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Resistant hypertension and sleep

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https://www.readbyqxmd.com/read/27906840/renal-artery-denervation-for-treatment-of-patients-with-self-reported-obstructive-sleep-apnea-and-resistant-hypertension-results-from-the-global-symplicity-registry
#1
Dominik Linz, Giuseppe Mancia, Felix Mahfoud, Krzysztof Narkiewicz, Luis Ruilope, Markus Schlaich, Ingrid Kindermann, Roland E Schmieder, Sebastian Ewen, Bryan Williams, Michael Böhm
BACKGROUND: Sleep-disordered breathing, predominantly obstructive sleep apnea (OSA), is highly prevalent in patients with hypertension. OSA may underlie the progression to resistant hypertension, partly due to increased activation of the sympathetic nervous system. This analysis of patients with and without OSA evaluated the blood pressure (BP)-lowering effect of sympathetic modulation by renal denervation (RDN) in a real-world setting. METHODS: The Global SYMPLICITY Registry (NCT01534299) is a prospective, open-label, multicenter registry conducted worldwide to evaluate the safety and effectiveness of RDN in patients with uncontrolled hypertension...
January 2017: Journal of Hypertension
https://www.readbyqxmd.com/read/27861249/the-antihypertensive-effects-of-aerobic-versus-isometric-handgrip-resistance-exercise
#2
Garrett I Ash, Beth A Taylor, Paul D Thompson, Hayley V MacDonald, Lauren Lamberti, Ming-Hui Chen, Paulo Farinatti, William J Kraemer, Gregory A Panza, Amanda L Zaleski, Ved Deshpande, Kevin D Ballard, Mohammadtokir Mujtaba, C Michael White, Linda S Pescatello
BACKGROUND: Aerobic exercise reduces blood pressure (BP) on average 5-7 mmHg among those with hypertension; limited evidence suggests similar or even greater BP benefits may result from isometric handgrip (IHG) resistance exercise. METHOD: We conducted a randomized controlled trial investigating the antihypertensive effects of an acute bout of aerobic compared with IHG exercise in the same individuals. Middle-aged adults (n = 27) with prehypertension and obesity randomly completed three experiments: aerobic (60% peak oxygen uptake, 30 min); IHG (30% maximum voluntary contraction, 4 × 2 min bilateral); and nonexercise control...
November 16, 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27837396/prognostic-importance-of-ambulatory-blood-pressure-monitoring-in-resistant-hypertension-is-it-all-that-matters
#3
REVIEW
Claudia R L Cardoso, Gil F Salles
PURPOSE OF REVIEW: This article reviews the current knowledge on the prognostic importance of ambulatory blood pressure (BP) monitoring parameters in patients with apparent treatment-resistant hypertension. RECENT FINDINGS: Although mean 24-h ambulatory BPs have been consistently established as better cardiovascular risk predictors than clinic (office) BPs in several clinical settings, and ambulatory BP monitoring is generally indicated in patients with resistant hypertension; there were only five previous longitudinal prospective studies that specifically evaluated the prognostic importance of ambulatory BP monitoring parameters in resistant hypertensive patients...
December 2016: Current Hypertension Reports
https://www.readbyqxmd.com/read/27823704/effect-of-different-types-of-exercise-on-sleep-quality-of-elderly-subjects
#4
José M T Bonardi, Leandra G Lima, Giulliard O Campos, Rodrigo F Bertani, Júlio C Moriguti, Eduardo Ferriolli, Nereida K C Lima
OBJECTIVE/BACKGROUND: There are still many gaps in research concerning the effect of different physical training modalities on sleep quality in the elderly population. Thus, the objective of the present study was to compare the quality of sleep of hypertensive elderly subjects submitted to two types of training (ie, aerobic exercise alone or combined aerobic and resistance training). PATIENTS/METHODS: Participants aged 60-75 years were randomized to three groups: aerobic group (AG), combined aerobic and resistance group (ARG), and control untrained group (CG)...
September 2016: Sleep Medicine
https://www.readbyqxmd.com/read/27813193/the-importance-of-and-potential-for-continuous-monitoring-of-intraocular-pressure
#5
REVIEW
Charles W McMonnies
Monitoring intraocular pressure (IOP) is a critically important part of glaucoma management; however, clinical tonometry predominantly involves sitting postures and is unable to detect variations in response to posture changes, muscular effort, deep respirations and during a wide range of activities, such as playing high wind-resistance instruments and wearing swimming goggles in addition to eye touching and rubbing. For example, the usefulness of 24-hour tonometric phasing may be increased, if nocturnal assessments included side and prone sleeping postures rather than being limited to supine posture tonometry...
November 3, 2016: Clinical & Experimental Optometry: Journal of the Australian Optometrical Association
https://www.readbyqxmd.com/read/27755119/sympathetic-nerves-and-hypertension-in-stress-sleep-apnea-and-caregiving
#6
Michael G Ziegler, Milos Milic
PURPOSE OF REVIEW: The sympathetic nervous system (SNS) mediates short-term increases in blood pressure. Evidence that psychosocial stress leads to chronic hypertension is mixed. The SNS activation found in obstructive sleep apnea (OSA), caregiving for a severely demented spouse, and obesity more specifically address whether SNS activation might lead to the metabolic syndrome and hypertension. RECENT FINDINGS: Obesity is associated with both increased SNS electrical activity and plasma norepinephrine...
January 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/27754279/hw-03-2-effect-of-cpap-on-the-treatment-of-resistant-hypertension
#7
Seong Hwan Kim
Resistant hypertension is defined as blood pressure that remains above 140/90 mmHg in spite of the concurrent use of three antihypertensive agents of different classes at optimal dosing, of which one should be a diuretic. Accordingly, it is not synonymous with uncontrolled hypertension. Among a variety of risk factors, obstructive sleep apnea (OSA), which is a common type of sleep-disordered breathing, has been recognized a well-established risk factor for resistant hypertension. Indeed, both European and American guidelines for the management of arterial hypertension stated that OSA is a modifiable cause of resistant hypertension...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27754274/sy-17-4-neuro-immune-communication-in-hypertension-a-new-therapeutic-angle
#8
Mohan Raizada
Hypertension (HTN) is the most prevalent modifiable risk for cardiovascular disease (CVD) and disorders directly influencing CVD (i.e. obesity, diabetes, chronic kidney disease, obstructive sleep apnea, etc.). About one billion people worldwide have HTN, with American adults having 90% lifetime risk of developing HTN. Despite aggressive campaign for lifestyle changes and advances in drug therapy, HTN remains an immense health, emotional, and economic challenge. This is due, in part, to the fact that ∼50% of HTN patients' blood pressure remains uncontrolled and ∼20% of HTN patients are resistant to or require > antihypertensive drugs...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27754015/br-04-1management-of-treatment-resistant-hypertension
#9
David John Webb
Treatment-resistant hypertension (TRH) is defined as the failure to achieve an office BP target of <140/90 mmHg (<130/80 mmHg in patients with chronic kidney disease (CKD) or diabetes) in patients with hypertension (HT), despite adherence to at least 3 antihypertensive medications at optimal tolerated doses, ideally including a diuretic (Calhoun et al., Circulation 2008). TRH identifies patients with hard-to-treat HT, who might benefit from specialist investigation and treatment. Although some studies put the prevalence of TRH as >10%, these levels may be inflated by white-coat hypertension and poor adherence...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27753946/os-07-02-differences-in-circadian-blood-pressure-variability-patterns-between-japanese-and-american-treatment-resistant-hypertensive-populations
#10
Kazuomi Kario, Deepak Bhatt, Sandeep Brar, George Bakris
OBJECTIVE: Dynamic changes in 24-hour ambulatory blood pressure (BP) are associated with basal autonomic function and cardiovascular risk. We examined the influence of ethnicity on these parameters by comparing ambulatory BP dynamics in Japanese, African American (AA), and white populations with treatment-resistant hypertension. DESIGN AND METHOD: Both HTN-Japan (N = 41) and SYMPLICITY HTN-3 (N = 384 white and 140 AA) enrolled patients with office systolic BP ≥ 160 mmHg and 24-hour ambulatory systolic BP ≥ 135 mmHg while on ≥3 antihypertensive medications...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27744513/effects-of-obesity-on-cardiovascular-hemodynamics-cardiac-morphology-and-ventricular-function
#11
Martin A Alpert, Jad Omran, Brian P Bostick
Obesity produces a variety of hemodynamic alterations that may cause changes in cardiac morphology which predispose to left and right ventricular dysfunction. Various neurohormonal and metabolic alterations commonly associated with obesity may contribute to these abnormalities of cardiac structure and function. These changes in cardiovascular hemodynamics, cardiac morphology, and ventricular function may, in severely obese patients, predispose to heart failure, even in the absence of other forms of heart disease (obesity cardiomyopathy)...
October 15, 2016: Current Obesity Reports
https://www.readbyqxmd.com/read/27698070/arousal-from-sleep-and-sympathetic-excitation-during-wakefulness
#12
Keri S Taylor, Hisayoshi Murai, Philip J Millar, Nobuhiko Haruki, Derek S Kimmerly, Beverley L Morris, George Tomlinson, T Douglas Bradley, John S Floras
Obstructive apnea during sleep elevates the set point for efferent sympathetic outflow during wakefulness. Such resetting is attributed to hypoxia-induced upregulation of peripheral chemoreceptor and brain stem sympathetic function. Whether recurrent arousal from sleep also influences daytime muscle sympathetic nerve activity is unknown. We therefore tested, in a cohort of 48 primarily nonsleepy, middle-aged, male (30) and female (18) volunteers (age: 59±1 years, mean±SE), the hypothesis that the frequency of arousals from sleep (arousal index) would relate to daytime muscle sympathetic burst incidence, independently of the frequency of apnea or its severity...
October 3, 2016: Hypertension
https://www.readbyqxmd.com/read/27681211/the-metabolic-syndrome-among-danish-seafarers-a-follow-up-study
#13
Jørgen Riis Jepsen, Hanna B Rasmussen
BACKGROUND: The metabolic syndrome (MS) represents a cluster of risk factors related to insulin resistance. Metabolic syndrome is a strong risk factor for chronic metabolic and cardiovascular diseases and is related to nutritional factors, sleep patterns, work-related stress, fatigue, and physical activity - all of which are critical issues at sea. We have previously demonstrated a MS prevalence of 24.2% in Danish seafarers. This study aimed to follow the trend of MS after 2 years' intervention...
2016: International Maritime Health
https://www.readbyqxmd.com/read/27643341/os-07-02-differences-in-circadian-blood-pressure-variability-patterns-between-japanese-and-american-treatment-resistant-hypertensive-populations
#14
Kazuomi Kario, Deepak Bhatt, Sandeep Brar, George Bakris
OBJECTIVE: Dynamic changes in 24-hour ambulatory blood pressure (BP) are associated with basal autonomic function and cardiovascular risk. We examined the influence of ethnicity on these parameters by comparing ambulatory BP dynamics in Japanese, African American (AA), and white populations with treatment-resistant hypertension. DESIGN AND METHOD: Both HTN-Japan (N = 41) and SYMPLICITY HTN-3 (N = 384 white and 140 AA) enrolled patients with office systolic BP ≥ 160 mmHg and 24-hour ambulatory systolic BP ≥ 135 mmHg while on ≥3 antihypertensive medications...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27643276/hw-03-2-effect-of-cpap-on-the-treatment-of-resistant-hypertension
#15
Seong Hwan Kim
Resistant hypertension is defined as blood pressure that remains above 140/90 mmHg in spite of the concurrent use of three antihypertensive agents of different classes at optimal dosing, of which one should be a diuretic. Accordingly, it is not synonymous with uncontrolled hypertension. Among a variety of risk factors, obstructive sleep apnea (OSA), which is a common type of sleep-disordered breathing, has been recognized a well-established risk factor for resistant hypertension. Indeed, both European and American guidelines for the management of arterial hypertension stated that OSA is a modifiable cause of resistant hypertension...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27643271/sy-17-4-neuro-immune-communication-in-hypertension-a-new-therapeutic-angle
#16
Mohan Raizada
Hypertension (HTN) is the most prevalent modifiable risk for cardiovascular disease (CVD) and disorders directly influencing CVD (i.e. obesity, diabetes, chronic kidney disease, obstructive sleep apnea, etc.). About one billion people worldwide have HTN, with American adults having 90% lifetime risk of developing HTN. Despite aggressive campaign for lifestyle changes and advances in drug therapy, HTN remains an immense health, emotional, and economic challenge. This is due, in part, to the fact that ∼50% of HTN patients' blood pressure remains uncontrolled and ∼20% of HTN patients are resistant to or require > antihypertensive drugs...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27642926/br-04-1management-of-treatment-resistant-hypertension
#17
David John Webb
Treatment-resistant hypertension (TRH) is defined as the failure to achieve an office BP target of <140/90 mmHg (<130/80 mmHg in patients with chronic kidney disease (CKD) or diabetes) in patients with hypertension (HT), despite adherence to at least 3 antihypertensive medications at optimal tolerated doses, ideally including a diuretic (Calhoun et al., Circulation 2008). TRH identifies patients with hard-to-treat HT, who might benefit from specialist investigation and treatment. Although some studies put the prevalence of TRH as >10%, these levels may be inflated by white-coat hypertension and poor adherence...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27583667/obstructive-sleep-apnea-during-rapid-eye-movement-sleep-clinical-relevance-and-therapeutic-implications
#18
Mohammed Alzoubaidi, Babak Mokhlesi
PURPOSE OF REVIEW: Obstructive sleep apnea (OSA) is a highly prevalent condition that has been associated with cardiovascular morbidity and mortality, impaired glucose metabolism and daytime functional impairment. Compared with nonrapid eye movement sleep, rapid eye movement (REM) sleep is associated with higher sympathetic activity and cardiovascular instability in healthy individuals and more so in patients with OSA. RECENT FINDINGS: Recent studies have indicated that REM OSA is independently associated with prevalent and incident hypertension, nondipping of nocturnal blood pressure, increased insulin resistance and impairment of human spatial navigational memory...
November 2016: Current Opinion in Pulmonary Medicine
https://www.readbyqxmd.com/read/27568910/impact-of-sleep-disordered-breathing-treatment-on-patient-reported-outcomes-in-a-clinic-based-cohort-of-hypertensive-patients
#19
Harneet K Walia, Sandra D Griffith, Nicolas R Thompson, Douglas E Moul, Nancy Foldvary-Schaefer, Reena Mehra
STUDY OBJECTIVES: We hypothesized that patient reported outcomes (PROs) improve with positive airway pressure (PAP) in patients with sleep-disordered breathing (SDB) and hypertension (HTN). METHODS: Questionnaire-based PROs (sleepiness [Epworth Sleepiness Scale, (ESS)], depression [Patient Health Questionnaire-9 (PHQ-9)], and fatigue [Fatigue Severity Scale (FSS)]) were retrospectively examined in patients with SDB and HTN at baseline and within a year following PAP initiation...
October 15, 2016: Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine
https://www.readbyqxmd.com/read/27566330/diagnosing-and-managing-primary-aldosteronism-in-hypertensive-patients-a-case-based-approach
#20
REVIEW
Robert M Carey
Primary aldosteronism with a prevalence of 8 % of hypertension and 20 % of pharmacologically resistant hypertension is the most common secondary cause of hypertension. Yet, the diagnosis is missed in the vast majority of patients. Current clinical practice guidelines recommend screening for primary aldosteronism in patients with sustained elevation of blood pressure (BP) ≥150/100 mmHg if possible prior to initiation of antihypertensive therapy, and in patients with resistant hypertension, spontaneous or diuretic-induced hypokalemia, adrenal incidentaloma, obstructive sleep apnea, a family history of early onset of hypertension or cerebrovascular accident <age 40, and first-degree relatives of patients with primary aldosteronism...
October 2016: Current Cardiology Reports
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