MyMedR

Endocrine hypertension--current understanding and comprehensive management review

Sukor N

Eur J Intern Med, 2011 Oct;22(5):433-40.

PMID: 21925049 DOI: 10.1016/j.ejim.2011.05.004

Hypertension is a very common disease, leading to significant morbidity with reduction in quality of life. In addition to being a major cause of morbidity and mortality, hypertension places a heavy burden on health care systems, families, and society as a whole. In patients with hypertension, the ability to identify a contributing or secondary cause that is potentially curable or amenable to specific forms of management is of great importance. Endocrine hypertension has emerged as one of the common forms of secondary hypertension. Primary aldosteronism, pheochromocytoma and Cushing's syndrome are among the common causes of endocrine hypertension. The application of new clinical, biochemical, and radiologic approaches has significantly advanced our understanding of the pathophysiology and clinical spectrum of these diseases and improved the management strategies of these challenging conditions.

Bilateral foot drop and cherry skin lesion

Ng CF, Remli R

Eur J Intern Med, 2021 Jan;83:82-83.

PMID: 33234390 DOI: 10.1016/j.ejim.2020.11.005

Rice bodies in the wrist joint

Sulaiman H, Atiya N, Loi KW, Ng KP

Eur J Intern Med, 2016 Nov;35:e7-e8.

PMID: 27498273 DOI: 10.1016/j.ejim.2016.07.014

Dysphagia in an elderly patient

Tan SH, Balachandran R, Prepageran N

Eur J Intern Med, 2019 02;60:e3-e4.

PMID: 29759815 DOI: 10.1016/j.ejim.2018.05.012

Fulltext Colchicine for COVID-19: Hype or hope?

Kow CS, Ramachandram DS, Hasan SS

Eur J Intern Med, 2021 Nov 13.

PMID: 34810043 DOI: 10.1016/j.ejim.2021.11.011

The recurrent intertriginous rash

How KN, Bhullar A

Eur J Intern Med, 2018 07;53:e4-e5.

PMID: 29307504 DOI: 10.1016/j.ejim.2017.12.016

Fulltext Diagnosis of acute aortic syndromes with ultrasound and d-dimer: the PROFUNDUS study

Morello F, Bima P, Castelli M, Capretti E, de Matos Soeiro A, Cipriano A, et al.

Eur J Intern Med, 2024 Jun 12.

PMID: 38871565 DOI: 10.1016/j.ejim.2024.05.029

BACKGROUND: In patients complaining common symptoms such as chest/abdominal/back pain or syncope, acute aortic syndromes (AAS) are rare underlying causes. AAS diagnosis requires urgent advanced aortic imaging (AAI), mostly computed tomography angiography. However, patient selection for AAI poses conflicting risks of misdiagnosis and overtesting.

OBJECTIVES: We assessed the safety and efficiency of a diagnostic protocol integrating clinical data with point-of-care ultrasound (POCUS) and d-dimer (single/age-adjusted cutoff), to select patients for AAI.

METHODS: This prospective study involved 12 Emergency Departments from 5 countries. POCUS findings were integrated with a guideline-compliant clinical score, to define the integrated pre-test probability (iPTP) of AAS. If iPTP was high, urgent AAI was requested. If iPTP was low and d-dimer was negative, AAS was ruled out. Patients were followed for 30 days, to adjudicate outcomes.

RESULTS: Within 1979 enrolled patients, 176 (9 %) had an AAS. POCUS led to net reclassification improvement of 20 % (24 %/-4 % for events/non-events, P < 0.001) over clinical score alone. Median time to AAS diagnosis was 60 min if POCUS was positive vs 118 if negative (P = 0.042). Within 941 patients satisfying rule-out criteria, the 30-day incidence of AAS was 0 % (95 % CI, 0-0.41 %); without POCUS, 2 AAS were potentially missed. Protocol rule-out efficiency was 48 % (95 % CI, 46-50 %) and AAI was averted in 41 % of patients. Using age-adjusted d-dimer, rule-out efficiency was 54 % (difference 6 %, 95 % CI, 4-9 %, vs standard cutoff).

CONCLUSIONS: The integrated algorithm allowed rapid triage of high-probability patients, while providing safe and efficient rule-out of AAS. Age-adjusted d-dimer maximized efficiency.

CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov, NCT04430400.

Fulltext East meets West: Bringing the ESH 2023 hypertension guidelines into Asia

Sukonthasarn A, Borghi C, Chan YH, Cheng F, Choi HI, Mehta R, et al.

Eur J Intern Med, 2024 Sep;127:25-30.

PMID: 38960822 DOI: 10.1016/j.ejim.2024.06.026

Hypertension remains a major problem worldwide, especially across the Asia-Pacific region, which reports high prevalence rates and slow improvements in treatment rate and blood pressure (BP) control rate. Asian patients with hypertension may also vary with regard to phenotype and the epidemiology of the complications of hypertension, especially when compared with Western patients. Given these differences, Western guidelines may not necessarily be applicable to countries in the Asia Pacific. This narrative review aims to provide a critical comparison between the recently published European Society of Hypertension (ESH) 2023 guidelines and existing local guidelines in select Asian countries, offer expert opinion on how to fill gaps in the ESH 2023 guidelines for hypertension in the Asian context, and examine the need for harmonisation of hypertension guidelines worldwide. This review focuses on the definition and diagnosis of hypertension, the treatment thresholds and targets, and recommendations on the use of pharmacotherapy.

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