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Chen ZW, Chan CK, Lin CH, Lee CF, Lo HY, Huang YC, Yeh CF, Chen MYC, Lai TH, Huang KC, Wu VC, Chen WJ, Lin YH. Evaluations of secondary hypertension and laboratory data in the elderly population. J Formos Med Assoc 2024:S0929-6646(24)00340-1. [PMID: 39030141 DOI: 10.1016/j.jfma.2024.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Accepted: 07/15/2024] [Indexed: 07/21/2024] Open
Abstract
Secondary hypertension in the elderly poses many challenges and requires a comprehensive diagnostic and management approach. This review explores the prevalence, diagnostic strategies, and treatment modalities for secondary hypertension in elderly patients, focusing on etiologies including primary aldosteronism, renal vascular disease, renal parenchymal disease, obstructive sleep apnea, thyroid disorders, Cushing's syndrome, pheochromocytomas and paragangliomas, and drug-induced hypertension. Key considerations include age-related changes in physiology and atypical presentations of underlying conditions necessitating thorough screening with a combination of clinical evaluation, laboratory tests, and imaging studies. Collaboration among healthcare providers is essential to ensure a timely diagnosis and personalized management tailored to the unique needs of elderly patients. Further research is needed to address knowledge gaps and optimize clinical strategies for managing secondary hypertension in this population.
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Affiliation(s)
- Zheng-Wei Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chieh-Kai Chan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu City, Taiwan
| | - Chia-Hung Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Feng Lee
- Division of Pulmonology, Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Hao-Yun Lo
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan
| | - Yung-Cheng Huang
- Department of Pharmacy, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Chih-Fan Yeh
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Michael Yu-Chih Chen
- Division of Cardiology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Tai-Hsuan Lai
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuo-Chin Huang
- Department of Family Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Jone Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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Li Y, Wang Y, Liu ZS, Ma N, Zhang WD, Ren JH. Clinical Practice Report of Contrast-Enhanced Ultrasound in Renal Artery Disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:117-125. [PMID: 37873731 DOI: 10.1002/jum.16345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVES To evaluate the diagnostic performance of renal artery contrast-enhanced ultrasound (CEUS) with modified inspection section and summarize subsequent changes in imaging assessment of renal artery disease. METHODS A total of 1015 patients underwent renal artery CEUS were included in the study. Among them, 79 patients (156 renal arteries) suspected with renal artery stenosis (RAS) underwent digital subtraction angiography (DSA) subsequently. DSA was used as the gold standard to evaluate the diagnostic performance of CEUS in detecting RAS (≥30%) and severe stenosis (≥70%), as well as the diagnostic accuracy of classification of stenosis degree. Besides, 127 of the 1015 patients underwent other imaging examinations such as computed tomography angiography (CTA) or magnetic resonance angiography (MRA) after CEUS and annual proportion of these imaging examinations was assessed. RESULTS The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of CEUS for detecting RAS (≥30%) was 96.4%, 88.6%, 94.2%, 95.6% and 90.7%, respectively and the kappa value was .857 (P < .01). CEUS had a good performance in distinguishing severe stenosis (≥70%) with a sensitivity of 91.1%, specificity of 95.5%, accuracy of 92.9%, PPV of 96.5%, NPV of 88.7% and the kappa value was 0.857(P < .01). There was no significant difference between CEUS and DSA in detecting stenosis (P = 1.0) and severe stenosis (P = .227). The diagnostic accuracy of CEUS in grading RAS was 85.3% and the kappa value was 0.753 (P < .01). Besides, the annual proportion of other imaging examinations decreased for 4 consecutive years. CONCLUSIONS CEUS is a non-invasive, safe and valuable technique for the assessment of renal artery disease and worthy of promotion.
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Affiliation(s)
- Yan Li
- Graduate School, Peking Union Medical College, Beijing, China
- Department of Sonography, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yang Wang
- Department of Sonography, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Zi-Shuo Liu
- Department of Sonography, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Na Ma
- Department of Sonography, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Wen-Duo Zhang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jun-Hong Ren
- Graduate School, Peking Union Medical College, Beijing, China
- Department of Sonography, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Velloni FG, Cardia PP, Torres UDS, Pereira MAH, Penachim TJ, Favaro LR, Ramalho M, D'Ippolito G. Unenhanced magnetic resonance angiography as an accurate alternative in the preoperative assessment of potential living kidney donors with contraindications to computed tomography angiography and to contrast-enhanced magnetic resonance angiography. Radiol Bras 2020; 53:229-235. [PMID: 32904775 PMCID: PMC7458566 DOI: 10.1590/0100-3984.2019.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate the accuracy of steady-state free precession (SSFP) unenhanced magnetic resonance angiography (MRA) at 1.5 T for the identification of multiple renal arteries, using computed tomography angiography (CTA) as the reference standard. Materials and Methods This was a prospective study involving 39 patients (26 males; mean age, 62.6 years) who underwent CTA and unenhanced MRA to evaluate the proximal and middle segments of the renal arteries. The analysis was performed in two phases: the quality of unenhanced MRA images was classified as diagnostic or nondiagnostic for the presence of multiple renal arteries by two independent readers; two other independent readers then evaluated the images previously classified as being of diagnostic quality. The sensitivity, specificity, and overall accuracy of unenhanced MRA were calculated, CTA being used as the reference standard. The kappa statistic was used in order to calculate interobserver agreement. Results The image quality of unenhanced MRA was considered diagnostic in 70-90% of the extrarenal arterial segments. The CTA examination revealed 19 multiple renal arteries (8 on the right and 11 on the left). The accuracy of unenhanced MRA for the identification of multiple renal arteries was greater than 90%, with a sensitivity of 72.7-100% and a specificity of 96.3-100%. Conclusion Unenhanced MRA provides high quality imaging of the extrarenal segments of renal arteries. This method may be used as an alternative for the evaluation of the renal arteries, given that it has an accuracy comparable to that of CTA.
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Affiliation(s)
- Fernanda Garozzo Velloni
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.,Diagnósticos da América SA (DASA), São Paulo, SP, Brazil
| | - Patrícia Prando Cardia
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.,Centro Radiológico Campinas, Campinas, SP, Brazil
| | | | - Marco Antonio Haddad Pereira
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.,Diagnósticos da América SA (DASA), São Paulo, SP, Brazil
| | | | - Larissa Rossini Favaro
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | | | - Giuseppe D'Ippolito
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.,Grupo Fleury, São Paulo, SP, Brazil
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Qin L, Ma Z, Yan F, Yang W. Iterative model reconstruction (IMR) algorithm for reduced radiation dose renal artery CT angiography with different tube voltage protocols. Radiol Med 2017; 123:83-90. [DOI: 10.1007/s11547-017-0821-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
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Burchell AE, Rodrigues JCL, Charalambos M, Ratcliffe LEK, Hart EC, Paton JFR, Baumbach A, Manghat NE, Nightingale AK. Comprehensive First-Line Magnetic Resonance Imaging in Hypertension: Experience From a Single-Center Tertiary Referral Clinic. J Clin Hypertens (Greenwich) 2016; 19:13-22. [DOI: 10.1111/jch.12920] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/19/2016] [Accepted: 07/23/2016] [Indexed: 01/03/2023]
Affiliation(s)
- Amy E. Burchell
- CardioNomics Research Group; Bristol Heart Institute; University Hospitals Bristol NHS Foundation Trust; University of Bristol; Bristol UK
- School of Clinical Sciences; Bristol Royal Infirmary; University of Bristol; Bristol UK
| | - Jonathan C. L. Rodrigues
- CardioNomics Research Group; Bristol Heart Institute; University Hospitals Bristol NHS Foundation Trust; University of Bristol; Bristol UK
- School of Physiology; Pharmacology & Neuroscience; Biomedical Sciences; University of Bristol; Bristol UK
- NIHR Bristol Cardiovascular Biomedical Research Unit; Bristol Heart Institute; University Hospitals Bristol NHS Foundation Trust; University of Bristol; Bristol UK
| | - Max Charalambos
- School of Clinical Sciences; Bristol Royal Infirmary; University of Bristol; Bristol UK
| | - Laura E. K. Ratcliffe
- CardioNomics Research Group; Bristol Heart Institute; University Hospitals Bristol NHS Foundation Trust; University of Bristol; Bristol UK
- School of Physiology; Pharmacology & Neuroscience; Biomedical Sciences; University of Bristol; Bristol UK
| | - Emma C. Hart
- CardioNomics Research Group; Bristol Heart Institute; University Hospitals Bristol NHS Foundation Trust; University of Bristol; Bristol UK
- School of Physiology; Pharmacology & Neuroscience; Biomedical Sciences; University of Bristol; Bristol UK
| | - Julian F. R. Paton
- CardioNomics Research Group; Bristol Heart Institute; University Hospitals Bristol NHS Foundation Trust; University of Bristol; Bristol UK
- School of Physiology; Pharmacology & Neuroscience; Biomedical Sciences; University of Bristol; Bristol UK
| | - Andreas Baumbach
- CardioNomics Research Group; Bristol Heart Institute; University Hospitals Bristol NHS Foundation Trust; University of Bristol; Bristol UK
- School of Clinical Sciences; Bristol Royal Infirmary; University of Bristol; Bristol UK
- NIHR Bristol Cardiovascular Biomedical Research Unit; Bristol Heart Institute; University Hospitals Bristol NHS Foundation Trust; University of Bristol; Bristol UK
| | - Nathan E. Manghat
- CardioNomics Research Group; Bristol Heart Institute; University Hospitals Bristol NHS Foundation Trust; University of Bristol; Bristol UK
- Dept of Clinical Radiology; Bristol Royal Infirmary; University Hospitals Bristol NHS Foundation Trust; University of Bristol; Bristol UK
| | - Angus K. Nightingale
- CardioNomics Research Group; Bristol Heart Institute; University Hospitals Bristol NHS Foundation Trust; University of Bristol; Bristol UK
- School of Clinical Sciences; Bristol Royal Infirmary; University of Bristol; Bristol UK
- NIHR Bristol Cardiovascular Biomedical Research Unit; Bristol Heart Institute; University Hospitals Bristol NHS Foundation Trust; University of Bristol; Bristol UK
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High-Pitch Dual-Source Computed Tomography Renal Angiography Comparison With Conventional Low-Pitch Computed Tomography Angiography. J Comput Assist Tomogr 2015; 39:737-40. [DOI: 10.1097/rct.0000000000000268] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Qian Q, Nasr SH. Diagnosis and treatment of glomerular diseases in elderly patients. Adv Chronic Kidney Dis 2014; 21:228-46. [PMID: 24602472 DOI: 10.1053/j.ackd.2014.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 12/19/2013] [Accepted: 01/07/2014] [Indexed: 02/07/2023]
Abstract
Glomerular diseases are common in elderly patients and are a major cause of kidney failure. Most glomerular diseases in the elderly are caused by chronic systemic diseases, including arterial hypertension, diabetes, and atherosclerotic vascular diseases, although acute systemic vasculitis, especially anti-neutrophil-cytoplamic-antibody-mediated vasculitis, and membranous nephropathy related to malignancy, drug toxicity, and idiopathic form also occur often. Complex age-related changes and sensitivity to drug toxicity can render diagnosis and treatment for elderly patients challenging. As the general population is aging and the rate of CKD rising, updating knowledge on managing these patients is critical for care providers. We provide a comprehensive review and update of the diagnosis and treatment of glomerular diseases in the elderly.
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