Ačkoliv nemáme pochyby o tom, že léčba chronické hypertenze snižuje kardiovaskulární riziko, málo se ví o tom, jak nakládat s akutními vzestupy hodnot krevního tlaku (TK) u jinak asymptomatických hospitalizovaných pacientů. Vzestupy hodnot TK za hospitalizace se vyskytují velmi často a velmi pravděpodobně nesouvisí se špatně kontrolovanou chronickou hypertenzí. Za hospitalizace se výrazně odlišují podmínky pro měření TK ve srovnání s ambulantními. Nedávno publikované observační studie ukázaly, že aktivní přístup k asymptomatickým vzestupům TK byl spojen s horšími výsledky než konzervativní přístup. Vedl k vzestupu komplikací spojených s poklesem TK jak během hospitalizace, tak i krátce po propuštění. Asymptomatické vzestupy TK většinou nevyžadují léčbu antihypertenzivy a mohou být léčeny konzervativně. Po propuštění by měli být tito pacienti pečlivě sledováni, zda tento vzestup TK byl přechodný, nebo trvalý.
Although they are no doubts that treatment of chronic hypertension reduces cardiovascular risk, little is known how to deal with acute elevations of blood pressure (BP) values among asymptomatic subjects during hospitalization. In-hospital BP pressure elevations are relatively frequent and may not correspond with poorly controlled chronic hypertension. Conditions for BP measurement during hospitalization significantly differ from those recommended for outpatient settings. Recent published observational studies showed that active approach for asymptomatic BP elevations was associated with worse outcome compared to the conservative approach. It increased the risk in-hospital and early post-discharge BP-related complications. Acute asymptomatic BP elevations usually do not require antihypertensive treatment and may be managed conservatively. After discharge, these patients should be followed very closely if these BP elevations were transient or permanent.
- MeSH
- adrenalektomie metody MeSH
- denervace * metody MeSH
- hypertenze * farmakoterapie terapie MeSH
- klinická studie jako téma MeSH
- ledviny chirurgie inervace MeSH
- lidé MeSH
- výběr pacientů MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- úvodní články MeSH
Primary aldosteronism (PA) is the most frequent form of endocrine hypertension. Recently, frequent clinically significant adrenal insufficiency after adrenalectomy in subjects with PA has been reported, which may make the early postsurgical management difficult. We retrospectively searched for possible adrenal insufficiency in subjects who underwent adrenalectomy for PA and have measured cortisol in the early postoperative course. We included subjects with confirmed diagnosis of PA who underwent either posture testing (blood draw at 06:00 and 08:00) and/or adrenal venous sampling (AVS) (blood draw between 08:00 and 09:00) and have also measured cortisol after surgery (cortisol measured approximately at 07:00). Cortisol was measured by immunoassay. In this study, we identified 150 subjects (age 48.5 ± 10.3 years) with available cortisol values in the early postoperative course (median [25th percentile, 75th percentile]) 6 [5,6] days. Postoperative cortisol values (551 ± 148 nmol/l) were normal and significantly higher, compared to preoperative standing cortisol values (404 ± 150 nmol/l; (P < 0.001) and AVS cortisol values (493 ± 198 nmol/l; P = 0.009), and did not significantly differ from preoperative supine cortisol values. Postsurgical cortisol values were not different among subjects with or without abnormal dexamethasone suppression test or elevated urinary free cortisol pre-surgery, and were significantly higher in subjects with abnormal diurnal cortisol variability compared with subjects with normal diurnal variability. No patient presented with adrenocortical crisis in the later follow-up. In conclusion, postoperative cortisol values did not indicate any suspicion of possible adrenal insufficiency. To exclude possible adrenal insufficiency, it may be sufficient to measure morning cortisol in the early postoperative course.
- MeSH
- adrenalektomie MeSH
- adrenální insuficience * diagnóza etiologie chirurgie MeSH
- dospělí MeSH
- hydrokortison MeSH
- hyperaldosteronismus * komplikace diagnóza chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- retrospektivní studie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
