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Antihypertensives treatment guideline review

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https://www.readbyqxmd.com/read/27919826/should-blood-pressure-goal-be-individualized-in-hypertensive-patients
#1
REVIEW
Alexandra Yannoutsos, Rania Kheder-Elfekih, Jean-Michel Halimi, Michel E Safar, Jacques Blacher
The aim of the present review is to consider the clinical relevance of individualized blood pressure (BP) goal under treatment in hypertensive patients according to their age, comorbidities or established cardiovascular (CV) disease. Evidence from large-scale randomized trials to support a lower BP goal, as initially recommended by guidelines in high-risk hypertensive patients, were lacking. Recently, the randomized intervention SPRINT trial studied two treatment targets for systolic BP (120mm Hg versus 140mm Hg in the intensive and standard treatment group, respectively) among high-risk hypertensive patients, without diabetes and without a history of prior stroke...
December 2, 2016: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
https://www.readbyqxmd.com/read/27771852/threshold-and-target-for-blood-pressure-lowering-in-the-elderly
#2
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
https://www.readbyqxmd.com/read/27754014/me-02-3-extending-sprint-results-to-diabetics
#3
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
https://www.readbyqxmd.com/read/27754012/me-02-1-is-lower-really-better-issue-of-the-j-curve-hypothesis-in-hypertension
#4
Bo Carlberg
The J curve hypothesis propose that the relation between blood pressure and risk for cardiovascular events is non-linear. Instead of a decreased risk with lower blood pressure, the risk increases at lower blood pressures. This issue has been discussed for many years, and is still a hot topic. The debates have most often had its origin in the question about how far blood pressure should be lowered with antihypertensive drugs.One one hand, we know that many patients with hypertension is not treated to targets according to guidelines and that this contributes to the high risk for cardiovascular diseases in patients with hypertension...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27753820/pl-01-1-cardiovascular-protection-in-hypertension-which-targets-for-treatment
#5
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
https://www.readbyqxmd.com/read/27690353/fixed-dose-versus-separate-drug-combinations-for-antihypertensive-treatment-literature-review
#6
José Luis Calleja Rivero, Franklin Zerpa, Loreto Rivera
INTRODUCTION: Hypertension requires effective interventions to reduce cardiovascular morbidity and mortality. Drug therapies have achieved optimal blood pressure levels in affected patients. Recent clinical guidelines suggest drug combinations a fact that has led to the development of various fixed-dose combinations. OBJECTIVE: To find the best available evidence about the effectiveness of antihypertensive drugs in fixed-dose combinations compared with separate dose combinations for blood pressure control, treatment adherence and reducing cardiovascular morbidity and mortality...
2016: Medwave
https://www.readbyqxmd.com/read/27689239/treatment-options-for-hypertension-in-pregnancy-and-puerperium
#7
Farah H Amro, Hind N Moussa, Olaide A Ashimi, Baha M Sibai
Hypertensive disorders have become increasingly prevalent and complicate an increasing number of pregnancies. Therefore it is essential that the medications used to treat these disorders be well understood. Furthermore the management is complicated by special consideration needed for the physiologic changes of pregnancy as well as the consideration for possible adverse fetal effects. Areas covered: We performed a review of the scientific literature of medications used to treat hypertensive disorders in pregnancy...
October 11, 2016: Expert Opinion on Drug Safety
https://www.readbyqxmd.com/read/27671866/device-therapies-for-resistant-hypertension
#8
Dagmara Hering, Carl Schultz, Markus P Schlaich
PURPOSE: Resistant hypertension (RH) is a major and growing public health problem. While noncompliance to antihypertensive medication is a major concern in RH patients, it is estimated that even with adequate multi-drug regimens, approximately 10% of patients diagnosed with hypertension fulfill the criteria of true RH. Patients with sustained blood pressure (BP) elevation display high risk for development of target organ damage and associated cardiovascular morbidity and mortality. While optimized pharmacologic therapy, including the use of mineralocorticoid receptor antagonists to guideline-based antihypertensive drug therapy, is effective for improving BP control in this patient cohort, a sizable proportion of RH patients' BP remains uncontrolled, and alternative therapeutic strategies are warranted...
September 23, 2016: Clinical Therapeutics
https://www.readbyqxmd.com/read/27642925/me-02-3-extending-sprint-results-to-diabetics
#9
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
https://www.readbyqxmd.com/read/27642923/me-02-1-is-lower-really-better-issue-of-the-j-curve-hypothesis-in-hypertension
#10
Bo Carlberg
The J curve hypothesis propose that the relation between blood pressure and risk for cardiovascular events is non-linear. Instead of a decreased risk with lower blood pressure, the risk increases at lower blood pressures. This issue has been discussed for many years, and is still a hot topic. The debates have most often had its origin in the question about how far blood pressure should be lowered with antihypertensive drugs.One one hand, we know that many patients with hypertension is not treated to targets according to guidelines and that this contributes to the high risk for cardiovascular diseases in patients with hypertension...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27642873/pl-01-1-cardiovascular-protection-in-hypertension-which-targets-for-treatment
#11
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
https://www.readbyqxmd.com/read/27615192/ambulatory-blood-pressure-monitoring-for-the-effective-management-of-antihypertensive-drug-treatment
#12
Eoin O'Brien, Eamon Dolan
PURPOSE: This purpose of this article is to review the current recommendations for ambulatory blood pressure measurement (ABPM) and the use of ABPM in assessing treatment. METHODS: We review current international guidelines and undertake a critical review of evidence supporting the clinical use of ABPM in effectively managing antihypertensive drug treatment. FINDINGS: Current guidelines emphasize the diagnostic superiority of ABPM, mainly from the ability of the technique to identify sustained hypertension by allowing for the exclusion of white-coat hypertension and by demonstrating the presence of masked hypertension...
September 8, 2016: Clinical Therapeutics
https://www.readbyqxmd.com/read/27476227/pattern-of-antihypertensive-therapy-among-diabetic-hyperten-sive-patients-in-zewditu-memorial-hospital-addis-ababa
#13
Hailu Abera, Mihret Woldemichael
INTRODUCTION: Diabetes mellitus is becoming a common chronic disease in both developed and developing nations and is associated with significant cardiovascular disease morbidity and mortality. The presence of hypertension in patients with diabetes mellitus doubles the risk of cardiovascular disease including coronary heart disease, congestive heart failure, ischemic and hemorrhagic stroke, renalfailure and peripheral arterial disease. OBJECTIVE: The aim of this study was to assess the pattern of antihypertensive drug therapy among diabetic hypertensive patients in Zewditu Memorial Hospital Diabetic Clinic in Addis Ababa...
April 2016: Ethiopian Medical Journal
https://www.readbyqxmd.com/read/27472680/treatment-efficacy-of-anti-hypertensive-drugs-in-monotherapy-or-combination-atom-systematic-review-and-meta-analysis-of-randomized-clinical-trials-according-to-prisma-statement
#14
Marco A Paz, Alejandro de-La-Sierra, Marc Sáez, María Antonia Barceló, Juan José Rodríguez, Sonia Castro, Cristina Lagarón, Josep M Garrido, Pilar Vera, Gabriel Coll-de-Tuero
BACKGROUND: The relative efficacy of antihypertensive drugs/combinations is not well known. Identifying the most effective ones and the patients' characteristics associated with best performance of the drugs will improve management of hypertensive patients. OBJECTIVE: To assess the blood pressure (BP) reduction attributed to antihypertensive drugs and identify characteristics associated with BP decrease. DATA SOURCES: MEDLINE, Cochrane Central Register of Controlled Trials from inception through July 2012 and selected papers...
July 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27407098/intermittent-hypoxia-training-as-non-pharmacologic-therapy-for-cardiovascular-diseases-practical-analysis-on-methods-and-equipment
#15
Tatiana V Serebrovskaya, Lei Xi
The global industrialization has brought profound lifestyle changes and environmental pollutions leading to higher risks of cardiovascular diseases. Such tremendous challenges outweigh the benefits of major advances in pharmacotherapies (such as statins, antihypertensive, antithrombotic drugs) and exacerbate the public healthcare burdens. One of the promising complementary non-pharmacologic therapies is the so-called intermittent hypoxia training (IHT) via activation of the human body's own natural defense through adaptation to intermittent hypoxia...
September 2016: Experimental Biology and Medicine
https://www.readbyqxmd.com/read/27297342/clinical-update-cardiovascular-disease-in-diabetes-mellitus-atherosclerotic-cardiovascular-disease-and-heart-failure-in-type-2-diabetes-mellitus-mechanisms-management-and-clinical-considerations
#16
Cecilia C Low Wang, Connie N Hess, William R Hiatt, Allison B Goldfine
Cardiovascular disease remains the principal cause of death and disability among patients with diabetes mellitus. Diabetes mellitus exacerbates mechanisms underlying atherosclerosis and heart failure. Unfortunately, these mechanisms are not adequately modulated by therapeutic strategies focusing solely on optimal glycemic control with currently available drugs or approaches. In the setting of multifactorial risk reduction with statins and other lipid-lowering agents, antihypertensive therapies, and antihyperglycemic treatment strategies, cardiovascular complication rates are falling, yet remain higher for patients with diabetes mellitus than for those without...
June 14, 2016: Circulation
https://www.readbyqxmd.com/read/27256435/triple-combination-therapy-for-global-cardiovascular-risk-atorvastatin-perindopril-and-amlodipine
#17
REVIEW
Michel E Bertrand, Charalambos Vlachopoulos, Jean-Jacques Mourad
Statins, angiotensin-converting enzyme (ACE) inhibitors, and calcium channel blockers (CCBs) have markedly changed the clinical progression of patients with coronary artery disease (CAD). The goal of this paper is to review the rationale and evidence for combining these three drug classes in hypertensive patients with hypercholesterolemia or CAD. Data sources include a literature search for publications on the use of a statin combined with various antihypertensive drugs in patients with hypertension and hypercholesterolemia or stable CAD...
August 2016: American Journal of Cardiovascular Drugs: Drugs, Devices, and Other Interventions
https://www.readbyqxmd.com/read/27133548/-cardiogenic-shock-due-to-spontaneous-neonatal-thrombosis-of-the-abdominal-aorta
#18
J Brice, P Venot, M Colinart-Thomas, P Morville
Neonatal arterial thrombosis is unusual and generally associated with an arterial umbilical catheter. Spontaneous aortic thrombosis is exceptional but its severity is related to high mortality rate and renovascular morbidity. We report here the observation of a 10-day-old term infant showing a large abdominal aortic thrombosis revealed by cardiogenic shock induced by systemic arterial hypertension. The resolution was fast following anticoagulant and antihypertensive therapy. Etiologic investigations showed renal failure and moderate hyperhomocysteinemia controlled by a vitamin supplement...
September 2016: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
https://www.readbyqxmd.com/read/27057288/current-and-future-treatment-of-hypertension-in-the-sprint-era
#19
Robert A Phillips
Based on the SPRINT trial, it is highly likely that new SPRINT-era guidelines will establish a blood pressure (BP) goal of < 130/80 mm Hg for those aged 50 or older who are at high risk for a cardiovascular event. In this group, SPRINT demonstrated that assignment to an intensive-treatment systolic BP (SBP) goal of < 120 mm Hg significantly reduced cardiovascular events and mortality compared to those assigned to a standard-treatment SPB goal of < 140 mm Hg. This review critically assesses current hypertension guidelines and presents predictions for SPRINT-era guidelines in the elderly, African Americans, and patients with uncomplicated essential hypertension, diabetes, chronic kidney disease, cardiovascular disease, and coronary artery disease...
October 2015: Methodist DeBakey Cardiovascular Journal
https://www.readbyqxmd.com/read/26945324/pediatric-cardiac-intensive-care-society-2014-consensus-statement-pharmacotherapies-in-cardiac-critical-care-antihypertensives
#20
Darren Klugman, Elizabeth S Goswami, John T Berger
OBJECTIVE: Hypertension remains a common condition in pediatric cardiac intensive care. The physiologic effects of hypertension in this population are complex and are impacted by patient age, comorbidities, and primary cardiac disease. The objective of this study is to review current pharmacotherapies for the management of systemic hypertension in the pediatric cardiac ICU. DATA SOURCES: Relevant literature to the treatment of systemic hypertension in children was included...
March 2016: Pediatric Critical Care Medicine
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