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By Venkatesh Ariyamuthu Transplant Nephrologist at UT Southwestern Medical Center
https://www.readbyqxmd.com/read/29700488/diagnosis-and-management-of-resistant-hypertension-state-of-the-art
#1
REVIEW
Fang-Fei Wei, Zhen-Yu Zhang, Qi-Fang Huang, Jan A Staessen
Resistant hypertension is defined as a lack of ambulatory blood pressure response to optimized medical treatment after exclusion of secondary hypertension in patients who are fully adherent to antihypertensive therapy. Patients with resistant hypertension are at high risk of complications, particularly cardiovascular events, and optimization of medical treatment remains the cornerstone of their management. Such optimization should be based on simple algorithms and include the use of aldosterone antagonists...
April 26, 2018: Nature Reviews. Nephrology
https://www.readbyqxmd.com/read/29482260/beta-blockers-in-patients-with-end-stage-renal-disease-evidence-based-recommendations
#2
REVIEW
Matthew A Weir, Charles A Herzog
For patients who require hemodialysis, beta blockers offer a simultaneous opportunity and challenge in the treatment of cardiovascular disease. Beta blockers are well supported by data from nondialysis populations and directly mitigate the sympathetic overactivity that links chronic kidney disease with cardiovascular sequelae. However, the evidence supporting their use in patients receiving hemodialysis is sparse and the heterogeneity of the beta blocker class makes it difficult to prescribe these medications with confidence...
May 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29475561/updated-guidelines-for-the-diagnosis-and-management-of-high-blood-pressure-implications-for-clinical-practice-in-nephrology
#3
Christina M Wyatt, Glenn M Chertow
No abstract text is available yet for this article.
April 2018: Kidney International
https://www.readbyqxmd.com/read/29483138/mechanisms-clinical-implications-and-treatment-of-intradialytic-hypotension
#4
REVIEW
Patrick B Reeves, Finnian R Mc Causland
Individuals with ESKD requiring maintenance hemodialysis face a unique hemodynamic challenge, typically on a thrice-weekly basis. In an effort to achieve some degree of euvolemia, ultrafiltration goals often involve removal of the equivalent of an entire plasma volume. Maintenance of adequate end-organ perfusion in this setting is dependent on the institution of a variety of complex compensatory mechanisms. Unfortunately, secondary to a myriad of patient- and dialysis-related factors, this compensation often falls short and results in intradialytic hypotension...
February 26, 2018: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/29483139/bp-measurement-techniques-what-they-mean-for-patients-with-kidney-disease
#5
REVIEW
George Thomas, Paul E Drawz
Patients with CKD typically have hypertension. Manual BP measurement in the office setting was used to define hypertension, establish eligibility, and assess BP targets in the epidemiologic studies and early randomized, controlled trials that inform current management of hypertension. Use of automated oscillometric devices has largely replaced manual BP measurement in the office and clinical trials. These newer devices may reduce the white coat effect and facilitate guideline-adherent measurement protocols...
February 26, 2018: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/28938954/blood-pressure-targets-for-hemodialysis-patients
#6
REVIEW
Jeffrey M Turner, Aldo J Peixoto
The association between blood pressure (BP) and mortality is unique in hemodialysis patients compared with that in the general population. This is because of an altered benefit-risk balance associated with BP reduction in these patients. An adequately designed study comparing BP targets in hemodialysis patients remains to be conducted. The current evidence available to guide dialysis providers regarding treatment strategies for managing hypertension in this population is limited to large observational studies and small randomized controlled trials...
October 2017: Kidney International
https://www.readbyqxmd.com/read/27633875/the-case-a-handful-of-hypertension
#7
Bert-Jan H van den Born, Louise C Oskam, Majida Zidane, Carolin Schächterle, Enno Klussmann, Sylvia Bähring, Friedrich C Luft
No abstract text is available yet for this article.
October 2016: Kidney International
https://www.readbyqxmd.com/read/27643001/os-19-03-treatment-with-patiromer-resulted-in-decreases-in-aldosterone-in-patients-with-chronic-kidney-disease-and-hyperkalemia-on-raas-inhibitors-results-from-opal-hk
#8
Matthew Weir, George L Bakris, Coleman Gross, Martha R Mayo, Dahlia Garza, Jinwei Yuan, Lance Berman, Gordon H Williams
OBJECTIVE: Elevated serum aldosterone can be vasculotoxic and facilitates cardiorenal damage. Renin-angiotensin-aldosterone inhibitors (RAASi) reduce serum aldosterone levels and/or block its effects but can cause hyperkalemia (HK). Patiromer, a nonabsorbed potassium binder, decreases serum potassium (K) in CKD patients on RAASi. We examined the effect of patiromer on serum aldosterone levels, plasma renin activity (PRA), systolic (SBP) and diastolic blood pressure (DBP), and urinary albumin-to-creatinine ratio (UACR) in CKD patients on RAASi with HK (serum K 5...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27516235/bp-control-and-long-term-risk-of-esrd-and-mortality
#9
Elaine Ku, Jennifer Gassman, Lawrence J Appel, Miroslaw Smogorzewski, Mark J Sarnak, David V Glidden, George Bakris, Orlando M Gutiérrez, Lee A Hebert, Joachim H Ix, Janice Lea, Michael S Lipkowitz, Keith Norris, David Ploth, Velvie A Pogue, Stephen G Rostand, Edward D Siew, Mohammed Sika, C Craig Tisher, Robert Toto, Jackson T Wright, Christina Wyatt, Chi-Yuan Hsu
We recently showed an association between strict BP control and lower mortality risk during two decades of follow-up of prior participants in the Modification of Diet in Renal Disease (MDRD) trial. Here, we determined the risk of ESRD and mortality during extended follow-up of the African American Study of Kidney Disease and Hypertension (AASK) trial. We linked 1067 former AASK participants with CKD previously randomized to strict or usual BP control (mean arterial pressure ≤92 mmHg or 102-107 mmHg, respectively) to the US Renal Data System and Social Security Death Index; 397 patients had ESRD and 475 deaths occurred during a median follow-up of 14...
February 2017: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/27012910/how-does-sprint-systolic-blood-pressure-intervention-trial-direct-hypertension-treatment-targets-for-ckd
#10
EDITORIAL
Sandra J Taler
No abstract text is available yet for this article.
July 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/26912547/masked-hypertension-and-elevated-nighttime-blood-pressure-in-ckd-prevalence-and-association-with-target-organ-damage
#11
Paul E Drawz, Arnold B Alper, Amanda H Anderson, Carolyn S Brecklin, Jeanne Charleston, Jing Chen, Rajat Deo, Michael J Fischer, Jiang He, Chi-Yuan Hsu, Yonghong Huan, Martin G Keane, John W Kusek, Gail K Makos, Edgar R Miller, Elsayed Z Soliman, Susan P Steigerwalt, Jonathan J Taliercio, Raymond R Townsend, Matthew R Weir, Jackson T Wright, Dawei Xie, Mahboob Rahman
BACKGROUND AND OBJECTIVES: Masked hypertension and elevated nighttime BP are associated with increased risk of hypertensive target organ damage and adverse cardiovascular and renal outcomes in patients with normal kidney function. The significance of masked hypertension for these risks in patients with CKD is less well defined. The objective of this study was to evaluate the association between masked hypertension and kidney function and markers of cardiovascular target organ damage, and to determine whether this relationship was consistent among those with and without elevated nighttime BP...
April 7, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/26806824/salt-and-health-time-to-revisit-the-recommendations
#12
Tilman B Drüeke
The relationship between salt and human health has been the subject of controversy over the past century. The largest study in the field demonstrates a J-curve relationship between sodium intake and adverse clinical outcomes, suggesting a need to reevaluate current recommendations to restrict sodium intake to less than 2 g/d in the general population.
February 2016: Kidney International
https://www.readbyqxmd.com/read/26806825/a-sprint-to-the-finish-or-just-the-beginning-implications-of-the-sprint-results-for-nephrologists
#13
RANDOMIZED CONTROLLED TRIAL
Michael V Rocco, Alfred K Cheung
The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated a significant reduction in major cardiovascular events and all-cause mortality with intensive blood pressure control in older individuals at high cardiovascular risk, including patients with chronic kidney disease and mild proteinuria. Nephrologists should consider the SPRINT results when determining the optimal blood pressure target for patients with chronic kidney disease.
February 2016: Kidney International
https://www.readbyqxmd.com/read/26804018/hypertension-rest-before-blood-pressure-measurement-a-lesson-from-sprint
#14
COMMENT
Rajiv Agarwal
No abstract text is available yet for this article.
March 2016: Nature Reviews. Nephrology
https://www.readbyqxmd.com/read/26636542/antihypertensive-treatments-in-adult-autosomal-dominant-polycystic-kidney-disease-network-meta-analysis-of-the-randomized-controlled-trials
#15
Cheng Xue, Chenchen Zhou, Bing Dai, Shengqiang Yu, Chenggang Xu, Zhiguo Mao, Chaoyang Ye, Dongping Chen, Xuezhi Zhao, Jun Wu, Wansheng Chen, Changlin Mei
BACKGROUND: Blood pressure (BP) control is one of the most important treatments of Autosomal dominant polycystic kidney disease (ADPKD). The comparative efficacy of antihypertensive treatments in ADPKD patients is inconclusive. METHODS: Network meta-analysis was used to evaluate randomized controlled trials (RCT) which investigated antihypertensive treatments in ADPKD. PubMed, Embase, Ovid, and Cochrane Collaboration were searched. The primary outcome was estimated glomerular filtration rate (eGFR)...
December 15, 2015: Oncotarget
https://www.readbyqxmd.com/read/26550920/time-to-reassess-blood-pressure-goals
#16
Aram V Chobanian
More than 70 million people in the United States and more than 1 billion worldwide have hypertension — defined by a systolic blood pressure of at least 140 mm Hg and a diastolic blood pressure of at least 90 mm Hg — and the numbers are increasing steadily. Despite remarkable advances in..
November 26, 2015: New England Journal of Medicine
https://www.readbyqxmd.com/read/26551394/redefining-blood-pressure-targets-sprint-starts-the-marathon
#17
EDITORIAL
Vlado Perkovic, Anthony Rodgers
Blood pressure is a potent determinant of cardiovascular risk, but the most appropriate targets for blood-pressure lowering have long been debated. Observational studies with a low risk of confounding have shown a linear relationship between blood pressure and cardiovascular risk down to 115/75 mm..
November 26, 2015: New England Journal of Medicine
https://www.readbyqxmd.com/read/26551272/a-randomized-trial-of-intensive-versus-standard-blood-pressure-control
#18
RANDOMIZED CONTROLLED TRIAL
Jackson T Wright, Jeff D Williamson, Paul K Whelton, Joni K Snyder, Kaycee M Sink, Michael V Rocco, David M Reboussin, Mahboob Rahman, Suzanne Oparil, Cora E Lewis, Paul L Kimmel, Karen C Johnson, David C Goff, Lawrence J Fine, Jeffrey A Cutler, William C Cushman, Alfred K Cheung, Walter T Ambrosius
BACKGROUND: The most appropriate targets for systolic blood pressure to reduce cardiovascular morbidity and mortality among persons without diabetes remain uncertain. METHODS: We randomly assigned 9361 persons with a systolic blood pressure of 130 mm Hg or higher and an increased cardiovascular risk, but without diabetes, to a systolic blood-pressure target of less than 120 mm Hg (intensive treatment) or a target of less than 140 mm Hg (standard treatment). The primary composite outcome was myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes...
November 26, 2015: New England Journal of Medicine
https://www.readbyqxmd.com/read/26553785/managing-hypertension-in-patients-with-ckd-a-marathon-not-a-sprint
#19
Glenn M Chertow, Srinivasan Beddhu, Julia B Lewis, Robert D Toto, Alfred K Cheung
In this manuscript, nephrologist-investigators from one of five Clinical Center Networks of the Systolic Blood Pressure Intervention Trial (SPRINT) provide background information and context on the intensity of anti-hypertensive therapy in conjunction with the release of detailed results from SPRINT's primary analysis. The authors highlight published evidence on the safety and efficacy of differing intensities of anti-hypertensive therapy in mild to moderate CKD, where SPRINT will help to inform practice, as well as where gaps in evidence will remain...
January 2016: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/26174784/orthostatic-hypotension-mechanisms-causes-management
#20
REVIEW
Phillip A Low, Victoria A Tomalia
Orthostatic hypotension (OH) occurs when mechanisms for the regulation of orthostatic BP control fails. Such regulation depends on the baroreflexes, normal blood volume, and defenses against excessive venous pooling. OH is common in the elderly and is associated with an increase in mortality rate. There are many causes of OH. Aging coupled with diseases such as diabetes and Parkinson's disease results in a prevalence of 10-30% in the elderly. These conditions cause baroreflex failure with resulting combination of OH, supine hypertension, and loss of diurnal variation of BP...
July 2015: Journal of Clinical Neurology
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