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hypertension guideline treatment

Susanne Muehlschlegel
PURPOSE OF REVIEW: This article reviews the epidemiology, clinical presentation, diagnosis, and management of patients with aneurysmal subarachnoid hemorrhage (SAH). SAH is a type of hemorrhagic stroke and is a neurologic emergency with substantial morbidity and mortality. This article reviews the most common and potentially life-threatening neurologic and medical complications to promote their early recognition and prevent secondary brain injury. RECENT FINDINGS: Over the past 30 years, the incidence of SAH has remained stable; yet, likely because of improved care in specialized neurocritical care units, discharge mortality has considerably decreased...
December 2018: Continuum: Lifelong Learning in Neurology
Maurizio Bussotti, Marinella Sommaruga
Background: Anxiety and depression are frequent disorders in patients with pulmonary arterial hypertension (PAH), but despite this only less than one-fourth of them is treated. Our aim was to review the studies regarding the prevalence and the impact of anxiety and depression and to propose management challenges. Methods: A literature review regarding 1) anxiety and depression studies in PAH patients and caregivers, 2) psychological interventions, 3) slow breathing approach, and 4) pharmacological approach was performed, based on evidence of effectiveness through a search of the most well-known databases (Cochrane Library, Medline, PsychINFO [2004-2018])...
2018: Vascular Health and Risk Management
Ute Hoffmann, Jan-Marc Thrun
In the "2018 ESC/ESH Guidelines for the management of arterial hypertension" there are new blood pressure (BP) recommendations with regard to older patients based on randomized controlled trials and well-conducted meta-analyses performed during the last years.It is recommended to base the diagnosis of hypertension on repeated office BP measurements under standardized conditions and in older people in out-of-office BP measurement with ABPM and/or HBPM if logistically and economically feasible. Furthermore lying and standing BP measurements should also be considered in subsequent visits in older people to exclude orthostatic hypotension...
December 2018: Deutsche Medizinische Wochenschrift
Andreas Jekell, Peter M Nilsson, Thomas Kahan
Background The development and risk potential of hypertension-induced left ventricular (LV) hypertrophy has been well described in epidemiological studies. Regression of LV hypertrophy reduces cardiovascular morbidity and mortality. However, the best treatment strategy is still debated, as well as the appropriate blood pressure target in these patients. Objective We here review the treatment of LV hypertrophy and the potential benefit on clinical outcomes, against a background of the epidemiology and pathophysiology...
December 2, 2018: Current Pharmaceutical Design
Konstantinos Dimopoulos, Robin Condliffe, Robert M R Tulloh, Paul Clift, Rafael Alonso-Gonzalez, Radwa Bedair, Natali A Y Chung, Gerry Coghlan, Samantha Fitzsimmons, Alessandra Frigiola, Luke S Howard, Petra Jenkins, Damien Kenny, Wei Li, Simon T MacDonald, Colm McCabe, James J Oliver, Mark S Spence, Gergely V Szantho, Kate von Klemperer, Dirk G Wilson, Stephen J Wort
Echocardiography is the mainstay in screening for pulmonary hypertension (PH). International guidelines suggest echocardiographic parameters for suspecting PH, but these may not apply to many adults with congenital heart disease (ACHD). PH is relatively common in ACHD patients and can significantly affect their exercise capacity, quality of life, and prognosis. Identification of patients who have developed PH and who may benefit from further investigations (including cardiac catheterization) and treatment is thus extremely important...
December 4, 2018: Journal of the American College of Cardiology
Edda Maria Capodaglio
OBJECTIVES: Physical activity is a key element in the prevention, treatment and rehabilitation of many diseases. METHODS: In the context of an adequate lifestyle, its practice amplifies the health benefits and increases the fitness, and furthermore counteracts the development and progression of chronic non-communicable diseases, modulating many risk factors. Its function is important in all life cycles and helps to keep the functional capabilities and independence even with aging...
June 2018: Giornale Italiano di Medicina del Lavoro Ed Ergonomia
Tamara Knežević, Lana Gellineo, Ana Jelaković, Vedran Premužić, Živka Dika, Mario Laganović, Bojan Jelaković
Regardless of having similar antihypertensive effect, different antihypertensive drug classes have different effect on albuminuria.Patients with albuminuria will usually need more than one drug to achieve blood pressure control, particularly if the aim is also to reduce albuminuria.Albuminuria is independently associated with cardiovascular and renal risk regardless of diabetes status. The recent ESC/ESH guidelines listed microalbuminuria among the hypertension-mediated organ damages. Albumin-to-creatinine ratio was suggested to be included in the routine workup for evaluation of every hypertensive patient and changes in albuminuria were considered to have moderate prognostic value...
November 26, 2018: Current Pharmaceutical Design
Juan Fdez-Olivares, Eva Onaindia, Luis Castillo, Jaume Jordán, Juan Cózar
The conciliation of multiple single-disease guidelines for comorbid patients entails solving potential clinical interactions, discovering synergies in the diagnosis and the recommendations, and managing clinical equipoise situations. Personalized conciliation of multiple guidelines considering additionally patient preferences brings some further difficulties. Recently, several works have explored distinct techniques to come up with an automated process for the conciliation of clinical guidelines for comorbid patients but very little attention has been put in integrating the patient preferences into this process...
November 22, 2018: Artificial Intelligence in Medicine
B Çitamak, A C Bozaci, M Altan, H B Haberal, O Kahraman, T Ceylan, H S Doğan, S Tekgül
INTRODUCTION: Vesicoureteral reflux (VUR) is an anatomic or functional disorder, and it is a condition associated with renal scarring, hypertension, and end-stage renal disease. Renal damage can be prevented by appropriate medical and surgical intervention for selected patients. OBJECTIVES: The objective of this study was to retrospectively analyze the surgically treated patient group of this study in reference to the risk analysis criteria used in European Association of Urology (EAU), European Society for Paediatric Urology (ESPU) guidelines to see the outcome of the study management protocol within the last 15 years in respect to this risk analysis...
October 27, 2018: Journal of Pediatric Urology
Rita Del Pinto, Claudio Ferri
Hypertension is a risk factor for cardiovascular morbidity and mortality with increasing prevalence with age, whose treatment is associated with benefits over fatal and non-fatal cardiovascular events even later in life. However, there are persistent concerns on the short- and long-term weighted benefits of treating hypertension in the very old, particularly in those with specific clinical features. In fact, a broad range of clinical scenarios can be observed at older ages, spanning from the healthy to the frailest patient, and hypertension clinical trials have traditionally excluded the latter, thus preventing the unconditioned application to these patients of the same recommendations as in younger ages...
November 22, 2018: High Blood Pressure & Cardiovascular Prevention: the Official Journal of the Italian Society of Hypertension
Dong Zhao, Jing Liu, Miao Wang, Xingguang Zhang, Mengge Zhou
Cardiovascular disease (CVD) is the leading cause of death in China. To develop effective and timely strategies to cope with the challenges of CVD epidemics, we need to understand the current epidemiological features of the major types of CVD and the implications of these features for the prevention and treatment of CVD. In this Review, we summarize eight important features of the epidemiology of CVD in China. Some features indicate a transition in CVD epidemiology owing to interrelated changes in demography, environment, lifestyle, and health care, including the rising burden from atherosclerotic CVD (ischaemic heart disease and ischaemic stroke), declining mortality from haemorrhage stroke, varied regional epidemiological trends in the subtypes of CVD, increasing numbers of patients with moderate types of ischaemic heart disease and ischaemic stroke, and increasing ageing of patients with CVD...
November 22, 2018: Nature Reviews. Cardiology
Tianmeng Yang, Rongjiong Zheng, Qingmei Chen, Yushan Mao
BACKGROUND: The treatment status of type 2 diabetes mellitus (T2DM) in Ningbo has not been reported in the past. To evaluate the current status of T2DM in Ningbo and provide evidence to formulate more policies, a multicenter investigation was needed. METHODS: The Ningbo Clinical Research Group of Diabetes constituted nine hospitals. Participants included 3015 patients who visited the nine hospitals from June to December 2016. General characteristics, the medication situation, the laboratory indexes in nearly 3 months consisting of glycosylated hemoglobin level (HbA1c), low-density lipoprotein cholesterol (LDL-C), and fasting blood glucose (FBG), and the results of ophthalmologic examination were investigated...
November 21, 2018: Journal of Clinical Laboratory Analysis
Ashish Kumar Dwivedi, Achal Sharma, Virendra Deo Sinha
Object: Coagulopathy is a common occurrence following traumatic brain injury (TBI). There are various studies showing incidence and risk factors of coagulopathy and their correlation with poor outcome in adult as well as paediatric age groups. Exact incidence, associated risk factors, treatment guideline for coagulopathy and its impact on outcome are still lacking. In our study we compared the adults and paediatric age groups TBI patients for incidence and risk factors of coagulopathy and its impact on outcome...
October 2018: Asian Journal of Neurosurgery
Monica Guzman-Limon, Joshua Samuels
The etiology of hypertension in children and adolescents is varied; however, the prevalence of pediatric primary hypertension is increasing. Early identification and appropriate management of hypertension in children and adolescents is important to prevent the development of hypertensive end organ disease. The 2017 American Academy of Pediatrics Clinical Practice Guidelines for the Screening and Management of High Blood Pressure in Children and Adolescents provide a comprehensive reference for evaluation and management of hypertension in this age group and should be used when assessing patients with elevated blood pressure and hypertension...
February 2019: Pediatric Clinics of North America
Veronica Franco, John J Ryan, Vallerie V McLaughlin
Prevalence of pulmonary arterial hypertension (PAH) is higher in women, and the mechanism remains unclear. Prognosis is overall better for female compared with male patients with PAH. Pregnancy is associated with significant risk, mortality, and morbidity in patients with PAH; consensus guidelines recommend against pregnancy and counsel about early termination in these patients. Recent advances in treatment showed improvement in prognosis in small case reports of pregnant patients with PAH, particularly with the early use of parental prostacyclin...
January 2019: Heart Failure Clinics
Lyudmyla N Prystupa, Irina O Moiseyenko, Victoria Yu Garbuzova, Vladyslava V Kmyta, Irina A Dudchenko
OBJECTIVE: Introduction: All components of the metabolic syndrome (MS) are the risk factors for the cardiovascular diseases, and their combination a great deal accelerates and complicates development of the diseases. Phenotypic expression of MS depends on the interaction of genetic and environmental factors. The aim: The aim is to study the association of metabolic syndrome components with the genotypes of the C825T polymorphism in the GNB3 gene, which allows predicting the risks and determining individual lifestyle and treatment program for the future...
2018: Wiadomości Lekarskie: Organ Polskiego Towarzystwa Lekarskiego
Habib Bouzina, Göran Rådegran
In pulmonary arterial hypertension (PAH), severe vasoconstriction and remodelling of small pulmonary arteries result in high mortality. Receptor tyrosine kinases and their ligands, such as transforming growth factor (TGF)-α, modulate proliferation in PAH. Although the receptor tyrosine kinase c-Kit has been shown to be overexpressed in PAH, the expression and role of its ligand stem cell factor (SCF) remain unknown. However, low plasma SCF levels are known to be linked to higher cardiovascular mortality risk...
October 2018: ERJ Open Research
Sumei Wang, Miao Yu, Xiangchun Zheng, Shangjuan Dong
Pulmonary arterial hypertension (PAH) can be relieved by pharmacological interventions, especially the targeted drug, which is classified into endothelin receptor antagonist, phosphodiesterase 5 inhibitor, prostaglandin I2 , soluble guanylate cyclase stimulator and selective non-prostanoid prostacyclin receptor agonist. To solve the contradictions existing in reported trials and provide a comprehensive guideline for clinical practice. PubMed, Embase, Cochrane library, and were searched. The basic information about the article, trial, arm, intervention, and the detailed data of outcome, including 6 minutes walking distance (6MWD) change, WHO functional class (FC) improvement, Borg dyspnea score (BDS) change, cardiac index (CI) change, mean pulmonary arterial pressure (mPAP) change, mean right arterial pressure (mRAP) change, pulmonary vascular resistance (PVR) change, clinical worsening, hospitalization, death, severe adverse events (SAEs), and withdrawal were extracted...
November 2018: Drug Delivery
Jiří Veselý
Spironolactone, a mineralocorticoid receptor antagonist, is used in the treatment of hypertension for over 50 years. Due to the absence of morbidity and mortality studies, it is not considered to be a first-choice drug in the treatment of patients with primary hyperaldosteronism. However, it has a secure and stable position in the treatment of resistant hypertension. The effect of spironolactone on blood pressure lowering in antihypertensive combination therapy was demonstrated in several uncontrolled trials...
2018: Vnitr̆ní Lékar̆ství
P Xhignesse, J M Krzesinski
New European guidelines for high blood pressure management have just been published in 2018, modifying those published in 2013 and may be seen as a response to those published by the American societies late 2017. The latter proposed a new definition of hypertension (blood pressure equal or higher than 130/80 mmHg), a therapeutic approach based on the evaluation of the cardiovascular risk, and a blood pressure target inferior to130/80 mmHg in all patients, even those older than 80 years still valid. The European guidelines, on the contrary, maintain the definition threshold of hypertension to a blood pressure equal or higher than 140/90 mmHg...
November 2018: Revue Médicale de Liège
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