment improvements in indicators of diastolic functions such as E/A ratio, deceleration time, and isovolumetric relaxation time were observed. CONCLUSION: The change observed in P(max) and PWD in Hypertensive Urgency may be associated with the rapid change in blood pressure and atrial strain, sympathetic nervous system activation, relative myocardial ischemia, and left ventricular diastolic dysfunction. Rapid regulation of blood pressure with nitroprusside brought about a marked decrease in P(max) and PWD in our patients. This improvement was interpreted as atrial conduction acquiring a stable and homogeneous character, which may reduce the risk of AF development in Hypertensive Urgency.

  • The effect of rapid blood pressure control on P-wave dispersion in Hypertensive Urgency
    Advances in Therapy, 2008
    Co-Authors: Ilgin Karaca, Polat Durukan, Necati Dagli, Mustafa Yavuzkir, Ibrahim Ikizceli, Mehmet Balin
    Abstract:

    Introduction A sharp increase in blood pressure, increase in atrial pressure and atrial strain, left ventricular diastolic dysfunction, and left ventricular hypertrophy (LVH) lead to heterogeneity and instability in atrial conduction. The resulting physiopathological situation may elevate maximum Pwave duration (P_max) and P-wave dispersion (PWD) in electrocardiography. The objective of our study was to explore the effect of the sudden change in atrial hemodynamics on P_max and PWD, which may indicate the risk of atrial fibrillation (AF) development in Hypertensive Urgency. Methods The study included patients diagnosed as Hypertensive Urgency (systolic blood pressure ≥180 mmHg, diastolic blood pressure ≥110 mmHg). Nitroprusside was started at a dose of 0.2 μg/kg/min, and the ensuing dose was arranged according to blood pressure. Echocardiography and electrocardiography were used to noninvasively measure changes in diastolic function and PWD and P_max, respectively. Results The study enrolled 102 patients (mean age 57.9±11.6 years; 32 [31.4%] males, and 70 [68.6%] females). P_max decreased from 99.9±11.1 msec (95% confidence intervals [CI] 97.7, 102) to 88.5±9.3 msec (95% CI 86.6, 90.3) ( P

  • The effect of rapid blood pressure control on P-wave dispersion in Hypertensive Urgency
    Advances in Therapy, 2008
    Co-Authors: Ilgin Karaca, Polat Durukan, Necati Dagli, Mustafa Yavuzkir, Ibrahim Ikizceli, Mehmet Balin
    Abstract:

    Introduction A sharp increase in blood pressure, increase in atrial pressure and atrial strain, left ventricular diastolic dysfunction, and left ventricular hypertrophy (LVH) lead to heterogeneity and instability in atrial conduction. The resulting physiopathological situation may elevate maximum Pwave duration (Pmax) and P-wave dispersion (PWD) in electrocardiography. The objective of our study was to explore the effect of the sudden change in atrial hemodynamics on Pmax and PWD, which may indicate the risk of atrial fibrillation (AF) development in Hypertensive Urgency.

Polat Durukan - One of the best experts on this subject based on the ideXlab platform.

  • The Relation Between Left Ventricular Wall Stress and QT Dispersion in Hypertensive Urgency Patients
    Turkish journal of emergency medicine, 2020
    Co-Authors: Polat Durukan, Ilgin Karaca, Murat Pekdemir, Yılmaz Özbay, Mustafa Yildiz, Mehmet Akbulut, Cemil Kavalci, Ali Rahman
    Abstract:

    6 SUMMARY O b j e c t i v e s : Mortality of Hypertensive patients is due to systolic and diastolic dysfunction and hypertrophy of left ventricle, coronary artery disease, arrhythmias and sudden death. Measurement of QT dispersion (QTD) is a non- invasive method for evaluation of heterogenity of myocardial repolarization and it is thought to accompany arrhyth- mogenic events. Left ventricular hypertrophy is accepted to be the major factor affecting QTD in Hypertensive patients. Aim of this study is to investigate the relation between QTD and left ventricular wall stress caused by an increase in afterload independant from left ventricular hypertrophy in Hypertensive Urgency patients. Materials and Methods: Standart 12-lead surface electrocardiographic records of 76 patients matching inclu- sion criteria were taken in Hypertensive period and period in which mean blood pressure lowered 10% by Na-nitro- prussid and then QTD and corrected QT dispersion (QTcD) were calculated. Left ventricular geometric patterns were determined by echocardiographic measurements. Results: Mean age of the patients was 57.29±11.3 and 68.4% of them were women. In the Hypertensive period mean systolic blood pressure (SBP), QTD and QTcD were 192.11±20.2 mmHg, 45.79±14.90 msec and 54.78±17.96 msec and in lowered blood pressure (LBP) period they are 149.08±11.9 mmHg, 29.47±13.65 msec and 34.06±15.73 msec respectively (p

  • the effect of rapid blood pressure control on p wave dispersion in Hypertensive Urgency
    Advances in Therapy, 2008
    Co-Authors: Ilgin Karaca, Polat Durukan, Necati Dagli, Mustafa Yavuzkir, Ibrahim Ikizceli, Mehmet Balin
    Abstract:

    INTRODUCTION: A sharp increase in blood pressure, increase in atrial pressure and atrial strain, left ventricular diastolic dysfunction, and left ventricular hypertrophy (LVH) lead to heterogeneity and instability in atrial conduction. The resulting physiopathological situation may elevate maximum Pwave duration (P(max)) and P-wave dispersion (PWD) in electrocardiography. The objective of our study was to explore the effect of the sudden change in atrial hemodynamics on P(max) and PWD, which may indicate the risk of atrial fibrillation (AF) development in Hypertensive Urgency. METHODS: The study included patients diagnosed as Hypertensive Urgency (systolic blood pressure > or =180 mmHg, diastolic blood pressure > or =110 mmHg). Nitroprusside was started at a dose of 0.2 microg/kg/min, and the ensuing dose was arranged according to blood pressure. Echocardiography and electrocardiography were used to noninvasively measure changes in diastolic function and PWD and P(max), respectively. RESULTS: The study enrolled 102 patients (mean age 57.9+/-11.6 years; 32 [31.4%] males, and 70 [68.6%] females). P(max) decreased from 99.9+/-11.1 msec (95% confidence intervals [CI] 97.7, 102) to 88.5+/-9.3 msec (95% CI 86.6, 90.3) (P<0.001), while PWD decreased from 60.1+/-7.4 msec (95% CI 58.7, 61.6) to 43.9+/-6.7 msec (95% CI 42.5, 45.2) (P<0.001). In addition, most patients had LVH and diastolic dysfunction. After nitroprusside treatment improvements in indicators of diastolic functions such as E/A ratio, deceleration time, and isovolumetric relaxation time were observed. CONCLUSION: The change observed in P(max) and PWD in Hypertensive Urgency may be associated with the rapid change in blood pressure and atrial strain, sympathetic nervous system activation, relative myocardial ischemia, and left ventricular diastolic dysfunction. Rapid regulation of blood pressure with nitroprusside brought about a marked decrease in P(max) and PWD in our patients. This improvement was interpreted as atrial conduction acquiring a stable and homogeneous character, which may reduce the risk of AF development in Hypertensive Urgency.

  • The effect of rapid blood pressure control on P-wave dispersion in Hypertensive Urgency
    Advances in Therapy, 2008
    Co-Authors: Ilgin Karaca, Polat Durukan, Necati Dagli, Mustafa Yavuzkir, Ibrahim Ikizceli, Mehmet Balin
    Abstract:

    Introduction A sharp increase in blood pressure, increase in atrial pressure and atrial strain, left ventricular diastolic dysfunction, and left ventricular hypertrophy (LVH) lead to heterogeneity and instability in atrial conduction. The resulting physiopathological situation may elevate maximum Pwave duration (P_max) and P-wave dispersion (PWD) in electrocardiography. The objective of our study was to explore the effect of the sudden change in atrial hemodynamics on P_max and PWD, which may indicate the risk of atrial fibrillation (AF) development in Hypertensive Urgency. Methods The study included patients diagnosed as Hypertensive Urgency (systolic blood pressure ≥180 mmHg, diastolic blood pressure ≥110 mmHg). Nitroprusside was started at a dose of 0.2 μg/kg/min, and the ensuing dose was arranged according to blood pressure. Echocardiography and electrocardiography were used to noninvasively measure changes in diastolic function and PWD and P_max, respectively. Results The study enrolled 102 patients (mean age 57.9±11.6 years; 32 [31.4%] males, and 70 [68.6%] females). P_max decreased from 99.9±11.1 msec (95% confidence intervals [CI] 97.7, 102) to 88.5±9.3 msec (95% CI 86.6, 90.3) ( P

  • The effect of rapid blood pressure control on P-wave dispersion in Hypertensive Urgency
    Advances in Therapy, 2008
    Co-Authors: Ilgin Karaca, Polat Durukan, Necati Dagli, Mustafa Yavuzkir, Ibrahim Ikizceli, Mehmet Balin
    Abstract:

    Introduction A sharp increase in blood pressure, increase in atrial pressure and atrial strain, left ventricular diastolic dysfunction, and left ventricular hypertrophy (LVH) lead to heterogeneity and instability in atrial conduction. The resulting physiopathological situation may elevate maximum Pwave duration (Pmax) and P-wave dispersion (PWD) in electrocardiography. The objective of our study was to explore the effect of the sudden change in atrial hemodynamics on Pmax and PWD, which may indicate the risk of atrial fibrillation (AF) development in Hypertensive Urgency.

  • the relation between left ventricular wall stress and qt dispersion in Hypertensive Urgency patients
    Turkish journal of emergency medicine, 2007
    Co-Authors: Polat Durukan, Ilgin Karaca, Murat Pekdemir, Yılmaz Özbay, Mustafa Yildiz, Mehmet Akbulut, Cemil Kavalci, Ali Rahman
    Abstract:

    6 SUMMARY O b j e c t i v e s : Mortality of Hypertensive patients is due to systolic and diastolic dysfunction and hypertrophy of left ventricle, coronary artery disease, arrhythmias and sudden death. Measurement of QT dispersion (QTD) is a non- invasive method for evaluation of heterogenity of myocardial repolarization and it is thought to accompany arrhyth- mogenic events. Left ventricular hypertrophy is accepted to be the major factor affecting QTD in Hypertensive patients. Aim of this study is to investigate the relation between QTD and left ventricular wall stress caused by an increase in afterload independant from left ventricular hypertrophy in Hypertensive Urgency patients. Materials and Methods: Standart 12-lead surface electrocardiographic records of 76 patients matching inclu- sion criteria were taken in Hypertensive period and period in which mean blood pressure lowered 10% by Na-nitro- prussid and then QTD and corrected QT dispersion (QTcD) were calculated. Left ventricular geometric patterns were determined by echocardiographic measurements. Results: Mean age of the patients was 57.29±11.3 and 68.4% of them were women. In the Hypertensive period mean systolic blood pressure (SBP), QTD and QTcD were 192.11±20.2 mmHg, 45.79±14.90 msec and 54.78±17.96 msec and in lowered blood pressure (LBP) period they are 149.08±11.9 mmHg, 29.47±13.65 msec and 34.06±15.73 msec respectively (p<0.001). In 50% of patients concentric hypertrophy and in 11.8% of patients nor- mal ventricular geometry were detected. According to left ventricular geometry mean QTD and QTcD were similar between the groups in Hypertensive and LBP periods. Although mean QTDs were similar (p=0.058) in normal left ventricular geometry group in both Hypertensive and LBP periods, mean QTcDs were different (p=0.036). In patient groups having other left ventricular geometric patterns mean QTD and QTcD were different in Hypertensive and LBP periods (for each p<0.05). In Hypertensive patients when blood pressure is high, due to an increase in afterload ven- tricular wall stress increases and due to myocardial ischemia QTD and QTcD lengthen, when the blood pressure comes to normal QTD and QTcD shorten. Conclusion: As a result it is thought that when blood pressure changes acutely, QTD and QTcD change due to left

Jan Börgel - One of the best experts on this subject based on the ideXlab platform.

  • the influence of meteorological parameters on the occurrence of Hypertensive Urgency and emergency
    Meteorologische Zeitschrift, 2011
    Co-Authors: Christina Koppe, Stephanie Springer, Jasmin Ghafoor, Daniel Arndt, Hanno Schilling, Andreas Mugge, Jan Börgel
    Abstract:

    Between 24 September 2007 and 06 September 2008, we investigated 195 persons with Hypertensive events who were admitted to the emergency unit of the Universityclinic St. Josef Hospital in Bochum. After stabilization of blood pressure patients were sent to the ward for further evaluation. Aldosterone, renin, and cortisol levels were monitored during the first 24 hours. Blood was taken at 8 am after 2 hours in supine position. Meteorological data at the time of admission were analyzed for potential associations with the temporary accumulation of Hypertensive events. The meteorological parameters were air temperature TA, relative humidity RH, air pressure P, and sunshine duration SD, observed at the meteorological station in Dusseldorf (airport). In addition, perceived temperature PT was calculated and included in the analysis.

  • Unrecognized secondary causes of hypertension in patients with Hypertensive Urgency/emergency: prevalence and co-prevalence
    Clinical Research in Cardiology, 2010
    Co-Authors: Jan Börgel, Stephanie Springer, Jasmin Ghafoor, Daniel Arndt, Hans-werner Duchna, Andreas Barthel, Sibylle Werner, Josef Helden, Christoph Hanefeld, Horst Neubauer
    Abstract:

    Background Hypertensive Urgency/emergency occurs frequently, yet no prospective data on common secondary causes, including sleep apnea (SA), renal artery stenosis (RAS), and hyperaldosteronism, are available. Methods Patients presenting to the emergency room for over 1 year with systolic blood pressure ≥180 mmHg and/or diastolic blood pressure ≥100 mmHg and typical symptoms were included. RAS was diagnosed by direct duplex/Doppler ultrasound of the renal artery, resistance index, and imaging. The aldosterone/renin ratio (ARR) was determined from morning blood samples taken with the patients supine after ≥2 h of rest. A positive ARR (>50) was followed by saline infusion to exclude primary hyperaldosteronism. SA was evaluated by nasal breathing flow screening; when positive [apnea/hypopnea index (AHI) >5/h], complete polysomnography was performed. Results Of 161 patients (age, 66.0 ± 13.1 years; BMI, 28.6 ± 5.1 kg), 131 had previously identified hypertension (duration, 12.7 ± 11.5 years; 1.9 ± 1.5 antiHypertensive medications). SA was found in 114 (70.8%) patients [18% mild (AHI: 5–15/h), 26.8% moderate (15.1–30/h), and 24.2% severe (>30/h)]. Aldosterone levels exceeded 160 pg/ml in 22 of 23 patients with hyperaldosteronism; 4 had primary and 12 had secondary hyperaldosteronism. Thirteen (8.1%) patients had RAS. Three secondary causes were found in 1 patient (0.6%), ≥2 in 25 (15.5%), and ≥1 in 124 patients (77.0%). Of 150 detected secondary causes, only 5 were recognized previously. Conclusions Secondary causes of hypertension are common and predominantly unrecognized in patients with Hypertensive Urgency/emergency. Co-prevalence of secondary causes occurs in about 15% and should be considered before therapeutic intervention.

  • unrecognized secondary causes of hypertension in patients with Hypertensive Urgency emergency prevalence and co prevalence
    Clinical Research in Cardiology, 2010
    Co-Authors: Jan Börgel, Stephanie Springer, Jasmin Ghafoor, Daniel Arndt, Hans-werner Duchna, Andreas Barthel, Sibylle Werner, Josef Helden, Christoph Hanefeld, Horst Neubauer
    Abstract:

    Hypertensive Urgency/emergency occurs frequently, yet no prospective data on common secondary causes, including sleep apnea (SA), renal artery stenosis (RAS), and hyperaldosteronism, are available. Patients presenting to the emergency room for over 1 year with systolic blood pressure ≥180 mmHg and/or diastolic blood pressure ≥100 mmHg and typical symptoms were included. RAS was diagnosed by direct duplex/Doppler ultrasound of the renal artery, resistance index, and imaging. The aldosterone/renin ratio (ARR) was determined from morning blood samples taken with the patients supine after ≥2 h of rest. A positive ARR (>50) was followed by saline infusion to exclude primary hyperaldosteronism. SA was evaluated by nasal breathing flow screening; when positive [apnea/hypopnea index (AHI) >5/h], complete polysomnography was performed. Of 161 patients (age, 66.0 ± 13.1 years; BMI, 28.6 ± 5.1 kg), 131 had previously identified hypertension (duration, 12.7 ± 11.5 years; 1.9 ± 1.5 antiHypertensive medications). SA was found in 114 (70.8%) patients [18% mild (AHI: 5–15/h), 26.8% moderate (15.1–30/h), and 24.2% severe (>30/h)]. Aldosterone levels exceeded 160 pg/ml in 22 of 23 patients with hyperaldosteronism; 4 had primary and 12 had secondary hyperaldosteronism. Thirteen (8.1%) patients had RAS. Three secondary causes were found in 1 patient (0.6%), ≥2 in 25 (15.5%), and ≥1 in 124 patients (77.0%). Of 150 detected secondary causes, only 5 were recognized previously. Secondary causes of hypertension are common and predominantly unrecognized in patients with Hypertensive Urgency/emergency. Co-prevalence of secondary causes occurs in about 15% and should be considered before therapeutic intervention.

  • Unrecognized secondary causes of hypertension in patients with Hypertensive Urgency/emergency: prevalence and co-prevalence
    Clinical Research in Cardiology, 2010
    Co-Authors: Jan Börgel, Stephanie Springer, Jasmin Ghafoor, Daniel Arndt, Hans-werner Duchna, Andreas Barthel, Sibylle Werner, Josef Helden, Christoph Hanefeld, Horst Neubauer
    Abstract:

    Hypertensive Urgency/emergency occurs frequently, yet no prospective data on common secondary causes, including sleep apnea (SA), renal artery stenosis (RAS), and hyperaldosteronism, are available. Patients presenting to the emergency room for over 1 year with systolic blood pressure ≥180 mmHg and/or diastolic blood pressure ≥100 mmHg and typical symptoms were included. RAS was diagnosed by direct duplex/Doppler ultrasound of the renal artery, resistance index, and imaging. The aldosterone/renin ratio (ARR) was determined from morning blood samples taken with the patients supine after ≥2 h of rest. A positive ARR (>50) was followed by saline infusion to exclude primary hyperaldosteronism. SA was evaluated by nasal breathing flow screening; when positive [apnea/hypopnea index (AHI) >5/h], complete polysomnography was performed. Of 161 patients (age, 66.0 ± 13.1 years; BMI, 28.6 ± 5.1 kg), 131 had previously identified hypertension (duration, 12.7 ± 11.5 years; 1.9 ± 1.5 antiHypertensive medications). SA was found in 114 (70.8%) patients [18% mild (AHI: 5–15/h), 26.8% moderate (15.1–30/h), and 24.2% severe (>30/h)]. Aldosterone levels exceeded 160 pg/ml in 22 of 23 patients with hyperaldosteronism; 4 had primary and 12 had secondary hyperaldosteronism. Thirteen (8.1%) patients had RAS. Three secondary causes were found in 1 patient (0.6%), ≥2 in 25 (15.5%), and ≥1 in 124 patients (77.0%). Of 150 detected secondary causes, only 5 were recognized previously. Secondary causes of hypertension are common and predominantly unrecognized in patients with Hypertensive Urgency/emergency. Co-prevalence of secondary causes occurs in about 15% and should be considered before therapeutic intervention.