Hypertension: Nguyen T

Brierley J, Carcillo JA, Choong K, Cornell T, Decaen A, Deymann A, Doctor A, Davis A, Duff J, Dugas MA, Duncan A, Evans B, Feldman J, Felmet K, Fisher G, Frankel L, Jeffries H, Greenwald B, Gutierrez J, Hall M, Han YY, Hanson J, Hazelzet J, Hernan L, Kiff J, Kissoon N, Kon A, Irazuzta J, Irazusta J, Lin J, Lorts A, Mariscalco M, Mehta R, Nadel S, Nguyen T, Nicholson C, Peters M, Okhuysen-Cawley R, Poulton T, Relves M, Rodriguez A, Rozenfeld R, Schnitzler E, Shanley T, Kache S, Skache S, Skippen P, Torres A, von Dessauer B, Weingarten J, Yeh T, Zaritsky A, Stojadinovic B, Zimmerman J, Zuckerberg A. · No affiliation provided · Crit Care Med. · Pubmed #19325359 No free full text.

Abstract: BACKGROUND: The Institute of Medicine calls for the use of clinical guidelines and practice parameters to promote "best practices" and to improve patient outcomes. OBJECTIVE: 2007 update of the 2002 American College of Critical Care Medicine Clinical Guidelines for Hemodynamic Support of Neonates and Children with Septic Shock. PARTICIPANTS: Society of Critical Care Medicine members with special interest in neonatal and pediatric septic shock were identified from general solicitation at the Society of Critical Care Medicine Educational and Scientific Symposia (2001-2006). METHODS: The Pubmed/MEDLINE literature database (1966-2006) was searched using the keywords and phrases: sepsis, septicemia, septic shock, endotoxemia, persistent pulmonary hypertension, nitric oxide, extracorporeal membrane oxygenation (ECMO), and American College of Critical Care Medicine guidelines. Best practice centers that reported best outcomes were identified and their practices examined as models of care. Using a modified Delphi method, 30 experts graded new literature. Over 30 additional experts then reviewed the updated recommendations. The document was subsequently modified until there was greater than 90% expert consensus. RESULTS: The 2002 guidelines were widely disseminated, translated into Spanish and Portuguese, and incorporated into Society of Critical Care Medicine and AHA sanctioned recommendations. Centers that implemented the 2002 guidelines reported best practice outcomes (hospital mortality 1%-3% in previously healthy, and 7%-10% in chronically ill children). Early use of 2002 guidelines was associated with improved outcome in the community hospital emergency department (number needed to treat = 3.3) and tertiary pediatric intensive care setting (number needed to treat = 3.6); every hour that went by without guideline adherence was associated with a 1.4-fold increased mortality risk. The updated 2007 guidelines continue to recognize an increased likelihood that children with septic shock, compared with adults, require 1) proportionally larger quantities of fluid, 2) inotrope and vasodilator therapies, 3) hydrocortisone for absolute adrenal insufficiency, and 4) ECMO for refractory shock. The major new recommendation in the 2007 update is earlier use of inotrope support through peripheral access until central access is attained. CONCLUSION: The 2007 update continues to emphasize early use of age-specific therapies to attain time-sensitive goals, specifically recommending 1) first hour fluid resuscitation and inotrope therapy directed to goals of threshold heart rates, normal blood pressure, and capillary refill <or=2 secs, and 2) subsequent intensive care unit hemodynamic support directed to goals of central venous oxygen saturation >70% and cardiac index 3.3-6.0 L/min/m.

Nguyen T, Toto RD. · Internal Medicine - Nephrology, The University of Texas Southwestern Medical Center Dallas, 5323 Harry Hines Blvd, Dallas, TX, 75390-8856, USA. · Pediatr Nephrol. · Pubmed #18324425 No free full text.

Abstract: Chronic kidney disease is generally thought to be a progressive disorder regardless of etiology. Over the past 15 years, investigations into the mechanisms of disease progression and treatment designed to slow or halt disease progression have been conducted, largely in the adult kidney disease population. Intervention trials have demonstrated that lowering blood pressure in hypertensive patients and administration of drugs that block the renin-angiotensin aldosterone system are effective at slowing kidney disease progression, including diabetes, hypertension, and various glomerular diseases. In addition, novel strategies including anemia therapy with erythropoietin-stimulating agents have been conducted to determine whether treatment of this common complication of kidney disease can stabilize kidney function. Whereas substantial success has been achieved in more common forms of adult kidney disease such as diabetes and hypertension, slowing progression of some immune-mediated glomerular disease such as lupus nephritis and immunoglobulin A (IgA) nephropathy remain a great challenge. Moreover, there is no proven strategy, including multifactorial interventions, that clearly halts progressive chronic kidney disease that has been studied prospectively in a large-scale, long-term trial. The purpose of this review is to discuss these trials, as they form the underpinnings for current clinical practice guidelines in adults with chronic kidney disease.

Al-Naamani K, Hijal T, Nguyen V, Andrew S, Nguyen T, Huynh T. · Division of Cardiology, McGill University Health Centre, Canada. · Int J Cardiol. · Pubmed #17651847 No free full text.

Abstract: OBJECTIVE: Determination of the prevalences and predictive values of specific electrocardiograms (ECG) criteria of right ventricular hypertrophy (RVH) or right atrial enlargement for pulmonary hypertension. METHODS: We examined the ECG and trans-thoracic echocardiograms (TTE) of 372 patients who had TTE and 12-lead ECG, performed within 24 h interval, during a 12-month period. There were 282 consecutive adults with pulmonary hypertension (pulmonary artery systolic pressure (PASP) >30 mm Hg) and 90 subjects with normal cardiac anatomy and normal PASP. The mean age of patients with pulmonary hypertension was 74.0+/-11.0 years and 66% of them were females. The control subjects had a mean age of 56.3+/-17.5 years and 58.8% were females. RESULTS: ECG patterns focusing on the R and S amplitudes and R/S ratio in V1 were more predictive of pulmonary hypertension than ECG patterns involving leads V5 and V6. In particular, each of the following ECG patterns had good positive predictive values for pulmonary hypertension (greater than 80%): R in I less than 2 mm+S in V1</=2 mm, R/S in V1 more than 1, R/S V6 less than 1, QRS axis more than 110 degrees , qR in V1. Right axis deviation with QRS axis more than 110 degrees had the best positive predictive value of severe pulmonary hypertension (PASP>/=60 mm Hg). Electrocardiographic criterion for right atrial enlargement was not found in any of the patients with pulmonary hypertension. CONCLUSIONS: ECG criteria of RVH were rare in patients with pulmonary hypertension. ECG patterns focusing on the R and S amplitude in V1 and right axis deviation with QRS axis deviation>/=110 degrees had excellent positive predictive values of pulmonary hypertension. However, the absence of ECG criteria of RVH could not exclude with certainty the presence of pulmonary hypertension.

Nguyen T, Vazquez M, Toto R. · Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA. · Lancet. · Pubmed #17223455 No free full text.

This publication has no abstract.

Sindhu RK, Ehdaie A, Farmand F, Dhaliwal KK, Nguyen T, Zhan CD, Roberts CK, Vaziri ND. · Division of Nephrology and Hypertension, Department of Medicine, College of Medicine, University of California at Irvine, Irvine, CA 92697-4066, USA. · Biochim Biophys Acta. · Pubmed #15777843 No free full text.

Abstract: Chronic renal failure (CRF) is associated with oxidative stress, the precise mechanism of which is yet to be elucidated. The present study was undertaken to investigate in renal insufficiency the expression of catalase and glutathione peroxidase, which play a critical role in antioxidant defense system by catalyzing detoxification of hydrogen peroxide (H2O2) and organic hydroperoxides. Rats were randomly assigned to the CRF (5/6 nephrectomized) and sham-operated control groups and observed for 6 weeks. Renal and thoracic aortic catalase and glutathione peroxidase protein abundance was measured by Western blotting. The enzyme activities in the renal and aortic extracts, hepatic glutathione levels, blood pressure and urinary nitric oxide metabolites (NO(x)) excretion were also measured. Blood pressure and urinary nitric oxide metabolite (NO(x)) excretion were also measured. The CRF group showed a significant down-regulation of both immunodetectable catalase and glutathione peroxidase proteins in the remnant kidney. Catalase activity was also significantly decreased in the remnant kidney whereas glutathione peroxidase activity was not significantly affected. Furthermore, the protein abundance of catalase was unchanged whereas the enzyme activity was significantly decreased in the thoracic aorta of CRF animals compared to the sham-operated controls. By contrast, both the protein abundance and the enzyme activity of glutathione peroxidase were not significantly affected in the aorta of CRF animals compared to the sham-operated controls. This was coupled with marked arterial hypertension, significant reduction of hepatic glutathione levels and urinary NO(x) excretion pointing to increased inactivation and sequestration of NO by superoxide. These events point to the role of impaired antioxidant defense system in the pathogenesis of oxidative stress in CRF.