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By Isabel Acosta-Ochoa Nephrology senior staff. Valladolid. Spain
Nadia A Khan
No abstract text is available yet for this article.
August 16, 2016: Annals of Internal Medicine
Gowri Raman, Gaelen P Adam, Christopher W Halladay, Valerie N Langberg, Ijeoma A Azodo, Ethan M Balk
Background: Atherosclerotic renal artery stenosis (ARAS) is associated with high blood pressure (BP), decreased kidney function, renal replacement therapy (RRT), and death. Purpose: To compare benefits and harms of percutaneous transluminal renal angioplasty with stent placement (PTRAS) versus medical therapy alone in adults with ARAS. Data Sources: MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from 1993 to 16 March 2016; gray literature; and prior systematic reviews...
August 16, 2016: Annals of Internal Medicine
Agnes Trautmann, Derek J Roebuck, Clare A McLaren, Eileen Brennan, Stephen D Marks, Kjell Tullus
OBJECTIVES: Renovascular disease (RVD) is found in about 10 % of secondary childhood hypertension. Digital subtraction angiography (DSA) is the gold standard to diagnose RVD. Non-invasive imaging methods like Doppler ultrasound (US), magnetic resonance angiography (MRA), and computed tomography angiography (CTA) are increasingly used. Our aim was to evaluate the role and accuracy of US, MRA, and CTA compared to DSA in diagnosing RVD in children. PATIENTS AND METHODS: A retrospective review of 127 children with suspected renovascular hypertension was performed in children referred to Great Ormond Street Hospital between 2006 and 2014 due to clinical suspicion of renovascular hypertension and/or findings on US and/or MRA or CTA...
October 17, 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
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
Panagiotis I Georgianos, Rajiv Agarwal
The diagnosis and management of hypertension among patients on chronic dialysis is challenging. Routine peridialytic blood pressure recordings are unable to accurately diagnose hypertension and stratify cardiovascular risk. By contrast, blood pressure recordings taken outside the dialysis setting exhibit clear prognostic associations with survival and might facilitate the diagnosis and long-term management of hypertension. Once accurately diagnosed, management of hypertension in individuals on chronic dialysis should initially involve non-pharmacological strategies to control volume overload...
October 2016: Nature Reviews. Nephrology
Melvin D Lobo, Paul A Sobotka, Atul Pathak
Hypertension management poses a major challenge to clinicians globally once non-drug (lifestyle) measures have failed to control blood pressure (BP). Although drug treatment strategies to lower BP are well described, poor control rates of hypertension, even in the first world, suggest that more needs to be done to surmount the problem. A major issue is non-adherence to antihypertensive drugs, which is caused in part by drug intolerance due to side effects. More effective antihypertensive drugs are therefore required which have excellent tolerability and safety profiles in addition to being efficacious...
July 11, 2016: European Heart Journal
Jeff Whittle, Amy I Lynch, Rikki M Tanner, Lara M Simpson, Barry R Davis, Mahboob Rahman, Paul K Whelton, Suzanne Oparil, Paul Muntner
BACKGROUND AND OBJECTIVES: Increased visit-to-visit variability of BP is associated with cardiovascular disease risk. We examined the association of visit-to-visit variability of BP with renal outcomes among 21,245 participants in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We measured mean BP and visit-to-visit variability of BP, defined as SD, across five to seven visits occurring 6-28 months after participants were randomized to chlorthalidone, amlodipine, or lisinopril...
March 7, 2016: Clinical Journal of the American Society of Nephrology: CJASN
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
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
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
Casey Crump, Jan Sundquist, Marilyn A Winkleby, Kristina Sundquist
IMPORTANCE: High body mass index (BMI) and low physical fitness are risk factors for hypertension, but their interactive effects are unknown. Elucidation of interactions between these modifiable risk factors may help inform more effective interventions in susceptible subgroups. OBJECTIVE: To determine the interactive effects of BMI and physical fitness on the risk of hypertension in a large national cohort. DESIGN, SETTING, AND PARTICIPANTS: This cohort study included all 1,547,189 military conscripts in Sweden from January 1, 1969, through December 31, 1997 (97%-98% of all 18-year-old men nationwide each year), who were followed up through December 31, 2012 (maximum age, 62 years)...
February 2016: JAMA Internal Medicine
Andrew S Bomback
Mineralocorticoid receptor antagonists (MRAs) that block aldosterone's effects on both epithelial and non-epithelial receptors have become a mainstay of therapy for chronic heart failure. Given that cardiovascular events remain the leading cause of death for patients with end-stage renal disease (ESRD), the question of whether these MRAs can be employed in dialysis patients arises. This review summarizes the rationale for blocking aldosterone in patients with chronic and end-stage kidney disease and surveys the data on both the efficacy and safety of using MRAs in the ESRD population...
2016: Blood Purification
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
Patrick Rossignol, Ziad A Massy, Michel Azizi, George Bakris, Eberhard Ritz, Adrian Covic, David Goldsmith, Gunnar H Heine, Kitty J Jager, Mehmet Kanbay, Francesca Mallamaci, Alberto Ortiz, Raymond Vanholder, Andrzej Wiecek, Carmine Zoccali, Gérard Michel London, Bénédicte Stengel, Denis Fouque
Resistant hypertension is defined as blood pressure above goal despite adherence to a combination of at least three optimally dosed antihypertensive medications, one of which is a diuretic. Chronic kidney disease is the most frequent of several patient factors or comorbidities associated with resistant hypertension. The prevalence of resistant hypertension is increased in patients with chronic kidney disease, while chronic kidney disease is associated with an impaired prognosis in patients with resistant hypertension...
October 17, 2015: Lancet
Ihsan Ates, Mesudiye Bulut, Nihal Ozkayar, Fatih Dede
BACKGROUND: We aimed to determine the association between platelet indices including plateletcrit (PCT), mean platelet volume (MPV), platelet distribution width (PDW), and proteinuria associated with hypertension (HT) as well as the relative power of each to predict proteinuria. METHODS: The study included 223 patients (68 men and 155 women) with primary HT. PCT, MPV, PDW, and proteinuria levels were measured. The patients were divided into two groups according to proteinuria status based on 24-hr urinary protein excretion: proteinuria (+) group (15 men and 40 women) and proteinuria (-) group (53 men and 115 women)...
November 2015: Annals of Laboratory Medicine
Rossen Mihajlov, Diliyana Stoeva, Blagovesta Pencheva, Elena Bogusheva, Adelaida Ruseva, Irena Gencheva-Angelova
BACKGROUND: Essential hypertension (EH) is a widespread disease. One frequent complication of EH is Chronic Kidney Disease (CKD), whose diagnosis is delayed due to its asymptomatic course. The purpose of this study is to determine the involvement of the kidneys in patients with EH by biomarkers for kidney damage (albuminuria) and glomerular filtration rate (GFR) with creatinine and cystatin C. METHODS: We observed a control group of 153 healthy volunteers and a group of 150 patients with EH...
2015: Clinical Laboratory
Pierre Lantelme, Brahim Harbaoui, Pierre-Yves Courand
Renal artery stenosis (RAS) is found in 1 to 2% of all hypertensive patients. Its diagnosis involves as a first step Doppler ultrasound and as a confirmatory test, CT scan or MRI. When the diagnosis isconfirmed, three questions should be addressed by the clinician: 1) the anatomical orm that is, fibromuscular dysplasia (FD) or atherosclerotic RAS (ARAS); 2) the potential relation between RAS and hypertension with major differences according to the two main etiologies; in the presence of FD hypertension is a priorir elated to the stenosis while it is not the case with ARAS; 3) is there an indication for revascularization with again two opposite situations...
June 2015: La Revue du Praticien
Michael J Cryer, Tariq Horani, Donald J DiPette
Cardiovascular disease plays a major role in the morbidity and mortality of patients with diabetes mellitus. In turn, hypertension is a major risk factor for cardiovascular disease, and its prevalence is increased in diabetes mellitus. Therefore, the detection and management of elevated blood pressure (BP) is a critical component of the comprehensive clinical management of diabetics. Despite significant advances in our understanding of the pathogenesis and treatment of hypertension, there continues to be debate regarding the pharmacologic treatment of hypertension, especially in high-risk groups such as in patients with diabetes mellitus with and without chronic kidney disease (CKD)...
February 2016: Journal of Clinical Hypertension
Rania Kheder-Elfekih, Alexandra Yannoutsos, Jacques Blacher, Gérard M London, Michel E Safar
Hypertension (HTN) in chronic kidney disease (CKD) is influenced by blood pressure (BP) and the progression of CKD, including hemodialysis and renal transplantation. To date, the efficacy of antihypertensive drug strategies has chiefly been assessed by measuring steady-state systolic, diastolic and mean arterial pressures (MAP). However, recently elucidated features of the BP curve have highlighted other important goals, that is, the specific roles of pulse pressure (PP), arterial stiffness, pulse wave velocity (PWV) and wave reflections as potentially deleterious factors affecting the progression of HTN and CKD...
October 2015: Journal of Hypertension
Raymond R Townsend, Sandra J Taler
Hypertension is a common comorbidity in patients with impaired kidney function. The kidney exerts a marked degree of control over blood pressure through various mechanisms, such as by regulating sodium balance and hormone secretion through the activity of the renin-angiotensin system. The kidney is susceptible to injury, and if already damaged can be at risk of further loss of function as a consequence of elevated blood pressure. Once elevated blood pressure is identified, a combination of sensible lifestyle measures, such as sodium restriction and weight loss, with pharmacological intervention to reduce blood pressure will usually achieve blood pressure goals...
September 2015: Nature Reviews. Nephrology
2015-07-30 09:09:18
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