Read by QxMD icon Read


Guido Grassi, Fosca Quarti-Trevano, Anna Casati, Raffaella Dell'Oro
PURPOSE OF REVIEW: Detection of elevated blood pressure values in elderly patients represents a common clinical condition associated with an increased cardiovascular risk. This has been shown to be the case in both systodiastolic and isolated systolic hypertension as well. However, despite the evidence of the benefits of the blood pressure lowering intervention in terms of reduction of cardiovascular morbidity and mortality, at least two issues related to antihypertensive drug treatment in aged individuals are still undefined: (1) the blood pressure threshold at which antihypertensive drug should be initiated and (2) the blood pressure goals of the therapeutic intervention...
December 2016: Current Atherosclerosis Reports
Muath M Altarawneh, Aaron Petersen, Robert Smith, David M Rouffet, Francois Billaut, Ben D Perry, Victoria L Wyckelsma, Antony Tobin, Michael J McKenna
PURPOSE: Salbutamol inhalation is permissible by WADA in athletic competition for asthma management and affects potassium regulation, which is vital for muscle function. Salbutamol effects on arterial potassium concentration ([K(+)]a) during and after high-intensity continuous exercise (HIcont) and intermittent exercise comprising repeated, brief sprints (HIint), and on performance during HIint are unknown and were investigated. METHODS: Seven recreationally active men participated in a double-blind, randomised, cross-over design, inhaling 1000 µg salbutamol or placebo...
October 22, 2016: European Journal of Applied Physiology
Anne-Laure Faucon, Anne-Marie Madjalian, Guillaume Bobrie, Laurence Amar, Michel Azizi
Blood pressure is a major determinant of cardiovascular risk. Blood pressure target to reach with antihypertensive therapy, and the population to whom it should apply, remain debatted. Blood pressure goals established by scientific societies may be revised after the publication of the US multicenter SPRINT study results (Systolic Blood Pressure Intervention Trial) obtained in 2015. Analysis of the generalizability of the SPRINT results shows that they may not be directly applied to the french population which is at lower risk than the US population and would have major medical and economic implications...
October 2016: Médecine Sciences: M/S
Satoshi Hoshide, Yuichiro Yano, Hajime Haimoto, Kayo Yamagiwa, Kiyoshi Uchiba, Shoichiro Nagasaka, Yoshio Matsui, Akira Nakamura, Motoki Fukutomi, Kazuo Eguchi, Joji Ishikawa, Kazuomi Kario
OBJECTIVE: The SPRINT (Systolic Blood Pressure Intervention Trial) recently demonstrated that strict blood pressure (BP) control resulted in a lower cardiovascular disease (CVD) risk compared to standard BP control, however, this association was not observed regarding the incidence of stroke. Previous studies revealed that the contribution of BP as a risk factor was higher for stroke incidence than for any other CVD, especially in Asian populations. It is thus not clear whether the results of the SPRINT can be generalized to all Asian populations...
September 2016: Journal of Hypertension
Jongha Park
Cardiovascular (CV) risk assessment is not easy in chronic kidney disease (CKD) patients. Age, male sex, race, family history of CV disease, smoking status and diabetes should be considered as CV risk factors as the general population. It is also accepted that hypertension (HTN) is associated with the greater risk of CV complications in this population. However, there are some concerns in this issue.First, supporting evidence for specific blood pressure (BP) targets in CKD is scarce. Many observational studies reported a J-shaped association between BP level and CV mortality unlike a linear association in the general population...
September 2016: Journal of Hypertension
Sadayoshi Ito
SPRINT is one of the landmark studies, demonstrating that extensive blood pressure (BP) control (BP < 120 mmHg) is superior to standard control (BP < 140 mmHg) in preventing cardiovascular event (CVE). Subjects recruited were older than 50 years without diabetes and had increased risk of CVE. Heart failure, death from cardiovascular cause and death from any cause were major endpoints reduced by extensive BP control. In subgroup analysis, whole spectrum of patients were benefitted. Contrary to several previous studies, this study provides strong evidence for the beneficial effect of extensive BP reduction...
September 2016: Journal of Hypertension
Clive Rosendorff
Many guidelines for the management of hypertension have recommended that the goal of antihypertensive treatment in the elderly (usually specified as 80 years or above) should be less than 150/90 mmHg. SPRINT included subjects 50 years or above, and a substantial proportion of subjects 75 years and older. These are individuals at high risk for adverse cardiovascular events because of high prevalence of hypertension and atherosclerotic disease. The less stringent BP goals have been based on a percieved danger of lowering BP to levels that threaten vital organ pefusion (myocardium, brain, kidney)...
September 2016: Journal of Hypertension
Daniel W Jones
Hypertension and Chronic Kidney Disease are both common. The vast majority of patients with chronic kidney disease (CKD) have hypertension. Hypertension can be both a cause and a result of CKD. Many patients with CKD, both diabetic and non-diabetic have overt proteinuria (>300 mg/day). Patients with proteinuria are at higher risk for progression of kidney disease and for atherosclerosis. Because patients with CKD are often excluded from hypertension trials with hard outcomes, there has been until recently less data than ideal to consider in making decisions...
September 2016: Journal of Hypertension
Paul Whelton
BACKGROUND: Choice of the optimal target for blood pressure (BP) reduction during treatment of patients with hypertension, including those with underlying co-morbid conditions, is an important challenge in clinical practice. The Systolic Blood Pressure Intervention Trial (SPRINT) was designed to provide guidance in selection of a Systolic BP target during treatment of hypertension. METHODS: Adults ≥50 years old with hypertension and at least one additional risk factor for cardiovascular disease (CVD), but excluding persons with diabetes mellitus, prior stroke, or advanced chronic kidney disease (CKD) were randomly assigned to intensive therapy (intensive), targeting a systolic BP (SBP) <120 mmHg, or standard therapy (standard), targeting a SBP <140 mmHg...
September 2016: Journal of Hypertension
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
Guido Grassi
The Systolic Blood Pressure Intervention Trial (SPRINT), sponsored by the National Heart, Lung and Blood Institute in the USA, allocated 9361 hypertensive patients (mean age 68 years) to two systolic blood pressure treatment targets (either < 120mmHg or < 140mmHg). Although SPRINT intended to enrol hypertensive patients at high cardiovascular risk, it specifically excluded patients with diabetes mellitus or prior stroke. SPRINT was stopped earlier than planned, after a mean follow-up of 3.26 years, on the recommendation of its data and safety monitoring board, and data were published on 9 November 2015...
September 2016: Journal of Hypertension
Alberto Zanchetti
The question of BP targets of antihypertensive treatment has been debated in recent guidelines, and reopened by publication of SPRINT. Although interpretation of SPRINT is made difficult by a preferential effect of more intense BP lowering on heart failure rather than stroke and myocardial infarction, and by a different method of BP measurement, recent meta-analyses by my group have shown SBP reduction <130 mmHg can reduce risk of cardiovascular (CV) outcomes further, but absolute benefit is smaller than that achieved across the 140 mmHg cutoff, and treatment discontinuations for adverse events become greater...
September 2016: Journal of Hypertension
Ernesto Schiffrin
Hypertension has been defined by the levels of BP above which lowering BP will reduce the cardiovascular risk associated with elevated BP. This level has been classically 140/90 mmHg on the basis of actuarial data from the insurance industry. However, we now know that cardiovascular risk rises progressively from levels as low as 115/75 mmHg upward with a doubling of the incidence of both coronary heart disease and stroke for every 20/10-mmHg increment of BP. In uncomplicated hypertension without cardiovascular risk factors or target organ damage, there is little randomized clinical trial evidence that lowering SBP of <160 mmHg reduces cardiovascular risk...
September 2016: Journal of Hypertension
David Wheeler
Hypertension is the most prevalent complication of chronic kidney disease (CKD). Lowering high blood pressure slows progressive loss of kidney function and may also reduce the associated risk of cardiovascular complications, a common cause of premature death in CKD patients.Current International Guidelines produced by Kidney Disease: Improving Global Outcomes (KDIGO) acknowledges that no single BP target is optimal for all CKD patients, and encourages individualization of treatment depending on age, the severity of albuminuria and comorbidities...
September 2016: Journal of Hypertension
Lawrence Appel
The identification of explicit blood pressure targets for clinical management remains controversial, particularly in older individuals with co-morbidities. Recommendations from the panel appointed to the Eighth Joint National Committee (JNC 8) and results of the SPRINT trial have rekindled interest in this issue. JNC8 recommended a higher (more relaxed) BP goal of < 150/90, instead of the traditional BP goal of <140/90, in persons aged 60+. In contrast, the recently completed SPRINT trial, which enrolled high risk patients without diabetes, documented that a lower (more stringent) SBP goal of <120 mmHg reduced total mortality and cardiovascular disease events compared to <140 mmHg...
September 2016: Journal of Hypertension
Hiromi Rakugi
European guidelines (ESH-ESC2013) for the elderly have discussed well about treatment blood pressure (BP) levels and targeting BP levels. In general, elderly patients with systolic BP (SBP) ≥160 mmHg including individuals older than 80 years in good physical and mental conditions are recommended reducing SBP to between 150 and 140 mmHg. Furthermore, fit elderly patients <80 years old are recommended to consider antihypertensive treatment at SBP values ≥140 mmHg with a target SBP <140 mmHg. On the other hand, frail elderly patients are recommended to leave decisions on antihypertensive therapy to the treating physician, and based on monitoring of the clinical effects of treatment...
September 2016: Journal of Hypertension
Michael Weber
: Age is the most powerful cardiovascular risk factor. Based on a meta-analysis of a million control patients in hypertension trials, the Clinical Trialists Collaboration has estimated that doubling of major cardiac and stroke events occurs with age increments of < 10 years (1). Data from the ACCOMPLISH trial, which will be presented at this ISH meeting for the first time, show that patients aged > 70 (mean: 75.2), compared with those < 70 (mean: 63.7), had a 2.82-fold greater event rate for cardiovascular death and a 2...
September 2016: Journal of Hypertension
Giuseppe Mancia
A huge amount of evidence is available that antihypertensive treatment is accompanied by a reduction in the risk of cardiovascular (CV) and renal outcomes as well as that a major portion of the beneficial effect is due to blood pressure (BP) lowering per se, regardless how it is obtained. Despite decades of research, however, information is still not conclusive on which might be the BP values to achieve with treatment in order to maximize CV and renal protection. This presentation will address this issue by reviewing the current target BP values recommended by guidelines in the general and elderly hypertensive population with a description of the related evidence...
September 2016: Journal of Hypertension
Katsuhiko Kohara
The effectiveness of antihypertensive treatment in elderly hypertensive patients has been established through numerous randomized clinical trials including the Hypertension in the Very Elderly Trial (HYVET). However, because of the diversity of biological aging among individuals, chronological age is not the sole determinant for the target blood pressure (BP) level at which antihypertensive medications are aimed. Several conditions, especially frailty, needed be evaluated in managing hypertension among elderly people...
September 2016: Journal of Hypertension
Christoph Zinner, David Morales-Alamo, Niels Ørtenblad, Filip J Larsen, Tomas A Schiffer, Sarah J Willis, Miriam Gelabert-Rebato, Mario Perez-Valera, Robert Boushel, Jose A L Calbet, Hans-Christer Holmberg
To elucidate the mechanisms underlying the differences in adaptation of arm and leg muscles to sprint training, over a period of 11 days 16 untrained men performed six sessions of 4-6 × 30-s all-out sprints (SIT) with the legs and arms, separately, with a 1-h interval of recovery. Limb-specific VO2peak, sprint performance (two 30-s Wingate tests with 4-min recovery), muscle efficiency and time-trial performance (TT, 5-min all-out) were assessed and biopsies from the m. vastus lateralis and m. triceps brachii taken before and after training...
2016: Frontiers in Physiology
Fetch more papers »
Fetching more papers... Fetching...
Read by QxMD. Sign in or create an account to discover new knowledge that matter to you.
Remove bar
Read by QxMD icon Read

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"