The Netherlands journal of medicine
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Hypertension (HT) is a chronic condition associated with serious complications. In the present cross-sectional study, we aimed to analyse factors that contribute to blood pressure control in subjects with HT. ⋯ We suggest that, in addition to dietary and exercise recommendations and smoking cessation, treatment with combination therapy could be better in reaching blood pressure targets in patients with HT.
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Clinical management of renal artery stenosis has seen a major shift, after randomised clinical trials have shown no group benefit of endovascular intervention relative to optimal medical control. However, the inclusion criteria of these trials have been criticised for focusing on a subset of patients with atherosclerotic renal artery stenosis where intervention was unlikely to be beneficial. ⋯ This review addresses the challenges associated with clinical decision making in patients with renal artery stenosis. Opportunities for novel diagnostic techniques to improve patient selection are discussed, along with ongoing Dutch studies and network initiatives that investigate these strategies.
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A 28-year-old female patient was admitted to our hospital with severe dyspnoea and hypoxemia due to methaemoglobinaemia caused by dapsone. The patient recovered completely after repeated infusions of methylene blue and cessation of dapsone. However, 12 days after cessation of dapsone, the patient was readmitted due to recurrence of symptoms based on a relapse of methaemoglobinaemia. ⋯ In addition to supportive care, treatment consisted of methylene blue; furthermore, cimetidine and ascorbic acid were added. An overview of the pathophysiology, diagnostics, treatment, and possible explanations for this relapse of methaemoglobinaemia caused by dapsone are given. This case shows the importance of considering the possibility of a late rebound methaemoglobinaemia after discontinuation of dapsone.