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Hypertension is a major risk factor for the development of cardiovascular disease. The prevalence of secondary hypertension, 10% is known as a common cause of resistant hypertension. Development of diagnostic technology and the aging is likely to be increased of the prevalence. Secondary hypertension, if it is not appropriate etiologic treatment may sometimes be fatal, as well as to the proper treatment be treatable or curable hypertension. Secondary causes of hypertension include a greater prevalence of obstructive sleep apnea, renal parenchymal disease, renovascular disease and primary aldosteronism. Uncommon secondary causes include pheochromocytoma, Cushing's syndrome, hyperparathyroidism and thyroid disease. Clinical clues for secondary hypertension is onset of hypertension in persons younger than age 20 or older than age 50 without family history of hypertension, poor response to therapy, worsening of control in previously stable hypertensive patient, markedly elevated blood pressure or hypertension with severe end-organ damage, presence of abdominal bruit (renal artery stenosis), moon face and abdominal striae (Cushing's syndrome), paroxysmal headaches and palpitations (pheochromocytoma), pronounced hypokalemia due to low dose diuretic therapy (primary aldosteronism), acute renal failure or hypokalemia after initiation of angiotensin converting enzyme inhibitors or angiotensin II receptor blocker (renal artery stenosis), hypercalcemia (hyperparathyroidism), snoring and daytime somnolence (obstructive sleep apnea). A combination of a good history and physical examination, astute observation, and accurate interpretation of available data usually are helpful in the diagnosis of a specific causation. This article provides an overview of the range of secondary hypertension, including key clinical features, appropriate diagnostic approach and treatment for primary physician.
Background Metabolic indexes (blood pressure, blood glucose, and lipid) differ depending on lower or upper normal value of obesity indexes (weight, percent-body-fat, and waist circumference) despite normal value. Therefore, we examined metabolic indexes changes across obesity indexes changes. Methods: We analyzed 344 adult men who received routine-checkups with normal weight and waist circumference before and after follow-up. We used multiple-linear-regression to examine associations between changes of obesity indexes and metabolic indexes before and after follow-up. We examined differences of metabolic indexes by t-test and odds ratios of normal or abnormal metabolic indexes by multiple-logistic-regression in groups where obesity indexes were increased and decreased.Results: The mean follow-up was 1.38 ± 0.32 years and there were associations between weight change rate and changes in systolic-blood-pressure (SBP), diastolic-blood-pressure (DBP), triglyceride (TG), and high–density-lipoprotein (HDL) (P = 0.001, 0.03, 0.001, 0.01), associations between percent-body-fat change and changes in SBP, DBP, fasting-blood-glucose (FBG) and TG (P = 0.02, 0.002, < 0.001, 0.03), and associations between waist circumference change rate and changes in FBG, TG, HDL (P = 0.01, 0.01, 0.02). There were significant SBP and HDL differences in weight decrease and increase groups (P = 0.04, < 0.001), FBG difference in percent-body-fat decrease and increase groups (P = 0.01), and FBG and TG differences in waist circumference decrease/increase groups (P = 0.03, 0.03). As compared with percent-body-fat decrease group, percent-body-fat increase group had odds ratio of FBG ≥ 100 of 2.98 (95% confidential interval [CI], 1.18 to 7.51) with a significance on only FBG of initially normal metabolic components and conversely percent-body-fat decrease group had odds ratio of FBG < 100 of 3.22 (95% CI, 1.21 to 8.60) with a significance on only FBG of initially abnormal metabolic components. Conclusion: Increased obesity indexes even within normal range, could change metabolic indexes.
Background Proteinuria is a predictor of chronic kidney disease and a common risk factor for cardiovascular disease. Previous studies have reported that a urinary albumin-creatinine ratio and a glomerular filtration rate was related to the metabolic syndrome. However, there have been few studies on association between the metabolic syndrome and proteinuria by the urine dip-stick test. We examined the association between the metabolic syndrome and the proteinuria by the urine dip-stick test. Methods: The subject of this study included 20,075 adults aged more than 18 years old who visited the Health Promotion Center of the Seoul National University Hospital from April 2001 to March 2007. The metabolic syndrome was defined according to the criteria of the American Heart Association and National Heart, Lung and Blood Institute, and proteinuria was defined as a dipstick test above the '1+' level. The crude and multivariated-adjusted odds ratios of proteinuria were calculated by using logistic regression models with each component of the metabolic syndrome.Results: Proteinuria was noticed in 5.7% of the subjects with metabolic syndrome, and 2.7% without metabolic syndrome. The multivariate-adjusted odds ratios of proteinuria in participants with elevated blood pressure level, elevated plasma glucose level and high triglyceride level were 2.23 (95% confidence interval [CI], 1.95 to 2.55), 2.33 (95% CI, 2.06 to 2.62), 1.64 (95% CI, 1.45 to 1.84). The multivariate-adjusted odds ratio of proteinuria in participants with the metabolic syndrome compared with participants without the metabolic syndrome was 2.30 (95% CI, 1.91 to 2.76), respectively.Conclusion: These findings suggest that proteinuria by the urine dip-stick test might be an important predictor in the metabolic syndrome.
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Background When physicians use the medical terms difficult to understand the meaning, patients regard it as an authority of the physician. It has negative influence on physician-patient relationship and hinders delivering accurate meaning to the patient. The purpose of this research is to investigate what kind of medical terms which meaning is difficult to understand (medical jargon) are used in medical interviews and survey the patients' understanding of the medical terms. Methods: In the preceding study 67 cases of physicians' interviewing with patient were videotaped in the family medicine clinic of a university hospital and they were transcribed from August, 2005 to January, 2007. For this study 60 cases of the transcribed conversations, which interviewing was completely recorded, were assessed for analyzing the content and frequency of medical jargon. The author selected 10 medical terms used in this study's interviews and surveyed the patients' understanding of the medical terms, who visited the family medicine clinic, by questionnaires. Results: In 26 of 60 interviews one or more medical jargon were used by the physician. In 39 of 73 terms (53.4%) the physicians explained meaning of the medical terms to the patient. 213 patients responded to the questionnaires. More than half (median, 55.4%; range, 11.7 to 75.1%) of the respondents expressed that they 'never know' or 'hardly know' the meaning of the medical terms if it was used without explanation. The scores of level of patients' understanding of 10 medical terms significantly increased according to increasing level of income, but the trend is not statistically significant according to increasing age, difference of sex, and level of education. Conclusion: The family physicians used medical jargon in 43.3% of medical interviews, and they explained meaning of the medical terms to the patients for more than half of the terms. More than half of the patients in a university hospital family medicine clinic responded that they never knew or hardly knew meaning of the medical terms if they were used without explanation.
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Background Korean versions of Fat Phobia Scale (short form) (F-scale), Beliefs About Obese Persons Scale (BAOP), and Attitudes Toward Obese Persons Scale (ATOP) which are scales of rating weight bias were assessed to find out the reliability and validity.Methods: Korean versions of F-scale, BAOP, and ATOP were completed twice by 165 adults (85 males, 80 females; 73 hospital staffs, and 92 teachers). Validity was tested using Spearman correlation and factor analysis. Reliability was analyzed using test-retest analyses (Spearman Rho value).Results: Using factor analyses, F-scale comprised of three factors explaining 55.20% of the total variance, BAOP two factors explaining 53.3% of the total variance, and ATOP six factors explaining 61.61% of the total variance. Spearman correlation between F-scale and ATOP was -0.28 to -0.36 (P < 0.05), suggesting that people who worried about being obese tended to have negative attitudes against obesity. The correlation between F-scale and BAOP was -0.25 to -0.27 (P < 0.05), meaning that people who worried about being obese had a tendency to blame obesity on environmental factors. Cronbach's alpha coefficients were 0.79 to 0.90 for F-scale, 0.34 to 0.38 for BAOP and 0.82 to 0.87 for ATOP. Spearman Rho values were 0.47 for F-scale, 0.50 for BAOP, and 0.47 for ATOP (P < 0.05). The scores of each scale were not related to subjects' sex, BMI, body perception, and weight control efforts, while for ATOP scores older subjects were more likely to have a negative view for obesity (P < 0.05).Conclusion: The Korean version of F-scale, ATOP and BAOP could be considered as a tool to evaluate weight-bias however, further study is needed for appropriate application.
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