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hypertension guideline treatment

Gerd Hasenfuß
Prevention strategies for cardiac events depend of the risk for such an event. A very high risk is defined by a risk >10% over 10 years. For example, a patient with known coronary artery disease has such a very high risk to die. However a patient with diabetes and severe hypertension without known coronary artery disease carries the same risk. Here, secondary prevention and primary prevention overlap. Prevention guidelines include a number of general recommendations such as changes in behavior, smoking intervention strategies, nutrition, body weight, and physical activity...
October 19, 2018: Kardiologia Polska
Punnaka Pongpanich, Pasvich Pitakpaiboonkul, Kullaya Takkavatakarn, Kearkiat Praditpornsilpa, Somchai Eiam-Ong, Paweena Susantitaphong
BACKGROUND: The prevalence of hypertension and its associated complications are markedly growing. Most patients need more than one drug to achieve blood pressure (BP) target. However, most guidelines only focus on the first-line treatment. We conducted a meta-analysis to explore the benefits of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin II receptor blockers (ARBs) combined with calcium channel blockers (CCBs) on metabolic, renal, and cardiovascular outcomes in hypertensive patients...
October 15, 2018: International Urology and Nephrology
Charles J Fox, Elyse M Cornett, Brendon M Hart, Aaron J Kaye, Shilpadevi S Patil, Michelle Carroll Turpin, Angelica Valdez, Richard D Urman, Alan D Kaye
Numerous conditions give rise to pulmonary arterial hypertension (PAH), with most of them being idiopathic. Signs and symptoms are generally difficult to recognize initially because they present as nonspecific and typically are mistaken for age-related physiological processes or alternate medical conditions. Many advances have been made toward PAH-specific therapies that have led to advanced clinical management of the disease. The present investigation describes new pulmonary vasodilator agents that are currently available or under development that could impact perioperative management...
June 2018: Best Practice & Research. Clinical Anaesthesiology
Carlos Moctezuma-Velazquez, Francesca Saffioti, Stephanie Tasayco-Huaman, Stefania Casu, Andrew Mason, Davide Roccarina, Victor Vargas, Jan-Erick Nilsson, Emmanuel Tsochatzis, Salvador Augustin, Aldo J Montano-Loza, Annalisa Berzigotti, Douglas Thorburn, Joan Genesca, Juan Gonzalez Abraldes
BACKGROUND: Baveno-VI guidelines recommend that patients with compensated cirrhosis with liver stiffness by transient elastography (LSM-TE) <20 kPa and platelets >150,000/mm3 do not need an esophagogastroduodenoscopy (EGD) to screen for varices, since the risk of having varices needing treatment (VNT) is <5%. It remains uncertain if this tool can be used in patients with cholestatic liver diseases (ChLDs): primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC)...
October 12, 2018: American Journal of Gastroenterology
Andrea Olschewski, Eva M Berghausen, Christina A Eichstaedt, Bernd K Fleischmann, Ekkehard Grünig, Gabriele Grünig, Georg Hansmann, Lars Harbaum, Jan K Hennigs, Danny Jonigk, Wolfgang M Kuebler, Grazyna Kwapiszewska, Soni S Pullamsetti, Elvira Stacher, Norbert Weissmann, Daniela Wenzel, Ralph T Schermuly
The European guidelines, which focus on clinical aspects of pulmonary hypertension (PH), provide only minimal information about the pathophysiological concepts of PH. Here, we review this topic in greater detail, focusing on specific aspects in the pathobiology, pathology and genetics, which include mechanisms of vascular inflammation, the role of transcription factors, ion channels/ion channel diseases, hypoxic pulmonary vasoconstriction, genetics/epigenetics, metabolic dysfunction, and the potential future role of histopathology of PH in the modern era of PH therapy...
September 20, 2018: International Journal of Cardiology
Nanna Maaløe, Camilla B Andersen, Natasha Housseine, Tarek Meguid, Ib C Bygbjerg, Jos van Roosmalen
OBJECTIVE: To estimate the effect of locally tailored clinical guidelines on intrapartum care and perinatal outcomes among women with severe hypertensive disorders in pregnancy (sHDP). METHODS: A pre-post study at Zanzibar's low-resource Mnazi Mmoja Referral Hospital, Zanzibar, included all laboring women with sHDP were included at baseline (October 2014 to January 2015) and at 9-12 months after implementation of the ongoing intervention (October 2015 to January 2016)...
October 11, 2018: International Journal of Gynaecology and Obstetrics
Ying Zheng, Li Tang, Weiguang Zhang, Delong Zhao, Dong Zhang, Li Zhang, Guangyan Cai, Xiangmei Chen
Background: The 2017 high blood pressure (BP) clinical practice guideline reported by the American College of Cardiology/American Heart Association put forward new categories of BP. This study aimed to assess the applicability of the new guideline in a nondialysis chronic kidney disease (CKD) population. Methods: This is a nationwide, multicenter, cross-sectional study with a large sample. A total of 8927 nondialysis CKD patients in 61 tertiary hospitals in all 31 provinces, municipalities and autonomous regions of China (except Hong Kong, Macao and Taiwan) were analyzed...
October 9, 2018: Nephrology, Dialysis, Transplantation
Craig S Anderson, Mark Woodward, Hisatomi Arima, Xiaoying Chen, Richard I Lindley, Xia Wang, John Chalmers, Thompson G Robinson
Background The ENhanced Control of Hypertension And Thrombolysis strokE study (ENCHANTED) trial was initiated as a 2 × 2 partial-factorial active-comparison, prospective, randomized, open, blinded endpoint clinical trial to evaluate in thrombolysis-eligible acute ischemic stroke (AIS) patients whether: (1) Arm A - low-dose (0.6 mg/kg body weight) intravenous (iv) alteplase has noninferior efficacy and lower risk of symptomatic intracerebral hemorrhage (sICH) compared with standard-dose (0.9 mg/kg body weight) iv alteplase; and (2) Arm B - early intensive blood pressure (BP) lowering (systolic target 130-140 mmHg) has superior efficacy and lower risk of ICH compared with guideline-recommended BP control (systolic target <180 mmHg)...
October 9, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
Jan Hoffmann, Susan P Mollan, Koen Paemeleire, Christian Lampl, Rigmor H Jensen, Alexandra J Sinclair
BACKGROUND: Idiopathic Intracranial Hypertension (IIH) is characterized by an elevation of intracranial pressure (ICP no identifiable cause. The aetiology remains largely unknown, however observations made in a number of recent clinical studies are increasing the understanding of the disease and now provide the basis for evidence-based treatment strategies. METHODS: The Embase, CDSR, CENTRAL, DARE and MEDLINE databases were searched up to 1st June 2018. We analyzed randomized controlled trials and systematic reviews that investigate IIH...
October 8, 2018: Journal of Headache and Pain
Dhruv Mahtta, Islam Y Elgendy, Carl J Pepine
Coronary artery disease (CAD) remains the leading cause of mortality and morbidity worldwide, and hypertension is its most prevalent modifiable risk factor. Patients with CAD and concomitant hypertension are a special population with distinct physiologic and structural alterations. Optimal blood pressure (BP) control in this population has been linked with reduction in adverse outcomes, however, excessive lowering of BP could jeopardize myocardial and cerebral perfusion. Areas covered: Authors highlight the prevalence of the CAD and hypertension dyad, as well as the implications of various structural and physiological changes in this population...
October 8, 2018: Expert Review of Cardiovascular Therapy
Guido Grassi
No abstract text is available yet for this article.
October 2, 2018: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
Brent Egan, John Flack, Mehul Patel, Sofia Lombera
A quantitative survey was completed by 103 primary care physicians (PCPs) and 59 cardiologists who regularly prescribed β-blockers to assess knowledge and use of this heterogeneous drug class for hypertension. More cardiologists than PCPs chose β-blockers as initial antihypertensive therapy (30% vs 17%, P < 0.01). Metoprolol and carvedilol were the most commonly prescribed β-blockers. Cardiologists rated "impact on energy" and "arterial vasodilation" as more important than PCPs (P < 0...
October 2018: Journal of Clinical Hypertension
Susana Lopes, José Mesquita-Bastos, Alberto J Alves, Fernando Ribeiro
Although there has been an observed progress in the treatment of hypertension, its prevalence remains elevated and constitutes a leading cause of cardiovascular disease development. Resistant hypertension is a challenge for clinicians, as the available treatment options have reduced success. Physical activity and exercise training play an important role in the management of blood pressure. The importance of physical activity and exercise training as part of a comprehensive lifestyle intervention is acknowledged by several professional organizations in their recommendations/guidelines for the management of arterial hypertension...
2018: Integrated Blood Pressure Control
Michel Farnier
Total cardiovascular risk estimation using a system such as SCORE is recommended for adults>40years of age without evidence of cardiovascular disease, diabetes, chronic kidney disease, severe hypertension or familial hypercholesterolemia. Before treatment, a full lipid profile is recommended, fasting in French guidelines, fasting or non-fasting in European guidelines. LDL-C has to be used as the primary target for treatment. For patients with elevated triglycerides, non-HDL-C level is also recommended as the secondary goal for treatment...
September 28, 2018: La Presse Médicale
Aziz S Alali, Nancy Temkin, Jason Barber, Jim Pridgeon, Kelley Chaddock, Sureyya Dikmen, Peter Hendrickson, Walter Videtta, Silvia Lujan, Gustavo Petroni, Nahuel Guadagnoli, Zulma Urbina, Randall M Chesnut
OBJECTIVE: While existing guidelines support the treatment of intracranial hypertension in severe traumatic brain injury (TBI), it is unclear when to suspect and initiate treatment for high intracranial pressure (ICP). The objective of this study was to derive a clinical decision rule that accurately predicts intracranial hypertension. METHODS: Using Delphi methods, the authors identified a set of potential predictors of intracranial hypertension and a clinical decision rule a priori by consensus among a group of 43 neurosurgeons and intensivists who have extensive experience managing severe TBI without ICP monitoring...
September 28, 2018: Journal of Neurosurgery
Cesar Augusto Guevara-Cuellar, Victoria Eugenia Soto, María Isabel Molina-Echeverry
Background: Hypertension represents a high burden of disease in different healthcare systems. Recent guideline published in 2017 by the American Heart Association and the American College of Cardiology has generated a debate between clinicians and policymakers due to the lowering of diagnosis threshold and the subsequent increase of the prevalence and healthcare costs. No empirical research exists addressing the question about the pressure on healthcare costs generated by new standards...
2018: Cost Effectiveness and Resource Allocation: C/E
Reinhold Kreutz, Insa M Schmidt, Dagmar Dräger, Franca Brüggen, Stefan Hörter, Christine Zwillich, Adelheid Kuhlmey, Paul Gellert
AIM: Evidence on antithrombotic therapy use in centenarians diagnosed with atrial fibrillation (AF) is sparse. Our objective was to investigate a possible underprescribing in centenarians relative to younger cohorts of the oldest-old. We assumed lower AF rates; and, within AF patients, lower use of anticoagulants in those who died as centenarians (aged ≥100 years) than in those who died aged in their 80s (≥80 years) or 90s (≥90 years). METHODS: The present study was a quarterly structured cohort study over the 6 years before death using administrative data from German institutionalized and non-institutionalized insured patients (whole sample n = 1398 and subsample of AF patients n = 401 subclassified according to age-of-death groups [≥80, ≥90, ≥100 years])...
September 26, 2018: Geriatrics & Gerontology International
Faisal Rahman, John W McEvoy
PURPOSE OF REVIEW: Recent US guidelines have changed the definition of hypertension to ≥ 130/80 mmHg and recommended more intense blood pressure (BP) targets. We summarize the evidence for intense BP treatment and discuss risks that must be considered when choosing treatment goals for individual patients. RECENT FINDINGS: The SPRINT study reported that treating to a systolic BP target of 120 mmHg reduces cardiovascular outcomes in high-risk individuals, supporting more intensive BP reduction than previously recommended...
September 26, 2018: Current Cardiology Reports
Leah Spiro, Donna Scemons
Aim: The aim of this discussion paper is to outline the guidelines, according to the American Congress of Obstetricians and Gynecologists, about how to manage hypertension before and during pregnancy. Primary providers lack the knowledge to initiate treatment and manage hypertension in patients who are family planning or in the early stages of pregnancy before transferring care to an obstetrician, or perhaps patients who never do transfer care for lack of accessibility or funding. This paper aims to discuss how the Family Nurse Practitioner, or other primary care providers, may safely and efficiently maintain stable blood pressures in patients with hypertension before, during, and after pregnancy...
2018: Open Nursing Journal
Lina Liu, Guang Su, Shuling Wang, Bingqian Zhu
PURPOSE: Obstructive sleep apnea (OSA) is common during pregnancy. Nevertheless, prevalence estimates of OSA have varied widely due to variabilities in the assessment methods. This meta-analysis aimed to examine the prevalence of objectively assessed OSA and its association with pregnancy-related health outcomes in pregnant women. METHODS: This review was developed following the PRISMA guideline. A systematic search was conducted in major electronic databases to identify studies conducted from inception to January 2018...
September 25, 2018: Sleep & Breathing, Schlaf & Atmung
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