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Tan LD, Hilliard AA, Peverini RL, Martin RD, Thomas TL, Wright TG, Edwards LC, Lalas AM, Staples-Evans HM, Sharp BJ, Ahn-Kim SL, Hansen KA, Hart RH. Navigating the Healthcare Conundrum: Leadership Perspective from a Premier Healthcare Organization in Loma Linda's Blue Zone. J Healthc Leadersh 2024; 16:83-91. [PMID: 38435701 PMCID: PMC10908333 DOI: 10.2147/jhl.s452188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/13/2024] [Indexed: 03/05/2024] Open
Abstract
Navigating the healthcare conundrum in the Blue Zone of Loma Linda, California, requires understanding the unique factors that make this region stand out in terms of health and longevity. But more important is understanding the healthcare system sustaining the Blue Zone in Loma Linda, California. In an era marked by soaring healthcare costs and diminishing reimbursement rates, hospitals and physicians face an unprecedented challenge: providing excellent patient care while maintaining financial sustainability. This leadership perspective publication paper delves into the multifaceted struggles encountered by healthcare and hospital leaders, exploring the root causes, implications, and potential solutions for this complex issue. As we examine the evolving healthcare landscape, we aim to shed light on the critical need for innovative approaches to sustain the future of healthcare excellence in one of the five original Blue Zones.
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Affiliation(s)
- Laren D Tan
- Department of Medicine, Pulmonary, Critical Care, Hyperbaric and Sleep Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Anthony A Hilliard
- Department of Medicine, Cardiology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Ricardo L Peverini
- Department of Pediatrics, Neonatology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Robert D Martin
- Department of Anesthesia, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Tamara L Thomas
- Department of Emergency Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | | | | | | | | | - Barbara J Sharp
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | | | | | - Richard H Hart
- Department of Preventive Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
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Basharat SA, Chatta P, Kirk S, Hilliard AA, Parwani P. CORONARY INVOLVEMENT IN EGPA: EYES DON’T SEE WHAT THE MIND DOESN’T KNOW! J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)04029-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kwok CS, Wong CW, Kontopantelis E, Barac A, Brown SA, Velagapudi P, Hilliard AA, Bharadwaj AS, Chadi Alraies M, Mohamed M, Bhatt DL, Mamas MA. Percutaneous coronary intervention in patients with cancer and readmissions within 90 days for acute myocardial infarction and bleeding in the USA. Eur Heart J 2021; 42:1019-1034. [PMID: 33681960 DOI: 10.1093/eurheartj/ehaa1032] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/13/2020] [Accepted: 12/14/2020] [Indexed: 01/04/2023] Open
Abstract
AIMS The post-discharge outcomes of patients with cancer who undergo PCI are not well understood. This study evaluates the rates of readmissions within 90 days for acute myocardial infarction (AMI) and bleeding among patients with cancer who undergo percutaneous coronary intervention (PCI). METHODS AND RESULTS Patients treated with PCI in the years from 2010 to 2014 in the US Nationwide Readmission Database were evaluated for the influence of cancer on 90-day readmissions for AMI and bleeding. A total of 1 933 324 patients were included in the analysis (2.7% active cancer, 6.8% previous history of cancer). The 90-day readmission for AMI after PCI was higher in patients with active cancer (12.1% in lung, 10.8% in colon, 7.5% in breast, 7.0% in prostate, and 9.1% for all cancers) compared to 5.6% among patients with no cancer. The 90-day readmission for bleeding after PCI was higher in patients with active cancer (4.2% in colon, 1.5% in lung, 1.4% in prostate, 0.6% in breast, and 1.6% in all cancer) compared to 0.6% among patients with no cancer. The average time to AMI readmission ranged from 26.7 days for lung cancer to 30.5 days in colon cancer, while the average time to bleeding readmission had a higher range from 38.2 days in colon cancer to 42.7 days in breast cancer. CONCLUSIONS Following PCI, patients with cancer have increased risk for readmissions for AMI or bleeding, with the magnitude of risk depending on both cancer type and the presence of metastasis.
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Affiliation(s)
- Chun Shing Kwok
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK.,Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Chun Wai Wong
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - Evangelos Kontopantelis
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, UK
| | - Ana Barac
- Department of Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington DC, USA
| | - Sherry-Ann Brown
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Poonam Velagapudi
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Anthony A Hilliard
- Department of Medicine, Division of Cardiology, Linda University School of Medicine, Loma Linda, CA, USA
| | - Aditya S Bharadwaj
- Department of Medicine, Division of Cardiology, Linda University School of Medicine, Loma Linda, CA, USA
| | - M Chadi Alraies
- Department of Cardiology, Wayne State University, Detroit Medical Center, Detroit Heart Hospital, MI, USA
| | - Mohamed Mohamed
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK.,Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Deepak L Bhatt
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK.,Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
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Ji Y, Desai A, Fraser GE, Narasimha D, Abudayyeh I, Jutzy KR, Hilliard AA. Predictors of Mortality and Associated Lactate Trends in Cardiogenic Shock Patients Treated with Impella® Placement - A Single Center Experience. ICFJ 2020. [DOI: 10.17987/icfj.v20i0.673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The Impella® devices have increasingly become a desired treatment option for cardiogenic shock (CS) as demonstrated by studies analyzing real-world use of hemodynamic support devices. However, data regarding outcomes after Impella® device implant and optimal timing of device placement remains scarce. This study investigates prognostic factors including serial lactate levels in CS patients treated with Impella®.Methods: This retrospective study reviewed 76 consecutive patients diagnosed with CS supported with Impella® at a large, tertiary-care university medical center. Clinical variables and outcomes examined include co-morbidities, pre- and post-procedural lactate levels, and mortality.Results: Of the 76 patients requiring an Impella®, 70% of patients survived to hospital discharge. Those who died post-device implant had a higher prevalence of hyperlipidemia (HLD), chronic kidney disease (CKD), and more likely to require multiple (>1) vasopressors. The mean pre-procedural lactate levels were significantly higher (5.86 +/- 5.11 vs 2.16 +/- 1.50, p = 0.01) in the population who died, along with the change in lactate levels (1.90 +/- 2.56 vs -0.40 +/- 1.73, p=0.04). Those who died within 24 hours of implant showed a trend toward higher mean pre-procedural lactate levels (8.46 +/- 6.00 vs 3.86 +/- 3.31, p = 0.12).Conclusions : Higher pre-procedural lactate levels, HLD, CKD, and increased vasopressor requirement were predictive of increased mortality in CS patients post-Impella® placement, especially within 24 hours of implant. Through serial lactate measurements, we demonstrated favorable outcomes in patients with early stabilization or greater lowering of post-procedural lactate levels suggestive of improved end organ perfusion.
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Nandkeolyar S, Doctorian T, Fraser G, Ryu R, Kagabo W, Fearon C, Tryon D, Hauschild C, Stoletniy L, Abramov D, Hilliard AA, Sakr A. PREDICTORS OF IN-PATIENT MORTALITY IN PATIENTS ON SHORT-TERM LOW-DOSE INOTROPES FOR CARDIOGENIC SHOCK. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31396-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Wayangankar SA, Elgendy IY, Xiang Q, Jneid H, Vemulapalli S, Khachatryan T, Pham D, Hilliard AA, Kapadia SR. Length of Stay After Transfemoral Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2019; 12:422-430. [DOI: 10.1016/j.jcin.2018.11.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 12/19/2022]
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Coney J, Hilliard AA, Prasad V, Lafian H, Ji Y, John M, Bansal N. A BENTALL DEBACLE: THROMBUS OR DISSECTION? J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32766-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Boler AN, Hilliard AA, Gordon BM. Functional assessment of anomalous right coronary artery using fractional flow reserve: An Innovative Modality to Guide Patient Management. Catheter Cardiovasc Interv 2016; 89:316-320. [PMID: 27785906 DOI: 10.1002/ccd.26660] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 06/14/2016] [Indexed: 11/06/2022]
Abstract
Anomalous origin of a coronary artery is a recognized cause of sudden cardiac death (SCD). To date, there is no standard test to predict which patients are at increased risk for SCD. Fractional flow reserve (FFR) is an invasive technique used to qualify focal obstructive coronary lesions. We present a case where FFR was used to guide therapy in a young patient with anomalous right coronary artery (ARCA) when standard noninvasive testing showed ischemic discrepancy. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Amber N Boler
- Department of Internal Medicine, Loma Linda University Health, Loma Linda, California
| | - Anthony A Hilliard
- Division of Cardiology, Loma Linda University Health, Loma Linda, California
| | - Brent M Gordon
- Division of Pediatric Cardiology, Loma Linda University Children's Hospital, Loma Linda, California
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Tankazyan HH, Stoletniy LN, Sakr A, Jutzy KR, Hilliard AA. Percutaneous Coronary Intervention of Unprotected Left Main Coronary Artery in Cardiac Allograft Vasculopathy: A Case Series of Pediatric Patients. ICFJ 2015. [DOI: 10.17987/icfj.v4i0.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
<p>Cardiac allograft vasculopathy is a major cause of morbidity and mortality in orthotopic heart transplantation. The optimal management remains uncertain, especially in left main coronary artery lesions. With the limited data available in the literature, we present a review of three pediatric cases of cardiac allograft vasculopathy, involving the left main coronary artery, treated with percutaneous coronary intervention.</p>
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Tong CW, Ahmad T, Brittain EL, Bunch TJ, Damp JB, Dardas T, Hijar A, Hill JA, Hilliard AA, Houser SR, Jahangir E, Kates AM, Kim D, Lindman BR, Ryan JJ, Rzeszut AK, Sivaram CA, Valente AM, Freeman AM. Challenges facing early career academic cardiologists. J Am Coll Cardiol 2014; 63:2199-208. [PMID: 24703919 PMCID: PMC4306449 DOI: 10.1016/j.jacc.2014.03.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 03/01/2014] [Accepted: 03/04/2014] [Indexed: 11/26/2022]
Abstract
Early career academic cardiologists currently face unprecedented challenges that threaten a highly valued career path. A team consisting of early career professionals and senior leadership members of American College of Cardiology completed this white paper to inform the cardiovascular medicine profession regarding the plight of early career cardiologists and to suggest possible solutions. This paper includes: 1) definition of categories of early career academic cardiologists; 2) general challenges to all categories and specific challenges to each category; 3) obstacles as identified by a survey of current early career members of the American College of Cardiology; 4) major reasons for the failure of physician-scientists to receive funding from National Institute of Health/National Heart Lung and Blood Institute career development grants; 5) potential solutions; and 6) a call to action with specific recommendations.
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Affiliation(s)
- Carl W Tong
- Department of Medical Physiology and Department of Medicine/Cardiology Division, Texas A&M University Health Science Center-Baylor Scott & White Healthcare, Temple, Texas.
| | - Tariq Ahmad
- Duke University Medical Center, Durham, North Carolina
| | - Evan L Brittain
- Department of Medicine/Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - T Jared Bunch
- Heart Rhythm Program, Intermountain Medical Center, Murray, Utah
| | - Julie B Damp
- Department of Medicine/Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Todd Dardas
- Department of Internal Medicine, University of Washington Medical Center, Seattle, Washington
| | - Amalea Hijar
- Member Strategy and Career Development Department, American College of Cardiology, Washington, DC
| | - Joseph A Hill
- Department of Internal Medicine/Cardiology Division and Harry S. Moss Heart Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Anthony A Hilliard
- Department of Medicine/Cardiology Division, Loma Linda University Medical Center, Loma Linda, California
| | - Steven R Houser
- Department of Physiology, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Eiman Jahangir
- Department of Cardiology, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, Louisiana
| | - Andrew M Kates
- Department of Medicine/Cardiology Division, Washington University School of Medicine, St. Louis, Missouri
| | - Darlene Kim
- Department of Medicine/Division of Cardiology, National Jewish Health, Denver, Colorado
| | - Brian R Lindman
- Department of Medicine/Cardiology Division, Washington University School of Medicine, St. Louis, Missouri
| | - John J Ryan
- Department of Medicine/Division of Cardiology, University of Utah Health Care, Salt Lake City, Utah
| | - Anne K Rzeszut
- Member Strategy and Career Development Department, American College of Cardiology, Washington, DC
| | - Chittur A Sivaram
- Department of Medicine/Cardiovascular Section, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | - Anne Marie Valente
- Department of Cardiology, Harvard Medical School, Brigham and Women's Hospital, and Boston Children's Hospital, Boston, Massachusetts
| | - Andrew M Freeman
- Department of Medicine/Division of Cardiology, National Jewish Health, Denver, Colorado
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Hilliard AA, From AM, Lennon RJ, Singh M, Lerman A, Gersh BJ, Holmes DR, Rihal CS, Prasad A. Percutaneous Revascularization for Stable Coronary Artery Disease. JACC Cardiovasc Interv 2010; 3:172-9. [DOI: 10.1016/j.jcin.2009.11.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 11/03/2009] [Accepted: 11/18/2009] [Indexed: 10/19/2022]
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Abstract
Myocarditis, an inflammatory disease of heart muscle, is an important cause of dilated cardiomyopathy worldwide. Viral infection is also an important cause of myocarditis, and the spectrum of viruses known to cause myocarditis has changed in the past 2 decades. Several new diagnostic methods, such as cardiac magnetic resonance imaging, are useful for diagnosing myocarditis. Endomyocardial biopsy may be used for patients with acute dilated cardiomyopathy associated with hemodynamic compromise, those with life-threatening arrhythmia, and those whose condition does not respond to conventional supportive therapy. Important prognostic variables include the degree of left and right ventricular dysfunction, heart block, and specific histopathological forms of myocarditis. We review diagnostic and therapeutic strategies for the treatment of viral myocarditis. English-language publications in PubMed and references from relevant articles published between January 1, 1985, and August 5, 2008, were analyzed. Main keywords searched were myocarditis, dilated cardiomyopathy, endomyocardial biopsy, cardiac magnetic resonance imaging, and immunotherapy.
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Affiliation(s)
- Jason C. Schultz
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN. Dr Schultz is now with the University of Minnesota, Minneapolis
| | - Anthony A. Hilliard
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN. Dr Schultz is now with the University of Minnesota, Minneapolis
| | - Leslie T. Cooper
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN. Dr Schultz is now with the University of Minnesota, Minneapolis
| | - Charanjit S. Rihal
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN. Dr Schultz is now with the University of Minnesota, Minneapolis
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Hilliard AA, Nishimura RA. The Interventional Cardiologist and Structural Heart Disease. JACC Cardiovasc Imaging 2009; 2:8-10. [DOI: 10.1016/j.jcmg.2008.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Accepted: 08/17/2008] [Indexed: 10/21/2022]
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Hilliard AA, Miller TD, Hodge DO, Gibbons RJ. Heart rate control in patients with atrial fibrillation referred for exercise testing. Am J Cardiol 2008; 102:704-8. [PMID: 18773992 DOI: 10.1016/j.amjcard.2008.04.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2008] [Revised: 04/26/2008] [Accepted: 04/26/2008] [Indexed: 11/26/2022]
Abstract
Clinical practice guidelines for patients with atrial fibrillation (AF) recommended a heart rate (HR) of 60 to 80 beats/min at rest and 90 to 115 at moderate exercise. The degree to which HR control at rest and with exercise in patients with AF complies with these recommendations is unknown. HR at rest and at peak exercise was retrospectively examined in 1,097 consecutive patients with AF referred for exercise myocardial perfusion imaging. In a subgroup of 195 patients, HR was also measured at an intermediate "moderate" level. Median HR at rest was 80 beats/min, at the upper end of the recommended range of 60 to 80. Only patients administered a beta blocker (BB; 31%) had lower (p <0.001) median HRs at rest. Median HR at moderate exercise was 128 beats/min, higher than the range of 90 to 115 recommended by the guidelines. Only patients administered a BB had significantly reduced HRs (p <0.003) at moderate exercise. Median peak exercise HR was 147 beats/min. Forty-five percent of patients exceeded their age-predicted maximal HR. Patients administered BBs were significantly less likely (p <0.01) to exceed their age-predicted maximal HR. In conclusion, in patients with AF, HR control at rest and during exercise often did not comply with guideline recommendations. Regimens including a BB were more effective in achieving HR control.
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Abstract
Hypertension is an important public health problem affecting more than 50 million individuals in the US alone. The most common form, essential hypertension, results from the complex interplay between genetic predisposition and environmental influences. In contrast, monogenic (mendelian) forms of hypertension are caused by single gene mutations that are influenced little, if at all, by environmental factors. Most monogenic forms of hypertension affect either electrolyte transport in the distal nephron, or the synthesis or activity of mineralocorticoid hormones, leading to the common pathogenic mechanisms of increased distal tubular reabsorption of sodium and chloride, volume expansion and hypertension. In young patients with a family history of hypertension who present with severe or refractory hypertension and characteristic hormonal and biochemical abnormalities, the differential diagnosis should include monogenic forms of hypertension. Genetic testing, which is increasingly available, can facilitate timely diagnosis and treatment of these relatively uncommon disorders, such that the underlying defect can be corrected or ameliorated and the long-term consequences of poorly controlled hypertension prevented.
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Affiliation(s)
- Vesna D Garovic
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Affiliation(s)
- Anthony A Hilliard
- Department of Medicine, Mayo Clinic and Foundation, Rochester, Minn, USA
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