Robert Bloomfield

Plasma Volume in Resistant Hypertension: Guide to Pathophysiology and Therapy

It might be expected that the tremendous increase in available antihypertensives would eliminate resistant hypertension by allowing many alternatives to its treatment. In spite of this, resistant hypertension remains a common problem due, the authors feel, to a poor understanding of the pathophysiology of this condition, particularly an understanding of whether plasma volume expansion mediates resistance to antihypertensive therapy. The authors evaluated the status of plasma volume as a major determinant of response to therapy in nine patients with resistant hypertension. Measuring plasma volume using I125 radiolabeled albumin, they found eight patients with elevated plasma volumes and one patient with a contracted plasma volume at the time of presentation with resistant hypertension. In all eight patients with plasma volume expansion, aggressive diuretic therapy allowed goal blood pressure to be achieved. The patient with plasma volume contraction achieved goal blood pressure with vasodilator therapy. Plasma volume expansion is common in resistant hypertension and it mediates resistance to therapy. Measurement of plasma volume gives the clinician important insight into the pathophysiology of resistant hypertension and increases the likelihood of successful management of the resistant hypertensive patient.

Cavernous hemangioma of the retina, cutaneous angiomas, and intracranial vascular lesion by computed tomography and nuclear magnetic resonance imaging.

In a 32-year-old man with a right-sided retinal cavernous hemangioma and cutaneous angiomas, computed tomography and nuclear magnetic resonance imaging confirmed the presence of cerebrovascular lesions. This supports the inclusion of cavernous hemangioma of the retina in the established group of neuro-oculo-cutaneous phacomatoses.

Blood pressure and renal function in type 2 diabetes mellitus

Source Citation Ravid M, Savin H, Lang R, et al. Proteinuria, renal impairment, metabolic control, and blood pressure in type 2 diabetes mellitus. A 14-year follow-up report on 195 patients. Arch I...

Fasting plasma glucose was a good test to screen for non-insulin-dependent diabetes mellitus in older adults

Source Citation Blunt BA, Barrett-Connor E, Wingard DL. Evaluation of fasting plasma glucose as screening test for NIDDM in older adults. Rancho Bernardo Study. Diabetes Care. 1991 Nov;14:989-93.

Venous blood glucose determination was more accurate than fingerstick glucose in hypotension

Source Citation Atkin SH, Dasmahapatra A, Jaker MA, Chorost MI, Reddy S. Fingerstick glucose determination in shock. Ann Intern Med. 1991 Jun 15;114:1020-4.

Diuretic therapy for hypertension was associated with increased mortality in patients with diabetes

Source Citation Warram JH, Laffel LM, Valsania P, Christlieb AR, Krolewski AS. Excess mortality associated with diuretic therapy in diabetes mellitus. Arch Intern Med. 1991 Jul;151:1350-6.