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Single-Pill Combination Treatments in Hypertension
Published in Giuseppe Mancia, Guido Grassi, Konstantinos P. Tsioufis, Anna F. Dominiczak, Enrico Agabiti Rosei, Manual of Hypertension of the European Society of Hypertension, 2019
Finally, combining therapeutic strategies offers advantages on the development of side effects. This was actually the principle of the initial concept of fixed low-dose combinations, according to which combining a low dose of two therapeutic agents has a greater antihypertensive efficacy but induces fewer side effects than a high-dose monotherapy. With the greatly improved tolerability profile of newer antihypertensive drugs such as angiotensin receptor blockers, the concept of low-dose combinations was progressively abandoned in favour of high-dose single-pill combinations. In this respect, when combining therapeutic strategies, each component has the potential of neutralizing counterregulatory mechanisms and thereby of reducing the development of potential side effects while the BP-lowering effect of each component of the combination is enhanced. One good example of such a synergism is the association of a blocker of the renin—angiotensin system (RAS) and a thiazide diuretic. The thiazide-induced natriuresis potentiates the antihypertensive efficacy of RAS blockers stimulating renin, whereas RAS blockers limit the kaliuresis induced by the thiazide diuretic and therefore limit the incidence of hypokalaemia (19). Among other examples, one can cite the reduction of the incidence of peripheral oedema with calcium channel blockers (CCBs) when these latter are associated with an RAS blocker (20) or the prevention of the dihydropyridine-induced tachycardia with the association of a beta-blocker.
Resuscitation Physiology
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
Atrial natriuretic factor (ANF) or peptide (ANP) is a hormone produced by the atria, along with brain or B-type natriuretic peptide (BNP) produced by the ventricular muscle cells, in response to an increase in vascular volume and thus distension and pressure.7 ANF and BNP produce similar increases in glomerular filtration and pronounced natriuresis and diuresis to decrease intravascular volume by inhibition of aldosterone which also minimizes kaliuresis.
Endocrine hypertension
Published in Philip E. Harris, Pierre-Marc G. Bouloux, Endocrinology in Clinical Practice, 2014
Frances McManus, John M. Connell, Marie Freel
Oral sodium intake is increased (with sodium chloride tablet if necessary) to >200 mmol (6 g)/day, for 3 days. The high-salt diet can increase kaliuresis and hypokalemia; therefore, potassium should be measured daily and normalized with supplementation, if necessary. A 24-h urine collection is undertaken from the morning of day 3 and analyzed for sodium (to ensure compliance with sodium intake) and urinary aldosterone. Urinary aldosterone can be measured by radioimmunoassay (aldosterone 18-oxo-glucuronide), but this measurement is less accurate than measuring aldosterone metabolites by liquid or gas chromatography and tandem mass spectroscopy, a method that is becoming more widely available. Autonomous secretion of aldosterone is confirmed if urinary aldosterone excretion exceeds 33 nmol/day (12 μg/24 h). This test is of limited value in patients with renal disease, because aldosterone 18-oxo-glucuronide is a renal metabolite, and its excretion may not rise in patients with renal disease. However, the main limitation of this test is the inherent inaccuracies of 24-h urine collections in most patients.
Machine learning algorithms identify hypokalaemia risk in people with hypertension in the United States National Health and Nutrition Examination Survey 1999–2018
Published in Annals of Medicine, 2023
Ziying Lin, Yuen Ting Cheng, Bernard Man Yung Cheung
Our study has several strengths. We developed a ML model to predict hypokalaemia risk in hypertensive patients and their CVD subgroup using a 20-year survey. Moreover, we provided a visualized interpretation of the risk factors associated with hypokalaemia. Besides, our prediction model based on a questionnaire-styled survey could be verified well through sensitivity analysis. The nomogram developed from easily accessible variables presents important risk features associated with hypokalaemia in hypertensive patients. It helps assess the hypokalaemia risk in these patients, which may be of clinical significance. Our study also has some limitations. First, although causal links and trends over time could not be established using the cross-sectional survey, the real-time prediction of hypokalaemia risk could provide further clinical decision-making and individual healthcare for hypertensive patients at risk of hypokalaemia. Also, our model lacked external validation in an independent cohort and may not be applicable to particular populations, such as inpatients. However, we used a large sample from a general population, and our findings could identify potential patients at risk early and provide a more personalized practice on health care. Second, we only focus on modelling common ML algorithms. Thirdly, our study did not include information from dietary questionnaires, bicarbonate levels, and 24-hour kaliuresis. Lastly, hypokalaemia often occurs in various clinical conditions, such as diarrhoea and vomiting, but we could not assess these from the dataset.
Duplicated adrenal veins in primary aldosteronism misdiagnosed with ectopic aldosteronoma due to apparent bilateral aldosterone suppression
Published in Blood Pressure, 2023
Jingwen Yu, Cunxia Fan, Weiping Wei, Haiwei Liu, Tuanyu Fang, Huibiao Quan, Kaining Chen, Yuhai Zhang
Laboratory analysis displayed mild hypokalaemia (potassium level of 3.29 mmol/L), kaliuresis (125.1 mmol/24h), and mild kidney dysfunction (creatinine level of 116.0 μmol/L). No abnormalities were observed in his normetanephrine/metanephrine level, adrenocorticotropic hormone (ACTH) level, and cortisol rhythms. Screening for PA demonstrated an ascending aldosterone-renin ratio. Captopril challenge test showed that aldosterone was not suppressed by 50 mg of oral captopril. Adrenal CT identified roundish nodules bilaterally in the adrenal glands. A larger nodule (white arrow) measuring 2.3 × 1.3 cm in diameter was located on the superior pole of the right adrenal gland (Figure 1).
The patient with metabolic alkalosis
Published in Acta Clinica Belgica, 2019
Valentine Gillion, Michel Jadoul, Olivier Devuyst, Jean-Michel Pochet
In patients with cardiac failure, large amounts of NaCl may be harmful. Acetazolamide, a carbonic anhydrase inhibitor, can be administered (250 to 500 mg, once or twice a day) [4]. The inhibition of proximal sodium bicarbonate reabsorption then increases urinary bicarbonate excretion. Acetazolamide must be used with caution due to the induced increase in sodium bicarbonate delivery to the potassium-secretory site in the collecting tubule, which will enhance potassium secretion. The resulting kaliuresis can indeed cause or worsen hypokalemia.