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Labile hypertension: a new disease or a variability phenomenon? J Hum Hypertens 2019; 33:436-443. [PMID: 30647464 DOI: 10.1038/s41371-018-0157-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 11/03/2018] [Accepted: 12/17/2018] [Indexed: 11/08/2022]
Abstract
Blood pressure (BP) is a physiological parameter with short- and long-term variability caused by complex interactions between intrinsic cardiovascular (CV) mechanisms and extrinsic environmental and behavioral factors. Available evidence suggests that not only mean BP values are important, but also BP variability (BPV) might contribute to CV events. Labile hypertension (HTN) is referred to sudden rises in BP and it seems to be linked with unfavorable outcomes. The aim of this article was to review and summarize recent evidence on BPV phenomenon, unraveling the labile HTN concept along with the prognostic value of these conditions.
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Summers SH, Sabeh K, Gottlieb J. Volatile Hypertension Following Anterior Cervical Discectomy and Fusion: A Case Report. JBJS Case Connect 2016; 6:e12. [PMID: 29252718 DOI: 10.2106/jbjs.cc.o.00154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A sixty-one-year-old man underwent anterior cervical discectomy and fusion (ACDF) from C4 to C7 for the treatment of cervical spondylosis. Postoperatively, the patient experienced paroxysmal surges in blood pressure with associated diaphoresis and anxiety that were difficult to control. He had additional episodes after discharge, requiring a second hospital admission. He was ultimately diagnosed with baroreflex failure syndrome and was managed with a three-drug regimen. He gradually improved and was symptom-free at seven months. CONCLUSION Baroreflex failure syndrome should be considered in the setting of volatile hypertension following ACDF. Prompt recognition of this condition can lead to early referral to a specialist and may reduce patient morbidity.
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Affiliation(s)
- Spencer H Summers
- Department of Orthopaedics and Rehabilitation, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Karim Sabeh
- Department of Orthopaedics and Rehabilitation, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida.,Department of Orthopaedics, Jackson Health System/University of Miami, Miami, Florida
| | - Jonathan Gottlieb
- Department of Orthopaedics and Rehabilitation, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida.,Department of Orthopaedics, Jackson Health System/University of Miami, Miami, Florida
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Hayat A, Whittam D. Baroreceptor failure related to bilateral carotid artery disease: an uncommon cause of labile hypertension. Intern Med J 2014; 44:105-6. [DOI: 10.1111/imj.12324] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 08/25/2013] [Indexed: 11/28/2022]
Affiliation(s)
- A. Hayat
- Department of Medicine and Nephrology; Taranaki Base Hospital; New Plymouth New Zealand
| | - D. Whittam
- Department of Medicine and Nephrology; Taranaki Base Hospital; New Plymouth New Zealand
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Monroe VD. Blood Pressure Lability. Crit Care Nurs Q 2013; 36:425-32. [DOI: 10.1097/cnq.0b013e3182a1eb3b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Govorkova EA, Ilyushina NA, Marathe BM, McClaren JL, Webster RG. Competitive fitness of oseltamivir-sensitive and -resistant highly pathogenic H5N1 influenza viruses in a ferret model. J Virol 2010; 84:8042-50. [PMID: 20519385 PMCID: PMC2916532 DOI: 10.1128/jvi.00689-10] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 05/24/2010] [Indexed: 11/20/2022] Open
Abstract
The fitness of oseltamivir-resistant highly pathogenic H5N1 influenza viruses has important clinical implications. We generated recombinant human A/Vietnam/1203/04 (VN; clade 1) and A/Turkey/15/06 (TK; clade 2.2) influenza viruses containing the H274Y neuraminidase (NA) mutation, which confers resistance to NA inhibitors, and compared the fitness levels of the wild-type (WT) and resistant virus pairs in ferrets. The VN-H274Y and VN-WT viruses replicated to similar titers in the upper respiratory tract (URT) and caused comparable disease signs, and none of the animals survived. On days 1 to 3 postinoculation, disease signs caused by oseltamivir-resistant TK-H274Y virus were milder than those caused by TK-WT virus, and all animals survived. We then studied fitness by using a novel approach. We coinoculated ferrets with different ratios of oseltamivir-resistant and -sensitive H5N1 viruses and measured the proportion of clones in day-6 nasal washes that contained the H274Y NA mutation. Although the proportion of VN-H274Y clones increased consistently, that of TK-H274Y virus decreased. Mutations within NA catalytic (R292K) and framework (E119A/K, I222L, H274L, and N294S) sites or near the NA enzyme active site (V116I, I117T/V, Q136H, K150N, and A250T) emerged spontaneously (without drug pressure) in both pairs of viruses. The NA substitutions I254V and E276A could exert a compensatory effect on the fitness of VN-H274Y and TK-H274Y viruses. NA enzymatic function was reduced in both drug-resistant H5N1 viruses. These results show that the H274Y NA mutation affects the fitness of two H5N1 influenza viruses differently. Our novel method of assessing viral fitness accounts for both virus-host interactions and virus-virus interactions within the host.
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Affiliation(s)
- Elena A. Govorkova
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-2794, The D. I. Ivanovsky Institute of Virology, Moscow 123098, Russia, Department of Pathology, University of Tennessee, Memphis, Tennessee 38105
| | - Natalia A. Ilyushina
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-2794, The D. I. Ivanovsky Institute of Virology, Moscow 123098, Russia, Department of Pathology, University of Tennessee, Memphis, Tennessee 38105
| | - Bindumadhav M. Marathe
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-2794, The D. I. Ivanovsky Institute of Virology, Moscow 123098, Russia, Department of Pathology, University of Tennessee, Memphis, Tennessee 38105
| | - Jennifer L. McClaren
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-2794, The D. I. Ivanovsky Institute of Virology, Moscow 123098, Russia, Department of Pathology, University of Tennessee, Memphis, Tennessee 38105
| | - Robert G. Webster
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-2794, The D. I. Ivanovsky Institute of Virology, Moscow 123098, Russia, Department of Pathology, University of Tennessee, Memphis, Tennessee 38105
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Abstract
A key question in pandemic influenza is the relative roles of innate immunity and target cell depletion in limiting primary infection and modulating pathology. Here, we model these interactions using detailed data from equine influenza virus infection, combining viral and immune (type I interferon) kinetics with estimates of cell depletion. The resulting dynamics indicate a powerful role for innate immunity in controlling the rapid peak in virus shedding. As a corollary, cells are much less depleted than suggested by a model of human influenza based only on virus-shedding data. We then explore how differences in the influence of viral proteins on interferon kinetics can account for the observed spectrum of virus shedding, immune response, and influenza pathology. In particular, induction of high levels of interferon ("cytokine storms"), coupled with evasion of its effects, could lead to severe pathology, as hypothesized for some fatal cases of influenza.
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