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Refractory Hypertension Is not Attributable to Intravascular Fluid Retention as Determined by Intracardiac Volumes.

ABSTRACT: Refractory hypertension (RfHTN) is an extreme phenotype of antihypertensive treatment failure defined as lack of blood pressure control with ?5 medications, including a long-acting thiazide and a mineralocorticoid receptor antagonist. RfHTN is a subgroup of resistant hypertension (RHTN), which is defined as blood pressure >135/85 mm?Hg with ?3 antihypertensive medications, including a diuretic. RHTN is generally attributed to persistent intravascular fluid retention. It is unknown whether alternative mechanisms are operative in RfHTN. Our objective was to determine whether RfHTN is characterized by persistent fluid retention, indexed by greater intracardiac volumes determined by cardiac magnetic resonance when compared with controlled RHTN patients. Consecutive patients evaluated in our institution with RfHTN and controlled RHTN were prospectively enrolled. Exclusion criteria included advanced chronic kidney disease and masked or white coat hypertension. All enrolled patients underwent biochemical testing and cardiac magnetic resonance. The RfHTN group (n=24) was younger (mean age, 51.7±8.9 versus 60.6±11.5 years; P=0.003) and had a greater proportion of women (75.0% versus 43%; P=0.02) compared with the controlled RHTN group (n=30). RfHTN patients had a greater left ventricular mass index (88.3±35.0 versus 54.6±12.5 g/m2; P<0.001), posterior wall thickness (10.1±3.1 versus 7.7±1.5 mm; P=0.001), and septal wall thickness (14.5±3.8 versus 10.0±2.2 mm; P<0.001). There was no difference in B-type natriuretic peptide levels and left atrial or ventricular volumes. Diastolic dysfunction was noted in RfHTN. Our findings demonstrate greater left ventricular hypertrophy without chamber enlargement in RfHTN, suggesting that antihypertensive treatment failure is not attributable to intravascular volume retention.

SUBMITTER: Velasco A

PROVIDER: S-EPMC6043380 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Refractory Hypertension Is not Attributable to Intravascular Fluid Retention as Determined by Intracardiac Volumes.

Velasco Alejandro A Siddiqui Mohammed M Kreps Eric E Kolakalapudi Pavani P Dudenbostel Tanja T Arora Garima G Judd Eric K EK Prabhu Sumanth D SD Lloyd Steven G SG Oparil Suzanne S Calhoun David A DA

Hypertension (Dallas, Tex. : 1979) 20180604 2

Refractory hypertension (RfHTN) is an extreme phenotype of antihypertensive treatment failure defined as lack of blood pressure control with ≥5 medications, including a long-acting thiazide and a mineralocorticoid receptor antagonist. RfHTN is a subgroup of resistant hypertension (RHTN), which is defined as blood pressure >135/85 mm Hg with ≥3 antihypertensive medications, including a diuretic. RHTN is generally attributed to persistent intravascular fluid retention. It is unknown whether altern ...[more]

PMID: 29866740

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Project description:PURPOSE:This work aims to develop a simple, anatomically and haptically realistic vascular phantom, compatible with intravascular and intracardiac ultrasound. The low-cost, dual-layered phantom bridges the gap between traditional wall-only and wall-less phantoms by showing both the vessel wall and surrounding tissue in ultrasound imaging. This phantom can better assist clinical tool training, testing of intravascular devices, blood flow studies, and validation of algorithms for intravascular and intracardiac surgical systems. METHODS:Polyvinyl alcohol cryogel (PVA-c) incorporating a scattering agent was used to obtain vessel and tissue-mimicking materials. Our specific design targeted the inferior vena cava and renal bifurcations which were modelled using CAD software. A custom mould and container were 3D-printed for shaping the desired vessel wall. Three phantoms were prepared by varying both the concentrations of scattering agent as well as the number of freeze-thaw cycles to which the phantom layers were subjected during the manufacturing process. Each phantom was evaluated using ultrasound imaging using the Foresight™ ICE probe. Geometrical validation was provided by comparing CAD design to a CT scan of the phantom. RESULTS:The desired vascular phantom was constructed using 2.5% and 0.05% scattering agent concentration in the vessel and tissue-mimicking layers, respectively. Imaging of the three phantoms showed that increasing the number of freeze-thaw cycles did not significantly enhance the image contrast. Comparison of the US images with their CT equivalents resulted in an average error of 0.9[Formula: see text] for the lumen diameter. CONCLUSION:The phantom is anatomically realistic when imaged with intracardiac ultrasound and provides a smooth lumen for the ultrasound probe and catheter to manoeuvre. The vascular phantom enables validation of intravascular and intracardiac image guidance systems. The simple construction technique also provides a workflow for designing complex, multi-layered arterial phantoms.

Dataset Information

Refractory Hypertension Is not Attributable to Intravascular Fluid Retention as Determined by Intracardiac Volumes.

Publications

Refractory Hypertension Is not Attributable to Intravascular Fluid Retention as Determined by Intracardiac Volumes.

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