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A Contemporary Review of Hypertension

Hypertension is a common and serious condition that contributes to an estimated 40% of deaths from coronary heart disease and stroke, and is the second leading cause of end-stage renal disease. Because of the importance and frequency of hypertension in primary care practices, we are devoting two issues to the subject. This issue focuses on the definition of blood pressure and current guidelines, risk factors, relationship to cardiovascular disease, blood pressure measurement, patient evaluation, and secondary causes. The next issue will cover treatments (pharmacological and non-pharmacological), initial therapy, relationship to various disease conditions (diabetes, ischemic heart disease, heart failure, chronic kidney disease, cerebrovascular disease, ischemic stroke, stroke prevention, atrial fibrillation, valvular heart disease, aortic regurgitation, sexual dysfunction), resistant hypertension, hypertensive crises and emergencies, preoperative management, and adherence strategies.

Anticoagulation Management After Intracerebral Hemorrhage in Mechanical Heart Valve Patients

An observational study of patients with mechanical heart valves on oral anticoagulants who had an intracranial hemorrhage demonstrates that it generally is safe to resume anticoagulants after 14 days. However, in high-risk-for-thromboembolism patients, such as those with atrial fibrillation, restarting anticoagulants six to 13 days postoperative may be considered.

When Can Surgeons Perform Aortic Valve Replacement Safely After a Stroke?

Interrogation of Danish administrative registry data demonstrated that a stroke within three to four months of aortic valve surgery was associated with a higher rate of perioperative stroke.

Tailored Anticoagulation for Paroxysmal Atrial Fibrillation

Intermittent anticoagulation guided by continuous assessment of arrhythmia status in patients with low-to-moderate risk did not result in any strokes or thromboembolic events over a relatively short follow-up period. Such a strategy may be an alternative to chronic anticoagulation but requires further study.

Invasive Procedures and the Risk of Infective Endocarditis

This large study suggests that several invasive, nondental medical procedures may be triggers for subsequent infective endocarditis, reopening the debate regarding prevention and management.

Choosing a Vasopressor in Cardiogenic Shock: Is There a Difference?

When studying cardiogenic shock after acute myocardial infarction, these investigators found using epinephrine compared to norepinephrine produced similar effects on blood pressure and cardiac index, but resulted in a higher incidence of refractory cardiogenic shock.

Are In-hospital Deaths Related to Community-acquired Pneumonia Preventable?

This secondary analysis of data from five tertiary care centers found that among patients hospitalized for community-acquired pneumonia, very few deaths potentially were related to a lapse in in-hospital quality of pneumonia care.

Neighborhood Socioeconomic Status Associated With Infection Risk, But Not Sepsis

Based on a large, national, prospective cohort study, lower neighborhood socioeconomic status was associated with a higher incidence of hospitalizations for infection (but not sepsis) at presentation.

Post-intensive Care Syndrome: What Happens After the ICU?

The number of ICU patients admitted annually continues to grow, with most recent estimates reaching 5.7 million. As there are growing numbers of critically ill patients, sepsis survivorship also has grown as a substantial public health concern, with a significant number of survivors diagnosed with post-intensive care syndrome (PICS). It is important to go beyond saving lives in the ICU and devote additional time and attention to preventing and treating the psychiatric, cognitive, and physical sequalae of ICU illness in the follow-up setting.

Avatrombopag Tablets (Doptelet)

Doptelet is prescribed for adults with thrombocytopenia and chronic liver disease who are scheduled to undergo a medical procedure.