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This document provides the final text of regulations governing employee protection (retaliation or whistleblower) claims under section 1558 of the Affordable Care Act, which added section 18C to the Fair Labor Standards Act to provide protections to employees who may have been subject to retaliation for seeking assistance under certain affordability assistance provisions (for example, health insurance premium tax credits) or for reporting potential violations of the Affordable Care Act's consumer protections (for example, the prohibition on rescissions)...
October 13, 2016: Federal Register
Ruth S Weinstock, Ingrid Schütz-Fuhrmann, Crystal G Connor, Julia M Hermann, David M Maahs, Morten Schütt, Shivani Agarwal, Sabine E Hofer, Roy W Beck, Reinhard W Holl
AIMS: Compare characteristics, therapies and clinical outcomes in older adults with type 1 diabetes in the United States T1D Exchange (T1DX) and German/Austrian Diabetes Patienten Verlaufsdokumentation (DPV) registries. METHODS: Cross-sectional study of adults ≥60years old with type 1 diabetes seen in 2011-2012 in the T1DX (n=1283) and DPV (n=2014) registries. Wilcoxon rank-sum test was used for continuous variables and chi-square test for categorical variables...
October 4, 2016: Diabetes Research and Clinical Practice
Min Shi, Liang Ma, Li Zhou, Ping Fu
Aristolochic acid nephropathy (AAN) is a progressive kidney disease caused by a Chinese herb containing aristolochic acid. Excessive death of renal tubular epithelial cells (RTECs) characterized the acute phase of AAN. Therapies for acute AAN were limited, such as steroids and angiotensin-receptor blockers (ARBs)/angiotensin-converting enzyme inhibitors (ACEIs). It was interesting that, in acute AAN, female patients showed relative slower progression to renal failure than males. In a previous study, female hormone 17β-estradiol (E2) was found to attenuate renal ischemia-reperfusion injury...
October 18, 2016: Molecules: a Journal of Synthetic Chemistry and Natural Product Chemistry
D L Liang, X Y Li, L Wang, H Xu, X P Tuo, Z J Jian
Objective: To investigate the current status and influence factors of ACEI/ARB application in elderly coronary heart disease outpatients complicated with diabetes mellitus in 21 provinces of China. Methods: In this multicenter, non-intervention and cross-sectional survey, the elderly coronary heart disease patients aged 60 years or over were recruited from 165 hospitals in 21 provinces across China from April to July 2011. Current status and influence factors of ACEI/ARB application among 1 789 cases with diabetes mellitus were investigated in the survey...
September 27, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Rajkumar Bharatia, Manoj Chitale, Ganesh Narain Saxena, Raman Ganesh Kumar, Chikkalingaiah, Abhijit Trailokya, Kalpesh Dalvi, Suhas Talele
INTRODUCTION: Hypertension (HTN), being a major risk factor for cardiovascular diseases (CVDs), is an important issue of medical and public health. High blood pressure (BP) is ranked as the third most important risk factor for attributable burden of disease in south Asia (2010). Hypertension (HTN) exerts a substantial public health burden on cardiovascular health status and healthcare systems in India. Uncontrolled hypertension among adults with hypertension is associated with increased mortality...
July 2016: Journal of the Association of Physicians of India
Eun Joo Cho, Hae Young Lee, Ki Chul Sung, Sungha Park, Chang Gyu Park, Dong-Ju Choi, Jong Won Ha, Young Keun Ahn, Jinho Shin, Soon-Jun Hong, Soon Kil Kim, Wook-Jin Chung, Byung Su Yoo, Taek Jong Hong, Ho Joong Youn, Myeong-Chan Cho, Shung Chull Chae, Young Jo Kim, Chong-Jin Kim
BACKGROUND: The aim of this study was to compare 24-hour central blood pressure (24 hr c-BP) reduction efficacy between angiotensin II receptor blocker (ARB) combined with calcium channel blocker and with diuretics. METHODS: We conducted a prospective, randomized, double-blind trial in 220 hypertensive patients [mean age = 59.6 ± 12.3 years, men = 154(70%)]. Patients received losartan 50 mg monotherapy for 4 weeks, followed by additional use of amlodipine 5 mg (L/A group) or hydrochlorothiazide 12...
September 2016: Journal of Hypertension
V V Muthusamy
Cardiovascular disease burden is increasing all over the world. The diagnosis of hypertension is considered when a person has persistently elevated BP (Systolic BP more than 140 mmHg and/or Diastolic BP more than 90 mmHg). Dyslipidemia denotes abnormal levels of lipids in the blood (Total Cholesterol >200 mg%, Low density lipoprotein (LDL) >100 mg%, Triglycerides (TGL) >150 mg% and High density lipoprotein (HDL) <40 mg in men and < 50 mg in women. Hypertension and Dyslipidemia constitute the important components of metabolic syndrome as per the definition of NCEP Guidelines-Adult Treatment Panel III (ATP III)...
September 2016: Journal of Hypertension
Zhiming Zhu
Management of hypertension in diabetes is critical for reducing cardiovascular mortality and morbidity. Dietary approaches for controlling high blood pressure have historically focused on sodium. Thus, many guidelines recommend that patients with type 2 diabetes reduce high sodium intake. Nonetheless, the potential benefits of sodium reduction are debatable. The kidney has a crucial role in glucose filtration and reabsorption in addition to its regulation of fluid and electrolyte homeostasis. A key factor linking sodium uptake and glucose transport is the sodium-glucose cotransporter 2 (SGLT2) in renal proximal tubular cells...
September 2016: Journal of Hypertension
Trefor Morgan
Central Systolic Blood Pressure is lower than brachial artery blood Pressure due to reflected waves and greater augmentation at the periphery. The relationship is not consistent during life and alters with aging of the blood vessels. Increasing stiffness means that a greater component of the reflected waves returns to the central aorta during systolic contraction causing more amplification and a higher systolic blood pressure. Diastolic blood pressure on the other hand is always higher in the aorta than at the periphery allowing blood flow...
September 2016: Journal of Hypertension
Zhao Yang, Ma Ruixin, Yu Jing
OBJECTIVE: The role of the renin angiotensin aldosterone system (RAAS) and the gene variants of its components in hypertension have been investigated in various studies. A local tissue-specific renin-angiotensin system (local RAS) has considered as a regulator of cardiovascular physiology and homeostasis. However, no report has described the vagina protective efficacy of RAS inhibitors including ARB and ACEI. Therefore, we aim to investigate the effect of ARBs and ACEI on the vagina and cardiac expression of the local renin-angiotensin components...
September 2016: Journal of Hypertension
Federico Giulietti, Francesco Spannella, Elisabetta Borioni, Francesca Elena Lombardi, Laura Landi, Emma Espinosa, Riccardo Sarzani
OBJECTIVE: ACE inhibitors and angiotensin receptor blockers (ARB) modulate the renin-angiotensin system (RAS) leading to an increase in plasma renin activity (PRA) together with a reduction of plasma aldosterone concentration (PAC), likely proportional to the pharmacological effect. AIM: to evaluate the efficacy of therapy based on ACEI or ARB, using PRA/PAC ratio values in real-life clinical-practice. DESIGN AND METHOD: We studied 184 essential hypertensives (59...
September 2016: Journal of Hypertension
ByungSu Yoo
Heart failure (HF) represents a significant healthcare issue because of its ever-increasing prevalence, poor prognosis and complex pathophysiology. The cornerstone of modern drug therapy in chronic HF is the inhibition of neurohormonal activation that plays a crucial role in the pathophysiology of HF development and progression and, more specifically, of the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system. LCZ696 is a first-in-class, angiotensin receptor NEP inhibitor (ARNI) that consists of a supramolecular complex of a molecule of the ARB valsartan in combination with a molecule of the NEP inhibitor prodrug AHU377 (also known as sacubitril)...
September 2016: Journal of Hypertension
Zhanna Kobalava
The burden of cardiovascular diseases (CVD) in general and heart failure (HF) in particular continues to increase worldwide. CVD are major contributors to death and morbidity and recognized as important drivers of healthcare expenditure. Chronic overactivity of the renin-angiotensin-aldosterone system (RAAS) plays a key role in human hypertension and HF pathophysiology. RAAS is fundamental in the overall regulation of cardiovascular homeostasis through the actions of hormones, which regulate vascular tone, and specifically blood pressure through vasoconstriction and renal sodium and water retention...
September 2016: Journal of Hypertension
Shokei Kim-Mitsuyama
There is accumulating evidence that RAS inhibitors not only reduce blood pressure, but also exert pleiotropic effects, including a renoprotective effect, amelioration of insulin resistance, reduction in onset of diabetes, and suppression of cardiovascular remodelling,. However, the definite benefit of RAS inhibition in treatment of hypertension with CKD or DM is not conclusive. We previously performed the OlmeSartan and Calcium Antagonists Randomized (OSCAR) study comparing the preventive effect of high-dose ARB therapy versus ARB plus CCB combination therapy on cardiovascular morbidity and mortality in 1164 Japanese elderly hypertensive patients with baseline type 2 diabetes and/or CVD (Am J Med (2012))...
September 2016: Journal of Hypertension
Alexander Danser
Blockade of the renin-angiotensin-aldosterone system (RAAS) can be accomplished at the level of the angiotensin-generating enzymes renin and angiotensin-converting enzyme (ACE; using renin inhibitors or ACE inhibitors), the type 1 angiotensin II (AT1) receptor or mineralocorticoid receptor (MR; using angiotensin receptor blockers [ARBs] or MR blockers) and/or renin release (using beta-blockers). Several of these drugs are often combined-for example in heart failure-but such approaches may ultimately lead to RAAS annihilation with adverse consequences such as hypotension, renal dysfunction and hyperkalaemia...
September 2016: Journal of Hypertension
Suzanne Oparil
Heart disease, stroke, and kidney failure are leading causes of death worldwide, and hypertension is a significant risk factor for each. Hypertension is less common in women, compared to men, in those younger than 45 years of age. This trend is reversed in those 65 years and older. In the US between 2011-2014, the prevalence of hypertension in women and men by age group was 6% vs 8% (18-39 years), 30% vs 35% (40-59 years), and 67% vs 63% (60 years and over). Awareness, treatment, and control rates differ between genders with women being more aware of their diagnosis (85% vs 80%), more likely to take their medications (81% vs 71%) and more frequently having controlled hypertension (55% vs 49%)...
September 2016: Journal of Hypertension
Naoki Nakagawa, Keisuke Maruyama, Motoki Matsuki, Nobuyuki Sato, Kenjiro Kikuchi, Naoyuki Hasebe
OBJECTIVE: Uric acid is a risk factor for cardiovascular disease. We investigated the relationship between the change of urinary albumin excretion (UAE) and the changes of serum uric acid (SUA) during antihypertensive treatment in hypertensive patients with microalbuminuria as a subanalysis of the results of the NICE Combi (Nifedipine and Candesartan Combination) Study. DESIGN AND METHOD: A total of 86 subjects with essential hypertension with microalbuminuria (UAE < 300 mg•g-1 creatinine) were randomly assigned in a double-blind manner to a combination therapy group (standard-dose candesartan at 8 mg/day plus controlled-release (CR) nifedipine 20 mg/day) (n = 42) or an up-titrated monotherapy group (candesartan 12 mg/day) (n = 44) for 8 weeks of continuous treatment after initially receiving standard-dose candesartan (8 mg/day) monotherapy for 8 weeks (initial treatment)...
September 2016: Journal of Hypertension
Hiroki Uchiwa, Hisashi Kai, Yoshiko Iwamoto, Takahiro Anegawa, Yoshihiro Fukumoto
OBJECTIVE: Morning hypertension is an independent risk for cerebrovascular and cardiovascular events. Although the incidence of morning hypertension increases with age, treatment of morning hypertension has not been established particularly in late-elderly patients. Among various combinations, ARB combined with a small dose of thiazide diuretic is desirable because the two drugs have complementary mechanisms of action, and effectively reduce BP. Thus, we investigated the safety and efficacy of ARB/hydrochlorothiazide (HCTZ) combination in controlling morning hypertension in the very elderly...
September 2016: Journal of Hypertension
Kaoru Yamashita, Atsuhiro Ichihara, Kentaro Ito, Naohiro Yoshida, Fumiko Mitani, Jin Endo, Motoaki Sano, Keiichi Fukuda, Satoshi Morimoto
OBJECTIVE: Numerous clinical trials demonstrated that renin-angiotensin-aldosterone system (RAAS) was involved in the pathogenesis of hypertension-induced heart failure. While RAS is a major machinery required for aldosterone production, multiple minor systems, including catecholamine, could give rise to the aberrant aldosterone production beyond the RAS activation. We investigated the mechanism underlying the RAS-independent aldosterone production in heart failure. DESIGN AND METHOD: Dahl-salt sensitive rats fed high salt diet developed malignant hypertension, resulting in heart failure with inappropriately increased plasma aldosterone level...
September 2016: Journal of Hypertension
Risa Ramadhiani, Muhammad Saifur Rohman, Nashi Widodo, Valerinna Y S Putri, Mifetika Lukitasari, Jayarani F Putri, Didik H Utomo
OBJECTIVE: To investigate whether the angiotensinogen (AGT) G-217A polymorphism affects blood pressure response of telmisartan and valsartan in hypertensive patients. DESIGN AND METHOD: A total of 46 primary hypertensive patients, 23 patients received telmisartan 80 mg and 23 patients received valsartan 160 mg, were observed and followed up for 4 months. The AGT G-217A polymorphism was determined by PCR-RFLP and direct sequencing method. Blood pressure response was measured daytime (6 am - 10 pm), night-time (10 pm - 6 am), and 24 hours using twenty-four hours ambulatory blood pressure monitoring (ABPM)...
September 2016: Journal of Hypertension
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