Polskie Archiwum Medycyny Wewnętrznej
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Resistant hypertension is defined as not achieving sufficient control of blood pressure (BP), that is, maintaining BP values equal to or above 140/90 mm Hg when using 3 antihypertensive drugs, including diuretics, properly combined and at maximum doses. The uncontrolled treated hypertension should be confirmed in out‑of‑office BP measurements, preferably with 24‑hour ambulatory BP monitoring. Demographic and clinical characteristics indicate that patients with resistant hypertension are older than the general population of patients with arterial hypertension and more often suffer from comorbidities. ⋯ An important step in management of resistant hypertension is targeted screening with diagnostic tests for secondary hypertension. Expanding of the drug therapy beyond a 3‑drug regimen should include a mineralocorticoid receptor antagonist, in particular spironolactone. In selected patients, device‑based hypertension treatment might be considered.
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Pol. Arch. Med. Wewn. · Dec 2023
Randomized Controlled TrialThe diuretic, natriuretic and chloride-regaining effects of oral acetazolamide as an add-on therapy for acute heart failure with volume overload. A single center, prospective, randomized study.
Decongestion is a therapeutic target in acute heart failure (AHF). Acetazolamide is a diuretic that decreases proximal tubular sodium reabsorption, and may also reverse hypochloremia Objectives: We assessed the decongestive, natriuretic, and chloride‑regaining effects as well as the renal safety profile of oral acetazolamide (250 mg) used as an add‑on therapy in patients with AHF. ⋯ Oral acetazolamide seems to be a valuable add‑on therapy that helps achieve comprehensive decongestion in patients with AHF.
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Pol. Arch. Med. Wewn. · Dec 2023
Permanent single chamber atrial pacing: obsolete or a viable alternative to dual-chamber in selected patients with sinus node disease?
Single atrial stimulation (AAI) has been commonly used for permanent pacing in sick sinus syndrome and significant bradycardia. ⋯ The reliability of AAI pacing decreases with each year of observation due to development of AF and AVB. However, in the current era of effective AF treatment, the advantages of AAI pacemakers, such as lower incidence of lead malfunction, venous occlusion, and infection, as compared with dual-chamber pacemakers, may make AAI pacemakers a viable option.