Table of Contents
Impact of Acute Hepatic Porphyria on Resistant Hypertension
Acute Hepatic Porphyria (AHP) is a group of rare inherited metabolic disorders that can manifest with various clinical complications, including resistant hypertension. Patients with AHP often experience acute neurovisceral attacks, which can lead to episodes of hypertension as part of dysautonomia. The underlying pathophysiology involves the accumulation of neurotoxic intermediates that adversely affect cardiovascular function (De Vos et al., 2024). Hypertension in this context is often overlooked during the diagnostic work-up for secondary hypertension.
A study indicated that a significant proportion of patients with resistant hypertension may be suffering from undiagnosed AHP, which complicates their treatment (De Vos et al., 2024). In Canada, hypertension prevalence among patients with AHP was reported to be as high as 75%. These findings suggest that clinicians should routinely consider AHP in the differential diagnosis of resistant hypertension to facilitate timely intervention and improve patient outcomes.
Table 1: Symptoms and Complications of Acute Hepatic Porphyria
| Symptom/Complication | Description |
|---|---|
| Abdominal Pain | Severe pain during acute attacks |
| Dysautonomia | Autonomic dysfunction leading to hypertension |
| Neurological Issues | Including seizures and behavioral changes |
| Chronic Kidney Disease | Long-term renal complications |
| Increased Risk of ICH | Intracranial hemorrhage due to thrombocytopenia |
Significance of Screening Pregnant Women for FNAIT
Fetal Neonatal Alloimmune Thrombocytopenia (FNAIT) is a condition stemming from maternal antibodies targeting fetal platelets, leading to potential complications such as severe intracranial hemorrhage (ICH) in newborns (de Vos et al., 2024). The current screening practices for anti-HPA-1a antibodies are not universally implemented, despite evidence suggesting that early detection and intervention with intravenous immunoglobulin (IVIg) can significantly reduce the incidence of ICH.
A cost-utility analysis demonstrated that screening for anti-HPA-1a antibodies during pregnancy could prevent significant morbidity and mortality associated with FNAIT. The incremental cost-effectiveness ratio (ICER) was calculated at €20,782 per quality-adjusted life year (QALY) gained, marking it as a potential cost-effective strategy (de Vos et al., 2024).
Table 2: Cost-Utility Analysis of FNAIT Screening
| Parameter | Without Screening | With Screening | Increment |
|---|---|---|---|
| Annual number of deaths | 3.83 | 0.00 | -3.83 |
| Annual number of disabilities | 2.48 | 0.00 | -2.48 |
| Total QALYs gained | 7,208,369 | 7,208,595 | +226 |
| Annual costs | €3,185,800 | €7,873,900 | +€4,688,100 |
Cost-Effectiveness of HPA-1a Antibody Screening Programs
The implementation of HPA-1a antibody screening programs shows promise in preventing adverse outcomes associated with FNAIT. The screening program not only aims to identify high-risk pregnancies but also facilitates timely intervention, thereby improving maternal and neonatal outcomes. The economic implications are significant, as the potential reduction in healthcare costs related to treating severe complications could offset the costs associated with screening and treatment (de Vos et al., 2024).
Key Findings
- Screening programs can prevent deaths and disabilities associated with FNAIT.
- The economic analysis supports the integration of screening into routine prenatal care.
- Future guidelines should include AHP and FNAIT screening as standard practices.
Variability in Corticosteroid Prescribing for Septic Shock
Septic shock remains a major cause of mortality in critically ill patients, with corticosteroids being a cornerstone of treatment to reduce inflammation and stabilize hemodynamics. However, a recent study highlighted significant variability in corticosteroid prescribing practices across different ICUs and attending physicians (Soni et al., 2024).
In a cohort of 5,322 patients with vasopressor-dependent septic shock, only 24.3% received corticosteroids within two days of vasopressor initiation. The factors influencing prescribing patterns include physician experience, ICU characteristics, and patient severity scores. The study emphasized the need for standardized protocols to enhance adherence to evidence-based guidelines.
Table 3: Corticosteroid Prescription Variability
| ICU/Physician Characteristics | Percentage of Patients Receiving Corticosteroids |
|---|---|
| ICU A | 46.2% |
| ICU B | 9.5% |
| Attending Physician 1 | 83.3% |
| Attending Physician 2 | 2.9% |
Effects of Cannabinoid Supplements on Sleep and Mood
A recent pilot study investigated the effects of a cannabinoid supplement on sleep quality and mood among adults with subthreshold insomnia (Hausenblas et al., 2025). The randomized double-blind placebo-controlled crossover trial included 20 participants who received either a cannabinoid supplement containing THC, CBN, and CBD or a placebo for ten days.
Results indicated significant improvements in sleep quality and related health outcomes, with participants reporting enhanced health-related quality of life and reduced insomnia symptoms after using the cannabinoid supplement compared to the placebo condition. These findings suggest that cannabinoids may offer a viable alternative for individuals struggling with sleep disturbances, although further research is warranted to confirm these results.
Table 4: Sleep Quality Outcomes from Cannabinoid Supplement Study
| Measure | Baseline M (SD) | Post-Condition M (SD) | p-value |
|---|---|---|---|
| Insomnia Severity Index | 12.30 (3.99) | 8.55 (5.32) | 0.003** |
| Pittsburgh Sleep Quality Index | 1.60 (0.68) | 1.05 (0.83) | 0.02** |
| Bergen Insomnia Scale | 21.40 (10.25) | 12.70 (8.43) | 0.002** |
FAQs
What is Acute Hepatic Porphyria?
Acute Hepatic Porphyria (AHP) is an inherited metabolic disorder characterized by the accumulation of porphyrins, which can lead to various symptoms including abdominal pain, neurological issues, and hypertension.
Why is screening for FNAIT important during pregnancy?
Screening for FNAIT allows for early detection and management of potential complications like intracranial hemorrhage in newborns, which can significantly improve outcomes.
What are the current trends in corticosteroid prescribing for septic shock?
Recent studies show considerable variation in corticosteroid prescribing practices across different ICUs and physicians, highlighting the need for standardized treatment protocols.
How do cannabinoid supplements affect sleep?
Cannabinoid supplements have been shown to improve sleep quality and overall health-related quality of life among individuals with insomnia, although more research is needed to fully understand their efficacy.
References
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de Vos, T. W., Tersteeg, I., Lopriore, E., Oepkes, D., Porcelijn, L., van der Schoot, C. E., & de Haas, M. (2024). Screening of pregnant women for foetal neonatal alloimmune thrombocytopenia: A cost–utility analysis. Vox Sang, 120, 178-187
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Hausenblas, H., Hooper, S., & Lynch, T. (2025). Effectiveness of a Cannabinoids Supplement on Sleep and Mood in Adults With Subthreshold Insomnia: A Randomized Double‐Blind Placebo‐Controlled Crossover Pilot Trial. Health Science Reports, 8(2), e70481
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Soni, K., Minturn, J. S., Davis, B. S., Bukowski, L. A., & Kahn, J. M. (2024). Variation in Corticosteroid Prescribing Practices for Patients With Septic Shock. Critical Care Explorations
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De Lima Serrano, P., Badia, B. M. L., Farias, I. B., & Pinto, W. B. V. R. (2025). Acute Hepatic Porphyria Should Be Included in the Diagnostic Work-Up of Patients with Resistant Hypertension or Suspected Secondary Hypertension. Medical Sciences, 13(1), 14. https://doi.org/10.3390/medsci13010014
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Allen, N. S., Yiu, Y., Ahmed, O. G., Takashima, M., & Jiang, Z. Y. (2024). Pediatric Adenotonsillectomy Opioid Prescriptions Before and After Practice Guidelines and American Academy of Pediatrics Challenge. Otolaryngology–Head and Neck Surgery
