Systemic hypertension following myocardial revascularization

Estafanous, Fawzy G.; Tarazi, Robert C.; Viljoen, John F.; Tawil, Michael

doi:10.1016/0002-8703(73)90424-9

Cited by 144 publications

(47 citation statements)

References 9 publications

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“…*' 10 The hypertension noted in our study bore many similarities to that previously reported by other investigators; it occurred within the first few hours following surgery, appeared to result from an increase in peripheral vascular resistance," 1 '• '• n and was normalized by administration of intravenous sodium nitroprusside. 4 -7> 10> 1J However, in contrast to the findings of Roberts et al 7 and Fouad et al, u our findings showed that hypertension was associated with a significant fall in SV and CI and an increase in LVSWI. The importance of these observations is uncertain since concomitant measurements of PCWP were unchanged from control values and within the normal range.…”

Section: Discussioncontrasting

confidence: 85%

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Hypertension following coronary artery bypass surgery. Role of preoperative propranolol therapy.

Flaherty¹,

MacAllister²,

Watkins³

et al. 1980

Hypertension

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SUMMARY Over a 9-month period, the incidence and characteristics of hypertension followtng coronary artery bypass surgery were studied in a group of 52 patients. Hypertension occurred in 61% of the patients and was characterized by an increase in arterial blood pressure of 35 ± 2 mm Hg mean ± SEM during the early postoperative period. Preoperative blood pressures and hemodynamk variables were similar in those who developed hypertension and those who remained normotenshe. Ninety-four percent of those who developed hypertension as compared to only 40% of those who remained normotensive received propranolol during the 24 hours preceding surgery (x 1 = 15.4; p < 0.001). Maximal blood pressures during the first 5 hours following the termination of cardiopulmonary bypass were significantly positively correlated with preoperative propranolol dosage (p < 0.01). Hypertension was not associated with significant changes in plasma renin activity or angiotensin II levels, but concomitant plasma catecholamine concentrations were elevated significantly (p < 0.005). However, a similar rise in plasma catecholamine concentrations was found in those who remained normotensive. Hypertension was associated with an increase in systemic vascular resistance (p < 0.001) and left ventricular stroke work index [p < 0.05), and a fall in stroke volume (p < 0.005) and cardiac index (p < 0.001). These studies suggest that hypertension following coronary artery bypass surgery is common, results from an increase in systemic vascular resistance, is not renin-angiotensin mediated, and may, in part, be related to preoperative propranolol administration. (Hypertension 2: 291-298, 1980) KEY WORDS • hypertension • coronary artery bypass surgery • renin activity catecholamine • hemodynamics D URING a 3-month period from March to May, 1977, more than 70% of patients undergoing coronary artery bypass surgery at The Johns Hopkins Hospital experienced vasomotor instability within the first 24 hours following revascularization. While hypotension requiring the administration of vasopressor agents was occasionally noted, the more common problem was that of hypertension. Since the incidence and severity of postoperative hypertension noted in this group was both surprising and disturbing, the circumstances surrounding the development of hypertension were carefully examined. In particular, we were anxious to define the hypertensive patients' clinical characteristics and to assess the roles of the sympathetic and renin-angiotensin systems in the genesis of this form of hypertension.

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Section: Discussioncontrasting

confidence: 85%

“…Since the original report of Estafanous et al 4 in 1973, it has become increasingly clear that hypertension may occur following coronary revascularization procedures. Indeed, this constitutes one of the most frequent complications following this form of surgery; it has been reported to occur in 33% to 76% of patients.…”

Section: Discussionmentioning

confidence: 99%

Hypertension following coronary artery bypass surgery. Role of preoperative propranolol therapy.

Flaherty¹,

MacAllister²,

Watkins³

et al. 1980

Hypertension

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“…Tarazi's group (Estafanous et al 62 ) interpreted the arterial hypertension immediately after myocardial revascularization by coronary bypass surgery as resulting from a sympathetic reflex elicited by coronary artery distension. 8 In fact, Tarazi et al 63 found that unilateral stellate ganglion block led to rapid and sustained control of arterial pressure in 18 of 27 patients in whom a successful lidocaine infiltration was achieved.…”

Section: Testing the Hypothesismentioning

confidence: 99%

Emerging Excitatory Role of Cardiovascular Sympathetic Afferents in Pathophysiological Conditions

Malliani¹,

Montano²

2002

Hypertension

136

119

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Abstract-There is sound experimental evidence that cardiovascular sympathetic afferent fibers mediate cardiovascular reflexes largely excitatory in nature with positive-feedback characteristics. This afferent neural channel is likely to normally participate in the neural regulation of cardiovascular function. The hypothesis, which is the core of this article, is that in some pathophysiological conditions, sympathetic overactivity may be partly due to an emerging excitatory reflex action of cardiovascular sympathetic afferents. In fact, the early phase of congestive heart failure can be characterized by an increase in arterial pressure and heart rate and/or by a diastolic dysfunction, leaving unchanged the cardiac output; in these conditions, in which no baroreceptor deactivation should occur, it is possible that cardiovascular sympathetic afferents with sensory endings in the thoracic low-pressure areas, highly responsive to volume loading, are responsible for mediating the reflex sympathetic excitation. Similarly, during acute myocardial infarction, ventricular sympathetic afferents are likely to mediate a reflex sympathetic overactivity, which is known to facilitate sudden death. Finally, numerous reports have described in essential arterial hypertension an increased sympathetic activity that may be due, at least in part, to the reinforcing action of sympathosympathetic reflexes. Thus, in pathophysiological conditions, cardiovascular sympathetic afferents would mediate a reflex sympathetic overactivity independently of baroreceptive mechanisms, and such an absence of a homeostatic purpose would provide a better rationale for some beneficial effects of therapeutic correction. Key Words: heart failure Ⅲ ischemia Ⅲ hypertension, arterial Ⅲ heart rate Ⅲ reflex Ⅲ lung T he present article will attempt to support the hypothesis that in the early phase of congestive heart failure and other pathophysiological conditions, such as myocardial ischemia and arterial hypertension, sympathetic excitation seems devoid of an ultimate homeostatic purpose, and its genesis may be, in part, attributable to an enhanced peripheral excitatory function of sympathetic afferent fibers.In physiological conditions, the cardiovascular neural regulation is likely to result from a complex interaction of central integration and peripheral inhibitory and excitatory reflexes. [1][2][3] In this interplay, cardiovascular sympathetic afferent fibers mediate a reflex action that is largely excitatory in nature 1 (Figure). When a sympathetic excitation is part of an integrated physiological pattern with a clear ultimate purpose, such as emotion, the central neural and, in particular, diencephalic mechanisms 4 are likely to play a predominant role. However, the central command is also likely to be reinforced by a synergistic enhancement of peripheral excitatory reflex mechanisms, accompanied by a simultaneous attenuation of mechanisms exerting an inhibitory action. 3,4

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“…A non-pulsatile pump was used during CPB despite earlier reports that this might encourage the development of hypertension 14 and stimulate renin release. 15 These findings were not confirmed by Salerno et al) 6 but their patients received greater beta blockade_…”

Section: Discussionmentioning

confidence: 85%