肾血管性高血压临和血管造影诊断95例分析

对９５例肾血管性高血压（ＲＶＨ＿临床和血管造影结果对照分析，大动脉炎（ＡＡ）组 脉纤维肌性结核不良（ＦＭＤ）组发病年龄明显低于动脉粥样硬化（ＡＳ）组。ＡＳ组高血压病程长于ＦＭＤ组和ＡＡ组，但无统计学意义。ＡＡ组腹部血管杂音检出多于ＦＭＤ组和ＡＳ组，ＦＭＤ组血钾水平明显低于ＡＡ组和ＡＳ组。ＡＡ组８１．４％侵犯胸腹主动脉。５２．５％侵犯双肾动脉。ＦＭＤ组无一例侵犯胸腹主动脉，８２．５％系单侧肾动脉病变     

骨髓增生异常综合征和再生障碍性贫血等细胞遗传学研究

为了探讨骨髓细胞遗传学分析在鉴别诊断骨髓增生异常综合征（ＭＤＳ）和再生障碍性贫血（ＡＡ）等不同血液病中的意义，我们联合应用骨髓细胞Ｒ－带核型分析和姐妹染色单体分化（ＳＣＤ）检测，对３３４例ＭＤＳ、ＡＡ等不同血液病进行分析并随访。结果表明：（１）ＲＡ／ＡＡ、ＲＡ／ＩＴＰ和ＲＡ／ＨＡ等可疑ＲＡ即为不典型ＲＡ或早期ＲＡ；（２）骨髓细胞从ＳＣＤ阳性转为ＳＣＤ阴性是骨髓细胞癌变过程；（３）骨髓细胞ＳＣＤ检测和核型分析具有肯定的诊断和预后价值；（４）ＦＡＢ分类法同细胞遗传学技术相结合可明显地提高ＭＤＳ诊断率或确诊率；（５）ＭＤＳ核型异常检出率６４．４％，与国外（４０％～７０％）相仿。本系列ＭＤＳ常见染色体异常为＋８，２ｑ￣－，一５／５ｑ￣－，一７／７ｑ￣－，７ｐ￣＋，以及一１１，一１４等，也与国外相似。（６）ＭＤＳ发病最初染色体异常看来是染色体数目异常即单体性为主。     

不稳定心绞痛经皮腔内冠状动脉成形术190例分析

１９８７年１２月至１９９４年２月该院共完成不稳定心绞痛的经皮腔内冠状动脉成形术（ＰＴＣＡ）１９０例，其中有单支血管病６９例（３６．３％）、双支血管病６７例（３５．２％）、三支血管病５４例（２８．４％）。ＰＴＣＡ共扩张血管２５０支，扩张病变２７８处。Ａ型病变５２处（１８．７％），Ｂ型病变１７５处（６２．９％）、Ｃ型病变５１处（１８．４％）。在１２１例多支血管病中，２３例（１９．０％）为完全血管再通，９８例（８１．０％）为不完全血管再通。６例采用双球囊对吻技术，５例采用灌注球囊导管，４例进行了冠脉内膜定向切除术（ＤＣＡ），４例放置冠状动脉内膜支架。ＰＴＣＡ的病例成功率为９４．７％（１８０／１９０），血管成功率９５．２％（２３８／２５０），病变成功率９５．５％（２６６／２７８），由ＰＴＣＡ术前平均狭窄８８．７％±８．３％至扩张后残余狭窄１７．９％±９．２％。发生严重并发症１８处（６．５％），其中１５处经处理成功，２例发生急性心肌梗塞，１例死亡，无紧急冠状动脉搭桥者。     

NIDDM患者ApoE基因型与大,微血管病变关系的研究

目的 研究ＮＩＤＤＭ患者ＡｐｏＥ基因型与大，微血管病变的关系。方法 采用ＡＲＭＳ技术检测２００例ＮＩＤＤＭ患者漱口水ＤＮＡ ＡｐｏＥ基因型，结果 （１）∈４／３∈４／４组ＣＡＤ发生率为７０．８％，显著高于∈３／３组４８．４％，和∈２／２∈３／２组４３．５；ＣＶＤ及ＰＶＤ亦存在这种趋势；∈４／３∈４／４组任何证据大血管病变发生率为７５％，显著高于∈３／３组５１．６％和∈２／２∈３／２组４７．８％。     

净化及非净化自体骨髓移植治疗白血病39例临床研究

报告自体骨髓移植治疗白血病３９例，其中非净化自体骨髓移植（ＡＢＭＴ）１４例，净化自体骨髓移植（ＰＡＢＭＴ）２５例。中位年龄２８岁（１０～４３岁）。ＡＭＬ２７例，ＡＬＬ１０例，ＣＭＬ２例。ＣＲ１３１例，ＣＲ２７例，ＮＲ１例。ＣＲ至移植时间中位数６．７个月（２～１９个月）。预处理方案：ＴＢＩ加Ａｒａ－ｃ、ＤＮＲ或ＶＰ１６。ＡＢＭＴ组及ＰＡＢＭＴ组３年无病生存（ＤＦＳ）率分别为６８．３２％及６７．５７％，复发率为３０．７６％及２６．８０％。但ＰＡＢＭＴ组ＡＭＬ患者３年ＤＦＳ率为８２．３５％及ＣＲ２期移７５％３年ＤＦＳ率为７５％，明显高于ＣＲ。期移植未净化者５０％。化疗组３年ＤＦＳ率为７．３８％及复发率７６．４％，两移植组疗效优于化疗组。     

链激酶与尿激酶静脉溶栓治疗急性心肌梗塞的临床对比研究

为对比研究链激酶（ＳＫ）与尿激酶（ＵＫ）静脉溶栓治疗急性心肌梗塞（ＡＭＩ）的疗效与安全性，将７０例发病１２小时内入院的ＡＭＩ患者，随机分为ＳＫ１５０万Ｕ／３０分钟加速静脉溶栓组（４例）及ＵＫ２００万Ｕ／３０分钟静脉溶栓组（３０例）。根据临床血管再通指标判断ＳＫ加速静脉溶栓组血管再通率为７７．５％（３１／４０），其中发病６小时内溶栓者再通率为８９．３％（２５／２８）。而ＵＫ组再通率为５６．７％（１７／３０），其中发病６小时内溶栓者再通率为６５％（１３／２０）。轻度出血、低血压、过敏反应等副作用的发生率，ＳＫ加速溶栓组分别为１２．５％（５／４０），７．５％（３／４０），２．５％（１／４０）；而ＵＫ溶栓组分别为１３．３％（４／３０），３．３％（１／３０），６．７％（２／３０）。急性期５周病死率ＳＫ组为２．５％（１／４０）、ＵＫ组为６．７％（２／３０）。对比研究结果表明：ＳＫ１５０万Ｕ／３０分钟的加速静脉溶栓与ＵＫ２００万Ｕ／３０分钟的静脉溶栓治疗ＡＭＩ是安全的。但ＳＫ加速溶栓的疗效优于ＵＫ溶栓的疗效。     

老年人颈内动脉颅外段硬化性病变与脑缺血性疾病的关系

目的探讨老年患者颈内动脉（ＩＣＡ）颅外段硬化性狭窄度及斑块形态学类型与脑缺血症状的关系。方法将接受颈动脉Ｄｕｐｌｅｘ超声检查的１８８例老年患者分成脑缺血组、下肢动脉硬化性闭塞症（ＰＡＯＤ）组和脑缺血＋ＰＡＯＤ组进行分析。狭窄度分成５级，斑块类型分成４型。结果１８８例中，无双侧ＩＣＡ颅外段均重度狭窄者。３７６条血管中，轻度狭窄２５７条，中度８９条，重度２８条，闭塞２侧；有症状１５８条血管中，轻度狭窄９４条（占３６．６％）、中度４０条（４４．９％）及重度２２条（７８．６％）、闭塞２条，轻、中、重３组间比较，差异有显著性（Ｐ＜０．０１）。在２１３条（５６．６％）有超声测定斑块类型记录者中，脑缺血组、ＰＡＯＤ组及脑缺血＋ＰＡＯＤ组中ＩＣＡ颅外段重度狭窄发生率分别为１２．５％、８．３％和３７．５％。狭窄度与斑块类型比较，狭窄度与症状之间较斑块类型与症状之间关系更密切（Ｐ＜０．０１）。结论脑缺血患者中存在ＩＣＡ颅外段重度狭窄者，ＩＣＡ颅外段动脉硬化病变是脑缺血性疾病发生的危险因素     

冠状动脉完全闭塞病变的经皮腔内冠状动脉成形术

我们自１９８７年１２月至１９９３年１０月对５５例５８支冠状动脉完全闭塞病变（ＴＯ）行经皮腔内冠状动脉成形术（ＰＴＣＡ），占同期ＰＴＣＡ总数的１８．２％。患者平均年龄５６．４±７．５岁，心绞痛患者１９例，心肌梗塞患者３６例，其中梗塞后１０小时内行急诊ＰＴＣＡ２例，１个月内和１个月以后行ＰＴＣＡ分别为６例和２８例。ＴＯ平均时间６８．４±４６．６天。完全闭塞和次全闭塞各占６５．５％和３４．５％。结果显示：病例成功率为８９．１％，病变成功率为８７．９％；完全闭塞成功率为８９．５％，次全闭塞成功率为８５．０％。闭塞类型、闭塞时间、闭塞长度等特征对成功率无显著性影响（Ｐ＞０．０５）；血管并发症率为１２．１％（７／５８），处理成功６处，死亡１例。     

经皮冠状动脉腔内成形术—病变特点与近期疗效的关系

本文分析１７０例ＰＴＣＡ近期疗效与病变特征的关系，１５６例患者（９１．８％）ＰＴＣＡ成功，２２３支血管２３６处病变中２１３处（９０．３％）扩张成功，Ａ型病变成功率为９７．７％），Ｂ型病变为９０．１％，Ｃ型病变为８１．１％。８例急性心肌梗塞并发心原性休克患者７例ＰＴＣＡ成功，４例存活。本组病例发生重要并发症９例（５．３％），其中３例（１．８％）血管急性闭塞及２例（１．２％）动脉夹层或严重内膜撕裂、濒     

经食管超声多普勒测定冠状动脉储备功能对冠状动脉病变程度的评价

经食管超声（ＴＥＥ）＋潘生丁（ｄｉｐｙｒｉｄａｍｏｌｅ）药物试验测定冠状动脉的血流速度，并根据冠状动脉最大扩张时的血流速度／基础状态下的血流速度之比值来计算冠状动脉储备功能（ＣＦＲ）的指数。我们先后对４４例胸痛待查的患者进行了冠状动脉造影和ＴＥＥ＋潘生丁药物试验，３８例（８６％）的病人获得了满意的ＴＥＥ图像。根据冠状动脉造影的结果将３５例患者分为二组：Ａ组１７例为左前降支狭窄≥５０％或（和）左回旋支狭窄者；Ｂ组２１例为左冠状动脉病变０～＜５０％者。经ＴＥＥ多普勒测定潘生丁注射前、后的左前降支舒张期血流速度，Ａ组的ＣＦＲ指数——峰值舒张期血流速度比值（Ｄ／ＢＰＤＶ）和平均舒张期血流速度比值（Ｄ／ＢＭＤＶ）均明显低于Ｂ组（Ｐ＜０．００１）。如以ＣＦＲ指数２．０作为判断严重冠状动脉病变（≥７５％）的临界点，则其敏感性为８２．４％，特异性为８５．７％，准确性为８４．２％，即提示：通过ＣＦＲ的测定可以从血流动力学的角度来评价冠状动脉病变的程度。     

Chlamydia pneumoniae seropositivity and systemic and renovascular atherosclerotic disease

BACKGROUND: Patients with hypertension may be vulnerable to vascular Chlamydia pneumoniae and/or cytomegalovirus (CMV) infection because of increased expression of adhesion molecules. OBJECTIVE: To determine whether C pneumoniae or CMV is associated with the presence of atherosclerotic lesions in hypertensive patients. METHODS: Ninety-six angiographic studies on 100 consecutive patients with of clinical signs or symptoms suggestive of renovascular hypertension were reviewed for the presence or absence of atherosclerotic lesions at the level of the renal arteries as well and abdominal aorta. Also, the presence of a hemodynamically notable renal artery stenosis and antibodies to C pneumoniae (IgG and IgA) and CMV (IgG and IgM) was determined, and all classic risk factors were recorded. RESULTS: Atherosclerotic lesions were documented in 67 patients (70%), and in 49 patients (51%) such lesions were present at the level of the renal artery. In the univariate analysis, significant associations between IgG (odds ratio, 3.8; 95% confidence interval, 1.2-11.7; P =.02) as well as IgA (odds ratio, 2.6; 95% confidence interval, 1.1-6.7; P =.03) antibodies to C pneumoniae and the presence of atherosclerosis were found for both the aorta and the renal arteries. Seroprevalence (IgG) to C pneumoniae in the 23 patients with a hemodynamically notable renal artery stenosis was 100% and differed (P =.01) from those without a notable renal artery stenosis (78%). In the multivariate analysis, IgG seropositivity to C pneumoniae was significantly associated with atherosclerosis (odds ratio, 6.0; 95% confidence interval, 1.33-27.5; P =.02), and age. There was no association between CMV seropositivity and atherosclerosis. CONCLUSION: The presence of antibodies to C pneumoniae was significantly associated with atherosclerosis and renovascular disease in hypertensive patients in whom a renal artery stenosis was strongly suspected.     

C-reactive protein, atherosclerosis and kidney function in hypertensive patients

Previous studies have shown a relationship between coronary or carotid atherosclerosis and C-reactive protein (CRP) concentrations. In the present investigation, we evaluated the relationship between high-sensitivity CRP (hsCRP) concentrations and the presence of atherosclerotic lesions in the renal arteries and/or abdominal aorta. In 95 hypertensive patients who underwent intra-arterial DSA on suspicion of renovascular disease, blood was sampled during the procedure for measurement of hsCRP. The presence of atherosclerotic lesions was assessed at the level of the renal arteries and the abdominal aorta. Haemodynamically significant renal artery stenosis was diagnosed when 50% or more stenosis was observed. Patients with fibromuscular disease (n = 8) or incomplete data (n = 4) were excluded from analysis. The results revealed that the median hsCRP concentrations were significantly higher among the 57 patients with atherosclerosis of the aorta and/or renal arteries compared to those in the 26 patients without any angiographic lesions (4.6 vs 1.7 mg/l; P < 0.005). Moreover, in patients with renal artery stenosis, levels of hsCRP were higher when the degree of stenosis exceeded 50%. However, the association between hsCRP and the presence of atherosclerosis appeared to be confounded by serum creatinine, creatinine clearance, age and gender. In the whole group a significant inverse relationship was found between creatinine clearance and hsCRP (P < 0.05). In conclusion, hsCRP concentrations are related to atherosclerotic lesions in the renal arteries and the abdominal aorta. While this supports the view that atherosclerotic renal artery stenosis is part of a systemic inflammatory vascular disease, increased concentrations of CRP may also coincide with decreased renal function.     

Isolated and combined lesions of renal arteries in patients with vaso-renal hypertension]

In the course of a 10-year study of the problem of renovascular hypertension in the A.N. Bakuley Institute of Cardiovascular Surgery, concomitant pathology of other arterial systems was found in 144 patients among 218 cases of acquired lesions of the renal arteries. The combination of the lesions of the renal arteries with those of other arteries (branches of the aortic arch, descending thoracic and abdominal aorta, its visceral branches and the arteries of the lower extremities) is, according to the author, one of the main peculiarities of renovascular hypertension that predetermines its malignant course. A purposeful study of the state of the major vessels in a patient with arterial hypertension permits to reveal their lesion or intactness, and to conduct a detailed clinical investigation accordingly, as well as to choose the proper method of angiography and surgery.     

Localizations of Takayasu's disease (author's transl)

Localizations of Takayasu's disease are described and discussed in relation to 10 cases. The affection causes panaortitis which produces stenosis, or less often dilatation, of the thoracic and/or abdominal aorta, and stenosis of occlusion of the arteries arising from the aorta. Lesions of the aortic arch and superior aortic branches, mainly subclavian and carotid, are the most frequently observed form of the disease, but coronary stenosis and aortic incompetence are sometimes noted. Lesions in the descending thoraco-abdominal aorta are frequently present, and stenosis and occlusion of the renal arteries are usually associated with the abdominal aortitis. Stenosis of the terminal aorta and iliofemoral axes is a more rare occurrence. The association of lesions in the aortic arch and its branches, and the descending aorta and its branches, was found in about 2/3rds of cases. Pulmonary arteries are affected in about half the cases according to recent reports.     

Abnormal ion and water composition of veins and normotensive arteries in coarctation hypertension in rats.

We examined the water, sodium, and potassium composition of the thoracic aorta, abdominal aorta (plus iliac arteries), and veins (vena cava and portal vein) from rats with aortic coarctation. The aortas of 10 rats (group A) were coarcted above the renal arteries to produce hypertension. Control groups consisted of 10 rats sham-coarcted above and 10 rats coarcted below the renal arteries. In group A rats heart weights and carotid artery pressures were elevated over controls (P less than 0.01), whereas there were no significant differences in femoral arterial pressures. In group A rats both the hypertensive thoracic aorta and the normotensive abdominal aorta contained about 20% more water per unit of wet weight, and about 35% and 60% more sodium and potassium, respectively, per unit of dry weight than did the corresponding portions of aorta from control rats (P less than 0.01). In group A rats water (P less than 0.01), sodium (P less than 0.02), and potassium (P less than 0.05) contents of veins also were increased. There were no significant correlations between level of carotid arterial pressure and magnitude of changes in arterial and venous composition, nor were there significant differences between the magnitude of changes in the normotensive and hypertensive portions of the aorta. These results indicate that in rats abnormalities in vascular wall salt and water content are not necessarily a direct effect of the elevated pressure in hypertension.     

Compensatory enlargement and stenosis develop in apoE(-/-) and apoE*3-Leiden transgenic mice

Atherosclerotic mouse models develop little ischemic organ damage and no infarctions, despite the presence of large atherosclerotic lesions. Therefore, we hypothesize that luminal changes do not follow atherosclerotic lesion development. Because a phenomenon that may explain the discrepancy between luminal changes and lesion size is vascular remodeling, we measured parameters of vascular remodeling in the carotid arteries (CAs), thoracic aorta (TA), and abdominal aorta (AA) of apolipoprotein E (apoE)-deficient (apoE(-/-)) and apoE*3-Leiden mice, 2 well-known mouse models of atherosclerosis. Atherosclerotic lesions were classified (American Heart Association [AHA] types II through V), and plaque thickness, compensatory enlargement versus constrictive remodeling, lumen diameter, stenosis, and media thickness were measured relative to the nondiseased arterial wall. In CAs, plaque thickness increased during atherogenesis. CAs showed compensatory enlargement (apoE(-/-) 55%, apoE*3-Leiden 38%). Regression analysis revealed a positive correlation between plaque and lumen area (for apoE(-/-), R=0.95; for apoE*3-Leiden, R=0.90). Medial thinning and elastolysis were also observed. During atherogenesis, lumen diameter decreased (apoE(-/-) -69%, apoE*3-Leiden -40%), and stenosis >70% developed. TA and AA showed similar features, but neither developed a progressive decrease in lumen diameter or stenosis >70%. In CAs, TA, and AA of apoE(-/-) and apoE*3-Leiden mice, atherogenesis is associated with compensatory enlargement, medial thinning, and elastolysis. A progressive decrease in lumen diameter and stenoses >70% occur only in CAs. Vascular remodeling is more prominent in apoE(-/-) mice.     

Severe hypoplasia of the abdominal aorta and its branches in a patient and his daughter

We report the history of a patient and his daughter, both affected with hypoplasia of the abdominal aorta and its branches, leading to early and dramatic complications. In the index patient, renal ischaemia as a result of severe hypoplasia of the abdominal aorta and the origin of renal arteries led to progressive renal failure and end-stage renal disease at the age of 32 years. Other vascular abnormalities included hypoplasia of the celiac trunk (CT) and superior mesenteric artery (SMA). After a successful kidney transplantation at the age of 40 years, he eventually deceased following an episode of possibly ischaemic acute pancreatitis at 47 years. The patient's daughter suffered from an haemorrhagic stroke at the age of 7 years, which led to the discovery of severe hypertension caused by bilateral narrowing of renal arteries, as well as hypoplasia of CT, SMA, subclavian and pulmonary arteries. Biopsy of the narrowed renal artery of the daughter showed a particular form of fibrodysplasia characterized by an unusual fibrosis of the inner part of the media, just beneath the internal elastic lamina. To our knowledge, this is the first report of familial hypoplasia of the abdominal aorta. It might be the cardinal manifestation of a familial form of fibromuscular dysplasia (FMD). Interestingly, the histological lesions described in the daughter's renal artery differ from the classical form of medial FMD.     

World Health Organization (WHO) and the World Heart Federation (WHF) Pathobiological Determinants of Atherosclerosis in Youth (PBDAY) Study. Lipid and raised lesion distribution in the right coronary artery of young people

BACKGROUND AND AIM: As part of the WHO-WHF PBDAY Study, we examined the proximal segment of the right coronary artery (RCA) (n = 469) of 5-34 yr-old otherwise healthy trauma victims from 15 countries to establish the topographical relation of atherosclerotic lesions to age, sex and geographical location. METHODS AND RESULTS: Topography and extent of lesions were analyzed by image processing and probability-of-occurrence maps of lipid lesions (mostly fatty streaks) and raised lesions on the intimal surface of the RCA were produced. Extension of lesions varied considerably between the groups and between individuals in the same group. The prevalence of lipid lesions was 68% (319/469) compared with 100% in the aorta. The prevalence of raised lesions was 22% (102/469) compared with 7% and 26% in the thoracic and abdominal aorta. Females had more lipid lesions, whereas raised lesions prevailed in males. Lipid lesion extent increased with age in both sexes. CONCLUSIONS: High probability-of-occurrence areas for lipid and raised lesions prevailed in the proximal 5 cm of the intimal surface of the RCA (myocardial side) and were greatly overlapping. Regression analysis between lipid and raised lesion extent in the thoracic or abdominal aorta and the RCA showed no correlations between the lipid lesion extent, whereas significant correlations were found between the raised lesion extent in the RCA and the thoracic aorta only, showing that the two types of lesion behave differently in different anatomical locations.     

Fibromuscular Dysplasia of Renal and Carotid Arteries

We report here two cases of fibromuscular dysplasia (FMD). The first case describes an asymptomatic 75-year-old man with FMD of the right internal carotid artery. The second case reports a 17-year-old man who presented with arterial hypertension caused by FMD of the left renal artery and was subsequently successfully treated by angioplasty. FMD is a rare nonatherosclerotic, noninflammatory angiopathy, which can involve almost every arterial vascular bed. It is a less common cause of stenosis of renal and carotid arteries. FMD can present with arterial hypertension when it involves renal arteries or with ischemic stroke or transient ischemic attack when the disease affects the carotid or vertebral arteries. Many cases are asymptomatic and may be discovered incidentally. Percutaneous transluminal angioplasty should be used in patients with a stenosis of the renal artery causing arterial hypertension. On the contrary, conservative therapy should be chosen in patients with asymptomatic and extensive lesions of the carotid arteries.     

Hypertension revealing aneurysmal renal fibrodysplasia

A 20-year-old woman consulted for severe hypertension which revealed aneurismal stenosing fibrodysplasia of the renal arteries. The diagnosis was established by duplex Doppler which visualized tight stenosis of the distal portion of the right renal artery and the proximal portion of the left, associated with aneurismal lesions downstream from the strictures (1.8 cm on the right and 1.3 cm on the left). The lesions were highly suggestive of fibrodysplasia and were confirmed by magnetic resonance angiography. Endoluminal revascularization was undertaken because of the severe hypertension and the presence of arterial lesions. Revascularization was unsuccessful and severe hypertension persisted. Surgery was performed in two stages. The first procedure consisted in resection of the left aneurismal lesion with aortorenal internal saphene bypass. Secondarily, exclusion of the right aneurysm was performed with cure of the stricture by extracorporal renal surgery with anastomosis of the renal artery to the aorta and the renal vein to the vena cava. Clinical outcome was favorable. Angioscan and duplex Doppler controls at three and six months confirmed the anatomic success of the revascularization. Aneurysm of the renal artery, like renal artery stenotic dysplasia, is a rare but probably underestimated condition due to insufficient screening. This diagnosis should be entertained in hypertensive young women. There is risk of rupture of the aneurysm. Aneurysmal lesions can be associated with renal artery stenosis which usually involves a short segment of the artery, as in our case. Renal aneurysms should be treated when one of the following elements is present: aneurysm measuring more than 20 mm, progressing aneurysm, dissection, discovery in a patient with a renal risk (single kidney, renal insufficiency), desire for pregnancy, severe hypertension recently discovered in a young subject associated with dysplastic stenosis, isolated aneurysm associated with recent severe hypertension, as reported here.