BACKGROUND: The use of ambulatory blood pressure monitoring (ABPM) in childhood hypertension has been in great advance. ABPM has been able to detect significantly high blood pressure (BP) and also helpful for identifying white coat hypertension. METHODS: Between March 2007 and December 2009, we evaluated individuals aged from 7 to 19 years who were referred as high BP with ABPM, echocardiogram, and abdominal computerized tomography, calculation of body mass index (BMI) at Ajou University Hospital. ABPM was performed using the Tonoport V monitors and SpaceLab 90217 monitors. Seventy were evaluated with 55 boys and 5 girls. The mean age of them was 13.1 +/- 2.8 years (mean +/- standard deviation). RESULTS: Forty of seventy (57.1%) were diagnosed as hypertension in ABPM and 8 of 40 were diagnosed as secondary hypertension with underline diseases such as hyperthyroidism, chronic renal disease, Takayasu's arteritis, coarctation of aorta. The mean BMI in 40 was 24.8 +/- 4.72 kg/m2. Twenty-three of seventy (32.8%) were obese with higher prevalence than in general population. White coat hypertension was diagnosed in 30 of 70 (42.9%). CONCLUSIONS: ABPM could provide more detailed data including mean values of BP, load, and night dip in assessment of children's BP. According to increasing children's obesity, use of ABPM was thought to be necessary for evaluation of their risk of hypertension and useful for diagnosis of masked hypertension and white coat hypertension. Further more study of ABPM in children and adolescents would be needed for absolute standards of ABPM.
Adolescent ; Aged ; Aortic Coarctation ; Blood Pressure Monitoring, Ambulatory ; Body Mass Index ; Child ; Humans ; Hypertension ; Hyperthyroidism ; Masked Hypertension ; Obesity ; Prevalence ; Renal Insufficiency, Chronic ; Takayasu Arteritis ; White Coat Hypertension

Renal artery embolism is an uncommon event, but a correct diagnosis and appropriate treatment are often delayed. We report a case in which viability was sustained by surgical intervention 18 hours after an episode of embolism that produced hypertension.
Diagnosis ; Embolism* ; Hypertension ; Hypertension, Renovascular* ; Renal Artery*

Renal hypertension is found to be the cause in 5-15ft of patients with hypertension, and may be vascular or parenchymal in nature. Renal studies in diagnostic technique and vascular reconstructive techniques now enable successful management in many patients with renal hypertension. We experienced one case of renovascular hypertension due to renal vein hypoplasia. This rare renal venous hypertension has been diagnosed preoperatively and can be cured by nephrectomy, so we reported this case with brief review of the literature.
Humans ; Hypertension ; Hypertension, Renal ; Hypertension, Renovascular* ; Nephrectomy ; Renal Veins*

Renal artery stenosis (RAS) is defined as a narrowing of main renal artery or its major branches over 50%, and can be the cause of pulmonary edema, renal failure, malignant hypertension and cerebrovascular diseases. The renin-angiotensin-aldosterone system works as a key role. In this paper, we report a case of a 53 year-old patient with left middle cerebellar peduncle infarction, who showed malignant hypertension and RAS. The RAS was diagnosed by renal artery computed tomography angiography and treated with renal artery angioplasty, stenting and antihypertensive medication. In a young patient with ischemic stroke who has refractory hypertension against antihypertensive medications, RAS should be suspected and evaluated.
Angiography ; Angioplasty ; Cerebral Infarction ; Humans ; Hypertension ; Hypertension, Malignant ; Hypertension, Renovascular ; Infarction ; Pulmonary Edema ; Renal Artery ; Renal Artery Obstruction ; Renal Insufficiency ; Renin-Angiotensin System ; Stents ; Stroke

The renal manifestations of systemic sclerosis include proteinuria, hypertension, azotemia, and renal crisis. Two types of scleroderma renal crisis (SRC) are recognized. Typical SRC is a syndrome consisting of acute-onset malignant hypertension accompanied by rapidly progressive renal failure, hypertensive retinopathy, and elevated plasma renin activity. The other type is normotensive renal failure, which is generally accompanied by antineutrophil cytoplasmic autoantibody (ANCA)-positive crescentic glomerulonephritis. A 51-year-old woman with scleroderma without marked dermatological change developed ANCA-related renal failure. She had neither malignant hypertension nor an elevated plasma rennin concentration. Renal biopsy showed crescentic glomerulonephritis (pauci-immune type), and the myeloperoxidase-specific ANCA (MPO-ANCA) titer was elevated at 1015 AAU. She was cured using steroid pulse therapy, combined with an angiotensin-converting-enzyme inhibitor and angiotensin-II receptor blocker
Antibodies, Antineutrophil Cytoplasmic ; Azotemia ; Biopsy ; Chymosin ; Cytoplasm ; Female ; Glomerulonephritis ; Humans ; Hypertension ; Hypertension, Malignant ; Hypertensive Retinopathy ; Isonipecotic Acids ; Middle Aged ; Plasma ; Proteinuria ; Renal Insufficiency ; Renin ; Scleroderma, Systemic

Atherosclerotic renovascular hypertension is a form of secondary hypertension due to renal artery stenosis. After the introduction of medical therapy such as with statins and angiotensin blocking agents, it has been considered a very slowly progressive disease. In the 1990s, surgical methods were compared to radiological intervention and showed no additional benefits. Recent clinical data also demonstrate that in cases of relatively stable atherosclerotic renovascular disease, medical therapy is as effective as other interventions with regard to patient outcomes. In this paper the recent clinical outcomes are reviewed.
Angiotensins ; Atherosclerosis ; Humans ; Hypertension ; Hypertension, Renovascular ; Renal Artery Obstruction

No abstract available.
Aneurysm* ; Arteriovenous Fistula* ; Hypertension, Renovascular* ; Renal Artery*

BACKGROUND AND OBJECTIVES: Blood pressure variability (BPV) was recently shown to be a risk factor of stroke. White coat hypertension (WCH) used to be regarded as innocuous, but one long-term follow-up study reported that WCH increased stroke rate compared to normotension (NT). In this study, we aimed to evaluate the relationship between WCH and BPV. SUBJECTS AND METHODS: We analyzed 1398 subjects from the Korean Ambulatory Blood Pressure Registry, who were divided into NT (n=364), masked hypertension (n=122), white coat hypertension (n=254), and sustained hypertension (n=658) groups. RESULTS: Baseline characteristics were similar among groups. The average real variability (ARV), a highly sensitive BPV parameter, was highest in the WCH group, followed by the sustained hypertension, masked hypertension, and NT groups. The results persisted after being adjusted for covariates. The WCH vs. sustained hypertension results (adjusted mean±standard error) were as follows: 24-h systolic ARV, 22.9±0.8 vs. 19.4±0.6; 24-h diastolic ARV, 16.8±0.6 vs. 14.3±0.5; daytime systolic ARV, 21.8±0.8 vs. 16.8±0.6; and daytime diastolic ARV, 16.2±0.6 vs. 13.4±0.5 (p<0.001 for all comparisons). CONCLUSION: From the registry data, we found that subjects with WCH or masked hypertension had higher BPV than NT. However, long-term follow-up data assessing the clinical influences of WCH on stroke are needed.
Blood Pressure Monitoring, Ambulatory* ; Blood Pressure* ; Follow-Up Studies ; Hypertension ; Masked Hypertension ; Risk Factors ; Stroke ; White Coat Hypertension*

BACKGROUND: Many studies have aimed to determine whether body mass index (BMI), waist circumference (WC), or waist to hip ratio (WHR) best predicts hypertension in diabetic patients, with conflicting results. However, no study has examined the specific relationship between these anthropometric parameters with sustained normotension (SNT), white coat hypertension (WCHT), masked hypertension (MHT), and sustained hypertension (SHT) based on office and ambulatory blood pressure (BP) measurements in these patients. METHODS: Patients with newly diagnosed type 2 diabetes underwent the following procedures: history taking, measurements of anthropometric parameters, office and ambulatory BP measurements, physical examination, laboratory analysis, and random and 24-hour urine analysis. RESULTS: In total, there were 65 dippers and 37 nondipper patients. None of the anthropometric parameters were different between the dippers and the nondippers. There were 25 patients with SNT, 32 with WCHT, seven with MHT, and 38 with SHT. A comparison of anthropometric parameters between these four groups of patients showed that WC (P=0.016) and WHR (P=0.015) were different among all groups. According to regression analysis, only BMI was independently related with MHT (odds ratio [OR], 1.373, P=0.022), whereas only WC has been associated with SHT (OR, 1.321, P=0.041). CONCLUSION: Among anthropometric parameters, only WC and WHR were different in SNT, WCHT, MHT, and SHT in newly diagnosed patients with type 2 diabetes.
Blood Pressure ; Body Mass Index ; Humans ; Hypertension ; Masked Hypertension ; Masks ; Physical Examination ; Waist Circumference ; Waist-Hip Ratio ; White Coat Hypertension

This review represents the clinical significance of home blood pressure (BP) and its possible practical application. Home BP is highly reproducible and its reproducibility is better than ambulatory BP. According to this feature home BP has a greater prognostic value at least than clinic BP and is extremely effective for the evaluation of drug effects and their duration. The introduction of home BP to the diagnosis and treatment of hypertension facilitates long-term BP control. Home BP is particularly important for the diagnosis and treatment of hypertension in diabetes mellitus, pregnancy, children and renal diseases. Home BP measurements improve the adherence to medications and medical consultations, and are indispensable for diagnosis of white coat hypertension and masked hypertension. Such efficiency of home BP improves medical economy. Home BP can detect minimal charge in BP mediated by medication, and intrinsic and extrinsic stimuli and detect long-term change in BP. Thus, home BP is now indispensable for improvement in the management of hypertension in medical practice as well as for the recognition of hypertension in the general population. Standardization of the measurement procedure may elevate the position of home BP in the practice of diagnosing and treating hypertension.
Blood Pressure ; Child ; Diabetes Mellitus ; Fees and Charges ; Humans ; Hypertension ; Masked Hypertension ; Pharmacology, Clinical ; Pregnancy ; Referral and Consultation ; White Coat Hypertension