Hypertension case study

Cardiovascular Effects. Two case studies were found that reported mild hypertension in humans from acute inhalation exposures to fuel oils. Mild hypertension was noted for 4 days in one of two individuals following a 1-hour exposure to JP-5 vapor while flying a small airplane (Porter 1990). Delayed mild hypertension was also noted in a man who was exposed to diesel fuel vapor for 10 days while driving a truck with a fuel injector leak (Reidenberg et al. 1964). The concentration of vapor was not reported in either study. Palpitations were noted in workers chronically exposed to jet fuel according to one epidemiological study (Knave et al. 1978). The limitations of this study are discussed in detail in Section 2.2.1.2 under Respiratory Effects. 

CASE Study Dr. Drew and the Hypertension Drug Trial... 

Case study level Mb - Hypertension-associated kidney disease... 

Case study level 3 - Pre-dialysis patient with anaemia 359 Case study level Ma - Diabetes and renal impairment 361 Case study level Mb - Hypertension-associated kidney disease 363... 

Case Conclusion According to the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) diuretics are the preferred first-line agents in patients with isolated systolic hypertension (ISH). Studies have shown significant reduction in strokes, heart attacks, and mortality with diuretics and dihydropyridine calcium channel blockers in the treatment of ISH. Because this patient has ISH and adequate renal function, a thiazide diuretic is appropriate as initial treatment. 

Cardiovascular Effects. The case of a 52-year-old woman who had been taking creosote (type and dose not specified) for 9 years to treat chronic bronchitis was reported by Robinson (1938). The woman was found to be weak, dizzy, light-headed, and hypertensive (blood pressure=206/140 mm Hg). A modified diet and diuretic therapy relieved all of these symptoms. Upon reinstitution of creosote therapy, her blood pressure rose to 235/130. The author concluded that creosote was responsible for the woman s hypertension. This study provides anecdotal evidence of creosote-induced cardiovascular effects, but the limited sample size, lack of detail on exposure, and possibility of confounding factors limit its usefulness. 

The primary objective of a Phase I trial is to assess the safety of the drug in humans. Studies are normally conducted in healthy male volunteers, although specific categories of subject may be used in certain cases. For example, to avoid the risk of low blood pressure, subjects with mild hypertension would be more appropriate for the evaluation of antihypertensive drugs, while patients are likely to be used in the case of drugs that are expected to produce significant toxic effects (e.g. anti-cancer cytotoxic drugs). Remuneration may be offered for participation in the study. The number of subjects is normally between 10 and 100 people. 

Hypertension has also been associated with lead exposure in the general population. In a case-control study of clinically defined groups, 38 male cardiovascular patients were compared with 48 matched normotensive patients (Khera et al. 1980b). The cardiovascular patients were found to have higher PbB levels (mean, 44.9 ig/dL) than the normotensive patients (mean, 29.0 pg/dL). However, this study is limited by small sample size and incomplete control of confounding factors. 

In the Chinese population, ACE genotypes associated with AD, but the ACE-I/I genotype was identified as a risk factor for AD (635), and in other Chinese studies the ACE-I/I genotype as a risk factor was restricted only in subjects with hypertension (636). In a study in the United Kingdom, the frequency of the ACE-/allele was not increased in AD, and in autopsy-confirmed AD cases, possession of the ACE-I allele had no impact on the pathology of AD, at least in terms of the amount of BAP... 

Williams RR, Feinleit M, Connor RJ, et al. Case-control study of anti-hypertensive and diuretic use by women with malignant and benign breast lesions detected in a mammography screening program. J Natl Cancer Inst 1978 61 325-7. 

Aromaa A, Hakama M, Hakulinen T, et al. Breast cancer and use of Rauwolfia and other antihypertensive agents in hypertensive patients a nationwide case-control study in Finland. Int J Cancer 1976 18 727-38. 

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