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Current Hypertension Reports

Fernando Pedro de Souza-Neto, Melissa Carvalho Santuchi, Mario de Morais E Silva, Maria José Campagnole-Santos, Rafaela Fernandes da Silva
PURPOSE OF REVIEW: The purpose of this review was to summarize the current knowledge on the role of angiotensin-(1-7) [Ang-(1-7)] and alamandine in experimental hypertension and atherosclerosis. RECENT FINDINGS: The renin-angiotensin system (RAS) is a very complex system, composed of a cascade of enzymes, peptides, and receptors, known to be involved in the pathogenesis of hypertension and atherosclerosis. Ang-(1-7), identified and characterized in 1987, and alamandine, discovered 16 years after, are the newest two main effector molecules from the RAS, protecting the vascular system against hypertension and atherosclerosis...
March 14, 2018: Current Hypertension Reports
Holly Kramer, Richard Cooper
PURPOSE OF REVIEW: The Systolic Blood Pressure Intervention Trial demonstrated significant decreases in cardiovascular events and total mortality with intensive systolic blood pressure lowering in adults with high cardiovascular risk in the absence of diabetes but benefits were accompanied by increased risk of adverse events. RECENT FINDINGS: Over 100,000 deaths and 46,000 cases of heart failure may be prevented annually if intensive systolic blood pressure lowering is implemented in 17 million US adults who are age 50 years and older, and have high cardiovascular risk in the absence of diabetes and meet eligibility for the Systolic Blood Pressure Intervention Trial...
March 6, 2018: Current Hypertension Reports
Sergey Kachur, Rebecca Morera, Alban De Schutter, Carl J Lavie
Prehypertension (pHTN) and metabolic syndrome (MetS) are both lifestyle diseases that are potentiated by increased adiposity, as both disease processes are closely related to weight. In the case of pHTN, increased adiposity causes dysregulation of the renin-angiotensin-aldosterone-system (RAAS) as well as adipokine- and leptin-associated increases in adrenergic tone. In MetS, excess weight potentiates hyperglycemia and insulin resistance which causes positive feedback into the RAAS system, activates an inflammatory cascade that potentiates atherosclerosis, and causes lipid dysregulation which together contribute to cardiovascular disease, especially coronary heart disease (CHD) and heart failure (HF)...
March 6, 2018: Current Hypertension Reports
Sharon D B de Morais, Julia Shanks, Irving H Zucker
PURPOSE OF REVIEW: The renin-angiotensin system (RAS) plays an important role in modulating cardiovascular function and fluid homeostasis. While the systemic actions of the RAS are widely accepted, the role of the RAS in the brain, its regulation of cardiovascular function, and sympathetic outflow remain controversial. In this report, we discuss the current understanding of central RAS on blood pressure (BP) regulation, in light of recent literature and new experimental techniques. RECENT FINDINGS: Studies using neuronal or glial-specifc mouse models have allowed for greater understanding into the site-specific expression and role centrally expressed RAS proteins have on BP regulation...
February 26, 2018: Current Hypertension Reports
Maja Lozić, Olivera Šarenac, David Murphy, Nina Japundžić-Žigon
PURPOSE OF REVIEW: We present recent advances in understanding of the role of vasopressin as a neurotransmitter in autonomic nervous system control of the circulation, emphasizing hypothalamic mechanisms in the paraventricular nucleus (PVN) involved in controlling sympathetic outflow toward the cardiovascular system. RECENT FINDINGS: Suggest that somato-dendritically released vasopressin modulates the activity of magnocellular neurons in the PVN and SON, their discharge pattern and systemic release...
February 26, 2018: Current Hypertension Reports
Vera Geraldes, Sérgio Laranjo, Isabel Rocha
Hypertension is a prevalent and major health problem, involving a complex integration of different organ systems, including the central nervous system (CNS). The CNS and the hypothalamus in particular are intricately involved in the pathogenesis of hypertension. In fact, evidence supports altered hypothalamic neuronal activity as a major factor contributing to increased sympathetic drive and increased blood pressure. Several mechanisms have been proposed to contribute to hypothalamic-driven sympathetic activity, including altered ion channel function...
February 26, 2018: Current Hypertension Reports
Joseph B Miller, Kushak Suchdev, Namita Jayaprakash, Daniel Hrabec, Aditya Sood, Snigdha Sharma, Phillip D Levy
PURPOSE OF REVIEW: This review summarizes the latest science on hypertensive encephalopathy and posterior reversible encephalopathy syndrome (PRES). We review the epidemiology and pathophysiology of these overlapping syndromes and discuss best practices for diagnosis and management. RECENT FINDINGS: Diagnosis of hypertensive encephalopathy largely relies on exclusion of other neurological emergencies. We review the extensive causes of PRES and its imaging characteristics...
February 26, 2018: Current Hypertension Reports
Mohammad G Saklayen
Metabolic syndrome, variously known also as syndrome X, insulin resistance, etc., is defined by WHO as a pathologic condition characterized by abdominal obesity, insulin resistance, hypertension, and hyperlipidemia. Though there is some variation in the definition by other health care organization, the differences are minor. With the successful conquest of communicable infectious diseases in most of the world, this new non-communicable disease (NCD) has become the major health hazard of modern world. Though it started in the Western world, with the spread of the Western lifestyle across the globe, it has become now a truly global problem...
February 26, 2018: Current Hypertension Reports
Marialuisa Perrotta, Giuseppe Lembo, Daniela Carnevale
PURPOSE OF REVIEW: Hypertension still represents a huge health problem, causing death and disability and rising at epidemic levels worldwide. The availability of a vast array of antihypertensive therapeutic strategies still fails to adequately treat significant fractions of refractory patients. The possible explanation to this disappointing evidence should be ascribed to the fact that myriad of mechanisms contribute to onset and maintenance of hypertension. Although we have been able to develop strategies aimed at counteracting the single mechanisms identified as master regulators of blood pressure, we still lack strategies capable to approach at the complex interactions established among the different pathophysiological mechanisms...
February 24, 2018: Current Hypertension Reports
Andrew King, Mirjana Dimovska, Luke Bisoski
PURPOSE OF REVIEW: Acute drug-induced hypertension, sympathomimetic toxicity, and other hyperadrenergic states can be caused by both xenobiotic toxicity and withdrawal. This manuscript is a selective review of the recent literature regarding pharmacologic causes of hypertensive emergencies and other hyperadrenergic states. RECENT FINDINGS: We will discuss designer stimulants, alpha2 and baclofen agonist withdrawal, and the clinical entity known as posterior reversible encephalopathy syndrome (PRES)...
February 24, 2018: Current Hypertension Reports
Sean Collins, Jennifer Martindale
PURPOSE OF REVIEW: In spite of advances in our understanding of acute heart failure (AHF) and its different phenotypic expressions, AHF management is still centered on volume removal with intravenous diuretics. This narrative review describes the pathophysiology underlying hypertensive AHF and appraises therapies targeting these mechanisms. RECENT FINDINGS: Vascular redistribution rather than volume overload may be the primary determinant of elevated cardiac filling pressures and subsequent pulmonary congestion in patients with hypertensive AHF; in these patients, vasodilators should be the predominant treatment...
February 24, 2018: Current Hypertension Reports
Kumuda C Das, Venkatesh Kundumani-Sridharan, Jaganathan Subramani
PURPOSE OF REVIEW: Although the roles of oxidant stress and redox perturbations in hypertension have been the subject of several reviews, role of thioredoxin (Trx), a major cellular redox protein in age-related hypertension remains inadequately reviewed. The purpose of this review is to bring readers up-to-date with current understanding of the role of thioredoxin in age-related hypertension. RECENT FINDINGS: Age-related hypertension is a major underlying cause of several cardiovascular disorders, and therefore, intensive management of blood pressure is indicated in most patients with cardiovascular complications...
February 14, 2018: Current Hypertension Reports
Alan L Hinderliter, Raven A Voora, Anthony J Viera
PURPOSE OF REVIEW: To review the data supporting the use of ambulatory blood pressure monitoring (ABPM), and to provide practical guidance for practitioners who are establishing an ambulatory monitoring service. RECENT FINDINGS: ABPM results more accurately reflect the risk of cardiovascular events than do office measurements of blood pressure. Moreover, many patients with high blood pressure in the office have normal blood pressure on ABPM-a pattern known as white coat hypertension-and have a prognosis similar to individuals who are normotensive in both settings...
February 5, 2018: Current Hypertension Reports
Robina Josiah Willock, Joseph B Miller, Michelle Mohyi, Ahmed Abuzaanona, Meri Muminovic, Phillip D Levy
PURPOSE OF REVIEW: This review aims to emphasize how therapeutic inertia, the failure of clinicians to intensify treatment when blood pressure rises or remains above therapeutic goals, contributes to suboptimal blood pressure control in hypertensive populations. RECENT FINDINGS: Studies reveal that the therapeutic inertia is quite common and contributes to suboptimal blood pressure control. Quality improvement programs and standardized approaches to support antihypertensive treatment intensification are ways to combat therapeutic inertia...
January 29, 2018: Current Hypertension Reports
Joseph M Pappachan, Nyo Nyo Tun, Ganesan Arunagirinathan, Ravinder Sodi, Fahmy W F Hanna
PURPOSE OF REVIEW: Pheochromocytomas and paragangliomas (PPGLs) are uncommon catecholamine-producing neuroendocrine neoplasms that usually present with secondary hypertension. This review is to update the current knowledge about these neoplasms, the pathophysiology, genetic aspects and diagnostic and therapeutic algorithms based on scientific literature mostly within the past 3 years. RECENT FINDINGS: Eighty to eighty-five percent of PPGLs arise from the adrenal medulla (pheochromocytomas; PCCs) and the remainder from the autonomic neural ganglia (paragangliomas; PGLs)...
January 22, 2018: Current Hypertension Reports
Mateus R Amorim, George Miguel P R Souza, Benedito H Machado
PURPOSE OF REVIEW: Surgical removal of the baroreceptor afferents [sino-aortic denervation (SAD)] leads to a lack of inhibitory feedback to sympathetic outflow, which in turn is expected to result in a large increase in mean arterial pressure (MAP). However, few days after surgery, the sympathetic nerve activity (SNA) and MAP of SAD rats return to a range similar to that observed in control rats. In this review, we present experimental evidence suggesting that breathing contributes to control of SNA and MAP following SAD...
January 22, 2018: Current Hypertension Reports
Korey A Kennelty, Linnea A Polgreen, Barry L Carter
PURPOSE OF REVIEW: We review studies published since 2014 that examined team-based care strategies and involved pharmacists to improve blood pressure (BP). We then discuss opportunities and challenges to sustainment of team-based care models in primary care clinics. RECENT FINDINGS: Multiple studies presented in this review have demonstrated that team-based care including pharmacists can improve BP management. Studies highlighted the cost-effectiveness of a team-based pharmacy intervention for BP control in primary care clinics...
January 18, 2018: Current Hypertension Reports
Matthew A Bailey
The metabolic syndrome describes a clustering of risk factors-visceral obesity, dyslipidaemia, insulin resistance, and salt-sensitive hypertension-that increases mortality related to cardiovascular disease, type 2 diabetes, cancer, and non-alcoholic fatty liver disease. The prevalence of these concurrent comorbidities is ~ 25-30% worldwide, and metabolic syndrome therefore presents a significant global public health burden. Evidence from clinical and preclinical studies indicates that glucocorticoid excess is a key causal feature of metabolic syndrome...
November 14, 2017: Current Hypertension Reports
Revathy Carnagarin, Cynthia Gregory, Omar Azzam, Graham S Hillis, Carl Schultz, Gerald F Watts, Damon Bell, Vance Matthews, Markus P Schlaich
Obesity-related hypertension is commonly characterized by increased sympathetic nerve activity and is therefore acknowledged as a predominantly neurogenic form of hypertension. The sustained sympatho-excitation not only contributes to the rise in blood pressure but also elicits a vicious cycle which facilitates further weight gain and progression of associated co-morbidities. While weight loss and exercise remain at the forefront of therapy for obesity and obesity-related hypertension, the difficulties in achieving and maintaining long-term weight loss with lifestyle measures and the variable blood pressure response to weight loss often necessitate prescription of antihypertensive drug therapy...
October 28, 2017: Current Hypertension Reports
Michael G Semanik
Elevated blood pressures often go unrecognized in pediatric patients, potentially putting children and adolescents at risk for the sequelae of untreated hypertension. This may be partially due to the complexity involved in diagnosing elevated pediatric blood pressures, which demands a high cognitive workload from providers. Tools built into electronic health records have the potential to alleviate this workload, and studies investigating these tools confirm they show promise in improving elevated blood pressure recognition...
October 26, 2017: Current Hypertension Reports
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