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  • 1
    Electronic Resource
    Electronic Resource
    The anatomy and blood system of the kidney in the river lamprey, Lampetra fluviatilis (1980)
    Springer
    Anatomy and embryology 158 (1980), S. 245-252 
    Details
    ISSN: 1432-0568
    Keywords: Kidney ; Lamprey ; Vasculature ; Nephron ; Microanatomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The anatomy and blood system of the kidney in the river lamprey, Lampetra fluviatilis, was studied after injecting microfil into nephrons or the arterial system. Renal arteries arose at irregular intervals from the dorsal aorta and gave rise to a regular arrangement of afferent arterioles supplying the network of glomerular capillaries. Nephron units were arranged in two longitudinal series on each side of the glomerular capillaries, with the capsule of each nephron closely related to the capillary network. A short neck segment lead into the convoluted proximal segment, which accounted for over half the length of each nephron and was surrounded by a network of capillaries and sinusoids supplied by efferent glomerular arterioles. The end of each proximal segment formed the descending limb of a nephron loop, which lay parallel to the ascending distal limb and the end of each collecting duct. Peritubular blood flow in this region was generally opposite the flow of tubular fluid and blood eventually drained into large thin-walled sinuses connected to the post-cardinal vein.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00315909
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    Paper (German National Licenses)
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  • 2
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    The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study): Is Severe Hypertension Just an Elevated Blood Pressure? [Clinical Trial: CHIPS] (2016)
    American Heart Association (AHA)
    Details
    Publication Date: 2016-10-13
    Description: To determine whether clinical outcomes differed by occurrence of severe hypertension in the international CHIPS trial (Control of Hypertension in Pregnancy Study), adjusting for the interventions of "less tight" (target diastolic blood pressure [dBP] 100 mm Hg) versus "tight" control (target dBP 85 mm Hg). In this post-hoc analysis of CHIPS data from 987 women with nonsevere nonproteinuric preexisting or gestational hypertension, mixed effects logistic regression was used to compare the following outcomes according to occurrence of severe hypertension, adjusting for allocated group and the influence of baseline factors: CHIPS primary (perinatal loss or high-level neonatal care for 〉48 hours) and secondary outcomes (serious maternal complications), birth weight 〈10th percentile, preeclampsia, delivery at 〈34 or 〈37 weeks, platelets 〈100 x 10 9 /L, elevated liver enzymes with symptoms, maternal length of stay ≥10 days, and maternal readmission before 6 weeks postpartum. Three hundred and thirty-four (34.1%) women in CHIPS developed severe hypertension that was associated with all outcomes examined except for maternal readmission ( P =0.20): CHIPS primary outcome, birth weight 〈10th percentile, preeclampsia, preterm delivery, elevated liver enzymes (all P 〈0.001), platelets 〈100 x 10 9 /L ( P =0.006), and prolonged hospital stay ( P =0.03). The association between severe hypertension and serious maternal complications was seen only in less tight control ( P =0.02). Adjustment for preeclampsia (464, 47.3%) did not negate the relationship between severe hypertension and the CHIPS primary outcome ( P 〈0.001), birth weight 〈10th percentile ( P =0.005), delivery at 〈37 ( P 〈0.001) or 〈34 weeks ( P 〈0.001), or elevated liver enzymes with symptoms ( P =0.02). Severe hypertension is a risk marker for adverse maternal and perinatal outcomes, independent of BP control or preeclampsia co-occurrence. Clinical Trial Registration— URL: http://pre-empt.cfri.ca/ . Unique identifier: ISRCTN 71416914. URL: https://www.clinicaltrials.gov/ . Unique identifier: NCT01192412.
    Keywords: High Blood Pressure, Hypertension
    Print ISSN: 0194-911X
    Topics: Medicine
    Published by American Heart Association (AHA)
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  • 3
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    Community Hypertension Programs in the Age of Mobile Technology and Social Media (2014)
    Oxford University Press
    Details
    Publication Date: 2014-08-08
    Print ISSN: 0895-7061
    Electronic ISSN: 1879-1905
    Topics: Medicine
    Published by Oxford University Press
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  • 4
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    The Cost Implications of Less Tight Versus Tight Control of Hypertension in Pregnancy (CHIPS Trial) [Arterial Stiffness] (2016)
    American Heart Association (AHA)
    Details
    Publication Date: 2016-09-09
    Description: The CHIPS randomized controlled trial (Control of Hypertension in Pregnancy Study) found no difference in the primary perinatal or secondary maternal outcomes between planned "less tight" (target diastolic 100 mm Hg) and "tight" (target diastolic 85 mm Hg) blood pressure management strategies among women with chronic or gestational hypertension. This study examined which of these management strategies is more or less costly from a third-party payer perspective. A total of 981 women with singleton pregnancies and nonsevere, nonproteinuric chronic or gestational hypertension were randomized at 14 to 33 weeks to less tight or tight control. Resources used were collected from 94 centers in 15 countries and costed as if the trial took place in each of 3 Canadian provinces as a cost-sensitivity analysis. Eleven hospital ward and 24 health service costs were obtained from a similar trial and provincial government health insurance schedules of medical benefits. The mean total cost per woman–infant dyad was higher in less tight versus tight control, but the difference in mean total cost (DM) was not statistically significant in any province: Ontario ($30 191.62 versus $24 469.06; DM $5723, 95% confidence interval, –$296 to $12 272; P =0.0725); British Columbia ($30 593.69 versus $24 776.51; DM $5817; 95% confidence interval, –$385 to $12 349; P =0.0725); or Alberta ($31 510.72 versus $25 510.49; DM $6000.23; 95% confidence interval, –$154 to $12 781; P =0.0637). Tight control may benefit women without increasing risk to neonates (as shown in the main CHIPS trial), without additional (and possibly lower) cost to the healthcare system. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01192412.
    Keywords: Clinical Studies, Pregnancy, Hypertension, Cost-Effectiveness, Ethics and Policy
    Print ISSN: 0194-911X
    Topics: Medicine
    Published by American Heart Association (AHA)
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  • 5
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    The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study)Novelty and Significance [Clinical Trial: CHIPS] (2016)
    American Heart Association (AHA)
    Details
    Publication Date: 2016-11-05
    Description: To determine whether clinical outcomes differed by occurrence of severe hypertension in the international CHIPS trial (Control of Hypertension in Pregnancy Study), adjusting for the interventions of “less tight” (target diastolic blood pressure [dBP] 100 mm Hg) versus “tight” control (target dBP 85 mm Hg). In this post-hoc analysis of CHIPS data from 987 women with nonsevere nonproteinuric preexisting or gestational hypertension, mixed effects logistic regression was used to compare the following outcomes according to occurrence of severe hypertension, adjusting for allocated group and the influence of baseline factors: CHIPS primary (perinatal loss or high-level neonatal care for 〉48 hours) and secondary outcomes (serious maternal complications), birth weight
    Keywords: High Blood Pressure, Hypertension
    Print ISSN: 0194-911X
    Topics: Medicine
    Published by American Heart Association (AHA)
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  • 6
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    Effect of Home Blood Pressure Telemonitoring With Self-Care Support on Uncontrolled Systolic Hypertension in Diabetics [Ambulatory Blood Pressure Monitoring] (2012)
    American Heart Association (AHA)
    Details
    Publication Date: 2012-06-14
    Description: Lowering blood pressure reduces cardiovascular risk, yet hypertension is poorly controlled in diabetic patients. In a pilot study we demonstrated that a home blood pressure telemonitoring system, which provided self-care messages on the smartphone of hypertensive diabetic patients immediately after each reading, improved blood pressure control. Messages were based on care paths defined by running averages of transmitted readings. The present study tests the system's effectiveness in a randomized, controlled trial in diabetic patients with uncontrolled systolic hypertension. Of 244 subjects screened for eligibility, 110 (45%) were randomly allocated to the intervention (n=55) or control (n=55) group, and 105 (95.5%) completed the 1-year outcome visit. In the intention-to-treat analysis, mean daytime ambulatory systolic blood pressure, the primary end point, decreased significantly only in the intervention group by 9.1±15.6 mmHg (SD; P 〈0.0001), and the mean between-group difference was 7.1±2.3 mmHg (SE; P 〈0.005). Furthermore, 51% of intervention subjects achieved the guideline recommended target of 〈130/80 mmHg compared with 31% of control subjects ( P 〈0.05). These improvements were obtained without the use of more or different antihypertensive medications or additional clinic visits to physicians. Providing self-care support did not affect anxiety but worsened depression on the Hospital Anxiety and Depression Scale (baseline, 4.1±3.76; exit, 5.2±4.30; P =0.014). This study demonstrated that home blood pressure telemonitoring combined with automated self-care support reduced the blood pressure of diabetic patients with uncontrolled systolic hypertension and improved hypertension control. Home blood pressure monitoring alone had no effect on blood pressure. Promoting patient self-care may have negative psychological effects.
    Keywords: Health policy and outcome research, Compliance/Adherence, Type 2 diabetes, Clinical Studies
    Print ISSN: 0194-911X
    Topics: Medicine
    Published by American Heart Association (AHA)
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  • 7
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    Influence of Lower Body Positive Pressure on Upper Airway Cross-Sectional Area in Drug-Resistant Hypertension [Original Articles] (2012)
    American Heart Association (AHA)
    Details
    Publication Date: 2012-12-13
    Description: We previously showed that in hypertensive patients the amount of fluid displaced from the legs overnight is directly related to the severity of obstructive sleep apnea and that the rostral fluid shift was greater in drug-resistant hypertensive patients. The findings suggested that this fluid redistribution increases upper airway collapsibility, yet more direct evidence is lacking. The present study examines the effects of graded lower body positive pressure on leg fluid volume, upper airway cross-sectional area, and neck circumference in patients with drug-resistant hypertension (n=25) and controlled hypertension (n=15). In both groups, the reduction in mean upper airway cross-sectional area and oropharyngeal junction area, assessed by acoustic pharyngometry, and the increase in neck circumference, determined by mercury strain gauge plethysmography, were related to the amount of fluid displaced from the legs ( R 2 =0.41, P 〈0.0001; R 2 =0.42, P 〈0.0001; and R 2 =0.47, P 〈0.0001, respectively). Displacement of leg fluid volume was significantly greater in patients with drug-resistant hypertension than in controlled hypertension ( P 〈0.0001), and as a consequence, the former experienced greater reductions in mean upper airway cross-sectional area and oropharyngeal junction area ( P =0.001 and P 〈0.0001, respectively). The findings support the concept that in hypertensive subjects, rostral fluid displacement may participate in the pathogenesis of obstructive sleep apnea by narrowing the upper airway and making it more susceptible to collapse during sleep. The exaggerated fluid volume displacement from the legs and upper airway response to lower body positive pressure in patients with drug-resistant hypertension provide additional evidence of an important link between drug-resistant hypertension and obstructive sleep apnea.
    Keywords: Clinical Studies
    Print ISSN: 0194-911X
    Topics: Medicine
    Published by American Heart Association (AHA)
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