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Management of Hypertension, Fatty Liver, and Stage 2 CKD in a 65-Year-Old Male
Abstract
The analysis of the elderly patients as their group integrates the highest instance of comorbidities poses a challenge in a multi-faceted management approach. The case study is aimed to provide an insight into managing a 65 year old male diagnosed with hypertension, chronic renal disease and fatty liver disease along with new symptoms of deterioration.
Presentation: This patient has a history of hypertension for 30 years, trained stage 2 CKD for 3 years, and developed fatty liver disease 5 years ago. He underwent coronary angioplasty with stenting at the retirement age of 55 years. Over the last six months, there has been development of progressive weakness, followed by weight gain and swelling of the legs. Despite multiple antihypertensive medications, the blood pressure remains high.
Physical Examination and Investigations: BP 150/90 mmHg, mild leg swelling & Headache and mildly enlarged liver were noted on physical examination. Creatinine level was 1.8 mg/dl, eGFR 50 ml/min/1.73m² and liver enzymes were elevated in laboratory tests. Studies showed fatty liver, no renal obstruction, and normal heart function after the stent insertion.
Management: The plan, after a while, will include a strictly optimized antihypertensive therapy regimen, lifestyle modification measures including a low salt diet and physical activity. On the side of the other medications, statin treatment should be kept at all times. It should not be forgotten that the kidney and liver parameters should be checked regularly as they have a direct relation with cardiovascular health.
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Chalasani N, Younossi Z, Lavine JE, Charlton M, Sanyal AJ. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67(1):328-57. https://aasldpubs.onlinelibrary.wiley.com/doi/10.1002/hep.29367
Collins R, Reith C, Emberson J. Effects of statin-based interventions for the prevention of stroke. Lancet Neurol. 2016;15(5):523-30. https://www.sciencedirect.com/science/article/pii/S1474442216000566]
KDIGO. KDIGO 2020 Clinical Practice Guideline for Blood Pressure in Chronic Kidney Disease. Kidney Int Suppl. 2020;10(4) https://www.kidney-international.org/article/S2468-0249(20)30143-8/fulltext
Kovesdy CP, Appel LJ, Grams ME. Management of hypertension and kidney disease: Integrating and optimizing current treatment strategies. Am J Kidney Dis. 2017;69(4):510-23. https://www.ajkd.org/article/S0272-6386(16)30730-4/fulltext
Mancia G, Fagard R, Narkiewicz K, Redon J. 2013 ESH/ESC Guidelines for the management of arterial hypertension. Eur Heart J. 2013;34(28):2159-219. https://academic.oup.com/eurheartj/article/34/28/2159/455938
Tabashnik BE, Zhang M, Fabrick JA, Wu Y, Gao M, Huang F, et al. Dual mode of action of BT proteins: Protoxin efficacy against resistant insects [Internet]. U.S. National Library of Medicine; 2015 [cited 2024 Sept 7]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4601037/
Lahoz-García N, García-Hermoso A, Milla-Tobarra M, Díez-Fernández A, Soriano-Cano A, Martínez-Vizcaíno V. Cardiorespiratory Fitness as a Mediator of the Influence of Diet on Obesity in Children. Nutrients [Internet]. 2018 Mar 1 [cited 2022 Mar 27];10(3):358. https://www.mdpi.com/2072-6643/10/3/358/htm
Lütje S, Feldmann G, Essler M, Brossart P, Bundschuh RA. Immune Checkpoint Imaging in Oncology: A Game Changer Toward Personalized Immunotherapy? Journal of Nuclear Medicine [Internet]. 2020 Jan 10 [cited 2023 Mar 5];61(8):1137–44. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413235/
Gosse, P., Dauphinot, V., Roche, F., Pichot, V., Celle, S., & Barthelemy, J. (2009). Prevalence of clinical and ambulatory hypertension in a population of 65‐Year‐Olds: the PROOF Study. Journal of Clinical Hypertension, 12(3), 160–165. https://doi.org/10.1111/j.1751-7176.2009.00235.x
Ma, C., Yan, K., Wang, Z., Zhang, Q., Gao, L., Xu, T., Sai, J., Cheng, F., & Du, Y. (2021). The association between hypertension and nonalcoholic fatty liver disease (NAFLD): literature evidence and systems biology analysis. Bioengineered, 12(1), 2187–2202. https://doi.org/10.1080/21655979.2021.1933302
Carey, R. M., Wright, J. T., Jr, Taler, S. J., & Whelton, P. K. (2021). Guideline-Driven Management of Hypertension: An Evidence-Based Update. Circulation research, 128(7), 827–846. https://doi.org/10.1161/CIRCRESAHA.121.318083
Kitt, J., Fox, R., Tucker, K. L., & McManus, R. J. (2019). New Approaches in Hypertension Management: a Review of Current and Developing Technologies and Their Potential Impact on Hypertension Care. Current hypertension reports, 21(6), 44. https://doi.org/10.1007/s11906-019-0949-4
Oparil S, Acelajado MC, Bakris GL, Berlowitz DR, Cífková R, Dominiczak AF, Grassi G, Jordan J, Poulter NR, Rodgers A, Whelton PK. Hypertension. Nat Rev Dis Primers. 2018 Mar 22;4:18014. doi: 10.1038/nrdp.2018.14. PMID: 29565029; PMCID: PMC6477925.
Risk Factors in Hypertension : Journal of Cardiovascular Pharmacology. (n.d.). LWW. https://journals.lww.com/cardiovascularpharm/abstract/1989/00131/Risk_Factors_in_Hypertension.3.aspx
Musso G, Gambino R, Tabibian JH, Ekstedt M, Kechagias S, Hamaguchi M, et al. Association of Non-Alcoholic Fatty Liver Disease With Chronic Kidney Disease: A Systematic Review and Meta-Analysis. Public Library of Science [Internet]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4106719/
Marcuccilli M, Chonchol M. NAFLD and Chronic Kidney Disease. Multidisciplinary Digital Publishing Institute [Internet]. https://www.mdpi.com/1422-0067/17/4/562
Kumar A, Yadav A, Rani S, Singh R, Kumar A, Gupta R. COVID-19: A Review of Its Impact on Health Care and Medical Education. J Med Internet Res. 2021;23(6). doi:10.2196/27261. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8448161/
Ibragimov A, Rahmatov N, Tashkentov D, et al. The impact of the COVID-19 pandemic on the mental health of healthcare workers in Uzbekistan. Eur J Med Res. 2023;28(1):114. doi:10.1186/s40001-023-01114-6. https://eurjmedres.biomedcentral.com/articles/10.1186/s40001-023-01114-6.
Lunev A, Sokolova N, Stetsenko I. Digitalization of agro-industrial complex as a basis for building organizational-economic mechanism of sustainable development: foreign experience and perspectives in Russia. https://www.researchgate.net/publication/335830132_Digitalization_of_Agro-
Industrial_Complex_as_a_Basis_for_Building_Organizational-Economic_Mechanism_of_Sustainable_Development_Foreign_Experience_and_Perspectives_in_Russia.
Shah AG, Lydecker A, Murray K, et al. Compensation for the increasing prevalence of nonalcoholic fatty liver disease in the United States. Hepatology. 2018;67(4):1400-1411. doi:10.1002/hep.29531456. https://pubmed.ncbi.nlm.nih.gov/29531456/
Mokdad AH, Forouzanfar MH, Daoud F, et al. The impact of nonalcoholic fatty liver disease on cardiovascular and renal outcomes in older adults: A systematic review. BMC Geriatr. 2021;21(1):216. doi:10.1186/s12877-021-02175-1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8001920/
Pugh D, Gallacher PJ, Dhaun N. Management of hypertension in chronic kidney disease - drugs [Internet]. Springer International Publishing; 2020 [cited 2024 Oct 10]. Available from: https://link.springer.com/article/10.1007/s40265-019-1064-1
DOI: http://dx.doi.org/10.52155/ijpsat.v47.1.6633
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