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https://www.readbyqxmd.com/read/27884231/guidelines-for-the-management-of-hypertension
#1
REVIEW
Aram V Chobanian
This article summarizes pertinent data from clinical trials on the effects of antihypertensive therapy on cardiovascular complications. Prior definitions of hypertension and blood pressure goals of therapy are discussed, and differences between national and international guidelines on such goals are summarized. The results of the SPRINT study are summarized, and the impact of this study on future goals of treatment is discussed. New recommendations are provided on blood pressure goals, and the effects such goals might have on clinical practice are discussed...
January 2017: Medical Clinics of North America
https://www.readbyqxmd.com/read/27865822/ambulatory-blood-pressure-in-hypertensive-patients-with-inclusion-criteria-for-the-sprint-trial
#2
Alejandro de la Sierra, José R Banegas, Juan A Divisón, Manuel Gorostidi, Ernest Vinyoles, Juan J de la Cruz, Julián Segura, Luis M Ruilope
We aimed to characterize 24-hour blood pressure (BP) values and categories in patients with inclusion/exclusion criteria of the Systolic Blood Pressure Intervention (SPRINT) trial from the Spanish ABPM Registry. We selected patients older than 50 years, with office systolic BP (SBP) above 130 mm Hg and at high cardiovascular risk, but without diabetes, previous stroke, or symptomatic heart failure. Ambulatory BP was compared among BP categories. A total of 39,132 patients (34%) fulfilled inclusion criteria of SPRINT trial...
November 5, 2016: Journal of the American Society of Hypertension: JASH
https://www.readbyqxmd.com/read/27862904/baseline-blood-pressure-control-in-hispanics-characteristics-of-hispanics-in-the-systolic-blood-pressure-intervention-trial
#3
Carlos J Rodriguez, Carolyn H Still, Katelyn R Garcia, Lynne Wagenknecht, Suzanne White, Jeffrey T Bates, Margareth V Del Cid, Michael Lioudis, Nieves Lopez Barrera, Abel Moreyra, Henry Punzi, Robert J Ringer, William C Cushman, Gabriel Contreras, Karen Servilla, Michael Rocco
The Systolic Blood Pressure Intervention Trial (SPRINT) tested whether a systolic blood pressure (SBP) value <120 mm Hg reduces adverse clinical outcomes compared with the goal of <140 mm Hg. Here the authors describe the baseline characteristics of Hispanic participants in SPRINT. Nondiabetic hypertensive patients 50 years and older with SBP 130-180 mm Hg taking zero to four blood pressure (BP) medications were enrolled from the mainland United States and Puerto Rico. Cross-sectional, bivariate analysis was employed comparing sociodemographic and clinical factors in Hispanics vs non-Hispanics...
November 14, 2016: Journal of Clinical Hypertension
https://www.readbyqxmd.com/read/27849563/effect-of-intensive-versus-standard-clinic-based-hypertension-management-on-ambulatory-blood-pressure-results-from-the-sprint-systolic-blood-pressure-intervention-trial-ambulatory-blood-pressure-study
#4
Paul E Drawz, Nicholas M Pajewski, Jeffrey T Bates, Natalie A Bello, William C Cushman, Jamie P Dwyer, Lawrence J Fine, David C Goff, William E Haley, Marie Krousel-Wood, Andrew McWilliams, Dena E Rifkin, Yelena Slinin, Addison Taylor, Raymond Townsend, Barry Wall, Jackson T Wright, Mahboob Rahman
: The effect of clinic-based intensive hypertension treatment on ambulatory blood pressure (BP) is unknown. The goal of the SPRINT (Systolic Blood Pressure Intervention Trial) ambulatory BP ancillary study was to evaluate the effect of intensive versus standard clinic-based BP targets on ambulatory BP. Ambulatory BP was obtained within 3 weeks of the 27-month study visit in 897 SPRINT participants. Intensive treatment resulted in lower clinic systolic BP (mean difference between groups=16...
November 14, 2016: Hypertension
https://www.readbyqxmd.com/read/27842710/-hypertension-and-coronary-artery-disease-new-concept
#5
G Lefèvre, E Puymirat
Hypertension is the most important preventable cause of heart disease and stroke worldwide. More than 1 in 5 adults worldwide have raised blood pressure - a condition that causes around half of all deaths from stroke and heart disease. Complications from hypertension account for 9.4 million deaths worldwide every year. During the last decade, the association between blood pressure reduction from above-normal initial values and cardiovascular-risk has been documented in a large number of randomized trials...
November 11, 2016: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/27771852/threshold-and-target-for-blood-pressure-lowering-in-the-elderly
#6
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/27758750/-towards-new-targets-in-the-treatment-of-hypertension
#7
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
https://www.readbyqxmd.com/read/27754290/br-08-2-cardiovascular-risk-assessment-in-hypertensives-with-ckd
#8
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
https://www.readbyqxmd.com/read/27754190/sp-05-3-does-the-sprint-trial-change-the-target-blood-pressure-in-the-elderly
#9
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
https://www.readbyqxmd.com/read/27754189/sp-05-2-what-should-be-the-target-blood-pressure-for-ckd-with-overt-proteinuria
#10
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
https://www.readbyqxmd.com/read/27754188/sp-05-1-should-the-target-for-blood-pressure-reduction-be-lower-in-adults-with-hypertension-and-a-history-of-cardiovascular-disease
#11
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
https://www.readbyqxmd.com/read/27754045/os-14-02-on-treatment-blood-pressure-values-and-cardiac-organ-damage-in-hypertensive-patients
#12
Massimo Salvetti, Anna Paini, Claudia Agabiti Rosei, Deborah Stassaldi, Fabio Bertacchini, Giulia Rubagotti, Giulia Maruelli, Laura Verzeri, Carlotta Donini, Maria Lorenza Muiesan, Enrico Agabiti Rosei
OBJECTIVE: The recent results of the SPRINT study suggest that "intensive" reduction of systolic blood pressure (BP) (to less than 120 mmHg) might provide greater cardiovascular protection as compared to less intensive (< 140 mmHg) reduction of BP, at least in some subsets of patients. Only few studies, have investigated the possible effect of tight blood pressure control on indices of left ventricular hypertrophy, and have been mainly based on electrocardiography. Aim of our study was to evaluate cardiac organ damage according to "on treatment" blood pressure values in a large cohort of hypertensive patients undergoing echocardiography (2D, M-mode with conventional and tissue Doppler analysis)at the echo-lab of an ESH Excellence Centre in Italy...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27754015/br-04-1management-of-treatment-resistant-hypertension
#13
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/27754014/me-02-3-extending-sprint-results-to-diabetics
#14
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/27754013/me-02-2-blood-pressure-targets-in-chronic-kidney-diseases-after-the-sprint-trial
#15
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
https://www.readbyqxmd.com/read/27754009/sp-02-5-do-we-need-a-new-definition-of-hypertension
#16
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
https://www.readbyqxmd.com/read/27754004/js-ish-isn-3-optimal-targets-for-bp-control-in-ckd
#17
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
https://www.readbyqxmd.com/read/27754001/db-02-3-strict-control-of-hypertension-in-the-elderly-with-diabetes-and-chronic-kidney-disease-pro
#18
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
https://www.readbyqxmd.com/read/27754000/db-02-2-strict-control-of-hypertension-in-the-frail-elderly-is-it-beneficial-con
#19
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
https://www.readbyqxmd.com/read/27753981/pl-02-3-management-of-elderly-hypertension-whom-to-treat-and-how-low-to-go
#20
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
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