Journal of Hypertension: Open Access

A young female was evaluated in the emergency department (ED) for persistent headache and fatigue one week after being started on antihypertensive therapy with poor response. Her medications were Amlodipine 10 mg daily, Hydrochlorothiazide 25 mg daily, Atenolol 100 mg daily and Hydralazine 50 mg three times daily. Further evaluation revealed cushingoid appearance, her blood pressure was 171/100 mmHg despite compliance with multiple antihypertensive therapy. Her clinical manisfestation prompted the evaluation for secondary causes of hypertension with laboratory evidence of hypokalemia, hyperglycemia, hypercortisolism with high ACTH that did not respond to low and high dose dexamethasone suppression. A splice mutation in MEN 1gene was found with the eventual diagnosis of metastatic pancreatic neuroendocrine tumor. Her turbulent course unravels how complex medical problems continue to masquerade as general medical ailments.

Objective: To construct a new predictive model and scoring system for hypertensive disorder complicating pregnancy by using a combination of simple clinical variables that can easily be obtained at antenatal visit, and evaluate its clinical diagnostic value.

Study design: Included in this study were 2,466 nulliparous pregnant women at the gestational age of 16~20 weeks who came to our hospital for the first antenatal visit between 2011 and 2013. They were classified as a derivation cohort (n=1,421) and a validation cohort (n=1,045). A predictive model was developed from a logistic regression model, scoring system was developed by using the regression coefficients obtained from the new model and then internally and externally validated.

Results: The predictive model comprised 8 variables: body mass index (BMI), mean arterial pressure (MAP), drinking history, gestational diabetes, occupational physical activity, family history of hypertension, platelet count (PLT) and uric acid (UA), with a scoring system ranging from 0 to 13. The risk of HDCP in participants with low-risk (≤ 4 scores) or high-risk (>4 scores) in the validation cohort was 4.5% and 24.4% respectively (P<0.001), indicating that the predictive model had good discrimination (area under the receiver operating characteristic curve = 0.783), 95% confidence interval (0.746, 0.820) and calibration (P=0.745). The sensitivity and specificity were 76.6% and 67.7% respectively.

Conclusion: We have developed and validated a new predictive model comprising 8 variables: BMI, MAP, drinking history, gestational diabetes, occupational physical activity, family history of hypertension, PLT and UA. Due to cost/ effectiveness and cost/utility, the new model can be applied to clinical screening of HDCP.

Our aim was to determine whether the prevalence of Primary Aldosteronism (PA) in a referral hypertensive population is high enough to warrant routine screening for PA amongst unselected hypertensive’s in general practice. A retrospective clinical audit was conducted on 635 patients referred for specialist hypertension review, over a period of 33 months (March 2009 till December 2011).

We found a PA prevalence of (confirmed or probable) in 8/635 referred patients (1.25%) which is lower that the previously reported prevalence. Among the 178 patients who at discharge had met the JNC-7 criteria for resistant hypertension the prevalence was 4.5% (8/178). All the PA cases met the criteria for resistant hypertension, and in addition, all had unprovoked hypokalaemia.

We conclude that in our population, routine screening for PA amongst hypertensive individuals in general practice cannot be justified, and that even in a specialist hypertension clinic population investigation should likely be reserved for those with a combination of resistant hypertension and unprovoked hypokalaemia.

The fermented soybean product natto is a popular traditional food in Japan and is considered a health supplement. To investigate the effect of supplements derived from natto on blood pressure in patients with lifestyle diseases, a cross-over, double-blind study was performed. The substances used were fermented soya (natto) extract and NKCP®, with main components of subtilisin NAT and bacillopeptidase F, respectively. A four-week course of NKCP® significantly decreased average systolic blood pressure from 130.9 to 120.5 mmHg (p=0.001) and diastolic blood pressure from 72.9 to 68.6 mmHg (p=0.024). However, after a four-week treatment with fermented soya (natto) extract, no significant changes in systolic or diastolic blood pressure were found (126.8 to 126.4 mmHg, and 70.9 to 68.3 mmHg, respectively). The difference in the effect on blood pressure between these two substances is considered as owing to the differences of the in vitro experimental results on blood fluidity. The use of dietary supplements, especially NKCP®, from natto provides additional blood pressure lowering effects in patients already receiving medical care.